Disasters, Terrorism and Weapons of Mass Destruction

You Are the Emergency Medical Responder Lesson 46: Disasters, Terrorism and Weapons of Mass Destruction You Are the Emergency Medical Responder You are an EMR dispatched to the scene of an explosion. On arrival you are staged with other emergency vehicles one block away. You are told that police suspect that a building was targeted by an extremist group and it is uncertain if there were injuries from the blast.

Terrorism The unlawful use of force and violence against persons or property to intimidate or coerce government, the civilian population or any segment thereof, in furtherance of political or social objectives.

Preparation for Disasters and Terrorism Federal Emergency Management Agency (FEMA) Responsible for coordinating the response in the U.S. National Response Framework (NRF) National Disaster Medical System (NDMS)

National Incident Management System Comprehensive national framework for managing incidents Outline of structures for response activities for command and management Provision of consistent, nationwide response at all levels Contains 15 Emergency Support Functions (ESFs) As EMRs you are supported by ESF #8 (public health and medical services)

Areas of NIMS Incident command systems (ICS) Multiagency coordination system (MACS) Unified command, training, identification and management of resources Mutual aid and assistance Situational awareness Qualifications and certification Collection, tracking and reporting of incident information Crisis action planning Exercises

Emergency Support Functions Transportation Communications Public works and engineering Firefighting Emergency management Mass care, emergency assistance, housing and human services Logistics management and resource support

Emergency Support Functions (cont’d) Public health and medical services Search and rescue Oil and hazardous materials response Agriculture and natural resources Energy Public safety and security Long-term community recovery External affairs

Three Main Categories of Disasters Natural Human-caused (terrorist attacks, HAZMAT incidents and MCIs) Biological

The Role of the Emergency Medical Responder Leadership if first responder on the scene If you are not the first responder on the scene— Assist the leader Assume other roles Triage patients Provide medical care Provide patient reception at staging facilities Prepare patients for evacuation

Weapons of Mass Destruction Known by the acronym CBRNE: Chemical Biological Radiological/Nuclear Explosives

Chemical Agents Nerve agents – act upon the nervous system Blister agents – as the name implies Blood agents – disrupt cellular respirations Pulmonary agents – lung tissue damage Incapacitating agents – pepper spray, tear gas

Biological Weapons Class A weapons – highest level of threat Anthrax, smallpox Class B weapons – moderate level Food/water pathogens, ricin toxin Class C weapons – easy spread Yellow fever, hanta virus, tick-borne viruses

Radiological/Nuclear Agents Damage due to the following: Air blast Heat Ionizing radiation Ground shock Secondary radiation Acute radiation syndrome follows a predictable pattern that unfolds over several days and weeks

Explosives and Incendiary Weapons High-order explosives: supersonic over-pressurization shock wave Low-order explosives: subsonic explosion

Response to CBRNE/WMD Incident Preparation Medical direction Personal preparation Equipment Transportation and communication Equipment and supplies Arrival on the scene Scene safety Providing care

Nerve Agent Poisoning Initial effects dependent on dose and route Inhalation via gas Absorption through skin Ingestion from liquids or food Dose and amount of exposure leads to varying effects

Care for Nerve Agent Poisoning Ventilation Antidotes Atropine Pralidoxime chloride Decontamination is critical for skin exposure Continued monitoring and transport (if ingested) Nerve agent auto-injector kit (for self- or peer-administration of nerve agent antidote)

Activity You and several other EMRs are providing care to patients at the scene involving exposure to a nerve agent. You observe a fellow EMR begin to sweat excessively and cough. He starts complaining of headache and nausea. You also notice a runny nose, watery eyes and pinpoint pupils. You suspect that he is exhibiting signs of nerve agent poisoning.

You Are the Emergency Medical Responder There is some question about the cause of the explosion but police strongly suspect that is was a terrorist attack using a WMD, most likely a high-order explosive. While in the staging area you observe a large trash bag near a dumpster in close proximity to staged apparatus.

Enrichment Pandemic Flu Three pillars: Preparedness and communication Surveillance and detection Response and containment Phases: Early detection Treatment with antiviral medications Infection control measures Vaccination

Enrichment Personal Preparedness Get a kit Make a plan Be informed