Chapter 39 EMS Response to Terrorism

Question 1

Key Terms

contact with or presence of a material (contaminant) that is present where it does not belong and that is somehow harmful to persons, animals, or the environment

Answer 1

Contamination

Question 2

Key Terms

spreading

Answer 2

Dissemination

Question 3

Key Terms

terrorism directed against one’s own government or population without foreign direction

Answer 3

Domestic terrorism

Question 4

Key Terms

the dose or concentration of an agent multiplied by the time, or duration

Answer 4

Exposure

Question 5

Key Terms

terrorism that is purely foreign based or directed

Answer 5

International Terrorism

Question 6

Key Terms

destructive devices, such as bombs, including both those used in the initial attack and those placed to be activated after an initial attack and times to injure emergency responders and others who rush in to help care for those targeted by an initial attack

Answer 6

Multiple Devices

Question 7

Key Terms

the movement of a substance through a surface or, on a molecular level, through intact materials; penetration, or spreading

Answer 7

Permeation

Question 7

Key Terms

the movement of a substance through a surface or, on a molecular level, through intact materials; penetration, or spreading

Answer 7

Permeation

Question 8

Key Terms

roentgen equivalent (in) man; a measure of radiation dosage

Answer 8

REM

Question 9

Key Terms

pathways into the body, generally by absorption, ingestion, injection, or inhalation

Answer 9

Routes of Entry

Question 10

Key Terms

destructive devices, such as bombs, placed to be activated after an initial attack and timed to injure emergency responders and others who rush in to help care for those targeted by an initial attack

Answer 10

Secondary Devices

Question 11

Key Terms

broad general plans designed to achieve desired outcomes

Answer 11

Strategies

Question 12

Key Terms

specific operational actions to accomplish assigned tasks

Answer 12

Tactics

Question 13

Key Terms

the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives. (U.S. Department of Justice, FBI, definition)

Answer 13

Terrorism

Question 14

Key Terms

packaging or producing a material, such as a chemical, biological, or radiological agent, so it can be used as a weapon, for example, by dissemination in a bomb detonation or as an aerosol sprayed over an area or introduced into a ventilation system

Answer 14

Weaponization

Question 15

Key Terms

weapons, devices, or agents intended to cause widespread harm and/or fear among a population

Answer 15

Weapons of Mass Destruction

Question 16

Key Terms

able to move through the animal-human barrier; transmissible from animals to humans

Answer 16

Zoonotic

Question 17

CRITICAL DECISION MAKING
Terrorism can come from many sources and on many scales—from local to nationwide. Your safety from a number of hazards is vital. In each situation explain what hazards you may suspect and how to keep yourself safe. It is the most important decision you can make.

You are called to respond with the police and fire department to an office complex where a worker opened an envelope containing white powder.

Answer 17

Do not enter the area. The hazmat team should bring decontaminated patients to you. Do not allow contaminated patients or rescuers into your ambulance nor take contaminated patients to the hospital.

Question 18

CRITICAL DECISION MAKING

Terrorism can come from many sources and on many scales—from local to nationwide. Your safety from a number of hazards is vital. In each situation explain what hazards you may suspect and how to keep yourself safe. It is the most important decision you can make.

There was an explosion in a downtown office complex. You respond with the police and fire department to treat patients from the blast.

Answer 18

Do not enter the area until it has been secured for stability and additional undetonated explosive devices. Terrorists may place secondary devices designed to harm rescuers.

Question 19

Short Answer

List and briefly describe the five most common types of terrorism incidents.

Answer 19

The five most common types of terrorist incidents are chemical, biological, radiological, nuclear, and explosive. A chemical event is usually gaseous material that is released into the atmosphere. This substance has properties that are very toxic or potentially fatal when inhaled. A biological substance is a bacterium, virus, or toxin that can cause immediate illness or death or a substance that can take time to incubate, making people sick in the process. A radiological event is when radiological material is released into the atmosphere. Depending on a number of factors such as proximity, quantity of the material, and potency, it can have an immediate or long-range impact on humans or animals. Nuclear devices can be very similar to radiological devices but may have the added concern of incendiary potential that may do immediate harm to a large area depending on its size. An explosive device, such as a bomb, can cause injury from the initial explosion as well as the secondary damage caused by destruction from the explosion. In addition, these devices sometimes contain materials (e.g., nails) that are shot into the area of the explosion that can also cause harm.

Question 20

Short Answer

What are multiple devices? What precautions should be taken by an EMT regarding multiple devices?

Answer 20

A secondary device is one that goes off after the first device. For example, a device may be set off inside a building, and a secondary device is then set to explode in an area where people might congregate after exiting the building. EMS responders need to be alert to the fact that in a terrorist event, there may be more than one device. Scene safety, including being alert to this fact, is a priority. Responders must try to stay clear of the area until it is deemed safe. When establishing staging and triage areas, make sure these areas have been secured and, if necessary, guarded during the entire event.

Question 21

Short Answer

List several types of events that should trigger an EMT’s suspicion of possible terrorism involvement.

Answer 21

Some of the types of events that should trigger the EMT to be suspicious are symbolic and historical targets, public buildings or places of assembly, controversial businesses, and infrastructure systems.

Question 22

Short Answer

List the seven types of harm that result from a terrorism incident and the seven-letter acronym for these types of harm.

Answer 22

The seven types of harm from an incendiary system are thermal, radiological, asphyxiation, chemical, etiological, mechanical, and psychological. The acronym for these is TRACEM-P.

Question 23

Short Answer

Briefly discuss the concept of time, distance, and shielding.

Answer 23

The concept of time, distance, and shielding suggests you minimize the time you are in the area of possible risk at a dangerous scene, maximize the distance from the hazardous area, and use as much shielding as possible whether it be a vehicle, structure, or use of specialized protective clothing and protective breathing apparatus. The more shielding, the better, so more than one method should be used when available.

Question 24

Short Answer

Discuss several self-protection measures for biological incidents.

Answer 24

Distance can be a helpful protection measure for biological incidents. The farther away from the immediate area of danger, the better. (Also pay attention to wind direction.) Use of appropriate protective equipment may be another effective protection technique, particularly if a responder intends to get near or within the contaminated area. This may include use of specialized protective breathing equipment. Limiting the time in the contaminated area should also be a consideration.

Question 25

Short Answer

Discuss the tactics for isolation, notification, identification, and protection.

Answer 25

Isolation can take on many forms at an incident where terrorism is suspected. Make sure emergency responders and civilians don’t get hurt by a secondary device; permit only those who have a need to be there and are wearing proper protective gear to enter the perimeter. This also allows for control in an area that is apt to be very chaotic. Notification is alerting the appropriate agencies that there is an event. Many times EMS is one of the first to arrive at an act of terrorism. Notifying additional resources and specialized response units needs to occur quickly. Identification refers to the agent or material that might be involved. This is important information for protecting responders and making decisions on the types of protective equipment and barriers that are required. In addition, knowing the agent will help in determining how to handle decontamination. Therefore, determining what agents are involved needs to be a priority. Protection is done to shield critical assets from additional harm and damage. Responders must first ensure that they are protected. Once that is done, they must try to protect vehicles, equipment, and supplies.

Question 26

Critical Thinking Exercises

When responding to a terrorist incident, remember that dangers to the responders may be as great as the dangers for the initial victims of the attack. The purpose of the exercise will be to consider how you might respond to such an incident.

You respond to an explosion in a crowded public market. Your supervisor tells you to wait before entering. You see injured people all around and wonder why you aren’t allowed in to help. Why would you be held back?

Answer 26

The scene may not have been deemed safe yet. Emergency Medical Responders are often principal targets of terrorist attacks, and it’s possible that law enforcement wants to ensure there is no secondary device planted somewhere that might injure EMS responders.

Question 27

Critical Thinking Exercises

When responding to a terrorist incident, remember that dangers to the responders may be as great as the dangers for the initial victims of the attack. The purpose of the exercise will be to consider how you might respond to such an incident.

You are one of a group of EMTs treating a group of patients that may have been exposed to a nerve agent in a public transportation system. You notice one, then another, of the EMTs you are working with develop an altered mental status. What should you do?

Answer 27

Treating patients exposed to a nerve agent is delicate work as it is, but to see your own colleagues potentially become victims themselves is terrifying. Stop what you are doing, evacuate immediately, request help for your colleagues, and report to the hazmat team for decontamination and treatment.

Question 28

Critical Thinking Exercises

When responding to a terrorist incident, remember that dangers to the responders may be as great as the dangers for the initial victims of the attack. The purpose of the exercise will be to consider how you might respond to such an incident.

You are picking up a friend at the bus station when you notice a man acting suspiciously. The man turns away every time a police officer or employee walks by. He has a large wheeled suitcase, which he pushes into a crowd. Then he runs away. What should you do? What are the possibilities of terrorist weapons that would fit in the suitcase? Which is the more important consideration: what he looks like (e.g., native American or foreign) or his pattern of behavior?

Answer 28

The ethnic background of the suspicious man is really irrelevant since many past terrorist incidents on American soil have been the responsibility of U.S. citizens. However, this gentleman appears very suspicious, and your intuition tells you something is wrong. You should definitely report your observations immediately to the nearest authority since a suitcase could easily conceal any of the CBRNE agents intended to cause widespread harm to the traveling public.