Disaster Response and Bio-Chemical Terrorism

Silver Cross EMS CME3rd Trimester September 2013

Our Agenda Today

• System Announcements – a new CME person!• Importance of disaster response preplanning and

preparedness• Bio-Chemical weapons of mass destruction agents first

responders should be concerned about• Epidemiologic clues that may indicate act of

bioterrorism• Strip o’ the month• BLS skill o’ the month

Introduction

• Disaster response– Challenges• Responder safety• Multiple patients• Equipment in short supply• Inexperience in mass casualty incidents

– Natural or manmade • Earthquakes, hurricanes, floods, tornados• Structural collapse, hazmats release, terrorist attacks

Disaster Response Preparedness

Local & state response◦Preplanning vital

Team effort Many agencies involved Operating procedures developed Response procedures to guide safe scene operations Patient decontamination Treatment Medication Destination protocols

Disaster Response Preparedness

• Local & state response– Medical equipment • Caches of supplies• PPE• Mass decontamination supplies• Antidotes

– Surge capacity hospitals• Equipment stored to open temporary hospitals• Convention centers, arenas• Portable tent hospitals

Disaster Response Preparedness

• Federal response– National response plan (NRP) • National approach to domestic incident management• Joins with local, state efforts• Goals

– Prevent terrorist attacks within US– Reduce US vulnerability to terrorism, major disasters & other

emergencies– Minimize damage from attacks, major disasters & other emergencies– Facilitate recovery from domestic incidents

Disaster Response Preparedness

• Federal response– National disaster medical system• Coordinated by Dept of Health & Human Services• Staffed by National Disaster Medical System• Disaster medical assistance teams (DMATs)• National medical response teams for WMD• International medical surgical teams• Disaster mortuary operations teams• National Veterinary Response Teams• FEMA urban search and rescue teams

Disaster Response Preparedness

Incident Management System

• National incident management system– Consistent nationwide approach– Provides protocols, concepts, terminology,

organization– Core concepts• Incident command system• Multiple-agency coordination• Training• Resource identification & management• Collection, tracking, reporting incident information

Incident Management SystemIncident command system (ICS)◦Use mandated by PSHA regulation & HASWOPER

standard◦Structure

Command◦ Incident commander (IC)

Operations section◦ Manages all tactical operations

Planning & intelligence◦ Collect & evaluate information about event◦ Suggest action plan to IC

◦

Incident Management System

Incident Management System• Incident command system (ICS)– Structure

• Logistics– Locating & organizing

• Finance or administration– Tracking incident costs

• Role of EMS– EMS falls into many function areas– Medical sector or group under operations– Medical sector or group leader– Logistics– Planning to ID patient needs

–

Incident Management System

• Incident command system (ICS)– Concepts• Common terminology• Command post operations• Unified command• Consolidated response plan• Span of control• Integrated communications• Staging area

Incident Management System

Weapons of Mass Destruction

• Chemical agents– Blood agents• Chemicals enter body, inhibit cellular use of O2

• Hydrogen cyanide (AC)• Cyanogen chloride (CK)

Weapons of Mass Destruction

• Chemical agents– Treatment

• Remove to fresh air• If liquid agent,

decontamination vital• Airway & circulatory

management• Antidote: Taylor Cyanide

Antidote Package

Weapons of Mass Destruction

• Chemical agents– Pulmonary agents• Responders should fear most• Easy to obtain• Choking agents• Attack lungs & lung tissue

Weapons of Mass Destruction

• Chemical agents– Pulmonary agents• Phosgene

– Colorless gas with newly mown hay odor– Highly volatile, nonpersistent agent– Heavier than air, remains in low-lying places for long period– Gas at temperatures >47°F– Easy to produce, unstable in storage, must be kept refrigerated

Weapons of Mass Destruction

• Chemical agents– Pulmonary agents• Chlorine

– Greenish-yellow gas or amber liquid with pungent odor– 2 x heavier than air– Highly volatile, nonpersistent– Strong oxidizer & highly corrosive

Weapons of Mass Destruction

• Chemical agents– Pulmonary agents• Anhydrous ammonia

– Used as fertilizer– Refrigerant for cooling & freezing– Colorless gas in lower concentrations– Higher concentrations can form white cloud– Volatile, persistent

Weapons of Mass Destruction

• Chemical agents– Vesicants

• Blister agents• Burn & blister skin/surface they contact• Severely damage skin, eyes, lungs, GI tract• Contaminate almost everything in contact• Signs/symptoms

– Erythema & blisters on skin– Irritation– Conjunctivitis– Corneal opacity– Mild upper respiratory signs to marked airway damage– GI effects

Weapons of Mass Destruction

• Chemical agents– Vesicants• Liquid or vapor• Presentation hours after exposure• No antidote• Care is supportive• Decontamination critical

Weapons of Mass Destruction

Weapons of Mass Destruction

• Chemical agents– Nerve agents

• Most well know type of chemical

• Most toxic• Hardest to acquire• G agents• Signs & symptoms similar,

onset varies• SLUDGE-BBM or SLUDGE-

BAM or DUMBELLS• Attach & deactivate acetyl

cholinesterase

Weapons of Mass Destruction

• Chemical agents– Riot control agents• CS & CN tear gas• CS more potent• Pepper spray

Weapons of Mass Destruction

• Biologic agents– Different response than chemical weapons– Biologics have incubation period of days, weeks– No ground zero for response– Hospital workers may be first responders– Bioterrorism agent threat list

Weapons of Mass Destruction

• Biologic agents– Anthrax

• Bacillus anthracis• Inhalation anthrax most

lethal form• Prodromal stage• Fulminant stage• Cutaneous anthrax

Weapons of Mass Destruction

• Biologic agents– Smallpox

• Variole major• Lesions begin in mouth• Uniform lesions across

body• Use N95 respiratory

protection• Adequate vaccine

available

Weapons of Mass Destruction

• Biologic agents– Plague• Yersinia pestis• Early symptoms

– Fever, chills, mylagia• Pneumonic plague• Bubonic plague• Septicemis plague• Treated with antibiotics• N-95 respiratory protection required

Weapons of Mass Destruction

Weapons of Mass Destruction

• Biologic agents– Tularemia• Rabbit fever, deer fly fever• Rapid onset fever, chills, myalgia• Treated with antibiotics

Weapons of Mass Destruction

• Biologic agents– Botulism• Only toxin listed as class A biologic agent by CDC• Foodborne most common type• Severe disease may lead to respiratory muscle failure

Weapons of Mass Destruction

• Biologic agents– Viral hemorrhagic fevers• Ebola, Marburg, Lassa• Inordinate risk to healthcare workers• Strict infection control precautions required

Weapons of Mass Destruction

• Radiologic agents– Simple radiologic device• Radioactive source placed in heavily populated area• Spontaneously emit ionizing radiation

Weapons of Mass Destruction

• Radiologic agents– Radiologic dispersal devices or weapons– Dirty bomb– Spreads radioactive material– May be traumatic injuries from blast effect– May cause acute radiation syndrome

Weapons of Mass Destruction

• Radiologic agents– Signs• 100 rads: GI symptoms, onset within hours• 600 rads: severe GI symptoms, dehydration & death• Several 1000s of rads: Neurologic & cardiovascular

symptoms– Bone marrow depression– Leukopenia– Infections

Weapons of Mass Destruction

• Radiologic agents– Acute radiation syndrome phases• Prodromal

– Acute illness– Generalized flu symptoms– Skin sensation changes– Skin burns

• Latent– Dormant period– No symptoms– Hours to week

Weapons of Mass Destruction

• Radiologic agents– Acute radiation syndrome phases• Manifest illness

– Severity of exposure– Organs damaged

• Recovery or death

Weapons of Mass Destruction

• Radiologic agents– Treatment• Remove clothing if dirty bombs• Reverse isolation• Ambulance ventilation• Notify ED en route

Strip o’ the month

• Not a strip, more of a device… the Left Ventricular Assist Device or LVAD!

• More and more patients in our area are wearing these devices.

Why the LVAD

• The LVAD is, in effect, a portable heart pump.

•Connected to left ventricle, which does the major work of pumping blood through the body.•Worn with chest harness and fanny pack.•So advanced, patients can wear them for a few years if necessary•Until a donor heart is available

Popularity of LVAD

• So advanced that many patients now use them not while waiting for a heart, but as an end-treatment.

• Research suggests releasing patients home with LVAD contributes to positive outcomes.

• Studies show depression and co-morbidities normally linked to heart surgery and transplants are much lower with the LVAD.

A short film

• One of the more commonly used LVADs in the area is the Thoratec HeartMate II.

• The Thoratec company has released a training film for EMS responders.

• There are other brands on the market.– If you have patients with LVADs in your community,

confirm with them which models they carry and how EMS instructions may differ.

– Link to Thoratec LVAD video: http://youtu.be/GHbwIy8LQ38

LVAD wrap-up

• We have much more information in the EMS office on LVAD patients and first responders.

• LVAD patients usually contact local fire departments and ambulance services to offer training.

• If unsure how to treat an LVAD patient on scene, contact medical control and patient’s hospital liaison.– Different models may require different procedures for CPR,

for example hand-pumps, etc.

BLS Skill o’ the Month

• Traction Splints! (bipolar)• There are other ones out there… – Practice on the model you have, but the principles are the

same.• Indications: obvious femur fractures• Contraindications: knee/ankle/lower leg injuries• How do they work?– When femurs break, the strong thigh muscles contract.– Traction splints pull thigh muscles back apart, easing

tension on the broken bone and easing pain, minimizing blood loss and internal injury.

References and picture sources

• Paramedic Practice Today: Aehlert• Prehospital Emergency Care: Mistovich and

Karren

Questions?If you are watching the live

presentation, please feel free to type questions into the text box

Otherwise: Email eball@silvercross.orgOr call 815-300-7130!