1. Response to Terrorism and Weapons of Mass Destruction
Chapter 39
Response to Terrorism and Weapons of Mass Destruction

2. Terrorism
The FBI defines terrorism as “the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.”
Terrorism is a part of life in the US
Terrorism can occur any place at any time

3. Terrorist Groups Groups may be domestic or foreign
Violent religious groups
Doomsday cults
Extremist political groups
Technology terrorists
Single-issue groups

4. Goals of Terrorism Create fear and panic (Top Goal)
-disrupt daily lives
-disrupt the infrastructure of the medical
community
Kill or harm as many persons as possible
Disrupt the infrastructure of all levels of the government

5. High Risk Targets Schools Churches Government Buildings
Water Treatment Plants
Hospitals
Public Gatherings
Mass Transit
Large Business and Shopping Centers

6. Threat Level
Be aware of the threat level issued by the Department of Homeland Security.
Courtesy of U.S. Department of Homeland Security

7. Recognizing a Terrorist Event
Type of location
Type of call
Number of patients
Victims’ statements
Pre-incident indicators
Courtesy of Photographer's Mate 2nd Class Bob Houlihan/U.S. Navy

8. Response Actions Scene safety Responder safety Notification procedures
Establishing command
Reassessing scene safety
Courtesy of Andrea Booher/FEMA

9. Types of WMD (B-NICE) Biological Agents Nuclear Agents
Incendiary Devices
Chemical Agents
Explosives

10. Types of WMD (CBRNE)
Chemical
Biologic
Radiologic
Nuclear
Explosive

11. Biological Agents

12. Biological Agents Includes: Viruses Bacterium Neurotoxins
Can be spread by dissemination
Water supply
Aerosolizing the agent into the air

13. Viruses Require living host Replicate themselves within healthy cells
Spread throughout the community from person to person

14. Smallpox Virus Highly contagious Utilize good BSI.
Begins with high fever, body aches
Lesions identical
Blisters begin on face and extremities.
Most contagious when blisters begin to form
Vaccine is available but has been linked to medical complications.

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

16. Bacteria Do not require a host Can be fought with antibiotics
Most infections begin with flu-like symptoms.
Anthrax and Plague are most feared

17. Anthrax Caused by the bacterium Bacillus anthracis
Can involve the skin, GI tract, and/or lungs
May be cutaneous or inhalation anthrax
Inhalation anthrax is most deadly
90% mortality if untreated
Vaccine is available for selected military groups
Consists of 6 vaccines

18. Cutaneous Anthrax
Courtesy of James H. Steele/CDC

19. Plague Bubonic Plague infects the lymph system Lymph glands will swell
Pneumonic plague infects the lungs
Pneumonic plague results from inhaling bacteria
Pneumonic plague has a higher death rate than does bubonic plague

20. Bubonic Plague
Courtesy of the CDC

21. Neurotoxins (1 of 2) Most deadly substances known
Produced by plants, marine animals, molds, and bacteria
May be inhaled, ingested, or injected

22. Neurotoxins (2 of 2) Botulinum toxin Produced by bacteria
The most potent neurotoxin
Causes paralysis that leads to respiratory arrest
Ricin
Derived from caster beans
Causes pulmonary edema and respiratory and cardiovascular failure

23. EMT Roles During Biological Events
Syndromic surveillance
Identification of outbreaks
Strategic National Stockpile
Participation at distribution sites
Courtesy of the Strategic National Stockpile/CDC

24. Nuclear Agents

25. Types of Radiation (1 of 3)
Alpha:
Weakest form
Can be stopped by a single sheet of paper
Most deadly when ingested
Beta
Can be stopped by ordinary clothing

26. Types of Radiation (2 of 3)
Gamma
Will penetrate the entire body
Requires lead or concrete to stop
Used for X-Rays
Neutron
Fastest moving and most powerful
Will penetrate lead
Requires several feet of concrete to stop

27. Types of Radiation (3 of 3)

28. Radiological/Nuclear Devices
Radiological dispersal devices “Dirty bombs”
Uses a regular explosive device to distribute radioactive material
Not very effective but creates fear
Nuclear weapons
Nuclear bombs/missiles
Special Atomic Demolition Munitions

29. 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

30. Treatment Decontaminate if needed. Support ABCs.
Treat associated burns and trauma.

31. Protective Measures Time Radiation has cumulative effect
Limit amount of exposure time
Distance
Radiation has limits to how far it can travel
Alpha radiation only travels inches
Maintain a safe distance from site
Shielding
Concrete shielding will stop strong radiation

32. EMS Role Maintain safe location Treat signs/symptoms
Avoid becoming a victim

33. Incendiary Devices

34. Incendiary Devices Devices to cause fires
Use of flammable materials (accelerants) to cause rapid burning
Molotov cocktails, timers, etc
Often used in conjunction with secondary explosives

35. EMS Role
Maintain safe location
Treat signs/symptoms

36. Chemical Agents

37. Characteristics of Chemical Agents
Persistency/volatility
How long an agent stays on a surface before evaporating
May be seconds or months
Route of exposure
Vapor hazard: inhaled
Contact hazard: absorbed through the skin

38. Vesicants (Blister Agents) (1 of 2)
Mustard gas and phosgene oxime are most common
Used in chemical warfare
Contact and vapor hazard
Causes burn like blisters
Causes most damage to moist areas

39. Vesicants (Blister Agents) (1 of 2)
Courtesy of Dr. Saeed Keshavarz/RCCI (Research Center of Chemical Injuries)/IRAN

40. S/S of Vesicant Exposure
Skin irritation/blisters
Immediate, intense pain
Eye injuries
Respiratory problems
Dyspnea
Cough
Hemoptysis
Courtesy of Dr. Saeed Keshavarz/RCCI (Research Center of Chemical Injuries)/IRAN

41. Treatment of Vesicant Exposure
Decontaminate.
Support airway.
Transport to burn center.

42. Pulmonary Agents (Choking Agents)
Inhaled gases
Also used in chemical warfare
Causes damage to lung tissue
Two classes:
Chlorine
Phosgene

43. Chlorine Odor of bleach Creates a green haze
Produces upper respiratory irritation
Mixing household bleach and ammonia can produce a similar gas
Causes pulmonary edema and constriction of airways
Characterized by hoarseness and stridor, chest tightness, gasping and coughing, and dyspnea

44. Phosgene Gas
Can be byproduct of commonly burned items including household items, metal works, and freon
Odor is like freshly cut grass or hay
Does not cause irritation when inhaled
Delayed onset of symptoms; normally several hours
Characterized by nausea, chest tightness, cough, and dyspnea

45. Treatment of Pulmonary Exposure
Have patient removed from contaminated atmosphere.
Aggressively manage airway.
Provide rapid transport in position of comfort.

46. Nerve Agents Vapor or contact hazards Pesticides and organophasphates
Causes overstimulation of organs
Two classes
G series: Sarin, Soman, and Tabun
V series: VX
100 times more potent than G series
Has consistency of baby oil with no odor

47. S/S of Nerve Agents “SLUDGEM”
Salivation, Sweating
Lacrimation (excessive tearing)
Urination
Defecation, Drooling, Diarrhea
Gastric upset and cramps
Emesis (vomiting)
Muscle twitching

48. S/S of Nerve Agents “DUMBELS”
Diarrhea
Urination
Miosis (pupil constriction)
Bradycardia, Bronchospasm
Emesis
Lacrimation
Seizures, Salivation, Sweating

49. Treatment of Nerve Agent Exposure
Patient decontamination
Airway and ventilatory support
Administration of MARK 1 kit if authorized
AKA: Nerve Agent Antidote Kit (NAAK)
Contains Atropine and 2-PAM chloride (pralidoxime chloride)
Uses auto-injectors

50. Insecticides Many insecticides are organophosphates.
Lower concentrations than found in nerve agents
Treatment is same as nerve agents

51. Metabolic Agents (Cyanides)
Common in industrial settings
Colorless with smell similar to almonds
Affect the body’s ability to use oxygen
Can kill in seconds
Commonly formed when fires involve textiles or plastics

52. Signs and Symptoms Breathing difficulty Altered mental status Seizures
Coma
Respiratory/cardiac arrest

53. Treatment of Metabolic Agents
Patient decontamination must occur.
Support ABCs.
Administer oxygen
Rapid transport
Antidote available

54. Explosives

55. Explosives One of the most common forms of terrorism
A favorite weapon of terrorists
Can be set off in buildings, cars, churches, or places with large crowds
Greatest danger is a “secondary device”
A secondary device is designed to go off after emergency personnel are on scene
This will instill fear and disrupt the government infrastructure

56. Keys to Dealing With Possible WMD (1 of 3)
Maintain a high level of suspicion
Location and type of call
-Public building or a place with a large numbers of people with same S/S
-Location that is vital to infrastructure
-Multiple locations with similar complaints

57. Keys to Dealing With Possible WMD (2 of 3)
Be Safe
-Be aware of possible secondary explosions
-Be aware of need to protect yourself
-Follow rules of HazMat, if appropriate
If in doubt, back-off
Use decontamination if any possibility of contamination of personnel, equipment, or hospitals

58. Keys to Dealing With Possible WMD (3 of 3)
Transport by other means if ambulance is not needed for medical care
Observe people, the scene, the surroundings. Take notes
If things don’t add up or make sense, think about terrorism
Many people complaining of same S/S
Remember “if it walks like a duck, quacks like a duck, and looks like a duck; it is probably a duck”.