1. Emergency Medical Response Disasters, Terrorism and Weapons of Mass Destruction

2. Emergency Medical Response You Are the Emergency Medical Responder You are an EMR dispatched to the scene of an explosion. On arrival you are staged with other emergency vehicles one block away. You are told that police suspect that a building was targeted by an extremist group and it is uncertain if there were injuries from the blast. Lesson 46: Disasters, Terrorism and Weapons of Mass Destruction

3. Emergency Medical Response Terrorism The unlawful use of force and violence against persons or property to intimidate or coerce government, the civilian population or any segment thereof, in furtherance of political or social objectives.

4. Emergency Medical Response Preparation for Disasters and Terrorism  Federal Emergency Management Agency (FEMA)  Responsible for coordinating the response in the U.S.  National Response Framework (NRF)  National Disaster Medical System (NDMS)

5. Emergency Medical Response National Incident Management System  Comprehensive national framework for managing incidents  Outline of structures for response activities for command and management  Provision of consistent, nationwide response at all levels  Contains 15 Emergency Support Functions (ESFs)  As EMRs you are supported by ESF #8 (public health and medical services)

6. Emergency Medical Response Areas of NIMS  Incident command systems (ICS)  Multiagency coordination system (MACS)  Unified command, training, identification and management of resources  Mutual aid and assistance  Situational awareness  Qualifications and certification  Collection, tracking and reporting of incident information  Crisis action planning  Exercises

7. Emergency Medical Response Emergency Support Functions 1.Transportation 2.Communications 3.Public works and engineering 4.Firefighting 5.Emergency management 6.Mass care, emergency assistance, housing and human services 7.Logistics management and resource support

8. Emergency Medical Response Emergency Support Functions (cont’d) 8.Public health and medical services 9.Search and rescue 10.Oil and hazardous materials response 11.Agriculture and natural resources 12.Energy 13.Public safety and security 14.Long-term community recovery 15.External affairs

9. Emergency Medical Response Three Main Categories of Disasters  Natural  Human-caused (terrorist attacks, HAZMAT incidents and MCIs)  Biological

10. Emergency Medical Response The Role of the Emergency Medical Responder  Leadership if first responder on the scene  If you are not the first responder on the scene—  Assist the leader  Assume other roles  Triage patients  Provide medical care  Provide patient reception at staging facilities  Prepare patients for evacuation

11. Emergency Medical Response Weapons of Mass Destruction Known by the acronym CBRNE:  Chemical  Biological  Radiological/Nuclear  Explosives

12. Emergency Medical Response Chemical Agents  Nerve agents – act upon the nervous system  Blister agents – as the name implies  Blood agents – disrupt cellular respirations  Pulmonary agents – lung tissue damage  Incapacitating agents – pepper spray, tear gas

13. Emergency Medical Response Biological Weapons  Class A weapons – highest level of threat  Anthrax, smallpox  Class B weapons – moderate level  Food/water pathogens, ricin toxin  Class C weapons – easy spread  Yellow fever, hanta virus, tick-borne viruses

14. Emergency Medical Response Radiological/Nuclear Agents  Damage due to the following:  Air blast  Heat  Ionizing radiation  Ground shock  Secondary radiation  Acute radiation syndrome follows a predictable pattern that unfolds over several days and weeks

15. Emergency Medical Response Explosives and Incendiary Weapons  High-order explosives: supersonic over- pressurization shock wave  Low-order explosives: subsonic explosion

16. Emergency Medical Response Response to CBRNE/WMD Incident  Preparation  Medical direction  Personal preparation  Equipment  Transportation and communication  Equipment and supplies  Arrival on the scene  Scene safety  Providing care

17. Emergency Medical Response Nerve Agent Poisoning  Initial effects dependent on dose and route  Inhalation via gas  Absorption through skin  Ingestion from liquids or food  Dose and amount of exposure leads to varying effects

18. Emergency Medical Response Care for Nerve Agent Poisoning  Ventilation  Antidotes  Atropine  Pralidoxime chloride  Decontamination is critical for skin exposure  Continued monitoring and transport (if ingested)  Nerve agent auto-injector kit (for self- or peer- administration of nerve agent antidote)

19. Emergency Medical Response Activity You and several other EMRs are providing care to patients at the scene involving exposure to a nerve agent. You observe a fellow EMR begin to sweat excessively and cough. He starts complaining of headache and nausea. You also notice a runny nose, watery eyes and pinpoint pupils. You suspect that he is exhibiting signs of nerve agent poisoning.

20. Emergency Medical Response You Are the Emergency Medical Responder There is some question about the cause of the explosion but police strongly suspect that is was a terrorist attack using a WMD, most likely a high-order explosive. While in the staging area you observe a large trash bag near a dumpster in close proximity to staged apparatus.

21. Emergency Medical Response Enrichment Pandemic Flu  Three pillars:  Preparedness and communication  Surveillance and detection  Response and containment  Phases:  Early detection  Treatment with antiviral medications  Infection control measures  Vaccination

22. Emergency Medical Response Enrichment Personal Preparedness  Get a kit  Make a plan  Be informed