Weapons of Mass Destruction. Lesson Goal. Lesson Objectives 9/10/2012

Transcription

1 Weapons of Mass Destruction Lesson Goal To become familiarize with the concept of weapons of mass destruction (WMD), how these weapons might be used, and the type of treatment that would be appropriate for each agent Lesson Objectives Identify the potential threat of WMD and their threat to society Identify various WMD threat agents, and signs and symptoms of exposure to them Select proper modality of treatment for various agents 1

2 Lesson Objectives Identify special threats to healthcare providers, such as secondary contamination and potentially unsafe scenes Describe types of chemical warfare agents Recognize signs and symptoms of exposure to WMD chemical agents Lesson Objectives Describe management of chemical agent attack victims Describe various types of biological warfare agents and recognize signs and symptoms of exposure Describe how to manage and treat infectious victims properly Lesson Objectives Determine what agents are a risk for secondary transmission and how to protect against this spread using PPE and isolation measures Describe various types of radiological hazards List acute health effects from radiation contamination and exposure 2

3 Lesson Objectives Describe principles of diagnosis, treatment, and management of radiation casualties Describe difference between exposure and contamination and how this impacts medical care of radiation accident victims Describe basic radiation protection principles Lesson Objectives Outline common injuries and management strategies associated with blast injuries Introduction WMD are agents that can cause widespread illness, injury, death, or generalized panic Categories: Biological agents Chemical agents Radiological/nuclear agents Explosive devices 3

4 Fallacies of WMD It can t happen here WMD are always highly toxic and will kill all victims There is nothing that healthcare providers can do to change the result of an attack Basic Principles Rescuer safety Removal from the source of exposure ABCs (no mouth-to-mouth) Decontamination Appropriate treatment Nerve agents Chemical Agents Vesicants (blister agents) Industrial chemicals (esp. those with severe pulmonary effects) 4

5 Nerve Agents Interfere with normal nerve transmissions Organophosphates Sarin (GB) VX Tabun Soman Nerve Agents Nature and extent of signs and symptoms depend on dose and method of exposure Salivation Lacrimation Urination Defecation Gastrointestinal distress Emesis Nerve Agents Other signs and symptoms include: Miosis Bronchoconstriction Muscle twitching, weakness, paralysis heart rate Unconsciousness Seizures 5

6 Nerve Agents Definitive determination of nerve agent presence cannot be made immediately Take appropriate precautions based on presumptive clues Level A for testing PPE for patient care providers Nerve Agents Presumptive presence of nerve agent: Multiple casualties with similar signs & symptoms and common time and/or location factors Presenting symptoms consistent with known symptoms of nerve agent exposure Nerve Agents The SLUDGE syndrome Salivation Lacrimation Urination Defecation GI distress Emesis 6

7 Sarin Nerve Agents Constricted pupils Runny nose Shortness of breath Nausea, vomiting, diarrhea Weakness Seizures Paralysis Respiratory arrest VX Nerve Agents Localized sweating & muscle twitching Gastrointestinal effects Seizures Respiratory arrest Paralysis Death Treatment of Nerve Agent Exposure Atropine 2 mg initially; <20 mg Titrate to improvement in signs/symptoms May be given IM, IV, ET Pralidoxime 1 gm IV or IM Mark I kit 2 mg atropine 600 mg pralidoxime 7

8 Treatment of Nerve Agent Exposure Asymptomatic patients no treatment For Sarin, observe 1 hr For VX, observe 18 hrs Use PPE Patients must be decontaminated prior to transport Vesicants Affect eyes, skin, organs Produce blisters Eye inflammation, blindness Cough, shortness of breath Nausea, vomiting Lewisite Sulfur mustard Pulmonary Toxicants Examples Phosgene Chlorine Ammonia Signs & symptoms Eye irritation Shortness of breath Cough 8

9 Pulmonary Toxicants Principles Rescuer safety Removal from the source of exposure ABC (no mouth-to-mouth resuscitation) Decontamination Supportive care Patient exertion can worsen shortness of breath Cyanide Hydrogen cyanide and cyanogen chloride Signs & symptoms Headache Weakness Dizziness Difficulty walking Seizures Respiratory arrest Cardiac arrest Antidote: Amyl nitrite Sodium nitrite Sodium thiosulfate Biologic Agents Include: Bacteria Viruses Toxins Category A biologic WMD High risk 9

10 Biologic Agents Biologic Agents Anthrax Found in cattle & sheep Cutaneous, pulmonary, gastrointestinal No reported person-toperson transmission of respiratory anthrax Antibiotics 10

11 Plague Pneumonic form most likely to be used as a WMD Spread via respiratory droplets Respiratory protection is imperative Tularemia Bacterial Ticks, rabbits, rodents Highly infectious Respiratory route 35%-60% mortality without treatment No reported person-to-person spread Smallpox Viral disease Transmission Respiratory droplets Contact with fluid from lesions 11

12 Viral Hemorrhagic Fevers Attack the vascular bed Ebola, Marburg, dengue, Hantavirus High fatality rate Treatment is supportive Toxins Botchulinum toxin Upper body nervous system affected first Progression to complete paralysis Could be aerosolized or placed in food/water supply Limited amounts of antitoxin Principles of Decontamination After signs & symptoms appear, use PPE For acute exposure, decontamination is required 12

13 Radiologic/Nuclear Agents Radiologic agents damage the body by emitting energy that causes molecular changes and cell damage Lethal dose over short duration for an adult: rads Types of Radiation Exposure External irradiation Contamination External Internal Incorporation Combined exposure Radiation Protection 4 principles determine effects of radiation: Duration of exposure Distance from source Shielding Quantity of radioactive material 13

14 Sources of Radiation Exposure Radiation point sources Radiologic dispersion device Nuclear reactor breach Improvised nuclear device Nuclear weapon Radiation Point Source Radioactive material left in a location so that anyone in the vicinity will be exposed Radiologic Dispersion Device Dirty bomb Radioactive material delivered with a conventional bomb Actual contamination is usually limited, especially in the short term 14

15 Nuclear Reactor Breach Shielding around the reactor is violated Difficult to achieve Nuclear Weapon A detonated nuclear weapon would be the most catastrophic way to use radiation as a WMD In addition to the blast wave, thermal pulse, and fires, survivors would have a significant risk of acute radiation syndrome CNS Radiation Sickness GI Blood 15

16 Treatment Treat life-threatening conditions first Then decontaminate Use PPE Explosive Devices Explosive devices Commonly used in terrorist acts Range from small, improvised devices to large ammonium nitrate/fuel oil bombs Explosive Devices Blast pressure wave 3 types of injury Primary Secondary Tertiary 16

17 Explosive Devices Primary blast injury affects air-filled structures Ruptured tympanic membranes Pulmonary injuries Air emboli Supportive treatment Position on left side, head down Blast lung injury manifestation may be delayed Summary WMD may be chemical, biological, radiation/nuclear, or explosive devices EMTs must know the hazards associated with specific agents and the precautions they must take to protect themselves Treatment is mainly supportive 17