Response to Terrorism and Weapons of Mass Destruction Chapter 39 Response to Terrorism and Weapons of Mass Destruction

Terrorism The FBI defines terrorism as “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.” Terrorism is a part of life in the US Terrorism can occur any place at any time

Terrorist Groups Groups may be domestic or foreign Violent religious groups Doomsday cults Extremist political groups Technology terrorists Single-issue groups

Goals of Terrorism Create fear and panic (Top Goal) -disrupt daily lives -disrupt the infrastructure of the medical community Kill or harm as many persons as possible Disrupt the infrastructure of all levels of the government

High Risk Targets Schools Churches Government Buildings Water Treatment Plants Hospitals Public Gatherings Mass Transit Large Business and Shopping Centers

Threat Level Be aware of the threat level issued by the Department of Homeland Security. Courtesy of U.S. Department of Homeland Security

Recognizing a Terrorist Event Type of location Type of call Number of patients Victims’ statements Pre-incident indicators Courtesy of Photographer's Mate 2nd Class Bob Houlihan/U.S. Navy

Response Actions Scene safety Responder safety Notification procedures Establishing command Reassessing scene safety Courtesy of Andrea Booher/FEMA

Types of WMD (B-NICE) Biological Agents Nuclear Agents Incendiary Devices Chemical Agents Explosives

Types of WMD (CBRNE) Chemical Biologic Radiologic Nuclear Explosive

Biological Agents

Biological Agents Includes: Viruses Bacterium Neurotoxins Can be spread by dissemination Water supply Aerosolizing the agent into the air

Viruses Require living host Replicate themselves within healthy cells Spread throughout the community from person to person

Smallpox Virus Highly contagious Utilize good BSI. Begins with high fever, body aches Lesions identical Blisters begin on face and extremities. Most contagious when blisters begin to form Vaccine is available but has been linked to medical complications.

Viral Hemorrhagic Fevers Ebola, Rift Valley, and Yellow Fever Cause blood to seep from tissues and blood vessels Initially present with flu-like symptoms Use BSI.

Bacteria Do not require a host Can be fought with antibiotics Most infections begin with flu-like symptoms. Anthrax and Plague are most feared

Anthrax Caused by the bacterium Bacillus anthracis Can involve the skin, GI tract, and/or lungs May be cutaneous or inhalation anthrax Inhalation anthrax is most deadly 90% mortality if untreated Vaccine is available for selected military groups Consists of 6 vaccines

Cutaneous Anthrax Courtesy of James H. Steele/CDC

Plague Bubonic Plague infects the lymph system Lymph glands will swell Pneumonic plague infects the lungs Pneumonic plague results from inhaling bacteria Pneumonic plague has a higher death rate than does bubonic plague

Bubonic Plague Courtesy of the CDC

Neurotoxins (1 of 2) Most deadly substances known Produced by plants, marine animals, molds, and bacteria May be inhaled, ingested, or injected

Neurotoxins (2 of 2) Botulinum toxin Produced by bacteria The most potent neurotoxin Causes paralysis that leads to respiratory arrest Ricin Derived from caster beans Causes pulmonary edema and respiratory and cardiovascular failure

EMT Roles During Biological Events Syndromic surveillance Identification of outbreaks Strategic National Stockpile Participation at distribution sites Courtesy of the Strategic National Stockpile/CDC

Nuclear Agents

Types of Radiation (1 of 3) Alpha: Weakest form Can be stopped by a single sheet of paper Most deadly when ingested Beta Can be stopped by ordinary clothing

Types of Radiation (2 of 3) Gamma Will penetrate the entire body Requires lead or concrete to stop Used for X-Rays Neutron Fastest moving and most powerful Will penetrate lead Requires several feet of concrete to stop

Types of Radiation (3 of 3)

Radiological/Nuclear Devices Radiological dispersal devices “Dirty bombs” Uses a regular explosive device to distribute radioactive material Not very effective but creates fear Nuclear weapons Nuclear bombs/missiles Special Atomic Demolition Munitions

Signs and Symptoms of Radioactive Exposure Varies depending on: Amount of radiation Route of exposure Low exposure: nausea, vomiting, diarrhea Moderate exposure: first-degree burns, hair loss, depletion of immune system, cancer Severe exposure: Second/third-degree burns, cancer, death

Treatment Decontaminate if needed. Support ABCs. Treat associated burns and trauma.

Protective Measures Time Radiation has cumulative effect Limit amount of exposure time Distance Radiation has limits to how far it can travel Alpha radiation only travels inches Maintain a safe distance from site Shielding Concrete shielding will stop strong radiation

EMS Role Maintain safe location Treat signs/symptoms Avoid becoming a victim

Incendiary Devices

Incendiary Devices Devices to cause fires Use of flammable materials (accelerants) to cause rapid burning Molotov cocktails, timers, etc Often used in conjunction with secondary explosives

EMS Role Maintain safe location Treat signs/symptoms

Chemical Agents

Characteristics of Chemical Agents Persistency/volatility How long an agent stays on a surface before evaporating May be seconds or months Route of exposure Vapor hazard: inhaled Contact hazard: absorbed through the skin

Vesicants (Blister Agents) (1 of 2) Mustard gas and phosgene oxime are most common Used in chemical warfare Contact and vapor hazard Causes burn like blisters Causes most damage to moist areas

Vesicants (Blister Agents) (1 of 2) Courtesy of Dr. Saeed Keshavarz/RCCI (Research Center of Chemical Injuries)/IRAN

S/S of Vesicant Exposure Skin irritation/blisters Immediate, intense pain Eye injuries Respiratory problems Dyspnea Cough Hemoptysis Courtesy of Dr. Saeed Keshavarz/RCCI (Research Center of Chemical Injuries)/IRAN

Treatment of Vesicant Exposure Decontaminate. Support airway. Transport to burn center.

Pulmonary Agents (Choking Agents) Inhaled gases Also used in chemical warfare Causes damage to lung tissue Two classes: Chlorine Phosgene

Chlorine Odor of bleach Creates a green haze Produces upper respiratory irritation Mixing household bleach and ammonia can produce a similar gas Causes pulmonary edema and constriction of airways Characterized by hoarseness and stridor, chest tightness, gasping and coughing, and dyspnea

Phosgene Gas Can be byproduct of commonly burned items including household items, metal works, and freon Odor is like freshly cut grass or hay Does not cause irritation when inhaled Delayed onset of symptoms; normally several hours Characterized by nausea, chest tightness, cough, and dyspnea

Treatment of Pulmonary Exposure Have patient removed from contaminated atmosphere. Aggressively manage airway. Provide rapid transport in position of comfort.

Nerve Agents Vapor or contact hazards Pesticides and organophasphates Causes overstimulation of organs Two classes G series: Sarin, Soman, and Tabun V series: VX 100 times more potent than G series Has consistency of baby oil with no odor

S/S of Nerve Agents “SLUDGEM” Salivation, Sweating Lacrimation (excessive tearing) Urination Defecation, Drooling, Diarrhea Gastric upset and cramps Emesis (vomiting) Muscle twitching

S/S of Nerve Agents “DUMBELS” Diarrhea Urination Miosis (pupil constriction) Bradycardia, Bronchospasm Emesis Lacrimation Seizures, Salivation, Sweating

Treatment of Nerve Agent Exposure Patient decontamination Airway and ventilatory support Administration of MARK 1 kit if authorized AKA: Nerve Agent Antidote Kit (NAAK) Contains Atropine and 2-PAM chloride (pralidoxime chloride) Uses auto-injectors

Insecticides Many insecticides are organophosphates. Lower concentrations than found in nerve agents Treatment is same as nerve agents

Metabolic Agents (Cyanides) Common in industrial settings Colorless with smell similar to almonds Affect the body’s ability to use oxygen Can kill in seconds Commonly formed when fires involve textiles or plastics

Signs and Symptoms Breathing difficulty Altered mental status Seizures Coma Respiratory/cardiac arrest

Treatment of Metabolic Agents Patient decontamination must occur. Support ABCs. Administer oxygen Rapid transport Antidote available

Explosives

Explosives One of the most common forms of terrorism A favorite weapon of terrorists Can be set off in buildings, cars, churches, or places with large crowds Greatest danger is a “secondary device” A secondary device is designed to go off after emergency personnel are on scene This will instill fear and disrupt the government infrastructure

Keys to Dealing With Possible WMD (1 of 3) Maintain a high level of suspicion Location and type of call -Public building or a place with a large numbers of people with same S/S -Location that is vital to infrastructure -Multiple locations with similar complaints

Keys to Dealing With Possible WMD (2 of 3) Be Safe -Be aware of possible secondary explosions -Be aware of need to protect yourself -Follow rules of HazMat, if appropriate If in doubt, back-off Use decontamination if any possibility of contamination of personnel, equipment, or hospitals

Keys to Dealing With Possible WMD (3 of 3) Transport by other means if ambulance is not needed for medical care Observe people, the scene, the surroundings. Take notes If things don’t add up or make sense, think about terrorism Many people complaining of same S/S Remember “if it walks like a duck, quacks like a duck, and looks like a duck; it is probably a duck”.