1. CHAPTER 36
Terrorism and EMS

2. Key Term
Terrorism
A violent act dangerous to human life, to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives

3. Domestic Terrorism
Directed at government or a population, without foreign direction
Often fragmented and leaderless

4. Domestic Terrorism

5. International Terrorism
Foreign based
Activities cross national boundaries
Often religious or politically motivated

6. Types of Terrorism Weapons of Mass Destruction Armed attacks
Chemical
Biological
Radiological
Nuclear Explosive
Weapons of Mass Destruction

7. September 11, 2001

8. Safety
Always remember that responders may be targets of terrorism. Never compromise your own safety during an incident.

9. Responder Safety Responders may be targets.
Consider the possibility of secondary devices/events.
Utilize SOPs & protocols.
Never compromise your own safety.

10. Responder Considerations
Identifying the possible threats posed by the event
Recognizing the possible harms posed by the event
Identifying protection measures based on the possible threats and harms

11. Identify Threat Posed by the Event
“OTTO”
Occupancy/Location
Type of Event
Timing of Event
On-Scene Warning Signs

12. Occupancy/Location Symbolic/Historic Targets
White House
IRS offices
Public buildings & assembly areas
Shopping malls
Convention centers

13. Occupancy/Location Controversial businesses Infrastructure systems
Nuclear facilities
Family planning offices
Infrastructure systems
Power plants
Hospitals

14. Type of Event Explosions/incendiaries Incidents involving firearms
Non-trauma MCIs

15. Timing of Event National holidays
Anniversaries of other terrorist events

16. On-Scene Warning Signs
Unexplained patterns of illness
Chemical containers
Unusual items at locations
Fires of unusual behavior

17. Recognize the Harms Posed by the Threat
“TRACEM-P”
Thermal Harm
Extreme heat or cold
Radiological Harm
Nuclear particles
Continued…

18. Recognize the Harms Posed by the Threat.

19. Recognize the Harms Posed by the Threat
“TRACEM-P”
Asphyxiation
Lack of oxygen in environment
Chemical Harm
Toxic or corrosive materials
Continued…

20. Recognize the Harms Posed by the Threat
“TRACEM-P”
Etiological Harm
Disease causing organisms
Mechanical Harm
Physical trauma
Continued…

21. Recognize the Harms Posed by the Threat
“TRACEM-P”
Psychological Harm
Creation of fear and panic

22. Possible Protection Measures
Time
Distance
Shielding

23. Responses to Chemical Incidents
Hazardous Materials
Industrial Waste
Warfare Agents
That may be:
Inhaled
Ingested
Absorbed
Injected

24. Specific Types of Harm from Chemical Incidents
Thermal
Flammability/heat from reactions
Asphyxiation
Reactions that displace oxygen
Chemical
Systemic to cardiac, nervous, & respiratory systems

25. from Chemical Incidents
Specific Types of Harm
from Chemical Incidents
Mechanical
Corrosives weaken structures
Psychological
Emotional reaction to exposure

26. Self Protection at Chemical Incidents
Be cautious of secondary devices.
Ensure victims are not the bomber.

27. Responses to Biological Incidents
May be a focused emergency or a
public health emergency.
Focused emergencies have a point of origin, minimizing spread.
Continued…

28. Responses to Biological Incidents
Public health emergencies have a sudden demand on public health with no apparent explanation.

29. Causative Agents of
Biological Incidents
Bacteria
Viruses
Toxins

30. Exposure
The dose or concentration multiplied by time (duration of exposure).

31. Four Biological Agent Routes of Entry
1. Absorption
Skin contact
2. Ingestion
Through mouth

32. Four Biological Agent Routes of Entry
3. Injection
Needles or projectiles
4. Inhalation
By breathing

33. Key Term Contamination
Contact with or presence of a contaminant, which is material that is present where it does not belong and that is somehow harmful to persons, animals, or the environment

34. Exposure vs. Contamination
Substance clings to body or clothing.
Exposure
Substance enters body through one of the routes of exposure.

35. Specific Types of Harm from Biological Incidents
Etiological
Poisonous hazardous materials
Chemical
Secondary events

36. Specific Types of Harm from Biological Incidents
Mechanical
Secondary events
Psychological
Emotional reaction to exposure

37. Self-Protection at Biological Incidents
Use personal protective equipment.
Limit exposure time.
Use buddy system/RIT team.

38. Responses to Radiological Incidents
Unlikely to occur
May be in the form of an explosive device
Difficult to initially detect

39. Specific Types of Harm from Radiological Incidents
Thermal
Nuclear explosion
Radiological
Ongoing, varies with substance
Chemical
Many substances are also chemical hazards
Continued…

40. Specific Types of Harm from Radiological Incidents
Mechanical
Nuclear explosion
Psychological
Emotional reaction to exposure

41. Self-Protection at Radiological Incidents
Use time/distance/shielding.
Use decontamination procedures.

42. Responses to Explosive Incidents
Vary in size from pipe bomb to car bombs
May have suicide bombers
May contain chemical or biological agents
Most frequent weapon used by terrorists

43. Specific Types of Harm from Explosive Incidents
Thermal
Heat from detonation
Asphyxiation
Dusty conditions
Chemical & Radiological
If present in the device
Continued…

44. Specific Types of Harm from Explosive Incidents
Mechanical
Shockwaves and fragmentation
Etiological
If biological agents present
Psychological
Stunned response

45. Self-Protection at Explosive Incidents
Be cautious of secondary devices.
Ensure victims are not the bomber.

46. Methods of Dissemination of Agents
Respiratory/Inhalation
Most effective method
Ingestion
Effectiveness
Continued…

47. Methods of Dissemination of Agents
Dermal
Some agents effective this way, others prevented by logistics/ immunization

48. Weaponization Use of sprayers to disseminate
Use of explosives to disseminate

49. Dissemination of Agents

50. Chemical Agent Considerations
Physical Considerations
Extremely varied
Must be gaseous, liquid, or solid
Volatility
May evaporate quickly

51. Chemical Agent Considerations
Reactivity & stability vary
Toxicological
Variety of factors influence sensitivity

52. Classification of Chemical Agents
Choking agents
Vessicating agents (blister agents)
Cyanides
Nerve agents
Riot control agents

53. Classification of Biological Agents
Bacterium
Can live outside host cell
Virus
Cannot survive outside of host cell
Toxin
Poisonous chemical compound

54. Weapon Considerations
Biological Agent
Weapon Considerations
Infectivity
Virulence
Toxicity
Incubation period
Continued…

55. Weapon Considerations
Biological Agent
Weapon Considerations
Transmissibility
Lethality
Stability

56. Classification of Biological Agents
Infectivity
Ease in invading host cell
Virulence
Severity of disease produced
Toxicity
Severity of illness from toxin
Continued…

57. Classification of Biological Agents
Incubation period
Time between exposure & symptoms
Transmissibility
Ease of passing fromperson to person
Continued…

58. Classification of Biological Agents
Lethality
Ease in causing death
Stability
Viability to outside influences

59. Biological Weapons Bacteria Anthrax Continued…
Single cells, require a host.
Easy to grow and spread .
Anthrax
Naturally occurring.
Inhalation is greatest concern.
Early treatment with antibiotics is key.
Continued…

60. Biological Weapons Cholera Plague Continued… Diarrheal disease.
Treat dehydration.
Plague
Transmitted by fleas.
Can be highly contagious.
Use respiratory precautions.
Continued…

61. Biological Weapons Q fever Tularemia Similar to anthrax.
Treat with antibiotics.
Tularemia
Usually from bites of animals.
Fever, headache, weight loss.

62. Toxin Weapons Do not aerosolize on their own Do not reproduce
Do not transmit person to person
Generally, intact skin is an effective barrier.
Continued…

63. Toxin Weapons Botulism Ricin One of the deadliest compounds
Easy to make, common weapon
Interrupts cell processes; causes death
Most effective through inhalation

64. Biological Weapons Staphylococcal Enterotoxin B (SEB)
Similar to food poisoning
Treatment is supportive
Trichothecene Mycotoxins (T2)
Death within 12 hours
No vaccine
Treat symptoms

65. Virus Weapons Simplest microorganisms Require a host cell
Not easy to manufacture
Continued…

66. Virus Weapons Smallpox Encephalitis Continued…
Thought to be eradicated, but may exist
Highly contagious
Spread by respiratory droplets
Encephalitis
Naturally occurring
Inflammation of the brain
More incapacitating than lethal
Continued…

67. Virus Weapons Viral Hemorrhagic Fever (VHFs)
Ebola, Dengue Fever, Yellow Fever
Changes the clotting ability of blood
Highly contagious & lethal
Liquefies internal organs
No vaccines or cures

68. Radioactive / Nuclear Weapons
Military / Sabotage
Highly unlikely
Improvised
Easy to gather knowledge, implementation very difficult
“Dirty Bomb”
Similar issues as improvised device

69. Incendiary Weapons More plausible by using: Molotov cocktails
Propane bombs
Shaped charges
May disseminate other weapons

70. Strategy and Tactics Strategies are broad plans; tactics
are specific methods to achieve
them.
Isolation
Notification
Identification
Protection

71. Isolation – Initial Considerations
Determine severity of danger.
Control the scene & size it up.
Isolate the hazard area.
Attempt to evacuate (based on hazards).
Establish perimeter control.

72. Isolation – Perimeter Control
May be difficult based on resources.
Overestimate the size of the perimeter.
Continued…

73. Isolation – Perimeter Control
Outer perimeter
Most distant boundary line
Restrict all public access beyond it
Inner perimeter
Isolates known hazards inside the outer perimeter

74. Perimeter Control Factors
Availability of resources
Size & configuration of incident
Stability of the incident

75. Notification
Notify federal & state support agencies during a suspected or known terrorist event (usually done by dispatch centers).

76. Identification May or may not be possible.
Do not endanger self to determine.
Report obvious signs or indicators.
Note placards and labels.
Use the Emergency Response Guidebook.
Report unusual patterns of illness.

77. Protection EMTs are responsible to protect
themselves and their equipment.
Perform an initial scene survey.
Request security police/military).
Establish vehicle staging and treatment areas.
Advise EMS command of concerns,
suspicious people, and/or activities.

78. Review Questions
List and briefly describe the five most common types of terrorism incidents.
2. What is a secondary device? What precautions should be taken by an EMT regarding secondary devices?

79. Review Questions
3. List several types of events that should trigger an EMT’s suspicion of possible terrorism involvement.
4. List the seven types of harm that result from a terrorism incident – and the seven letter acronym for these types of harm.

80. Review Questions
5. Briefly discuss the concepts of time, distance, and shielding.
6. Discuss several self-protection measures for biological incidents.
7. Discuss the tactics for isolation, notification, identification, and protection.

81. STREET SCENES
What are the indicators that this is a suspicious incident?
What steps should be taken to isolate the area?

82. STREET SCENES
What steps should be taken to identify a possible mechanism of injury?
Identify the critical personal protection issues on this scene.

83. STREET SCENES
What are the indicators that this is a suspicious incident?
What protection precautions should be initiated?

84. STREET SCENES
Discuss the proper notification procedures. What support agencies are required on this scene?