Transcript Document 7208186

CBRNE Training Academy
Understanding Nuclear, Biological
and Chemical Events
Risk Assessment
Lecture Goals
• Understand the basics of:
– Biological exposure
– Chemical exposure
– Nuclear/Radiological exposure
– Transmission and contamination
• Develop personal risk assessment
– Am I in danger?
Basic assumptions
• The hospital is not the scene
• EMS/Fire decontaminate patients
• 60-80% of people bypass EMS
Biological, Chemical and
Nuclear
General Concepts
Why are hazards hazardous?
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“Chemical” nature
Host factors
Environmental issues
Exposure
Dose
Philip Theophrastus Bombast
von Hohenheim
aka PARACELSUS (1493-1541)
What it is makes it bad
• Chemical nature and physical properties
Who you are makes it bad
• Age, health and disease
Where you are makes it bad
• Wind, water and weather
Exposure
• Route, duration
and degree
The Specifics
Biological agents
ready.gov
If you see signs
of a chemical
attack, quickly
try to define the
impacted area or
where the
chemical is
coming from, if
possible.
Not ready.gov
Hurricanes,
animal corpses
and the
biohazard symbol
have a lot in
common. Think
about it.
Biological basics
• Particles that cause disease
– Bacteria
– Viruses
– Fungi
Awareness
• Unusual syndromes
– Flu out of flu-season
• Unexpected geography or clusters
– Plague in NYC
– Pets and humans
– Whole neighborhoods
– Everyone from a Knicks game
• Unusual diseases
– Hemorrhagic fevers
Protection basics
Standard precautions
Examples of
Personal Protective Equipment
Examples of biologic agents
• Bacteria
Anthrax
Tularemia
Pneumonic Plague
• Viruses
Smallpox
Influenza
Viral Hemorrhagic Fevers (VHFs);
Lassa, Ebola, Marburg
• Biological Toxins
Botulism
How do they present?
• “Flu” like symptoms
– Inhalational anthrax
– Smallpox
– Pneumonic plague
– Viral Hemorrhagic fever
– Tularemia
– Pandemic influenza
– Avian influenza
– SARS
• Almost all of them
Can I catch this?
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Anthrax
Brucellosis
Q fever
Tularemia
Equine encephalitis
Toxins: Botulism, Staph enterotoxin B,
Ricin
NO
Can I catch this?
• Pneumonic plague
• Smallpox
• Viral hemorrhagic fevers (VHF)
– Lassa, Ebola, Marburg
MAYBE
• Not contagious prior to symptoms
Pneumonic Plague
• Naturally transmitted from person to
person through large respiratory droplets
• Surgical mask is adequate for most people
in most situations
• Droplet precautions
Smallpox
• Naturally transmitted from person to
person through large respiratory
droplets & through direct contact with
oral/pharyngeal secretions
• Less contagious than measles, chicken
pox
N100
Quarantine
I’m exposed, now what?
• Antibiotics (Doxycycline, Ciprofloxacin)
– Anthrax, Plague
• Vaccine
– Smallpox (within 4 days of exposure)
• Supportive care and experimental
– Botulism
– VHF
– Equine encephalitis
– Ricin exposure
Biological summary
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Exposed
Bag clothes
Shower
Universal
precautions
Quarantine
Post-exposure
prophylaxis (patient)
Sick and contagious
• Isolate
• Universal
precautions
• Respiratory
precautions
• Post-exposure
prophylaxis (patient
and maybe staff)
Risk summary
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Not sick, unlikely to be contagious
Decontaminate (maybe)
Universal and respiratory precautions
Isolation and hand washing
Post exposure prophylaxis
The Specifics
Chemical hazards
ready.gov
If you become
aware of an
unusual or
suspicious
release of an
unknown
substance
nearby, it
doesn't hurt to
protect yourself.
Not ready.gov
If you are
sprayed with an
unknown
substance,
stand and think
about it instead
of seeing a
doctor.
Awareness
• Five senses
• Toxidromes
– Skin
– Pupils
– Bowels
– Bladder
– Mucous membranes
– Mental status
Chemical basics
• What are its properties?
– Solid, liquid, gas
• Any properties of concern?
– Volatility
– Flammability
• How was it released / distributed?
• How did it get here?
If you remember one thing. . .
• Decontamination
•Decontamination
•Decontamination
What do we worry about?
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Nerve Agents
Blood Agents
Choking Agents
Blister (vesicant) Agents
Riot Control Agents
Nerve Agents
• Anti-human pesticide
• Absorbed through ALL routes, inhalation
causes most rapid onset of symptoms
• Cholinergic toxidrome; SLUDGEM
Primary effects observed in Tokyo were
pinpoint pupils, dimmed vision,
weakness
• Decontamination & PPE vital
Nerve Agents
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March 1995
Sarin release
11 killed
5510 sought
emergency
medical care
How do I treat this?
• Decontaminate
• ABC’s
• Antidotes
– Mark I kit
– Atropine
– Oximes for aging
• Central Nervous System (CNS)
depressants
“Off-gassing”
• “Contagious” chemical
– Georgia nurse
– Tokyo doctors
• No decontamination performed
• No PPE used in any cases
“Blood” or metabolic agents
• Cyanide is primary example
• Common industrial agent
• Interrupts aerobic respiration (ability to use
oxygen)
• Rapid, severe clinical deterioration
Leads to collapse, apnea, seizures,
severe metabolic acidosis & death
• Therapy
Decontaminate
Oxygen, bicarbonate, sodium thiosulfate
Blister (vesicant) agents
• Sulfur Mustard
Environmental persistence
Dermal effects in 1-2 minutes
Systemic effects in 4-8 hours
• Decontamination
and supportive care
Choking (pulmonary) agents
• Phosgene and Chlorine
– Common industrial agents
• Cause delayed lung injury
Chlorine + water = HCL
• Airway management
• Decontamination (maybe)
• Supportive care
“Riot control” agents
• Many compounds
– Solids within liquids
• Primarily irritants
– High pressure particulate
– Burns (eyes, skin)
– Coughing, asthma-like
symptoms
• Decontamination is key
Chemical summary
• Decontamination
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Protect yourself
Identify the toxidrome
Many agents have specific therapies
Aggressive supportive care
Monitor for delayed toxicity
• Decontamination
Risk summary
• Whatever patient had, staff has less
• Protect yourself
– Decontamination . . .
– Personal protective equipment
• Low risk once clean
The Specifics
Nuclear/Radiological hazards
ready.gov
Or if it would be better to go inside a building
and follow your plan to shelter-in-place.
Not ready.gov
After exposure to radiation it is important to
consider that you may have mutated to gigantic
dimensions: watch your head.
Basics of radiation
Contamination
Incorporation
Irradiation
Risk
Maybe Risk
No Risk
Awareness and protection
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Detection
Decontamination
Distance
Deflection
Radiologic principles
• Alpha, Beta, Gamma, Neutron
• RAD’s and REM’s
0.003 REM
200 REM
0.005 REM
6 REM/yr
> 400 REM
45 REM
??? REM
What do we worry about?
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Simple radiological device
Radiological dispersal device
Reactor
Improvised nuclear device
Nuclear weapon
Acute Radiation Syndrome
• Associated effects
– Rapidly dividing cell populations
– GI distress, altered mental status, shock
– Therapy is primarily supportive
• Trauma and radiation
– Treatment within 48 hours
– Or delay 2 to 3 months
Radiation summary
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You must think about it
Detection, decontamination, distance
Treatment is primarily supportive
Trauma and radiation within 48 hours
– Stabilize first, decontaminate second
Risk summary
• Stay away from source (distance)
• Whatever patient had, staff has less
• Decontaminate contaminated patients
– Irradiated patients pose no risk
– Incorporated depends on source
• Very low risk to staff
Am I safe?
Risk Assessment
General Rule #1
• Unless patient is sick with a contagious
illness, they pose no threat to staff.
Corollary
Treat all patients as contagious.
Decontaminate everyone.
Protect yourself.
General Rule #2
• Whatever the patient was exposed to,
the staff will be exposed to far less.
Corollary
Decontamination reduces risk even more.
Decontaminate everyone.
Protect yourself.
General rule #3
• You can only detect radiation if you
think about radiation.
Corollary
Screen everyone with a Geiger counter.
Decontaminate everyone.
Protect yourself.
Questions?