1. CBRNE Training Academy Relating the Exotic to the Mundane

2. Objectives Integrate Awareness, Hazard Recognition and SIN Illustrate the “All Hazards” approach Personal empowerment Integrate Awareness, Hazard Recognition and SIN Illustrate the “All Hazards” approach Personal empowerment

3. Scenario #1 You are a security guard You work at the large county hospital You control flow into the emergency department You are a security guard You work at the large county hospital You control flow into the emergency department

4. Here’s what you see... Patient presents with a cough Fifth patient in last hour with cough They all also have fever They are all from the same place What do you do now? Patient presents with a cough Fifth patient in last hour with cough They all also have fever They are all from the same place What do you do now?

5. Approach Awareness –Abnormal for time of year, hospital Hazard Recognition –Cough and fever is infectious S-I-N –Protect yourself (mask, isolate) –Protect others (isolate, masks, etc.) –Notify the triage nurse or supervisor Awareness –Abnormal for time of year, hospital Hazard Recognition –Cough and fever is infectious S-I-N –Protect yourself (mask, isolate) –Protect others (isolate, masks, etc.) –Notify the triage nurse or supervisor

6. Gather information They are all from the same shelter / prison They are all from the same apartment building / office They are all from the same day care / nursing home They are all from Hong Kong They are all from the same train They are all from the same shelter / prison They are all from the same apartment building / office They are all from the same day care / nursing home They are all from Hong Kong They are all from the same train

7. What is this? “A cold?” Influenza? Tuberculosis? Atypical pneumonia (Legionella)? SARS? Anthrax? More importantly, does it matter? “A cold?” Influenza? Tuberculosis? Atypical pneumonia (Legionella)? SARS? Anthrax? More importantly, does it matter?

8. Common ground This is an infectious disease problem –The organism defines the menace –The intent defines the malice A biological terrorism event is an “Infectious Disease Outbreak” –Initial approach is the same –Subsequent is modified by what you learn Anyone can sound the alarm This is an infectious disease problem –The organism defines the menace –The intent defines the malice A biological terrorism event is an “Infectious Disease Outbreak” –Initial approach is the same –Subsequent is modified by what you learn Anyone can sound the alarm

9. Scenario #2 You work at the gift shop in the hospital lobby It is a popular place for employees They get discounts on medicine, food and drink It is a slow day because of the blizzard You work at the gift shop in the hospital lobby It is a popular place for employees They get discounts on medicine, food and drink It is a slow day because of the blizzard

10. Here’s what you see... An employee has tearing, and difficulty breathing Third employee in last hour with similar problem They all smell funny You start to feel the same symptoms What do you do now? An employee has tearing, and difficulty breathing Third employee in last hour with similar problem They all smell funny You start to feel the same symptoms What do you do now?

11. Approach Awareness –This is not normal; you are healthy Hazard Recognition –Something is causing irritation –This is being brought by the employees S-I-N –Close up shop, find clean air –Remove contaminated clothing, seek care –Notify your supervisor, security, the ER, etc. Awareness –This is not normal; you are healthy Hazard Recognition –Something is causing irritation –This is being brought by the employees S-I-N –Close up shop, find clean air –Remove contaminated clothing, seek care –Notify your supervisor, security, the ER, etc.

12. Gather information They all work in the kitchen They all work as groundskeepers They all work in environmental services They all work in the same lab They all work in security They all work in the mailroom They all work in the kitchen They all work as groundskeepers They all work in environmental services They all work in the same lab They all work in security They all work in the mailroom

13. What is this? Environmental allergy? Pesticide? Chlorine gas? Tear gas? Nerve agent? More importantly, does it matter? Environmental allergy? Pesticide? Chlorine gas? Tear gas? Nerve agent? More importantly, does it matter?

14. Common ground This is an chemical exposure problem –The chemical defines the menace –The intent defines the malice A chemical terrorism event is a “Hazardous Materials Incident” –Initial approach is the same –Subsequent is modified by what you learn Anyone can sound the alarm This is an chemical exposure problem –The chemical defines the menace –The intent defines the malice A chemical terrorism event is a “Hazardous Materials Incident” –Initial approach is the same –Subsequent is modified by what you learn Anyone can sound the alarm

15. Scenario #3 You are an emergency physician You are responsible for medical command of the local EMS units It is three o’clock in the morning You are an emergency physician You are responsible for medical command of the local EMS units It is three o’clock in the morning

16. Here’s what happens... EMS calls There was an explosion They are bringing five critical patients They are all coming from the same place What do you do now? EMS calls There was an explosion They are bringing five critical patients They are all coming from the same place What do you do now?

17. Approach Awareness –Know resources, staff and community Hazard Recognition –Know what exists near the hospital –Know your EMS units and paramedics S-I-N –Prepare –Activate trauma team, plan; get info –Let people know (administration, etc.) Awareness –Know resources, staff and community Hazard Recognition –Know what exists near the hospital –Know your EMS units and paramedics S-I-N –Prepare –Activate trauma team, plan; get info –Let people know (administration, etc.)

18. What you learn Construction site Fireworks factory Chemical production plant Nuclear power plant Subway car / Train station Church / Synagogue FBI building Construction site Fireworks factory Chemical production plant Nuclear power plant Subway car / Train station Church / Synagogue FBI building

19. What is this? Explosive + Thermal? Explosive + Thermal + Chemical? Explosive + Thermal + Radiological? More importantly, does it matter? Explosive + Thermal? Explosive + Thermal + Chemical? Explosive + Thermal + Radiological? More importantly, does it matter?

20. Common ground This is an fire / explosive problem –The blast defines the menace –The intent defines the malice A fire / explosion terrorism event is a “Mass Casualty-Trauma/Burn Incident” –Initial approach is the same –Subsequent modified by what you learn Anyone can sound the alarm This is an fire / explosive problem –The blast defines the menace –The intent defines the malice A fire / explosion terrorism event is a “Mass Casualty-Trauma/Burn Incident” –Initial approach is the same –Subsequent modified by what you learn Anyone can sound the alarm

21. Summary Be calm Be aware Recognize hazards Remember to S-I-N and count to T-E-N Healthcare focuses on the menace Consistent, common approach Anyone can sound the alarm Be calm Be aware Recognize hazards Remember to S-I-N and count to T-E-N Healthcare focuses on the menace Consistent, common approach Anyone can sound the alarm

22. Questions?