terrorism, personal protective equipment, decontamination.pdf

terrorism, ppe, decontamination.pdf

4. WEAPONS OF MASS DESTRUCTION
Weapons of Mass destruction: biological,
chemical and radioactive weapons

6. Biologic weapons – weapons used to spread
disease
Biological warfare is a covert method of
effecting objectives by inflicting significant
morbidity and mortality
Applied to food or drinks; or by inhalation/ direct
contact

8. TULAREMIA – ALSO KNOWN AS RABBIT FEVER, A DISEASE CAUSE BY THE BACTERIUM FRANCISELLA
TULAREMSIS.

9. BOTULISM – RARE BUT SERIOUS ILLNESS CAUSED BY A TOXIN THAT ATTACKS THE BODY’S NERVES
AND CAUSE DIFFCULTY BREATHING, MUSCLE PARALYSIS AND EVEN DEATH.
THIS TOXIN CAN BE KILLED BY BOILING AND COOKING.

10. PLAGUE – A DISEASE THAT AFFECTS HUMANS AND OTHER MAMMALS CAUSED BY BACTERIUM
YERSIMIA PESTIS
COMMON SIGNS AND SYMPTOMS INCLUDE: FEVER, HEADACHE, CHILLS AND WEAKNESS AND ONE
OR MORE SWELLING AND PAINFUL NODES (BUBOES).

12. Biologic Agents
Anthrax – Bacillus Anthracis; replicates if exposed
to air and infective in their spore state only.
Infects through direct contact or inhalation
Odorless and invisible; can travel great distances
before disseminating
8000 to 50,000 spores must be inhaled to be
infected
1500 BC (Egypt); 1979 (Russia); 1995 (Japan); 2001
(US)

13. S/Sx:
Causes hemorrhage, edema and necrosis
Incubation time: 1-6 days
Skin, Inhalation and Gastrointestinal
Skin lesions are the primary infection; develops to a
ulcer with 1-3mm vesicles and lastly a painless
eschar falls off after 1-2weeks
GI: fever, nausea, vomiting, abdominal pain,
bloody diarrhea and ascites; attacks the terminal
ileum and cecum

14. URT: flulike symptoms and not treated by antibiotics
Incubation: 60 days
Cough, headache, fever, vomiting, chills, weakness,
mild chest discomfort, dyspnea, syncope
Brief recovery followed by a second stage within 1-3
days
Fever, severe respiratory distress, stridor, hypoxia,
cyanosis, diaphoresis, hypotension and shock
Mediastinitis on CXR (Hallmark sign)
Mortality at 100% 24 to 36 hours after onset of the
second stage

15. Treatment:
Penicillin sensitive
Penicillin, Erythromycin, Gentamicin, Doxycycline
In MCI: Doxycycline; Ciprofloxacin for 60 days
Death: cremation is recommended
No vaccine available to the public except the
military

16. Small pox (Variola)
A DNA virus
Approx. 12 days incubation period
Extremely contagious; spread by direct contact,
contact with vectors or by droplets
Rashes will appear after the fever state; 30% case
fatality rate
Smallpox survives in a cool and low humidity
environment up to 24H

17. S/Sx:
Initial: high fever, malaise, headache, backache
After 1-2 days: maculopapular rash appears from
the face to the trunk
Smallpox is contagious after the appearance of the
rash
Treatment:
Isolation, antibiotics, decontamination
Cremation; virus survives in scabs for 13 years

18. Severe Acute Respiratory Syndrome (SARS)
SARS-CoV
Incubation period: 2-10 days
Started in China as an ‘atypical’ pneumonia (Feb.
2003)
S/Sx: SOB, Dry Cough, Pneumonia or ARDS in CXR;
Evident of 7-10 days
Tx: Droplet precaution; support; antiviral drugs

20. Radiologic weapon or “dirty bomb”
Weapon grade plutonium or uranium
Nuclear fuel or medical nuclear supplies
Types of radiation:
Alpha particles – cannot penetrate the skin;
ingestion, inhalation and injection; local
damage
Beta particles – moderately penetrate the skin;
skin damage
Gamma radiation – short wavelength
electromagnetic energy; penetrating; X-ray

21. Measurement:
rad – 0.01 joule of energy/kg of tissue; basic unit
of measurement
rem (roentgen equivalent man) – reflects the
type of radiation and the potential of damage;
normal exposure per year is at 360mrem (1 rem
= 1000mrem)
Half-life – amount of time for a radioactive product
to lose half of its radioactivity
Detected by: a Geiger counter or Geiger-Mueller
survey meter

22. Exposure:
External Irridation – physical exposure
Contamination – exposure to gases, liquids and
solids
Incorporation – uptake of cells, tissues and organs
Decontamination:
Done outside the ER
Survival:
Probable – no s/sx
Possible – nausea and vomiting for 1-2 days
Improbable – rad at 800; shock

23. Phase Time of Occurrence Signs and Symptoms
Prodromal Phase
(presenting s/sx)
48-72H after exposure Nausea, vomiting, loss of
appetite, diarrhea,
fatigue
Latent Phase (no s/sx) After prodromal phase
up to 3 weeks or shorter
Decreased lymphocytes,
leukocytes,
thrombocytes and RBC’s
Illness Phase After latent phase Infection, F/E imbalance,
bleeding, diarrhea,
shock
Recovery Phase or After illness phase Weeks to months for full
recovery
Death After illness phase Increased ICP

25. CHEMICAL WEAPONS
Chemical weapons – used in chemical warfare; covert
agents
Results in major mortality or morbidity, panic, social
disturbance
These chemicals are:
Nerve Agents
Blood Agents
Vesicants
Heavy metals
Volatile Toxins
Pulmonary Agents
Corrosive Acids

28. Characteristics of Chemicals:
Volatility – tendency of a chemical to be a vapor;
most chemicals are heavier than air; most volatile
are phosgene and cyanide
Persistence – Less likely to vaporize and disperse;
most industrial chemicals are not persistent
Toxicity – potential of a chemical to cause injury to
the body
Latency – time from absorption to the appearance of
s/sx; sulfur mustards and pulmonary agents

29. Lethal dose (LD50)
Effective dose (ED50)
Concentration time (CT):
Concentration x time of exposure = mg/min

30. Vesicants
Cause blisters and results in burning, conjunctivitis,
bronchitis, pneumonia, hematopoietic suppression
and death
Lewisite, phosgene, nitrogen mustard and sulfur
mustard
Liquid sulfur is the most commonly used vesicant
Highly incapacitating
S/Sx: superficial to partial thickness burns in warm
and moist areas, stinging and erythema, pruritus
and vesicle formation at 2-18 hours

31. Eye: photophobia, lacrimation and decreased
vision
Respiratory: airway obstruction
GI: nausea, vomiting, upper GI bleeding
Tx: decontamination, avoid scrubbing, eye
irrigation, intubation and bronchoscopy,
Dimercaprol IV for Lewisite exposure

32. Nerve agents
Most toxic agents
Sarin, Soman, Tabun, VX and
organophosphates(pesticides)
Inexpensive, effective in small quantities and
easily dispersed
Usually evaporates to a colorless and odorless
vapor
Effects begin at 30min to 18 hours after
exposure

33. S/Sx: cholinergic crisis, visual disturbances,
increased GI motility, nausea and vomiting,
diarrhea, substernal spasm, indigestion,
bradycardia
Insomia, forgetfulness, impaired judgement,
depression, LOC, seizures, copious secretions,
flaccid muscles, apnea
Tx: decontamination with soap and water or saline
solution for 8-20min, blotted dry, maintain airway
patency, suctioning, Atropine 2-4mg IV,
Pralidoxine IV and Diazepam

34. Blood agents
Hydrogen cyanide, cyanogen chloride
Directly affects cellular metabolism and results to
asphyxiation
 also emitted during house fires during combustion
of plastic, rugs, furniture and other construction
materials
Ingested, inhaled or absorbed
S/Sx: respiratory muscle failure, respiratory arrest,
cardiac arrest, flushing, tachypnea, bradycardia,
stupor and coma

35. Pulmonary Agents
Chlorine, Phosgene
Causes: pulmonary edema, SOB
Mask is used for protection

36. Tx: Administration of Amyl nitrate, sodium
nitrate and sodium thiosulfate
intubation
Hydroxocobalamin (Vit. B12a) binds to
cyanide to form cyanocobalamin (Vit. B12)