Copyright © 2008 Lippincott Williams & Wilkins. Chapter 72 Terrorism, Mass Casualty, and Disaster Nursing

Copyright © 2008 Lippincott Williams & Wilkins.

Chapter 72

Terrorism, Mass Casualty, and

Disaster Nursing

Chapter 72

Terrorism, Mass Casualty, and

Disaster Nursing


Emergency Operations Plan (EOP)Emergency Operations Plan (EOP)

• Health care facilities are required by the Joint Commission on Accreditation of Healthcare Organizations to create a plan for emergency preparedness and to practice this plan twice a year

• Essential components of the plan:

– An activation response

– An internal/external communication plan

– A plan for coordinated patient care

– Security plans

– Identification of external resources

– A plan for people management and traffic flow


Emergency Operations Plan (EOP) (cont.)Emergency Operations Plan (EOP) (cont.)

• Essential components of the plan:

– A data management strategy

– Deactivation response

– Post-incident response

– A plan for practice drills

– Anticipated resources

– Mass casualty incident planning

– An education for all of the above


TriageTriage

• The sorting of patients to determine priority health care needs and the proper site of treatment

• In nondisaster situations, health care workers assign the highest priority and allocate the most resources to the most critically ill

• In disaster situations with large numbers of casualties, decisions are based on the likelihood of survival and the consumption of resources

• Triage categories: see Table 72-1


Managing Short- and Long-Term Psychological Effects After a Disaster


• Provide active listening and emotional support

• Provide information as appropriate

• Refer to therapist or other resources

• Discourage repeated exposure to media regarding the event

• Encourage return to normal activities and social roles



(cont.)


(cont.)

• Critical incident stress management (CISM)

– Programs that include education, field support, defusing, debriefing, demobilization, and follow-up components

• Persons with ongoing stress reactions should be referred to mental health specialists


Personal Protective Equipment (PPE)Personal Protective Equipment (PPE)• Purpose: to shield the health care provider from

chemical, physical, biological, and radiologic hazards that may exist when caring for contaminated patients

• Categories of protective equipment:

– Level A: self-contained breathing apparatus (SCBA) and vapor-tight chemical-resistant suit, gloves, and boots

– Level B: high level of respiratory protection (SCBA) but lesser skin and eye protection; chemical-resistant suit

– Level C: air-purified respirator, coverall with splash hood, and chemical-resistant gloves and boots

– Level D: typical work uniform


Isolation Precautions for Biological Terrorism AgentsIsolation Precautions for

Biological Terrorism Agents• Biological agents may be delivered or spread in a number

of ways

• Due to modern travel, spread of infection may occur in areas thousands of miles apart

• Health care providers need to be aware of potential signs of biological weapon dissemination; signs and symptoms are similar to those of common disease process

• Isolation practices depend upon the infecting agent• Always use Standard Precautions• Some agents require Transmission-Based Precautions

• Terminal disinfection and disposal of wastes depends on the infecting agent


Chemical Weapons Chemical Weapons • Chemical substances that quickly cause injury and/or

death and cause panic and social disruption• Agents: see Table 72-3

– Nerve agents – Blood agents– Vesicants– Pulmonary agents

• Agents vary in volatility, persistence, toxicity, and period of latency

• Limitation of exposure is essential with evacuation and decontamination as soon possible and as close to the scene of the incident as possible


Nerve AgentsNerve Agents

• Sarin and soman organophosphates

• Inhibit cholinesterase-causing cholinergic symptoms progressing to loss of consciousness, seizures, copious secretions, apnea, and death

• Treatment: supportive care, atropine, benzodiazepine, and pralidoxime

• Decontaminate with copious amounts of soap and water or saline for at least 20 minutes

• Blot; do not wipe off

• Plastic equipment will absorb sarin gas


VesicantsVesicants

• Lewisite, sulfur mustard, nitrogen mustard, and phosgene

• Cause blistering and burning

• Respiratory effects can be serious and cause death

• Decontaminate with soap and water; do not scrub or use hypochlorite solutions

• Eye exposure requires copious irrigation

• Treatment for lewisite exposure: dimercaprol IV or topically


Radiation ExposureRadiation Exposure

• Radiation exposure may occur due to nuclear weapons, nuclear reactor incidents, or exposure to radioactive samples

• Exposure to radiation is affected by time, distance, and shielding

• Types of radiation exposure:

– External radiation: all or part of the body is exposed to radiation; as decontamination is not necessary, it is not a medical emergency


Radiation Exposure (cont.)Radiation Exposure (cont.)

• Types of radiation exposure (cont.):

– Contamination: exposure to radioactive gases liquids or solids; requires immediate medical management to prevent incorporation

– Incorporation: uptake of the radioactive material into the body


Radiation DecontaminationRadiation Decontamination

• Triage outside the hospital

• Cover floor and use strict isolation precautions to prevent the tracking of contaminants

• Seal air ducts and vents

• Waste is double bagged and put in a container labeled radiation waste

• Staff protection

– Water-resistant gowns, 2 pairs of gloves, caps, goggles, masks, and booties

– Dosimetry devices


Radiation Decontamination (cont.)Radiation Decontamination (cont.)• Patients are surveyed for radiation and directed to the

decontamination area

• Each patient is decontaminated with a shower outside the ED

• Water, tarps, towels, soap, gowns, all the patient’s belongings, etc., must be collected and contained

• Patients are surveyed and showered again as necessary

• Showering should be performed so as not to contaminate clean areas with runoff from the showering

• Biologic samples: nasal and throat swabs; blood

• Internal contamination requires additional treatment: catharsis and gastric lavage with chelating agents


Radiation InjuriesRadiation Injuries

• Acute radiation syndrome (ARS): dose of radiation determines if ARS will develop

• All body systems are affected by ARS

• Presenting signs and symptoms determine predicted survival

• Probable survivors have no initial symptoms or only minimal symptoms

• Possible survivors present with nausea and vomiting that persists for 24 to 48 hours

• Improbable survivors are acutely ill with nausea, vomiting, diarrhea, and shock; neurologic symptoms suggest lethal dose; and survival time is variable

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Copyright © 2008 Lippincott Williams & Wilkins. Chapter 72 Terrorism, Mass Casualty, and Disaster Nursing