EMS Response to Weapons of Mass Destruction: Preparing for WMD Incidents

1. Chapter 42 EMS Response to Weapons of Mass Destruction Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

2. Topics 42 • Weapons of Mass Destruction (WMD) • Prehospital response to WMD • Conventional weapons and incendiary devices • Chemical agents • Biological agents • Nuclear weapons and radiation • Personal protection and patient decontamination © 2008 by Pearson Education, Inc. Upper Saddle River, New Jersey Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

3. Introduction 42 • Terrorism involving weapons of mass destruction is an ever present threat in today’s world • Weapons of mass destruction represent a variety of different agents and means of delivery and can be difficult to control once enacted or released Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

4. Weapons of Mass Destruction 42 • Weapons of mass destruction (WMD) are weapons intended to cause widespread and indiscriminate death and destruction • The mnemonic CBRNE is a useful way to remember the types of WMD Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

5. Weapons of Mass Destruction 42 • The prehospital role in a WMD incident depends on the specific WMD employed • EMTs will have to work with many other public, private, and military agencies should a WMD occur • The key to an effective prehospital response is planning and cooperation Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

6. Prehospital Response to WMD 42 • Supplies and equipment • Different types of WMD incidents require different types of preparation • Examples include: • Medical equipment and medications • Search and rescue teams • Electronic detection devices • Personal protective equipment Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

7. Prehospital Response to WMD 42 • Medical direction • A plan to address how medical direction must be in place prior to the actual incident • Such a plan should address: • Triage and transport protocols • The provision of medical direction • Specialized standing orders Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

8. Prehospital Response to WMD 42 • Provider preparation and responding to the scene • Be aware of risks • Recognize when a WMD event may have occurred • Employ ICS as in any MCI Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

9. Prehospital Response to WMD 42 Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

10. Prehospital Response to WMD 42 • Role of the EMT-Basic at a WMD incident • Generally, the EMT will serve one of three functions: • EMS incident command • Triage, treatment, supply, or transportation officer • Care and transportation of the injured victims Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

11. Prehospital Response to WMD 42 Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

12. Conventional Weapons and Incendiary Devices 42 • Conventional weapons like explosives and incendiary devices are the most widely used WMD by terrorists Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

13. Conventional Weapons and Incendiary Devices 42 • Explosives • Explosives work by igniting special fuels that burn extremely rapidly, causing a shock wave or blast Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

14. Conventional Weapons and Incendiary Devices 42 • Dynamics of explosion injuries • Primary, secondary, tertiary effects • Body position • Injury patterns Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

15. Conventional Weapons and Incendiary Devices 42 • Incendiary devices • Incendiary devices are designed to burn at extremely high temperatures. Examples include napalm, thermite, and white phosphorous. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

16. Chemical Agents 42 • Chemical agents are often the most feared weapons of mass destruction • However, with proper training and knowledge, it is possible to administer emergency care close to or even within a contaminated environment Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

17. Chemical Agents 42 • Types of chemical agents: • Nerve agents • Vesicants • Cyanide • Pulmonary agents • Riot control agents • Industrial chemicals Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

18. Chemical Agents 42 • Nerve agents • Nerve agents generally work by causing muscular paralysis, which results in inadequate-to-no ventilation Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

19. Chemical Agents 42 • Vesicants • Vesicants are chemicals that enact damage on the body by causing blistering, burning, and tissue damage upon contact with the body Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

20. Chemical Agents 42 • Cyanide • Cyanide interferes with the cells’ ability to use oxygen. The cells will quickly die as will the patient when large amounts of cyanide are inhaled or swallowed. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

21. Chemical Agents 42 • Pulmonary agents • Pulmonary agents directly attack the airway and lung tissue. The smaller airways and alveoli are particularly susceptible to the effects of pulmonary agents. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

22. Chemical Agents 42 • Riot control agents • Riot control agents like tear gas are extremely irritating to the eyes, nose, mouth, and respiratory tract Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

23. Chemical Agents 42 • Industrial chemicals • There are literally thousands of industrial chemicals and pesticides that can be used as weapons of mass destruction Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

24. Biological Agents 42 • Biological agents are made up of living organisms and used to cause disease in a target population Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

25. Biological Agents 42 • Biological agents pose a serious threat and are categorized into 4 groups: • Pneumonia-like agents • Encephalitis-like agents • Biological toxins • Other agents Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

26. Biological Agents 42 • Pneumonia-like agents • Pneumonia-like agents present with fever and rapidly progressing dyspnea. Death typically occurs from respiratory failure. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

27. Biological Agents 42 • Encephalitis-like agents • Encephalitis-like agents present with symptoms similar to the flu, with more lethal results • These agents tend to cause disability and death by targeting the brain and spinal cord Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

28. Biological Agents 42 • Biological toxins • Biological toxins are the products of living organisms and potentially represent the greatest threat of all weapons of mass destruction Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

29. Biological Agents 42 • Emergency care for biological agents • Address any problems with the airway, breathing, and circulation • Care is primarily supportive • Advanced and pharmacological care is provided in the hospital setting Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

30. Nuclear Weapons and Radiation 42 • Nuclear weapons and radiation cause disability and death by a variety of mechanisms: • Radiation exposure • Blast injuries • Thermal burns Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

31. Nuclear Weapons and Radiation 42 • Radiation exposure • Radiation exposure can result from the initial blast (primary exposure) or fallout after the blast Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

32. Nuclear Weapons and Radiation 42 • Radiation exposure • Neutron radiation • Beta radiation • Alpha radiation Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

33. Nuclear Weapons and Radiation 42 • Blast injuries • Blast injuries occur when a large scale nuclear detonation occurs. Blast injuries are generally not seen when the source of radiation is a nuclear power reactor. Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

34. Nuclear Weapons and Radiation 42 • Thermal burns • Thermal burns occur when a large scale nuclear weapon is detonated Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

35. Nuclear Weapons and Radiation 42 • Radiological Dispersal Devices • Dirty bomb or RDD • Conventional explosive attached to a radioactive material Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

36. Nuclear Weapons and Radiation 42 • Care for nuclear and radiation injuries • Ensure that the patient has been properly decontaminated and assure the ABCs • Treat thermal burns, pressure injuries, and radiation exposure as appropriate • Protect the patient from undue exposure to the environment • Iodine tablets may be beneficial Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

37. Personal Protection and Patient Decontamination 42 • Personal protection is a critical component of any WMD incident • The appropriate personal protective equipment will be determined by the specific WMD employed Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

38. Personal Protection and Patient Decontamination 42 • Patient decontamination is an essential task at a WMD incident • The same principles used for a hazardous materials incident can be applied to a chemical, biological, or nuclear incident Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen