1. Response to Terrorism and Weapons of Mass Destruction Chapter 38

2. Terrorist Groups Violent religious groups Doomsday cults Extremist political groups Technology terrorists Single-issue groups Violent religious groups Doomsday cults Extremist political groups Technology terrorists Single-issue groups

3. Types of WMD Nuclear Chemical Biological Explosives Nuclear Chemical Biological Explosives

4. Threat Level Be aware of the threat level issued by the Department of Homeland Security

5. Recognizing a Terrorist Event Pre-incident indicators Type of location Type of call Number of patients Victims’ statements Pre-incident indicators Type of location Type of call Number of patients Victims’ statements

6. Response Actions Scene safety Responder safety Notification procedures Establishing command Reassessing scene safety Scene safety Responder safety Notification procedures Establishing command Reassessing scene safety

7. Characteristics of Chemical Agents Persistency/volatility Route of exposure Vapor hazard Contact hazard Persistency/volatility Route of exposure Vapor hazard Contact hazard

8. Vesicants (Blister Agents)

9. Signs and Symptoms of Vesicant Exposure Skin irritation/blisters Eye injuries Respiratory problems Treatment of Vesicant Exposure: – Decontaminate – Support airway – Transport to burn center Skin irritation/blisters Eye injuries Respiratory problems Treatment of Vesicant Exposure: – Decontaminate – Support airway – Transport to burn center

10. Pulmonary Agents Inhaled gases Causes damage to lung tissue Two classes: – Chlorine – Phosgene Treatment of Pulmonary Exposure: – Have patient removed from contaminated atmosphere – Aggressively manage airway – Provide rapid transport Inhaled gases Causes damage to lung tissue Two classes: – Chlorine – Phosgene Treatment of Pulmonary Exposure: – Have patient removed from contaminated atmosphere – Aggressively manage airway – Provide rapid transport

11. Nerve Agents Vapor or contact hazards Causes overstimulation of organs Two classes – G series- thus named because German scientists first synthesized them – V series – about 10x more toxic than G series V stands for Victory, Venomous, or Viscous Vapor or contact hazards Causes overstimulation of organs Two classes – G series- thus named because German scientists first synthesized them – V series – about 10x more toxic than G series V stands for Victory, Venomous, or Viscous

12. Signs and Symptoms of Nerve Agents Salivation, Sweating Lacrimation (excessive tearing) Urination Defecation, Drooling, Diarrhea Gastric upset and cramps Emesis (vomiting) Muscle twitching Salivation, Sweating Lacrimation (excessive tearing) Urination Defecation, Drooling, Diarrhea Gastric upset and cramps Emesis (vomiting) Muscle twitching –Diarrhea –Urination –Miosis –Bradycardia Bronchospasm –Emesis –Lacrimation –Seizures, Salivation, Sweating –Diarrhea –Urination –Miosis –Bradycardia Bronchospasm –Emesis –Lacrimation –Seizures, Salivation, Sweating

13. Treatment of Nerve Agent Exposure Patient decontamination Airway and ventilatory support Administration of MARK 1 kit Patient decontamination Airway and ventilatory support Administration of MARK 1 kit

14. Insecticides Many insecticides are organophosphates. Lower concentrations than found in nerve agents Many insecticides are organophosphates. Lower concentrations than found in nerve agents

15. Metabolic Agents Cyanide Common in industrial settings Affect the body’s ability to use oxygen Signs and Symptoms: – Breathing difficulty – Altered mental status – Seizures – Coma – Respiratory/cardiac arrest Treatment: – Patient decontamination must occur – Support ABCs Cyanide Common in industrial settings Affect the body’s ability to use oxygen Signs and Symptoms: – Breathing difficulty – Altered mental status – Seizures – Coma – Respiratory/cardiac arrest Treatment: – Patient decontamination must occur – Support ABCs

16. Biological Agents Bacterium Neurotoxins Viruses – Require living host – Replicate themselves within healthy cells Bacterium Neurotoxins Viruses – Require living host – Replicate themselves within healthy cells

17. Smallpox Highly contagious Utilize good BSI Begins with high fever, body aches Blisters begin on face and extremities Vaccine linked to medical complications Highly contagious Utilize good BSI Begins with high fever, body aches Blisters begin on face and extremities Vaccine linked to medical complications

18. Viral Hemorrhagic Fevers Ebola, Rift Valley, and Yellow Fever Cause blood to seep from tissues and blood vessels Initially present with flu-like symptoms Ebola, Rift Valley, and Yellow Fever Cause blood to seep from tissues and blood vessels Initially present with flu-like symptoms

19. Bacteria Do not require a host Can be fought with antibiotics Most infections begin with flu-like symptoms Do not require a host Can be fought with antibiotics Most infections begin with flu-like symptoms

20. Cutaneous Anthrax

21. Plague

22. Neurotoxins Most deadly substances known Produced by plants, marine animals, molds, and bacteria May be inhaled, ingested, or injected Most deadly substances known Produced by plants, marine animals, molds, and bacteria May be inhaled, ingested, or injected

23. Botulinum Toxin Most potent neurotoxin Produced by bacteria Causes paralysis Paralysis leads to respiratory arrest Most potent neurotoxin Produced by bacteria Causes paralysis Paralysis leads to respiratory arrest

24. Ricin Comes from castor beans Causes pulmonary edema, respiratory/circulatory failure Treatment = respiratory and cardiovascular support Comes from castor beans Causes pulmonary edema, respiratory/circulatory failure Treatment = respiratory and cardiovascular support

25. EMT Roles During Biological Events Syndromic surveillance Identification of outbreaks Strategic National Stockpile Participation at distribution sites Syndromic surveillance Identification of outbreaks Strategic National Stockpile Participation at distribution sites

26. Types of Radiation

27. Radiological/Nuclear Devices Radiological dispersal devices – Dirty bombs Nuclear weapons – Nuclear bombs/missiles – Special Atomic Demolition Munitions Radiological dispersal devices – Dirty bombs Nuclear weapons – Nuclear bombs/missiles – Special Atomic Demolition Munitions

28. Signs and Symptoms of Radioactive Exposure Varies depending on: – Amount of radiation – Route of exposure Low exposure: nausea, vomiting, diarrhea Moderate exposure: first-degree burns, hair loss, depletion of immune system, cancer Severe exposure: Second/third-degree burns, cancer, death Varies depending on: – Amount of radiation – Route of exposure Low exposure: nausea, vomiting, diarrhea Moderate exposure: first-degree burns, hair loss, depletion of immune system, cancer Severe exposure: Second/third-degree burns, cancer, death