terrorism, personal protective equipment, decontamination.pdf
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4. WEAPONS OF MASS DESTRUCTION
Weapons of Mass destruction: biological,
chemical and radioactive weapons
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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
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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).
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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
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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
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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
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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
