Terrorism and EMS

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CHAPTER 36
Terrorism and EMS
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Key Term
Terrorism
A violent act dangerous to human life, to
intimidate or coerce a government, the civilian
population, or any segment thereof, in
furtherance of political or social objectives
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Domestic Terrorism

• Directed at government or a population, without
  foreign direction
• Often fragmented and leaderless

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Domestic Terrorism
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International Terrorism

• Foreign based
• Activities cross national boundaries
• Often religious or politically motivated

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Types of Terrorism

• Armed attacks
• Chemical
• Biological
• Radiological
• Nuclear Explosive

Weapons of Mass Destruction
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September 11, 2001
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Safety

Always remember that responders may be targets of
terrorism. Never compromise your own safety
during an incident.
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Responder Safety

• Responders may be targets.
• Consider the possibility of secondary
  devices/events.
• Utilize SOPs protocols.
• Never compromise your own safety.

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Responder Considerations

• Identifying the possible threats posed by the
  event
• Recognizing the possible harms posed by the event
• Identifying protection measures based on the
  possible threats and harms

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Identify Threat Posed by the Event

OTTO
Occupancy/Location Type of Event Timing of
Event On-Scene Warning Signs
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Occupancy/Location

• Symbolic/Historic Targets
• White House
• IRS offices
• Public buildings assembly areas
• Shopping malls
• Convention centers

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Occupancy/Location

• Controversial businesses
• Nuclear facilities
• Family planning offices
• Infrastructure systems
• Power plants
• Hospitals

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Type of Event

• Explosions/incendiaries
• Incidents involving firearms
• Non-trauma MCIs

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Timing of Event

• National holidays
• Anniversaries of other terrorist events

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On-Scene Warning Signs

• Unexplained patterns of illness
• Chemical containers
• Unusual items at locations
• Fires of unusual behavior

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Recognize the Harms Posed by the Threat

TRACEM-P

• Thermal Harm
• Extreme heat or cold
• Radiological Harm
• Nuclear particles

Continued
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Recognize the Harms Posed by the Threat.
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Recognize the Harms Posed by the Threat

TRACEM-P

• Asphyxiation
• Lack of oxygen in environment
• Chemical Harm
• Toxic or corrosive materials

Continued
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Recognize the Harms Posed by the Threat

TRACEM-P

• Etiological Harm
• Disease causing organisms
• Mechanical Harm
• Physical trauma

Continued
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Recognize the Harms Posed by the Threat

TRACEM-P

• Psychological Harm
• Creation of fear and panic

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Possible Protection Measures

• Time
• Distance
• Shielding

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Responses to ChemicalIncidents

• Hazardous Materials
• Industrial Waste
• Warfare Agents

That may be

• Inhaled
• Ingested

• Absorbed
• Injected

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Specific Types of Harm from Chemical Incidents

• Thermal
• Flammability/heat from reactions
• Asphyxiation
• Reactions that displace oxygen
• Chemical
• Systemic to cardiac, nervous, respiratory
  systems

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Specific Types of Harm from Chemical Incidents

• Mechanical
• Corrosives weaken structures
• Psychological
• Emotional reaction to exposure

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Self Protection at Chemical Incidents

• Be cautious of secondary devices.
• Ensure victims are not the bomber.

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Responses to Biological Incidents

• May be a focused emergency or a
• public health emergency.
• Focused emergencies have a point of origin,
  minimizing spread.

Continued
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Responses to Biological Incidents

• Public health emergencies have a sudden demand
  on public health with no apparent explanation.

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Causative Agents of Biological Incidents

• Bacteria
• Viruses
• Toxins

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Exposure
The dose or concentration multiplied by time
(duration of exposure).
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Four Biological Agent Routes of Entry

• 1. Absorption
• Skin contact
• 2. Ingestion
• Through mouth

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Four Biological Agent Routes of Entry

• 3. Injection
• Needles or projectiles
• 4. Inhalation
• By breathing

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Key Term
Contamination
Contact with or presence of a contaminant, which
is material that is present where it does not
belong and that is somehow harmful to persons,
animals, or the environment
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Exposure vs. Contamination

• Contamination
• Substance clings to body or clothing.
• Exposure
• Substance enters body through one of the
  routes of exposure.

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Specific Types of Harm from Biological Incidents

• Etiological
• Poisonous hazardous materials
• Chemical
• Secondary events

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Specific Types of Harm from Biological Incidents

• Mechanical
• Secondary events
• Psychological
• Emotional reaction to exposure

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Self-Protection at BiologicalIncidents

• Use personal protective equipment.
• Limit exposure time.
• Use buddy system/RIT team.

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Responses to RadiologicalIncidents

• Unlikely to occur
• May be in the form of an explosive device
• Difficult to initially detect

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Specific Types of Harm from Radiological Incidents

• Thermal
• Nuclear explosion
• Radiological
• Ongoing, varies with substance
• Chemical
• Many substances are also chemical hazards
  
• Continued

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Specific Types of Harm from Radiological Incidents

• Mechanical
• Nuclear explosion
• Psychological
• Emotional reaction to exposure

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Self-Protection at Radiological Incidents

• Use time/distance/shielding.
• Use decontamination procedures.

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Responses to ExplosiveIncidents

• Vary in size from pipe bomb to car bombs
• May have suicide bombers
• May contain chemical or biological agents
• Most frequent weapon used by terrorists

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Specific Types of Harm from Explosive Incidents

• Thermal
• Heat from detonation
• Asphyxiation
• Dusty conditions
• Chemical Radiological
• If present in the device
• Continued

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Specific Types of Harm from Explosive Incidents

• Mechanical
• Shockwaves and fragmentation
• Etiological
• If biological agents present
• Psychological
• Stunned response

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Self-Protection at ExplosiveIncidents

• Be cautious of secondary devices.
• Ensure victims are not the bomber.

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Methods of Disseminationof Agents

• Respiratory/Inhalation
• Most effective method
• Ingestion
• Effectiveness

Continued
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Methods of Disseminationof Agents

• Dermal
• Some agents effective this way, others
  prevented by logistics/ immunization

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Weaponization

• Use of sprayers to disseminate
• Use of explosives to disseminate

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Dissemination of Agents

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Chemical AgentConsiderations

• Physical Considerations
• Extremely varied
• Must be gaseous, liquid, or solid
• Volatility
• May evaporate quickly

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Chemical AgentConsiderations

• Chemical
• Reactivity stability vary
• Toxicological
• Variety of factors influence sensitivity

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Classification of ChemicalAgents

• Choking agents
• Vessicating agents (blister agents)
• Cyanides
• Nerve agents
• Riot control agents

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Classification of BiologicalAgents

• Bacterium
• Can live outside host cell
• Virus
• Cannot survive outside of host cell
• Toxin
• Poisonous chemical compound

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Biological Agent Weapon Considerations

• Infectivity
• Virulence
• Toxicity
• Incubation period

Continued
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Biological Agent Weapon Considerations

• Transmissibility
• Lethality
• Stability

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Classification of BiologicalAgents

• Infectivity
• Ease in invading host cell
• Virulence
• Severity of disease produced
• Toxicity
• Severity of illness from toxin
• Continued

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Classification of BiologicalAgents

• Incubation period
• Time between exposure symptoms
• Transmissibility
• Ease of passing fromperson to person

Continued
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Classification of BiologicalAgents

• Lethality
• Ease in causing death
• Stability
• Viability to outside influences

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Biological Weapons

• Bacteria
• Single cells, require a host.
• Easy to grow and spread .
• Anthrax
• Naturally occurring.
• Inhalation is greatest concern.
• Early treatment with antibiotics is key.
• Continued

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Biological Weapons

• Cholera
• Diarrheal disease.
• Treat dehydration.
• Plague
• Transmitted by fleas.
• Can be highly contagious.
• Use respiratory precautions.
• Continued

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Biological Weapons

• Q fever
• Similar to anthrax.
• Treat with antibiotics.
• Tularemia
• Usually from bites of animals.
• Fever, headache, weight loss.
• Treat with antibiotics.

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Toxin Weapons

• Do not aerosolize on their own
• Do not reproduce
• Do not transmit person to person
• Generally, intact skin is an effective barrier.
• Continued

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Toxin Weapons

• Botulism
• One of the deadliest compounds
• Ricin
• Easy to make, common weapon
• Interrupts cell processes causes death
• Most effective through inhalation

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Biological Weapons

• Staphylococcal Enterotoxin B (SEB)
• Similar to food poisoning
• Treatment is supportive
• Trichothecene Mycotoxins (T2)
• Death within 12 hours
• No vaccine
• Treat symptoms

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Virus Weapons

• Simplest microorganisms
• Require a host cell
• Not easy to manufacture
• Continued

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Virus Weapons

• Smallpox
• Thought to be eradicated, but may exist
• Highly contagious
• Spread by respiratory droplets
• Encephalitis
• Naturally occurring
• Inflammation of the brain
• More incapacitating than lethal
• 
  Continued

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Virus Weapons

• Viral Hemorrhagic Fever (VHFs)
• Ebola, Dengue Fever, Yellow Fever
• Changes the clotting ability of blood
• Highly contagious lethal
• Liquefies internal organs
• No vaccines or cures

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Radioactive / Nuclear Weapons

• Military / Sabotage
• Highly unlikely
• Improvised
• Easy to gather knowledge, implementation very
  difficult
• Dirty Bomb
• Similar issues as improvised device

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Incendiary Weapons

• More plausible by using
• Molotov cocktails
• Propane bombs
• Shaped charges
• May disseminate other weapons

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Strategy and Tactics

• Strategies are broad plans tactics
• are specific methods to achieve
• them.
• Isolation
• Notification
• Identification
• Protection

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Isolation Initial Considerations

• Determine severity of danger.
• Control the scene size it up.
• Isolate the hazard area.
• Attempt to evacuate (based on hazards).
• Establish perimeter control.

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Isolation Perimeter Control

• May be difficult based on resources.
• Overestimate the size of the perimeter.

Continued
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Isolation Perimeter Control

• Outer perimeter
• Most distant boundary line
• Restrict all public access beyond it
• Inner perimeter
• Isolates known hazards inside the outer perimeter

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Perimeter Control Factors

• Availability of resources
• Size configuration of incident
• Stability of the incident

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Notification

Notify federal state support agencies during a
suspected or known terrorist event (usually done
by dispatch centers).
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Identification

• May or may not be possible.
• Do not endanger self to determine.
• Report obvious signs or indicators.
• Note placards and labels.
• Use the Emergency Response Guidebook.
• Report unusual patterns of illness.

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Protection

• EMTs are responsible to protect
• themselves and their equipment.
• Perform an initial scene survey.
• Request security police/military).
• Establish vehicle staging and treatment areas.
• Advise EMS command of concerns,
• suspicious people, and/or activities.

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Review Questions

• List and briefly describe the five most common
  types of terrorism incidents.
• 2. What is a secondary device? What precautions
  should be taken by an EMT regarding secondary
  devices?

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Review Questions

3. List several types of events that should
trigger an EMTs suspicion of possible terrorism
involvement. 4. List the seven types of harm
that result from a terrorism incident and the
seven letter acronym for these types of harm.
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Review Questions

5. Briefly discuss the concepts of time,
distance, and shielding. 6. Discuss several
self-protection measures for biological
incidents. 7. Discuss the tactics for
isolation, notification, identification, and
protection.
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STREET SCENES

• What are the indicators that this is a suspicious
  incident?
• What steps should be taken to isolate the area?

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STREET SCENES

• What steps should be taken to identify a possible
  mechanism of injury?
• Identify the critical personal protection issues
  on this scene.

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STREET SCENES

• What are the indicators that this is a suspicious
  incident?
• What protection precautions should be initiated?

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STREET SCENES

• Discuss the proper notification procedures. What
  support agencies are required on this scene?