Disaster Mx 3 WMD
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Transcript of Disaster Mx 3 WMD
Nik Ahmad Shaiffudin Bin Nik Him MMC: 35241
MD, MMed (Emerg.Medicine, USM), AM(Mal)
WEAPON OF MASS WEAPON OF MASS DESTRUCTION (WMD)DESTRUCTION (WMD)
• Objectives : Develop the understanding of disaster medicine and mass casualty incident management
• Subject contents : Weapon of mass destruction (WMD)– Biological– Radiological– Chemical
• Performance criteria :– Discuss principles of decontamination– Perform on site decontamination procedure
ObjectiveObjective
1.1. Able to discuss Able to discuss the decontamination procedures in the decontamination procedures in WMDWMD
2.2. Perform the decontamination for suspected Perform the decontamination for suspected biological, chemical and radiological contamination.biological, chemical and radiological contamination.
Learning OutcomeLearning Outcome
Presentation OutlinesPresentation Outlines
1. Introduction2. Category of WMD3. Initial Management4. Summary
• Terrorism involving WMD is an ever-present threat in today’s world........
• As a health care provider, we may be called on to dealwith patients involved in an incident involving WMD's
IntroductionIntroduction
Terrorist ActTerrorist Act...??...??
– 2002 Homeland Security Act Public Law 107-2002 Homeland Security Act Public Law 107-295, 116 Statue 2135:295, 116 Statue 2135:• Activities that involve danger to human lifeActivities that involve danger to human life• Potential destruction of key infrastructure or key Potential destruction of key infrastructure or key
resourceresource• Influence governmentInfluence government• Intimidate or coerce civilian populationIntimidate or coerce civilian population
What Define’s a Terrorist Act?What Define’s a Terrorist Act?
• Weapons of Mass Destruction:– are chiefly designed to incite
terror, not to kill– consist of a variety of different
agents– can be delivered through a
variety of different means– can be extremely difficult to
control– are designed to cause
widespread and indiscriminate death and destruction
IntroductionIntroduction
Categorization ofCategorization ofWeapons of Mass DestructionWeapons of Mass Destruction
B NICE CBRNE
B Biological C Chemical
N Nuclear B Biological
I Incendiary R Radiological
C Chemical N Nuclear
E Explosive E Explosive
1. Chemical 1. Chemical Weapons....Weapons....
Classification of Chemical WeaponsClassification of Chemical Weapons
• Chemical agents are classified by the toxic effects they have on the body
• Chief Categories of Agents:– Nerve Agents– Vesicants or Blistering Agents– Choking or Pulmonary Agents– Blood Agents– Incapacitating or Riot-Control Agents
Why CW are attractive to terrorists ?
1. Difficult to detect
2. Highly efficient (little quantity is needed)
3. Inexpensive manufacturing to obtain
4. Simple technology is needed to produce them
Nerve Agents
• Action: Irreversibly bind to acetylcholinesterase (AChE), the enzyme that degrades acetylcholine (ACh)
• Leads to accumulation of acetylcholine, resulting in:– Muscarinic Effects: small pupils, dim vision, smooth muscle
contraction, copious hypersecretion (sweat, tears, runny nose)– Nicotinic Effects: skeletal muscle weakness, paralysis– CNS Effects: changes in mood, decreased mental status,
seizures, coma... respiratory failure and terminal arrhythmia
• Ex: Sarin (GB), Soman (GD), Tabun (GA), VX Gas
Muscarinic Effects of Nerve Agents
S.L.U.D.G.E.S.L.U.D.G.E.Salivation
Lacrimation
Urination
Diaphoresis
GI distress (diarrhea, vomiting)
Emesis
Nerve Agent Antidote:
• Self-injectable needle– Pralidoxime Chloride (600 mg)– Atropine (2 mg)
Vesicants / Blister Agents• Produce severe blisters and chemical burns, effecting
epithelium of the skin and respiratory tract• Slow acting: causes death in 48-72 hours• Fatality due to:
– Impaired gas exchange (hypoxia)– Loss of body fluids– Secondary infection
• Skin and eyes affected first, then lungs and bone marrow• Once symptoms have begun, decontamination is no longer
effective• Ex: Mustard Gas, Lewisite
2. Pulmonary Damaging Agents• Immediately irritating to the bronchial tree• Early effects:
– rhinitis/pharyngitis– tearing– eyelid spasm– upper respiratory tract irritation
• Later effects:– severe pulmonary toxicity– respiratory failure
• Ex: Phosgene, Chlorine
3. Blood Agents or Cyanides
• Combines with a cellular enzyme inhibiting the body’s ability to transport oxygen to vital organs
• Quick acting: causes death in minutes• Relatively large dose needed to be effective• Initial effects: rapid/deep breathing, anxiety,
agitation, dizziness, weakness, nausea, muscle trembling
• Later effects: loss of consciousness, decreased respirations, seizures, arrhythmias
• Ex: Hydrogen cyanide
4. Riot Control Agents
• Potent lacrimators and irritants
• Effects are believed to be transient, not meant to be lethal (though some deaths in asthmatics and the elderly have been documented)
• Considered more humane than the alternative
• Ex: CN gas, CS gas
General General ManagementManagement Guidelines Guidelinesfor all classes of Chemical Weaponsfor all classes of Chemical Weapons
1. Move to fresh air2. Remove clothing3. Decontaminate 4. Supplemental oxygen5. Antidote6. Restrict physical activity7. Hospitalization/ medical attention
BiologicalWeapons of Mass Destruction
What is What is Bioterrorism?Bioterrorism?
“Intentional or threatened use of viruses, bacteria, fungi or toxins from living organisms to produce death or disease in humans, animals or plants”
1918 2004
Why Biologics are attractive to Why Biologics are attractive to terroriststerrorists ? ?
1. High morbidity and mortality2. Can be obtained from nature3. Creates panic and chaos4. Potential dissemination over large
geographic area5. Can overwhelm medical services6. Civilian populations may be highly
susceptible7. Difficult to diagnose and/or treat8. Some are transmitted person-to-
person via aerosol
Characteristics of Biological Attacks
• Incident may not be recognized for weeks• Responders and health workers are at risk of
becoming casualties themselves• Continuing effect with re-infection• Require special training and equipment to handle• Large numbers of “worried well” (30:1 ratio)• Fear of the unknown
Category A Bioterrorism Agents
• Variola major(Smallpox)
• Bacillus anthracis(Anthrax)
• Yersinia pestis(Plague)
• Clostridium botulinum(Botulism)
• Francisella tularensis(Tularemia)
• Ebola hemorrhagic fever • Marburg hemorrhagic
fever • Lassa fever• Argentine hemorrhagic
fever
Hart Senate Building/USPSHart Senate Building/USPS20012001
Anthrax: Cutaneous Vesicle
Development
Day 4
Day 6
Day 10
Day 2
Mediastinal wideningJAMA 1999;281:1735–1745
Anthrax: Inhalational
Category B Bioterrorism Agents
• Coxiella burnetti
(Q fever)• Brucella species
(brucellosis)• Burkholderia mallei
(glanders)• Venezuelan encephalomyelitis• Eastern and Western equine
encephalomyelitis • Ricin toxin from Ricinus
communis (castor beans)
• epsilon toxin of Clostridium perfringens
• Staphylococcus enterotoxin B
Food/Water Borne Agents• Salmonella species• Shigella dysenteriae• Escherichia coli O157:H7• Vibrio cholerae• Cryptosporidum parvum
Category C Bioterrorism Agents
• Nipah virus• Hantavirus• Tickborne hemorrhagic
fever viruses• Tickborne encephalitis
viruses• Yellow fever• Multi-drug resistant
tuberculosis (MDRTB)
Radioactive and NuclearWeapons of Mass Destruction
Radiation vs. Radioactive Material
• Radiation: energy transported in the form of particles or waves (alpha, beta, gamma)
• Radioactive Material: material that contains atoms that spontaneously emit radiation
• Light, radio waves and microwaves are types of radiation (Ionizing radiation is what we are concerned about)
• Radiation comes in the forms:– Alpha particles– Beta particles– Gamma rays
Penetration Abilities of Different Penetration Abilities of Different Types of RadiationTypes of Radiation
Alpha ParticlesStopped by a sheet of paper
Beta ParticlesStopped by a layer of clothingor less than an inch of a substance (e.g. plastic)
Gamma RaysStopped by inches to feet of concreteor less than an inch of lead
RadiationSource
Exposure vs. Contamination
Exposure: irradiation of the body
Contamination: radioactive material on patient (external) or within patient (internal)
Internal ContaminationThe biological pathways that can introduce radioactive
contamination internally include:
Injection
Inhalation
Ingestion
Absorption
Injuries Associated with Injuries Associated with Radiation Exposure Radiation Exposure
1.Acute Radiation Syndrome (ARS)
2.Cutaneous Radiation Syndrome
3.Chronic radiation exposure
4.Teratogenic effects
Radioactive/Nuclear WMDs:Possible Scenarios
1.Nuclear power plant incident
2.Nuclear weapon3. Improvised Nuclear
Device (IND)4. “Dirty bomb”
Acute Radiation Syndrome (A Spectrum of Disease)
Acute Radiation Syndrome (A Spectrum of Disease)
Methods of protection
• Time
• Distance
• Shielding
Explosive
1.1. Pipe BombsPipe Bombs
2.2. IED’sIED’s
3.3. C4, TNTC4, TNT
Atlanta Olympic GamesAtlanta Olympic Games19961996
World Trade CenterWorld Trade Center19931993
Oklahoma CityOklahoma City19951995
MEDICAL MANAGEMENT OF CBRNE
The Principles Of Management - The Principles Of Management - RAINRAIN
1.1. RecognizeRecognize the hazard or threat the hazard or threat– Rapid interpretationRapid interpretation
2.2. AvoidAvoid the hazard, contaminant or injury potential the hazard, contaminant or injury potential– Liquids, powders, vapor clouds, Liquids, powders, vapor clouds,
3.3. IsolateIsolate the hazard area the hazard area– Time, distance & shielding from you and othersTime, distance & shielding from you and others
4.4. NotifyNotify the appropriate support agencies the appropriate support agencies– Notify command authority (law enforcement, fire, etc.)Notify command authority (law enforcement, fire, etc.)
Initial On-site Activities
• Manage the Scene
• Manage the Victims: Triage, Treat, Transport
Manage the Scene• Notify appropriate authorities • Control incident perimeter • Establish Incident Command • Identify radiation types and isotopes • Measure levels of radiation continuously • Ensure responder safety
– Wear personal protective equipment (PPE) – Use personal dosimeters – Consult radiation worker exposure guides
• Establish "zones of response" – Radiological incident zones of response – IND incident zones of response
• Establish patient handling flows – In the field
• Establish locations for field activities (IAEA) • Patient handling flows in the field for a radiological event (IAEA) • RTR system (Triage, treatment and transport after an IND detonation)
– In a medical facility • Control zone in the emergency department
Recommendation for Generic Areas to be Established by First Responders
SALT Mass Casualty Triage Algorithm (Sort, Assess, Lifesaving Interventions, Treatment/Transport) — Adapted for a Very Large Radiation Emergency
Perform Lifesaving Tasks Before Managing Radiation Problems
Managing victims with contamination General guidance
• Rescuing victims with contamination should occur only after On-scene management activities have been taken to ensure responder and public safety • Minimally contaminated victims do not pose a health risk to rescuers or healthcare providers. • Perform life and limb-saving tasks before managing external or internal radiation contamination. • Do not delay life-saving rescue or transport of a seriously injured or contaminated person.
Transport Victims of Radiation Emergencies
• Perform life-saving tasks before managing radiation problems or assessing contamination and decontamination status.
• Victims of exposure and contamination should be transported to medical facilities (to Appropriate
Facilities ) with the expertise to manage these problems.
DecontaminationDecontamination
A chemical and/or physical process to remove and prevent the spread of a contaminant from an emergency scene because of the contaminant’s ability to cause harm to living beings and/or the environment
Can First Responders Do Decon!
• If it can be done safely!
• Contaminated live victims should receive immediate emergency decon.
Live Patients Can’t Wait for Technical Decon to Arrive!
Types of DecontaminationTypes of Decontamination
1.Emergency
2.Gross
3.Technical
Emergency DecontaminationEmergency Decontamination
• Fire Hose near point of Entry• Decontamination Foam
Distributor• Design system per the mission
WET
STRIPFLUSHCOVER
Mengasingkan Mangsa di Bilik Dekontaminasi
Pengurusan Dekontaminasi Mangsa –mangsa di
“Hot Zone”
Pengurusan Mangsa di “Warm Zone”
Kemasukan Pesakit ke WadMelalui “Speed Path”
“Cold Zone” Keluar
Dekontaminasi Petugas-petugas
Petugas-petugas memakai PPE
Gross DecontaminationGross Decontamination
• Remove clothing – Cut victim clothing off if needed– Better to remove clothing dry if possible– Remove respiratory protection last
• Remove contaminates– Water– Brushes and/or wipes
Gross Decontamination
Technical DeconTechnical Decon
Four Step process– Gross Wash– Wash & Rinse– Doffing or removal of
Equipments/ attire– Personal Shower
Emergency vs. Mass DeconEmergency vs. Mass Decon
Mass Decon is Emergency Decon for More People!
Main Purposes of Mass Decontamination
• Protect response and medical personnel
• Remove chemical agent from Contaminated victims
• Limit spread of contamination
Summary
1.1. Ensure safetyEnsure safety2.2. Know the HazardsKnow the Hazards3.3. Develop Rapid ThinkingDevelop Rapid Thinking...... WMD??...... WMD??4.4. Understand the Terrorism IssuesUnderstand the Terrorism Issues5.5. Incident Command System.....Coordination!!!Incident Command System.....Coordination!!!6.6. Decontamination ProceduresDecontamination Procedures7.7. Don’t Become Part of the ProblemDon’t Become Part of the Problem
THANK THANK YOUYOU