1. Weapons of Mass Destruction

2. Weapons of Mass Destruction
Definition: Any weapon, nuclear device, biological agent, or chemical that can kill a large number of people.
Three types of delivery systems usually are considered for WMD, ballistic missiles, cruise missiles, and combat aircraft

3. Guided Rocket
A guided rocket powered delivery vehicle for use against ground targets. A large portion of its flight is in a ballistic trajectory. It’s the optimum delivery system for WMD.

4. Cruise Missile
A cruise missile is a guided missile that flies at a moderate speed and at low altitude, following the terrain beneath it. The Tomahawk is a cruise missile

5. Common Biological Agents
Anthrax
Botulism Toxin
Plague
Small pox
Tularemia
Viral Hemorrhagic fevers
Ricin

6. Anthrax Primarily a disease of large hoofed animals
Gram positive bacillus spore
Human contact
Inhalation: pulmonary anthrax
Ingestion: gastrointestinal anthrax
Skin: cutaneous anthrax

7. Anthrax Signs and Symptoms
Inhalation: common cold like symptoms, after several days patient begins to have severe difficulty breathing
Cutaneous: Raised itchy bump, 1-2 days painless ulcer with a black necrotic center
Intestinal: Acute inflammation of the gastrointestinal tract, N/V, fever, abdominal pain, hemoptosis, severe diarrhea

8. Botulism
Clostridium botulinum, gram positive anaerobic bacillus which form endospores
When spores enter an anaerobic environment such as cans and jars it germinates producing a nerve toxin

9. Botulism Signs and Symptoms
Develop within hours to day of ingesting the contaminated food
Blurred vision, slurred speech, difficulty swallowing and chewing, labored breathing
Toxin affects the nerves by inhibiting the neurotransmitter acetylcholine into the junctions of nerve and muscle
Ultimately causes respiratory paralysis

10. Plague Transmitted by fleas from infected rodents to humans Bubonic
Septicemic
Pnuemonic (bioterrorism)
Aerosol for dissemination
After infection can be transmitted from infected individual via cough or sneeze

11. Tularemia Non spore forming bacterium
Contact with diseased rodents, rabbits, ticks, mosquitoes, or deer flies
Aerosol form of the bacterium most likely administration by bioterrorists

12. Tularemia Signs and Symptoms
Very non specific often patients are treated for strep throat, rickettsail, lymphoid cancer or cat- scratch fever

13. Smallpox Extremely cantagious disease. Person to person transmission
Contact with bodily fluids
Exposure through aerosol

14. Smallpox Signs and Symptoms High fever and malaise
Pink to red spots (macules) starting on face then progressing to trunk of body
Progress to looking like pink pimples (vesicles) filled with fluid
Finally progress to a deep pustule which emits pus

15. Hemorrhagic Fever
The hemorrhagic fever viruses (HFVs) are a diverse group of viruses capable of causing a “viral hemorrhagic fever syndrome”. Each virus belongs to one of four distinct families:
Filoviridae: Ebola and Marburg viruses
Arenaviridae: Lassa fever virus and New World arenaviruses
Bunyaviridae: Crimean Congo hemorrhagic fever virus, Rift Valley fever virus, and a group of related viruses referred to as “agents of hemorrhagic fever with renal syndrome”
Flaviviridae: Dengue, Yellow fever, Omsk hemorrhagic fever, and Kyasanur Forest disease virus

16. Hemorrhagic Fevers
Depending on the specific virus, illness may develop within 2 to 21 days after exposure to a hemorrhagic fever virus; however, specific disease manifestations may vary according to virus.
The classic VHF syndrome is characterized by fever, fatigue, body aches, rashes, malaise, nausea, abdominal pain, and headaches.
Progression of disease results in hemorrhagic manifestations that may include bleeding under the skin, in internal organs, or from body orifices. In severe cases, death results 1 to 2 weeks after the onset of symptoms, often caused by kidney failure, multiorgan system failure, or shock. Not all patients develop the classic VHF syndrome

17. Ricin
Ricin is a poison that can be made from the waste left over from processing castor beans.
It can be in the form of a powder, a mist, or a pellet, or it can be dissolved in water or weak acid.
It is a stable substance. For example, it is not affected much by extreme conditions such as very hot or very cold temperatures

18. Ricin
Ricin works by getting inside the cells of a person’s body and preventing the cells from making the proteins they need. Without the proteins, cells die. Eventually this is harmful to the whole body, and death may occur.
Effects of ricin poisoning depend on whether ricin was inhaled, ingested, or injected.

19. Ricin Signs and Symptoms
Inhalation: Within a few hours of inhaling significant amounts of ricin, the likely symptoms would be respiratory distress (difficulty breathing), fever, cough, nausea, and tightness in the chest.
Heavy sweating may follow as well as fluid building up in the lungs (pulmonary edema).

20. Ricin
Ingestion: Vomiting and diarrhea that may become bloody. Severe dehydration may be the result, followed by low blood pressure.
Other signs or symptoms may include hallucinations, seizures, and blood in the urine.
Within several days, the person’s liver, spleen, and kidneys might stop working, and the person could die.
Skin and eye exposure: Ricin in the powder or mist form can cause redness and pain of the skin and the eyes.
Death from ricin poisoning could take place within 36 to 72 hours of exposure, depending on the route of exposure (inhalation, ingestion, or injection) and the dose received. If death has not occurred in 3 to 5 days, the victim usually recovers.

21. Treatment of Biologicals
In general the prehospital treatment for any of these biological agents will include supportive measures for ABC’s
Because of the potential for infection appropriate protective equipment should be used

22. Chemical Agents
Multiple forms of chemical and or nerve agents that could be used for a WMD
Classified by the symptoms they cause
Blistering agents
Blood agents
Nerve agents

23. Blistering Agents Mustard Gas Mustard Lewisite Nitrogen Mustard
Burning and blistering of the eyes and skin
Coughing and respiratory distress

24. Blood Agents Cyanogens chloride Hydrogen chloride Seizures
Respiratory Arrest / Cardiac Arrest

25. Choking Agents Chlorine Diphosgene Phosgene
Cause eye and airway irritation
Respiratory irritation; coughing, hoarseness, dyspnea, chest tightness, and pulmonary edema

26. Nerve Agents Tabun Sarin Soman VX
These agents act on all parts of the nervous system
Pinpointed pupils, runny noses ,difficulty breathing, seizures, and convulsions

27. Blistering Agents Treatment Protective clothing / gas mask
Avoid vapor clouds
Begin the decontamination process
Support the patients ABC’s
Dress large blisters

28. Blood Agents Treatment Protective suits / masks
Decontamination procedures
Support patients ABC’s
Cyanide Antidote Kits-- not approved for EMS

29. Choking Agents Treatment Protective clothing Immediate evacuation
Support patients ABC’s

30. Nerve Agents Treatment Protective suits / gas masks
Mark I Antidote Kit (2 Pam)
Two auto injectors
Atropine 2 mgs
Pralidoxime Chloride 600 mg

31. Additional Weapons Nuclear Weapons Incendiary Devices Dirty Bombs
A small incendiary device used to disperse radioactive material

32. Nuclear Attack Evacuation of residents around the targeted area
If a nuclear blast occurs, seek cover preferably underground. You can take cover behind anything, lie flat on the ground and cover head.
Fallout will take minutes to arrive

33. Nuclear Attack Signs and Symptoms Blast type injuries and burns
Radiation exposure
Vomiting
Headache
Fatigue
Weakness
Thermal burn like effects
Secondary infections
Bleeding and hair loss

34. Nuclear Attack Treatment Protective equipment
Radioactive decontamination procedures
Support patients ABC’s

35. Conventional Incendiary Devices
Terrorist organizations are prone to wipe out the rescuers through secondary blast devices
Scene safety should be of paramount concern
Burns and blast injuries
Utilize standard MCI protocols