Homeland Security
and Emergency Medical Response

Did you Know?

Crisis at the Mall

You receive a call to your local mall for multiple persons having difficulty breathing and shortness of breath. While en route you have an update that many people are fleeing the mall and there are multiple 911 calls with citizens complaining of tearing, visual difficulty and rhinorrhea. The appropriate action is:

1. Stop and stage upwind until the hazardous materials unit assesses the scene.
2. Proceed into the scene as this is obviously a pepper spray incident.
3. Don Level C protection and segregate the ambulatory patients and begin initial decontamination by having patients remove their outer clothing.
4. Both A and C

Did you know?

If you answered B then you might be walking into a nerve agent attack. The initial symptoms from pepper spray and Sarin are very similar with the diagnostic difference pinpoint pupils present in nerve agent vapor exposure versus normal pupils in pepper spray incident. Further, if you failed to don your Level C protection you can rapidly become contaminated from either pepper spray or Sarin as it off gases from the clothing of those exposed. Many responders in the Tokyo Sarin attack exhibited symptoms from the off gassing of victims clothing. The same is true with pepper sprays. One important component of Homeland Security and EMS is the ability to differentiate the types of chemical agents that present threats and the signs and symptoms.

Unknown Explosion

You respond to an unknown type explosion at a large multi-national company in your jurisdiction. You realize that this is site of several protests including one which became violent. As you approach the scene you begin to note broken windows in surrounding structures, smoke and debris in the street and people fleeing the scene. The initial action in this circumstance is to:

1. Stop at this location and begin triage
2. Perform bullhorn triage and direct those who are injured to a triage area as far as feasible from the site upwind and report to dispatch
3. Enter the scene in Level C protective gear and begin rescue and treatment of those injured.
4. A and C

Did you know?

The correct action is B. This is a high risk event for several reasons. First you have a high profile target and second you have an explosion of unknown origin. Another factor is the visible smoke. You should not enter an unknown area with visible smoke, vapors, and mists especially following an explosion of unknown origin. The scene should be avoided until cleared by bomb technicians and hazardous materials personnel. Have those who can move on their own to evacuate upwind as far as feasible (1,500’ is recommended) and don your Level C protective clothing and begin triage. Explosives can be used to disperse toxic chemicals, radioactive material or biological agents. The explosives themselves are toxic and may contaminate those involved in the explosion. Homeland Security and EMS educates responders on the correct procedures to deal with explosions and the injuries produced by overpressure and shrapnel.

Flu-Like Illness

You find this a busy shift. You have made seven runs in less than four hours with all the patients having the same complaint of general body aches and pains, fever and lethargy. All the patients are referred to their family physician. You stop at the local pharmacy to pick up a prescription and the pharmacist asks if you have had a busy shift. You respond yes and there seems to an influenza outbreak. The pharmacist comments he has had numerous walk-ins requesting over-the-counter influenza medications. You find this odd since it is mid-July and not the influenza season. You proceed to a motor vehicle crash and transport a young motorcycle operator the local emergency department with a fractured tibia. You notice the emergency department seems more crowded than usual and in passing you ask the ER physician what is happening. She comments that there are a large number of patients presenting with flu-like symptoms. You explain your earlier runs and ask if there is a new strain of influenza emerging. With this information you should:

1. Notify your supervisor and request your observations be passed to local public health and emergency management.
2. This is not an EMS function and you should not be concerned with the issue
3. Confer with the emergency room physician and see what steps she recommends for infection control and personal protection
4. A and C

Did you know?

Unless you answered D you are likely to have missed substantial signs of an emerging event. The key is this event a natural epidemic or a biological attack. What is important to note is most biological agents such as anthrax, communicable diseases such as pneumonic plague, influenza and SARS present with flu-like symptoms. Regardless of the origin and extent your prompt reporting to your supervisor and notification of local public health and emergency management is essential. Homeland Security and EMS carefully educates the EMS responder to identify those syndromes that are suspicious and require assistance from public health authorities for situations dealing with a biological attack or epidemic.