Operational Level Refresher Presentation

Operational Level Refresher Presentation

Hazardous Materials for First Responders, 3rd Ed.

Terrorism and WMD Incidents

Terminal ObjectiveGiven classroom instruction, the student will

identify the dangers to first responders involving terrorist and CBRNE incidents based on the training provided.

Operational Level7–2

Enabling Objectives

• Identify hazards associated with an incident involving criminal or terrorist activity

• Identify UN/DOT hazard class for chemical/biological/radiological materials

• Identify characteristics of CBRNE materials• Identify evidence preservation procedures • Identify NFPA 1994 Protective Ensembles



Terrorism

• The unlawful use of force against persons or property to intimidate or coerce a government, the civilian population or any segment thereof, in the furtherance of political or social objectives.

According to the Federal Bureau of Investigation


Weapons of Mass Destruction

• Any weapon or device that is intended, or has the capability, to cause death or serious bodily injury to a significant number of people through the release, dissemination, or impact of:– Toxic or poisonous chemicals or their precursors– A disease organism– Radiation or radioactivity

According to the United States Code


Goals of Terrorist Operations

• Recognition – national or international attention

• Coercion – act in a desired manner

• Intimidation – diminish public confidence

• Provocation – force government security to act


Circumstances Faced that are Different from Routine Emergencies• Large numbers of casualties• Materials that first responders have little

experience dealing with• Secondary events intended to incapacitate or

delay emergency responders• Armed resistance• Use of weapons• Booby traps• Secondary contamination from handling patients


Potential Terrorist Targets

• Public assembly occupancies and locations• Public buildings• Mass transit systems• Places with high economic impact• Telecommunications facilities• Places with historical or symbolic significance• Military installations• Airports• Industrial facilities


Cues to Consider thePossibility of Terrorism

• A report of two or more medical emergencies in public locations such as a shopping mall, transportation hub, mass transit system, office building, assembly occupancy, or other public buildings

• An unusually large number of people with similar signs and symptoms coming or being transported to physicians’ offices or medical emergency rooms

(1 of 2)


Cues to Consider thePossibility of Terrorism

• A reported explosion at a movie theater, department store, office building, government building, or a location with historical or symbolic significance

(2 of 2)

CBRNE Incidents

• Chemical• Biological• Radiological• Nuclear• Explosive



Categories of Terrorist Attacks

• Biological

• Nuclear

• Incendiary

• Chemical

• Explosive


Biological Attacks

• Type of biological agents– Viral agents– Bacterial agents– Rickettsias– Biological toxins

• Indicators of terrorist activity involving biological agents– Numerous sick or dead animals, fish, or birds– Unscheduled spraying or abandoned spray devices– Vapor clouds or mists that are unusual for the area

or for the time of day (1 of 6)


Biological Attacks

• Indicators of terrorist activity involving biological agents– The absence of crops, wildlife, or insects that are

common for the area, time of day, or time of year– Out of place and unattended packages, boxes, or

vehicles– Packages that are leaking– Materials or equipment that are unusual for the area– Small explosions that disperse liquids, mists, or

gases

(2 of 6)


Biological Attacks

• Indicators of terrorist activity involving biological agents– Unusual odors or tastes– Multiple casualties without obvious signs of trauma– Multiple victims who are exhibiting similar symptoms– Large numbers of persons seeking medical attention

with similar symptoms that are not characteristic of the season

(3 of 6)


Biological Attacks

• Type A biological agents– Can be easily disseminated or transmitted person-

to-person– Cause high mortality and subsequently have a

major public health impact– Might cause public panic and social disruption– Requires special action for public health

preparedness– Examples: Smallpox, anthrax, plague, botulism

(4 of 6)


Biological Attacks

• Type B biological agents– Are moderately easy to disseminate– Cause moderate morbidity and low mortality– Require specific enhancements of the Centers for

Disease Control and Prevention’s diagnostic capacity and enhanced disease surveillance

– Examples: Brucellosis, epsilon toxin of clostridium perfringens, glanders

(5 of 6)


Biological Attacks

• Type C biological agents — Emerging pathogens that could be engineered for mass dissemination in the future because of their:– Availability– Ease of production and dissemination– Potential for high morbidity and mortality and

major health impact– Examples: Nipah virus, hantaviruses, tickborne

hemorrhagic fever viruses(6 of 6)


Nuclear/Radiological Attacks

• Three scenarios most likely:– Detonation of a conventional explosive device

incorporating nuclear materials (commonly known as a dirty bomb)

– An attack on a source of nuclear materials such as detonating a truck bomb in the vicinity of a nuclear power plant or radiological cargo in transport

– Detonation (or threatening to detonate) a nuclear bomb, improvised nuclear device, or suitcase bomb

(1 of 2)


Nuclear/Radiological Attacks

• Types of nuclear/radiological bombs that terrorists might use– Dirty bomb– Atomic/nuclear device (bomb)– Improvised nuclear device (IND)– Suitcase bomb– Nuclear power plant sabotage or attack

(2 of 2)


Incendiary Devices

• Any mechanical, electrical, or chemical device used intentionally to initiate combustion and start a fire

• Examples of easily made devices– Bottle, gasoline, rag, match (Molotov cocktail)– Low flashpoint flammable liquid and a candle– Match heads and sulfuric acid– Road flare ignited by a model rocket fuse

(1 of 2)


Incendiary Devices

• Indicators– Warning or threat of an attack– Accelerant odors– Multiple fires– Incendiary device components– Unexpectedly heavy burning or high temperatures– Unusually fast-burning fires– Unusual colored smoke or flames– Presence of propane or other flammable gas

cylinders in unusual locations(2 of 2)


Chemical Attacks

• The deliberate release of a toxic gas, liquid, or solid that can poison people and the environment

• May involve chemical warfare agents or toxic industrial materials (TIMs)

• Effects are usually noticed quickly, within minutes to hours

• Results are usually disabling or fatal

(1 of 5)


Chemical Attacks

• Indicators of terrorist activity involving chemical agents– Numerous sick or dead animals, fish, or birds– Unscheduled spraying or abandoned spray

devices– Vapor clouds or mists that are unusual for the area

or the time of day– The absence of crops, wildlife, or insects that are

common for the area, time of day, or time of year

(2 of 5)


Chemical Attacks

• Indicators of terrorist activity involving chemical agents– Out of place and unattended packages, boxes, or

vehicles– Packages that are leaking– Materials or equipment that are unusual for the

area– Small explosions that disperse liquids, mists, or

gases– Unusual odors or tastes

(3 of 5)


Chemical Attacks

• Indicators of terrorist activity involving chemical agents– Multiple casualties without obvious signs of trauma– Multiple victims who are exhibiting similar

symptoms– Large numbers of persons seeking medical

attention with similar symptoms that are not characteristic of the season

(4 of 5)


Chemical Attacks

• Chemical-agent types– Nerve agents– Blister agents (vesicants)– Blood agents (cyanide agents)– Choking agents (pulmonary or lung-damaging

agents)– Riot control agents (irritants)– Toxic industrial materials (normal hazardous

materials used for terrorist purposes)(5 of 5)


Nerve Agents

• Attack the nervous system by affecting the transmission of impulses

• Routes of entry– Inhalation– Through the skin

• Symptoms– Increased production of saliva– Runny nose– Feeling of pressure on the chest

(1 of 3)


Nerve Agents

• Tabun (GA) — Usually a low-volatility persistent chemical agent that is taken up through skin contact and inhalation of the substance as a gas or aerosol; DOT hazard class 6.1

• Sarin (GB) — Usually a volatile nonpersistent chemical agent mainly taken up through inhalation; class 6.1

• Soman (GD) — Usually a moderately volatile chemical agent that can be taken up by inhalation or skin contact; class 6.1

(2 of 3)


Nerve Agents

• Cyclohexyl sarin (GF) — A low-volatility persistent chemical agent that is taken up through skin contact and inhalation of the substance either as a gas or aerosol

• V-agent (VX) — A low-volatility persistent chemical agent that can remain on material, equipment, and terrain for long periods; class 6.1

(3 of 3)


Blister Agents (Vesicants)• Burn and blister the skin or any other part of the

body they contact• Groupings

– Mustard agents– Examples: Sulfur mustards (class 6.1), nitrogen

mustards (class 6.1)– Arsenical vesicants

– Examples: Lewisite (class 6.1), mustard/lewisite mixture, phenyldichloroarsine

– Halogenated oximes– Example: Phosgene oxime (no hazard class

found) (1 of 2)


Blister Agents (Vesicants)

• Routes of entry– Are readily absorbed by all parts of the body

• Symptoms– Inflammation– Blisters– General destruction of tissues

(2 of 2)


Blood Agents

• Chemical asphyxiants that interfere with oxygen utilization at the cellular level

• Types– Arsine (SA) (class 2.3)– Hydrogen cyanide (AC) (class 6.1)– Cyanogen chloride (CK) (class 2.3)


Choking Agents

• Chemicals that attack the lungs causing tissue damage

• Types– Phosgene (CG) (class 2.3)– Chlorine (CL) (class 2.3)


Riot Control Agents(Irritating Agents)

• Chemical compounds that temporarily make people unable to function by causing immediate irritation to the eyes, mouth, throat, lungs, and skin

• Types– Chlorobenzylidene malononitrile (CS, tear gas)

(class 6.1)– Chloroacetophenone (CN, mace) (class 6.1)– Dibenzoxazepine (CR) (class 6.1)– Chloropicrin (PS) (class 6.1)– Oleoresin capsicum (OC, pepper spray) (class 2.2)


Explosive Attack Classes

• High explosives — Decompose extremely rapidly (almost instantaneously)– Examples: Plastic explosives, nitroglycerin, TNT,

blasting caps, dynamite

• Low explosives — Decompose rapidly, but don’t produce an explosive effect unless they’re confined; they deflagrate (burn rapidly)

(1 of 3)



• Primary explosives — Are easily initiated and highly sensitive to heat– Examples: Lead azide, mercury fulminate, lead

styphnate• Secondary explosives — Are designed to

detonate only under specific circumstances; are less sensitive to heat or flame– Example: TNT

• Propellants — Deflagrate rather than explode– Example: Black powder

(2 of 3)



(3 of 3)


Improvised Explosive Devices(IEDs)

• Are explosive devices that are constructed in an improvised manner

• Are categorized by their container• Are homemade and usually constructed for a

specific target• Usually have a firing train that consists of a

fusing system, detonator, and main charge


Types of IEDs

• Vehicle bombs• Pipe bombs• Satchel/backpack/knapsack/briefcase, or box bomb• Mail/package/letter bomb• Plastic bottle bombs• Fireworks• M-devices• CO2 grenades• Tennis ball bombs


Additional Actions at Terrorist or Criminal Activity Incidents

• Notify authorities.– Law enforcement, other emergency responders,

and EMS personnel– Other local, state/provincial, or federal/national

agencies and health or medical providers– Additional trained and equipped personnel

immediately (i.e., bomb technicians• Preserve crime scene evidence.

(1 of 2)


Additional Actions at Terrorist or Criminal Activity Incidents

• Take additional measures to isolate exposed people and animals.

• Take additional measures to secure the scene.• Take additional precautions with regard to the

possibility of secondary devices.• Exercise additional caution in regards to other

potential hazards associated with terrorist and criminal activities.

(2 of 2)


The Importance of Crime Scene Evidence Preservation

• It is important for first responders to preserve evidence so that investigators can identify and successfully prosecute the guilty parties.


Guidelines forPreserving Evidence

• Unless you must touch something, DON’T.

• Avoid disturbing areas not directly involved in rescue activities.

• Remember what the scene looked like upon first arrival as well as details about the progression of the incident.

(1 of 3)



• Document your observations as quickly as you can.

• Take photographs and videos of the scene as soon as possible.

• When you must touch or move something, remember what you did. In your report, document where it was and where you put it. If you can, photograph it before you do anything.

• Minimize the number of people working in the area, if possible.

(2 of 3)



• Leave fatalities and their surroundings undisturbed.

• Identify witnesses, victims, and the presence of evidence.

• Preserve potentially transient physical evidence (e.g., evidence present on victims, evidence that may be compromised by weather conditions such as chemical residue, body fluids, or footprints).

(3 of 3)


Biological Attack Incidents

• Many people are potentially at risk– Traditional first responders who transport ill

patients to medical facilities– Health care workers who care for patients in

hospitals, residential facilities, outpatient settings, at home, or elsewhere

– Laboratory personnel handling clinical specimens– Health department staff who visit patients in or out

of health care facilities while conducting outbreak assessment or control measures

(1 of 3)



• First responders and others involved in patient transport should take additional precautions.– Run the ambulance ventilation system on its

highest setting using outside air circulation, which will minimize air changes in the vehicle.

– For diseases that are transmitted by respiratory transmission, the patient should wear a surgical mask, disposable respirator, or, if needed for respiratory support, an oxygen mask that does not exhaust to ambient air.

(2 of 3)



• First responders and others involved in patient transport should take additional precautions.– Responders transporting patients with different

diseases may require different levels of worker respiratory protection.

(3 of 3)


Nuclear/Radiological Incidents

• Use radiation and contamination survey instruments to determine radiation levels.

• Use the principles of time, distance, and shielding to protect against radiation exposure.

• Stay away from ground zero. Enter the surrounding area only to save lives, and only if wearing appropriate PPE. Radiation levels may be very high in these areas.

• Establish control zones like other incidents.(1 of 4)



• Isolate, evacuate, and/or shelter the public in place as appropriate.

• Wear respiratory protection to reduce the dose from inhalation of radioactive dust.

• Wear PPE. Standard firefighting gear or easily removed outer clothing is sufficient to protect from alpha and beta radiation, but it may not protect against other environmental hazards.

(2 of 4)



• Avoid skin contact with radioactive dust. Protect open wounds or abrasions from radioactive contamination by covering them.

• Do not eat, drink, chew, or smoke while exposed to potentially radioactive dust or smoke. When it is absolutely necessary to drink water, drink from a canteen or other closed container.

(3 of 4)



• Remember that physical injuries are more serious than radioactive contamination. Deal with life-threatening conventional injuries first.

• Decontaminate.

(4 of 4)


Incendiary Incidents

• Only specially trained personnel should handle incendiary devices discovered prior to ignition.

• If it is suspected that an incendiary device started the fire, proper handling of potential evidence is critical for crime scene preservation.


Chemical Agent Incidents

• Expect at least a 5:1 ratio of unaffected to affected casualties.

• Decontaminate victims as soon as possible.• Disrobe victims from head to toe to decontaminate

successfully. The more clothing that can be removed, the better.

• Flush with water; generally this is the best mass decontamination method.

• Decontaminate after a known exposure to liquid chemical agent as soon as possible to avoid serious effects.


Chemical Agent Decontamination

Disrobing Showering


Explosives/Bomb Incidents

• Agencies that may be called for extra assistance:– Local bomb technicians– State Bureaus of Investigation– Explosives ordnance detachments (military)

NFPA 1994 Protective Ensembles for CBRNE Incidents

• Originally published in 2001• Revised in 2007 sets performance/certification• Provides minimum design/testing for outer

garments• Covers Class 2,3,4 ensembles• Class 1 is addressed in NFPA 1991• All classes require NIOSH approved CBRN

respirator


NFPA vs OSHA/EPA

• Classes 1-4 similar but not equivalent to Levels A,B, C and D

• NFPA specifies performance specifications• Class 4 requires NIOSH approved CBRN APR

and more strict apparel. OSHA Level D does not.


Class 1 Protection

• Fully encapsulating, gas and vapor tight• Components provide highest level of

permeation resistance against chem/bio agents• High level of durability (puncture,cuts)• Requires SCBA• Heat related disorders, difficult to don/doff


Class 1


Class 2 Ensemble

• Agent/threat has been identified and release has subsided

• Provides vapor protection with SCBA• Demonstrate permeation resistance• Demonstrates durability to abrasion, resistance

to punctures and cuts• Designed for single use exposure• No flash fire protection


Class 2


Class 3 Ensemble

• Intended for use long after release has occurred

• Certified with CBRN APR• Designed for single exposure involving CBRN

agents• Not for fire protection


Class 3


Class 4 Ensemble

• Situations involving potential exposure to biological aerosols/particles and low level radiological particles

• Tested for resistance to liquid or bloodborne pathogens


Summary

• CBRNE response• Be vigilant and aware of your surroundings• Preserve evidence• Report all findings• Protect yourself


Operational Level Refresher Presentation

Documents

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office building

public buildingsan

public locations

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large number of people

medical emergency rooms1