Terrorism Response and Disaster Management

Question 1

B-NICE

Answer 1

Biological Nuclear Incendiary Chemical and Explosive weapons

Question 2

CBRNE

Answer 2

Chemical, Biologic, Radiologic, Nuclear, and Explosive weapons

Question 3

During a WMD call, you should stage your vehicle ____ from the incident.

Answer 3

1-2 blocks

Question 4

Vesicant agents consist of :

Answer 4

sulfur mustard, lewisite, and phosgene oxime

Question 5

Signs of vesicant exposure to skin

Answer 5

Skin irritation, burning, and reddening
Immediate, intense skin pain
Formation of large blisters
Gray discoloration of skin
Swollen and closed or irritated eyes
Permanent eye injury

Inhaled: 
Hoarseness and stridor
Severe cough
Hemoptysis
Severe dyspnea

Question 6

Signs and symptoms of mustard gas exposure produces :

Answer 6

4-6 hours after exposure

Question 7

Mutagen is considered a mutagen which means?

Answer 7

It mutates, damages, and changes the structures of cells.

Question 8

Characteristics of mustard gas

Answer 8

Brownish, yellowish oily substance
Smell of garlic or mustard
Affects moist, damp areas more - respiratory, armpits, groin

Question 9

Difference between mustard gas and lewisite/phosgene oxime.

Answer 9

Onset of symptoms form more rapidly in lewisite and phosgene oxime exposures.

Question 10

s/s of chloride exposure

Answer 10

Upper airway irritation
Choking sensation 
SOB
Tightness of chest
Hoarseness and stridor
Gasping and coughing
Pulmonary edema
Complete airway constriction
Death

Question 11

Management of pulmonary agents

Answer 11

Aggressively manage ABCs with particular attention to oxygenation, ventilation, and suctioning.
Do not allow pt to be active.
Gain IV access
Position of comfort w/ head elevated
Initiate prompt transport
Consider ALS

Question 12

Characteristics of phosgene

Answer 12

Pulmonary agent
Delayed onset of sxs
Freshly mowed grass or hay odor

Question 13

s/s of phosgene exposure

Answer 13

Mild :
Nausea
Tightness of chest
Severe cough
DOE

Severe: 
Dyspnea at rest
Excessive pulmonary edema
Hypovolemia
Hypotension

Question 14

Characteristics of sarin (GB)

Answer 14

Nerve agent
Highly volatile colorless and odorless liquid.
Turns from liquid to gas w/in seconds to minutes @ room temp.
Respiratory tract main route.

Question 15

Characteristic of soman (GD)

Answer 15

Nerve agent
Twice as persistent as sarin and 5x as lethal.
Fruity odor
Additive causes it to bind to cell to attack faster.
Skin absorption and respiratory tract route.

Question 16

Characteristics of tabun (GA)

Answer 16

Nerve agent
Half as lethal as sarin and 36 x more persistent.
Remains present for several days.
Fruity odor
Skin absorption and respiratory tract transmission route.

Question 17

Characteristics of V agent (VX)

Answer 17

Nerve agent
Clear oily agent with no odor and looks like baby oil.
100 x more lethal than sarin and extremely persistent.

Question 18

DUMBELS mnemonic

Answer 18

Diarrhea
Urination
Miosis, muscle weakness
Bradycardia, bronchospasm, bronchorrhea
Emesis
Lacrimation
Seizures, salivation, sweating

Question 19

SLUDGEM

Answer 19

Salivation, sweating
Lacrimation
Urination
Defecation
Gastric upset and cramps
Emesis
Muscle twitching/miosis

Question 20

What is the most common symptom of nerve agent exposure?

Answer 20

Miosis

Question 21

DuoDote Auto-Injection

Answer 21

Contains 2.1 mg of atropine and 600 mg of pralidoxime chloride (2-PAM)

Question 22

Pathophysiology of Duo-Dote

Answer 22

Atropine blocks nerve agent

2-PAM eliminates agent from body

Question 23

s/s of metabolic agents

Answer 23

Low doses: 
Dizziness
Light-headedness
Headache
Vomiting

Higher doses:
SOB, gasping respirations
Respiratory distress or arrest
Tachypnea
Flushed skin
Tachycardia
AMS
Seziures
Coma
Apnea 
Cardiac arrest

Question 24

Cyanide

Answer 24

Metabolic agent
Colorless gas
Similar odor to almonds
Affects body’s ability to use oxygen

Question 25

Cyande treatment

Answer 25

``` Remove all clothing Decontaminate Support ABCs IV access Aggressive oxygenation and ventilation w/ supplemental oxygen for severe exposure Always use BVM ALS if no antidote available ```

Question 26

Biologic agents are grouped as

Answer 26

Viruses Bacteria Neurotoxins

Question 27

Characteristics of smallpox

Answer 27

Virus biologic agent Most contagious when blisters begin to form PPE : HEPA-filter, gloves, eye protection

Question 28

s/s of smallpox

Answer 28

``` High fever Body aches Headaches Rash - identical in development, begin on face and extremities Blister ```

Question 29

Characteristics of viral hemorrhagic fevers (VHFs)

Answer 29

Virus biological agent Group of diseases caused by Ebola, Rift Valley, Marburg, and yellow fever. Causes blood in the body to seep out of tissues and blood vessels.

Question 30

s/s of VHFs

Answer 30

Sudden onset of fever, weakness, muscle pain, headache, and sore throat. Followed by vomiting and internal and external bleeding.

Question 31

Characteristics of antrhax

Answer 31

Bacterial biological agent Routes - inhalation, cutaneous, GI Inhalation deadliest Treatment - abx

Question 32

s/s of anthrax

Answer 32

``` Flulike sxs Fever respiratory distress w/ tachycardia Shock Pulmonary edema Respiratory failure after 3-5 days of flulike sxs ```

Question 33

Medical management of anthrax

Answer 33

Pulmonary : Standard precautions, oxygen, ventilatory support, and transport cutaneous : standard precautions, apply dry sterile dressing to prevent accidental contact w/ wounds and fluids

Question 34

Medical management of smallpox

Answer 34

Standard precautions | Support ABCs

Question 35

Medical management of VHF

Answer 35

Standard precautions Support ABCs Tx for shock and hypotension of present

Question 36

Characteristics of plague

Answer 36

Bacterial biological agent | Natural vectors are rodents and fleas

Question 37

Bubonic plague

Answer 37

Infects lymphatic system causing them to grow large and round, forming buboes. Infection may spread through the body leading to sepsis and possible death. Not contagious.

Question 38

Pneumonic plague

Answer 38

Lung infection that results from inhalation of plague bacteria. Contagious and much higher death rate than bubonic.

Question 39

Medical management of plague agents

Answer 39

Standard precautions Supportive ABCs Oxygen if indicated

Question 40

s/s of botulinum toxin

Answer 40

``` Dry mouth Intestinal obstruction Urinary retention Constipation N/V Abnormal pupil dilation Blurred vision, dipoplia, drooping eyelids Dysphagia, difficulty speaking Respiratory failure ```

Question 41

Medical management of botulinum toxin

Answer 41

Supportive ABCs | Ventilatory support if paralysis of respiratory muscles

Question 42

Characteristics of botulinum

Answer 42

Neurotoxin | Affects nervous system's function. Eventually muscle paralysis occurs beginning in head and face, spreading downward.

Question 43

Characteristics of ricin

Answer 43

Neurotoxin Mash left from castor bean 1-3 mg is lethal Least toxic by oral rout due to poor absorption.

Question 44

s/s of ingested ricin

Answer 44

``` 4-8 hours after exposure Fever Chills Headache Muscle aches N/V/D Severe abdominal cramping Dehydration GI bleeding Necrosis of liver, spleen, kidneys, and GI ```

Question 45

s/s of inhaled ricin

Answer 45

``` 4-8 hours after exposure Fever Chills Nausea Local irritation of eyes, nose, and throat Profuse sweating Headache Muscle aches Nonproductive cough CP Dyspnea Pulmonary edema Severe lung inflammation Cyanosis Seizures Respiratory failure ```

Question 46

Medical management of ricin exposure

Answer 46

Support ABCs IV access and nl saline for dehydration Early intubation for pulmonary edema

Question 47

Ionizing radiation

Answer 47

Energy emitted in the form of rays or particles

Question 48

Alpha radiation

Answer 48

Least harmful | Cannot penetrate through most objects (paper, skin)

Question 49

Beta radiation

Answer 49

Slightly more penetration than alpha. | Requires layer of clothing to stop it.

Question 50

Gamma (x-ray) radiation

Answer 50

Travels faster and has more energy than alpha and beta. | Easily penetrate though human body and require lead or several inches of concrete to prevent penetration.

Question 51

Neutron radiation

Answer 51

Most powerful | Easily penetrate through lead and require several feet of concrete to stop them.