Terrorism, Mass Casualty and

Disaster Nursing
Terrorism: the unlawful use of force or

threats of violence against people in order

to intimidate or coerce
Mass Casualty Incident (MCI): a
situation in which the number of casualties
exceeds the number of resources
Disaster Nursing: the adaptation of
professional nursing knowledge, skills and
attitude in recognizing and meeting the
nursing, health and emotional needs of
disaster victims.

DISASTER NURSING
Doing the best for the most, with the least, by the
fewest

Definition: The adaptation of professional

nursing knowledge, skills and attitude in

recognizing and meeting the nursing, health
and emotional needs of disaster victims.
Goal: To achieve the best possible level of
health for the people and the community
involved in the disaster.

PRINCIPLES OF DISASTER
NURSING
Rapid assessment of the situation and of

nursing care needs.

Triage and initiation of life-saving measures
first.
The selected use of essential nursing
interventions
Adaptation of necessary nursing skills and
resourcefulness in dealing with a lack of
supplies, equipment, and personnel.
Evaluation of the environment and the
lessening or removal of any health hazards.

Prevention of further injury or illness.

Leadership in coordinating patient triage,

care, and transport

The teaching, supervision, and utilization
of auxiliary medical personnel and
volunteers.
Provision of understanding, compassion,
and emotional support to all victims and
their families.

Classification Levels for

Disasters
Classified by the anticipated necessary response

Level I: Local emergency response;

personnel and organizations

Level II: Regional assistance is needed from
surrounding communities
Level III: Statewide or federal assistance

Federal Agencies
Federal agencies that may provide resources in

response to mass casualty or disaster include:

Department of Health and Human Services (DHHS)

DMORTs
NVRTs
IMSuRTs

Disaster Medical Assistance Teams (DMATs) organize

voluntary medical personnel (Health care providers, nurses,
EMTs, Technical Staff, and other health care professionals)
Department of Justice (DOJ)
Department of Homeland Security

Emergency Operations Plan

Health care facilities are required by the
(EOP)

Joint Commission (TJC) 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

Essential components of the plan cont.
(EOP)
A data management strategy
Deactivation response
Post-incident response
A plan for practice drills
Anticipated resources
Mass casualty incident planning
Education for all of the above

The Nurses Role in Disaster

Response Plans
Nursing care in a disaster focuses on essential

care from a perspective of what is best for all

patients.
Depends on the specific needs of the facility
for patient care (Atypical roles)
Serve as a triage officer
Take roles normally held by physicians based
on their area of expertise. i.e. CCN may
intubate patients

DISASTER MANAGEMENT
CYCLE
The Disaster Event: Real-time
event of a hazard occurring
The response phase is the actual
implementation of the disaster plan
Recovery the organization and
staff needs to recover
Evaluation & Development:
determine what went well
Mitigation: ways to lessen the
impact of a disaster
Preparedness: Evaluate the
facilitys vulnerabilities for
disasters

Triage
Determines priority health care needs and the

proper site of treatment.

In non-disaster situations, the highest priority
and allocation of resources are for the most
critically ill.
In disaster situations with large numbers of
casualties, decisions are based on survival and
the consumption of resources
Triage categories separate patients according to
severity of injury.

Triage Categories:
Triage

Description

Color

Emergent

Immediate threats to life.

Require immediate attention.

Urgent

Major injuries. Requires

treatment 30 mins-2 hours

Nonurgent

Minor injuries. Can be treated

in a delayed fashion >2 hours

GREEN

Expectant/
Deceased

Expected to die or is deceased

BLACK

RED

YELLOW

TYPES OF TRIAGE
Two types of triage:
Simple triage
S.T.A.R.T. (Simple Triage and Rapid Treatment) performed by
first responders and emergency personnel in emergencies.
0 The deceased who are beyond help
1 The injured who can be helped by immediate
transportation
2 The injured whose transport can be delayed
3 Those with minor injuries, who need help less urgently
Advanced triage

Diverts scarce resources away from patients with little

chance of survival in order to increase the chances of
survival of others who are more likely to survive.
Do the greatest good for the greatest number
Ethical decisions are made

Critical Incident Stress

Management (CISM)
Critical Incident Stress Management (CISM) is

implemented to prevent /treat emotional trauma

affecting emergency responders
Incident stress can affect anyone who is
involved in a disaster or mass casualty.
Agencies, resources and education are made
available
Defusing is a process by which the person

receives education about recognition of stress

reactions and management strategies for handling
stress.

Personal Protective Equipment

(PPE)
The purpose of PPE: shield health care

workers from the chemical, physical, biologic,

and radiologic hazards that may exist when
caring for contaminated patients.
Chemical or biologic agents and radiation are
silent killers (color-less and odorless)
U.S. Environmental Protection Agency
(EPA)has
Four categories Levels A D

Personal Protective Equipment

(PPE)
PPE donned before patient contact
Use specific PPE based on agent involved
Training is required

Personal Protective Equipment

Level A highest level of

respiratory, skin and eye,

fully encapsulated chemical
resistant suit, full face piece
and supplied air (selfcontained breathing
apparatus or SCBA)

Level B - protection

requires the highest level

of
respiratory
protection but a lesser
level of skin and eye
protection than with level
A situations.

Level C Full face piece

with air purifying canisterequipped respirator,
chemical-resistant clothing
(including gloves & boots)

Level D Regular

work clothing, safety

shoes,
goggles/splash shield

Decontamination
Reduction or removal of

contamination agents.
Radioactive agents
the runoff also needs to
be contained
Victims need to be
decontaminated before
they can be admitted to
the emergency facility
or hospital

Terrorism
Disrupt Daily Life & Cause Terror and Panic
FBI definition the unlawful use of force or

violence against persons or property to

intimidate or coerce a government, the
civilian population, or any segment thereof, in
furtherance of political or social objectives

Blast Injuries
Physical Injuries After Blast Events
Blast Lung
Tympanic Membrane Rupture
Abdominal and Head Injuries

Biologic Weapons
Biologic weapons are weapons that spread disease
Bacteria - Viruses - Toxins
Delivered in either a liquid or dry state, applied to foods or

water, or vaporized for inhalation or direct contact.

Anthrax the most likely biologic agent available; a highly
debilitating agent for centuries.
Bacteria releases toxins causing hemorrhage, edema, and
necrosis. Penicillin sensitive; initiate treatment within 24
hours
Smallpox (variola) is a DNA virus. Incubates 12 days. Highly
contagious and is spread by direct contact, by contact with
clothing or linens, or by droplets. Patient isolation and
antibiotic therapy.

Chemical Weapons
Chemical substances that quickly cause

injury and/or death

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

Radiation Exposure
Radiation exposure may occur due to nuclear weapon

or exposure to radioactive samples

Signs and symptoms determine predicted survival;
most common nausea and vomiting persists for 24-48
hours
Improbable survivors are acutely ill with nausea,
vomiting, diarrhea, and shock. Neurologic symptoms
suggest lethal dose. Survival time is variable
Radiation Decontamination
Triage outside the hospital
Cover floor and use strict isolation precautions
to prevent the tracking of contaminants
Air ducts and vents are sealed
Waste is double bagged and labeled radiation waste

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

The point is to save

as many people as
possible!