Chapter 40- Terrorism Response and Disaster Management

__________ rays easily penetrate through the human body and require lead or several inches of concrete to prevent penetration.

Gamma

After eating at a local restaurant, a 20-year-old male complains of blurred vision, difficulty speaking, and difficulty breathing. He is conscious; however, his respirations are profoundly labored and producing minimal tidal volume. You should:

assist his ventilations with high-flow oxygen

All of the following are vesicant agents, EXCEPT:

sarin

An attack on an abortion clinic would MOST likely be carried out by a(n):

C. single-issue group.

As you and your partner report for duty, you check your ambulance and begin talking about the possibility of a terrorist attack. The MOST effective and appropriate way to determine the likelihood of this happening is to:

D. know the current threat level issued by the Department of Homeland Security.

At present, the likelihood of a nuclear attack against the United States is very low because:

A. terrorist nations do not have the ability to deliver a nuclear weapon via missile or bomb.

Continual reassessment of the scene at a suspected terrorist or weapon of mass destruction incident is MOST important because:

D. a secondary explosive device may detonate.

In determining the potential for a terrorist attack, you should routinely observe all of the following on every call, EXCEPT:

B. weather conditions.

Most cases of anthrax begin with:

B. flulike symptoms.

Multiple people in a small town began experiencing abdominal cramps, excessive salivation and urination, and muscle twitching shortly after a small crop duster plane made several passes over the community. As you are assessing the patients, you further determine that most of them are bradycardic and have miosis. In addition to high-flow oxygen, the MOST appropriate treatment for these patients includes:

D. atropine and pralidoxime chloride.

Points of distribution (PODs) are strategically placed facilities where:

B. antidotes, antibiotics, and vaccines are distributed.

The Centennial Park bombing during the 1996 Summer Olympics is an example of:

C. domestic terrorism.

The EMT should expect that a patient who was exposed to cyanide will have:

B. a normal pulse oximetry reading.

The incubation period for Ebola can be up to:

C. 21 days.

The means by which a terrorist will spread a particular agent is called:

dissemination

The type and severity of wounds sustained from incendiary and explosive devices primarily depend on the:

A. patient’s distance from the epicenter of the explosion.

To date, the preferred weapons of mass destruction for terrorists have been:

A. explosive weapons.

Unlike viral agents, bacterial agents:

B. respond to antibiotics.

Which of the following statements regarding blast injuries is correct?

C. Solid organs are relatively protected from shock wave injury but may be injured during the secondary or tertiary blast phase.

You and your partner arrive at the scene of a fire at a large office complex. Witnesses tell you that they heard a loud explosion shortly before the building caught fire. You should:

A. ensure that your ambulance is parked upwind and uphill from the building.

The chemical attacks that occurred in Tokyo between 1994 and 1995 were carried out by a(n):

violent religious group.

Which of the following terrorist groups poses the LEAST threat to a person’s physical safety?

Cyber terrorists

A weapon of mass destruction is MOST accurately defined as:

any agent used to bring about mass death, casualties, or massive infrastructural damage.

The process performed to artificially maximize the target population’s exposure to a biologic agent, thereby exposing the greatest number of people and achieving the desired result, is called:

weaponization.

Most terrorist attacks are:

covert

You are dispatched to the scene of a building explosion. Upon arrival, you see people frantically fleeing the building, screaming, "Everyone is passing out!" You should:

carefully assess the situation and ensure your own safety.

Cross-contamination occurs when:

an EMT is exposed to a victim who has not yet been decontaminated.

As the first-arriving emergency responder at the scene of a suspected terrorist or weapon of mass destruction incident, you should request additional resources as needed and then:

function as the incident commander until additional personnel arrive.

A persistent or nonvolatile chemical agent can:

remain on a surface for more than 24 hours.

Exposure to _________ would MOST likely result in immediate respiratory distress.

chlorine

Signs and symptoms of exposure to a nerve agent include:

salivation, pinpoint pupils, and diarrhea.

You are treating a patient who experienced a significant exposure to cyanide. He is semiconscious and is breathing inadequately. The MOST appropriate method of providing assisted ventilations to this patient is to:

use a bag-valve mask.

Early signs and symptoms of smallpox include all of the following, EXCEPT:

skin blisters.

You are assessing a 30-year-old female who presents with respiratory distress and tachycardia after she opened a package that was delivered to her home. The patient tells you that there was a fine white powder on the package, but she did not think it was important. This patient has MOST likely been exposed to:

anthrax

When introduced into the body, ricin causes:

pulmonary edema and circulatory failure.

The LEAST harmful form of ionizing radiation is:

alpha

Which of the following is NOT a factor in determining how to protect oneself against the effects of radiation?

Body size

Pulmonary hemorrhage and inner ear damage are examples of __________ blast injuries.

primary

Which of the following would you expect to encounter in a patient with moderate radiation toxicity?

Hair loss and first-degree burns

Unlike viruses and bacteria, neurotoxins:

are not contagious.

international terrorism

Terrorism that is carried out by people in a country other than their own; also known as cross-border terrorism.

domestic terrorism

Terrorism that is carried out by people in their own country

weapon of mass destruction (WMD)

Any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports); also known as a weapon of mass casualty (WMC).

weapon of mass casualty (WMC)

Any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure (bridges, tunnels, airports, and seaports); also known as a weapon of mass destruction (WMD).

B-NICE

A memory device to recall the types of weapons of mass destruction: biologic, nuclear, incendiary, chemical, and explosive.

weaponization

The creation of a weapon from a biologic agent generally found in nature and that causes disease; the agent is cultivated, synthesized, and/or mutated to maximize the target population’s exposure to the germ.

state-sponsored terrorism

Terrorism that is funded and/or supported by nations that hold close ties with terrorist groups.

covert

An act in which the public safety community generally has no prior knowledge of the time, location, or nature of the attack.

secondary device

A secondary explosive used by terrorists, set to explode after the initial bomb.

cross-contamination

Occurs when a person is contaminated by an agent as a result of coming into contact with another contaminated person.

persistency

Describes how long a chemical agent will stay on a surface before it evaporates.

volatility

How long a chemical agent will stay on a surface before it evaporates.

route of exposure

The manner by which a toxic substance enters the body.

vapor hazard

The term used to describe danger posed by an agent that enters the body through the respiratory tract.

contact hazard

The term used to describe danger posed by a chemical whose primary route of entry into the body is through the skin; posed by a hazardous agent that gives off very little or no vapors; also called a skin hazard.

vesicants

Blister agents; the primary route of entry for this agent is through the skin.

sulfur mustard (H)

A vesicant; it is a brownish, yellowish oily substance that is generally considered very persistent; has the distinct smell of garlic or mustard and, when released, is quickly absorbed into the skin and/or mucous membranes and begins an irreversible process of damaging the cells. Also called mustard gas.

mutagen

A substance that mutates, damages, and changes the structures of DNA in the body’s cells.

lewisite (L)

A blistering agent that has a rapid onset of symptoms and produces immediate, intense pain and discomfort on contact.

phosgene oxime (CX)

A blistering agent that has a rapid onset of symptoms and produces immediate, intense pain and discomfort on contact.

chlorine (Cl)

The first chemical agent ever used in warfare. It has a distinct odor of bleach and creates a green haze when released as a gas. Initially it produces upper airway irritation and a choking sensation.

phosgene

A pulmonary agent that is a product of combustion, resulting from a fire at a textile factory or house or from metalwork or burning Freon. It is a very potent agent that has a delayed onset of symptoms, usually hours.

nerve agents

A class of chemical called organophosphates; they function by blocking an essential enzyme in the nervous system, which causes the body’s organs to become overstimulated and burn out.

DuoDote Auto-Injector

A nerve agent antidote kit containing atropine and pralidoxime chloride; delivered as a single dose through one needle.

Antidote Treatment Nerve Agent Auto-Injector (ATNAA)

A nerve agent antidote kit containing atropine and pralidoxime chloride; delivered as a single dose through one needle.

cyanides

An agent that affects the body’s ability to use oxygen. It is a colorless gas that has an odor similar to almonds. The effects begin on the cellular level and are very rapidly seen at the organ and system levels.

When ________ is on clothing, it has the effect of off-gassing, which renders the victim and the victim’s clothing contaminated.

Sarin(GB)

dissemination

The means by which a terrorist will spread an agent, for example, by poisoning the water supply or aerosolizing the agent into the air or ventilation system of a building.

disease vector

An animal that spreads a disease, once infected, to another animal.

incubation

The period of time between a person being exposed to an agent to the first time when symptoms appear.

smallpox

A highly contagious disease; it is most contagious when blisters begin to form.

viral hemorrhagic fevers (VHF)

A group of diseases caused by viruses that include the Ebola, Rift Valley, and yellow fevers, among others. This group of viruses causes the blood in the body to seep out from the tissues and blood vessels.

Anthrax

is caused by deadly bacteria that lay dormant in a spore (protective shell).

bubonic plague

Bacterial infection that affects the lymphatic system. It is transmitted by infected rodents and fleas and characterized by acute malaise, fever, and the formation of tender, enlarged, inflamed lymph nodes that appear as lesions, called buboes. Also called the Black Death.

pneumonic plague

A lung infection, also known as plague pneumonia, that is the result of inhalation of plague-causing bacteria.

neurotoxin

Biologic agents that are the most deadly substances known to humans; they include botulinum toxin and ricin.

The most potent neurotoxin is _________, which is produced by bacteria.

botulinum

ricin

A neurotoxin derived from mash that is left from the castor bean; causes pulmonary edema and respiratory and circulatory failure leading to death.

Syndromic surveillance

The monitoring, usually by local or state health departments, of patients presenting to emergency departments and alternative care facilities, the recording of EMS call volume, and the use of over-the-counter medications.

Points of distribution (PODs)

Existing facilities used as mass distribution sites for antibiotics, antidotes, vaccinations, and other medications and supplies during an emergency.

ionizing radiation

Energy that is emitted in the form of rays, or particles.

decay

A natural process in which a material that is unstable attempts to stabilize itself by changing its structure.

Alpha Radiation

-The least harmful penetrating type of radiation -Cannot penetrate through most objects (a sheet of paper or the body’s skin can easily stop it)

Beta radiation

Slightly more penetrating than alpha and requires a layer of clothing to stop it

Gamma (x-ray) radiation

These rays easily penetrate through the human body and require lead or several inches of concrete to prevent penetration.

Neutron radiation

-Neutron particles are among the most powerful forms of radiation. -Neutrons easily penetrate through lead and require several feet of concrete to stop them.

radiologic dispersal device (RDD)

Any container that is designed to disperse radioactive material.

dirty bomb

Name given to an explosive radiologic dispersal device.

Special Atomic Demolition Munitions (SADM)

Small suitcase-sized nuclear weapons that were designed to destroy individual targets, such as important buildings, bridges, tunnels, and large ships.

pulmonary blast injuries

Pulmonary trauma resulting from short-range exposure to the detonation of high-energy explosives.

What is a mustard gas considered to be?

Mutagen

In which group of agents is miosis a sign of exposure?

nerve agent

Which of the following requires a host to survive?

small pox

Which is the most deadly route of entry for anthrax?

inhalation

Which of the following is the means by which an agent is spread?

Dissemination

Which of the following is true regarding a dirty bomb?

The destructive capability is limited to the explosives that are attached to it

Which type of blast injury is most likely to produce penetrating trauma?

Secondary

You are on scene at a suspected terror attack in which a RDD has detonated. A 67-year-old patient reports tightness in his chest. The patient is coughing up blood and is in respiratory distress. During the physical assessment, you notice subcutaneous emphysema. What is the condition most likely to be?

Pulmonary blast injury