Terrorism, Mass Casualty, and Disaster Nursing

Chapter 72
Terrorism, Mass Casualty, and

Disaster Nursing
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

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.)
• 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
Triage
• 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:

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
Managing Short- and Long-Term
Psychological Effects After a Disaster
(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)
• 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 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 substances that quickly cause injury and/or
death and cause panic and social disruption
• Agents:
– 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 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

Vesicants
• 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 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.)
• 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 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.)
• 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 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

Terrorism, Mass Casualty, and Disaster Nursing

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Chapter 72

Terrorism, Mass Casualty, and

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Essential components of the plan:

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Discourage repeated exposure to media regarding

• Encourage return to normal activities and social

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Types of radiation exposure (cont.):

– Contamination: exposure to radioactive gases

– Incorporation: uptake of the radioactive

Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

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