CBRNE Training Academy

Relating the Exotic to the Relating the Exotic to the MundaneMundane

Objectives• Integrate Awareness, Hazard

Recognition and SIN• Illustrate the “All Hazards”

approach• Personal empowerment

Scenario #1• You are a security guard• You work at the large county

hospital• You control flow into the

emergency department

Here’s what you see . . .• Patient presents with a cough• Fifth patient in last hour with

cough• They all also have fever• They are all from the same place

• What do you do now?

Approach• Awareness

– Abnormal for time of year, hospital• Hazard Recognition

– Cough and fever is infectious• S-I-N

– Protect yourself (mask, isolate)– Protect others (isolate, masks, etc.)– Notify the triage nurse or supervisor

Gather information• They are all from the same

shelter / prison• They are all from the same

apartment building / office• They are all from the same day

care / nursing home• They are all from Hong Kong• They are all from the same train

What is this?• “A cold?”• Influenza?• Tuberculosis?• Atypical pneumonia (Legionella)?• SARS?• Anthrax?

• More importantly, does it matter?

Common ground• This is an infectious disease problem

– The organism defines the menace– The intent defines the malice

• A biological terrorism event is an “Infectious Disease Outbreak”– Initial approach is the same– Subsequent is modified by what you learn

Anyone can sound the alarm

Scenario #2• You work at the gift shop in the

hospital lobby• It is a popular place for employees• They get discounts on medicine,

food and drink• It is a slow day because of the

blizzard

Here’s what you see. . .• An employee has tearing, and

difficulty breathing• Third employee in last hour with

similar problem• They all smell funny• You start to feel the same

symptoms

• What do you do now?

Approach• Awareness

– This is not normal; you are healthy• Hazard Recognition

– Something is causing irritation– This is being brought by the employees

• S-I-N– Close up shop, find clean air– Remove contaminated clothing, seek

care– Notify your supervisor, security, the ER,

etc.

Gather information• They all work in the kitchen• They all work as groundskeepers• They all work in environmental

services• They all work in the same lab• They all work in security• They all work in the mailroom

What is this?• Environmental allergy?• Pesticide?• Chlorine gas?• Tear gas?• Nerve agent?

• More importantly, does it matter?

Common ground• This is an chemical exposure problem

– The chemical defines the menace– The intent defines the malice

• A chemical terrorism event is a “Hazardous Materials Incident”– Initial approach is the same– Subsequent is modified by what you

learn

Anyone can sound the alarm

Scenario #3• You are an emergency physician• You are responsible for medical

command of the local EMS units• It is three o’clock in the morning

Here’s what happens . . .• EMS calls• There was an explosion• They are bringing five critical

patients• They are all coming from the same

place

• What do you do now?

Approach• Awareness

– Know resources, staff and community• Hazard Recognition

– Know what exists near the hospital– Know your EMS units and paramedics

• S-I-N– Prepare– Activate trauma team, plan; get info– Let people know (administration, etc.)

What you learn• Construction site• Fireworks factory• Chemical production plant• Nuclear power plant• Subway car / Train station• Church / Synagogue• FBI building

What is this?• Explosive + Thermal?• Explosive + Thermal + Chemical?• Explosive + Thermal +

Radiological?

• More importantly, does it matter?

Common ground• This is an fire / explosive problem

– The blast defines the menace– The intent defines the malice

• A fire / explosion terrorism event is a “Mass Casualty-Trauma/Burn Incident”– Initial approach is the same– Subsequent modified by what you learn

Anyone can sound the alarm

Summary• Be calm• Be aware• Recognize hazards• Remember to S-I-N and count to T-

E-N• Healthcare focuses on the menace• Consistent, common approach• Anyone can sound the alarm

Questions?