1 / 21

Preparing for the Unthinkable

This publication explores the scope of the threat and possible responses to respiratory care and gas warfare terrorism. It covers the history of toxic gases, lessons learned from past attacks, characteristics of chemical warfare agents, and more. The text is written by Prof. T. Johnson.

leta
Download Presentation

Preparing for the Unthinkable

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Preparing for the Unthinkable Respiratory Care and Gas Warfare Terrorism Scope of the threat and possible responses Prof. T. Johnson

  2. N – B – C is not TV • Nuclear • Biological (BW) • Chemical (CW) • B-N-I-C-E: biological, nuclear, incendiary, chemical, explosive Prof. T. Johnson

  3. Introduction • History of the use of toxic gases • The agents may be employed by terrorists • Pre-hospital response /Hospital response-Lessons Learned from Tokyo and the WTC Attack • 10 Conclusions Prof. T. Johnson

  4. The Chemical Weapons • What are the chemical agents? • How are they dispensed? • What are the characteristic of chemical warfare agents? • What symptomology do they present? • What immediate care must be rendered? • How does one protect the medical personnel? Prof. T. Johnson

  5. The Tokyo Attack Timeline • March 20, 1995 Prof. T. Johnson

  6. Tokyo Terrorist’s Gas Victims Prof. T. Johnson

  7. Topic One: Chemical Agents • Pulmonary agents: chlorine, phosgene, cyanide • Blister agents: Lewisite and the nitrogen mustard agents • Nerve Agents: Tabun, sarin and VX • Lachrymators: CN (Mace), CS • Insecticides: Malathion, parathion and sevin Prof. T. Johnson

  8. Topic Two: Characteristics • Pulmonary Agents: asphyxia, mucosal edema and bronchorhea. • Blister Agents: Burn-like phenomenon affecting eyes, bronchi and skin • Nerve agents: nausea, fasiculations, rhinorrhea, bronchorrhea, sweating, drooling, diarrhea, loss of consciousness, flaccid paralysis, apnea Prof. T. Johnson

  9. Characteristic Symptomology: Nerve Gas • Eyes: Miosis, tearing, conjunctival injection (pain, dim vision, blurred vision) • Nose: Rhinorrhea • Airway: Bronchoconstriction, bronchorrhea, dyspnea, cough • GI: Hypermotility, nausea, vomiting, diarrhea, cramps • Skeletal muscles: Fasciculations, twitching, paralysis, muscle weakness • CNS: High dose Loss of Consciousness, seizures, apnea; Low dose cognitive difficulties • Other: Salivation and diaphoresis Prof. T. Johnson

  10. Inhaled Nerve Gas Vapor • Mild: Miosis, rhinorrhea, dyspnea, weakness, blurred vision • Severe: as above with – Loss of consciousness, seizures and apnea – death • Onset: Within seconds to minutes of exposure • Treatment: Atropine and pralidoxime auto-injectable. Prof. T. Johnson

  11. Dermal/conjunctival/liquid Exposure to Nerve Agents • Mild: Local sweating and fasciculations • Moderate: Nausea, vomiting, diarrhea, weakness • Severe (as above plus): Loss of consciousness, seizures, apnea – death • Onset: 5 min to 18 hrs • Treatment: Atropine, diazepam and 2-PAM (2 pyridine-aldoxime-methiodide), ventilatory and cardiovascular support. Prof. T. Johnson

  12. Vesicants or Blister Agents • Mustard gas vapor causes no pain on contact. • Onset: 4 to 8 hrs (range 2 to 24 hrs) • Initial/Mild: Erythema, periorbital edema, blurring, oro-nasal edema, hoarseness, non-productive cough • Late/Severe: Corneal damage, leukocytopenia, decreased RBC & platelets, sepsis, airway obstruction, atelectasis, sepsis, DIC, death • TX: Early skin decontamination, anti-lewisite, support care similar to burn management. Prof. T. Johnson

  13. Inhaled Cyanide • Severe: Brief period of hyperpnea, seizures, decreased breathing rate, arrhythmias, apnea – death • Mild: Nausea, vertigo, weakness, shortness of breath. • TX: Amyl nitrite by inhalation; sodium nitrite and sodium thiosulfate IV; assisted ventilation and oxygen Prof. T. Johnson

  14. Topic Three: Care • Early andGENTLE Skin decontamination • Pulmonary Agents: OXYGEN, amyl nitrate inhalation, IV sodium nitrate or sodium thiosulfate • Blister agents: Early and Gentle skin surface decontamination to include the eyes, anti-Lewsite for internal injury, & burn wound care • Nerve agents: Atropine sulfate, 2-Pam (2 pyridine-aldoxime-methiodide) and Valium (diazepam) Prof. T. Johnson

  15. Real Life – Protect the Care Givers • Military hospitals treating Iranian casualties of the Iran-Iraq War had casualties in hospital personnel • The Tokyo Experience: 10% of EMT, firefighters and police became casualties – none seriously; 110 hospital staff became casualties, 1 nurse required hospitalization. Prof. T. Johnson

  16. Lessons Learned from Tokyo • Decontamination of victims not accomplished. • Charting became improvised. • Communications became impossible by phone or page. (The WTC attack overloaded phones too.) • Misleading Initial Data: gas explosion, tear gas, etc. (Expect secondary casualties.) • Inadequate Pharmacological support in volume. • No transfer plan and failure of police to clear traffic. Prof. T. Johnson

  17. What Worked? • In-house hospital databases. Prof. T. Johnson

  18. New age of terrorism: individuals & cults CW & BW are within the grasp of terrorists CW & BW attacks overwhelm the healthcare system Psychogenic casualties persist beyond the initial incident, even PTS in care givers. “Hero Effect” results in casualties. 6. Medical staff is unfamiliar with these injuries. 7. HVAC and C level protection for staff. 8. Insufficient drug stocks. 9. Decontamination areas inadequacy. 10. Communication system will be overloaded. Conclusions Prof. T. Johnson

  19. Each hospital worked with only its own staff. NYC was divided into security zones. Communications/Legal/Risk Management issues limited use of clinical volunteers. Lessons Learned From the WTC Prof. T. Johnson

  20. What This Means to You • Respiratory Therapists are vital to the care of these victims and must don PPE early. • Respiratory Care is unprepared, under-educated and insufficiently cross-trained • Respiratory Therapists have a responsibility to know how to treat these victims. • Preparation, Anticipation, Recognition, Action-Plan Training Issues Must be addressed. Prof. T. Johnson

  21. Take Home Message • Educate your people! • Contact your local office of Emergency Preparedness • Work with your Emergency Medical and Nursing staff to develop an action-plan. • Conduct disaster drills on all shifts. • Managers must be prepared with manpower, supplies and staff readiness education. Prof. T. Johnson

More Related