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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 Classied 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, EMT’s, Technical Staff, and other health care professionals)
▪ Department of Justice (DOJ) ▪ Department of Homeland Security
Emergency Operations Plan (EOP)� Health care facilities are required by the 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 (EOP)� Essential components of the plan cont.
● 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 Nurse’s 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 facility’s 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.
RED
Urgent Major injuries. Requires treatment 30 mins-2 hours
YELLOW
Nonurgent Minor injuries. Can be treated in a delayed fashion >2 hours
GREEN
Expectant/Deceased
Expected to die or is deceased BLACK
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 (self-contained 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 canister-equipped 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 person’s 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!