Ch. 39 – EMS Response to Terrorism

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Terrorism is defined as
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the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population or any segment thereof, in furtherance of political or social objectives
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2 types of terrorism in US are:
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domestic & international
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Domestic terrorism involves
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groups/individuals whose terrorist activities are directed at their own government/population without foreign direction
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International terrorism involves
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groups/individuals whose terrorist activities are purely foreign based and/or directed by countries/groups outside the targeted country or whose activities cross national boundaries
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In addition to armed attacks, incidents of terrorism may involve CBRNE agents:
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Chemical, Biological, Radiological, Nuclear, Explosive
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Weapons of mass destruction (WMBD) are
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weapons, devices, or agents intended to cause widespread harm and/or fear among a population
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The EMT should recognize that any terrorist event in the US is considered
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a crime scene
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Two additional terrorism related factors that all responders will have to take into account are:
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deliberate targeting of responders and crime scene considerations
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A secondary device is those used to
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injure first responders
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Clues such as the OTTO signs will help recognizing suspicious incidents:
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Occupancy or location Type of event Timing of the event On-scene warning signs
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Types of harm to which you can be exposed TRACEM-P are:
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Thermal harm Radiological harm Asphyxiation Chemical harm Etiological harm (causes of disease like bacteria/virus/toxin) Mechanical harm Psychological harm
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Protection of the EMR is based on avoiding/minimizing exposure based on
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Time: minimize time at a dangerous scene Distance: maximize distance from hazard area Shielding: to address specific hazards (PPE, buildings, vehicles)
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Types of harm from chemical incidents:
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Primary: C Secondary: TAM-P
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Biological incidents can be caused by
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bacteria, viruses, or toxins
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Exposure is
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the dose or concentration of an agent multiplied by the time, or duration
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Chemical doses are generally measured in
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milligrams per kilogram of body weight
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Biological doses are measured in
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fractions of micrograms per kilogram of body weight
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The concentration of an agent is measured in
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parts per million
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Infectious dose data are standardized and typically based on
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a 150-pound male in good health
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The four major routes of entry are:
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Absorption (skin contact) Ingestion (mouth) Injection (needles/projectiles) Inhalation (breathing)
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Contamination is caused by
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contact with or presence of a contaminant, a material that is present where it does not belong and is somehow harmful to persons/animals/environment
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Exposure vs. Contamination
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Exposure occurs when a substance is taken into the body through one of the routes of exposure while contamination occurs when a substance clings to surface areas of the body or clothing
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Permeation is
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the movement of a substance through a surface or, on a molecular level, through intact materials; mass penetration or spreading
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The removal of _______ removes most of the contamination.
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Clothing
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Types of harm from biological incidents
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Primary: E Secondary: CM-P
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Types of harm from radiological/nuclear incidents:
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Primary: TRM Secondary:C-P
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Types of harm from explosive incidents:
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Primary: TCM Secondary: A-P
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Dissemination is
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spreading
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The most effective and most common means of dissemination is to enable the material to enter through
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the respiratory tract
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Weaponization is
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the packaging or producing a material so ti can be used as a weapon
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Chemical agents with a ____ boiling point tend to be more persistent
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high
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SLUDGEM is a
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mnemonic used to remember the signs and symptoms of nerve agent poisoning
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SLUDGEM stands for
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Salivation Lacrimation (due to stimulation of the lacrimal glands) Urination Defecation GI upset Emesis (vomiting from GI system effects) Miosis (abnormal contraction of the pupils)
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Biological agents are
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microorganisms or toxins that can cause disease processes
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A zoonotic disease is
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a disease that can move through the animal-human barrier; anthrax
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Anthrax is a ______ bacterium and can survive
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sporulating (spore-producing); the acids of the stomach
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An RDD is a
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radiological dispersal device (RDD) or “dirty bomb”
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If a terrorist were to use a radiological material, the three body systems that would be most severely affected are:
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Blood-forming system (specifically bone marrow) GI system CNS
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Rem is the
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roentgen equivalent man; a measure of radiation dosage
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Strategies vs. Tactics
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Broad general plans designed to achieve desired outcomes vs. specific operational actions to accomplish assigned tasks
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Tasks for responders are:
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Isolation Notification Identification Protection
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An EMT’s protection responsibilities include:
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Make an initial scene size-up to determine security threats Request protection via radio Establish vehicle staging & triage/treatment areas in protected locations Advise EMS command about protection/security concerns Immediately report suspicious people/activities
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How to protect yourself in terrorist attacks:
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Recognize a possible terrorist event with OTTO don’t rush in Understand the TRACEM-P harms Time, distance, and shielding
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Injuries received during the secondary blast phase are caused? by
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blast projectiles
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?”Blast lung” is a consequence? of
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a high-energy overpressurization wave
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Which type of weapon ignites certain elements that burn? rapidly, causing violent air? displacement?
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Explosive
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What penetrating power do alpha particles? have?
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Alpha particles have little penetrating ability and can be stopped by paper or clothing
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Thermal injury would MOST likely be due? to
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an explosive event
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Who is responsible for perimeter control at a terrorism? incident?
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Law enforcement personnel
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When treating thermal injuries at a terrorism? incident, the EMT? should
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follow local protocols
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For an ingested weapon to be? effective, it? would
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have to survive in an acidic environment
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Into what category of hazardous materials do weapons of mass destruction commonly? fall?
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Toxic & flammable gases NOT Flammable? solids, materials that are dangerous when? wet, or materials that are spontaneously combustible NOT corrosives NOT organic peroxides
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What is a measure of radiation dosage?
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Rem
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Nerve agents are _______ agents
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chemical
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A type of harm that you may be exposed to as an EMT responding to a terrorist incident that is characterized by a resulting? post-traumatic stress disorder? (PSTD) is typically called? a(n)
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psychological harm
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An outbreak of _______ would be LEAST likely to occur naturally
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anthrax
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Two elements that differentiate a hazardous materials incident from a terrorist incident? are
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crime scene considerations and targeting responders
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The current trend in international terrorism is that it tends to be motivated by?
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Religion
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An oxygen level of? ________ is required for normal breathing.
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19.5%
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A terrorist incident may have features in common with
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mass casualty, haz mat, and infectious disease incidents
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Tertiary injuries from a blast? include
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extremity fractures
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Standard management of a chemical burn caused by a terrorist incident? includes
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irrigating vigorously with cool water
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What chemical agent prohibits the use of oxygen in the? cells?
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Cyanide
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Primary injuries from a blast? include
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lung injuries
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What method decontamination is NOT usually a prehospital activity during a terrorism? incident?
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Neutralization
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What methods of decontamination are usually a prehospital activity during a terrorism incident?
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Dilution, Absorption, and Isolation
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Anthrax can infect an individual through which of the following routes of? exposure?
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Skin, inhalation, ingestion
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What impacts the behavior of a chemical in an MCI?
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Physical state of the agent, route of entry into the body, and volatility of the agent. NOT whether it was an intentional or accidental exposure
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Which of the following animals is the direct source of exposure of the bacterium that causes the plague to? humans?
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Rats
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Dangerous organisms that can grow in a variety of environments and are capable of producing toxic substances are known? as
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bacteria
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Concerning the threat of nuclear devices used in terrorist? attacks, which of the following is MOST likely to be used in such an? attack?
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Sabotage of facilities for nuclear research
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The formula dose multiplied by time represents which of the? following?
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Exposure
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You are on the scene of a probable terrorist attack with several other? agencies, both local and federal. In order to operate in an efficient? manner, all agencies should follow? the
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Incident Command System (ICS)
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Dangerous organisms that grow inside of living cells and reproduce are known? as
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viruses
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Vesicants are ______ and are a type of ________
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blistering agents; chemical weapon
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A biological event will likely lead to patients with
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unexplained illness
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Your patient has been exposed to a vesicant agent. His injuries will be caused? by:
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Absorption

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