Emergency Response to TerrorismTC: Emergency Medical Services

Unit 4: Patient CarePart B

4B-2

Physiological Effects

B - BiologicalN - NuclearI - IncendiaryC - ChemicalE - Explosives

4B-3

Nuclear/Radioactive Devices

Four possibilities Radioactive decay Types of ionizing radiation

Alpha, Beta, Gamma Units of measure Scene control considerations

4B-4

Sample Exposure Limits

RAD = REM (for our purposes)mREM = millirem = 1/1,000 of a REM

Natural background radiation - 1-year dose 300 mREMFlight from LA to Paris 4.8 mREMBarium enema 8,000 mREMSmoking 1.5 packs per day - 1-year dose 8,000 mREMHeart catheterization 45,000 mREMMild Acute Radiation Syndrome 200,000 mREMLD50 for irradiation 450,000 mREM

4B-5

Acute Radiation Syndrome (ARS)

Effects of radiation Blood effects starting at 150 REM Gastrointestinal effects starting at 500 REM CNS effects starting at 1,000 REM

Personal protection Time, Distance & Shielding Use of personal protective equipment

4B-6

Physiological Effects

B - BiologicalN - NuclearI - IncendiaryC - ChemicalE - Explosives

4B-7

Incendiary Devices

Consider materials used Fuels Phosphorus Hypergolic mixtures

Thermal burn treatment Maintain body temperature Follow local burn treatment protocols

4B-8

Physiological Effects

B - BiologicalN - NuclearI - IncendiaryC - ChemicalE - Explosives

4B-9

Chemical Agents

Classifications Choking agents Vesicating agents Cyanides (blood agents) Nerve agents

Overview

4B-10

Choking Agents: Physiological Effects

Respiratory structure Particulate disposition Respiratory irritants Respiratory irritation Non-cardiogenic pulmonary edema

4B-11

4B-12

Vesicating Agents

Vesicles Oldest chem warfare agent Signs & symptoms Clinical effects Personal protection Treatment Triage considerations

4B-13

Cyanides

Description Clinical effects Symptoms Protection Treatment

4B-14

Nerve Agents

Very toxic relatives of pesticides Disrupt nerve impulses to muscles,

glands & nerves Not gases; generally oily liquids Effect function of material used and

method of dissemination related to whether victim is in enclosed or open space

4B-15

Nerve Agent Vapor Pressure

GA Tabun 0.07 mm/HgGB Sarin 2.9 mm/HgGD Soman <0.01 mm/HgVX V-Agents 0.0007 mm/Hg

4B-16

Nerve Agent Considerations

Tokyo sarin experience Clinical effects Protection Signs & symptoms Treatment

4B-17

Activity 4.3

Determining Patient Care Considerations

4B-18

Physiological Effects

B - BiologicalN - NuclearI - IncendiaryC - ChemicalE - Explosives

4B-19

Explosive Weapons

The most commonly used Types: high & low Pressure effects Primary & secondary injury effects Crush syndrome Treatment modalities In-the-rubble management Controversial interventions

4B-20

Mass Patient Decontamination

“Cleaning in Numbers”

4B-21

Primary Considerations

Basic steps remain the same Gross Secondary Tertiary Patient care

Runoff control is of limited concern

4B-22

Extent of Decontamination

Factors to secondary contamination risks Physical state of agent Water solubility Vapor pressure

Mass decontamination systems

4B-23

Crowd Emergency Decon

Various examples 2-engine 3-engine

4B-24

Crowd Emergency Decon

Engine 14

Engine 63

Victims

4B-25

Crowd Emergency Decon

Engine 14

Engine 63Truck 673

Victims

4B-26

Two-Corridor Mass Decon

4B-27

Three-Corridor Mass Decon

Trailer positioned in center for non-ambulatory patients

Shower heads off both sides of trailer Shower areas have privacy curtains Males to one side Females to other side

4B-28

Accessories - Tents

4B-29

Accessories - Stretchers

4B-30

Accessories - Systems

4B-31

Activity 4.4

Post Office Scenario (Part 2)

4B-32

Post Office: Phase 1

1000 hours MONDAY Your agency is dispatched to the local

post office on an EMS call for a female with shortness of breath. The local police department also responds with 1 police car. While you are responding, your dispatcher notifies you that there are additional calls. Some of the callers are reporting a male victim.

4B-33

Post Office: Phase 2

1005 hours MONDAY Upon arrival you see approx. 15 people outside

the main door to the post office coughing, tearing, & calling for help. Several are on their knees. As you put the vehicle in park, 5 people start running toward you calling for help.

The people report that there was a white cloud in the lobby & their eyes & skin started burning.

4B-34

Post Office: Phase 3

1010 hours MONDAY Law enforcement units are arriving to

secure the outer perimeter and the high ground around the post office. Your EMS director has arrived and has formed a unified command with law enforcement and the fire department command officer.

4B-35

Post Office: Phase 3 (cont.)

1015 hours MONDAY (cont.) Two additional ambulances have arrived and

your EMS supervisor is currently serving as the Mass Casualty Branch director and has ordered you to assume position of treatment group leader. You are still presented with 15 patients generally complaining of burning eyes, respiratory irritation and coughing

4B-36

Summary

Mainstays of patient care Rescuer self-protection Prevention of further exposure Provide supportive care Decon BLS & ALS treatment Transport Transfer

Key recognition of terrorist event Weapons present with specific patient

injuries & system impacts: B-NICE