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PREHOSPITALPREHOSPITAL
EMERGENCY CAREEMERGENCY CARE
CHAPTER
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Prehospital Emergency Care, 10th
edition
Mistovich | Karren
TENTH EDITION
EMS Response to
Terrorism Involving
Weapons of Mass
Destruction
46
Prehospital Emergency Care, 10th
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Mistovich | Karren
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Learning ReadinessLearning Readiness
• EMS Education Standards, text p. 1232
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Learning ReadinessLearning Readiness
ObjectivesObjectives
• Please refer to page 1232 of your text
to view the objectives for this chapter.
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Learning ReadinessLearning Readiness
Key TermsKey Terms
• Please refer to page 1233 of your text
to view the key terms for this chapter.
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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Weapons of Mass Destruction
 Prehospital Response to Terrorism
Involving WMD
 Conventional Weapons and Incendiary
Devices
 Chemical Agents
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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Biological Agents
 Nuclear Weapons and Radiation
 Personal Protection and Patient
Decontamination
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Case Study IntroductionCase Study Introduction
EMTs 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
EMS supervisor is en route to establish
incident command.
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Case StudyCase Study
• 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?
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IntroductionIntroduction
• Weapons of mass destruction (WMD)
are a possibility EMTs must be prepared
to respond to to.
• WMD includes chemical, biological,
nuclear, explosives, and incendiary
devices, as well as unconventional
weapons.
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Weapons of Mass DestructionWeapons of Mass Destruction
• WMD are intended to cause widespread
death and destruction.
• The mnemonics CBRNE and B-NICE can
be used to remember types of WMD.
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Weapons of Mass DestructionWeapons of Mass Destruction
• C – Chemical
• B – Biological
• R – Radiological
• N – Nuclear
• E – Explosive
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Weapons of Mass DestructionWeapons of Mass Destruction
• B – Biological
• N – Nuclear/radiological
• I – Incendiary
• C – Chemical
• E - Explosive
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Weapons of Mass DestructionWeapons of Mass Destruction
• The general approach to a WMD
incident is the same as for other
disasters with multiple casualties.
• Because the nature of a disaster may
not be clear initially, the general
management takes an all-hazards
approach.
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The World Trade Center attack of September 11, 2001, required a massive coordinated effort for rescue and
recovery operations. (© Suzanne Plunkett/AP Images)
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Prehospital Response to WMDPrehospital Response to WMD
• To ensure adequate equipment and
response, there must be a community
response to the disaster.
• Each type of WMD requires different
specialty equipment and supplies.
• A plan must allow immediate
deployment of individuals, equipment,
and supplies.
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Coordinated community medical response to the World Trade Center attack.
(© Louis Lanzano/AP Images)
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Prehospital Response to WMDPrehospital Response to WMD
• 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.
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Prehospital Response to WMDPrehospital Response to WMD
• As always, EMS provider safety is the
highest priority.
• You must be aware of indications of
weapons used and the potential for
secondary effects of the attack or
secondary attacks.
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Prehospital Response to WMDPrehospital Response to WMD
• The earlier a WMD incident is
recognized, the better.
• The incident command system is used
in WMD attacks.
• Hazardous materials principles are used
if the agent is a chemical.
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Prehospital Response to WMDPrehospital Response to WMD
• Signs of a toxic and unsafe
environment
 Respiratory distress
 Dyspnea
 Cough
 Burning chest
 Burning eyes
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Prehospital Response to WMDPrehospital Response to WMD
• Wear HEPA 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.
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Prehospital Response to WMDPrehospital Response to WMD
• Recognize locations or events that may
be terrorist targets and use caution
when responding to those locations.
• Be aware that perpetrators may be
among the injured.
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Prehospital Response to WMDPrehospital Response to WMD
• To maintain security, there should be a
single point of entry for rescuers and
there should be a designated escape
plan.
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Prehospital Response to WMDPrehospital Response to WMD
• EMT roles at WMD incidents may
include:
 Initial incident command and scene size-
up
 Sector leader or officer, such as triage,
treatment, or transportation
 Providing care and transportation
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Conventional explosives and incendiary
devices are the most widely used
WMDs.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• 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, and causes blast
injuries.
 There are primary, secondary, and
tertiary blast effects.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Primary effects are caused by the blast
wave.
• Secondary effects result from flying
debris, flames, and hot gases.
• Tertiary effects result from the patient
being propelled by the blast wave.
• A wide variety of injuries may occur.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Lungs
 Blast lung and pneumothorax may
occur.
 Look for altered mental status, dyspnea,
bloody sputum, chest pain, stroke-like
signs and symptoms.
 Use caution with positive pressure
ventilation to avoid creating air emboli
and tension pneumothorax.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Abdomen
 Bowel may bleed or leak contents into
the abdomen.
 Evisceration is possible.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Ears
 The eardrum may rupture and the inner
ear bones may be disrupted.
 There may be temporary or permanent
hearing loss.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Crush injuries
 May occur from structural collapse and
entrapment
 Complications occur when the pressure
on the crushed area is relieved.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Shrapnel injuries
 Penetrating injuries can affect various
tissues and organs and cause bleeding,
hollow organ penetration, and fractures.
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Conventional Weapons andConventional Weapons and
Incendiary DevicesIncendiary Devices
• Incendiary devices primarily cause
burns.
• Assess burns according to the rule of
nines.
• Pay attention to airway and breathing.
• Dress the burned areas.
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Chemical AgentsChemical Agents
• 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.
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Chemical AgentsChemical Agents
• Chemicals in the form of liquid, solids,
vapor, or gas can enter the body
through the respiratory tract, skin, and
eyes.
• Chemical exposure can cause local and
systemic effects.
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Chemical AgentsChemical Agents
• Types of chemical agents
 Nerve agents
 Vesicants
 Cyanide
 Pulmonary agents
 Riot control agents
 Toxic industrial chemicals
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Chemical AgentsChemical Agents
• Nerve agents
 Potent and easily made
 Block an enzyme that breaks down the
neurotransmitter acetylcholine (ACh),
allowing accumulation of ACh
 The result is overstimulation of the
muscles, smooth muscles, glands, and
nerves.
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Table 46-1 Nerve Agents
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Table 46-2 Signs and Symptoms of Nerve Agent
Exposure
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Chemical AgentsChemical Agents
• Pulmonary effects
 Respiratory failure from paralysis of
respiratory muscles
 Copious airway secretions and
bronchoconstriction
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Chemical AgentsChemical Agents
• The SLUDGE mnemonic summarizes
signs and symptoms.
 S – Salivation
 L – Lacrimation
 U – Urination
 D – Defecation
 G – Gastric distress
 E - Emesis
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Chemical AgentsChemical Agents
• Nerve agent emergency care
 Ensure an adequate airway and
ventilation; be prepared to suction.
 The medications atropine and
pralidoxime are antidotes.
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The two-injector Mark I™ kit.
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Chemical AgentsChemical Agents
• Vesicants
 Cause blistering, burning, and tissue
damage
 Agents include sulfur and nitrogen
mustards, lewisite, and phosgene
oxime.
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Chemical AgentsChemical Agents
• Vesicant exposure
 Signs and symptoms
• Burning, redness, blistering, necrosis of
the skin
• Stinging, tearing, and development of
ulcers in the eyes
• Shortness of breath, coughing, wheezing,
pulmonary edema
• Nausea and vomiting
• Fatigue
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Chemical AgentsChemical Agents
• Vesicant
 Emergency medical care
• Irrigation
• Manage chemical burns
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Chemical AgentsChemical 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.
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Chemical AgentsChemical Agents
• Cyanide exposure
 Signs and symptoms
• Anxiety
• Weakness
• Dizziness
• Nausea
• Muscular trembling
• Tachycardia
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Chemical AgentsChemical Agents
• Cyanide exposure
 Signs and symptoms
• Tachypnea
• Pale, cyanotic, or normal color skin
• Seizures
• Apnea
• Unresponsiveness
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Chemical AgentsChemical Agents
• Cyanide exposure
 Emergency treatment
• Manage the airway, breathing, and
oxygenation.
• There are antidotes available.
• Nitrites and sodium thiosulfate
• Hydroxocobalamin
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Chemical AgentsChemical Agents
• Pulmonary agents
 Include phosgene, other halogen
compounds, and nitrogen-oxygen
compounds
 Act primarily to cause lung injury
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Chemical AgentsChemical Agents
• Pulmonary agent exposure
 Signs and symptoms
• Tearing
• Runny nose
• Throat irritation
• Dyspnea
• Wheezing
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Chemical AgentsChemical Agents
• Pulmonary agent exposure
 Signs and symptoms
• Cough
• Crackles
• Stridor
• Secretions
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Chemical AgentsChemical Agents
• Pulmonary agent exposure
 Emergency medical treatment
• Manage the airway and breathing; be
prepared to suction, administer oxygen.
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Chemical AgentsChemical Agents
• 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.
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Chemical AgentsChemical Agents
• Toxic industrial chemicals
 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.
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Case StudyCase Study
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.
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Case StudyCase Study
• What should be the approach to this
situation?
• Where should EMS units be located?
• What special resources are needed?
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Biological AgentsBiological Agents
• 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.
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Biological AgentsBiological Agents
• Groups of biological agents
 Pneumonia-like agents
 Encephalitis-like agents
 Biological toxins
 Other agents
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Biological AgentsBiological Agents
• Pneumonia-like agents present with
fever and difficulty breathing, and
include:
 Anthrax
 Plague
 Tularemia
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Biological AgentsBiological Agents
• Encephalitis-like agents cause fever,
headache, and altered mental status,
and include:
 Smallpox
 Venezuelan equine encephalitis
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Biological AgentsBiological Agents
• Biological toxins
 Botulinum
• Descending paralysis
• Double vision
• Blurred vision
• Dry mouth and throat
• Difficulty speaking and swallowing
• Dyspnea and respiratory failure
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Biological AgentsBiological Agents
• Biological toxins
 Ricin
• Weakness
• Fever
• Cough
• Hypothermia
• Death
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Biological AgentsBiological Agents
• Biological toxins
 Staphylococcus enterotoxin 13
• Fever
• Chills
• Headache
• Body aches
• Nonproductive cough
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Biological AgentsBiological Agents
• Biological toxins
 Epsilon toxin
• Cough, wheezing, shortness of breath
• Respiratory failure
• Death
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Biological AgentsBiological Agents
• Biological toxins
 Trichothecene myotoxins
• Pain
• Itching
• Lesions
• Runny nose, sneezing
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Biological AgentsBiological Agents
• Biological toxins
 Trichothecene myotoxins
• Sloughing skin
• Dyspnea, wheezing
• Chest pain
• Hemoptysis
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Biological AgentsBiological Agents
• Other biological agents
 Cholera
• Vomiting, abdominal distention, profuse
diarrhea
• Severe dehydration
• Little or no fever
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Biological AgentsBiological Agents
• Other biological agents
 Brucellosis
• Fever
• Malaise
• Body aches
• Joint pain
• Headache
• Cough
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Biological AgentsBiological Agents
• Other biological agents
 Viral hemorrhagic fevers
• Malaise
• Body aches
• Headache
• Vomiting
• Flushing and petechiae
• Easy bleeding, hypotension, shock
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Biological AgentsBiological 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.
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Biological AgentsBiological Agents
• Emergency medical care for biological
agent
 Hospital care includes antibiotics and
antitoxin.
 Immunizations and prophylactic
treatment are used in some cases.
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Click on the WMD agent below that is aClick on the WMD agent below that is a
biological agent.biological agent.
A. Phosgene
B. Nerve agents
C. Ricin
D. Hydroxocobalamin
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Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Three primary mechanisms of death
 Radiation
 Blast
 Thermal burns
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Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Radiation
 Energy released from radioactive atoms
passes through and changes the
structure of molecules in cells of the
human body.
 The cells may die, repair, or produce
mutated cells.
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Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Radiation
 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.
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Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Radiation
 Beta radiation is a low-speed, low-
energy particle that is easily stopped by
6–10 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.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Radiation exposure associated with a
nuclear explosion
 Primary exposure
 Fallout
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Primary exposure
 Limited to blast proximity or near the
source of radiation, such as a nuclear
reactor
 The source, duration of exposure,
shielding, and distance affect the
potential for injury and death.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Fallout
 Radioactive dust and particles that can
be carried far from the blast site
 The greatest danger occurs within 48
hours and within close proximity to the
blast.
 May damage cell DNA
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• 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.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Thermal burns
 Causes most deaths and injuries from
nuclear explosion
 Heating is short duration, but very
intense.
 The eyes can be damaged from the
intense light.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Radiologic dispersal devices
 "Dirty bomb"
 A conventional explosive attached to
radioactive materials
 Risk of widespread radiation illness and
contamination of the environment
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Nuclear detonation and radiation injury
 Assessment and care
• Most destruction and death is nearest the
center of the blast.
• There is less death and injury further
from the blast.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Nuclear detonation and radiation injury
 Signs and symptoms
• Nausea, fatigue, malaise, clotting
disorders
• Vomiting, loss of appetite, diarrhea, fluid
loss
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Nuclear detonation and radiation injury
 Signs and symptoms
• Reddening of the skin
• Rapid onset of incapacitation,
cardiovascular collapse, confusion,
burning sensation
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Nuclear Weapons and RadiationNuclear Weapons and Radiation
• Nuclear detonation and radiation injury
 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.
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Personal Protection andPersonal Protection and
DecontaminationDecontamination
• Personal protective equipment is
required for chemical, biological, and
radiological/nuclear exposure.
• Apply principles of hazardous material
response.
• Apply principles of time, distance, and
shielding for radiation exposure.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Personal Protection andPersonal Protection and
DecontaminationDecontamination
• Apply principles of decontamination as
for hazardous materials exposure.
• Do not perform tasks you are not
trained to perform.
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case Study ConclusionCase Study Conclusion
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.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case Study ConclusionCase Study Conclusion
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.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case Study ConclusionCase Study Conclusion
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.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case Study ConclusionCase Study Conclusion
The attack is later determined to be the
work of a small domestic group staging a
protest.
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Lesson SummaryLesson Summary
• WMD are intended to produce
widespread death and destruction.
• WMD may be chemical, biological,
radiological, nuclear, or explosive
agents.
• Conventional explosive agents have the
greatest likelihood of being used in an
attack.
continued on next slide
Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Lesson SummaryLesson Summary
• 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.

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DMACC EMT Chapter 46

  • 1. PREHOSPITALPREHOSPITAL EMERGENCY CAREEMERGENCY CARE CHAPTER Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Emergency Care, 10th edition Mistovich | Karren TENTH EDITION EMS Response to Terrorism Involving Weapons of Mass Destruction 46
  • 2. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness • EMS Education Standards, text p. 1232
  • 3. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness ObjectivesObjectives • Please refer to page 1232 of your text to view the objectives for this chapter.
  • 4. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Learning ReadinessLearning Readiness Key TermsKey Terms • Please refer to page 1233 of your text to view the key terms for this chapter.
  • 5. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Setting the StageSetting the Stage • Overview of Lesson Topics  Weapons of Mass Destruction  Prehospital Response to Terrorism Involving WMD  Conventional Weapons and Incendiary Devices  Chemical Agents continued on next slide
  • 6. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Setting the StageSetting the Stage • Overview of Lesson Topics  Biological Agents  Nuclear Weapons and Radiation  Personal Protection and Patient Decontamination
  • 7. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study IntroductionCase Study Introduction EMTs 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 EMS supervisor is en route to establish incident command. continued on next slide
  • 8. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study • 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?
  • 9. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved IntroductionIntroduction • Weapons of mass destruction (WMD) are a possibility EMTs must be prepared to respond to to. • WMD includes chemical, biological, nuclear, explosives, and incendiary devices, as well as unconventional weapons.
  • 10. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Weapons of Mass DestructionWeapons of Mass Destruction • WMD are intended to cause widespread death and destruction. • The mnemonics CBRNE and B-NICE can be used to remember types of WMD. continued on next slide
  • 11. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Weapons of Mass DestructionWeapons of Mass Destruction • C – Chemical • B – Biological • R – Radiological • N – Nuclear • E – Explosive continued on next slide
  • 12. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Weapons of Mass DestructionWeapons of Mass Destruction • B – Biological • N – Nuclear/radiological • I – Incendiary • C – Chemical • E - Explosive continued on next slide
  • 13. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Weapons of Mass DestructionWeapons of Mass Destruction • The general approach to a WMD incident is the same as for other disasters with multiple casualties. • Because the nature of a disaster may not be clear initially, the general management takes an all-hazards approach.
  • 14. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved The World Trade Center attack of September 11, 2001, required a massive coordinated effort for rescue and recovery operations. (© Suzanne Plunkett/AP Images)
  • 15. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • To ensure adequate equipment and response, there must be a community response to the disaster. • Each type of WMD requires different specialty equipment and supplies. • A plan must allow immediate deployment of individuals, equipment, and supplies. continued on next slide
  • 16. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Coordinated community medical response to the World Trade Center attack. (© Louis Lanzano/AP Images) continued on next slide
  • 17. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • 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. continued on next slide
  • 18. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • As always, EMS provider safety is the highest priority. • You must be aware of indications of weapons used and the potential for secondary effects of the attack or secondary attacks. continued on next slide
  • 19. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • The earlier a WMD incident is recognized, the better. • The incident command system is used in WMD attacks. • Hazardous materials principles are used if the agent is a chemical. continued on next slide
  • 20. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • Signs of a toxic and unsafe environment  Respiratory distress  Dyspnea  Cough  Burning chest  Burning eyes continued on next slide
  • 21. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • Wear HEPA 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. continued on next slide
  • 22. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • Recognize locations or events that may be terrorist targets and use caution when responding to those locations. • Be aware that perpetrators may be among the injured. continued on next slide
  • 23. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • To maintain security, there should be a single point of entry for rescuers and there should be a designated escape plan. continued on next slide
  • 24. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Prehospital Response to WMDPrehospital Response to WMD • EMT roles at WMD incidents may include:  Initial incident command and scene size- up  Sector leader or officer, such as triage, treatment, or transportation  Providing care and transportation
  • 25. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Conventional explosives and incendiary devices are the most widely used WMDs. continued on next slide
  • 26. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • 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, and causes blast injuries.  There are primary, secondary, and tertiary blast effects. continued on next slide
  • 27. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Primary effects are caused by the blast wave. • Secondary effects result from flying debris, flames, and hot gases. • Tertiary effects result from the patient being propelled by the blast wave. • A wide variety of injuries may occur. continued on next slide
  • 28. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Lungs  Blast lung and pneumothorax may occur.  Look for altered mental status, dyspnea, bloody sputum, chest pain, stroke-like signs and symptoms.  Use caution with positive pressure ventilation to avoid creating air emboli and tension pneumothorax. continued on next slide
  • 29. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Abdomen  Bowel may bleed or leak contents into the abdomen.  Evisceration is possible. continued on next slide
  • 30. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Ears  The eardrum may rupture and the inner ear bones may be disrupted.  There may be temporary or permanent hearing loss. continued on next slide
  • 31. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Crush injuries  May occur from structural collapse and entrapment  Complications occur when the pressure on the crushed area is relieved. continued on next slide
  • 32. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Shrapnel injuries  Penetrating injuries can affect various tissues and organs and cause bleeding, hollow organ penetration, and fractures. continued on next slide
  • 33. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Conventional Weapons andConventional Weapons and Incendiary DevicesIncendiary Devices • Incendiary devices primarily cause burns. • Assess burns according to the rule of nines. • Pay attention to airway and breathing. • Dress the burned areas.
  • 34. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • 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. continued on next slide
  • 35. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Chemicals in the form of liquid, solids, vapor, or gas can enter the body through the respiratory tract, skin, and eyes. • Chemical exposure can cause local and systemic effects. continued on next slide
  • 36. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Types of chemical agents  Nerve agents  Vesicants  Cyanide  Pulmonary agents  Riot control agents  Toxic industrial chemicals continued on next slide
  • 37. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Nerve agents  Potent and easily made  Block an enzyme that breaks down the neurotransmitter acetylcholine (ACh), allowing accumulation of ACh  The result is overstimulation of the muscles, smooth muscles, glands, and nerves. continued on next slide
  • 38. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Table 46-1 Nerve Agents continued on next slide
  • 39. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Table 46-2 Signs and Symptoms of Nerve Agent Exposure continued on next slide
  • 40. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Pulmonary effects  Respiratory failure from paralysis of respiratory muscles  Copious airway secretions and bronchoconstriction continued on next slide
  • 41. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • The SLUDGE mnemonic summarizes signs and symptoms.  S – Salivation  L – Lacrimation  U – Urination  D – Defecation  G – Gastric distress  E - Emesis continued on next slide
  • 42. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Nerve agent emergency care  Ensure an adequate airway and ventilation; be prepared to suction.  The medications atropine and pralidoxime are antidotes. continued on next slide
  • 43. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved The two-injector Mark I™ kit. continued on next slide
  • 44. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Vesicants  Cause blistering, burning, and tissue damage  Agents include sulfur and nitrogen mustards, lewisite, and phosgene oxime. continued on next slide
  • 45. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Vesicant exposure  Signs and symptoms • Burning, redness, blistering, necrosis of the skin • Stinging, tearing, and development of ulcers in the eyes • Shortness of breath, coughing, wheezing, pulmonary edema • Nausea and vomiting • Fatigue continued on next slide
  • 46. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Vesicant  Emergency medical care • Irrigation • Manage chemical burns continued on next slide
  • 47. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical 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. continued on next slide
  • 48. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Cyanide exposure  Signs and symptoms • Anxiety • Weakness • Dizziness • Nausea • Muscular trembling • Tachycardia continued on next slide
  • 49. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Cyanide exposure  Signs and symptoms • Tachypnea • Pale, cyanotic, or normal color skin • Seizures • Apnea • Unresponsiveness continued on next slide
  • 50. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Cyanide exposure  Emergency treatment • Manage the airway, breathing, and oxygenation. • There are antidotes available. • Nitrites and sodium thiosulfate • Hydroxocobalamin continued on next slide
  • 51. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Pulmonary agents  Include phosgene, other halogen compounds, and nitrogen-oxygen compounds  Act primarily to cause lung injury continued on next slide
  • 52. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Pulmonary agent exposure  Signs and symptoms • Tearing • Runny nose • Throat irritation • Dyspnea • Wheezing continued on next slide
  • 53. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Pulmonary agent exposure  Signs and symptoms • Cough • Crackles • Stridor • Secretions continued on next slide
  • 54. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Pulmonary agent exposure  Emergency medical treatment • Manage the airway and breathing; be prepared to suction, administer oxygen. continued on next slide
  • 55. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • 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. continued on next slide
  • 56. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Chemical AgentsChemical Agents • Toxic industrial chemicals  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.
  • 57. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study 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. continued on next slide
  • 58. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case StudyCase Study • What should be the approach to this situation? • Where should EMS units be located? • What special resources are needed?
  • 59. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • 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. continued on next slide
  • 60. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Groups of biological agents  Pneumonia-like agents  Encephalitis-like agents  Biological toxins  Other agents continued on next slide
  • 61. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Pneumonia-like agents present with fever and difficulty breathing, and include:  Anthrax  Plague  Tularemia continued on next slide
  • 62. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Encephalitis-like agents cause fever, headache, and altered mental status, and include:  Smallpox  Venezuelan equine encephalitis continued on next slide
  • 63. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Biological toxins  Botulinum • Descending paralysis • Double vision • Blurred vision • Dry mouth and throat • Difficulty speaking and swallowing • Dyspnea and respiratory failure continued on next slide
  • 64. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Biological toxins  Ricin • Weakness • Fever • Cough • Hypothermia • Death continued on next slide
  • 65. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Biological toxins  Staphylococcus enterotoxin 13 • Fever • Chills • Headache • Body aches • Nonproductive cough continued on next slide
  • 66. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Biological toxins  Epsilon toxin • Cough, wheezing, shortness of breath • Respiratory failure • Death continued on next slide
  • 67. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Biological toxins  Trichothecene myotoxins • Pain • Itching • Lesions • Runny nose, sneezing continued on next slide
  • 68. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Biological toxins  Trichothecene myotoxins • Sloughing skin • Dyspnea, wheezing • Chest pain • Hemoptysis continued on next slide
  • 69. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Other biological agents  Cholera • Vomiting, abdominal distention, profuse diarrhea • Severe dehydration • Little or no fever continued on next slide
  • 70. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Other biological agents  Brucellosis • Fever • Malaise • Body aches • Joint pain • Headache • Cough continued on next slide
  • 71. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Other biological agents  Viral hemorrhagic fevers • Malaise • Body aches • Headache • Vomiting • Flushing and petechiae • Easy bleeding, hypotension, shock continued on next slide
  • 72. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological 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. continued on next slide
  • 73. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Biological AgentsBiological Agents • Emergency medical care for biological agent  Hospital care includes antibiotics and antitoxin.  Immunizations and prophylactic treatment are used in some cases.
  • 74. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Click on the WMD agent below that is aClick on the WMD agent below that is a biological agent.biological agent. A. Phosgene B. Nerve agents C. Ricin D. Hydroxocobalamin
  • 75. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Three primary mechanisms of death  Radiation  Blast  Thermal burns continued on next slide
  • 76. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Radiation  Energy released from radioactive atoms passes through and changes the structure of molecules in cells of the human body.  The cells may die, repair, or produce mutated cells. continued on next slide
  • 77. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Radiation  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. continued on next slide
  • 78. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Radiation  Beta radiation is a low-speed, low- energy particle that is easily stopped by 6–10 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. continued on next slide
  • 79. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Radiation exposure associated with a nuclear explosion  Primary exposure  Fallout continued on next slide
  • 80. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Primary exposure  Limited to blast proximity or near the source of radiation, such as a nuclear reactor  The source, duration of exposure, shielding, and distance affect the potential for injury and death. continued on next slide
  • 81. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Fallout  Radioactive dust and particles that can be carried far from the blast site  The greatest danger occurs within 48 hours and within close proximity to the blast.  May damage cell DNA continued on next slide
  • 82. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • 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. continued on next slide
  • 83. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Thermal burns  Causes most deaths and injuries from nuclear explosion  Heating is short duration, but very intense.  The eyes can be damaged from the intense light. continued on next slide
  • 84. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Radiologic dispersal devices  "Dirty bomb"  A conventional explosive attached to radioactive materials  Risk of widespread radiation illness and contamination of the environment continued on next slide
  • 85. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Nuclear detonation and radiation injury  Assessment and care • Most destruction and death is nearest the center of the blast. • There is less death and injury further from the blast. continued on next slide
  • 86. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Nuclear detonation and radiation injury  Signs and symptoms • Nausea, fatigue, malaise, clotting disorders • Vomiting, loss of appetite, diarrhea, fluid loss continued on next slide
  • 87. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Nuclear detonation and radiation injury  Signs and symptoms • Reddening of the skin • Rapid onset of incapacitation, cardiovascular collapse, confusion, burning sensation continued on next slide
  • 88. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Nuclear Weapons and RadiationNuclear Weapons and Radiation • Nuclear detonation and radiation injury  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.
  • 89. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Personal Protection andPersonal Protection and DecontaminationDecontamination • Personal protective equipment is required for chemical, biological, and radiological/nuclear exposure. • Apply principles of hazardous material response. • Apply principles of time, distance, and shielding for radiation exposure. continued on next slide
  • 90. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Personal Protection andPersonal Protection and DecontaminationDecontamination • Apply principles of decontamination as for hazardous materials exposure. • Do not perform tasks you are not trained to perform.
  • 91. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion 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. continued on next slide
  • 92. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion 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. continued on next slide
  • 93. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion 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. continued on next slide
  • 94. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Case Study ConclusionCase Study Conclusion The attack is later determined to be the work of a small domestic group staging a protest.
  • 95. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Lesson SummaryLesson Summary • WMD are intended to produce widespread death and destruction. • WMD may be chemical, biological, radiological, nuclear, or explosive agents. • Conventional explosive agents have the greatest likelihood of being used in an attack. continued on next slide
  • 96. Prehospital Emergency Care, 10th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved Lesson SummaryLesson Summary • 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.

Editor's Notes

  1. 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 Review local protocols and operating procedures regarding response to WMD incidents. Bring examples of nerve agent antidote kits. Plan 160 to 180 minutes for this class as follows: Weapons of Mass Destruction: 15 minutes Provides an overview of types of WMD and issues involved in responding to WMD incidents Prehospital Response to Terrorism Involving WMD: 30 minutes Describes the essential components and principles of effective response to WMD incidents Conventional Weapons and Incendiary Devices: 20 minutes Explains the effects of explosives and incendiary devices Chemical Agents: 30 minutes Describes properties and types of chemical agents likely to be used in WMD Biological Agents: 30 minutes Describes the use of biological agents as WMD, including pneumonia-like and encephalitis-like agents, and biological toxins. Nuclear Weapons and Radiation: 30 minutes Describes the types of radiation used in nuclear weapons and other mechanisms of dispersing radiation Discusses the effects of nuclear and radiological weapons. Personal Protection and Patient Decontamination: 5 minutes Reviews the use of personal protective equipment in the response to WMD events, and decontamination of patients 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.
  2. 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.
  3. Objectives are more specific statements of what students should be able to do after completing all reading and activities related to a specific chapter. Remind students they are responsible for the learning objectives and key terms for this chapter.
  4. Assess and reinforce the objectives and key terms using quizzes, handouts from the electronic instructor resources, and workbook pages.
  5. 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
  6. During this lesson, students will learn special considerations related to weapons of mass destruction.
  7. 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?  
  8. 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?
  9. Discussion Question What are some anticipated issues with medical direction in the response to WMD incidents?
  10. Discussion Question In what ways must EMTs be prepared for response to WMD incidents?
  11. 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?  
  12. 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 three phases of a blast?  
  13. Knowledge Application Students should be able to apply the information in this section when responding to potential WMD incidents.  
  14. 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.
  15. Teaching Tips Identify any potential sources of chemical agents in your community.
  16. 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.  
  17. Discussion Question What are some examples of pulmonary agents?
  18. Discussion Question What are some examples of toxic industrial chemicals?
  19. 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.  
  20. 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.
  21. Discussion Question What are the effects of exposure to radiation on different body systems?
  22. Teaching Tipd 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?
  23. 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
  24. 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.