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National Guard Chaplain Service Ministry During Chaos: Operating Safely in a CBRNE Environment

National Guard Chaplain Service Ministry During Chaos: Operating Safely in a CBRNE Environment. Chemical, Biological and Explosive Events (JMETL: 1,2,9). Chemical Agents. May be weaponized in liquid, vapor, aerosol form Enter skin or lungs All require protective gear and decontamination

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National Guard Chaplain Service Ministry During Chaos: Operating Safely in a CBRNE Environment

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  1. National Guard Chaplain ServiceMinistry During Chaos:Operating Safely in a CBRNE Environment Chemical, Biological and Explosive Events (JMETL: 1,2,9)

  2. Chemical Agents • May be weaponized in liquid, vapor, aerosol form • Enter skin or lungs • All require protective gear and decontamination • May quickly incapacitate/kill • Antidotes exist for blood and nerve agents

  3. Chemical Decontamination • Decontamination requires removal of clothing and decontamination with soap and water. • Treating contaminated patients in the emergency department before decontamination will contaminate the facility. • Report suspected chemical warfare agents to hospital leadership, public health officer, and FBI.

  4. Chemical Agents: TYPES • Nerve • Blister • Blood • Choking • Irritating • Incapacitating

  5. Nerve Agents • Physical Form • Thickened Liquid • Vapor • Types • G Types • VX

  6. Nerve Agents: Symptoms • Pinpointing of Pupils • Blurred Vision • Runny Nose • Tightness of Chest • Muscular Twitching • Excessive Sweating • Drooling • Nausea & Vomiting • Involuntary Urination & Defecation • Convulsions • Coma & Death

  7. Blister Agents • Physical Form • Liquid • Gas • Powder • Types • Levinstein Mustard (H) • Distilled Mustard (HD) • Nitrogen Mustard (HN-3) • Lewisite (L) • Phosgene Oxime (CX)

  8. Blister Agents: Symptoms • May Take Up to 4 Hours to Appear • May Cause Stinging Upon Contact • Burns or Blisters Tissue • Red, Watering Eyes & Blurred Vision • Light Sensitivity • Blindness • The Groin & Armpits Are More Susceptible to Blister Agents Because They Are Sweaty

  9. Blood Agents • Physical Form • Quickly Evaporating Liquid • Gas • Types • Hydrogen Cyanide (AC) • Cyanogen Chloride (CK) • Arsine (SA) • Dissipates quickly, effective in a closed system (e.g.subway)

  10. Choking Agents • Physical Form • Quickly Evaporating Liquid • Types • Phosgene (CG) • Diphosgene (DP) • Especially effective from attack on industrial chemical plant

  11. Choking Agents: Symptoms • Coughing • Choking • Tightness of Chest • Fatigue • Nausea • Headache • Watering Eyes • Breathing Discomfort • Lungs Fill with Fluid (Dry-Land Drowning)

  12. Irritating Agents • Physical Form • Liquid • Gas • Powder • Types • Tear Gas (CN) • Tear Gas Plus Nausea (CS) • Mace • Pepper Spray • Adamsite (DM) (Vomiting Agent)

  13. Incapacitating Agents • Physical Form • Injection, IV • Powder • Aerosol • Types • Fentanyl • Other opiods • BZ (QNB)

  14. What Is Bio-terrorism?Definition • The intentional use of micro-organisms or toxins derived from living organisms to produce death or disease in humans, animals, or plants • The goal of bioterrorism is to produce fear in the population with subsequent disruption of society --UW Northwest Center for Public Health Practice

  15. History of Bio-terrorism • Biological warfare (BW) employed as far back as 6th century BC. • Examples of past BW: • 14th Century: Mongols catapulted corpses with bubonic plague over walls into Crimea. • 16th Century: Pizarro presented native South Americans with smallpox-contaminated clothing. • 1940: Japan’s “Unit 731” dropped plague-infected fleas over Manchuria & China. --UW Northwest Center for Public Health Practice

  16. History of Bio-terrorism • 1984: Rajneeshee Cult contaminated restaurant salad bars with Salmonella typhimurium. • 1995: Aum Shinrikyo cult attempted unsuccessfully to disperse BW agents in aerosol form; sarin gas attack in Tokyo. • 2001: Anthrax-contaminated letters to U.S. media and government offices. --UW Northwest Center for Public Health Practice

  17. Biological agents have uniquely frightening characteristics: • Invisible • Odorless • Imperceptible to humans • Effects often delayed and protracted • Can disfigure and deform • Potential for person-to-person transmission Hall et al, 2005

  18. Biological Agents • Decontamination of patients usually not required for biological agents. • Clothing removal and biosafety bagging is recommended. • Handle equipment used according to standard infection control practices. • Report suspected biological warfare agents to hospital leadership, public health officer, and FBI.

  19. CDC Biological Diseases/Agents “Category A” High priority agents: • Smallpox • Viral hemorrhagic fevers (e.g., Ebola) • Anthrax • Botulism • Plague • Tularemia

  20. Biological Agents • Types • Employment & Duration of Hazard • Physiological Effects • Protective Actions

  21. Biological Agents • Pathogens • Anthrax • Smallpox • Plague • Toxins • Ricin • Botulism toxins

  22. Biological Agents Example: Anthrax • Time to Effect • 12 hours to 5 days • Symptoms • Headache • Nausea • Fever • Vomiting • Malaise • Pretreatment • Vaccine • Treatment (cutaneous only) • Penicillin • tetracycline

  23. Biological Agents Example: Smallpox • Time to Effect • 14 - 16 Days • Symptoms • Headache • Fever • Prostration • Rash • Pretreatment • Vaccine, Isolate infected personnel for 6 days • Treatment • Immunization

  24. Biological Agents Employment & Duration • Aerosol • Exploding Devices • Sprayers • Vectors • Insects • Rodents • Clandestine • Terrorist • Covert (living agents are hard to keep secret and hard to do)

  25. Biological Agents Physiological Effects • Based on the Type of Agent • Examples • Anthrax • Small Pox • Portals of Entry • Skin • Respiratory Tract • Digestive Tract

  26. Biological Agents Protective Actions • Immunizations • Physical Health • Hygiene • Sanitation • Contamination Avoidance • Protective Equipment • Immediate Decontamination

  27. Bio-Terrorism Videos • Anthrax - Video Link • Botulism - Video Link • Plague - Video Link • Smallpox - Video Link • Tularemia - Video Link • Viral Hemorrhagic Fevers - Video Link

  28. Detection of Chemical & Biological Agents • Be Aware Of: • Groups of individuals becoming ill around the same time or place. • Any sudden increase in illness in previously healthy people. • Any sudden increase in non-specific syndromes: weakness, dimmed or blurred vision, hypersecretion, inhalation symptoms.

  29. Detection of Chemical & Biological Agents • Signs and Symptoms • Unusual • Tearing • Urination • Defecation • Gastrointestinal Disorder • Vomiting • Casualty Patterns • More Than One Victim Exhibiting the Symptoms • Large Amounts of Dead Birds or Animals

  30. Psychological Effects of Chemical & Biological Incidents (JMETL: 2) • It is critical to differentiate symptoms of chemical and biological agents from emotional and psychological effects • Most health and mental health professionals are not trained in this differential diagnosis • Long-term research being done by Tokyo Metro Fire Department

  31. Psychological Effects of Chemical & Biological Incidents (JMETL: 2) • Physical and/or Psychological Symptoms May Include: • Acute autonomic arousal, anxiety, high blood pressure, tachycardia, increased respiration, muscle tension, muscle and joint aches, tremor, nausea, headache, apathy, mood swings, thought disorders, sleep disorders, delusions, hallucinations, stress symptoms

  32. Psychological Effects of Chemical & Biological Incidents (JMETL: 2) • Vulnerability, demoralization, and fear based on: • Lack of information about agents, risk, response • Lack of confidence in health system and in government

  33. Psychological Effects of Chemical & Biological Incidents (JMETL: 2) • Fear of illness and outcome; high perceived life-threat • Uncertainty about effectiveness and safety of treatments and vaccination • Fear of premature death, horrific death (smallpox, ebola) • Fear of disfigurement (smallpox) • Contagion: fear of other persons

  34. Psychological Effects of Chemical & Biological Incidents (JMETL: 2) • Fear of quarantine and separation from family at time of illness or death • Self-imposed quarantine and isolation • Fear about dormant agents (e.g. anthrax spores) and enduring threat • Increased levels of outbreaks of multiple, unexplained symptoms (OMUS) and multiple, unexplained physical symptoms (MUPS)

  35. Psychological Effects of Chemical & Biological Incidents (JMETL: 2) • Worry about possible genetic or congenital birth defects • Worry about future health status • Outbreaks of multiple unexplained symptoms (OMUS) and multiple unexplained physical symptoms (MUPS)

  36. Spiritual Effects of Chemical & Biological Incidents (JMETL: 1,9) • Overwhelming fear, helplessness, hopelessness • Feeling “alone” due to social stigma, isolation, quarantine, and separation from loved ones • Experiencing pain on multiple levels • Facing own death or long-term illness • Experiencing the death or exposure of family members

  37. Spiritual Effects of Chemical & Biological Incidents (JMETL: 1,9) • Questioning God’s place in suffering and death, e.g.”How could God allow this to happen?” • Experiencing a “Crisis of Faith” • Feeling abandoned by God • Finding it hard to pray • Ethical Concerns (who gets vaccinated, who doesn’t, etc.)

  38. Explosive Weapons • Bombs are involved in 70% of terrorist acts • Most “popular” and easy to make of weapons • Can look like anything, be placed anywhere

  39. Explosives (Conventional) • Terrorists “weapons of choice” • Can be: • Military munitions • Improvised explosive devices • Considered high risk

  40. Incendiary Devices • Used to initiate combustion • Easy to make • Easy to use • Considered high risk/low impact

  41. Incendiary Devices • Extreme temperatures • Molotov cocktail • Aircraft • Trucks

  42. Critical Infrastructure Threats Buildings, roads, bridges, dams, utilities, petrochemical systems, transportation systems, airspace, banking and stock exchange, telecommunications) -- California Specialized Training Institute, 2002

  43. Main Designs • IEDs are defined by their purpose and are divided into two main functioning designs: • Antiproperty • Antipersonnel

  44. Antiproperty – Blast Devices Nairobi Embassy Murrah Federal Building

  45. Antipersonnel – Blast Devices Blast Injury—Hand GI Tract Blast Injury— Ruptured Tympanic Membrane Blast Injury—X-ray

  46. Antipersonnel – Fragmentation IED Containers That Will Fragment Fragments Added to an IED

  47. Antipersonnel – Fragmentation Fragmentation Injury Small Fragmentation (Nuts) Fragmentation Penetration Large Fragmentation

  48. IEDs Without High/Homemade Explosives • Not all IEDs have only high or homemade explosives; some may contain: • Pyrotechnics • Incendiary mixes • Lethal or noxious chemicals • Body fluids and/or pathological waste

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