Chapter 40 Flashcards
weapons of mass destruction: Also called weapons of mass casualty Any agent designed to bring about: … … Massive damage to … and … B-NICE and CBRNE are mnemonics for the kinds of WMDs.
mass death
casualties
property; infrastructure
...have been the preferred WMD. Chemical agents consist of: … (blister agents) … agents (choking agents) … agents ... agents (cyanides)
Explosives vesicants respiratory nerve metabolic
Biologic terrorism/warfare Biologic agents are organisms that cause disease. The primary types are: … … ...
viruses
bacteria
toxins
Nuclear/radiologic terrorism
Only two publicly known incidents: Hiroshima and Nagasaki
These materials are far easier for a determined terrorist to acquire and require less expertise to use.
“… can cause widespread panic
Recognizing a terrorist event
Planning of acts of terror is covert.
You must know the current threat level issued by the Department of Homeland Security (DHS).
.
Dirty bombs”
…(NTAS).
Alerts from the NTAS contain a … and the actions that first responders, government agencies, and the public can take to maintain safety.
National Terrorism Advisory System; summary of the threat
On every call, you must make the following observations: Type of … Type of ... … of patients Victims’ ... ... indicators
location call number statements preincident
Scene safety
Stage your vehicle a safe distance away.
Wait for law enforcement personnel.
If you have any doubt, do not enter.
The best location for staging is upwind and uphill from the incident.
…:
Additional explosives set to explode after the initial bomb
upwind; uphill; Secondary device
Responder safety
The best form of protection is preventing yourself from coming in contact with the agent.
The greatest threats facing you in a WMD attack are …and ….
contamination; cross-contamination
Notification procedures Notify the dispatcher of: The … of the event Any … that may be required The estimated … of patients The … or … of approach
Establish a …
Trained responders in PPE are the only persons equipped to handle the WMD incident.
nature additional resources number upwind; optimal route staging area
Establishing command You may need to establish command until additional personnel arrive. You and other EMTs may function as: ... directors ..., ..., or ...supervisors ...officers ...and general staff
medical branch
triage; treatment; transportation
logistics
command
Liquids or gases that are dispersed to kill or injure
… agents can remain on a surface for long periods.
…agents evaporate rapidly.
Persistent (nonvolatile)
Nonpersistent (volatile)
… is a term used to describe how the agent most effectively enters the body.
Agents with a vapor hazard enter through the … in the form of vapors.
Agents with a … hazard (or skin hazard) give off very little vapor or no vapors and enter the body through the skin.
Route of exposure; respiratory tract; contact
vesicants:
Primary route is the …
Cause … to form on the victim’s skin and in the respiratory tract
Usually cause the most damage to … or …areas of the body
Signs of vesicant exposure on the skin
Signs and symptoms if vapors were inhaled
skin (contact).
burnlike blisters
damp; moist
vesicants:
Sulfur mustard (H)
Brownish-yellowish oily substance
Generally considered very … Begins an irreversible process of damage to the cells
Attacks vulnerable cells within the … and depletes the body’s ability to reproduce …
Sulfur mustard vapors can be inhaled, creating upper and lower airway compromise.
persistent; bone marrow; white blood cells
Lewisite (L) and phosgene oxime (CX)
Produce …wounds very similar to those caused by mustard
Produce immediate intense pain and discomfort when contact is made
The patient may have a … discoloration at the contaminated site.
Vesicant agent treatment
blister; grayish
pulmonary agents:
Gases that cause immediate harm to persons exposed to them
Primary route is through the ….
Once inside the lungs, they damage the lung tissue and … leaks into the lungs.
…develops, resulting in difficulty breathing because of severely impaired gas exchange.
respiratory tract
fluid
Pulmonary edema
pulmonary agents:
Chlorine (Cl)
First chemical agent ever used in warfare
Initially, produces …irritation and a … sensation
Signs and symptoms
upper airway; choking
Phosgene Product of combustion pulmonary agents: …: Very potent agent with a delayed onset of symptoms Signs and symptoms of mild exposure Pulmonary agent treatment
phosgene
nerve agents:
Among the most deadly chemicals developed
Can cause …within seconds to minutes of exposure
…came from the early nerve agents, the G series.
Nerve agents all produce similar symptoms but have varying routes of entry.
Use SLUDGEM and DUMBELS
cardiac arrest; G agents
metabolic agents:
Hydrogen cyanide (AC) and cyanogen chloride (CK) are both agents that affect the body’s ability to ….
Commonly found in many industrial settings
Associated with …, …, …, and …Signs and symptoms of high doses
Cyanide agent treatment
use oxygen; dizziness; light-headedness; headache; vomiting
biologic agents:
Can be almost completely undetectable
Diseases caused will be similar to other minor illnesses
May be spread in various ways
…is the means by which a terrorist will spread the agent.
A … is an animal that spreads disease to another animal.
Dissemination
disease vector
biologic agents:
How easily the disease is able to spread from one human to another human is called ….
…is the period of time between the person becoming exposed to the agent and the appearance of the first symptoms.
communicability
Incubation
Smallpox is highly contagious.
You must wear examination gloves, a HEPA-filtered respirator, and eye protection.
Observe the … , …, and … of the lesions.
size; shape; location
Viral hemorrhagic fever (VHF)
Causes the blood in the body to .. from the tissues and blood vessels
The patient will have … symptoms, progressing to more serious symptoms such as internal and external ….
All standard precautions must be taken.
seep out; flulike; hemorrhaging
bacteria:
Inhalation and cutaneous anthrax
Anthrax is caused by a deadly bacterium that lays dormant in a spore.
Routes of entry are …, …, and ….
…anthrax is the most deadly.
Antibiotics can be used to treat anthrax successfully.
inhalation; cutaneous; gastrointestinal
pulmonary
bacteria contd:
Plague
Natural vectors are … and ….
…infects the lymphatic system and creates buboes.
… is a lung infection that results from inhalation of plague bacteria.
rodents; fleas; Bubonic plague; Pneumonic plague
neurotoxins:
Most deadly substances known to humans
Produced from …, … animals, …, and …
Route of entry is ingestion, inhalation, or injection.
Not contagious and have a faster onset of symptoms
plants; marine; molds; bacteria
neurotoxins:
Botulinum toxin
Most potent neurotoxin
Produced by … Affects the nervous system’s ability to function
… diminishes.
Eventually the toxin causes muscle paralysis, leading to …
bacteria;
Voluntary muscle control
respiratory arrest.
neurotoxins: Ricin Derived from mash from the castor bean Causes ... and ...and ... failure, leading to death Quite stable and extremely toxic Signs and symptoms Treatment
pulmonary edema; respiratory; circulatory
…:
Monitoring of patients presenting to EDs and alternative care facilities
Patients with signs and symptoms that resemble influenza are important.
Quality assurance and dispatch need to be aware of an unusual number of calls from patients with unexplainable symptom clusters.
Syndromic surveillance
…:
Established in the time of need for the mass distribution of antibiotics, antidotes, vaccinations, and other medications and supplies
Push packs distributed by the Centers for Disease Control and Prevention Strategic National Stockpile
Push packs have a delivery time of 12 hours anywhere in the country.
Points of distribution (POD)
radiologic/nuclear devices:
Ionizing radiation is emitted in the form of …, or ….
Alpha, beta, gamma (x-ray), and neutron radiation
… is the least harmful type.
… is slightly more penetrating.
… rays are faster and stronger.
… particles are the most powerful.
rays; particles alpha beta gamma neutron
Once radiologic material has been used, the remaining material is called ….
These materials can be found at:
Hospitals and health care facilities with radiology departments
Colleges and universities
Nuclear power plants
Chemical and industrial sites
radiologic waste
Radiologic dispersal devices (RDDs)
Any container designed to …
A “dirty bomb” can injure victims with the radioactive or explosive material.
The dirty bomb is an ineffective WMD.
disperse radioactive material
Nuclear energy is artificially made by ….
The result is an immense amount of energy that usually takes the form of heat.
Nuclear material is used in:
Medicine
Weapons
Naval vessels
Power plants
altering (splitting) radioactive atoms
Nuclear weapons
Kept only in secure facilities
The likelihood of a nuclear attack is extremely remote.
The whereabouts of many small nuclear devices are unknown: …(SADM)
Special Atomic Demolition Munition
Patients exposed to excessive radiation are considered victims of ..
Effects of radiation exposure will vary depending on the …of radiation and the …
Radiation can be introduced into the body by all routes of entry.
acute radiation toxicity; amount; route of entry
Being exposed to a radiation source does not make a patient contaminated or radioactive.
However, when patients have a radioactive source on their body, they must be initially cared for by a …
After decontamination, you may begin treatment with the ABCs.
Wear appropriate PPE and place all body fluids in …for proper disposal.
HazMat responder; containers
There is no protective gear designed to completely shield you from radiation.
The less time that you are exposed to the source, the …will be.
Make certain that responders are stationed far enough from the incident.
Always assume it is the strongest form of radiation and use … shielding.
less the effects; concrete
… (used to start fires) and … devices come in various shapes and sizes.
It is important to identify an object you believe is a potential device.
Notify the authorities and safely evacuate the area.
Always remember that there is the possibility of a secondary device when you respond to the scene.
Incendiary; explosive
Primary blast injury
Direct effects of the pressure wave on the body
Seen almost exclusively in the … organs
An injury to the … causes the greatest morbidity and mortality.
Secondary blast injury
Penetrating or nonpenetrating injury that results from …
hollow; lungs; flying debris
Tertiary blast injury Whole body displacement and subsequent impact with ... Also includes ... Quaternary blast injury Any other injury caused by a blast
environmental objects; crush injury
The physics of an explosion
When a substance is detonated, a solid or liquid is chemically converted into …under high pressure.
This generates a …
Flying debris and high winds commonly cause conventional blunt and penetrating trauma.
gas;; spherical blast wave.
Hollow organs such as the …, …, and … are most susceptible to pressure changes.
The … is the organ system most sensitive to blast injuries.
Primary pulmonary blast injuries occur as contusions and hemorrhages.
middle ear; lung; GI tract; ear
… is the most common cause of death from blast injury.
… and head trauma are also common causes of death from blast injuries.
Extremity injuries, including traumatic amputations, are common.
Blast lung; Neurologic injuries