TERRORISM, MASS

CASUALTY, AND DISASTER

NURSING
DISASTERS
Any catastrophic situation in which the normal
patterns of life (or ecosystems) have been
disrupted and extraordinary, emergency
interventions are required to save and preserve
human lives and/or the environment
TYPES OF DISASTERS
According to CAUSE/OCCURRENCE

Natural-caused by forces of nature
e.g. earthquake, typhoons, volcanic
eruptions
TYPES OF DISASTERS
According to CAUSE/OCCURRENCE

Man-made- caused by errors of man
e.g. war, civil strife or other conflicts

Technological
e.g. air crashes, pollution, nuclear accidents,
explosions


According to PREDICTABILITY

Sudden Onset- no warning issued
Slow Onset-disasters that come with
warnings
e.g. typhoons, volcanic eruptions
According to EXTENT OF DAMAGE

Large scale-effects not solely
limited to the impact area

Small scale-effects are localized;
limited only to the impact area
Phenomenon that poses threat (s) to
people structure or economic asset that
may cause a disaster either
-human introduces or
-naturally occurring in the
environment

DISASTER NURSING
The adaptation of Professional Nursing
KNOWLEDGE , Skills and ATTITUDE in
recognizing and MEETING the nursing and
MEDICAL NEEDS of DISASTER VICTIMS
BASIC PRINCIPLES IN PLANNING FOR
DISASTER NURSING
N- ursing Plans should be integrated and coordinated
U- pdate physical and Psychological preaparedness
R- esponsible for Organizing, Teaching and
Supervision
S- timulate Community Participation
E- xercise Competence

BASIC PRINCIPLES OF NURSING CARE for
DISASTER VICTIMS
A- daptation of Skills to Situation
C- are for Disaster Victims
C- ontinuous Awareness of the patients
condition
T- each AUXILLARY personnel
S-election of Essential Care
ROLES and RESPONSIBILITIES of a DISASTER
NURSE
D- isseminate information on the prevention and
control of environmental Hazards
I- nterpret health laws and regulations
S- erve yourself of self-survival
A- ccepts directions and take orders from an
organized authority
ROLES and RESPONSIBILITIES of a
DISASTER NURSE
S- erve the best of the MOST
T- each the meaning of warning signals
E- xercise leadership
R- efer to appropriate agencies

HAZARD
Rare or extreme event in the natural or man-
made environment that adversely affect
human life, property or activity to the extent
of causing disaster

VULNERABILITY
Extent to which the community,
structure, service or geographic
area is likely to be damaged or
disrupted by the impact of a
particular hazard

HAZARD+VULNERABILITY/CAPACIT
Y=DISASTER RISK
PHYSICAL VULNERABILITY
Extent of likely damage/disruption on account
of nature/construction and proximity to man-
made environment (buildings and natural
environment, forest, aquaculture)
CAPABILITIES
Resources and skills people posses, can
develop, mobilize and have access to
which allow them to have more control
over shaping their future
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

describes how a facility will respond to and recover
from all hazards.

Emergency Operations Plan (EOP)
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
Emergency Operations Plan (EOP)
Essential components of the plan:
A plan for people management and traffic flow
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
START Triage
START - Simple Triage And Rapid Treatment
"The Race Against Time"
You're first at the scene of an accident involving a car
and a bus. There are two people in the car and thirty
on the bus.
There are various levels of injuries, but everyone
seems to be hurt. Where do you START? The crying
child, the pregnant woman, the hysterical bus
driver? You feel overwhelmed and your mind is
overloaded.

START Triage
Are you prepared to handle so many patients?
By triaging patients, you will be able to
concentrate first responder resources on the
most seriously injured.
What is START
A Simple Triage and Rapid Treatment plan
designed for first responders.
The START system was designed in 1983 and
updated in 1994.

START Triage
It is meant for rescuers with basic first aid skills.
It can be applied by fire-rescue squads,
industrial or school safety personnel, and other
medical professionals.


Classification

First responders using START evaluate victims
and assign them to one of the following four
categories:
Immediate (red)
Delayed (yellow)
Walking wounded/minor (green)
Deceased/expectant (black)
[


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The colors correspond to triage tags, to
indicate each victim's status
Responders arriving to the scene of a mass
casualty incident may first ask that any victim
who is able to walk relocate to a certain area,
thereby identifying the ambulatory, or walking
wounded, patients.
Non-ambulatory patients are then assessed.
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The only medical intervention used prior to
declaring a patient deceased is an attempt to
open the airway.
Any patient who is not breathing after this
attempt is classified as deceased and given a
black tag.
No further interventions or therapies are
attempted on deceased patients until all other
patients have been treated.
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Patients who are breathing and have any of
the following conditions are classified as
immediate:
respiratory rate greater than 30 per minute.
unresponsive (unable to follow commands)
All other patients are classified as delayed

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Treatment and Evacuation
After all patients have been evaluated,
responders use the START classifications to
determine priorities for treatment or
evacuation to a hospital.
The most basic way to use the START
classifications is to transport victims in a fixed
priority manner: immediate victims, followed
by delayed victims, followed by the walking
wounded
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Military Triage
Military Triage
Classic military triage is based on a series of guidelines
known as the conventional North American Treaty
Organization triage classification.

1) The "immediate" category includes patients who are
to be treated first and include those with the
following injuries:
airway obstruction
cardiorespiratory failure
significant external hemorrhage
shock
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Military Triage
Classic military triage is based on a series of guidelines
known as the conventional North American Treaty
Organization triage classification.

sucking chest wound
partial-or full-thickness burns of the face and neck.
These patients have life-threatening injuries that can
be treated with minimal use of resources
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Military Triage
2) The "delayed" category includes patients with the
following types of injuries: open thoracic wound,
penetrating abdominal wound, severe eye injury,
avascular limb, fractures, and partial-or full-thickness
burns not involving the face, neck, or perineum.
A delay in treatment of up to 6 to 8 hours will not
substantially alter outcome.
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Military Triage
3) The "minimal" category includes patients with the
following injuries:
minor lacerations
Contusions
Sprains
superficial burns, and partial-thickness burns of less
than 20% of body surface area.
These patients will not suffer significant morbidity
even if no further medical intervention is performed.
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Military Triage
4) The "expectant" category includes patients in whom
there are signs of impending death or those with
treatable injuries requiring a vast expenditure of
resources. This includes patients with
head injury and a GCS score lower than 8,
partial-or full-thickness burns affecting greater than
85% of body surface area
multisystem trauma.
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Military Triage
Unfortunately, this category must exist when there are
inadequate resources to treat all patients, such as
during wartime and in situations involving mass
casualties.
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Hospital Emergency Incident
Command System

created in the late 1980s as an important foundation
for the 5,815 registered hospitals in the United States
in their efforts to prepare for and respond to various
types of disasters.
designed for hospitals and intended for use in both
emergency and non-emergency situations.
It provides hospitals of all sizes with tools needed to
advance their emergency preparedness and
response capabilityboth individually and as
members of the broader response community.
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Incident Command Education
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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
Personal Protective Equipment (PPE)
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


Hazardous Material
A hazardous material is defined as any
substance or material could adversely affect
the safety of the public, handlers or carriers
during transportation.
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Hazard Class 1: Explosives
1.1 mass explosion hazard
1.2 projectile hazard
1.3 minor blast/projectile/fire
1.4 minor blast
1.5 insensitive explosives
1.6 very insensitive explosives
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Hazard Class 2: Compressed Gases
2.1 flammable gases
2.2 non flammable compressed
2.3 poisonous

Flammable (flash point below 141)
Combustible (flash point 141-200

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Hazard Class 4: Flammable Solids
4.1 flammable solids
4.2 spontaneously combustible
4.3 dangerous when wet

5.1 Oxidizer
5.2 Organic Peroxide

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Hazard Class 6: Toxic Materials
6.1 Material that is poisonous

6.2 Infectious Agents

Radioactive I
Radioactive II
Radioactive III


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Class 8: Corrosive Material

Destruction of the human skin
Corrode steel at a rate of 0.25 inches per year
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Hazard Class 9: Miscellaneous

A material that presents a hazard during
shipment but does not meet the definition of
the other classes
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Decontamination
the process of removing accumulated
contaminants, is critical to the health and safety of
health care providers by preventing secondary
contamination.
The decontamination plan should establish
procedures and educate employees about
decontamination procedures, identify the
equipment needed and methods to be used, and
establish methods for disposal of contaminated
materials
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Decontamination
The first step is removal of the patients
clothing and jewelry and then rinsing the
patient with water- this step alone can remove
a large amount of the contamination and
decrease secondary contamination
The second step consists of a thorough soap-
and-water wash and rinse.
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Decontamination
When patients arrive at the facility from a
prehospital provider, it should not be assumed
that they have been thoroughly
decontaminated.
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WEAPONS OF TERROR
Biological Weapons
Biological weapons
weapons that spread disease among the
general population or the military.
Use of biological weapons dates far back into
history, but improved production techniques
and genetic engineering have expanded the
potential for widespread casualties as a result
of biological weaponry.
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Biological Warfare
is a covert method of severely affecting the
target.
biological weapons are easily obtained and
easily disseminated, and they result in
significant mortality and morbidity.
Biological agents are delivered in either a
liquid or dry state, applied to foods or water,
or vaporized for inhalation or direct contact
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Biological Warfare
Vaporization may be accomplished through
spray or explosives loaded with the agent.
With increased travel, an agent could be
released in one city and affect people in other
cities thousands of miles away.
The vector can be an insect, animal, or person,
or there may be direct contact with the agent
itself.
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Biological Weapons
ANTHRAX
SMALLPOX
TularemiaFrancisella tularensis: gram-
negative coccobacillus, one of the most
infectious bacteria known
BotulismClostridium botulinum: Botulinum
resulting in a flaccid paralysis.
PlagueYersinia pestis The bacterium causes
destruction and necrosis of the lymph nodes.
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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
Always use Standard Precautions
Some agents require Transmission-Based
Precautions
Terminal disinfection and disposal of wastes
depends on the infecting agent