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2	A War Time Response
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14	2 Types of Weapon Classifications
15	What is the monitoring equipment for biological agents?
16	Biological Weapons Would cause a catastrophic medical emergency in a city Requires a timely and focused medical response May have hours or days to respond to incident Preplanning on treating approx 10% of population. 80,000 people for Indianapolis
17	Recognizing Biological Attacks Onset of symptoms may be a few days or weeks No physical signs, odorless and colorless Unusual numbers of sick or dying people Discarded Sprayers or aerosols Hospitals may be the first to see the signs Victims have a common history
18	Definition: Biological Agent Living organisms, or materials derived from them that cause disease in, or harm in humans, animals, or plants Liquid Droplets, aerosols, or dry powders. 3 Types Bacteria Viruses toxins
19	Definition: Chemical Agent 5 Classes Nerve Blister Blood Choking Irritating A chemical used to kill, seriously injure, or incapacitate people through its effects
20	Biological Weapons Anthrax Botulism Paque Small Pox
21	Anthrax Acute Infectious Disease Spores inhaled or ingested Prevention - Vaccine
22	Anthrax - Symptoms Starts out like common cold Severe Breathing Problems If ingested Inflammation of the intestinal tract Vomiting of blood Severe diarrhea Death can occur within 24hrs
23	Anthrax - Treatment Antibiotics Penicillin Delay in use of antibiotics --- even in terms of hours ---- may lessen chances of survival Vaccine
24	Botulism The most potent lethal substance know to man Inhaled or ingested via food or water
25	Botulism - Symptoms Double vision Slurred speech Dry Mouth Muscle Weakness Starts Top and works down Begin from 6 hours to 2 weeks after exposure Death by paralysis of diaphragm
26	Botulism -Treatment Botulism anti – toxin Supplied by CDC Prevention by vaccine
27	Plague Causative agent of plague Found in rodents Found in fleas Can be disseminated by aerosol Can spread from respiratory droplets
28	Plague - Symptoms Signs 1 to 6 days of exposure Fever Headache Weakness Can lead to death within 2 to 4 days
29	Plague - Treatment Antibiotics within 24 hours of fist symptom
30	Chemical Weapons
31	Chemicals Used Sulfur Mustards Vx Sarin Chlorine Hydrogen Cyanide
32	Sulfur Mustards Vesicants – Bister agents colorless when pure are generally a yellow to brown color slight garlic or mustard odor absorbed through the eyes, skin and mucous membranes.
33	Sulfur Mustards - Health Effects Skin, eye and respiratory tract injury. May cause bone marrow suppression Neurologic and gastrointestinal toxicity. Although cellular changes occur within minutes of contact, pain and other clinical effects are delayed for one to 24 hours.
34	Sulfur Mustards - Treatments No Antidote Decontamination of all potentially exposed areas within minutes after exposure is the only effective means of decreasing tissue damage
35	Vx Highly toxic compound Liquid and vapor form Attacks the central nervous system 100 times more toxic by entry through the skin than the nerve-agent sarin, and twice as toxic by inhalation. VX can persist for long periods under average weather conditions and for months in very cold conditions.
36	Vx – Health Effects can cause death minutes after exposure. Enter the body by inhalation, ingestion, through the eyes and through the skin. Runny nose, water eyes, drooling, excessive sweating, difficulty in breathing, dimness of vision, nausea and twitching. It kills by attacking the body's voluntary muscle and gland "on switch," causing the muscles to tire so they can no longer sustain breathing.
37	Vx – Treatment Immediate Treatment is decontamination. Remove Clothing Flush…not forgetting the eyes Hospitals may have antidotes
38	Sarin Highly toxic compound Liquid and Vapor Attacks the central nervous system.
39	Sarin – Health Effects Can cause death minutes after exposure Enters the body by inhalation, ingestion, through the eyes and the skin.
40	Sarin - Treatment Immediate decontamination removing clothing and flushing eyes and skin with water. Hospitals in many communities are stocking the antidotes.
41	Chorine Greenish-yellow gas Pungent odor Heavier than air reacts violently with many organic compounds, creating a fire and explosion hazard.
42	Chorine – Health Effects Corrosive to the eyes and the skin Cause tearing blurred vision and burns. Inhalation may cause labored breathing and lung edema. The symptoms of lung edema often do not manifest until a few hours after exposure. High exposure levels may result in death.
43	Chorine – Treatment Fresh air in the case of inhalation rinsing with plenty of water in case of exposure to skin and eyes.
44	Hydrogen Cyanide Extremely flammable Colorless gas or liquid. Gives off toxic fumes in a fire and is highly explosive
45	Hydrogen Cyanide – Health Effects Irritates the eyes, skin, respiratory tract. Burning and redness for the skin and eyes. Inhalation causes confusion, drowsiness and shortness of breath, leading to collapse. Affects the central nervous system, resulting in impaired respiratory and circulatory functions. Exposure can be fatal.
46	Hydrogen Cyanide – Treatment Fresh air in the case of inhalation Rinsing with plenty of water in the case of skin or eye exposure
47	Radiation
48	Indicators of Chemical Weapon Incident Explosion / little damage Found Device Multi casualties / similar symptoms Mass casualties / no apparent reason
49	Indicators of Chemical Weapon Incident Reports of unusual Odors Liquids Spray devices Cylinders Dead Animals Discarded PPE
50	Dispatcher is Key First Opportunity to Identify Multi-call incident Key to saving the lives of first responders How many / Symptoms Anyone wearing PPE?
51	Dispatcher is Key Provide responders with info Weather / Upwind routs Provide number of victims Provide Signs / Symptoms
52	The First Hour Our ability to contain and control the incident will be decided in the first hour.
53	"High number of victims with..." High number of victims with burns dead fish, wildlife, or insects unusual metal debris unusual droplets low-lying clouds; abandoned spray devices
54	Actions On Arrival Uphill / Upwind Stop at a distance ERG Inform Incoming help Direct all to use full gear & SCBA Be aware secondary devices (look for them) Perpetrator still on scene?
55	Actions on Arrival Establish Command Secure, Isolate, and Deny Entry Establish Safety Zones Establish Water Supply Pull hand lines Even if you see no need at the time. Identify if live victims in area of attack Rescue live victims
56	Actions On Arrival This is a crime scene Restrict entry Preserve evidence Avoid contact with liquids Relay to dispatch status and request additional resources If you think it’s a terrorist incident tell dispatch
57	Actions Establish casualty collection points Perform mass Decon Triage Treatment Monitor and maintain water run off. Not at the expense at treating
58	Command Chemical threat Potential to save lives Risk to responders Time constraints to achieve level of responder protection before determining what level of PPE to use to perform rescue operations.
59	Command Request for additional equipment immediately Establish a dedicated radio channel to dispatch Consider secondary devices Establish accountability Request for highest ranking law enforcement officer to command post Alert all personnel of crime scene and preserve evidence. Sony Example
60	Command Coordinate rescue ops with law enforcement Ensure law enforcement advises on activities being conducted in the immediate area. Assign a police liaison
61	Casualty Rescue Must be a rapid removal from: Contamination Triage Decon
62	Casualty Rescue As many ambulatory casualties as possible should be removed from the area without rescuers entering the site.
63	Casualty Rescue It should be expected that live non-ambulatory will be present.
64	What PPE are you going to use for rescue? Level A Level B Firefighter Gear SCBA
65	Rescue Avoid any contact with liquids Do not make contact with any dead victims
66	Decon Must be performed minutes after agent exposure. (hoseline) Up wind / Up grade Firefighter gear taped with SCBA Encourage victims to remove clothing to their undergarments.
67	Decon Coordinate with EMS Be alert (look) for secondary devices, weapons, and perpetrators. (we are now in the business of bombs) Establish Technical decon for firefighters away from civilians
68	Decon Concerns Large volumes of run off Weather Decon corridors are ideal targets for secondary devices. Perpetrators among victims Victim tracking Security of personal property How will water be applied in decon
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71	Bio and Chemical Weapons Causes A Painful 180-degree Choice About Triage, Patient Care, and Liability We will be thrown into this new standard of care.
72	Non War Time Triage Favors those most seriously injured
73	War Time Triage Military Tactics Battlefield Conditions Reverse Normal Triage
74	War Time Triage The most likely to survive get treated first Certain People will not get care.
75	War Time Triage Priorities Who gets treated first? How many firefighters will be needed? What resources are needed? How will contacts be made for resources.
76	"Hospital resources should be redirected..." Hospital resources should be redirected to care for the most seriously ill. Elective admissions should temporarily cease, while critical medical/surgical and 911 functions will continue.
77	"Establishing a system to quickly..." Establishing a system to quickly expand outpatient and inpatient acute care facilities is necessary to provide rapid treatment to a large population of patients.
78	"In a mass casualty situation" In a mass casualty situation, health care workers will provide care to as many victims as possible, but individualized treatment plans may be rare or nonexistent.
79	"Advanced life-saving technology and treatment..." Advanced life-saving technology and treatment options will either not be available, or they will be unable to be implemented due to lack of specially trained medical personnel.
80	Preplanning Treatment of Large Numbers of People Pre-identifying casualty collection points. The use of hotels, schools, etc. may be considered as alternative care facilities,
81	"Outpatient centers initially should implement..." Outpatient centers initially should implement a triage policy caring for the sickest patients first. Then, as the system becomes further overburdened, the triage policy should refocus to treat those most likely to survive with the level of care available.
82	"Treatment centers should be established..." Treatment centers should be established quickly in structures of sufficient size that are located close to existing hospitals.
83	Examples of suitable treatment facilities Schools Community centers Hospital cafeterias Hotel conference rooms.
84	These structures are advantageous because They contain adequate floor space for patient care, Bathrooms Kitchens Refrigeration Laundry service, Electricity Generator backup.
85	Treatment centers should have room for: Initial triage Admissions Registration Family/visitor waiting area Staff Break room Pharmacy Administration (control center) Communications Staff workstations, Storage, locked security area Temporary morgue. Inpatients should be able to rest on portable cots that can be arranged to maximize space ample room between beds (at least 18 inches) for personnel to maneuver and circulate.
86	"The better the job the..." The better the job the fire service does in minimizing the impact of terrorist incidents, the more terrorists will seek new and terrible ways to make their statements.
87	How To Base Decisions During an Event If chemical agent detector is not available and/or entry into an unknown environment for detection is not performed: Must operate based on other indicators. These include signs and symptoms and reports from escaping victims, and knowledge of the room size and air handling characteristics.
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91	Known Living Victims Only Use victims as a detector Indicates the nerve agent vapor concentration is relatively low compared to the range of concentrations achievable. If at least one victim remains alive 15 minutes after the incident, a rescuer can assist that victim with little or no risk. while wearing turnout gear with SCBA, or more protective FFPE configurations.
92	Unknown Environments Responders entering an unknown nerve agent vapor environment for reconnaissance should assume worst-case conditions and assume agent Sarin for nerve agent.
93	Maximum Reconnaissance Exposure Time (Unknown Environment)
94	WARNING Even small amounts (several droplets) of liquid nerve agent contacting the unprotected skin can be severely incapacitating or lethal if the victim or responder is not decontaminated rapidly (minutes) and treated medically.
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96	Chemical Agents
97	Rescue Warning Minimizing rescuer exposure duration will minimize their potential hazard. However, a rescuer in standard turnout gear with SCBA is protected adequately for 30 minutes, even without taking time to apply quick fixes, such as duct tape. Time delays before rescuing known live victims may increase the cumulative dosage a victim receives. Quick entry, rescue, and exit, while diligently avoiding any contact with liquid contamination, will minimize the hazards to victims and rescuers.
98	Key Factors To Rescue or No Rescue Weather Conditions Scene Hazard Assessment Avoid “tunnel vision.” Don’t just assume chemical-related hazards. Also consider the possible presence of biological agents, radiological materials, and/or explosive devices.
99	Reconnaissance View area through a closed window or an entrance doorway (or other upwind location)
100	Before entering the building, the Recon team must don at least turnout gear with SCBA. Observe living victims with nerve agent exposure symptoms Victims have been exposed for 15 minutes or more Mustard is not suspected, The room the victims occupy is directly accessible without having to transit stairwells, or other adjacent rooms
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102	Search If no living victims are visible from outside the building assume a high concentration of chemical agent May consider a rapid reconnaissance by entering the building for no more than 3 minutes only to look for living victims.
103	Warning Before Entry Must increase their level of protection by at least self-duct taping protective clothing openings and closures and continuing SCBA use.
104	Taping Neck Around the face piece Fly Wrists, ankles, waist, and the closure down the front of the jacket.
105	Rescue in Conjunction with Recon Observe living victims with nerve agent exposure symptoms Victims have been exposed for 15 minutes or more, and Mustard (HD) is not suspected
106	Warning: Take special care to avoid contaminating footwear and clothing with liquid chemical agent. Skin contact with liquid chemical agent dosage may be lethal. Liquid contamination is very easy to spread. Spread liquid contamination will “off gas” highly toxic vapors and continues as a skin contact hazard.
107	Without Rescue in Conjunction with Recon If no living victims are seen, then leave the building immediately, seal and secure the building, and wait for the HAZMAT team in Level A suits to arrive at the scene.
108	Victim Location Are casualties visible near an entrance? Are they in the line-of-sight? Can they be heard? Estimate how long it would take to reach and remove them.
109	Victim Number: If there are enough HAZMAT team personnel in Level A suits available to rescue live victims in a timely manner, use them. Otherwise, consider using personnel who are wearing an acceptable protective clothing alternative (i.e. taped or untaped turnout gear with SCBA),
110	Victims Condition: Are casualties ambulatory or non-ambulatory? Signs and symptoms? Traumatic injuries? Entanglement? Mental state?
111	Chemical Agent Hazard Reduction: Consider use of PPV fans. Be sure that use of these fans will not spread chemical agent to endanger other people. If fans are acceptable, they should be placed in service while rescuers are donning their protective ensemble.
112	SCBA SCBA must be used for all rescue missions.
113	Personal Protective Ensemble Must wear standard turnout gear with SCBA. If the situation permits, PPE closures and openings should be taped with duct tape either by the responder or a buddy.
114	Rescue Team Exposure Time: Limit the initial exposure time to 30 minutes. No entry team will re-enter the contaminated area unless authorized and extreme circumstances clearly warrant doing so.
115	Face Piece Removal. After exiting rescuers must continue using their SCBA until their decontamination of chemical agent from the protective clothing. Remove the regulator and face piece last (after protective clothing).
116	Emergency Decontamination: Must be set up before entry is made, Locate setup upwind and as close as practicable. Rescuers must be decontaminated immediately. Before they remove their regulator and face piece (to avoid breathing any vapors possibly trapped in their clothing protective clothing) or any of their protective clothing. If possible, remove regulator and face piece last. Use chemical agent monitors.
117	Medical Monitoring: Check vital signs ECG. Check again for chemical agent signs and symptoms.
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119	FFPE and SCBA First responders would enter a hot zone only to rescue living victims. Only until Level A entry is available Level A to perform other missions such as reconnaissance, sampling or detection, or mitigation.
120	Positive Pressure Ventilation Fans To Reduce The Hazards of Entering Chemically Contaminated Buildings
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122	Two Phases of Testing Examined the ventilation rates of a building in both the natural and with PPV. Examined the use of the PPV fans in the same building during a live-rescue mission scenario.
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130	Results of PPV PPV fan can purge the majority of chemical vapors from a building after 10 minutes of use.
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132	PPV and WMD Increased protection provided to firefighters and emergency rescue personnel,
133	PPV Testing Absorption occurring under the suit is measured with absorptive samplers placed in several locations on the body.
134	PPV and WND Bunker Gear and SCBA should be worn while setting the PPV in place.
135	PPV and WMD PPV applications are considered as an additional way of reducing risks associated with a quick rescue in chemical contamination.
136	PPV and WMD Warning! Prior to using PPV, firefighters must ensure that there are no unprotected people at the door, window, or other opening selected as the PPV exit point. If there are unprotected people at the exit, or downwind, they must be evacuated before PPV is employed. When unprotected people can not be moved from the exit point, or from the area immediately downwind of the exit point, it may be possible to select an alternate exit point, and still safely employ PPV fans.
137	PPV and WMD Limitations May force the agent to spread to other zones of a building. when the agent has been released in the lobby of a multi-story building, PPV applications may spread agent to upper floors of the building.
138	PPV and WMD Limitations Could put people at risk on upper floors. Negative pressure ventilation may be preferable. Negative pressure ventilation usually was just as efficient as positive pressure ventilation and, in one case, slightly more efficient.
139	PPV Guidelines The use of PPV fans dramatically decreases the interior chemical agent vapor concentration of structures. For example, PPV fans can reduce the vapor concentration by 50% - 70% during the first 10 minutes of use
140	PPV Guidelines PPV significantly increases the first responders’ protection above and beyond the adequate protection provided by standard turnout gear with SCBA when rescuing known live victims.
141	PPV Guidelines Before using PPV, consider the downwind hazard for unprotected people.
142	PPV Guidelines Bigger fans are better. Two fans are better than one. Tilting the fan improves performance.
143	PPV Guidelines Use Negative Pressure Ventilation (NPV) at buildings where victims are present in closed interior rooms (doors closed).