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CBRNE Training Academy

CBRNE Training Academy. Understanding Nuclear, Biological and Chemical Events Risk Assessment. Lecture Goals. Understand the basics of: Biological exposure Chemical exposure Nuclear/Radiological exposure Transmission and contamination Develop personal risk assessment Am I in danger?.

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CBRNE Training Academy

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  1. CBRNE Training Academy Understanding Nuclear, Biological and Chemical Events Risk Assessment

  2. Lecture Goals • Understand the basics of: • Biological exposure • Chemical exposure • Nuclear/Radiological exposure • Transmission and contamination • Develop personal risk assessment • Am I in danger?

  3. Basic assumptions • The hospital is not the scene • EMS/Fire decontaminate patients • 60-80% of people bypass EMS

  4. Biological, Chemical and Nuclear General Concepts

  5. Why are hazards hazardous? • “Chemical” nature • Host factors • Environmental issues • Exposure • Dose Philip Theophrastus Bombast von Hohenheim aka PARACELSUS (1493-1541)

  6. What it is makes it bad • Chemical nature and physical properties

  7. Who you are makes it bad • Age, health and disease

  8. Where you are makes it bad • Wind, water and weather

  9. Exposure • Route, duration and degree

  10. The Specifics Biological agents

  11. ready.gov If you see signs of a chemical attack, quickly try to define the impacted area or where the chemical is coming from, if possible.

  12. Not ready.gov Hurricanes, animal corpses and the biohazard symbol have a lot in common. Think about it.

  13. Biological basics • Particles that cause disease • Bacteria • Viruses • Fungi

  14. Awareness • Unusual syndromes • Flu out of flu-season • Unexpected geography or clusters • Plague in NYC • Pets and humans • Whole neighborhoods • Everyone from a Knicks game • Unusual diseases • Hemorrhagic fevers

  15. Protection basics

  16. Standard precautions

  17. Examples of Personal Protective Equipment

  18. Examples of biologic agents • Bacteria Anthrax Tularemia Pneumonic Plague • Viruses Smallpox Influenza Viral Hemorrhagic Fevers (VHFs); Lassa, Ebola, Marburg • Biological Toxins Botulism

  19. How do they present? • “Flu” like symptoms • Inhalational anthrax • Smallpox • Pneumonic plague • Viral Hemorrhagic fever • Tularemia • Pandemic influenza • Avian influenza • SARS • Almost all of them

  20. Can I catch this? • Anthrax • Brucellosis • Q fever • Tularemia • Equine encephalitis • Toxins: Botulism, Staph enterotoxin B, Ricin NO

  21. Can I catch this? • Pneumonic plague • Smallpox • Viral hemorrhagic fevers (VHF) • Lassa, Ebola, Marburg MAYBE • Not contagious prior to symptoms

  22. Pneumonic Plague • Naturally transmitted from person to person through large respiratory droplets • Surgical mask is adequate for most people in most situations • Droplet precautions

  23. N100 Smallpox • Naturally transmitted from person to person through large respiratory droplets & through direct contact with oral/pharyngeal secretions • Less contagious than measles, chicken pox

  24. Quarantine

  25. I’m exposed, now what? • Antibiotics (Doxycycline, Ciprofloxacin) • Anthrax, Plague • Vaccine • Smallpox (within 4 days of exposure) • Supportive care and experimental • Botulism • VHF • Equine encephalitis • Ricin exposure

  26. Exposed Bag clothes Shower Universal precautions Quarantine Post-exposure prophylaxis (patient) Sick and contagious Isolate Universal precautions Respiratory precautions Post-exposure prophylaxis (patient and maybe staff) Biological summary

  27. Risk summary • Not sick, unlikely to be contagious • Decontaminate (maybe) • Universal and respiratory precautions • Isolation and hand washing • Post exposure prophylaxis

  28. The Specifics Chemical hazards

  29. ready.gov If you become aware of an unusual or suspicious release of an unknown substance nearby, it doesn't hurt to protect yourself.

  30. Not ready.gov If you are sprayed with an unknown substance, stand and think about it instead of seeing a doctor.

  31. Awareness • Five senses • Toxidromes • Skin • Pupils • Bowels • Bladder • Mucous membranes • Mental status

  32. Chemical basics • What are its properties? • Solid, liquid, gas • Any properties of concern? • Volatility • Flammability • How was it released / distributed? • How did it get here?

  33. If you remember one thing. . . • Decontamination • Decontamination • Decontamination

  34. What do we worry about? • Nerve Agents • Blood Agents • Choking Agents • Blister (vesicant) Agents • Riot Control Agents

  35. Nerve Agents • Anti-human pesticide • Absorbed through ALL routes, inhalation causes most rapid onset of symptoms • Cholinergic toxidrome; SLUDGEM Primary effects observed in Tokyo were pinpoint pupils, dimmed vision, weakness • Decontamination & PPE vital

  36. March 1995 Sarin release 11 killed 5510 sought emergency medical care Nerve Agents

  37. How do I treat this? • Decontaminate • ABC’s • Antidotes • Mark I kit • Atropine • Oximes for aging • Central Nervous System (CNS) depressants

  38. “Off-gassing” • “Contagious” chemical • Georgia nurse • Tokyo doctors • No decontamination performed • No PPE used in any cases

  39. “Blood” or metabolic agents • Cyanide is primary example • Common industrial agent • Interrupts aerobic respiration (ability to use oxygen) • Rapid, severe clinical deterioration Leads to collapse, apnea, seizures, severe metabolic acidosis & death • Therapy Decontaminate Oxygen, bicarbonate, sodium thiosulfate

  40. Blister (vesicant) agents • Sulfur Mustard Environmental persistence Dermal effects in 1-2 minutes Systemic effects in 4-8 hours • Decontamination and supportive care

  41. Choking (pulmonary) agents • Phosgene and Chlorine • Common industrial agents • Cause delayed lung injury Chlorine + water = HCL • Airway management • Decontamination (maybe) • Supportive care

  42. “Riot control” agents • Many compounds • Solids within liquids • Primarily irritants • High pressure particulate • Burns (eyes, skin) • Coughing, asthma-like symptoms • Decontamination is key

  43. Chemical summary • Decontamination • Protect yourself • Identify the toxidrome • Many agents have specific therapies • Aggressive supportive care • Monitor for delayed toxicity • Decontamination

  44. Risk summary • Whatever patient had, staff has less • Protect yourself • Decontamination . . . • Personal protective equipment • Low risk once clean

  45. The Specifics Nuclear/Radiological hazards

  46. ready.gov Or if it would be better to go inside a building and follow your plan to shelter-in-place.

  47. Not ready.gov After exposure to radiation it is important to consider that you may have mutated to gigantic dimensions: watch your head.

  48. Basics of radiation Contamination Incorporation Irradiation Risk Maybe Risk No Risk

  49. Awareness and protection • Detection • Decontamination • Distance • Deflection

  50. 0.003 REM 6 REM/yr 0.005 REM 45 REM ??? REM > 400 REM 200 REM Radiologic principles • Alpha, Beta, Gamma, Neutron • RAD’s and REM’s

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