High-risk calls

Situations will vary and are not predictable. Many high-risk calls resolve into a non-event, whereas routine calls can evolve into a life-threatening scenario. The key is for all responders to practice the same initial approach to calls regardless of the call s apparent nature. Every call or incident should be assessed in the same manner, with appropriate tactics practiced as needed. Any hazardous materials incident is a possible terrorist attack, especially if multiple casualties are involved. Also, any multicasualty incident that appears unusual, or any report of unusual casualties from an unknown source, should raise a red caution flag and be approached as a possible terrorist attack (Box 1-2). 

Based on the information you have obtained en route to the scene, you should be able to differentiate between a high-risk call, a suspicious call, and a routine call. 

High-risk call. High-risk calls include situations of known violence,... 

Because public safety responders are likely to be first on the scene of a chemical attack, your recognition of the incident as a chemical attack can prevent contamination of responders, including yourself. In a chemical attack there are usually reports of a number of persons reported to be sick or down. If dispatch states that you are responding to a scene of multiple people down, you know you are responding to a high-risk call. Keep in mind that in addition to the chemical attack, there may be other hazards ... 

Your relapse prevention plan will help remind you of what to do to successfully cope with high-risk situations when you are confronted with them. If you are facing a tough situation in which you are tempted to use drugs, your plan will remind you to seek help. Contact your counselor or therapist before you use drugs, if possible. Even if you do have a lapse, remember that it is not the end of the world, but rather a chance to improve your recovery plan. Remember to call your counselor or therapist as soon as you can after a lapse. Lapses are not unusual and your counselor or therapist can help you return to recovery. 

Atypical Antidepressants. None of the so-called atypical antidepressants have been tested in the treatment of AN. However, mianserin, an antidepressant available in Europe, has been found to increase body weight in patients with various depressive disorders. Although bupropion (Wellbutrin, Zyban) has not been tested in the treatment of AN, it is effective in the treatment of BN. However, immediate-release bupropion is associated with an especially high risk for seizures in these patients and is therefore contraindicated in those with eating disorders. The seizure risk associated with sustained-release bupropion remains unclear at this time, as the doses studied have not been as high as those for immediate-release bupropion. 

At this point, the more recent development of so-called gel propellants should be mentioned. We have seen above that for military missiles, hypergolicity is a desired property. On the other hand, transportation of IRFNA or NTO in combination with MMH or UDMH on a ship or submarine for example also carries high risks... 

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