EMS Response to Terrorism Flashcards Preview

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Flashcards in EMS Response to Terrorism Deck (71):
1

Terrorism****

• “The unlawful use of force or violence against persons or property to intimidate
or coerce a government, the civilian population or any segments thereof, in furtherance of political or social objectives”

2

Domestic Terrorism*****

• “Groups or individuals whose terrorist activities are directed at a government or population, without foreign direction”
– Environmental terrorists
– Survivalists
– Militias
– Racial-hate groups
– Extreme political or religious groups

3

International Terrorism******

• “Groups or individuals whose terrorist activities are foreign-based and/or directed
by countries or groups outside the targeted country or whose activities cross national borders.”
• Growing trend toward loosely organized, international networks of terrorists (for example, Al Qaeda)

4

Types of Terrorism Incidents

• Weapons of mass destruction (CBRNE)
– Chemical
– Biological
– Radiological
– Nuclear
– Explosive
– Criminal activities

5

First Responders as Targets

• First responders often principle targets of terrorist attacks
• Safety of EMS provider is most important consideration when responding to potential terrorist incident

6

Identify Threat Posed by Event

• Incident that is a potential act of terrorism
is also a crime scene
• Recognizing OTTO signs may help protect
against secondary attack
– Occupancy (or location)
– Type of event
– Timing of event
– On-scene warning signs

7

Occupancy or Location

• Symbolic or historic targets
• Public buildings or assembly areas
• Controversial businesses
• Infrastructure systems

8

Type of Event

• Types of events with high suspicion of terrorist involvement
– Explosions and/or use of incendiaries
– Incidents involving firearms
– Nontrauma mass casualty incidents

9

Timing of Event

• National holidays
• Anniversary dates of previous attacks
• Incidents occurring in major public areas at busy points of business day

10

On-Scene Warning Signs

• Unexplained patterns of illness or death
• Unexplained signs and symptoms or skin, eye, or airway irritation
• Containers that appear out of place

11

Recognize Harms
Posed by Threat—TRACEM-P

• Thermal: caused by either extreme heat or extreme cold
• Radiological: from alpha particles, beta particles, or gamma rays, generally
produced by nuclear events
• Asphyxiation: caused by lack of oxygen in atmosphere

12

Recognize Harms
Posed by Threat—TRACEM-P

• Chemical: caused by toxic or corrosive materials
• Etiological: caused by disease
• Mechanical: caused by physical trauma (gunshot, bomb fragments)
• Psychological: results from any violent event

13

Time

• Minimize time in dangerous area or exposed to hazardous material, biological agent, or radiation
• Execute rapid entries to perform
reconnaissance or rescue

14

Distance

• Maximize distance from hazard area or projected hazard area
• Follow recommended guidelines regarding hazardous materials in Emergency Response Guidebook

15

Shielding

• Use appropriate shielding for specific hazards
• Can be vehicles, buildings, fire-protection clothing, hazmat suits, positive-pressure self-contained breathing apparatus, PPE
• Vaccinations against specific diseases

16

Chemical Incident

• Includes many classes of hazardous materials
– Can be inhaled, ingested, absorbed, injected
– Can include industrial chemical or warfare type agents

17

Harms of Chemical Incident

• Thermal (secondary): reactions create heat
• Asphyxiation (secondary): reactions deplete oxygen
• Chemical (primary): systemic effects
• Mechanical (secondary): corrosive chemicals weaken structures
• Psychological (secondary)

18

Self-Protection Measures

• Respiratory protection
• Protective clothing
• Be aware of possible contamination from patients

19

Biological Incident

• Presents as focused emergency or public health emergency
– Focused emergency: potential or actual point of origin located; attempts made to prevent or
minimize damage and spread
– Public health emergency: sudden demand upon public health infrastructure with no
apparent explanation

20

Biological Incident

• Causative agents
– Bacteria
– Viruses
– Toxins

21

Biological Incident

• Four major routes of entry to body
– Absorption: skin contact
– Ingestion: by mouth
– Injection: from needles or projectiles
– Inhalation: by breathing

22

Exposure/Contamination

• Exposure: substance taken into body through route of exposure
• Contamination: substance clings to surface areas of body or clothing

23

Harms of Biological Incident

• Chemical (secondary): scene of
clandestine laboratory
• Etiological (primary): agents classified as poisons
• Mechanical (secondary): explosives used to disperse agents
• Psychological (secondary)

24

Self-Protection Measures

• PPE and respiratory protection
• Get as much information as possible
• Prioritize protective measures
– Self-protection
– Buddy system
– Availability of rapid intervention teams
– Civilian protection

25

Radiological/Nuclear Incident

• Small nuclear devices (“suitcase bombs”)
stockpiled in foreign nations
• Radiologic dispersion more practical and difficult to detect as radiation symptoms are delayed for hours or days
– Sickness treatable if detected early

26

Self-Protection Measures

• Time, distance, shielding
• Radiologic detecting equipment helps determine effectiveness of measures
• Assume dissemination of radiological,biological, or chemical materials
• Follow decontamination procedures

27

Explosive Incident

• Wide variety of devices from small pipe bombs to large vehicle bombs
• May involve attacks on a fixed target or group of people
• May be designed to disperse biological, chemical, or radiological materials

28

Harms of Explosive Incident

• Thermal (primary): heat of detonation
• Asphyxiation (secondary): possibility of extremely dusty conditions
• Chemical (secondary): result of explosive reaction from chemicals present at detonation site
• Mechanical (primary): typically seen at bombing incidents
• Psychological (secondary)

29

Self-Protection Measures

• Responder needs both pre blast and postblast protection
– Preblast: operations occurring after written or verbal warning received but before explosion
takes place
– Postblast: operations occurring after at least
one detonation

30

Dissemination of CBRNE Materials

• Respiratory route
– Most effective, most common means
• Ingestion route
• Dermal route
• Human-to-human contact

31

Weaponization
of CBRNE Materials

• Most effective when targeted through inhalation route
• Particles in 3–5 micron size
• Such airborne dissemination can be created by applying energy to material
• Heat, explosives, sprayers can aerosolize materials

32

Chemical Agents

• Can be gaseous, liquid, or solid
• Vapor pressures and densities can vary across the spectrum
• Volatility
– Low boiling point and high vapor pressure will evaporate more readily
– Allows agent to have greater airborne release potential

33

Classes of Chemical Agents

• Choking agents
– Predominately respiratory
• Vesicating (blister) agents
– Cause chemical changes in cells of exposed tissue
• Cyanides
– Prevent use of oxygen within cells

34

Classes of Chemical Agents

• Nerve agents
– Inhibit enzyme critical to proper nerve transmission, causing out-of-control parasympathetic nervous system
• Riot control agents
– Irritating materials and lacrimators (tear-flow
increasers)

35

Nerve Agents—SLUDGEM

• Signs and symptoms of exposure
– Salivation
– Lacrimation
– Urination
– Defecation
– GI Upset
– Emesis
– Miosis

36

Biological Agents

• Role of EMS primarily
supportive
• Some material can
replicate itself
creating greater
potential for
transmission from
person to person

37

Radioactive/Nuclear Devices

• Military nuclear device
• Improvised nuclear device
• Radiological dispersal device (dirty bomb)
• Sabotage

38

Effects of Radiation

• Radiologic
exposure affects
bone marrow,
gastrointestinal
system, central
nervous system

39

Incendiary Devices

• Blast injury patterns
– Lung injury: bradycardia, apnea, and hypotension from blast wave
– Ear injury: rupture of tympanic membrane
– Abdominal injury: rupture of gas-containing section of intestine
– Brain injury: concussion or mild traumatic brain injury (MTBI) from blast wave

40

Isolation

• Controlling scene, isolating hazards, and attempting to conduct controlled evacuation is resource-intensive and requires law enforcement personnel
• Law enforcement must establish and control perimeter throughout incident

41

Notification

• Generally required by established directives, procedures, and statutes
• Request for additional specialized agencies carried out by communications center based upon early reports of EMTs
on scene

42

Identification and Protection

• Identification of agent
– Observe indicators of particular agent or
presence of chemical containers or lab
materials
• Protection of critical assets
– People, vehicles, equipment/supplies
– Requires close partnership between EMS and
security agencies

43

Decontamination

• Gross decontamination by EMS personnel
– Removing surface contamination via
mechanical means and initial rinsing
– Amount of surface contamination significantly
reduced

44

Recognition: Scene Size-up

• Victims displaying signs of hazardous
substance exposure?
• Unconscious victims?
• Victims exhibiting SLUDGEM signs?
• Blistering, reddening of skin, discoloration
or skin irritation?
• Victims having difficulty breathing?

45

Recognition:
Situational Awareness

• Medical mass casualties or fatalities with
minimal or no trauma
• Responder casualties
• Dead animals and vegetation
• Unusual odors, color of smoke, vapor
clouds

46

Remember OTTO Clues

• Occupancy (location)
• Type of event
• Timing
• On-scene clues

47

Don’t Rush In

• Wait until appropriate authority says scene
is safe
• Follow incident command protocols
• Wear appropriate PPE
• Beware possible secondary explosive
devices
• Search all patients for explosives or
weapons

48

Protect Yourself

• Understand
TRACEM-P harms
• Time, distance, shielding
• Use specific tactics
for each CBRNE threat

49

Chapter Review

• There have been terrorist attacks throughout history. After 9/11 the world has been a different place because of the
threat of terrorism.
• CBRNE helps recall the types of agents and weapons that can be used by terrorists. TRACEM-P helps recall the types of hazards of these agents.

50

.

• You must be sure to protect yourself from terrorist attacks as well as secondary attacks which are designed to injure or kill
rescuers and further the physical and psychological impact of the attack.

51

Remember

• Responders often are targets of terrorists. Safety must be the highest priority. Use scene clues to identify potential terrorist
incidents.
• Adapt protective measures to the specific threat. Know the protective principles of CBRNE events.

52

Remember

• Important priorities for responders at a
terrorist incident are life safety, incident
stabilization, and protection of property.
• Isolation, perimeter control, and
appropriate notifications are important
priorities in managing a terrorist incident.

53

Remember

• Force protection is an extension of general
safety procedures. It refers to the safety
and security of both providers and
resources.

54

Questions to Consider

• How can I best protect myself from danger
and hazards during a terrorist incident?
• What is my role in the incident response plan for a terrorist incident?

55

Critical Thinking

• You arrive at an office where multiple patients are complaining of the same symptoms. They state their office received
several threats due to its role in a
controversial foreign relations incident.
You and your partner recognize the similar symptoms and decide these may be linked.

56

Critical Thinking

• What is your best course of action next?
Should you remove yourself from the scene at this point or remain with your patients?

57

Common theme about terrorist groups

religious base pg 1065

58

CBRNE*******

Chemical
Biological
Radiological
Nuclear
Explosive

59

second explosion is for the responder

atlanta
think about the things that folks may have against this business

be careful of the secondary device - constantly monitor your situation********especially if you are somewhere that people could dislike

60

OTTO

Occupancy (or location)
Type of event
timing of event
on-scene warning signs

Think before you ask

61

TRACEM-P

gamma radiation is the worst**

thermal
radiological
asphxiation
Chemical
Etiological
Mechanical
Psycological

62

how do you protect yourself***

TDS
Time
Distance
Shielding

63

1070 / 1071

4 routes of entry
inhaled
ingested
injected
absorption

64

biological incident

presents as a focused emergency or public health emergency

65

weaponization****

packaging or producing a material, such as a chemical, biological, or radiological agent, so that 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.

O'Keefe, Michael F. (2011-04-21). Emergency Care (12th Edition) (Page 1077). Prentice Hall. Kindle Edition.
1077
sm respiratory particles anthrax 3-5 micron

66

Vesicating Agent

choking - chlorine

vesciating - blister agent chemical agent causes damage to what part of the body

cyanides - celluar axsphyxiants - mess with HbG
can't put them on O2 and they don't get better - can only

nerve agents - produced in germany to kill rats originally

acetylcholinesterase - nerve agent binds it - down effect for parasympathetic

riot ctl agents -

67

SLUDGEM

nerve agents slow everything down make Some nerve agents act on the parasympathetic nervous system.

For example, the enzyme acetylcholinesterase is inhibited by the nerve agent and fails to break down the neurotransmitter acetylcholine. This causes an overstimulation of the parasympathetic nervous system and a specific set of signs and symptoms.

SLUDGEM is a mnemonic used to remember the signs and
symptoms of nerve agent poisoning. The letters stand for:

S alivation–due to stimulation of the salivary glands
L acrimation–due to stimulation of the lacrimal glands
U rination–due to relaxation of
the internal sphincter muscle of
the urethra
D efecation–due to relaxation of the anal sphincter
G I upset–changes to smooth muscle tone in the GI tract
E mesis–vomiting because of GI system effects
M iosis–abnormal contraction of the pupils

know the first four
salivation, lacrimation, urination, defecation

68

Anthrax

zoonotic bacteria which produces spores. When aerosolized (3 - 5 microns) it can be inhaled and is deadly if not tx early (12-41 hr eclipse)

69

Plague

Plague bacterium (Yersinia pestis) is a zoonotic bacteria carried by rats & ground squirrels and transmitted to humans by fleas

70

Botulinum

Botulinum
Bacterial toxin

The botulinum toxin is one of the deadliest compounds known. It has an LD (50) (lethal dose for 50 percent of the test population) of 0.001 mcg/kg or . By weight, botulinum is 15,000 to 100,000 times more toxic than the nerve agents.

71

dissemination

spreading