Objectives

At the conclusion of this unit, the participants should be able to:

§         Describe the post-disaster emotional environment.

§         Describe the steps that rescuers can take to relieve their own stressors and those of disaster survivors.

Scope

The scope of this unit will include:

§         Introduction and Unit Overview.

§         Dealing with Survivors’ Trauma.

§         Dealing with CERT Members’ Stress.

§         Unit Summary.

Estimated Completion Time

45 minutes

Training Methods

The Lead Instructor will begin this unit by welcoming the participants to Unit 7:  Disaster Psychology, and will introduce the instructors for the session.  The Instructor will then present a brief overview of this session.

Next, the Instructor will explain the importance of having an understanding of the disaster and post-disaster emotional environment and the impact that the emotional crisis may have on CERT members as well as victims.  The Instructor will present the psychological and physiological symptoms that victims and rescue personnel may exhibit and provide some suggestions for how CERT members can help survivors cope with disaster trauma and control their own stress.

Resources Required

§         Community Emergency Response Team Instructor Guide

§         Community Emergency Response Team Participant Handbook

§         Visuals 7.1 through 7.15

Equipment

The following additional equipment is required for this unit:

§         A computer with PowerPoint software

§         Computer projector and screen

Notes

A suggested time plan for this unit is as follows:

Introduction and Unit Overview........................................... 5 minutes

Dealing with Survivors’ Trauma.......................................... 15 minutes

Dealing with CERT Members’ Stress.................................... 20 minutes

Unit Summary.................................................................. 5 minutes

Total Time:  45 minutes

Acknowledgement

The information from this unit has been provided by Victor Welzant, Psy.D. and George Everly, Jr., Ph.D. of the International Critical Incident Stress Foundation; and Joanne Tortorici Luna, Ph.D., California State University, Long Beach, and Culver City, California CERT.  The Federal Emergency Management Agency wishes to thank them for their assistance.

Introduction and Unit Overview

Introduce Unit

Introduce the instructors for this unit and ask any new instructors to briefly describe their experience with disaster psychology.

Stress the need for CERT members to prepare themselves for their role during and following a disaster by learning about the possible impact of disaster on them and others, emotionally and physically.  This knowledge will help CERT members understand and manage their reactions to the event and to work better with others.

Instructor’s Note

Remind the group that they recently learned about team organization.  Point out that team organization concepts can help them both operationally and psychologically.  Working together and looking out for each other is an important aspect of successful teams.

Tell the group that this unit will address techniques for managing one’s personal situation so that the needs of the victims and those of CERT team members can be met.

Introduction and Unit Overview (Continued)

Visual 7.1

Unit Objectives

1.      Describe the disaster and post-disaster emotional environment.

2.      Describe the steps that rescuers can take to relieve their own stress and those of disaster survivors.

Visual 7.1

Tell the participants that at the end of this unit, they should be able to:

§         Describe the disaster and post-disaster emotional environment.

§         Describe the steps that rescuers can take to relieve their own stress and those of disaster survivors.

Team Well-Being

Introduce this section by telling the participants that, during a disaster, they may see and hear things that will be extremely unpleasant. 

Visual 7.2

Vicarious Trauma

The process of change in the rescuer resulting from empathic engagement with survivors

Visual 7.2

Explain that vicarious trauma is the process of change in the rescuer resulting from empathic engagement with survivors.  Explain that it is an “occupational hazard” for helpers.

Warn the participants against overidentifying with the survivors. Caution them against taking on the survivors’ feelings as their own.  Advise the group that taking ownership of others’ problems will compound their own stress and affect the CERT’s overall effectiveness.

Caution the participants to be alert to signs of disaster trauma in themselves, as well as in disaster victims, so that they can take steps to alleviate stress.

Team Well-Being (Continued)

Visual 7.3

Possible Psychological Symptoms

§         Irritability, anger

§         Self-blame, blaming others

§         Isolation, withdrawal

§         Fear of recurrence

§         Feeling stunned, numb, or overwhelmed

§         Feeling helpless

§         Mood swings

§         Sadness, depression, grief

§         Denial

§         Concentration, memory problems

§         Relationship conflicts/marital discord

Visual 7.3

Give examples of the types of psychological and physiological responses that may be observed in rescuers after a disaster.

Psychological symptoms may include:

§         Irritability or anger.

§         Self-blame or the blaming of others.

§         Isolation and withdrawal.

§         Fear of recurrence.

§         Feeling stunned, numb, or overwhelmed.

§         Feeling helpless.

§         Mood swings.

§         Sadness, depression, and grief.

§         Denial.

§         Concentration and memory problems.

§         Relationship conflicts/marital discord.

Team Well-Being (Continued)

Visual 7.4

Possible Physiological Symptoms

§         Loss of appetite

§         Headaches, chest pain

§         Diarrhea, stomach pain, nausea

§         Hyperactivity

§         Increase in alcohol or drug consumption

§         Nightmares

§         Inability to sleep

§         Fatigue, low energy

Visual 7.4

Physiological symptoms may include:

§         Loss of appetite.

§         Headaches or chest pain.

§         Diarrhea, stomach pain, or nausea.

§         Hyperactivity.

§         Increase in alcohol or drug consumption.

§         Nightmares.

§         The inability to sleep.

§         Fatigue or low energy.

Team Well-Being (Continued)

Visual 7.5

Team Well-Being

CERT team leaders should:

§         Provide pre-disaster stress management training.

§         Brief personnel before response.

§         Emphasize teamwork.

§         Encourage breaks.

§         Provide for proper nutrition.

§         Rotate.

§         Phase out workers gradually.

§         Conduct a brief discussion.

§         Arrange for a post-event debriefing.

Visual 7.5

Explain that there are steps that CERT team leaders can take to reduce the stress on rescue workers before, during, and after an incident:

§         Provide pre-disaster stress management training to all CERT personnel.

§         Brief CERT personnel before the effort begins on what they can expect to see and what they can expect in terms of emotional response in the survivors and themselves.

§         Emphasize that the CERT is a team.  Sharing the workload and emotional load can help defuse pent-up emotions.

§         Encourage rescuers to rest and re-group so that they can avoid becoming overtired.

§         Direct rescuers to take breaks away from the incident area, to get relief from the stressors of the effort.

§         Encourage rescuers to eat properly and maintain fluid intake throughout the operation.  Explain that they should drink water or other electrolyte-replacing fluids, and avoid drinks with caffeine or refined sugar.

§         Rotate teams for breaks or new duties (i.e., from high-stress to low-stress jobs).  Team members can talk with each other about their experiences.  This is very important for their psychological health.

Team Well-Being (Continued)

§         Phase out workers gradually.  Gradually phase them from high- to low-stress areas of the incident.

§         Conduct a brief discussion (defusing) with workers after the shift, in which workers describe what they encountered and express their feelings about it.

§         Arrange for a debriefing 1 to 3 days after the event in which workers describe what they encountered and express their feelings about it in a more in-depth way.

CERT leaders may invite a mental health professional trained in Critical Incident Stress Management (CISM) to conduct a Critical Incident Stress Debriefing (CISD).

Explain that a CISD is a formal group process held between 1 to 3 days after the event and is designed to help emergency services personnel and volunteers cope with a traumatic event.

Team Well-Being (Continued)

Visual 7.6

Reducing Stress

§         Get enough sleep.

§         Exercise.

§         Eat a balanced diet.

§         Balance work, play, and rest.

§         Allow yourself to receive as well as give.  Remember that your identity is broader than that of a helper.

§         Connect with others.

§         Use spiritual resources.

Visual 7.6

Remind the group that they should spend some time thinking about other ways to reduce stress personally.  Emphasize that only they know what makes them able to reduce stress within themselves and that expending the effort required to find personal stress reducers is worthwhile before an incident occurs.  Remind the participants that they can take the following preventive steps in their everyday lives:

§         Get enough sleep.

§         Exercise.

§         Eat a balanced diet.

§         Balance work, play, and rest.

§         Allow themselves to receive as well as give.  They should remember that their identity is broader than that of a helper.

§         Connect with others.

§         Use spiritual resources.

Point out that experienced rescue workers find these steps helpful in controlling their stress levels, but that, in some cases, it might be necessary to seek help from mental health professionals.

Team Well-Being (Continued)

Visual 7.7

Critical Incident Stress Debriefing

Seven phases:

§         Introductions and a description

§         Review of the factual material

§         Sharing of initial thoughts/feelings

§         Sharing of emotional reactions to the incident

§         Instruction about normal stress reactions

§         Review of the symptoms

§         Closing and further needs assessment

Visual 7.7

Point out that CISD is one type of intervention within a more comprehensive, multicomponent crisis intervention system that is based on a careful assessment of the needs of a group or individual.  CISD should not be used as a stand-alone intervention but should be used in conjunction with other types of intervention.

Explain that a CISD has seven phases:

§         Introductions and a description of the process, including assurance of confidentiality

§         Review of the factual material about the incident

§         Sharing of initial thoughts/feelings about the incident

§         Sharing of emotional reactions to the incident

§         Review of the symptoms of stress experienced by the participants

§         Instruction about normal stress reactions

§         Closing and further needs assessment

Team Well-Being (Continued)

Emphasize that participation in CISD should be voluntary.

Tell the group that to schedule a CISD, they should contact the Red Cross, local emergency management agency, or community mental health agency.  They could also ask their local fire or police department for help in contacting the appropriate person.

Working with Survivors’ Trauma

Visual 7.8

Phases of a Crisis

§         Impact

§         Inventory

§         Rescue

§         Recovery

Visual 7.8

Tell the group that research studies show survivors go through distinct emotional phases following a disaster:

§         In the impact phase, survivors do not panic and may, in fact, show no emotion. 

§         In the inventory phase, which immediately follows the event, survivors assess damage and try to locate other survivors.  During this phase, routine social ties tend to be discarded in favor of the more functional relationships required for initial response activities (e.g., search and rescue).

§         In the rescue phase, emergency services personnel (including CERTs) are responding and survivors are willing to take their direction from these groups without protest.  This is why CERT identification (helmets, vests, etc.) is important.

§         In the recovery phase, the survivors appear to pull together against their rescuers, the emergency services personnel.

Tell the participants that they should expect that survivors will show psychological effects from the disaster—and that they should expect that some of the psychological warfare will be directed toward them.

Working with Survivors’ Trauma (Continued)

Visual 7.9

Traumatic Crisis

An event in which people experience or witness:

§         Actual or potential death or injury to self or others.

§         Serious injury.

§         Destruction of homes, neighborhood, or valued possessions.

§         Loss of contact with family/close relationships.

Visual 7.9

Introduce this section by defining a crisis as an event that is experienced or witnessed in which people’s ability to cope is overwhelmed:

§         Actual or potential death or injury to self or others.

§         Serious injury.

§         Destruction of their homes, neighborhood, or valued possessions.

§         Loss of contact with family members or close friends.

Working with Survivors’ Trauma (Continued)

Visual 7.10

Traumatic Stress

Traumatic stress may affect:

§         Cognitive functioning.

§         Physical health.

§         Interpersonal reactions.

Visual 7.10

Traumatic stress may affect:

§         Cognitive functioning.  Those who have suffered traumatic stress many act irrationally, have difficulty making decisions; or may act in ways that are out of character or them normally.  They may have difficulty sharing or retrieving memories.

§         Physical health.  Traumatic stress can cause a range of physical symptoms—from exhaustion to heat problems.

§         Interpersonal relationships.  Those who survive traumatic stress my undergo temporary or long-term personality changes that make interpersonal relationships difficult.

Working with Survivors’ Trauma (Continued)

Visual 7.11

Mediating Factors

§         Prior experience with a similar event

§         The intensity of the disruption in the survivors’ lives

§         Individual feelings that there is no escape, which sets the stage for panic

§         The emotional strength of the individual

§         The length of time that has elapsed between the event occurrence and the present

Visual 7.11

Explain that the strength and type of personal reaction vary because of:

§         The person’s prior experience with the same or a similar event.  The emotional effect of multiple events can be cumulative, leading to greater stress reactions.

§         The intensity of the disruption in the survivors’ lives. The more the survivors’ lives are disrupted, the greater their psychological and physiological reactions may become.

§         The meaning of the event to the individual.  The more catastrophic the victim perceives the event to be to him or her personally, the more intense will be his or her stress reaction.

§         The emotional well-being of the individual and the resources (especially social) that he or she has to cope.  People who have had other recent traumas may not cope with additional stresses.

§         The length of time that has elapsed between the event’s occurrence and the present.  The reality of the event takes time to “sink in.”

Working with Survivors’ Trauma (Continued)

Caution the group, however, that they should not take the survivors’ surface attitudes personally.  Rescuers may expect to see a range of responses that will vary from person to person, but the responses they see will be part of the psychological impact of the event—and probably will not relate to anything that the CERTs have or have not done.

Visual 7.12

Stabilizing Individuals

§         Assess the survivors for injury and shock.

§         Get uninjured people involved in helping.

§         Provide support by:

	Listening.
	Empathizing.

§         Help survivors connect with natural support systems.

Visual 7.12

Explain that the goal of on-scene psychological intervention on the part of CERT members should be to stabilize the incident scene by stabilizing individuals.  Suggest that they do this in the following ways:

§         Assess the survivors for injury and shock.  Address any medical needs first.  Observe them to determine their level of responsiveness and whether they pose a danger to themselves or to others.

§         Get uninjured people involved in helping.  Focused activity helps to move people beyond shock, so give them constructive jobs to do, such as running for supplies.  This strategy is especially effective for survivors who are being disruptive.

Working with Survivors’ Trauma (Continued)

§         Provide support by:

	Listening to them talk about their feelings and their physical needs.  Victims often need to talk about what they’ve been through—and they want someone to listen to them.
	Empathizing.  Show by your responses that you hear their concerns.  Victims want to know that someone else shares their feelings of pain and grief.

§         Help survivors connect to natural support systems, such as family, friends, or clergy.

Stress that, survivors that show evidence of being suicidal, psychotic, or unable to care for themselves should be referred to mental health professionals for support.  (This will be infrequent in most groups of survivors.)

Visual 7.13

Avoid Saying . . .

§         “I understand.”

§         “Don’t feel bad.”

§         “You’re strong/You’ll get through this.”

§         “Don’t cry.”

§         “It’s God’s will.”

§         “It could be worse” or “At least you still have …”

Visual 7.13

Tell the participants that, when providing support, they should avoid saying the following phrases.  On the surface, these phrases are meant to comfort the survivors, but they do not show an understanding of the person’s feelings.

§         “I understand.”  In most situations we cannot understand unless we have had the same experience.

§         “Don’t feel bad.”  The survivor has a right to feel bad and will need time to feel differently.

Working with Survivors’ Trauma (Continued)

§         “You’re strong/You’ll get through this.”  Many survivors do not feel strong and question if they will recover from the loss.

§         “Don’t cry.”  It is ok to cry.

§         “It’s God’s will.”  Giving religious meaning to an event to a person you do not know may insult or anger the person.

§         “It could be worse” or “At least you still have …”  It is up to the individual to decide whether things could be worse.

Emphasize that these types of responses could elicit a strong negative response or distance the survivor from you.

Point out that it is ok to apologize if the survivor reacts negatively to something that you said.

Visual 7.14

Managing the Death Scene

§         Cover the body; treat it with respect.

§         Have one family member look at the body and decide if the rest of the family should see it.

§         Allow family members to hold or spend time with the deceased.

§         Let the family grieve.

Visual 7.14

Explain that one unpleasant task that CERT members may face is managing the family members at the scene of the death of a loved one.  Suggest the guidelines below (T.W. Dietz, 2001; J.M. Tortorici Luna, 2002) for dealing with this situation:

§         Cover the body; treat it with respect.  Wrap mutilated bodies tightly.

§         Have one family member look at the body and decide if the rest of the family should see it.

Working with Survivors’ Trauma (Continued)

§         Allow family members to hold or spend time with the deceased.  Stay close by, but don’t watch—try to distance yourself emotionally.

§         Let the family grieve.  Don’t try to comfort them out of a need to alleviate your own discomfort.

Visual 7.15

Informing Family of a Death

§         Separate the family members from others in a quiet, private place.

§         Have the person(s) sit down, if possible.

§         Make eye contact and use a calm, kind voice.

§         Use the following words to tell the family members about the death:  “I’m sorry, but your family member has died.  I am so sorry.”

Visual 7.15

In some cases, the family may not know of the death of their loved one, and CERT members may be called upon to tell them.  Suggest that in this situation, CERT members:

§         Separate the family members from others in a quiet, private place.

§         Have the person(s) sit down, if possible.

§         Make eye contact and use a calm, kind voice.

§         Use the following words to tell the family members about the death:  “I’m sorry, but your family member has died.  I am so sorry.”

Unit Summary

Ask Question

After answering all of the participants’ questions, pose some “What would you do if . . .” questions to ensure that they understand the concepts of this section.  For example, ask the participants, “What would you do if you were attempting to rescue a victim and the victim became hysterical?”

Instructor’s Note

Ask the participants if anyone has any questions about the types of emotional and physiological responses that they can expect to see during and following a disaster.

Homework Assignment

Handout

Thank the participants for attending, and remind them of the date and time for the next session, if necessary.

Objectives

At the conclusion of this unit, the participants should be able to:

§         Define terrorism.

§         Identify potential targets within the community.

§         Identify CERT operating procedures for a terrorist incident.

§         Describe the actions to take following a suspected terrorist incident.

Scope

The scope of this unit will include:

§         Introduction and Unit Overview.

§         What is Terrorism?

§         Terrorist Targets

§         Terrorist Weapons

§         B-NICE Indicators

§         Preparing at Home and Work

§         Unit Summary

Estimated Completion Time

2 hours 30 minutes

Training Methods

The Instructor will introduce this unit by describing CERT’s role within the President’s Citizen Corps program.  He or she will then define terrorism, using the Department of Justice definition and provide several examples of terrorist attacks within the United States.  Then, the Instructor will describe the terrorists’ goals.

Next, the Instructor will describe the main categories of weapons that terrorists are known to have or are suspected of having.  During this discussion, the Instructor will introduce the acronym B-NICE (biological, nuclear, incendiary, chemical, explosive) as a way of remembering each category of weapons.  The Instructor will describe each type of weapon briefly, including the types of damage or injury that they can cause and, in the case of biological and chemical weapons, routes of exposure.  At the end of this discussion, the Instructor will present a graphic that describes the FBI's assessment of the risk posed by and the impact that could be expected from each type of weapon.

Following this topic, the Instructor will cover steps to take to prepare for a terrorist incident and steps to take if an incident has occurred including shelter-in-place procedures and emergency decontamination procedures.

Training Methods (Continued)

In the next topic, the Instructor will describe the environmental and physical indicators that serve as cues that a terrorist attack has occurred or may be imminent.  Then, he or she will link these cues to CERT protocols for terrorist incidents, emphasizing team safety as the first priority.  This discussion will include measures that CERT members can take to increase their safety levels (e.g., time, distance, and shielding; immediate decontamination; and not treating those who may have been contaminated), what they can do to protect others, and what to expect when professional responders arrive.

At the end of this unit, the participants will work in teams to apply CERT principles to a suspected terrorist incident.

Resources Required

§         Community Emergency Response Team Instructor Guide

§         Community Emergency Response Team Participant Manual

§         Visuals 8.1 through 8.27

Equipment

The following additional equipment is required for this unit:

§         A computer with PowerPoint software

§         A computer projector and screen

Notes

A suggested time plan for this unit is as follows:

Introduction and Unit Overview......................................... 10 minutes

What is Terrorism?.......................................................... 10 minutes

Terrorist Targets............................................................ 10 minutes

Terrorist Weapons.......................................................... 30 minutes

B-NICE Indicators........................................................... 20 minutes

Preparing at Home and Work............................................. 20 minutes

CERTs and Terrorist Incidents........................................... 20 minutes

Activity:  Applying CERT Principles to a Suspected

Terrorist Incident....................................................... 25 minutes

Unit Summary.................................................................. 5 minutes

Total Time:  2 hours 30 minutes

Remarks

It is not possible to present comprehensive information about terrorists or their weapons in the timeframe provided for this unit.  Refer the participants to Are You Ready? for more information about possible terrorist attacks and how to prepare for them.

Introduction and Unit Overview

Introduce Unit

Introduce the instructors for this unit and ask any new instructors to briefly describe their experience with terrorism planning.

Remind the group that, in his January 29, 2002, State of the Union address, the President asked Americans to volunteer their services to improve and safeguard our country and created the Citizen Corps program to help Americans meet this call to service.

Visual 8.1

Citizen Corps

Citizen Corps areas of emphasis:

§         Crime

§         Natural disasters

§         Terrorism

Visual 8.1

Explain that one of the volunteer opportunities offered to the American public under the Citizen Corps umbrella is the CERT program.

Given the increased threat of terrorist attacks on American soil, CERT members must be educated about CERT protocols and procedures for terrorist incidents and the actions that CERTs should take following a possible terrorist attack.

Introduction and Unit Overview (Continued)

Visual 8.2

Unit Objectives

§         Define terrorism.

§         Identify potential targets in the community.

§         Identify CERT operating procedures for a terrorist incident.

§         Describe the actions to take following a suspected terrorist incident.

Visual 8.2

Tell the participants that at the end of this unit, they should be able to:

§         Define terrorism.

§         Identify potential targets in the community.

§         Identify CERT operating procedures for a terrorist incident.

§         Describe the actions to take following a suspected terrorist incident.

What is Terrorism?

Visual 8.3

What is Terrorism?

The unlawful use of force or violence committed by a group or individual against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.

-- U.S. Department of Justice

Visual 8.3

Introduce this topic by providing the U.S. Department of Justice’s definition of terrorism:

     . . .the unlawful use of force or violence committed by a group or individual against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.

Stress that terrorism may be perpetrated by foreign or domestic individuals or groups.  Point out that while the United States has not had as many terrorist incidents as some other countries, we have had several serious attacks, including:

§         The bombing of the World Trade Center (1993).

§         The bombing of the Murrah Federal Building in Oklahoma City (1995).

§         The bombing at the Atlanta Olympic Games (1996).

§         Bombings at family planning clinics and gay bars in the Atlanta area (1996 and 1997).

§         The destruction of the World Trade Center and a portion of the Pentagon (2001).

§         The sending of anthrax through the U.S. Mail (2001).

What is Terrorism? (Continued)

Each of these incidents demonstrates that we live with the possibility of additional terrorist attacks on our own soil.

Visual 8.4

Terrorist Goals

§         Mass casualties

§         Loss of critical resources

§         Disruption of vital services

§         Disruption of the economy

§         Individual and mass panic

Visual 8.4

Explain that terrorist attacks can occur with or without warning.  Because of the nature of terrorist attacks, they can—and are often intended to—result in:

§         Mass casualties.

§         Loss of critical resources.

§         Disruption of vital services.

§         Disruption of the economy.

§         Individual and mass panic.

Terrorist Targets

Tell the group that terrorists choose their targets to meet their goals.  For example, the Oklahoma City bombing was a strike against the Federal government that caused mass panic in the Oklahoma City area.  The 9/11 attacks struck both our economy and our military establishment, while raising casualty levels to new heights and changing the way America thinks about its safety.

Point out that terrorists select “soft” or lightly protected targets over “hard” or very secure targets.

Ask Question

Based on what you know about terrorists and their goals, what do you think would be likely targets in this area?

Allow the group time to respond.  Summarize their responses by suggesting potential terrorist targets:

§         Seats of government

§         Key industries

§         Bridges, subways, tunnels, and other key transportation facilities

§         Water supplies and utilities

Remind the group that terrorists may also be drawn to major events such as parades or athletic events.  Also, remind them that because of this, participants may see increased security measures to help deter and prevent terrorism.

Terrorist Weapons

Tell the group that experts generally agree that there are five categories of possible terrorist weapons.  The acronym B-NICE will help the participants to remember.

Visual 8.5

Terrorist Weapons

§         Biological

§         Nuclear

§         Incendiary

§         Chemical

§         Explosive

Visual 8.5

§         Biological weapons

§         Nuclear weapons and radiological dispersal devices

§         Incendiary devices

§         Chemical devices

§         Explosive devices

Terrorist Weapons (Continued)

Visual 8.6

Biological Weapons

§         Targets:  People, animals, crops

§         Routes of exposure:  Inhalation, ingestion, absorption

Agents:

§         May take days or weeks to be confirmed.

§         May spread for beyond initial contamination point.

§         Considered high risk.

Visual 8.6

The weapons thought to be available to at least some terrorist groups include:

1.      Biological weapons.  Biological agents are found in nature.  Some countries, however, have devised ways to weaponize biological agents so that they can be disseminated to affect broad segments of the population, animal populations, or crops. 

Some biological agents are contagious, but many are not.  Routes of exposure for biological weapons are:

§         Inhalation.

§         Ingestion.

§         Absorption.

Many, but not all, biological agents take days or even weeks for their symptoms to appear.  It is possible for a biological attack to occur and remain unnoticed for some time. 

It is also possible for some biological agents to spread far beyond their initial point of contamination as the daily routines of affected individuals broaden the reach of the agent.

Terrorist Weapons (Continued)

Instructor’s Note

Although, not a biological attack, the Severe Acute Respiratory Syndrome epidemic is an example of how a biological agent can be spread far from its point of origin.

Fortunately, most biological agents are very delicate and are easily destroyed by heat, light, and other environmental factors.  Additionally, the technical complexities of milling agents small enough for them to remain suspended in the air is beyond the capability of most terrorist groups.

Visual 8.7

Nuclear Weapons

§         Much different than conventional weapons:

·         Many causalities

·         Very large area affected

·         Long-term health effects

§         Considered relatively low risk

Visual 8.7

2.      Nuclear weapons.  A terrorist attack with a nuclear weapon would be much different from an attack with a conventional explosive device.  There would be potential for physical injury and death to persons who were not injured in the initial attack.  The affected area would be much larger than in a conventional attack, and debris and other usually harmless items would be contaminated.  The long-term health effects would be more difficult to ascertain and manage.  Fortunately, experts believe that the complexities of a terrorist group obtaining a nuclear weapon and maintaining the tolerances that are required for the weapon to function make the use of nuclear weapons by terrorist groups a low risk.

Terrorist Weapons (Continued)

Visual 8.8

Radiation Dispersal Devices

§         Conventional explosive with radioactive element

§         Radiological materials readily available

§         Considered moderate to high risk

Visual 8.8

Radiation dispersal devices (RDDs) are considered to be a much higher threat because radiological materials are much easier to obtain than enriched nuclear materials and the technology required to detonate an RDD is similar to that involved in detonating conventional explosives.

Radiological materials are readily available in hospitals and other medical facilities, in university science laboratories, and in many products with commercial uses.  Terrorists who would attack using an RDD would need relatively small amounts of radioactive material to make an effective device.

Terrorist Weapons (Continued)

Visual 8.9

Incendiary Devices

§         Used to initiate combustion

§         Easy to make

§         Easy to use

§         Considered high risk/low impact

Visual 8.9

3.      Incendiary devices.  Incendiary devices are mechanical, electrical, or chemical devices used intentionally to initiate combustion and start a fire.  Incendiary devices consist of three basic components:

§         An igniter or fuse

§         A container or body

§         An incendiary material or filler

Incendiary devices are relatively easy to make.  A device containing a chemical incendiary would usually be metal or other nonbreakable material (but not plastic because many chemicals are corrosive); a device containing a liquid incendiary material would usually be a breakable material such as glass.

Terrorist Weapons (Continued)

Visual 8.10

Chemical Agents

§         Five types

§         Components readily available

§         Onset of symptoms from immediate to 18 hours

§         Considered moderate risk

Visual 8.10

4.      Chemical agents.  Unlike biological agents or nuclear materials, which are difficult to produce or purchase, the ingredients used to produce chemical weapons are found in common products and petrochemicals.  Terrorists can turn these common products into lethal weapons.

There are five categories of chemical weapons:

§         Blister agents cause blisters, burns, and other tissue damage.  Exposure may be made through liquid or vapor contact with any exposed skin, inhalation, or ingestion.  Blister agents include several families of chemicals, including mustard and lewisite.  The effects of blister agents may be similar to those experienced with riot control agents (e.g., CS gas) but do not clear upon movement into fresh air.  In fact, the effects of most blister agents increase with time and may not reach their full impact for 12 to 18 hours.

Terrorist Weapons (Continued)

§         Blood agents are absorbed into the bloodstream and deprive blood cells of oxygen. Exposure may be made through liquid or vapor contact with any exposed skin, inhalation, or ingestion.  Blood agents include two main families of chemicals, including hydrogen cyanide and cyanogen chloride.  Those who are affected by blood agents may appear “bluish” across the nose and cheeks and around the mouth.  As the symptoms of blood agents progress, the victim will convulse and lose consciousness.

§         Choking agents attack the lungs.  Following exposure through inhalation, the lungs fill with fluid, which prevents oxygen from being absorbed by, and carbon dioxide from being removed from, the blood.  Death results from lack of oxygen and is similar to drowning.  Two common examples of choking agents are phosgene and chlorine.

§         Nerve agents affect the central nervous system.  These agents act most quickly and are the most lethal of all chemical agents, acting within seconds of exposure.  Victims of nerve agents experience constricted pupils, runny nose, shortness of breath, convulsions, and cessation of breathing.  Sarin is an example of a nerve agent.

§         Riot-control agents cause respiratory distress and tearing and are designed to incapacitate rather than kill.  Riot-control agents cause intense pain, especially in the moist areas of the body.  Common riot-control agents include CS (also known as “tear” gas) and capsicum (also called pepper spray).

Terrorist Weapons (Continued)

Visual 8.11

Conventional Explosives

§         Terrorists “weapons of choice”

§         Can be:

·         Military munitions

·         Improvised explosive devices

§         Considered high risk

Visual 8.11

5.      Conventional explosives have been the “weapon of choice” for most terrorists who have used them in more than 80 percent of attacks.  While terrorists have used military munitions such as grenades, mortars, and shoulder-fired surface-to-air missiles, experts rate conventional explosives in the form of improvised explosive devices as a greater threat.

Improvised explosive devices (IEDs) include any device that is created in an improvised manner, incorporating explosives or other materials designed to destroy, disfigure, distract, or harass.  Most bombs used by terrorists are improvised.  The raw materials required for many explosives can be purchased commercially (e.g., ammonium nitrate, which is also used as fertilizer), purchased from commercial blasting supply companies, or developed using readily available household ingredients.

Terrorist Weapons (Continued)

Visual 8.12

What is the Risk?

Visual 8.12

Tell the participants that Visual 8.12 illustrates the impact versus the likelihood of the various types of terrorist weapons.  Point out that:

§         Although nuclear weapons present the highest impact, they are considered the lowest risk because of the difficulty in obtaining enough weapons-grade material and the technical complexity of developing and maintaining the tolerances required for a nuclear device to detonate.

§         Incendiary, chemical, and conventional devices are considered higher-risk but lower-impact weapons.

§         Biological weapons are considered both high-risk and high-impact weapons—but only for diseases that are highly contagious.  Other types of biological weapons (i.e., those requiring dispersal devices) are considered a lower risk because of the sensitivity of the biological agents to heat, light, and shock.

B-NICE Indicators

Stress the need to be alert to changes in the environment as a clue to a possible terrorist attack. 

Visual 8.13

B-NICE Indicators

Environmental indicators:

§         Sick or dead animals, fish, or birds

§         Unscheduled spraying

§         Vapor clouds or mists

§         Absence of crops, wildlife, or insects

Visual 8.13

Explain that environmental indicators of a biological or chemical attack could include:

§         Numerous sick or dead animals, fish, or birds.  Wildlife are often more sensitive to chemical or biological agents than humans.  Animals, fish, or birds that are obviously sick, dying, or dead may indicate the presence of a biological or chemical attack.

§         Unscheduled spraying or abandoned spray devices.  Several September 11 terrorists are known to have made inquiries into purchasing and learning to fly crop dusters.  Many other types of agricultural sprayers can be used to disperse biological and (more likely) chemical agents.

§         Vapor clouds or mists that are unusual for the area or for the time of day.  Although many biological and chemical agents cannot be seen with the naked eye, the substances in which they are suspended when dispersed may be visible for a period of time after an attack.

§         The absence of crops, wildlife, or insects that are common for the area, time of day, or time of year.  Being aware of what is not in the environment that should be is as important as being aware of what is in the environment but is out of place.

B-NICE Indicators (Continued)

Visual 8.14

B-NICE Indicators

Environmental indicators:

§         Out of place and unattended packages, boxes, or vehicles

§         Packages that are leaking

§         Unusual materials or equipment

§         Small explosions that disperse liquids, mists, or gases

§         Unusual odors or tastes

Visual 8.14

Continue describing environmental indicators:

§         Out of place and unattended packages, boxes, or vehicles.  Terrorists have a long history of hiding explosive devices in packages, boxes, or vehicles.  Items that are out of place and unattended could signal a possible terrorist attack.

§         Packages that are leaking may be harmless—but they may also signal a terrorist incident.  The terrorists who released Sarin in the Tokyo subway system (Aum Shinrikyo) merely poked holes in bags containing Sarin, then left the area as the poison leaked out.

§         Materials or equipment that are unusual for the area.  Dispersal devices, lab equipment, or quantities of hazardous materials that are not typically located in the area may indicate that a terrorist attack is occurring or is about to occur.

§         Small explosions that disperse liquids, mists, or gases are an obvious sign that something is wrong.

§         Unusual odors or tastes. 

Instructor’s Note

Caution the group not to try to identify unusual odors or tastes.  Tell the participants that, if they smell something that is clearly not usual for the area or time of day, they should leave the area immediately.

B-NICE Indicators (Continued)

Visual 8.15

B-NICE Indicators

Physical indicators:

§         Many casualties without signs of obvious trauma

§         Victims who are exhibiting similar symptoms

§         Large numbers seeking medical attention

Visual 8.15

Tell the group that they may observe physical indications of a terrorist attack.  Some possible physical indicators include:

§         Multiple casualties without obvious signs of trauma.  This may indicate a biological or chemical attack.

§         Multiple victims who are exhibiting similar symptoms.  Symptoms may range from difficulty breathing to skin necrosis to uncontrolled salivating, uncontrolled muscle twitching, or convulsions.  All of these symptoms indicate that a chemical attack may have taken place.

§         Large numbers of persons seeking medical attention with similar symptoms that are not characteristic of the season.  The symptoms of many biological agents mimic the flu or other common illnesses.  An unusually large number of persons seeking medical attention for the flu in July could indicate that a biological attack has taken place.

Instructor’s Note

Caution the group that they may be unaware of an increased number of persons seeking medical attention or patterns that may develop.  These data are tracked and reported by medical personnel, who would be among the first responders to a biological incident.

Preparing at Home and Work

Stress that because team safety is the first priority, CERT members should treat possible terrorist incidents as a stop sign.  CERTs are not equipped or trained to respond to terrorist incidents.

Point out that there are ways to prepare for a terrorist incident.  Some of the steps for preparing for a terrorist incident are the same as for natural hazards but some require special planning.

Visual 8.16

Preparing for Terrorism

§         Assembling a disaster supply kit.

§         Identify a safe room and meeting place outside of the home or workplace.

§         Develop a family communication plan.

§         Learn shelter-in-place procedures .

Visual 8.16

The steps to take to prepare for a terrorist attack include:

§         Assembling a disaster supply kit.  Disaster supplies for terrorist incidents are the same as for other hazards and should definitely include a battery-powered radio with extra batteries and a cordless or cellular telephone.  Those who live in high-risk areas (such as those who live within the 10-mile emergency planning zone around a nuclear facility) will be provided with additional information by their local emergency management agencies.

§         Identifying a safe room in the home or workplace and a meeting place outside of the home or workplace.  Because the public will not know in advance whether to evacuate or shelter in place, it is necessary to plan for both.  Because many chemicals are heavier than air, a safe room in the house should be on the main level or second level (not in the basement) and should have as few doors and windows as possible.  A meeting place outside of the home should be outside of the area and upwind from the incident.

Preparing at Home and Work (Continued)

§         Develop a family communication plan.  Depending on the family members’ locations at the time of an attack, it may not be possible to get to the meeting place.  Identifying an out-of-state or out-of-area contact or other family communication plan will facilitate the knowledge that family members are safe.

§         Learn shelter-in-place procedures and prepare a sheltering kit.  Shelter-in-place procedures for a chemical or biological attack are shown in the visual.

Visual 8.17

Shelter-in-Place Procedures

§         Shut off ventilation system.

§         Go to safe room with disaster supply kit.

	Duct tape plastic sheeting over openings where outside air can come in.
	Seal with duct tape other areas where air can come in.
	Listen to battery-powered radio for all clear.

Visual 8.17

Procedures for sheltering in place during a chemical or biological attack include:

§         Shutting off the ventilation system and latching all doors and windows to reduce airflow from the outside.

§         Using precut plastic sheeting to cover openings where air can enter the room, including doors, windows, vents, electrical outlets, and telephone outlets!  When cut, the sheeting should extend several inches beyond the dimensions of the door or window to allow room the duct tape the sheeting to the walls and floor.

§         Taping the plastic sheeting around all doors and windows using duct tape to ensure a good seal.

Preparing at Home and Work (Continued)

§         Seal with duct tape other areas where air can come in, such as under doors and areas where pipes enter the home.  Air can be blocked by placing towels or other soft objects in areas where air could enter, then securing them with duct tape.

§         Listen to a battery-powered radio for the all clear.  Chemicals used in an attack will be carried on the wind and will dissipate over time.  Listen to EAS broadcasts to know when it is safe to leave the safe room.

Instructor’s Note

Acknowledge that the media have created negative publicity concerning plastic sheeting and duct tape.  Point out that studies have shown that sheltering in place using plastic sheeting and duct tape reduces exposure to chemical agents by 35 percent (in mobile homes) to more than 90 percent (in office buildings[1]).

CERTs and Terrorist Incidents

Remind the participants of the guiding principles governing all CERT operations.

Visual 8.18

CERT Guiding Principles

§         Team safety is the number one priority.

§         Always do a thorough sizeup.

	What are the dangers?
	What are team capabilities?
	What are team limitations?

Visual 8.18

Stress that:

§         Team safety is the number one priority.  All CERT members owe it to themselves and their loved ones not to become victims while trying to help others.

§         Always do a thorough size up and stop, look, listen, and think before taking any action.  .  Consider:

	Dangers, both existing and possible.
	Team capabilities, including how many CERT members are available, the training that they have had, and the equipment that is available at the scene.
	Team limitations.

Instructor’s Note

Remind the participants that the possibility of them experiencing a terrorist attack is very low.  Stress the importance of considering the possibility following a suspicious incident.

CERTs and Terrorist Incidents (Continued)

Describe CERT protocols for terrorist incidents:

§         As with hazardous materials, terrorist incidents are a stop sign for CERT members. 

§         Take in the whole area during the sizeup.  If any of the indicators of a terrorist incident are present, do not proceed with the response.

Stress that if terrorism using WMD is suspected, CERTs will be very limited in what they can do.  Professional responders will need specialized equipment and personnel to respond to a terrorist incident.

Urge the participants to follow the protocols shown in the visual if they think that they may be dealing with a terrorist incident.

Visual 8.19

CERTs and Terrorist Incidents

§         Do not touch it!

§         Move away from the object or area.

§         Report it to authorities.

Caution!  Using cellular phones or

two-way radios may detonate

an explosive device!

Visual 8.19

Tell the group that, if they observe any of the indicators of a terrorist incident, they should:

§         Not touch it!

§         Move away from the object or area.

§         Report it to authorities immediately.

CERTs and Terrorist Incidents (Continued)

Caution the group that cellular phones and two-way radios create static electricity and may detonate explosive devices.  CERT members should always report suspected explosive devices via landline.

Instructor’s Note

Remind the group of the warning against using cellular phones while pumping gas.  Explain that the rationale is the same.

Self-Care During Terrorist Incidents

Introduce this topic by stressing the importance of knowing what actions to take in a terrorist incident.

Visual 8.20

Self-Care During Terrorist Incidents

At the incident:

§         Limit exposure time.

§         Increase the distance from the hazard.

§         Add shielding.

Visual 8.20

Stress that there are three factors that significantly affect safety at a terrorist incident:

§         Time.  Limiting the amount of time in the area of an incident limits exposure.

§         Distance.  Evacuate the area.  Professional responders suggest a maintaining distance of between 1,000 and 1,500 feet from the incident.  Move upwind and uphill from the incident site.

§         Shielding.  The shielding provided by a sturdy building or even a wall can increase protection from contamination, radiation, or blast effects.

CERTs and Terrorist Incidents (Continued)

Time, distance, and shielding requirements are based on an initial sizeup of the situation.  Suggest that, if CERT members are inside a building that is not damaged and they are not in immediate danger, they should listen to Emergency Alert System (EAS) broadcasts for information about whether to evacuate or shelter in place.

If there is any reason to believe that chemical, or radiological contamination has occurred in your area, put distance between you and the agent.  If exposed to a chemical agent or radiation, use basic decontamination procedures.

Instructor’s Note

If anyone asks why decontamination procedures do not apply to possible biological incidents, remind the group that they probably will not be able to identify biological contamination and symptoms will not show up for a while.

Visual 8.21

Basic Decontamination Procedures

1.      Leave the contaminated area.

2.      Take decontamination action.

§         Remove everything.

§         Wash hands before using them to shower.

§         Shower or flush with cool water.

§         Blot dry.

3.      Report for decontamination.

Visual 8.21

Be sure to make the points listed below:

§         Leave the contaminated area immediately (at least 1,000 to 1,500 feet upwind and uphill) to limit the time of exposure and reduce contamination levels.

CERTs and Terrorist Incidents (Continued)

§         Take decontamination action.  Seconds count!  The goal is to limit the time that the agent is in contact with the skin.

·         Remove everything from the body, including jewelry.  Cut off clothing that would normally be removed over the head to reduce the probability of inhaling the agent.

·         Wash hands before using them to shower.

Flush the entire body, including the eyes, underarms, and groin area, with copious amounts of cool water.  Hot water opens the pores of the skin and can promote absorption of the contaminant.  Using copious amounts of water is important because some chemicals react to small amounts of water.

If soap is immediately available, mix the soap with water for decontamination.  Avoid scrubbing with soap because scrubbing can reduce the layer of protective skin, thus increasing absorption of the contaminant.

If working with a buddy, work together to decontaminate each other.  If hosing someone else off, avoid both physical contact with the person and with the runoff.

Blot dry using an absorbent cloth.  Do not rub the skin!  Put on clean clothes.

§         Report for decontamination as soon as possible.  Professional responders will be setting up decontamination stations somewhere around the site.

CERTs and Terrorist Incidents (Continued)

Treating Others

Stress again that the first priority for CERT teams is personal safety.  CERT members should take self-protective measures only.  They should not attempt to treat victims in the contaminated area.  CERT members can tell people who are leaving the area about using basic decontamination procedures and waiting for responders.

Instructor’s Note

As with professional responders, CERT members may have difficulty dealing with the idea that they should not try to help others who are injured but may have been contaminated.  To help the participants deal with the potential of having to make a decision to deny assistance, stress that:

1.     They have a responsibility to themselves, to other CERT members, and to their families to operate safely.

2.     They are neither trained nor equipped to deal with contaminated victims.

3.     They cannot help anyone if they become victims.  In fact, they may make matters considerably worse if they spread the contamination.

Emphasize that CERT members must make the best decisions possible with the information that they have at hand.  Even if an incident turns out not to be terrorist-related, they have made the right decision if they have done the most good for the greatest number and have not become victims themselves.

CERTs and Terrorist Incidents (Continued)

What Professional Responders Will Do

Tell the group that there are several measures that they can expect professional responders to take when they arrive at the scene of a terrorist incident.

Explain that the first step that professional responders will take when they arrive at the scene is to conduct a thorough sizeup.  They will follow steps that are very similar to those that CERTs take to determine:

§         What is going on.

§