define international terrorism
terrorism that occurs outside the United States
define domestic terrorism
terrorism that occurs inside the united states
what are the similarities between international and domestic terrorism?
1. violent and dangerous acts that violate federal or state law
2. appear to be intended to intimidate or coerce a civilian population or to influence policy of government by intimidation or coercion
3. affect conduct of government by mass destruction, as
examples of incidents caused by International terrorism
in central and South America, political terrorist groups target oil resources as a means to instill fear
examples of incidents caused by domestic terrorism
centennial park bombing, Boston marathon bombing
four types of goals that commonly motivate terrorist groups to carry out terrorist attacks
1. religious extremist groups/doomsday cults
2. extremist political groups
3. cyber terrorists
4. single issue groups- antiabortion, animal rights, anarchists, racists
define weapon of mass destruction/weapons of mass casualty
agent designed to bring mass death, casualties, massive damage to property and infrastructure
what are examples of weapons that are considered WMDs
B-NICE:
1. biologic
2. nuclear
3. incendiary
4. chemical
5. explosive
CBRNE
1. chemical
2. biologic
3. radiologic
4. nuclear
5. explosive weapons
name key observations EMTs must make on every call to determine possibility of terrorist attack
-type of location- monument, government building, temple, place w/ large gathering
-type of call- is there report of explosion or suspicious device nearby? Are there reports of people fleeing the scene
-number of patients- are there multiple victims with
explain critical response actions related to establishing and reassessing scene safety, personnel protection, notification procedures, and establishing command EMTs must perform at suspected terrorist event
-scene safety- stage vehicle sage distance(1-2 blocks) from incident, wait for law enforcement to advise you that scene is safe
-best location for staging is upwind and uphill
-prevent yourself from coming into contact with agent
-notify dispatcher if ter
discuss history of chemical agents
-first developed during WW1 and WWII
-Cold War: many agents are perfected and stockpiled
4 main classifications of chemical agents
1. vesicants/blister agents
2. pulmonary/choking agents
3. nerve agents
4. metabolic agents/cyanides
routes of exposure for chemical agents
1. vapor- enter body through respiratory tract
2. contact- enter body through skin
chemical agents: effects on patient care
...
three categories of biologic agents
1. viruses
2. bacteria
3. neurotoxins
biologic agents: routes of exposure
various ways
biologic agents: effect on patient and pt. care
...
explain role of EMS in relation to syndromic surveillance
-valuable in overall tracking of biologic terrorist event or infectious disease outbreak
explain role of EMS in points of distribution (PODS) during a biologic event
-may be called to assist in delivery of medications to the public
-triage, treatment, patient transport
discuss history of nuclear/radiologic devices
-since Soviet Union collapsed, whereabouts of nuclear devices are unknown
discuss sources of radiologic materials and dispersal devices
-radiologic materials: used in medicine, killing germs in food, construction
-radiologic waste- hospitals, colleges and universities, nuclear power plants, chemical and industrial sites
-dispersal devices: dirty bombs
discuss medical management of patients and protective measures EMTs must take during nuclear/radiological incident
-time: less time you're exposed to source, less the effects will be
-distance: moving only few feet away is enough to remove you from immediate danger
-shield: path of radiation can be stopped by shield
-don't enter HAZMAT unless trained
describe mechanisms of injury caused by incendiary and explosive devices
-incendiary devices: type and severity of wounds depends on patient's distance from epicenter of explosion
-those close to source likely to suffer from all wound causing agents
-pts. who are further away are likely to experience combination of blast injur
describe types and severity of wounds
1. primary blast injury: direct effect of pressure wave on body, hollow organs of body- lungs, intestines, inner ears
2. secondary blast: penetrating or non penetrating injury- struck from flying debris
3. tertiary blast injury: whole body displacement an
preferred WMD for terrorists
explosive devices
what two historical incident involved use of nuclear device
1. hiroshima
2. nagasaki
-planning of most acts of terror is ______, which means community has no prior knowledge
covert
in April 2011, color coded homeland security advisory system was replaced by what
national terrorism advisory system(NTAS)
what's a secondary device
-additional explosive that's set to explode after initial bomb
how long agent will stay on surface before it evaporates
persistency, volatility
primary route of exposure to vesicants/blister agents
skin/contact
what are the vesicant agents
1. sulfur mustard(H)
2. lewisite(L)
3. Phosgene oxime(CX)
where do vesicants cause most damage
damp and moist areas of body
S/S of vesicant exposure
1. skin irritation, burning, reddening
2. intense skin pain
3. formation of large blisters
4. gray discoloration of skin
5. swollen and closed or irritated eyes
6. permanent eye injury
S/S of vapor vesicants
1. hoarseness
2. stridor
3. severe cough
4. hemoptysis
5. severe dyspnea
-mustard gase
-brown, yellow
-very persistent- stays on surface long time
-garlic or mustard smell
-quickly absorbed into skin or mucous membranes
-irreversible damage to cells
-deplete's body ability to reproduce WBCs
-attacks cells in bone marrow
-delay
sulfur mustard
mustard gas is considered a __________
mutagen
-these two produce blister wounds
-highly volatile
-rapid onset of S/S
-intense pain
-discomfort
lewisite, phosgene oxime
are there antidotes for mustard gas or CX exposure?
no
antidote for agent L
British anti-lewisite
gases that cause immediate harm to people exposed to them
pulmonary agents
what are the pulmonary agents
1. chlorine
2. phosgine
-first chemical agent used in warfare
-distinct odor of bleach
-green haze when released as gas
-upper airway irritation
-choking sensation
-S/S: SOB, chest tightness, hoarseness, stridor, gasping, coughing, pulmonary edema
chlorine
-produced in chemical warfare
-product of combustion
-result of fire or other chemicals
-very potent, delayed onset of symptoms
-no severe irritation
-odor similar to mowed grass or hay
-dyspnea at rest or excessive pulmonary edema
phosgene
are there antidotes for pulmonary agents
no
most deadly chemicals developed
nerve agents
nerve agents are classified as what
WMDs
-cause cardiac arrest within seconds to minutes
-discovered while in search for pesticide
-body organs become overstimulated and burn out
nerve agents
what are the nerve agents
1. G agents- sarin, soman, tabun
-this nerve agent is highly volatile
-colorless
-odorless
-liquid
-turns from liquid to gas quickly
-main route of entry is respiratory tract
Sarin(GB)
-nerve agent that is twice as persistent as sarin
-five times as lethal as sarin
-fruity odor
-contact and inhalation hazard- enters through skin and respiratory tract
-binds to cells and attack them faster than other agents
Soman(GD)
-half as lethal as sarin, 36x more persistent
-present for several days
-fruity smell
-similar appearance to sarin
-easy to make- what makes it unique
-contact and inhalation
Tabun(GA)
-clear and oily agent
-no odor
-looks like baby oil
-developed by British after WWII
-100x more lethal than sarin and extremely persistent
-unchanged for weeks to months
V Agent(VX)
nerve agent treatment
DuoDote auto injector
military form of combination injector for nerve agent treatment
antidote treatment nerve agent auto injector (ATNAA)
-colorless gas
-odor similar to almonds
-found in many industrial settings
-SOB, gasping respirations, tachypnea, flushed skin, seizures, coma, apnea, cardiac arrest, altered mental status
-death is likely- S/S show up in minutes
-prevent O2 from being us
cyanide
germs that require living host to multiply and survive
-spread through respiratory droplets or vector
virus
temperature in smallpox
101F-104F
-how to differentiate smallpox from other skin disorders
-observe shape, location of lesions- lesions are identical, begin on face and extremities and move toward chest and abdomen
-group of diseases caused by viruses that include ebola, Rift Valley, Marburg, yellow fever
-blood in body seeps out of tissue and blood vessels
-initially, flu like symptoms->int. and ext. hemorrhaging
viral hemorrhagic fever
-don't require host to multiply
-more complex, rapidly divide
-begin with flu like symptoms
bacteria
-caused by deadly bacteria that lay dormant in spore
-inhalation, cutaneous, GI
-most deadly
-severe cold
anthrax
most deadly- 90% death rate
pulmonary anthrax
-infected rodents and fleas
-infects lymphatic system
-lymph nodes become infected and grow
-not contagious
bubonic plague
-lung infection
-inhalation of plague bacteria
-much higher death rate and contagious
pneumonic plague
-most deadly toxins known to humans
-produced from plants, animals, molds, bacteria
-route of entry- ingestion, inhalation, aerosols, injection
-not contagious
-faster onset of S/S
neurotoxins
most potent neurotoxin
-produced by bacteria
-affects nervous system's ability to function
-muscle paralysis
botulinum toxin
-derived from mash left from castor bean
-pulmonary edema, resp. and cardiac failure- death
-seeds are most toxic
-rapid onset of nausea, vomiting, abd. cramps, diarrhea, vascular collapse
-many routes of exposure
ricin
sign of sulfur mustard
H
sign of Lewisite
L
sign of phosgene oxime
CX
sign of Sarin
GB
sign of Soman
GD
sign of Tabun
GA
Sign of V Agent
VX
sign of hydrogen cyanide
AC
sign of cyanogen chloride
CK
this is when terrorist will spread agent and means to do it
dissemination
monitoring used by local or state health departments of patients presenting to ED and care facilities
syndromic surveillance
existing facilities that are used as mass distribution sites for antibiotics, antidotes, vaccines
points of distribution
least harmful penetrating type of radiation, cannot penetrate through objects. Skin or sheet of paper can stop it
Alpha rays
requires layer of clothing to stop it
beta rays
-travel faster
-more energy
-penetrate through human body
-require lead or several inches of concrete to prevent penetration
gamma rays
-penetrate through lead and require several feet of concrete to stop them
neutrons
any container that is designed to disperse radioactive material
-dirty bomb
radiologic dispersal device
has potential to cause injury as result of radioactive material and explosive material
dirty bomb
this is artificially made by altering radioactive atoms
nuclear energy
what hollow organs are more susceptible to pressure changes
1. middle ear
2. lungs
3. GI tract
most common cause of death from blast injury
blast lung