Prehospital: Emergency Care

Prehospital: Emergency Care
Eleventh Edition Chapter 46 E M S Response to Terrorism Involving Weapons of Mass Destruction If this PowerPoint presentation contains mathematical equations, you may need to check that your computer has the following installed: 1) MathType Plugin 2) Math Player (free versions available) 3) NVDA Reader (free versions available) Advance Preparation Student Readiness Assign the associated section of MyBRADYLab and review student scores. Review the chapter material in the Instructor Resources, which includes Student Handouts, PowerPoint slides, and the MyTest Program. Prepare Preview the case study presented in the PowerPoint slides. The total teaching time recommended is only a guideline. Take into consideration factors such as the pace at which students learn, the size of the class, breaks, and classroom activities. The actual time devoted to teaching objectives is the responsibility of the instructor. Slides in this presentation contain hyperlinks. JAWS users should be able to get a list of links by using INSERT+F7 Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved

Learning Readiness E M S Education Standards, text p. 1340.
Chapter Objectives, text p Key Terms, text p Purpose of lecture presentation versus textbook reading assignments. Explain to students what the National EMS Education Standards are. The National EMS Education Standards communicate the expectations of entry-level EMS providers. As EMTs, students will be expected to be competent in these areas. Acknowledge that the standards are broad, general statements. Although this lesson addresses the listed competencies, the competencies are often complex and require completion of more than one lesson to accomplish. The student is also expected to review the chapter objectives to foreshadow what will be in the chapter. By mastering the key terms the EMT student will better understand the learning and be able to communicate more clearly. Additionally, explain to the students that the purpose of using these slides is to help keep the instructor focused on highlighting important portions of the material, explain interrelationships of topics, and discuss how to apply this information. It’s not the intent of the presentation (or slides alone) to include every component in the chapter. This presentation still requires the student to thoroughly read the chapter.

Setting the Stage (1 of 2) Overview of Lesson Topics
Weapons of Mass Destruction Prehospital Response to Terrorism Involving W M D Conventional Explosives and Incendiary Devices Chemical Agents Biological Agents Nuclear Weapons and Radiation These bulleted points are the major headings from the chapter, in order. The purpose is to provide a basic lecture navigation for the student.

Setting the Stage (2 of 2) Overview of Lesson Topics
Personal Protection and Patient Decontamination Active Shooter Incident Cyberterrorism These bulleted points are the major headings from the chapter, in order. The purpose is to provide a basic lecture navigation for the student.

Case Study Introduction
E M Ts Louis Fine and Alvin Hahn are called to a report of a sick person at a baseball stadium. Before they arrive, three more calls are reported to dispatch for additional sick people at the baseball stadium. Dispatch advises all responding units to use caution and to stage outside the stadium. An E M S supervisor is en route to establish incident command. Case Study Present the Case Study Introduction provided in the PowerPoint slide set. Lead a discussion using the case study questions provided on the subsequent slide(s). The Case Study with discussion questions continues throughout the PowerPoint presentation. Case Study Discussion Use the case study content and questions to foreshadow the upcoming lesson content.

Case Study (1 of 3) Why should arriving units use caution in this situation? What could be responsible for several reports of sick people at an event? What additional information is needed? Case Study Discussion Use the case study content and questions to foreshadow the upcoming lesson content. Gauge the students’ responses as a guide of how well- versed they are in this topic.

Introduction Weapons of mass destruction (W M D) are a possibility E M Ts must be prepared to respond too. During this lesson, students will learn special considerations related to weapons of mass destruction. WMD includes chemical, biological, nuclear, explosives, and incendiary devices, as well as unconventional weapons.

Weapons of Mass Destruction (1 of 4)
W M D are intended to cause widespread death and destruction. The mnemonics C B R N E and B-N I C E can be used to remember types of W M D. Discussion Questions What are the general effects of conventional and nuclear bomb explosions? How are the onset and duration of chemical and biological weapons different from those of more conventional weapons? Critical Thinking Discussion What are some likely targets of terrorism? What is your personal level of worry about the possibility of terrorism in the United States? What are some ways in which public life has changed since September 11, 2001?

C B R N E is commonly used to remember the types of W M Ds. C – Chemical B – Biological R – Radiological N – Nuclear E – Explosive These are types of WMDs or agents that might be employed in a terrorist attack.

B -N I C E is also commonly used to remember the types of W M Ds. B – Biological N – Nuclear/radiological I – Incendiary C – Chemical E - Explosive These are types of WMDs or agents that might be employed in a terrorist attack.

Dissemination means bringing the W M D agent into contact with its intended target population. The general approach to a W M D incident is the same as for other disasters with multiple casualties. Dissemination can take many forms with widely varying results. For example, a small amount of a chemical agent might kill hundreds or thousands of people if it is spread over a densely populated area, with minimal or no physical damage suffered to the structures in that area. How long do the effects of various weapons and agents last? How harmful are the various types of weapons and agents, and how likely are they to be used? What is the balance between structural damage and other effects of a given weapon type? What kind of response do the various types of attacks require and elicit? How can WMDs be detected? Detection of WMDs is a challenge. How can EMS prepare for a WMD attack?

The World Trade Center Attack of September 11, 2001, Required a Massive Coordinated Effort for Rescue and Recovery Operations Conventional weapons, such as explosives, and unconventional ones, such as jetliners, might require such resources as hazardous materials response teams, technical rescue teams, and confined-space rescue; whereas biological weapons can require more involvement from epidemiologists and other public health officials, but less involvement of rescue personnel. (© Suzanne Plunkett/A P Images)

Prehospital Response to Terrorism Involving W M D (1 of 8)
Supplies and Equipment To ensure adequate equipment and response, there must be a community response to the disaster. Each type of W M D requires different specialty equipment and supplies. A plan must allow immediate deployment of individuals, equipment, and supplies. Teaching Tips Discuss any known high-risk targets for terrorism in your community. Discussion Question Why is it difficult for one community to be completely prepared for all possible threats?

Coordinated Community Medical Response to the World Trade Center Attack
It is unrealistic to think that a single EMS agency has the equipment necessary to manage a terrorist incident. Rather, it is necessary to establish a community response to the disaster. (© Louis Lanzano/A P Images)

Medical Direction There must be a plan to establish medical direction and verify credentials of responders from outside areas. Communications may be unreliable, requiring reliance on standing orders. Discussion Question What are some anticipated issues with medical direction in the response to WMD incidents? The communications system should not be relied on to provide on-line medical direction because it will likely become overloaded. One possibility is to make all protocols standing orders in a case involving a WMD.

Provider Preparation As always, E M S provider safety is the highest priority. You must be aware of the indications of the weapons used and the potential for secondary effects of the attack or secondary attacks. For patient care, you must be aware of the various agents that can be used as WMDs and the signs and symptoms of the conditions that result from exposure. Discussion Question In what ways must EMTs be prepared for response to WMD incidents?

Responding to the Scene The earlier a W M D incident is recognized, the better. The incident command system is used in W M D attacks. Hazardous materials principles are used if the agent is a chemical. Be wary of the possibility of secondary explosions when conventional weapons are used. Discussion Questions What are some specific considerations for scene safety in the response to WMD incidents? What clues can help you determine what kind of weapon is involved?

Issues of Scene Safety Signs of a toxic and unsafe environment include: Respiratory distress. Dyspnea. Cough. Burning chest. Burning eyes. Chemical and biological weapons present a danger that is much more difficult to recognize and identify as compared to the nuclear or conventional blast. Chemical weapons can release gases or aerosols that are only recognized upon exposure or shortly thereafter. If numerous patients present with similar signs and symptoms with an unexplainable or unidentifiable cause, a chemical weapon should be suspected.

Issues of Scene Safety Wear H E P A or N -95 masks, gloves, eye protection, and gowns for suspected communicable illnesses. Approach from upwind. Avoid confined spaces. Entry must be made only by those with specialized training and protection. Alert direction prior to transport. If excessive salivation, loss of bowel and bladder control, and tearing are noted, suspect a serious chemical exposure. Inspect the scene for dead or incapacitated animals or insects. Odors of bitter almond, peaches, mustard, garlic, onions, or fresh-cut grass or hay can also be indications of deadly chemical weapons. Whenever possible, all responders should enter the scene from a single staging or mobilization point to maintain security. An escape plan should be determined and communicated to all responders on the scene, with a predesignated responder collection point.

Role of the E M T at the Terrorist Incident Involving a W M D Initial incident command and scene size-up Sector leader or officer, such as triage, treatment, or transportation Providing care and transportation Regardless of your role, the overall goal is ensuring that the most good is done for the most people. Utilize triage principles when faced with challenging decisions. Patients must be protected from harm, informed of your actions, and cared for to the best of your ability despite the difficult situation.

Role of the E M T at the Terrorist Incident Involving a W M D Recognize locations or events that may be terrorist targets and use caution when responding to those locations. The dead from terrorist incidents are now considered evidence. Be aware that perpetrators may be among the injured. As evidence, the dead must be disturbed as little as possible from their original location. Included in this is not disturbing their clothing, which can further help investigators. It also cannot be discounted that among the injured or deceased are the actual perpetrators of the terrorist incident.

Conventional Explosives and Incendiary Devices (1 of 8)
Conventional explosives and incendiary devices are the most widely used W M Ds. Explosives Ignition of fuels that burn rapidly, causing hot gases to displace air, creating a shock wave The blast moves out in all directions at supersonic speed causing blast injuries. Explosives work by using chemicals whose primary characteristic is to burn extremely rapidly when exposed to certain stimuli, causing hot gases to displace air in a violent fashion, creating a shock wave or a blast. This is referred to as detonation or deflagration.

Improvised Explosive Devices Improvised from easily obtainable products Vehicle-Borne Improvised Explosive Device (V B I E D) Car or truck bomb. Commonly use an explosive called A N F O (ammonium nitrate and fuel oil). An improvised explosive device (IED) is defined as an explosive device constructed from homemade or readily available materials that is used to kill, incapacitate, distract, or harass a specific target.

Common Explosive Compounds E G D N H M T D P E T N R D X Semtex T A T P

Primary, Secondary, Tertiary, Quaternary, and Quinary Effects The explosion blast is the primary effect. The secondary effects result from flying debris or shrapnel. Tertiary effects are injuries produced by the propulsion of the person’s body. Quaternary effects include burn, crush, and inhalation injuries. Quinary effects result from environmental exposures as to bacteria, chemicals, radiation, fuels, and metals. The World Trade Center attack produced primarily quaternary and quinary injuries from the fire, building collapse, and exposure to toxic contaminants. Teaching Tips Identify any high-risk facilities in your community, such as fuel refineries/storage facilities or fertilizer manufacturing/storage facilities. Discussion Questions Why are conventional weapons and incendiary devices the most commonly used WMDs? What types of injuries are produced in each of the phases of a blast?

Types of Injuries Lungs Blast lung and pneumothorax may occur. Look for altered mental status, dyspnea, bloody sputum, chest pain, and stroke-like signs and symptoms. Use caution with positive pressure ventilation to avoid creating air emboli and tension pneumothorax. Knowledge Application Students should be able to apply the information in this section when responding to potential WMD incidents.

Types of Injuries Abdomen Bowel may bleed or leak contents into the abdomen. Evisceration is possible. Ears The eardrum may rupture and the inner ear bones may be disrupted. There may be hearing loss. Manage the evisceration and transport rapidly.

Types of Injuries Crush injuries They may occur from structural collapse and entrapment. Complications occur when the pressure on the crushed area is relieved. Shrapnel injuries Penetrating injuries can cause bleeding, hollow organ penetration, and fractures. The weight of the debris on the patient can create excessive compression forces, causing a crush syndrome. In addition, the structural collapse can inflict direct blunt and penetrating injury, whereas dust and smoke can cause respiratory and eye injuries. Crush syndrome is associated with entrapment for 4 hours or more. The crushed tissue can produce harmful by-products. After the pressure to the crushed area is relieved, the accumulated by-products are released into the systemic circulation, causing serious problems. Each can experience a different effect from the missile. Solid organ tissues are rapidly compressed and stretched. Contents of ruptured hollow organs can leak out into surrounding cavities. Connective tissue injuries are frequently limited to the shrapnel pathway because of their resiliency. Bones can fracture when struck by shrapnel.

Be cautious of secondary and undetonated devices. They primarily cause burns. Assess burns according to the Rule of nine’s Pay attention to airway and breathing. Dress the burned areas. Hypergolic substances are chemicals that spontaneously ignite when they encounter one another without the need for an ignition source. An example of such a combination of chemicals is pool chemicals that, upon contact with automobile fluids, spontaneously ignite. Hypergolic substances are often used as incendiary chemicals by terrorists because of their wide availability. Class Activity Assign students to do a "windshield survey" of the community over the next week and report back any facilities that could play a role in supplying materials needed to create a WMD or that could be a target of a WMD.

Chemical Agents (1 of 16) Properties of Chemical Weapons
Can be dispersed using munitions or aerosol devices The tendency of an agent to evaporate and create vapors is its volatility. Agents that do not evaporate are characterized as persistent. Evaporation is affected by temperature. Chemical agents in the form of aerosolized liquids or solids, vapor, or gas can enter the body through the respiratory tract (lungs), skin, and eyes. Entry through the lungs is by far the most critical because a large quantity of chemicals can be absorbed and dispersed throughout the body by this route, causing severe systemic effects. Liquid agents are primarily absorbed through the skin and eyes. They can cause both severe local effects, such as chemical burns, and serious systemic effects. Accidental ingestion of chemical agents in contaminated food is possible, yet rare. Teaching Tips Identify any potential sources of chemical agents in your community.

Chemical Agents (2 of 16) Types of Chemical Agents Nerve agents
Vesicants Cyanide Pulmonary agents Riot-control agents Toxic industrial chemicals Discussion Questions How would you recognize exposure to a nerve agent? What is the treatment for exposure to nerve agents? How do vesicants work? What would be some clues that a large number of people have been exposed to cyanide? Knowledge Application Students should be able to apply the information in this section to the response to patients exposed to chemical agents.

Chemical Agents (3 of 16) Types of Chemical Agents Nerve Agents
Potent and easily made Block the enzyme that breaks down the neurotransmitter acetylcholine (A C h), allowing accumulation of A C h overstimulation of the muscles, smooth muscles, glands, and nerves as result. This is apparent in movements that are jerky. Seizures can also occur. The muscles eventually fatigue, stop working, and begin to die. Death usually results from inadequate breathing resulting from respiratory muscle failure.

Table 46-1 Nerve Agents Tabun (G A) Sarin (G B) Soman (G D) G F
Methylphosphonothioic acid (VX) Novichok Agents (Russian nerve agents) Nerve agents are among the deadliest known chemicals.

Table 46-2 Signs and Symptoms of Nerve Agent Exposure
Vapor Small Exposure Large Exposure Blank Runny nose, mild dyspnea, pupillary constriction Sudden onset of unresponsiveness, seizures, apnea, copious secretions, pupillary constriction Liquid Localized sweating, nausea, vomiting, fatigue Sudden onset of unresponsiveness, seizures, apnea, paralysis, copious secretions The larger the dose with direct respiratory inhalation of the nerve agent vapor, the quicker the onset and severity of the effects.

Signs and symptoms: Respiratory failure from paralysis of respiratory muscles. Copious airway secretions and bronchoconstriction. S L U D G E —salivation, lacrimation, urination, defecation, gastric distress, and emesis. The patient might be in respiratory distress or arrest. They might drool or have a large amount of secretions in the oropharynx. You might also hear wheezing on auscultation of the lungs if they move air on respiration. Other signs and symptoms include miosis (pinpoint pupils), rhinorrhea (runny nose), excessive salivation, tearing in the eyes, blurry vision, nausea and vomiting, diarrhea, sweating, and loss of bladder control. Use the mnemonic SLUDGE (salivation, lacrimation, urination, defecation, gastric distress, and emesis) to remember the signs and symptoms.

Emergency Medical Care Ensure an adequate airway and ventilation; be prepared to suction. The medications atropine and pralidoxime are antidotes. To combat seizures, benzodiazepine (diazepam, lorazepam, or midazolam) should be used. Wounds should be covered quickly to prevent further contamination and absorption of the nerve agent. Keep the patient warm and transport them as soon as possible.

Chemical Agents (6 of 16) Types of Chemical Agents Vesicants
Cause blistering, burning, and tissue damage Agents include sulfur and nitrogen mustards, lewisite, and phosgene oxime. Vesicants are another group of chemical agents that result in damage to exposed skin, lungs, and eyes. If a significant amount is absorbed, they can also produce systemic effects, including generalized illness.

Chemical Agents (7 of 16) Types of Chemical Agents Vesicants
Signs and symptoms: Burning, redness, blistering, and necrosis. Stinging, tearing, and development of ulcers in the eyes. Shortness of breath, coughing, wheezing, and pulmonary edema. Nausea and vomiting. Fatigue. It can take 2 to 24 hours for mustard exposure to produce signs and symptoms. Eye damage can occur within 1 to 2 hours after exposure.

Chemical Agents (8 of 16) Types of Chemical Agents Vesicant
Emergency medical care Irrigation Manage chemical burns Apply a dry, sterile dressing Lewisite, an arsenic-based agent, has an antidote called dimercaprol The most important emergency care that can be provided for vesicant exposure is immediate irrigation. Treatment during the first few minutes after exposure is crucial to preventing damage. Irrigate with water or a chemical decontamination kit.

Chemical Agents (9 of 16) Types of Chemical Agents Cyanide
Rapidly disrupts the ability of the cells to use oxygen May be inhaled and ingested Death may occur in 6 to 8 minutes with high doses. Even moderate exposure can lead to death. Low-dose exposures can lead to illness, but the patient would likely recover.

Chemical Agents (10 of 16) Types of Chemical Agents Cyanide
Signs and symptoms: Anxiety. Weakness and dizziness. Nausea. Muscular trembling. Tachycardia and tachypnea or apnea. Seizures and unresponsiveness. Pale, cyanotic, or normal color skin. Low concentrations of cyanide exposure cause milder signs and symptoms and a slower rate of onset.

Chemical Agents (11 of 16) Types of Chemical Agents Cyanide Exposure
Emergency treatment: Manage the airway, breathing, and oxygenation. There are antidotes available. Nitrites and sodium thiosulfate Hydroxocobalamin An antidote might be necessary to save the patient. It consists of a nitrite, such as amyl nitrite or sodium nitrite, and sodium thiosulfate. Some EMS systems only use thiosulfate as an initial treatment.

Chemical Agents (12 of 16) Types of Chemical Agents Pulmonary Agents
Include phosgene, other halogen compounds, and nitrogen-oxygen compounds Act primarily to cause lung injury Discussion Question What are some examples of pulmonary agents?

Chemical Agents (13 of 16) Types of Chemical Agents
Pulmonary Agent Exposure Signs and symptoms: Tearing and runny nose. Throat irritation. Dyspnea and wheezing. Cough. Crackles and stridor. Secretions. Relatively small concentrations of phosgene irritate the mucous membranes of the mouth, eyes, nose, and throat. The initial signs and symptoms can reflect this irritation. Pulmonary edema can take several hours to develop after exposure.

Pulmonary agent exposure Emergency medical treatment: Manage the airway and breathing; be prepared to suction and administer oxygen. The priority in pulmonary agent exposure is to manage the airway and ensure the patient breathes adequately. Tracheal intubation might be needed if airway obstruction is evident. Activate ALS response for advanced airway care.

Riot Control Agents Tear gas and pepper spray cause extreme irritation of the eyes, nose, mouth, skin, and respiratory tract. Emergency medical care is supportive and may include irrigation of the eyes. Terrorists might expose persons to these agents but report them as being exposed to nerve agents to cause greater fear and panic. To determine whether such a hoax is occurring, the EMT must keep in mind the differential diagnosis that nerve agent exposure results in the hallmark sign of miosis (excessive constriction of the pupil) whereas exposure to tear gas or pepper spray does not.

Toxic Industrial Chemicals They may be obtained from hijacking rail or truck transportation of chemicals or sabotage of chemical plants. The approach and treatment depends on the agent involved. The effects of and emergency care for industrial chemicals are as diverse as the chemicals. Many of the more potent chemicals behave like pulmonary agents; that is, they primarily attack the respiratory tract. Examples include phosgene and methyl isocyanate (the chemical that killed thousands in Bhopal, India). Discussion Question What are some examples of toxic industrial chemicals?

Case Study (2 of 3) The incident commander communicates with security officers inside the stadium and learns that now there are about two dozen individuals complaining of coughing, gagging, and irritation of the eyes, nose, and mouth. As they are communicating, there are additional reports of affected patients from other areas of the stadium. Case Study Discussion Review the case study findings presented.

Case Study (3 of 3) What should be the approach to this situation?
Where should E M S units be located? What special resources are needed? Case Study Discussion Use the case study content and questions to foreshadow the upcoming lesson content. Gauge the students’ responses as a guide of how well- versed they are in this topic.

Biological Agents (1 of 13)
They consist of living organisms or their toxins. Small amounts can cause widespread illness and may take days to detect. Dispersal methods vary. The respiratory tract is the most common portal of entry. Discussion Questions How are biological agents introduced into the population? What are some indications that illness in a community may be the result of terrorism? What agents cause pneumonia-like signs and symptoms? What are biological toxins? Knowledge Application Students should be able to apply the information in this section to the response to patients exposed to biological agents.

Specific Biological Agents Groups of biological agents include: Pneumonia-like agents. Encephalitis-like agents. Biological toxins. Other agents. Several biological agents can be used as WMDs and pose a serious threat. They are categorized into four groups.

Specific Biological Agents Pneumonia-Like Agents Present with fever and difficulty breathing, and include: Anthrax. Plague. Tularemia. Encephalitis-Like Agents include: Smallpox. Venezuelan equine encephalitis. Anthrax—Incubation period is 1 to 6 days. Fever, malaise, fatigue, nonproductive cough, mild chest discomfort with progressing dyspnea, diaphoresis, stridor, cyanosis, shock, and death can occur within 2 to 36 hours. Plague—Incubation period is 2 to 3 days. Headache, hemoptysis (coughing up blood), severe dyspnea, high fever, stridor, cyanosis, and death from respiratory failure, circulatory collapse, and bleeding disorder. Tularemia—Chest pain that worsens with breathing, headache, malaise, nonproductive cough, and weight loss. Encephalitis-like agents cause fever, headache, and altered mental status. Smallpox –Sudden onset of malaise, fever, headache, vomiting, and backache; Vesicular rash in same stage of development appears in 2 to 3 days. Venezuelan equine encephalitis –Sudden onset with malaise, fever, severe headache, rigor, nausea, vomiting, cough, sore throat, and diarrhea, with recovery within 1 to 2 weeks.

Specific Biological Agents Biological Toxins Botulinum Descending paralysis Double vision Blurred vision Dry mouth and throat Difficulty speaking and swallowing Dyspnea and respiratory failure Symptoms typically begin in 12 to 36 hours, or occur several days after inhalation or ingestion, and lead to respiratory failure and death.

Specific Biological Agents Biological Toxins Ricin Weakness Fever Cough Hypothermia Death Weakness, fever, cough, and hypothermia approximately 36 hours after inhalation, followed by death with in the following 12 hours from hypotension and cardiovascular collapse.

Specific Biological Agents Biological Toxins Staphylococcus enterotoxin 13 Fever Chills Headache Body aches Nonproductive cough Fever, chills, headache, body aches, and nonproductive cough occurs 3 to 12 hours after inhalation. Shock and death can occur at high-dose exposure.

Specific Biological Agents Biological Toxins Epsilon toxin Cough, wheezing, and shortness of breath Respiratory failure Death Cough, wheezing, and shortness of breath occur within 6 hours of exposure. Respiratory failure and death follow shortly from high exposure. Liver damage can also occur.

Specific Biological Agents Biological Toxins Trichothecene myotoxins Pain Itching and lesions Runny nose, and sneezing Sloughing skin Dyspnea and wheezing Chest pain Hemoptysis Pain, itching, redness, and lesions on the exposed skin, nose, and throat; pain; runny nose and sneezing; skin can slough; nasal discharge; dyspnea; wheezing; chest pain; and hemoptysis (coughing up blood).

Specific Biological Agents Other Biological Agents Cholera Vomiting, abdominal distention, and profuse diarrhea Severe dehydration Little or no fever Vomiting, abdominal distention, profuse watery diarrhea, severe dehydration, and little or no fever. Death results from severe dehydration and shock associated with hypovolemia.

Specific Biological Agents Other Biological Agents Viral hemorrhagic fevers Malaise Body aches Headache Vomiting Flushing and petechiae Easy bleeding, hypotension, and shock Malaise, body aches, headache, vomiting, flushing of the face and chest, edema, petechiae (small pinpoint hemorrhages), easy bleeding (early), hypotension, and shock (late).

Specific Biological Agents Other Biological Agents Brucellosis Fever Malaise Body aches Joint pain Headache Cough Fever, malaise, body aches, joint pain, headache, and cough.

Specific Biological Agents Emergency medical care for biological agent Prehospital care is supportive. Recognition and contacting public health officials is crucial. Smallpox, plague, and Ebola are highly contagious; use appropriate personal protective equipment. The care for biological agents is primarily supportive. Recognition is extremely important for an advanced management of the patient. Only a few of the biological agents are highly contagious and can be passed from an infected individual to another person. Smallpox, plague, and Ebola are all typically contagious. Isolate these patients, as best you can in the field, from those who are not affected. Response personnel should use personal protective equipment, including a HEPA respirator; head and face protection; and impervious boots, gloves, and body-splash protection.

Specific Biological Agents Emergency medical care for biological agent Hospital care includes antibiotics and antitoxin. Immunizations and prophylactic treatment are used in some cases. The use of antibiotics and antitoxins is imperative in the management of patients exposed to biological agents. The EMS provider must recognize a patient who might need such treatment, summon the necessary medical personnel, and continue to assist with the treatment.

Click on the W M D Agent Below That is a Biological Agent
A. Phosgene B. Nerve agents C. Ricin D. Hydroxocobalamin

Nuclear Weapons and Radiation (1 of 11)
Three primary mechanisms of death Radiation Blast Thermal burns Energy released from radioactive atoms passes through and changes the structure of molecules in cells of the human body. Discussion Questions What are the different kinds of radiation? How does the pattern of injury from a nuclear explosion change according to the distance from the explosion? Knowledge Application Students should be able to apply the information in this section to the response to patients exposed to radiation.

The cells may die, repair, or produce mutated cells. X-ray/gamma radiation is the most penetrating type and can travel long distances. Neutron radiation is a powerful, damaging particle associated with nuclear reactors and nuclear bombs. X-ray/gamma radiation –This is the type of radiation that is generated in the reactor of a nuclear power plant, by a nuclear bomb, and through the decay of radioactive particles, such as in fallout. Gamma radiation is the major external hazard and, to a lesser extent, internal hazard associated with a nuclear detonation or a reactor accident. Neutron radiation –is a powerful and damaging particle that penetrates several hundred meters of air and easily passes through the body. Because it occurs infrequently outside of the nuclear chain reaction, its greatest threat to life occurs near an active nuclear reactor or bomb explosion.

Beta radiation is a low-speed, low-energy particle that is easily stopped by 6 to 10 feet of air, clothing, or the first few millimeters of skin, but poses a serious hazard if ingested. Alpha radiation is heavy, slow-moving, and easily stopped, but poses a serious threat if inhaled or ingested. Beta radiation is a low-speed, low-energy particle that is easily stopped by 6 to 10 feet of air, clothing, or the first few millimeters of skin. It is a common product of fallout decay and is a serious threat when ingested in contaminated foods and inhaled in airborne particles. Thus, it poses a great internal hazard. Alpha radiation—is a heavy and slow-moving particle that travels only inches in the air and is stopped by clothing or the outer layer of the skin. It is a serious internal contaminant because it causes a great amount of damage along its short course of travel. As in beta radiation, alpha radiation can be ingested or inhaled.

Exposure associated with a nuclear explosion Primary exposure Radiation injury that occurs during or shortly after the detonation Fallout Radioactive dust and particles that can be life threatening to people far from the epicenter of the detonation. The closer the detonation occurs to the ground, the greater the updraft of particles, resulting in more fallout. The radioactive material can scatter anywhere from a few miles from the detonation site to around the world. The most immediate danger from fallout occurs within 48 hours and within proximity to the blast.

Blast Injuries Nuclear detonation causes a rapid heating of air and an explosively expanding gas cloud. Injuries are the same as those from conventional explosives. The windblast can reach 160 miles per hour. The windblast can reach 160 miles per hour, displacing personnel and collapsing structures, leading to crush injuries and entrapment. Blast effects to the victims are reduced the farther they are from ground zero.

Thermal burns Cause most deaths and injuries from nuclear explosion Heating is a short duration, but very intense. The eyes can be damaged from the intense light. Eye injuries can be associated with the brilliant light flash. The patient can be blinded for a few seconds, minutes, or longer.

Radiological Dispersal Devices/Radiological Exposure Devices “Dirty Bomb” A conventional explosive attached to radioactive materials Risk of widespread radiation illness and contamination of the environment A Radiological Exposure Device Does not use an explosive Similar to a Radiological dispersal device (RDD), a radiological exposure device (RED) results in persons exposed to dangerous levels of radiation, resulting in acute radiation sickness (ARS). However, such a device does not have the tell-tale indication of an initial explosion. An RED works by exposing individuals to lethal levels of radiation without the use of an explosive.

Improvised Nuclear Device Assembled and built specifically for a terrorist incident. Low-quality materials May not detonate properly Owing to its illegal assembly, such a device presents the additional hazard of not detonating properly and exposing patients to radiation hazards as would an RDD or RED.

Assessment and Care for Nuclear Detonation and Radiation Injuries Assessment Most destruction and death is nearest the center of the blast. There is less death and injury further from the blast. Identify the time after exposure that the patient complains of any radiation related signs and symptoms. As the energy travels away from the blast center, it quickly dissipates. This is viewed as concentric circles of injury and destruction. In the innermost circle of destruction, the buildings will be flattened and burned and no people will be found alive. The next circle will contain massive destruction to all structures. Most people will suffer lethal injuries from the radiation, blast wave, and burns. Some victims might survive if they are shielded from the heat and flying debris; however, they might die from a building collapse. The next circle has more survival with those patients exposed to the flash suffering from burns. Discussion Question What are the effects of exposure to radiation on different body systems?

Assessment and Care for Nuclear Detonation and Radiation Injuries Signs and symptoms: Nausea, fatigue, malaise, and clotting disorders. Vomiting, no appetite, diarrhea, and fluid loss. Reddening of the skin. Rapid onset of incapacitation, cardiovascular collapse, confusion, and burning sensation. Victims of a nuclear incident can include patients suffering thermal burns, blunt trauma and pressure injuries from the explosive blast, and radiation exposure.

Assessment and Care for Nuclear Detonation and Radiation Injuries Emergency Medical Care Protect yourself and patients from further radioactive exposure. Treat thermal and blast injuries. Manage airway, breathing, and oxygenation. Iodine tablets can help protect against long-term effects of radiation. Iodine protects against only one of the many harmful effects of radiation, and its use does not reduce the need for proper shielding, personal protective equipment, decontamination, and long-term monitoring.

Personal Protection and Patient Decontamination
Personal protective equipment is required for chemical, biological, and radiological/nuclear exposure. Apply the principles of hazardous material response. Apply the principles of time, distance, and shielding for radiation exposure. Apply the principles of decontamination as for hazardous materials exposure. Do not perform tasks you are not trained to perform. Teaching Tip Refer students back to Chapter 44 if you desire further discussion on this topic. Discussion Question What are the activities of the hot, warm, and cold zones in a hazardous materials incident?

Active Shooter Incident
Tactical E M S Tactical emergency medicine( T E M) is not normally taught as part of most E M T or paramedic curriculums. No one specific operational setup for a T E M exists. A subspecialty of EMS that has grown in part because of the tragic increase in the frequency of ASIs is that of tactical emergency medical services (TEMS). Although no one specific definition of tactical EMS exists, it can generally be defined as the medical support of operational law enforcement activities.

Cyberterrorism The use of computer network tools to shut down critical national infrastructure. Medical devices and technology rely on networked computer systems. Protected health information (P H I) can be illegally accessed. Attacks against industrial control systems (ICS) and supervisory control and data acquisition (SCADA) systems within various industries can initiate technological (“man-made”) disasters that can escalate into multiple-casualty incidents (MCIs) that the EMT might need to respond to. Medical devices such as ventilators, defibrillators, or intravenous pumps can all be accessed and exploited to cause patients harm.

Case Study Conclusion (1 of 4)
Louis and Allan, along with other responding units, are relocated to a position upwind from the stadium. Meanwhile, security reports that several of the affected patients reported seeing canisters that they thought might be tear gas or pepper spray. Case Study Discussion Review the case conclusion and emphasize the application of knowledge learned from this presentation.

Incident command works with security to stage an orderly evacuation of the stadium, and orders a decontamination area to be set up at the stadium exit. Triage, treatment, and transport sectors are established. Case Study Discussion Review the case conclusion and emphasize the application of knowledge learned from this presentation.

In all, nearly 100 people are decontaminated by hazardous materials personnel at the scene. Hazardous materials crews confirm that the substance involved was a riot control agent. Ultimately 36 of the patients are transported for further treatment at area hospitals. Case Study Discussion Review the case conclusion and emphasize the application of knowledge learned from this presentation.

The attack is later determined to be the work of a small domestic group staging a protest. Case Study Discussion Review the case conclusion and emphasize the application of knowledge learned from this presentation.

Lesson Summary (1 of 2) W M D are intended to produce widespread death and destruction. W M D may be chemical, biological, radiological, nuclear, or explosive agents. Conventional explosive agents have the greatest likelihood of being used in an attack. Follow-Up Answer student questions. Follow-Up Assignments Review Chapter 46 Summary. Complete Chapter 46 In Review questions. Complete Chapter 46 Critical Thinking questions. Assessments Handouts Chapter 46 quiz

Lesson Summary (2 of 2) Preplanning is crucial to management of the incident and the patients. Preplanning must consider supplies and equipment, medical direction, provider education and preparation, response to the scene, and scene safety issues. Class Activity As an alternative to assigning the follow-up exercises in the lesson plan as homework, assign each question to a small group of students for in-class discussion. Teaching Tips Answers to In Review questions are in the appendix of the text. Advise students to review the questions again as they study the chapter.

Correct! Ricin is a biological toxin.
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Incorrect (1 of 3) Phosgene is a chemical agent.
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Incorrect (2 of 3) Nerve agents are chemical agents.
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Incorrect (3 of 3) Hydroxocobalamin is an antidote to cyanide, a chemical agent. Click here to return to the quiz.

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Prehospital: Emergency Care

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Prehospital: Emergency Care

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