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Chapter 72 Terrorism, Mass Casualty, and Disaster Nursing

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement True or False? Health care facilities are required by the Joint Commission to create a plan for emergency preparedness and to practice this plan once a year.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False Health care facilities are required by the Joint Commission to create a plan for emergency preparedness and to practice this plan twice a year, not once a year.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Emergency Operations Plan (EOP)


Health care facilities are required by the Joint Commission 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
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Emergency Operations Plan (EOP)


Essential components of the plan: A data management strategy Deactivation response Post-incident response A plan for practice drills Anticipated resources Mass causality incident planning An education for all of the above
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
What is the name for the triage category where injuries are significant and require medical care, but can wait hours without threat to life or limb? A. Delayed B. Expectant C. Immediate D. Minimal

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
A Delayed injuries are significant and require medical care, but can wait hours without threat to life or limb. Expectant injuries are extensive and chances of survival are unlikely even with definitive care. Immediate injuries are life threatening but survivable with minimal intervention. Minimal injuries are minor and treatment can be delayed hours to days.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Triage
The sorting of patients to determine priority health care needs and the proper site of treatment. In nondisaster situations healthcare workers assign highest priority and allocate 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

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement True or False? Critical incident stress management programs include education, field support, defusing, debriefing, demobilization and follow-up components.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True Critical incident stress management programs include education, field support, defusing, debriefing, demobilization and follow-up components.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 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
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
What is level A protective equipment?
A. Self-contained breathing apparatus (SCBA) and vaportight chemical resistant suit, gloves and boots B. High level of respiratory protection (SCBA) but lesser skin and eye protection; chemical resistant suit C. Air-purified respirator, coverall with splash hood, chemical resistant gloves and boots D. Typical work uniform

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
A
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, chemical resistant gloves and boots. Level D: typical work uniform

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Personal Protective Equipment (PPE)


Purpose: To shield the health care provider from chemical, physical, biological, and radiological 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, chemical resistant gloves and boots Level D: typical work uniform
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Injuries After Blast Events


Blast Lung Tympanic Membrane Rupture Abdominal and Head Injuries

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 is dependent upon the infecting agent.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nerve Agents
Sarin, 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
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Vesicants
Lewisite, sulfur mustard, nitrogen mustard, phosgene Cause blistering and burning Respiratory effects can be serious and cause death Decontamination with soap and water, do not scrub or use hypochlorite solutions Eye exposure requires copious irrigation

Treatment for lewisite exposure: dimercaprol IV or topically

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Radiation Exposure
Radiation exposure may occur due to nuclear weapon, 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 s exposed to radiation; decontamination is not necessary; not a medical emergency
Contamination: exposure to radioactive gases liquids or solids; requires immediate medical management to prevent incorporation Incorporation: uptake of the radioactive material into the body
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Radiation Decontamination
Triage outside the hospital Cover floor and use strict isolation precautions to prevent the tracking of contaminants

Air ducts and vent are sealed


Waste is double bagged and labeled radiation waste Staff protection Water resistant gowns, two pairs of gloves, caps, goggles, masks, and booties Dosimetry devices
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Radiation Decontamination
Patients are surveyed for radiation and directed to the decontamination area Decontaminate each patient outside the ED with a shower Water, tarps, towels, soap, gowns, all patient belongings, etc. must be collected and contained Patients are resurveyed and reshowered as necessary Showering should be performed to not contaminate clean areas with runoff from the showering Biologic samplesnasal and throat swabs, blood Internal contamination requires additional treatment catharsis, gastric lavage with chelating agents
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 2448 hours Improbable survivors are acutely ill with nausea, vomiting, diarrhea, and shock. Neurologic symptoms suggest lethal dose. Survival time is variable
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins