Scene Safety 1. Do not enter the scene if there is any doubt that it is not safe 2. Best location for staging is upwind and uphill 3. Wait for assistance from trained personnel. 4. Wait for law enforcement personnel. Responder Safety
Best form of protection is preventing contact with the agent. The greatest threat in a WMD attack: 1. Contamination 2.
Cross-contamination Notification procedure and resource requests 1. As soon as you suspect a terrorist or WMD event, notify the dispatcher. 2. Establish a safe staging area. 3. Request HazMat teams as early as possible.
Command Is first arriving paramedic Tasks of first arriving paramedic( incident commander) : 1. Report to incident command post. 2. Establish a medical branch. 3. Determine scope of incident. 4. Gather and disseminate information to dispatch.
Command 5. Assign a supervisor for the following areas: a. Decontamination b. Treatment c. Transportation d. Staging e. Rehabilitation
6. Report EMS activities to operations chief. Weapons of Mass Destruction Definition : Any agent designed to bring about: 1. Mass death
2. Multiple casualties 3. Massive damage to property and infrastructure Kinds of Weapons of Mass Destruction CBRNE is mnemonics for the kinds of WMDs: 1. Chemical
2. Biologic 3. Radiologic 4. Nuclear 5. Explosive Explosives/inflammable Weapons Explosives are most common
weapon used by terrorists. Ammonium Nitrate or Fertilizer Bombs 1. Commonly used as an industrial-grade fertilizer
2. Requires special license for purchase 3. Can be mixed to create an extremely explosive compound Chemical Agents Definition : Man-made substances that can have devastating effects on living organisms Produced in multiple forms: I.
Liquid II. Powder III.
Vapor Chemical Agents Chemical weapon classifications depends on : 1. Properties or characteristics of an agent 2. Persistency and volatility 3. Route of exposure ( Vapor hazard , Contact hazard )
chemical agents Chemical agents are categorized into : 1. Vesicants (blister agents). 2. Respiratory agents (choking agents). 3. Nerve agents. 4. Metabolic agents (cyanides). 5. Irritating agents Vesicants (blister agents)
Definition : they are substances that cause burnlike blisters to form on the victims skin and in the respiratory tract. Primary route of exposure of vesicants is skin. If the substances are left long enough , it can produce vapor that will cause respiratory tract irritation. Vesicants Examples of vesicants :
1. Mustard (H) 2. Lewisite (L) 3. Phosgene oxime (CX) Signs of vesicant exposure on the skin 1. Immediate, intense skin pain Remember
normal burn feeling and stages 2. Skin irritation, burning and reddening 3. Formation of large blisters 4. Gray discoloration of skin 5. Swollen and closed or irritated eyes 6. Permanent eye injury (including blindness).
Management 1.Rapid removal of the patient by specially trained personnel. 2. Aggressive decontamination by specially trained personnel wearing PPE. 3. Address ABCS. 4. Antidote : there is no known antidote for mustard and phosgene oxime , British antilewisite is used as
antidote for lewisite. Pulmonary Agents Gases that cause immediate harm to persons exposed to them Primary route is through the respiratory tract. Produce respiratory-related symptoms: 1. Dyspnea 2. Tachypnea
3. Pulmonary edema Examples of pulmonary agents: 1. Chlorine. 2. Phosgene. Chlorine (CL) First chemical agent ever used in warfare Clinical presentation :
1. First upper airway irritation and a choking sensation 2. Shortness of breath 3. Chest tightness 4. Hoarseness and stridor 5. Gasping and coughing\ How to identify the presence of chlorine in the scene?
1. Characteristic smell of chlorine bleach 2. Green haze it produces in the atmosphere
Phosgene Product of combustion. Clinical presentation : Very potent with a delayed onset of symptoms , mild exposure causes : 1. Nausea 2. Chest tightness and 3. Severe cough 4. Dyspnea on exertion
Pulmonary agent treatment 1. Remove the patient from the contaminated atmosphere. 2. Manage the ABCs aggressively. 3. Pay attention to oxygenation, ventilation, and suctioning. 4. Do not allow the patient to be active. 5. There are no antidotes.
Nerve agents Definitions : WMDs designed to kill large number of peoples with small quantities , they belong to Organophosphorus class. Mechanism of
action: they block cholinesterase enzymes accumulation of acetylcholine
at nerve overstimulation of body organs. ending
Types : four major types ,which vary in their onset of action and lethal dose: 1. Sarin (GB) 2. Soman (GD) 3. Tabun (GA) 4. V agent (VX) Nerve Agents
Clinical presentation Nerve gases is one of deadliest chemicals known . Can cause cardiac arrest within seconds to minutes of exposure. Clinical presentation of nerve gas toxicity is known by two mnemonics military and medical. ( SLUDGEM , DUMBLES).
Clinical effects of nerve agent mnemonics Management 1. Decontamination . 2. Address ABCs . 3. Seizing patient will need nerve gas antidote kit .
4.DuoDote Antidote Kit contains a single injection of atropine and 2-PAM chloride. Metabolic agents (cyanides) Include cyanide agent
and cyanogen chloride . Widely used in industry. Colorless gases with almond odor. Mechanism of action : impair the body
ability to utilize oxygen. Clinical presentation Low dose symptoms High dose symptoms 1.Dizziness
1.Shortness of breath 2.Light-headedness 2.Tachycardia 3.Headache 3.Seizures
4.Vomiting 4.Cardiac arrest Management of cyanide toxicity 1. Decontamination : Patient should be removed from the contaminated area and all their clothes should be removed to prevent offgasing by trained personnel wearing PPE.
2. Address ABCs and insert an I.V access : in case of sever exposure patient will require aggressive oxygenation and ventilation. Biologic terrorism. Biologic agents are organisms that cause disease. The primary types are: 1. Viruses
2. Bacteria 3. Toxins Why Biologic Agents are considered extremely dangerous 1. Almost completely undetectable. 2. Diseases caused is similar to other minor illnesses. 3. May be spread in various ways : a. Dissemination is the means by which a terrorist will
spread the agent. b. A disease vector is an animal that spreads disease to another animal. Viruses Special characters : 1. require a living host to multiply and survive. 2. Invades healthy cells and replicates itself
to spread through the host 3. Moves from host to host by direct methods or through vectors Examples of viruses used in biological warfare: 1. Small pox. 2. Viral hemorrhagic fever e.g. Ebola and yellow fever.
Small box Extremely infectious. The most contagious phase is when blisters begin to form. Clinical presentation : A. Non specific symptoms : high grade fever , headache and bony aches. B. Followed by blisters appearance
Small pox blisters Management 1. You must wear examination gloves, a HEPAfiltered respirator, and eye protection. 2. Observe the size, shape, and location of the lesions. 3. Vaccine is offered only to first responders due to its medical complication.
Viral hemorrhagic fever (VHF) Definition : group of disordered that Causes blood to seep out from the tissues and blood vessels. Examples: 1. Ebola 2. Rift Valley 3. Yellow fever viruses
Clinical presentation of viral hemorrhagic fever A. First : flu like symptoms. B. Followed by massive internal and external hemorrhage from every organ , tissue and body orifice. ( hall mark ) Management 1. Standard precautions must be strictly
followed , this is only available method of protection . 2. There is no working vaccine for VHF. 3. Treatment is mainly supportive 4. Manage ABCS and treat shock and hypotension if present VHF
Bacteria A. Does not require a host to multiply and live B. Larger and more complex than viruses C. Can be fought with antibiotics D. Most infections symptoms.
begin with flulike Two types of bacteria are most commonly used :
1. Anthrax. 2. Plague . Anthrax Definition : deadly bacterium that lies dormant in a spore which are released when exposed to optimal temperature and moisture Routes of entry :
1. Inhalation 2. Cutaneous 3. Gastrointestinal Plague Natural vectors of plague are rodents and fleas. Two types of plague : A. Bubonic.
B. Pneumonic Types Pneumonic 1. Infects lymphatic system 2. Can lead to sepsis 3. Not contagious
Bubonic 1. Lung infection 2. Contagious 3. Higher death rate Clinical presentation It starts with flu like symptoms :
headache , fever and bone aches. Symptoms of pneumonia : cough , shortness of breath . Painful enlargement of lymph nodes. Management of bacterial biologic agents A. Follow standard precautions. B. Address ABCS
C. Patient with respiratory affection may require assisted ventilation. D. Rapid transport to specialized facility. plague Neurotoxins Most deadly substances known to humans. Produced from:
Botulinum toxin Most potent neurotoxin produced from bacteria Affects the nervous systems ability to function : 1. Leading to muscle paralysis .
2. Patient will go into respiratory arrest ( cause of death ). Ricin Derived from mash left from the castor bean. Quite stable and extremely toxic
Causes : A. Pulmonary edema B. Respiratory failure C. Death and circulatory
Clinical presentation A. Ingestion causes rapid onset of : 1. Nausea 2. Vomiting 3. Abdominal cramps 4. Severe diarrhea Clinical presentation
B. Inhalation signs and symptoms: 1. Irritation of eyes, nose, and throat. 2. Profuse sweating. 3. Cyanosis. Management Treatment is supportive: 1. Intubation 2. Ventilation
3. Positive end-expiratory pressure 4. Treatment of pulmonary edema as appropriate Radiation Definition : Energy emitted in the form of rays or particles Found in radioactive material , Radioactive material is unstable. Radiation
Energy emitted from a strong radiologic source and it has four categories. 1. Alpha 2. Beta 3. Gamma (x-rays) 4. Neutron radiation Effects of radiation on the Body Effects vary depending on amount and
route of entry Three levels of exposure: 1. Radioactive exposure 2. External contamination 3. Internal contamination Clinical presentation Radiation can enter through all routes of entry as well as through irradiation
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