UNIT V STUDY GUIDETerrorismCourse Learning Outcomes for Unit VReadingAssignmentChapter 15:Bombing EventsChapter 16:Biological AgentsChapter 17:Chemical AgentsChapter 18:Radiological AgentsSupplementalReadingSee information below.Suggested FurtherReadingSee information below.Learning Activities(Non-Graded)See information below.Key Terms1.2.3.4.Alpha particlesBeta particlesCategory B AgentsClostridium botulinumtoxin5. Gamma-rays6. Improvised NuclearDevice (IND)7. Irritant gas syndromesEMS 4306, Public Health EmergenciesUpon completion of this unit, students should be able to:1. Discuss public health emergency response functions for EMSorganizations.1.1. Illustrate bombing, bioweapons, chemical agents, and radiologicalagents.1.2. Explain injury prevention and control measures for terrorist events.3. Identify key components of a continuity of operations plan.3.1. Analyze collaborative planning that includes vertical integrationamong other levels of government, site-specific plans for accessand control, evacuations, and triage operation.3.2. Evaluate the recommendations to develop preparedness andresponse plans.6. Describe the role of public health during disasters.6.1. Identify the key principles in public health emergencies duringterrorist events.6.2. Define scene management, evaluation, and denomination forterrorist events.Unit LessonTerrorism is a major buzz word among public safety professionals. It seemedthat only a few years ago, terrorism was something that occurred in othercountries. The events of September 11, 2001, changed this perspective in adramatic way. Prior to the New York bombings, the Oklahoma City bombing(1995) brought awareness to domestic terrorism. Today, incidents such as thestudent massacres of Columbine High School, the Aurora Colorado movieshooting, and the Newtown school shootings have raised the level of awarenessto new heights. Not all public health emergencies are biological, nor are theynatural disasters. These terroristic events not only bring death and destruction toa community, but they threaten the emotional well-being of all involved in theincident and the community. To an extent, they also touch those not directlyinvolved but made aware through news reports and constant media coverage.Questions have been asked regarding the link between cuts to mental healthcare and the increase in violent attacks on innocent people. This is yet anotherexample of the public health link to major disasters.It is very difficult to prepare for bombing events. There is a possibility ofheightened awareness, following up on suspicious activity, and monitoring ofsocial media sites as well as other personal communications. Preparedness forthese events, predominantly response to them, is something that must bepracticed. Although the U. S. has experienced only a small number of majorbombing events in the past decades, the devastation and emotional toll hasbeen huge. Responders pay a heavy price, both emotionally and physically,when dealing with these types of events.18. Metabolic poisoningsyndromes9. Organophosphatesyndrome10. Radiation EmissionDevice (RED)11. Radioactive intensity12. Radiological DispersalDevice (RDD)13. Tularemia14. Vesicant syndrome15. Yersinia pestisLocal governments, in conjunction with public safety personnel and emergencymanagement agencies, are responsible for having plans regarding how to dealwith large scale events on vulnerable targets. These plans must be tested andre-evaluated periodically as technology and threats change. Response plansare important, but the healthcare community must also have plans in place forhow to deal with large numbers of critical patients as well as storage options formass fatalities. Many states have invested in caches of extra supplies, mobilehospitals, and mobile morgues to accommodate large numbers of patients.Additionally, the incident command system has expanded to include all keyplayers in the management of large scale events. Hospital personnel, as wellas public health and public safety personnel, are expected to be familiar withthe National Incident Command Structure. Communications should becompliant with the National Incident Management System, using plainlanguage to eliminate any misunderstanding when managing a scene andevent.Biological agents are also a concern as technology advances to allow widespread dissemination of contaminants. Water supplies, air ventilation systems,and food are all ways to reach hundreds, thousands, even tens of thousands ofpeople. Biological agents have often been the most terrifying of threats due tothe lack of warning. Many often have no odor, no color, and require only minuteamounts to bring death. Your textbook categorizes some agents or diseasesthat are classified by the CDC as bioterrorism agents. See page 308, Table16-1, for specific information about the level of risk and the basis forassignment of these levels, including which agents fall into which category.Specific protective clothing, including a specialized breathing apparatus, arerequired to deal with each level of agent. As a rule, EMS organizations aretypically left to wait for patients following decontamination and removal from hotzones. Depending on local guidelines and your organization’s policies,personnel should be trained to the appropriate type of response expected atthese scenes and provided with the specific protective gear to help ensure theirown safety.Chemical agents are similar to biological agents in that not all have a color,odor, or require large quantities to cause death. In 1995, the Sarin gas attacksin Japan raised awareness of just how deadly chemical agents can be.Following this event, additional training and protective guidelines were offeredto EMS personnel. New emphasis was placed on responder safety as kitsbegan to appear on emergency vehicles to provide antidotes for public safetypersonnel. Chemical warfare is also not new, having been used during WorldWar I, World War II, and in the Iran-Iraq conflict. These events also require thatresponders have specific personal protective equipment, depending on thearea and exposure they will be working in. Decontamination is crucial as manyof these chemicals can continue to spread if patients and their clothing areintroduced to hospital emergency departments or into the general public. Manyvictims will self-transport without being evaluated at the scene of the incident,thereby moving the incident to a new location. Hospitals are stronglyencouraged to provide for decontamination areas and procedures in case thisoccurs in a real attack. Fire departments and hazardous material responseunits are also outfitted with decontamination supplies, including mobileshowers, to attempt to control spreading the contamination.EMS 4306, Public Health Emergencies2Chemical exposures are not limited to intentional attacks but can occur ingeneral industry as well. They are also capable of occurring in a normalhousehold accident such as the exposure to organophosphates for gardeningas well as hydrofluoric acid burns when doing crafts or home improvements.Chemicals are classified by the type of injury or effects they have on a human.Personal protective equipment is specific to address these risks. As an EMSmanager, you should instruct staff not properly trained or tasked with dealingwith the immediate threat to wait well away from the incident, up wind, andreport any unusual occurrences. Responder safety is paramount to avoidbecoming part of the incident.Radiological agents are of concern because they represent not only thepotential for major damage or destruction but also to long term health.Radiological or nuclear materials are also of particular concern because theyhave no color or odor either. Many exposures occur in conjunction with a typeof bombing or physical event. Depending on the dose of radiation, location ofexposure, and duration, patients will respond differently. Radiation surveyequipment must be used to detect levels in the atmosphere or on the patient.Without radiation equipment, it is likely that responders will be unaware that anexposure has occurred. Individuals exposed to radiation must also bedecontaminated in a similar manner to those exposed to biological or chemicalagents. There is medication that can be used to attempt to block certainisotopes from collecting in the body. Depending on the dose of radiation, thepatient may not have immediate signs or symptoms of radiation exposure.Some may not be noted until years later.Regardless of the type of disaster or public health emergency involving agents,diseases, or chemicals, responders must be prepared. Preparation is achievedthrough planning activities, forming coalitions or groups that work together toestablish guidelines for responding to these types of emergencies, andeducation for how to deal with these types of emergencies. Everyone will havea role to play in a response, so EMS managers should participate in communityplanning activities to be prepared to assist. In most cases, events areunexpected and severe, even when the number of fatalities is low. Consideryour organization’s place in the ESF structure for your community. Make sureyou have provided adequate training for personnel, and remain active in eventsthat allow your organization to practice their response.Supplemental ReadingIf you would like to learn about this week’s topic, feel free to locate thefollowing books in the ebrary section of the CSU Online Library:Cole, L. A., & Connell, N. D. (2012). Local planning for terror and disaster:From bioterrorism to earthquakes. Somerset, NJ: Wiley.Cummings, C. E., & Stikova, E. (2007). Strengthening national public healthpreparedness and response to chemical, biological and radiologicalagent threats. Amsterdam, NLD: IOS Press.Dickson, E. F. G. (2012). Personal protective equipment for chemical,biological, and radiological hazards: Design, evaluation, and selection.Somerset, NJ: Wiley.EMS 4306, Public Health Emergencies3National Research Council, Committee for Oversight and Assessment of BlastEffects and Related Research. (2001). Protecting people and buildingsfrom terrorism: Technology transfer for blast-effects mitigation.Washington, DC: National Academies Press.National Research Council, Committee on Laboratory Security and PersonnelReliability Assurance Systems for Laboratories Conducting Researchon Biological Select Agents and Toxins. (2009). Responsible researchwith biological select agents and toxins. Washington, DC: NationalAcademies Press.National Research Council, Committee on Protecting Occupants of DODBuildings from Chemical and Biological Release. (2007). Protectingbuilding occupants and operations from biological and chemicalairborne threats: A framework for decision making. Washington, DC:National academies Press.National Research Council, Subcommittee on Toxicologic Assessment of LowLevel Exposures to Chemical Warfare Agents. (2005). Review of thedepartment of defense research program on low-level exposures tochemical warfare agents. Washington, DC: National Academies PressSuggested Further ReadingInternational Association of Fire Chiefs. (2008). Model procedures forresponding to a package with suspicion of a biological threat. Retrievedfromhttp://www.iafc.org/files/1HAZ/IAFCmodelProceduresForSuspiciousPackages.pdfLearning Activities (Non-Graded)Reflection Essay (non-graded)Although you will not need to submit this work for a grade, construct a one totwo page reflection essay on how your well you believe your community isprepared to withstand a major man-made disaster. What types of buildings orbusinesses would be considered high risk in your area? If terrorists wereplanning to attack your community, how might they get away with this?Non-graded Learning Activities are provided to aid students in their course ofstudy. You do not have to submit them. If you have questions, contact yourinstructor for further guidance and information.EMS 4306, Public Health Emergencies4