EMS Response to Terrorism

[Music] EMS instructor Ken here with chapter 41 em response to terrorism as always you can find additional information in the textbook including great illustrations and charts to support the presentation if you use text other than Emergency Care use this to supplement the information in your own text as we start to discuss terrorism from the EMS perspective first we need to Define what terrorism is most of us have grown up in an era where we've seen terrorism occurring either on the news or in person person this is a picture of the 2013 Boston Marathon two brothers who were radicalized online attempted to cause chaos they actually caused chaos and during the Boston Marathon killing three and injuring multiple multiple people the definition of terrorism is the unlawful use of force or violence against persons or property to intimidate coers a government the civilian population or any segment thereof in furtherance of political or social objectives this is from the US Department of Justice FBI this is our national definition of terrorism and it can be stretched pretty far to include lots of different uh occurrences whether it's domestic or International domestic terrorism are groups or individuals whose terrorist activities are directed towards their own government or population this could be things like environmental ter terrorists uh common one is elf environmentally liberate Liberation Front we have anti-government militias ra uh racial hate groups uh all different groups fit in this category and groups with extreme political religious or other philosophies or beliefs there's a difference from having the belief and actually using that belief to further your uh actions against the government or other parties so that's where we have the the definition change a little bit there international terrorism are usually state sponsored uh foreign based they have countries or groups outside the targeted country or their activities cross National borders like Al-Qaeda Isis uh groups we were familiar with from the 9911 attacks and other attacks throughout the world growing Trends towards Loosely organized International networks with the use of the internet these groups are able to recruit train and direct their followers from all over the world and attack multiple locations at the same time types of terrorism uh were were mainly focused on C Bernie uh these are the four the methods that are used to actually create the uh Terror uh it all falls under weapons of mass destruction you hear the term C Bernie mentioned quite a bit when we're talking terrorism it's chemical biological radiological nuclear and explosives and we're going to delve into each one a little bit further detail here so terrorism and EMS what are our hazards and how do we help uh reduce the impact of a terrorist event and how do we keep ourselves safe so most people are familiar with the terrorism attacks on September 11th 2001 uh terrorists hijacked multiple airplanes flew them into the World Trade Centers and into the Pentagon on that day uh there was one other plane that was brought down by the passengers that they're not sure which Target it was intended to be for but somewhere else in DC so these are international terrorists but we have terrorism happening on a regular basis throughout the world unfortunately emergency responders are a prime target for terrorists they like to do a primary attack and then have some type of secondary device trying to capture or trying to injure the people that are uh responding to the emergency suicide bombers in Israel typically have a secondary bomb uh planted so you have the initial uh explosion and then you will have a secondary device go off once the responders get there and people start trying to solve the problem so we take out additional people so it's really key as emergency responders that you do everything you can to identify threats and maintain your safety and eliminate the hazards that are there that are going to create more terror for the organization trying to trying to enact their plans as I said the terrorists are typically trying to draw in the more body count uh try to draw in responders so that we uh become part of their victims what we want to do is uh try to identify what the threat is if we think it's a terrorism uh threat try to limit our exposure meur es and uh you also have to remember that most of these scenes are all crime scenes so we have to treat those with the respect of a crime scene try to prevent any further contamination so they can identify the source of the terrorist attack we use the acronym Auto to try to help us identify the the potential problem we're running into um as we get to a scene to figure out if there's a a potential for a terrorist attack uh we we look at the occupancy or location where we're at the type of event that we're responding to the timing of the event and then other unseen warning signs let's look a little bit deeper in these occupancy or location looking for symbolic or historic targets the Pentagon that was a Target on 911 that's a historic or for a national significance public buildings assembly areas in Colorado Springs we've had attacks on Planned Parenthood uh Club Q we've had tax attacks on a uh IRS building have controversial businesses are attacked sometimes and infrastructure systems there are regular threats against utilities Bridges um and other uh locations the type of events we're looking for uh explosions or incendiary bombs is really easy to get the information on how to make a bomb uh do not go subscribe to inspire magazine but that's the English language magazine for uh Isis uh I believe it's actually Al-Qaeda not Isis uh but you can they will tell you how to make bombs and where to get your materials so you don't draw attention uh Firearms people can get Firearms fairly easily in in United States but we have to remember that they come with responsibility the other thing we're seeing a a potential for is non-traumatic mass casually incidents say somebody released a virus into a community and uh created havoc and uh had non-traumatic uh type of mask casually that that's a potential out there the timing the event national holidays anniversaries uh September 11th has been a Target since the original attacks July 4th is always a higher risk Day New Year's Eve um April 19th that was the uh day that cold and Harris attacked the schools in Littleton it's also been an attack a favorite date for several other type of attacks we're also looking at time of day if you were going to threaten a large event you'd want to do it when the most people are there or to cause the most havoc on seeing warning sign if you you've heard the uh analogy or the the past practice of having a canary in the mindes what we're looking for things that are canaries do you see a lack of vegetation lack of animals lack of words uh unexplained symptoms we used to have a system tied into our 911 call center that if you had multiple calls for similar symptoms it would flag the response the system was uh kind of overwhelmed during coid because everybody was calling in with the same symptoms throughout the whole Community but that uh the system is there that it can uh detect symptoms so that we can identify what's going on and uh possibly uh head off an attack before it becomes a big deal we also looking for containers that are out of place uh backpacks you try to leave a backpack or a bag unattended at airport this is what we're talking about they want to identify what the hazards are and get those out of the system so the each type of threat going back to the SE Beres they all have similar um hazards that they're going to create they're going to create damage by thermal uh release either hot or cold some way we uh create a heat we create uh a severe cold uh event may have radiological harm from the alpha beta gamma particles x-rays depends on what kind of source they have for how they're releasing the radiological uh subst substances asphixiation just displacing the oxygen they can fill a location with things that will displace oxygen similar to a fire suppression system and make it really hard for people to breathe chemical harm uh either toxic or corrosive there are some concerns that terrorists may use acids or uh some alkalis to weaken Bridge structures and cause uh Bridge collapses uh or that could be toxic and a chemical harm to the people that they're in contact with eological harm a disease maybe somebody uh releases a a virus from a lab and uh infects a large population could be mechanical harm uh gunshot bombs bomb fragments the the two terrorists that did the attack on the Boston Marathon used a pressure cooker bomb it was a pressure cooker filled with lots of different sources of shrapnel and then a detonation device so you had the bone bomb fragments that were causing the most damage to people and then just the psychological harm to say maybe we told everybody that going outside is going to be dangerous and if you go outside you you could die what what would that do to the economy um what would what did the September 11th uh airplane attacks due to the uh airline industry what does any any type of terrorist attack do to the population that's not impacted and how does it in affect their psychological well-being so these things we're going to talk about on each one of our SE Bernie type of attacks and try to figure out what the threats are and then that's going to help us understand what kind of injury patterns we're going to run into and how we're going to react act as a community of EMS responders and as a community at large so with any hazardous material hazardous event we're looking at the best way to keep ourselves safe time distance shielding you hear that mentioned in radiological incidents if you take a radioactive safety class but you're also going to hear it with any other type of event you want to limit the amount of time you're exposed to whatever the agent is when we were talking about Co we were saying you if you had exposure more than 15 minutes to somebody that was testing positive because if you limited it to less than 15 your time was not considered significant enough to have a a good exposure so we want to reduce our time being exposed to any Hazard distance stay away if you have a hazardous material you can use the Emergency Response Guide book it will tell you the minimum distance but again use the rule of thumb put your thumb up if you can see the incident around your thumb back up get plenty of distance between you and the hazard and then some type of shielding that can be your clothes it could be a face shield it could be a vehicle it may be the point where you need some type of lead uh apron like you would in an x-ray uh system but there's all kinds of ways to give you some type of shielding vaccinations are also another type of shielding it gives your body the uh heads up to make antibodies before the exposure so you already have that L line of defense built into your body uh and keep you safe from any hazards so let's talk about our response to different types of terrorist events a chemical incident could be terrorism it could be uh an accidental release so we're going to we're going to treat these all the same so we're going to do the best we can to reduce our exposure limit our time make sure we have plenty of distance between us and the in incident and then have some type of protective layer between us and the incident itself so remembering that any of these toxins the chemicals can get into our body through inhalation ingestion absorption and injection that's how we're going to set up our defenses against these so on the tracem you're looking at the thermal chemical reactions can create heat uh they have an exothermic reaction when you combine the two chemicals it can create a large Heat ball and large problems for us it can use up the oxygen that's one of the problems in in a house that's on fire is the fire consumes the oxygen and reduces the amount of oxygen in the air for the occupants of that house uh could have systemic effects through the chemical reactions in the lungs the corrosiveness of the chemicals could weaken structures it could weaken uh bridges over highways and allow trains to collapse onto the roadway it could re uh weaken the the structure of a building and have it collapse and just thinking of the the psychological harm of a chemical attack because they're hard to detect initially and they create chaos so the people that aren't impacted directly are going to have some psychological fears they're going to have some concerns and that's going to be the the benefit to the terrorists there is they get a lot of psychological harm for a very small impact protective measures for chemical incidents use a respiratory protection and for chemicals we're not talking a paper mask we're talking a uh respirator with appropriate filtering cartridges or a self-contained breathing apparatus SCBA where it makes sure you have the protective clothing fire bunker gear is typically not protective clothing against chemicals so you need to have the proper chemical suit a CL level a level B suit something to keep it self-contained to keep the chemical out if you have a patient who's contaminated do not touch them until you get them deconned make some good decisions there but we want to make sure that we're being safe there have been incidents where they've people have loaded a contaminated patient in the ambulance then the whole crew ends up getting decontaminated at the hospital along with the ambulance is out of service until it's can be decontaminated so Biologicals these are more of a public health emergency they typically are not uh immediate um scene it's one that develops over hours or days could be a focused emergency where we actually know what happened at one uh one time in history there was a group that was trying to influence election in a small town in in Oregon where they actually contaminated the salad bar at a restaurant with salmonella made everybody sick and then kept them from voting so what we want to do is identify the the the symptoms and try to isolate where the source is if we have a large Public Health Emergency our Public Health Department gets involved and they try to sort these things out uh every week we get a what's going around bulletin from our local Health Department that tells us the disease processes that they're show that are showing up uh within the last week they use these to create patterns the epidemiologists will look at Trends look at locations look at age groups and they try to piece a pattern together and use statistics to try to identify if we have a h a threat that's going to be a problem for our community causal agents that we run into bacterial uh viruses and just other toxins uh toxins would be like R ryen it's a easy to make uh toxin you can get from Castor Castor beans when we're looking at biologics we're considering the amount of the exposure the dose or concentration multiply by the time so dose is how many milligrams per kilogram of your body weight so the smaller you are the bigger the chance of your exposure because you have a higher concentration and then for concentration we're looking at parts per million we we want to figure out how much you were exposed to and how long you were exposed to and then how much the patient weighs and we can calculate uh the threat to the body but again with every threat to the body we have the m multiplying factors of mitigating uh medical conditions so if somebody had they're over 55 or under five they are uh they diabetic heart disease COPD they are on certain type of immune suppression um medication your dose and concentration are going to be a lot more uh threatening as a reminder the four routes of Entry absorption through the the skin ingestion by the mouth injection needles projectiles or inhalation by breathing for Biologicals the easiest to weaponize is the breathing uh that's the the the route that's you just get one person infected they cough and then they uh spread it throughout everybody else the around there's been some chatter in Terrorist organizations about infecting somebody with small box putting them onto a plane uh having them infect everybody on the plane by just being in the vicinity and then switching planes at every destination switch to a new plane infect another 250 people and then those 250 people get into their own planes and move and spread rapidly throughout the world uh injection from Needles is uh usually self-inflicted uh but the projectiles there is a trend uh suicide bombers being recruited that have communicable diseases like he Hepatitis B or HIV and when they explode when they detonate themselves their bone fragments become projectiles that are infected and they go into other people um causing that uh biological contamination I mentioned the uh salad bar with the uh botulism that's a common uh or it's a it's a threat out there absorption through the skin is a little bit harder uh because the skin is a good uh Defender but it's it's one of those that we have to be aware of contamination you have material on you I can get material on my arm that's contamination it's not an exposure I've just been contaminated I can wash it off I can uh clean it I can get uh contamination on the inside of the ambulance on skin or hair or on my clothing so that's why we we really like to have an extra set of uniforms around just so we can swap out scrubs if you have to grab them to the hospital change out something to get the contamination off of you and exposure is when it actually enters the body if I get blood on my back of my hand I've been contaminated if I have a cut on my hand that it can go through and contaminate or to introduce the for the blood born pathogens into my system then I've had an exposure so somehow that breaks through the surface area either through the uh molecular level if I've got a protective suit I have to make sure that it's rated for the chemicals that I'm being exposed to the other thing when we are trying to get rid of this exposure contamination before it becomes an exposure we're dropping the clothing off our patients yes we should try to pre preserve dignity but you will need to understand that we're trying to save a life here so it's probably okay to have a little dignity issues there as long as we're saving a life uh we have a Decon trailer here in Colorado Springs it has male and female sides uh we were in a conference with the uh Israeli defense fund uh forces IDF and they were making fun of us having two lanes they said they just run everybody through the same Decon area and worry about dignity later so it's it's cultural thing but try to preserve it if you can if you have a choice between dignity and life take the life so on biological we'll go back to the trace some harms chemical we get the scene of the lab where uh where they're making the product um most of your Biologicals take a really really robust lab like a state sponsored lab but uh people are trying things all the time um eological you got the harm from the poisons you got the mechanical cuz to try to get the toxins or the the Biologicals exposed to everybody they sometimes use mechanical explosives the good thing here is most of the time the heat from the explosion destroys the biologic uh so we don't have much threat there but think of the psychological harm say just a little virus that you let loose give somebody a bat burger and then all of a sudden you've got uh a virus floating around the country and then out into the the World Market and then uh you got all kinds of psychological distress going on protections against Biologicals we do that every day with our PPE bloodborne pathogens are Biologicals so we're using our PPE we're using our respiratory protection the thing you want to know is get as much information as possible look for good quality sources of information uh CDC National Institute of Health are good reliable sources of information uh Facebook Tik Tok Myspace are probably not your best sources of information so use protective measures take care of yourself first make sure you are protected then take care of your partner know if you have the rapid intervention teams uh in Colorado the col uh Air National Guard has a civilian support team that will respond to any type of terrorist attack and they they specialize I in all of the suburn fields out there uh and then do some type of Civilian Protection keep people away from the hazard radiological or nuclear incidents uh our concern here are the uh suitcase bombs at one time some of our larger nation states had small nuclear devices but as the different uh Nations uh changed leadership some of these devices have gone unaccounted for uh there's some concern that they may be hiding out in car caves in Afghanistan waiting to be dropped off at the right place so uh always be concerned with anything going on out there the trouble is or the good thing for us is that they take a lot of uh skill and knowledge and uh some of the people using them are not the most skilled or knowledgeable so um if you get exposed to radiation there's some really simple treatments for that uh we do have a good system in place for that kind of response and our Hospital Systems can take care of that but thinking about the tracem the nuclear explosion uh that probably won't be an issue because if you are close enough to be involved in the explosion you won't have to worry about it anymore the problem we're going to run into is the uh nuclear winter or the uh radi radioactive materials that are around the area um then we have the explosions or the psychological harm uh you detonate nuclear bombs on major cities around the United States everybody takes off hides in the woods and uh then we have to fight for our country again our best protection advents nuclear radiological incidences are time distance shielding limiter exposure we typically have dosimeters that will tell us when we've reached the acceptable uh permissible exposure limits we want to keep our distance because it is an Airborne particle uh gamma uh beta and Alpha are all particles and they can only travel as far as the wind will take them so if we have enough uh distance between us and the event we should be good and then shielding uh most Alpha and beta particles your clo simple clothing can protect you from uh gamma is a little bit more dangerous so you have to have uh better shielding but uh take a radiological uh safety class that'll be really good for you and you learn a lot if you do get exposed decontamination is the best process uh follow your Decon processes within your system explosive events are the ones that scare me the most uh these could be anything from a simple pipe bomb uh which is fairly easy to get the information how to make to a large vehicle born uh explosive uh packing a vehicle say a U-Haul truck full of ammonium nitrate and a little fuel oil detonation of ice and you have a really large bomb uh they had one in Nashville a few years ago we had the Oklahoma City bombing we we've had several incidents we actually had one here in Colorado Springs a couple weeks ago a guy was using propane to try to make his vehicle into a uh a v vehicle born explosive device they they typically Target groups they're trying to find a way to get the most bang for their Buck um sometimes they add the Biologicals like I said about the uh suicide bombers uh then we have the chemicals or the radiological agents that they may enclude in there so there's all kinds of extra hazard that we want to be aware of again with the explosives we're going to look at the tracem PS thermal you get the heat of the detonation that's a definite uh problem with the fix asphixiation it does two things one it uses up the oxygen in the area and then the other is creates a large dust cloud everybody I'm sure seen the uh videos of the uh officers and the uh firefighter is coming out of the World Trade Center area after the towers collapsed and the huge dust cloud that was all around them you may have a chemical harm from the explosion from the the chemicals that caused the explosion or what was that whatever else was included in the explosive device uh the mechanical harm is just the actual blowing up of things and then the psychological just the fact that somebody managed to get a bomb to go off uh uh is is a problem for us so um maybe a delayed post- trumatic stress dis uh disorders so we're we're keeping an eye on our uh bystanders to make sure that they're not suffering psychological harm either protective measures be aware of the hazards so you can identify them before they become a problem uh know what the threats are know when things don't appear right somebody in a long trench coat comes into the the entertainment establishment you're at doesn't uh fit the time of year be concerned check them out uh somebody in the wrong neighborhood at the wrong time check them out try to figure out what's wrong uh after the blast occurs be aware of secondary devices and be be careful there so dissemination and weaponization that is the the hard part of set off terrorism event the best way to get it into a body is the respiratory route uh it goes in it's hard to protect um lots of surface area so we get a good absorption into the body systems the problem is getting it weaponized so that we can spread it person to person so you'd have like I said be a state sponsored lab and convince somebody e a bat burger or something other routes ingestion that is a potential uh there's potential always for somebody uh contaminating the food supply or a water supply not probable but it's a potential dmal route you would have to be pretty uh pretty close to get something on people's skin to make it go through but then the human to human contact if we can infect one person and then start spreading the disease person to person it could be a problem for us um you could could infect a drug Supply and have people that are known drug users share need uh share needles share share the drugs between each other and actually cause a a a terrorism threat on that that level too weaponization uh typically does the insul inhalation route it has to get it pretty small to the three to five microns in diameter so again like I said it's it's going to take a uh sophisticated lab uh something like the National Institute of labs or uh foreign uh government Labs get it Airborne if you try to use heat or an explosion to disseminate it you're going to degrade the uh the the product you're trying to get into the person but if you can use some type of aerosolized uh system uh there have been concerns about aerosol cans people walking through malls um fortunately uh we're pretty safe on malls anymore because no one goes to them but you could go to a sporting event uh go to a concert and start spraying uh these chemicals around just while you're walking just a little may even make it scented so it fits in with the other smells you'd smell at a concert so you'd never know it was there so characteristics of the seab Bernie agents chemicals they're typically gaseous liquid or solid the problem with chemicals is you have to get them to vaporize to get into the esor site so it's a little bit harder um they have low boiling points and high vapor pressure so they're they evaporate but you can't control their sources they have to be stable enough to survive dissemination typically chemicals will break down quickly over time and with dilution through the air we had had a concern at one time of somebody using car fetanyl which is 100 times more potent than fentanyl to contaminate a water supply so I was part of a team that looked at ways we could contaminate the water supply in a major city and it would take significant amount of car fetanyl more like eight tractor trailer tankers full of this uh carfentanyl to actually get a significant dose at the end user so it's it's a hard hard process to do um but there are people out there looking trying to do things so we're going to keep an eye on those one chemical agent we're really concerned about are the agop phosphates these are commonly used as uh fertilizers but you can also have them used as a uh chemical agent the the acronym we use for the nerve agent is slud if you see somebody that exhibits all these symptoms salivation lacrimation urination defecation GI upset emesis and meiosis we're going to have some concerns um it's fairly quick to uh occur when you get exposed to it and it's hard to treat uh typical treatment involves ALS they need the tup Pam nerve agent uh antidotes or directly uh atropine um so that's definitely an ALS call get the paramedic involved and uh hopefully we can treat them quick enough to to save them from the the attack we also have choking agents uh those are ones that uh uh like tear gas pretty simple uh device the gas that goes out we have the blistering agents mustard gas um Colorado everybody's familiar with that since we have the chemical depot in public blow and then cyanides cyanides actually uh keep the hemoglobin from taking up uh oxygen so that could be a problem for us the more common uh location we've been finding cyanides is in house fires the when you burn certain Furniture it off Gast cyanides into the air so when somebody's in the fire without the proper rest protection such as a victim they're going to be exposed to cyanides uh real simple treatment is a cyano kit it's an IV infusion over a length of time that gives you protection from the cyanides but we have to identify the threat and start treating it right away nerve agents these are uh like uh sarin gas um other other chemical weapons that are used in war and can sometimes be uh synthesized um outside of a lab or outside of a governmental lab there usually uh makes the parasympathetic nervous system go out of control and that's where you get your SL sudum signs and symptoms then we have uh riot control agents the nerve gas or the not nve gas the uh tear gases those happen pretty much uh we we see those used a lot in crowd control uh we also use pepper spray which is similar but not quite the same it just cause a burning sensation to the eyes biological agents we talked about they're going to B bacteria are actually free living organisms they uh can survive on their own so they're a little bit better for a weapon viruses have to have a host cell um if they aren't in a host they cannot reproduce they cannot live for very long uh Hepatitis B is one of those exceptions it can actually last outside the host for up to two weeks so maybe you had a a dried blood on a a on an object or a piece of equipment in your ambulance it can still have an active virus um toxins are the poisons produced by the living organism so you can have ryen is the the common one that we see but there's other uh toxins that botulism uh just uh lots of toxins out there things when we're looking at the biological agents is how infective it is how bad it is once you get it how quickly it runs its course uh does it kill the host or does it uh transmit uh becomes infectious how long is the incubation period 72 hours 2 weeks weeks is it transmittable during the incubation period uh Co was transmittable during our in incubation period so that's why it was spreading so fast uh it's easy to transmit uh fortunately for us with Co plexiglass was a cure all uh if you've been to any store that had the plexiglass we knew that uh Co would not go around or through it uh lethality how bad is it and is it stable enough to transport all concerns when we're setting up a biological agent bacterias we're talking about Anthrax cha the plague Q fever toia these are all biologics that actually attack the cells in the body and uh weaken the structures toxins we've got a chemical organ uh compound produced by the or uh living organisms they don't replicate you just have to be exposed to it so we've got botulism um ryson that's the one I said you could make real easy you've got uh stafl Cole X intertox inter terot toxin b or uh t22 I won't try to butcher that one viruses are the simplest microorganisms they're very s small uh they only replicate inside another living organism they have to have a host they're not easily to manufacture in large quantities so you have to uh get them into the population let the host reproduce them common ones we've uh had issues with in the past small poox en sephtis uh St Louis and sephtis uh westnile virus or viral hemorrhagic fever uh that would be your Ebola uh that's the one that uh hits W western Africa uh the last several years they've had outbreaks of that so radiological could be a military nuclear device U they could decide to play global thermonuclear war pop a bunch of uh nukes off at each other and ensure total Destruction but hopefully uh the governments are smart enough not to do that we could have an improvised nuclear device where they uh they use something that's uh not quite a nuclear it's a dirty bomb maybe they get something from a uh Radioactive uh lab and try to use that to make something or we could have sabotage fortunately for us with our transportation here in the United States our nuclear radioactive uh transports are fairly well secure very difficult to damage and sabotage but you could be doing training uh two pilots get into a fight drop a nuclear bomb and sell it on the open market so things can happen so we're always watching out for potential hazards keeping an eye on things and uh reacting as needed the problems when we have a nuclear device is it gets in the bone marrow and messes up our blood uh causes problems with blood production causes cancers throughout the body it will mess up the digestive system uh you will not be able to uh keep food in um and it'll you won't be able to absorb the nutrients and then also has central nervous system uh people exposed to radioactive materials typically have uh a lot of history of seizures incendiary device probably the best uh terrorist attack device outside of guns uh it's not hard to obtain or initiate what you want uh like I said you can go online and find all kinds of resources on how to make these weapons uh had a friend of mine that was a instructor for defusing weapons uh as a contractor in Afghanistan and he gave me very very good details on how to make a pressure bomb cooker when the uh uh Boston Marathon guys did theirs just it was not hard uh we do have a bomb squad that deals with these things if you have anything the suspect you need to call the bomb squad let them do it don't go in there thinking you're going to cut the red wire or the blue wire and hopefully it's the right wire uh stay away do not mess with any incendiary devices problem with uh explosive devices you have the blast injuries uh you have lung damage actually uh severe hypotension from the blast wave it causes Superior pressure on the lung forcing the blood out of the lung tissue causes braic cardia apnea it can rupture the ears which not is is not life-threatening on its own but if somebody can't hear then they can't respond to other warning signs it will rupture any uh any uh Hollow organ in the gut because of the pressure changes and then also you have the TBI uh concussion threats from the shock wave that hits the patient initially and then the impact to the ground or other objects after the shock wave so we got a lot of injury patterns we're going to have to worry about with blast treat them just like any other trauma but just be aware of what caused the injury could be a uh a a symptom that something else is going to happen let's start talking about the T strategies and tactics going use to try to address terrorism attacks our TFT ERG Emergency Response Guide gives us some basic information about most of the weapons of mass destruction tells us how far to stay away again it's the rule of thumb if you have uh uh a good understanding of instant command make sure you're using that system when you get there use the tactics involved you're going to be relying heavily on police Fire EMS and other responders so practice together make sure you understand how each other wants to work within the system first thing we have to do is consider isolation do not let people leave the scene keep everybody in the same location if you are evacuating have everybody go the same direction so that we can control any uh contamination um we can also control any threats the uh there may be the actors hiding inside the evacuation uh patients so you need to kind of control that Pro uh system do a perimeter control make sure everybody is staying within the system and nobody's coming in it's all going to depend on how many resources imagine trying to lock down uh the World Arena or a large uh Event Center how many exits are there fire code says you have to have a certain am of exits but you have to be able to control those exits to for isolation so you're going to have a a hard Pro uh a difficult time on your hands trying to figure out how many resources so you also have to figure out the stability of the scene how do we keep everybody in place so that we can make sure they're taken care of notification dispatch gets as much information as possible I talked about the ability of some dispatch centers to gather um common symptoms in common areas and try to give us some heads up for that but anything we can do to try to figure out what's going on know what resources you're Community has and how to get access to those maybe you in a small community and you need to reach out to a larger Community or even to the state or federal response uh we'll talk a little bit later about the national strategic stockpile but the federal government does have resources to respond we have the civilian support team through the Air National Guard in lot of States we have military resources that can come out off base if needed identifying what the hazard is if all possible any chemicals any lab uh information you can get is even better use the most current addition of the ERG and try to figure out what the problem is and how to protect yourselves make sure you have the right equipment to protect you whether it's enough people the vehicles uh level a suits level B suits tyvex suits air respirators whatever it takes to make sure you're safe make sure you have uh the ility to ask for additional resources do you have phones do you have radios do you have a backup system and then once you establish that there is an emergency start your staging process start your triage uh make sure those are in protected locations so they don't become injured one of the biggest things we have is responders like to park as close to the scene as possible and then they get trapped in and uh can't get out if you think there is a need for additional protection let the command system know let incident command know let your EMS work group know um if you see anybody suspicion see something say something make sure you're telling people there's a problem decontamination really simple lots of water 20 minutes or more uh water water water scrubbing uh we have uh mechanical means rinsing we scrub them with a brush and soap make sure we contain the runoff so that we can make there's not any additional threats but it's it's all necessary to get them cleaned off uh we have several Decon teams that practice regularly here in our community know what resources you have in yours your self- protection knowing what's there what's um what are the symptoms your patients having are they symptoms that could be something that causes you problems do you have multiple unresponsive patients that's a clue something's not going right uh do you have patience experience in sludge them that that just tells you there's some type of parasympathetic nervous agent out there so you need to be aware of what's going on uh patient multiple patients having difficulty breathing reden skin discolored skin um smoke that isn't the right color uh smoke is usually black or uh grayish but if it's coming off purple something is not right ma medical mask casually with no or no medical or no mental or no trauma you have a classroom of kids that multiple kids are having uh uh episodes of nausea and vomiting you start having responder casualties you you walk up and there's two cops laying next to the garage probably something in that garage is not good dead animals vegetation color of smoke favor clouds odors you notice taste is not on here taste is not an acceptable way to identify dangerous chemicals just remember that and then being aware of where you are and what's going on around you using that auto acronym again are we in a location that has a higher risk do we have a type of event going on that could be a risk the timing are we on any type of significant uh date in history are we uh any type of day that would be more active or do we have unseen Clues things that are telling us something's not right so protect yourself first thing you do is take a breath sit in your ambulance and say is it safe for me to be here if it's not leave if you don't feel safe if you don't know you can't make it safe stay away stay in your ambulance back up uh follow your command protocols set up an instant command system follow what they tell you wear the appropriate PPE if you don't have the PPE stay out if there was an explosion be aware of secondary devices look for booby traps um they the terrorists know that we will take care of our patients and they will likely set them up so that uh they can catch more people and uh cause more damage and harms and think of the psychological Terror if they uh take out multiple people search all your patients for explosives and weapons could they have something on them if you find a weapon back away let law enforcement take over understand the harms that from the trace and P make sure you have your time distance shielding limit your exposures get in and out as quick as possible if you have to go in if you don't stay a distance away get space between you and the event and then use some type of shielding your ambulance is a good shield from lot of things chemical instance look at the harms Biologicals look at the harms don't get it on you don't be Breathe It radiological time distance shielding shielding or don't expose yourself and explosions make sure it's safe for you to be there dress for the part if you see somebody wearing a suit like this that probably means that uh you shouldn't be standing next to them in your regular uniform there's probably a hazard he knows about that you don't know about so back away dress for the party so like I said the we have a national strategic stockpile uh that's a cache of pharmaceuticals medical equipment they're scattered throughout the United States in uh very diverse locations they are sitting right next to a a a Tarmac with c130s already planned out on how they would load these up they could be in any location within 12 hours uh we have used it here in Colorado before and they were on the ground in Denver within uh 6 hours and then distributed down to Colorado Springs in about 3 hours after that so it's uh they have antibiotics they have antivirals they have medic other medications they have Glo PPE they have medical equipment we also have a stockpile in Colorado Springs itself uh we have that set up just in case something happens so uh there's lots of resources know your emergency plans in your region know in your local community if you ever get a chance to practice in a drill practice so we can find out how things work and how we can make them better so some future Trends we've seen coming around active Shooters mass shootings we're familiar with them uh depends on what your Source you're listening to but there's an increase in active Shooters and mass shootings cyber terrorism are the one that's kind of scary right now uh where I work uh during the day we've had uh we get about a thou uh million cyber attacks a day 1 million attacks uh tribe intrusions some of them are looking to gather information they're trying to do a data breach others are trying to access control systems and cause damages uh there was a dam in Iran I believe that cyber terrorists managed to get the turbin on the dam Hydro uh generation site to turn tooo fast and blow up so there's there's a potential for cyber terrorism it's not just trying to hack your uh pen on your debit card to get a couple of bucks there's actually some pretty serious things could be a use of drugs or uh use of drugs of abuse as chemical weapons think we just got a a nefar a drug dealer with nefarious intents most uh businessmen will not kill off their customers but if you had somebody that was a terrorists that wanted to in uh contaminate a marijuana Supply or a fentol batch or uh any other drug that they sold on the open market you could kill a lot of people fairly quickly uh and cause mass chaos so these are some things you need to think about um and uh just be be safe make smart decisions and enjoy thank you for taking the time to watch this video hopefully it helped you on your journey to become an EMT please like And subscribe and let me know in the comments how you're doing on your class and if you have any questions thanks and have a great [Music] day [Music] he

[Music] EMS instructor Ken here with chapter 41 em response to terrorism as always you can find additional information in the textbook including great illustrations and charts to support the presentation if you use text other than Emergency Care use this to supplement the information in your own text as we start to discuss terrorism from the EMS perspective first we need to Define what terrorism is most of us have grown up in an era where we&#39;ve seen terrorism occurring either on the news or in person person this is a picture of the 2013 Boston Marathon two brothers who were radicalized online attempted to cause chaos they actually caused chaos and during the Boston Marathon killing three and injuring multiple multiple people the definition of terrorism is the unlawful use of force or violence against persons or property to intimidate coers a government the civilian population or any segment thereof in furtherance of political or social objectives this is from the US Department of Justice FBI this is our national definition of terrorism and it can be stretched pretty far to include lots of different uh occurrences whether it&#39;s domestic or International domestic terrorism are groups or individuals whose terrorist activities are directed towards their own government or population this could be things like environmental ter terrorists uh common one is elf environmentally liberate Liberation Front we have anti-government militias ra uh racial hate groups uh all different groups fit in this category and groups with extreme political religious or other philosophies or beliefs there&#39;s a difference from having the belief and actually using that belief to further your uh actions against the government or other parties so that&#39;s where we have the the definition change a little bit there international terrorism are usually state sponsored uh foreign based they have countries or groups outside the targeted country or their activities cross National borders like Al-Qaeda Isis uh groups we were familiar with from the 9911 attacks and other attacks throughout the world growing Trends towards Loosely organized International networks with the use of the internet these groups are able to recruit train and direct their followers from all over the world and attack multiple locations at the same time types of terrorism uh were were mainly focused on C Bernie uh these are the four the methods that are used to actually create the uh Terror uh it all falls under weapons of mass destruction you hear the term C Bernie mentioned quite a bit when we&#39;re talking terrorism it&#39;s chemical biological radiological nuclear and explosives and we&#39;re going to delve into each one a little bit further detail here so terrorism and EMS what are our hazards and how do we help uh reduce the impact of a terrorist event and how do we keep ourselves safe so most people are familiar with the terrorism attacks on September 11th 2001 uh terrorists hijacked multiple airplanes flew them into the World Trade Centers and into the Pentagon on that day uh there was one other plane that was brought down by the passengers that they&#39;re not sure which Target it was intended to be for but somewhere else in DC so these are international terrorists but we have terrorism happening on a regular basis throughout the world unfortunately emergency responders are a prime target for terrorists they like to do a primary attack and then have some type of secondary device trying to capture or trying to injure the people that are uh responding to the emergency suicide bombers in Israel typically have a secondary bomb uh planted so you have the initial uh explosion and then you will have a secondary device go off once the responders get there and people start trying to solve the problem so we take out additional people so it&#39;s really key as emergency responders that you do everything you can to identify threats and maintain your safety and eliminate the hazards that are there that are going to create more terror for the organization trying to trying to enact their plans as I said the terrorists are typically trying to draw in the more body count uh try to draw in responders so that we uh become part of their victims what we want to do is uh try to identify what the threat is if we think it&#39;s a terrorism uh threat try to limit our exposure meur es and uh you also have to remember that most of these scenes are all crime scenes so we have to treat those with the respect of a crime scene try to prevent any further contamination so they can identify the source of the terrorist attack we use the acronym Auto to try to help us identify the the potential problem we&#39;re running into um as we get to a scene to figure out if there&#39;s a a potential for a terrorist attack uh we we look at the occupancy or location where we&#39;re at the type of event that we&#39;re responding to the timing of the event and then other unseen warning signs let&#39;s look a little bit deeper in these occupancy or location looking for symbolic or historic targets the Pentagon that was a Target on 911 that&#39;s a historic or for a national significance public buildings assembly areas in Colorado Springs we&#39;ve had attacks on Planned Parenthood uh Club Q we&#39;ve had tax attacks on a uh IRS building have controversial businesses are attacked sometimes and infrastructure systems there are regular threats against utilities Bridges um and other uh locations the type of events we&#39;re looking for uh explosions or incendiary bombs is really easy to get the information on how to make a bomb uh do not go subscribe to inspire magazine but that&#39;s the English language magazine for uh Isis uh I believe it&#39;s actually Al-Qaeda not Isis uh but you can they will tell you how to make bombs and where to get your materials so you don&#39;t draw attention uh Firearms people can get Firearms fairly easily in in United States but we have to remember that they come with responsibility the other thing we&#39;re seeing a a potential for is non-traumatic mass casually incidents say somebody released a virus into a community and uh created havoc and uh had non-traumatic uh type of mask casually that that&#39;s a potential out there the timing the event national holidays anniversaries uh September 11th has been a Target since the original attacks July 4th is always a higher risk Day New Year&#39;s Eve um April 19th that was the uh day that cold and Harris attacked the schools in Littleton it&#39;s also been an attack a favorite date for several other type of attacks we&#39;re also looking at time of day if you were going to threaten a large event you&#39;d want to do it when the most people are there or to cause the most havoc on seeing warning sign if you you&#39;ve heard the uh analogy or the the past practice of having a canary in the mindes what we&#39;re looking for things that are canaries do you see a lack of vegetation lack of animals lack of words uh unexplained symptoms we used to have a system tied into our 911 call center that if you had multiple calls for similar symptoms it would flag the response the system was uh kind of overwhelmed during coid because everybody was calling in with the same symptoms throughout the whole Community but that uh the system is there that it can uh detect symptoms so that we can identify what&#39;s going on and uh possibly uh head off an attack before it becomes a big deal we also looking for containers that are out of place uh backpacks you try to leave a backpack or a bag unattended at airport this is what we&#39;re talking about they want to identify what the hazards are and get those out of the system so the each type of threat going back to the SE Beres they all have similar um hazards that they&#39;re going to create they&#39;re going to create damage by thermal uh release either hot or cold some way we uh create a heat we create uh a severe cold uh event may have radiological harm from the alpha beta gamma particles x-rays depends on what kind of source they have for how they&#39;re releasing the radiological uh subst substances asphixiation just displacing the oxygen they can fill a location with things that will displace oxygen similar to a fire suppression system and make it really hard for people to breathe chemical harm uh either toxic or corrosive there are some concerns that terrorists may use acids or uh some alkalis to weaken Bridge structures and cause uh Bridge collapses uh or that could be toxic and a chemical harm to the people that they&#39;re in contact with eological harm a disease maybe somebody uh releases a a virus from a lab and uh infects a large population could be mechanical harm uh gunshot bombs bomb fragments the the two terrorists that did the attack on the Boston Marathon used a pressure cooker bomb it was a pressure cooker filled with lots of different sources of shrapnel and then a detonation device so you had the bone bomb fragments that were causing the most damage to people and then just the psychological harm to say maybe we told everybody that going outside is going to be dangerous and if you go outside you you could die what what would that do to the economy um what would what did the September 11th uh airplane attacks due to the uh airline industry what does any any type of terrorist attack do to the population that&#39;s not impacted and how does it in affect their psychological well-being so these things we&#39;re going to talk about on each one of our SE Bernie type of attacks and try to figure out what the threats are and then that&#39;s going to help us understand what kind of injury patterns we&#39;re going to run into and how we&#39;re going to react act as a community of EMS responders and as a community at large so with any hazardous material hazardous event we&#39;re looking at the best way to keep ourselves safe time distance shielding you hear that mentioned in radiological incidents if you take a radioactive safety class but you&#39;re also going to hear it with any other type of event you want to limit the amount of time you&#39;re exposed to whatever the agent is when we were talking about Co we were saying you if you had exposure more than 15 minutes to somebody that was testing positive because if you limited it to less than 15 your time was not considered significant enough to have a a good exposure so we want to reduce our time being exposed to any Hazard distance stay away if you have a hazardous material you can use the Emergency Response Guide book it will tell you the minimum distance but again use the rule of thumb put your thumb up if you can see the incident around your thumb back up get plenty of distance between you and the hazard and then some type of shielding that can be your clothes it could be a face shield it could be a vehicle it may be the point where you need some type of lead uh apron like you would in an x-ray uh system but there&#39;s all kinds of ways to give you some type of shielding vaccinations are also another type of shielding it gives your body the uh heads up to make antibodies before the exposure so you already have that L line of defense built into your body uh and keep you safe from any hazards so let&#39;s talk about our response to different types of terrorist events a chemical incident could be terrorism it could be uh an accidental release so we&#39;re going to we&#39;re going to treat these all the same so we&#39;re going to do the best we can to reduce our exposure limit our time make sure we have plenty of distance between us and the in incident and then have some type of protective layer between us and the incident itself so remembering that any of these toxins the chemicals can get into our body through inhalation ingestion absorption and injection that&#39;s how we&#39;re going to set up our defenses against these so on the tracem you&#39;re looking at the thermal chemical reactions can create heat uh they have an exothermic reaction when you combine the two chemicals it can create a large Heat ball and large problems for us it can use up the oxygen that&#39;s one of the problems in in a house that&#39;s on fire is the fire consumes the oxygen and reduces the amount of oxygen in the air for the occupants of that house uh could have systemic effects through the chemical reactions in the lungs the corrosiveness of the chemicals could weaken structures it could weaken uh bridges over highways and allow trains to collapse onto the roadway it could re uh weaken the the structure of a building and have it collapse and just thinking of the the psychological harm of a chemical attack because they&#39;re hard to detect initially and they create chaos so the people that aren&#39;t impacted directly are going to have some psychological fears they&#39;re going to have some concerns and that&#39;s going to be the the benefit to the terrorists there is they get a lot of psychological harm for a very small impact protective measures for chemical incidents use a respiratory protection and for chemicals we&#39;re not talking a paper mask we&#39;re talking a uh respirator with appropriate filtering cartridges or a self-contained breathing apparatus SCBA where it makes sure you have the protective clothing fire bunker gear is typically not protective clothing against chemicals so you need to have the proper chemical suit a CL level a level B suit something to keep it self-contained to keep the chemical out if you have a patient who&#39;s contaminated do not touch them until you get them deconned make some good decisions there but we want to make sure that we&#39;re being safe there have been incidents where they&#39;ve people have loaded a contaminated patient in the ambulance then the whole crew ends up getting decontaminated at the hospital along with the ambulance is out of service until it&#39;s can be decontaminated so Biologicals these are more of a public health emergency they typically are not uh immediate um scene it&#39;s one that develops over hours or days could be a focused emergency where we actually know what happened at one uh one time in history there was a group that was trying to influence election in a small town in in Oregon where they actually contaminated the salad bar at a restaurant with salmonella made everybody sick and then kept them from voting so what we want to do is identify the the the symptoms and try to isolate where the source is if we have a large Public Health Emergency our Public Health Department gets involved and they try to sort these things out uh every week we get a what&#39;s going around bulletin from our local Health Department that tells us the disease processes that they&#39;re show that are showing up uh within the last week they use these to create patterns the epidemiologists will look at Trends look at locations look at age groups and they try to piece a pattern together and use statistics to try to identify if we have a h a threat that&#39;s going to be a problem for our community causal agents that we run into bacterial uh viruses and just other toxins uh toxins would be like R ryen it&#39;s a easy to make uh toxin you can get from Castor Castor beans when we&#39;re looking at biologics we&#39;re considering the amount of the exposure the dose or concentration multiply by the time so dose is how many milligrams per kilogram of your body weight so the smaller you are the bigger the chance of your exposure because you have a higher concentration and then for concentration we&#39;re looking at parts per million we we want to figure out how much you were exposed to and how long you were exposed to and then how much the patient weighs and we can calculate uh the threat to the body but again with every threat to the body we have the m multiplying factors of mitigating uh medical conditions so if somebody had they&#39;re over 55 or under five they are uh they diabetic heart disease COPD they are on certain type of immune suppression um medication your dose and concentration are going to be a lot more uh threatening as a reminder the four routes of Entry absorption through the the skin ingestion by the mouth injection needles projectiles or inhalation by breathing for Biologicals the easiest to weaponize is the breathing uh that&#39;s the the the route that&#39;s you just get one person infected they cough and then they uh spread it throughout everybody else the around there&#39;s been some chatter in Terrorist organizations about infecting somebody with small box putting them onto a plane uh having them infect everybody on the plane by just being in the vicinity and then switching planes at every destination switch to a new plane infect another 250 people and then those 250 people get into their own planes and move and spread rapidly throughout the world uh injection from Needles is uh usually self-inflicted uh but the projectiles there is a trend uh suicide bombers being recruited that have communicable diseases like he Hepatitis B or HIV and when they explode when they detonate themselves their bone fragments become projectiles that are infected and they go into other people um causing that uh biological contamination I mentioned the uh salad bar with the uh botulism that&#39;s a common uh or it&#39;s a it&#39;s a threat out there absorption through the skin is a little bit harder uh because the skin is a good uh Defender but it&#39;s it&#39;s one of those that we have to be aware of contamination you have material on you I can get material on my arm that&#39;s contamination it&#39;s not an exposure I&#39;ve just been contaminated I can wash it off I can uh clean it I can get uh contamination on the inside of the ambulance on skin or hair or on my clothing so that&#39;s why we we really like to have an extra set of uniforms around just so we can swap out scrubs if you have to grab them to the hospital change out something to get the contamination off of you and exposure is when it actually enters the body if I get blood on my back of my hand I&#39;ve been contaminated if I have a cut on my hand that it can go through and contaminate or to introduce the for the blood born pathogens into my system then I&#39;ve had an exposure so somehow that breaks through the surface area either through the uh molecular level if I&#39;ve got a protective suit I have to make sure that it&#39;s rated for the chemicals that I&#39;m being exposed to the other thing when we are trying to get rid of this exposure contamination before it becomes an exposure we&#39;re dropping the clothing off our patients yes we should try to pre preserve dignity but you will need to understand that we&#39;re trying to save a life here so it&#39;s probably okay to have a little dignity issues there as long as we&#39;re saving a life uh we have a Decon trailer here in Colorado Springs it has male and female sides uh we were in a conference with the uh Israeli defense fund uh forces IDF and they were making fun of us having two lanes they said they just run everybody through the same Decon area and worry about dignity later so it&#39;s it&#39;s cultural thing but try to preserve it if you can if you have a choice between dignity and life take the life so on biological we&#39;ll go back to the trace some harms chemical we get the scene of the lab where uh where they&#39;re making the product um most of your Biologicals take a really really robust lab like a state sponsored lab but uh people are trying things all the time um eological you got the harm from the poisons you got the mechanical cuz to try to get the toxins or the the Biologicals exposed to everybody they sometimes use mechanical explosives the good thing here is most of the time the heat from the explosion destroys the biologic uh so we don&#39;t have much threat there but think of the psychological harm say just a little virus that you let loose give somebody a bat burger and then all of a sudden you&#39;ve got uh a virus floating around the country and then out into the the World Market and then uh you got all kinds of psychological distress going on protections against Biologicals we do that every day with our PPE bloodborne pathogens are Biologicals so we&#39;re using our PPE we&#39;re using our respiratory protection the thing you want to know is get as much information as possible look for good quality sources of information uh CDC National Institute of Health are good reliable sources of information uh Facebook Tik Tok Myspace are probably not your best sources of information so use protective measures take care of yourself first make sure you are protected then take care of your partner know if you have the rapid intervention teams uh in Colorado the col uh Air National Guard has a civilian support team that will respond to any type of terrorist attack and they they specialize I in all of the suburn fields out there uh and then do some type of Civilian Protection keep people away from the hazard radiological or nuclear incidents uh our concern here are the uh suitcase bombs at one time some of our larger nation states had small nuclear devices but as the different uh Nations uh changed leadership some of these devices have gone unaccounted for uh there&#39;s some concern that they may be hiding out in car caves in Afghanistan waiting to be dropped off at the right place so uh always be concerned with anything going on out there the trouble is or the good thing for us is that they take a lot of uh skill and knowledge and uh some of the people using them are not the most skilled or knowledgeable so um if you get exposed to radiation there&#39;s some really simple treatments for that uh we do have a good system in place for that kind of response and our Hospital Systems can take care of that but thinking about the tracem the nuclear explosion uh that probably won&#39;t be an issue because if you are close enough to be involved in the explosion you won&#39;t have to worry about it anymore the problem we&#39;re going to run into is the uh nuclear winter or the uh radi radioactive materials that are around the area um then we have the explosions or the psychological harm uh you detonate nuclear bombs on major cities around the United States everybody takes off hides in the woods and uh then we have to fight for our country again our best protection advents nuclear radiological incidences are time distance shielding limiter exposure we typically have dosimeters that will tell us when we&#39;ve reached the acceptable uh permissible exposure limits we want to keep our distance because it is an Airborne particle uh gamma uh beta and Alpha are all particles and they can only travel as far as the wind will take them so if we have enough uh distance between us and the event we should be good and then shielding uh most Alpha and beta particles your clo simple clothing can protect you from uh gamma is a little bit more dangerous so you have to have uh better shielding but uh take a radiological uh safety class that&#39;ll be really good for you and you learn a lot if you do get exposed decontamination is the best process uh follow your Decon processes within your system explosive events are the ones that scare me the most uh these could be anything from a simple pipe bomb uh which is fairly easy to get the information how to make to a large vehicle born uh explosive uh packing a vehicle say a U-Haul truck full of ammonium nitrate and a little fuel oil detonation of ice and you have a really large bomb uh they had one in Nashville a few years ago we had the Oklahoma City bombing we we&#39;ve had several incidents we actually had one here in Colorado Springs a couple weeks ago a guy was using propane to try to make his vehicle into a uh a v vehicle born explosive device they they typically Target groups they&#39;re trying to find a way to get the most bang for their Buck um sometimes they add the Biologicals like I said about the uh suicide bombers uh then we have the chemicals or the radiological agents that they may enclude in there so there&#39;s all kinds of extra hazard that we want to be aware of again with the explosives we&#39;re going to look at the tracem PS thermal you get the heat of the detonation that&#39;s a definite uh problem with the fix asphixiation it does two things one it uses up the oxygen in the area and then the other is creates a large dust cloud everybody I&#39;m sure seen the uh videos of the uh officers and the uh firefighter is coming out of the World Trade Center area after the towers collapsed and the huge dust cloud that was all around them you may have a chemical harm from the explosion from the the chemicals that caused the explosion or what was that whatever else was included in the explosive device uh the mechanical harm is just the actual blowing up of things and then the psychological just the fact that somebody managed to get a bomb to go off uh uh is is a problem for us so um maybe a delayed post- trumatic stress dis uh disorders so we&#39;re we&#39;re keeping an eye on our uh bystanders to make sure that they&#39;re not suffering psychological harm either protective measures be aware of the hazards so you can identify them before they become a problem uh know what the threats are know when things don&#39;t appear right somebody in a long trench coat comes into the the entertainment establishment you&#39;re at doesn&#39;t uh fit the time of year be concerned check them out uh somebody in the wrong neighborhood at the wrong time check them out try to figure out what&#39;s wrong uh after the blast occurs be aware of secondary devices and be be careful there so dissemination and weaponization that is the the hard part of set off terrorism event the best way to get it into a body is the respiratory route uh it goes in it&#39;s hard to protect um lots of surface area so we get a good absorption into the body systems the problem is getting it weaponized so that we can spread it person to person so you&#39;d have like I said be a state sponsored lab and convince somebody e a bat burger or something other routes ingestion that is a potential uh there&#39;s potential always for somebody uh contaminating the food supply or a water supply not probable but it&#39;s a potential dmal route you would have to be pretty uh pretty close to get something on people&#39;s skin to make it go through but then the human to human contact if we can infect one person and then start spreading the disease person to person it could be a problem for us um you could could infect a drug Supply and have people that are known drug users share need uh share needles share share the drugs between each other and actually cause a a a terrorism threat on that that level too weaponization uh typically does the insul inhalation route it has to get it pretty small to the three to five microns in diameter so again like I said it&#39;s it&#39;s going to take a uh sophisticated lab uh something like the National Institute of labs or uh foreign uh government Labs get it Airborne if you try to use heat or an explosion to disseminate it you&#39;re going to degrade the uh the the product you&#39;re trying to get into the person but if you can use some type of aerosolized uh system uh there have been concerns about aerosol cans people walking through malls um fortunately uh we&#39;re pretty safe on malls anymore because no one goes to them but you could go to a sporting event uh go to a concert and start spraying uh these chemicals around just while you&#39;re walking just a little may even make it scented so it fits in with the other smells you&#39;d smell at a concert so you&#39;d never know it was there so characteristics of the seab Bernie agents chemicals they&#39;re typically gaseous liquid or solid the problem with chemicals is you have to get them to vaporize to get into the esor site so it&#39;s a little bit harder um they have low boiling points and high vapor pressure so they&#39;re they evaporate but you can&#39;t control their sources they have to be stable enough to survive dissemination typically chemicals will break down quickly over time and with dilution through the air we had had a concern at one time of somebody using car fetanyl which is 100 times more potent than fentanyl to contaminate a water supply so I was part of a team that looked at ways we could contaminate the water supply in a major city and it would take significant amount of car fetanyl more like eight tractor trailer tankers full of this uh carfentanyl to actually get a significant dose at the end user so it&#39;s it&#39;s a hard hard process to do um but there are people out there looking trying to do things so we&#39;re going to keep an eye on those one chemical agent we&#39;re really concerned about are the agop phosphates these are commonly used as uh fertilizers but you can also have them used as a uh chemical agent the the acronym we use for the nerve agent is slud if you see somebody that exhibits all these symptoms salivation lacrimation urination defecation GI upset emesis and meiosis we&#39;re going to have some concerns um it&#39;s fairly quick to uh occur when you get exposed to it and it&#39;s hard to treat uh typical treatment involves ALS they need the tup Pam nerve agent uh antidotes or directly uh atropine um so that&#39;s definitely an ALS call get the paramedic involved and uh hopefully we can treat them quick enough to to save them from the the attack we also have choking agents uh those are ones that uh uh like tear gas pretty simple uh device the gas that goes out we have the blistering agents mustard gas um Colorado everybody&#39;s familiar with that since we have the chemical depot in public blow and then cyanides cyanides actually uh keep the hemoglobin from taking up uh oxygen so that could be a problem for us the more common uh location we&#39;ve been finding cyanides is in house fires the when you burn certain Furniture it off Gast cyanides into the air so when somebody&#39;s in the fire without the proper rest protection such as a victim they&#39;re going to be exposed to cyanides uh real simple treatment is a cyano kit it&#39;s an IV infusion over a length of time that gives you protection from the cyanides but we have to identify the threat and start treating it right away nerve agents these are uh like uh sarin gas um other other chemical weapons that are used in war and can sometimes be uh synthesized um outside of a lab or outside of a governmental lab there usually uh makes the parasympathetic nervous system go out of control and that&#39;s where you get your SL sudum signs and symptoms then we have uh riot control agents the nerve gas or the not nve gas the uh tear gases those happen pretty much uh we we see those used a lot in crowd control uh we also use pepper spray which is similar but not quite the same it just cause a burning sensation to the eyes biological agents we talked about they&#39;re going to B bacteria are actually free living organisms they uh can survive on their own so they&#39;re a little bit better for a weapon viruses have to have a host cell um if they aren&#39;t in a host they cannot reproduce they cannot live for very long uh Hepatitis B is one of those exceptions it can actually last outside the host for up to two weeks so maybe you had a a dried blood on a a on an object or a piece of equipment in your ambulance it can still have an active virus um toxins are the poisons produced by the living organism so you can have ryen is the the common one that we see but there&#39;s other uh toxins that botulism uh just uh lots of toxins out there things when we&#39;re looking at the biological agents is how infective it is how bad it is once you get it how quickly it runs its course uh does it kill the host or does it uh transmit uh becomes infectious how long is the incubation period 72 hours 2 weeks weeks is it transmittable during the incubation period uh Co was transmittable during our in incubation period so that&#39;s why it was spreading so fast uh it&#39;s easy to transmit uh fortunately for us with Co plexiglass was a cure all uh if you&#39;ve been to any store that had the plexiglass we knew that uh Co would not go around or through it uh lethality how bad is it and is it stable enough to transport all concerns when we&#39;re setting up a biological agent bacterias we&#39;re talking about Anthrax cha the plague Q fever toia these are all biologics that actually attack the cells in the body and uh weaken the structures toxins we&#39;ve got a chemical organ uh compound produced by the or uh living organisms they don&#39;t replicate you just have to be exposed to it so we&#39;ve got botulism um ryson that&#39;s the one I said you could make real easy you&#39;ve got uh stafl Cole X intertox inter terot toxin b or uh t22 I won&#39;t try to butcher that one viruses are the simplest microorganisms they&#39;re very s small uh they only replicate inside another living organism they have to have a host they&#39;re not easily to manufacture in large quantities so you have to uh get them into the population let the host reproduce them common ones we&#39;ve uh had issues with in the past small poox en sephtis uh St Louis and sephtis uh westnile virus or viral hemorrhagic fever uh that would be your Ebola uh that&#39;s the one that uh hits W western Africa uh the last several years they&#39;ve had outbreaks of that so radiological could be a military nuclear device U they could decide to play global thermonuclear war pop a bunch of uh nukes off at each other and ensure total Destruction but hopefully uh the governments are smart enough not to do that we could have an improvised nuclear device where they uh they use something that&#39;s uh not quite a nuclear it&#39;s a dirty bomb maybe they get something from a uh Radioactive uh lab and try to use that to make something or we could have sabotage fortunately for us with our transportation here in the United States our nuclear radioactive uh transports are fairly well secure very difficult to damage and sabotage but you could be doing training uh two pilots get into a fight drop a nuclear bomb and sell it on the open market so things can happen so we&#39;re always watching out for potential hazards keeping an eye on things and uh reacting as needed the problems when we have a nuclear device is it gets in the bone marrow and messes up our blood uh causes problems with blood production causes cancers throughout the body it will mess up the digestive system uh you will not be able to uh keep food in um and it&#39;ll you won&#39;t be able to absorb the nutrients and then also has central nervous system uh people exposed to radioactive materials typically have uh a lot of history of seizures incendiary device probably the best uh terrorist attack device outside of guns uh it&#39;s not hard to obtain or initiate what you want uh like I said you can go online and find all kinds of resources on how to make these weapons uh had a friend of mine that was a instructor for defusing weapons uh as a contractor in Afghanistan and he gave me very very good details on how to make a pressure bomb cooker when the uh uh Boston Marathon guys did theirs just it was not hard uh we do have a bomb squad that deals with these things if you have anything the suspect you need to call the bomb squad let them do it don&#39;t go in there thinking you&#39;re going to cut the red wire or the blue wire and hopefully it&#39;s the right wire uh stay away do not mess with any incendiary devices problem with uh explosive devices you have the blast injuries uh you have lung damage actually uh severe hypotension from the blast wave it causes Superior pressure on the lung forcing the blood out of the lung tissue causes braic cardia apnea it can rupture the ears which not is is not life-threatening on its own but if somebody can&#39;t hear then they can&#39;t respond to other warning signs it will rupture any uh any uh Hollow organ in the gut because of the pressure changes and then also you have the TBI uh concussion threats from the shock wave that hits the patient initially and then the impact to the ground or other objects after the shock wave so we got a lot of injury patterns we&#39;re going to have to worry about with blast treat them just like any other trauma but just be aware of what caused the injury could be a uh a a symptom that something else is going to happen let&#39;s start talking about the T strategies and tactics going use to try to address terrorism attacks our TFT ERG Emergency Response Guide gives us some basic information about most of the weapons of mass destruction tells us how far to stay away again it&#39;s the rule of thumb if you have uh uh a good understanding of instant command make sure you&#39;re using that system when you get there use the tactics involved you&#39;re going to be relying heavily on police Fire EMS and other responders so practice together make sure you understand how each other wants to work within the system first thing we have to do is consider isolation do not let people leave the scene keep everybody in the same location if you are evacuating have everybody go the same direction so that we can control any uh contamination um we can also control any threats the uh there may be the actors hiding inside the evacuation uh patients so you need to kind of control that Pro uh system do a perimeter control make sure everybody is staying within the system and nobody&#39;s coming in it&#39;s all going to depend on how many resources imagine trying to lock down uh the World Arena or a large uh Event Center how many exits are there fire code says you have to have a certain am of exits but you have to be able to control those exits to for isolation so you&#39;re going to have a a hard Pro uh a difficult time on your hands trying to figure out how many resources so you also have to figure out the stability of the scene how do we keep everybody in place so that we can make sure they&#39;re taken care of notification dispatch gets as much information as possible I talked about the ability of some dispatch centers to gather um common symptoms in common areas and try to give us some heads up for that but anything we can do to try to figure out what&#39;s going on know what resources you&#39;re Community has and how to get access to those maybe you in a small community and you need to reach out to a larger Community or even to the state or federal response uh we&#39;ll talk a little bit later about the national strategic stockpile but the federal government does have resources to respond we have the civilian support team through the Air National Guard in lot of States we have military resources that can come out off base if needed identifying what the hazard is if all possible any chemicals any lab uh information you can get is even better use the most current addition of the ERG and try to figure out what the problem is and how to protect yourselves make sure you have the right equipment to protect you whether it&#39;s enough people the vehicles uh level a suits level B suits tyvex suits air respirators whatever it takes to make sure you&#39;re safe make sure you have uh the ility to ask for additional resources do you have phones do you have radios do you have a backup system and then once you establish that there is an emergency start your staging process start your triage uh make sure those are in protected locations so they don&#39;t become injured one of the biggest things we have is responders like to park as close to the scene as possible and then they get trapped in and uh can&#39;t get out if you think there is a need for additional protection let the command system know let incident command know let your EMS work group know um if you see anybody suspicion see something say something make sure you&#39;re telling people there&#39;s a problem decontamination really simple lots of water 20 minutes or more uh water water water scrubbing uh we have uh mechanical means rinsing we scrub them with a brush and soap make sure we contain the runoff so that we can make there&#39;s not any additional threats but it&#39;s it&#39;s all necessary to get them cleaned off uh we have several Decon teams that practice regularly here in our community know what resources you have in yours your self- protection knowing what&#39;s there what&#39;s um what are the symptoms your patients having are they symptoms that could be something that causes you problems do you have multiple unresponsive patients that&#39;s a clue something&#39;s not going right uh do you have patience experience in sludge them that that just tells you there&#39;s some type of parasympathetic nervous agent out there so you need to be aware of what&#39;s going on uh patient multiple patients having difficulty breathing reden skin discolored skin um smoke that isn&#39;t the right color uh smoke is usually black or uh grayish but if it&#39;s coming off purple something is not right ma medical mask casually with no or no medical or no mental or no trauma you have a classroom of kids that multiple kids are having uh uh episodes of nausea and vomiting you start having responder casualties you you walk up and there&#39;s two cops laying next to the garage probably something in that garage is not good dead animals vegetation color of smoke favor clouds odors you notice taste is not on here taste is not an acceptable way to identify dangerous chemicals just remember that and then being aware of where you are and what&#39;s going on around you using that auto acronym again are we in a location that has a higher risk do we have a type of event going on that could be a risk the timing are we on any type of significant uh date in history are we uh any type of day that would be more active or do we have unseen Clues things that are telling us something&#39;s not right so protect yourself first thing you do is take a breath sit in your ambulance and say is it safe for me to be here if it&#39;s not leave if you don&#39;t feel safe if you don&#39;t know you can&#39;t make it safe stay away stay in your ambulance back up uh follow your command protocols set up an instant command system follow what they tell you wear the appropriate PPE if you don&#39;t have the PPE stay out if there was an explosion be aware of secondary devices look for booby traps um they the terrorists know that we will take care of our patients and they will likely set them up so that uh they can catch more people and uh cause more damage and harms and think of the psychological Terror if they uh take out multiple people search all your patients for explosives and weapons could they have something on them if you find a weapon back away let law enforcement take over understand the harms that from the trace and P make sure you have your time distance shielding limit your exposures get in and out as quick as possible if you have to go in if you don&#39;t stay a distance away get space between you and the event and then use some type of shielding your ambulance is a good shield from lot of things chemical instance look at the harms Biologicals look at the harms don&#39;t get it on you don&#39;t be Breathe It radiological time distance shielding shielding or don&#39;t expose yourself and explosions make sure it&#39;s safe for you to be there dress for the part if you see somebody wearing a suit like this that probably means that uh you shouldn&#39;t be standing next to them in your regular uniform there&#39;s probably a hazard he knows about that you don&#39;t know about so back away dress for the party so like I said the we have a national strategic stockpile uh that&#39;s a cache of pharmaceuticals medical equipment they&#39;re scattered throughout the United States in uh very diverse locations they are sitting right next to a a a Tarmac with c130s already planned out on how they would load these up they could be in any location within 12 hours uh we have used it here in Colorado before and they were on the ground in Denver within uh 6 hours and then distributed down to Colorado Springs in about 3 hours after that so it&#39;s uh they have antibiotics they have antivirals they have medic other medications they have Glo PPE they have medical equipment we also have a stockpile in Colorado Springs itself uh we have that set up just in case something happens so uh there&#39;s lots of resources know your emergency plans in your region know in your local community if you ever get a chance to practice in a drill practice so we can find out how things work and how we can make them better so some future Trends we&#39;ve seen coming around active Shooters mass shootings we&#39;re familiar with them uh depends on what your Source you&#39;re listening to but there&#39;s an increase in active Shooters and mass shootings cyber terrorism are the one that&#39;s kind of scary right now uh where I work uh during the day we&#39;ve had uh we get about a thou uh million cyber attacks a day 1 million attacks uh tribe intrusions some of them are looking to gather information they&#39;re trying to do a data breach others are trying to access control systems and cause damages uh there was a dam in Iran I believe that cyber terrorists managed to get the turbin on the dam Hydro uh generation site to turn tooo fast and blow up so there&#39;s there&#39;s a potential for cyber terrorism it&#39;s not just trying to hack your uh pen on your debit card to get a couple of bucks there&#39;s actually some pretty serious things could be a use of drugs or uh use of drugs of abuse as chemical weapons think we just got a a nefar a drug dealer with nefarious intents most uh businessmen will not kill off their customers but if you had somebody that was a terrorists that wanted to in uh contaminate a marijuana Supply or a fentol batch or uh any other drug that they sold on the open market you could kill a lot of people fairly quickly uh and cause mass chaos so these are some things you need to think about um and uh just be be safe make smart decisions and enjoy thank you for taking the time to watch this video hopefully it helped you on your journey to become an EMT please like And subscribe and let me know in the comments how you&#39;re doing on your class and if you have any questions thanks and have a great [Music] day [Music] he

Transcript for:EMS Response to Terrorism

Transcript for:
EMS Response to Terrorism