FOR EMERGENCY MEDICAL SERVICES
EMS responders are faced with the threat of bombs and explosive substances as never before. Whether due to a terrorist threat, a hazardous materials incident, a drug lab or something in the patient’s vicinity, the nature of the danger and the ability to recognize potential threats is paramount.
This paper is intended to provide you with information you can use to protect yourself and the people around you.
Remember that NYS and national protocols place scene safety as YOUR first priority. It’s common sense as well. You cannot provide aid to anyone if you are injured or killed.
While terrorism is a major part of the threat to EMS providers, we should remember that we will likely NEVER be involved in an incident of terrorism. Lessons drawn from terrorist incidents do apply to the other types of explosive dangers that we WILL see on a daily basis.
Use of Chlorine Tanks
To date in 2007 there have been about 14 attacks in Iraq which used a combination of explosives concealed in a motor vehicle and one or more tanks of chlorine gas. The vehicles have usually been trucks, due to the necessity of carrying a large quantity of explosives as well as the tanks of chlorine. In Iraq, most explosives are military grade, either salvaged from the billions of dollars in munitions stockpiled by the former regime or imported. There has been some use of the diesel fuel / fertilizer type bomb, similar to the ones used in Oklahoma City and in the first World Trade Center bombing.
The tanks are standard tanks found in industrial use. The Chlorine Institute states this about the use of chlorine:
Because of its reactivity and bonding characteristics, chlorine has become an essential chemical building block, leading to a myriad of materials that are used to make the products we use every day for public health, safety, nutrition, security, transportation, lifestyle and high-tech innovation. Drinking water, agricultural abundance, disinfected waste water, essential industrial chemicals, bleaches and fuels, all depend on chlorine.
Pharmaceuticals, plastics, dyes, cosmetics, coatings, electronics, adhesives, clothing and automobile parts are examples of product groups that depend on chlorine chemistry.
As with any hazardous material, the effects of exposure to chlorine increase as the dose increases. In Iraq, most of the exposures resulted in respiratory distress and eye injuries. No deaths have been reported from exposure though the blasts did result in some fatalities.
The use of chlorine in this manner does not result in the horrific casualties seen in World War I from its use on the battlefield. Explosives are not an efficient method to disperse the gas. In addition, the chemical reactivity of the chlorine means that much of the toxic cloud is converted by the blast to other substances.
Chlorine in a gas cloud is yellow and the odor is distinctive. We’ve all smelled it before, either from drinking water, bleaches or swimming pools. The keys to exposure prevention are avoiding entering yellow gas clouds and retreating from areas that smell of chlorine. Chlorine is heavier than air. It will flow to low spots and remain in areas that do not have air circulation. As EMT’s, you DO NOT carry any equipment to reduce exposure to chlorine. Standard firefighting gear, including SCBA, WILL NOT protect you from chlorine.
Rapid retreat is your only option.
EFP - Explosively Forged Penetrator
These have been seen in Iraq in the last eighteen months. They are purposely manufactured explosives designed to penetrate armor, including that of main battle tanks. Their use against lightly armored or non-armored vehicles produces a catastrophic kill. Iran is the major manufacturer of EFP’s being used in Iraq.
It is unlikely that you will be threatened by such a weapon in your normal duties.
VBEIDS
Vehicle borne explosive devices have become common worldwide. The use of trucks allows for a large quantity of explosive to be carried to the target and detonated. The use of cars and small trucks allows the bombs to be placed in plain sight, since parked cars are as common in nearly any setting.
In Iraq, we have seen the extensive use of dump trucks. Ambulances have been used in Iraq, and in Israel. Automobiles of all sizes have been used. As we recently saw in Glascow, most VBIED drivers will try to get very close to their target, if not ram it with the vehicle before detonation.
Non-occupied VBIEDS are triggered by several methods. Washing machine timers are popular. Radio triggers such as garage door openers are also common. These bombs are rarely triggered by wire since it is unusual to see wires leading from a vehicle to the bushes or a nearby house.
The only limits on these bombs are the amount and type of explosive available, and the size of the vehicle. The vehicle itself becomes part of the bomb, sending its parts flying in the blast.
VBIED’s may be found in pairs. Often one is detonated, with a second bomb designed to detonate ten minutes later when emergency personnel are on scene. This type of attack has cost the lives of hundreds of emergency personnel worldwide. It is vital that personnel trained in bomb detection clear the scene before EMS enters.
Bombs attract crowds. In many areas where this sort of terrorism exists, a bomb, even a very small device, will be used to draw a crowd. A second bomb or an attack with firearms will then follow against the responders and the crowd.
Unless the scene of an explosion has been cleared by trained bomb detection personnel, do not assume that the threat from a bomb has vanished.
In Israel, Lebanon and Iraq these bombs have also been used outside of hospitals to strike the responders delivering patients and others who traveled to the hospital because of an attack elsewhere.
IEDS
Improvised explosive devices are any sort of bomb that is home-built and then emplaced. In Iraq they are generally made from military explosives reworked, carefully, by the bomb maker into the form he needs. They can be a pipe bomb or a series of 155mm artillery shells. In the United States pipe bombs are the most common though variations occur based on the designer and his intent.
The Global Security website says:
An IED can be almost anything with any type of material and initiator. It is a “homemade” device that is designed to cause death or injury by using explosives alone or in combination with toxic chemicals, biological toxins, or radiological material. IEDs can be produced in varying sizes, functioning methods, containers, and delivery methods. IEDs can utilize commercial or military explosives, homemade explosives, or military ordnance and ordnance components.
They are unique in nature because the IED builder has had to improvise with the materials at hand. Designed to defeat a specific target or type of target, they generally become more difficult to detect and protect against as they become more sophisticated.
Bomb makers usually settle on a design that they are most comfortable with. The design of a bomb can very often be used to identify the bomber, or link a series of bombing to the same maker. The maker will use the same explosive, the same placement, the same parts and that will become his signature.
These bombs are triggered in the same ways that the VBIED’s are, with hard wiring very common in Iraq. Many IED’s are spotted because of the wires running from the road to a place of concealment. For the bomb maker, not having to build a triggering mechanism makes the construction process far easier. These wires do make detection easier. To counter this, the bombers have taken to running dozens of wires in the area of each IED, making it far more difficult to locate the actual command wires.
IED’s are common worldwide. Trash bins are very popular as the victims of IRA and ETA bombings can attest. In Iraq, anything out of the ordinary on or alongside a road may be an IED. A dead animal, a pile of trash, turned over soil can all be indicators that an IED may be present.
Deeply buried IED’s are also being found in Iraq as we move into areas where the terrorists have had months to prepare. Huge bombs buried with earthmoving equipment beneath roads have been used with devestating effect. Culverts and overpasses have also been mined in a similar manner. We are also finding numbers of buildings rigged to explode. These are newer tactics made possible by the time the bombers had to emplace their devices.
Here again the bombers may plant several, designed to take out responders or to attack a convoy of vehicles.
Workplace accidents are common, and tend to rapidly separate out the skilled bomb maker from the wanna be.
Suicide Bomber
Suicide bombers may be mentally ill or they may be willing to kill themselves for a belief or cause. While much of the news focuses upon the Islamic fanatics in Iraq and Afghanistan, these bombings happen throughout the world.
A suicide bomber may be driving a vehicle borne explosive device. Driving such a bomb allows it to be precisely targeted. Such a bomber may try to ram the vehicle of an important person, or an important building. Some drivers in Iraq have been found to be chained to the steering wheel, unwilling participants under threat to their families.
In Israel the use of the suicide vest has reached its greatest level. A suicide vest consists of a combination of explosives carried by the bomber along with possible additions to maximize the damage caused. Bomb vests have been recovered with the explosives covered with glued-on nails or ball bearing to provide projectiles in the blast. Here’s a pic of one found in Iraq.
Vests will normally have a trigger that the wearer uses to detonate the bomb. While triggers sometimes fail to function, other times the bomber is killed without any additional damage by premature activation of the triggering mechanism.
Suicide bombers may be dressed inappropriately for the weather, bulky clothing when everyone is in shorts. They may actively conceal one hand, the one with the trigger, despite the awkwardness of opening doors and such. Behavioral analysis by trained spotters may often detect these bombers before they can detonate their bomb.
A suicide bomber killed himself outside the football stadium at Oklahoma State this past Fall. It does happen in the United States.
Other Threats in Explosives and Bombs
Terrorists throughout the world are constantly coming up with new ways to use bombs.
- The use of ambulances and police cars as VBIED’s
- The use of common industrial chemicals such as chlorine or nitric acid as adjuncts to the explosives
- The use of LP gas cylinders in bombs
- Secondary and tertiary devices intended to harm emergency responders or crowds drawn by the original event
- Increased sophistication in bomb triggering devices, using cell phones, remote car entry systems
- Increased sophistication in the selection and use of materials to increase the damage caused by the original blast, purposely designed vests made of ball bearings
Hazardous Materials
As EMT’s we receive training in the recognition of hazardous materials incidents yearly. As time passes, we may become nonchalant about the dangers especially if we rarely see such incidents.
There are many hazardous materials that are explosive. Most of them we will never come across in our careers. Some we will see on an almost daily basis and we must be aware of them
Gasoline produces vapors that can create an explosion as well as a fire. Patients with gasoline vapors on their clothing are an explosion risk. Applying oxygen to such a patient may kill you.
Dust, common dust, can be explosive. Many substances that we see as safe and non-reactive will explode under the right circumstances in dust form. Iron is highly explosive as dust in an atmosphere heavy with oxygen. Flour will explode if it is in the air and a spark is created. Remove patients from dusty atmospheres due to the potential for an explosion.
Let the experts handle haz mat incidents. Don’t go rushing in and discover your mistake after the fact.
Drug Labs
The Honolulu Police Department has this to say:
WHAT ARE SOME OF THE SIGNS OR INDICATIONS OF A CLAN LAB?
- Extra ordinary security precautions being taken by the people to protect their privacy, such as security cameras, added locks, bars over windows, etc.
- Chemical containers, even more so when the labels are obliterated.
- Unusual foot traffic, containers moved in and out.
- Persons who come outside only to smoke and/or eat and drink.
- Unusual odors coming from a structure or location, such as the odor of ether or acetone (odor of fingernail polish remover).
- Dead foliage in run off areas.
- The discarding of numerous match books with only the striker pads missing.
- The discarding numerous empty containers or blister packs of over-the-counter cold medicines.
WHAT TYPE OF CHEMICALS ARE FOUND AT A CLAN LAB?
You might see all or only some of these normal household chemicals that are used to manufacture illicit drugs such as Muriatic Acid, Caustic Soda, Red Devil Lye, Rock or table salt, camping fuel, paint thinners, Toluene, automobile or diesel starting fluid, denatured or rubbing alcohol, Iodine tincture or crystals, numerous (more than a normal household would use normally) pseudoephedrine, Sudafed or cold tablets that contain the chemical ephedrine.
DANGERS AND HAZARDS OF A CLAN LAB
FIRE - Heating elements are used in some synthesis. Heat can also be generated by two or more chemicals or elements reacting with each other.
EXPLOSIONS - A violent chemical reaction between chemicals, water and/or air could result in an explosion.
CHEMICAL BURNS - Acids are used in some synthesis process of producing illicit drugs. Physical contact with a contaminated item or area could result in a chemical burn.
TOXIC GASES - Lethal phosphine and phosgene gases, and other non-lethal but irritant or obnoxious odor gases.
Terrorism
Terrorist incidents happen every week in the United States. Most do not involve bombs or explosives.
The cause with the most terrorist incidents is that of the environmentalist / animal rights groups. Letter bombs have been mailed by supporters of these causes. Attempts to sabotage electrical infrastructure have been made. Buildings have been burned. Captive animals in farm settings as well as in laboratories have been released.
Opponents of abortion have also committed terrorist acts involving bombs. Letter bombs and fire bombs have been used.
School shooters have, on occasion, used bombs as part of their attacks. The murders at Columbine are the primary example of this.
From the FBI, this on bombings:
Terrorist Incidents > by Region > by Country > by United States
Range: 01/01/2000 - 04/29/2007
Animal Liberation Front (ALF) attacked Business target (Mar. 2, 2001, United States)
Animal Liberation Front (ALF) attacked Government target (Sept. 20, 2001, United States)
Earth Liberation Front (ELF) attacked Business target (Mar. 11, 2003, United States)
Earth Liberation Front (ELF) attacked Government target (Aug. 11, 2002, United States)
Earth Liberation Front (ELF) attacked Government target (Oct. 15, 2001, United States)
Earth Liberation Front (ELF) attacked Private Citizens & Property target (Apr. 13, 2005, United States)
Earth Liberation Front (ELF) attacked Private Citizens & Property target (Dec. 29, 2000, United States)
Earth Liberation Front (ELF) attacked Private Citizens & Property target (Mar. 3, 2005, United States)
Revolutionary Cells Animal Liberation Brigade attacked Business target (Sept. 26, 2003, United States)
Unknown Group attacked Abortion Related target (June 11, 2001, United States)
Unknown Group attacked Business target (Aug. 28, 2003, United States)
Unknown Group attacked Business target (Jan. 12, 2005, United States)
Unknown Group attacked Diplomatic target (May 5, 2005, United States)
Unknown Group attacked Government target (Feb. 13, 2005, United States)
Unknown Group attacked Government target (Nov. 5, 2001, United States)
Unknown Group attacked Other target (June 3, 2002, United States)
Unknown Group attacked Other target (June 3, 2002, United States)
Unknown Group attacked Private Citizens & Property target (Dec. 27, 2004, United States)
Accidental
If you think about it, there are a lot of things around the home, the office, our lives that can explode in some way or another. As we attend to our patients on calls, we may be exposing ourselves to these threats.
From a regional council in New Zealand:
You may be surprised to learn that many everyday products we use around the home can be hazardous to our families, ourselves, and the environment. They include:
• solvents - for example, mineral turpentine
• cleaning fluids - for example, oven and drain cleaners
• garden chemicals - for example, herbicides, fungicides and insecticides
• paints - for example, enamel based paints
• dyes - for example, textile and hair dyes
• adhesives - for example, those containing solvents
• stored fuels - for example, petrol and oil
• old car batteries.
Heat increases the chances that something that is pressurized will explode. Oxygen can also increase that chance.
Paint, petroleum products, hunting supplies, fireworks and a wide range of other materials can be found where we are called for emergencies. Our emergencies may involve fires, crashes, collapses and all sorts of events that may have something to do with an explosion or may create the danger of an explosion.
As we treat our patients, be aware of the surroundings and move yourself and / or your patient if necessary to a safer place.
Awareness of your surroundings and a healthy suspicion of unusual circumstances are scene safety. As stated earlier, your first protocol is scene safety. If any of your five senses are sounding the alarm, the scene may not be safe. Your best judgment will keep you and your coworkers alive and able to respond to future emergencies.
