1. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 14 Responding to Terrorist Acts

2. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Introduction Explosive Agents Nuclear Agents Chemical Agents Biological Agents General Considerations

3. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Terrorism is a violent act or an act dangerous to human life, in violation of the criminal laws of the United States or any segment, to intimidate or coerce a government, the civilian population or any segment thereof, in the furtherance of political or social objectives. -U.S. Department of Justice

4. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Impact of September 11, 2001 Conventional weapons Unconventional weapons Maintain high index of suspicion Potential target locations

5. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Explosive Agents Weapon of choice Initial dangers –Blast pressure wave –Debris Associated dangers –Structural collapse –Secondary explosions –Fire and other hazards Management

6. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Incendiary Agents Subset of explosive agents Examples –Napalm –Molatov cocktail –White phosphorus –Magnesium Cause severe and extensive burn injuries

7. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nuclear Detonation and Contamination Energy generated as bonds within the nucleus are broken and re-established Concentric circles of damage Energized particles of debris and dust Nuclear contamination Assessment Management

8. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chemical Agents Simple to sophisticated chemicals Confined spaces are most common target Absorption or inhalation Volatility Specific gravity Environmental conditions

9. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nerve Agents (1 of 2) Affect nerve impulse conduction Examples –GB (sarin) –VX –GD (soman) –GA (tabun) –Organophosphates

10. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Nerve Agents (2 of 2) Absorption or inhalation Assessment: SLUDGE Management –Atropine –Pralidoxime chloride

11. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Vesicants (Blistering Agents) Damage exposed skin and mucous membranes Examples –Sulfur mustard (HD) –Nitrogen mustard (HN) –Lewisite and phosgene oxime (CX) Assessment Management

12. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chemical Pulmonary Agents Chemical injury to lungs Attack mucous membranes Examples –Phosgene –Chlorine –Synthetic by-products Assessment Management

13. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Biotoxins Biological agents that act like chemical agents Toxins produced by living organisms Examples –Ricin –Staphylococcal enterotoxin –Botulinum –Trichothecene mycotoxins

14. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Other Hazardous Chemicals Any toxic chemical Emergency Response Guidebook

15. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Recognition of a Chemical Agent Release Possible cloud or puddle Possible strange or unusual odor Dead or damaged plants and/or animals Potential targets Key: manifestation of common signs and symptoms occurring rapidly among a large group of individuals

16. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of Chemical Agent Release Approach from uphill. Maintain distance. Evacuate. Decontaminate. Provide appropriate medical treatment.

17. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Biological Agents Living organisms or toxins Human-to-human contagious Not human-to-human contagious Can spread quickly Recognition of release Numerous patients with similar signs and symptoms

18. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Types of Biological Agents Biological pulmonary agents –Anthrax –Pneumonic plague –Tularemia –Q fever Encephalitis-like agents –Smallpox –Venezuelan equine encephalitis (VEE) Other agents –Cholera –Viral hemorrhagic fever

19. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Comparison of Biological Agents Disease Incubation Period MortalityFeverChillsCoughMalaise Chest Tightness Head- ache N/V Anthrax1–6 days90% XXXX Plague1–6 days57–100% XXXXX Tularemia3–5 days35% XXXX Q Fever2–14 days1% X?XX Smallpox12 days30% XXXX VEE1–5 days1% XXXXXX Cholera1–3 days50% X VHF3–7 days5–20% XX Ebola3–7 days80–90% XX

20. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Considerations Scene safety Recognition of a terrorist attack –Explosion –Nuclear –Chemical –Biological Protection against transmission –BSI precautions –Immunizations –Exposure followup

21. Bledsoe et al., Paramedic Care Principles & Practice Volume 5: Special Considerations © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Introduction Explosive Agents Nuclear Agents Chemical Agents Biological Agents General Considerations