Mod 7 EMS response to terrorism Flashcards
Terrorism
-The unlawful use of force or violence against persons or property to intimidate or coerce a government the civilian, the civilian population, or any segment thereof, in furtherance of political or social objectives (U.S. department of justice, FBI, definition)
Domestic terrorism
-Terrorism directed against ones own government or population without foreign direction
International terrorism
-Terrorism that is purely foreign based or directed
Weapons of mass destruction (WMD)
-Weapons, devices, or agents intended to cause widespread harm and/or fear among a population
The CBRNE agents
- Often called weapons of mass destruction
- Chemical
- Biological
- Radiological
- Nuclear
- Explosive
Multiple devices
-Destructive devices, such as bombs, including both those used in the initial and those placed to be activated after the initial attack and timed to injury emergency responder’s and others who rush in to help care for those targeted by an initial attack
Secondary devices
- Destructive devices to be activated after an initial attack and timed to injure emergency responders.
- Emergency response planners prefer the term multiple devices because it is more likely to make first responders aware of and prepared for the possibility of more than one destructive event following the first.
OTTO
- Clues that may indicate terrorism
- Occupancy or location
- Type of event
- Timing of the event
- On-scene warning signs
Types occupancy or location that are sometimes targeted by terrorists
- Symbolic and historical agents (Government buildings, statue of liberty, liberty bell ect.)
- Public buildings or assembly areas (Shopping malls, convention centers ect.)
- Controversial businesses (Family planning clinics, nuclear facilities ect.)
- Infrastructure systems (bridges, power plants, water treatment plants ect.)
Type of event
- Explosions and/or incendiaries
- Incidents involving firearms
- Nontrauma mass-casualty incidents such as the spread of illness
Timing of event
-Specific days of the week and times of the day are worth treating with suspicion
TRACEM-P
- Types of harm I can be exposed to
- Thermal Harm
- Radiological harm
- Asphyxia (caused by lack of oxygen in the atmosphere)
- Chemical harm
- Etiological harm (concerns the cause of disease)
- Mechanical harm (bombs, guns ect.)
- Psychological harm (result of any traumatic event causing panic and terror.
Principles of protection for the responder to minimize exposure
- Time (Send shortest amount of time at the scene as possible)
- Distance (Maximizing distance from scene)
- Shielding (Use of Hazmat suits, positive pressure self contained breathing apparatus, and PPE. also consider vaccinations)
Types of chemical incidents and whether it is primary or secondary harm
- Thermal harm is secondary harm
- Asphyxia is secondary harm because some chemical reactions may deplete oxygen or create gases
- Chemical harms are primary harms and include wide variety of effects such as corrosivity and reactivity
- Mechanical harm is a secondary harm. Must be taken into consideration because corrosive chemicals can weaken structural elements
- Psychological harm is secondary harm because many individuals will react emotionally to a possible chemical exposure.
Agents that may cause harm by being inhaled or ingested into the body
- Bacteria: single celled organisms that can grow in a variety of environments
- Viruses: smallest know entity that is capable of reproduction. Grow inside of living cells and cause those cells to produce additional viruses
- Toxins: Poisons produced by living organisms. (bacteria, fungi, insects ect.)
Exposure
-The dose or concentration of an agent multiplied by the time, or duration
Chemical doses
- Generally measured in milligrams per kilogram of body weight.
- Biological doses are measured in fractions of micrograms per kilogram of body weight
Concentration
- The concentration of an agent is measured in parts per million
- If you reduce does, concentration, or time near the agent you will reduce exposure
Routes of entry
-Pathways into the body, generally by absortion, ingestion, injection, or inhalation
Absortion
-Skin contact
Ingestion
-Mouth
Injection
-Needles or projectiles
Inhalation
-Breathing
Items that affect skin absortion
- Injury to skin
- Skin tempreture/blood flow
- Higher concentration=greater exposure
- Area with more hair=more exposure
- Length of exposure
- Type of agent
Common infection routes for biological infection
- Vector (a disease-carrying organism)
- Jagged glass or metal
- Syringes
- High pressure devices
Degree of infection is based on what?
- Rate of breathing
- Depth breathing
Contamination
-Contact with or presence of a material (contaminant) that is present where it does not belong and is somehow harmful to persons, animals, or the environment
Things that can be contaminated
- Hard and soft tissues
- Skin and hair
- Clothing
Exposure versus contamination
- Exposure occurs when a substance is taken into the body through one of the routes of exposure
- Contamination occurs when a substance clings to surface areas of the body or clothing
Permeation
-The movement of a substance through a surface or, on a molecular level, through intact material; penetration, or spreading
The types of harm that can result from biological incident primary and secondary
- Chemical harm is secondary hazard
- Etiological harm is a primary type of harm
- Mechanical harm is a possible secondary hazard where explosives have been used to disperse the agent.
- Psychological harm is a secondary harm
The order of protection priorities
- Self protection
- Using the buddy system
- Availability of rapid intervention teams
- Civilian pretection
Types of harm from radiological/nuclear incidents primary and secondary
- Thermal harm is a primary harm
- Radiological harm is a primary harm
- Chemical harm is a secondary harm. Often over looked by responders who are concentrated on radiation effects
- Mechanical harm is a primary harm
- Psychological harm is secondary harm
Something to keep in mind if the bombing was a suicide bombing
-Make sure to check all patients before transport. If a bomb is found evacuate all persons from the area
Types of harm from explosive incidents primary and secondary
- Thermal harm is a primary hazard
- Asphyxia is a secondary harm because of possibility of dusty conditions
- Chemical hazards created as a result of the explosive reaction
- Mechanical harm is a primary harm from blast over pressure, shock waves, and fragmentation
- Psychological harm is a secondary harm
Preblast VS postblast
- Preblast takes place after a written or verbal warning is received but before the explosion take place
- Postblast takes place after at least one detonation has occured
Dissemination
- Spreading
- The most common means of dissemination is through the respiratory tract
Weaponization
-Packaging or producing a material, such as a chemical, biological, or radiological agent, so it can be used as a weapon, for example by dissemination in a bomb detonation or as an aerosol sprayed over an area or introduced into ventilation systems
Chemical agent considerations
- Physical considerations is that known agents cover the whole range of physical properties
- Volatility considerations is agents that have a low boiling point and high vapor pressure tend to be nonpersistent what is they will evaporate more readily
- Chemical considerations is they are sufficiently stable to survive dissemination and transport to the site of their action
- Toxicological considerations is that not all individuals of a species react the same way to a given amount of agent
Classifications of chemical agents
- Choking agents
- Vesicating agents (blister agents) may not be apparent until hours after exposure
- Cyanides formerly known as blood agents preventing the use of oxygen withing the body’s cells
- Nerve agents inhibit enzymes that is critical to proper nerve transmission.
- Riot control agents include irritating materials and tear flow increasers (lacrimators) (pepper spray, mace ect.)
Biological agents
- A bacterium is a small free living micro-organism meaning it can live outside of a host
- Virus is an organism that requires a host cell inside which to live and reproduce.
- Toxins are not living organisms. Is a poisonous chemical compound that is produced by or derived from a living organism
Features of biological agents that influence their potential use as weapons
- Infectivity
- Virulence
- Toxicity
- Incubation period
- Transmissibility
- Lethality
- Stability
Infectivity
-Does not mean that signs appear quickly nor that illness will be more severe. Simply means that it takes only a small number of organisms to produce symptoms
Virulence
-Reflects the relative severity of the disease
Toxicity
-Reflects relative severity of the illness or incapacitation produced by a toxin
Incubation period
-The time between exposure and the appearance of symptoms
Transmissibility
-Ability to spread
Lethality
-Reflects the relative ease with an agent causes death in susceptible population
Stability
-Viability of biological agent is affected by many environmental factors
Zoonotic
-Able to move through the animal human barrier, transmissible from animals to humans
Examples of bacteria
- Anthrax
- Cholera
- Plague
- Q Fever
- Tularemia
Examples of toxins
- Botulinium
- Ricin
- Staphylococcal Enterotoxin B (SEB)
- Trichothecene Mycotoxins (T2)
Examples of viruses
- Small pox
- Encephalitis
- The viral hemorrhagic fevers (VHF’s)
4 potential scenarios for nuclear device usage
- The use of military nuclear weapon
- The use of improvised nuclear devices
- The use of a “dirty bomb” or radiological dispersal device
- The sabatoge of a nuclear facility
The three body systems that would be most severely affected by radiological materials
- Blood forming system specifically bone marrow
- The gastrointestinal system
- The central nervous system
Blast injury patterns
- Lung injury
- Ear injury
- Abdominal injury
- Brain injury
Priorities for responders
- Life safety
- Incident stabilization
- Protection of property
- Additional critical asset considerations include responders, responders equipment, organizational function continuity
Strategies
-Broad general plans designed to achieve desired outcomes
Tactics
-Specific operational actions to accomplished assigned tasks
Notification
- Done by a dispatch center or an emergency operations center
- The trigger event is the initial radio report made by an EMT
Identification
-Identifying any indicators of a particular agent. take notice in anything that may be out of place or take notice in any hazardous materials
Protection responsibility’s of an EMT
- Make an initial scene size up to determine security threats
- Request protection via radio as soon as practical
- Establish vehicle staging and triage/treatment areas in protected locations
- Advise EMS command about protection/security concerns
- Immediately report suspicions people or activities
