1. Disasters, Terrorism and Weapons of Mass Destruction

2. 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.

3. 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.

4. 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)

5. 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)

6. 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

7. 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

8. 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

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

10. 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

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

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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)

19. 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.

20. 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.

21. 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

22. Enrichment Personal Preparedness
Get a kit
Make a plan
Be informed