Copyright © 2008 Lippincott Williams & Wilkins. Chapter 72 Terrorism, Mass Casualty, and Disaster...
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Transcript of Copyright © 2008 Lippincott Williams & Wilkins. Chapter 72 Terrorism, Mass Casualty, and Disaster...
Copyright © 2008 Lippincott Williams & Wilkins.
Chapter 72
Terrorism, Mass Casualty, and
Disaster Nursing
Chapter 72
Terrorism, Mass Casualty, and
Disaster Nursing
Copyright © 2008 Lippincott Williams & Wilkins.
Emergency Operations Plan (EOP)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
Copyright © 2008 Lippincott Williams & Wilkins.
Emergency Operations Plan (EOP) (cont.)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
Copyright © 2008 Lippincott Williams & Wilkins.
TriageTriage
• 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: see Table 72-1
Copyright © 2008 Lippincott Williams & Wilkins.
Managing Short- and Long-Term Psychological Effects After a Disaster
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
Copyright © 2008 Lippincott Williams & Wilkins.
Managing Short- and Long-Term Psychological Effects After a Disaster
(cont.)
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
Copyright © 2008 Lippincott Williams & Wilkins.
Personal Protective Equipment (PPE)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
Copyright © 2008 Lippincott Williams & Wilkins.
Isolation Precautions for Biological Terrorism AgentsIsolation 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
Copyright © 2008 Lippincott Williams & Wilkins.
Chemical Weapons Chemical Weapons • Chemical substances that quickly cause injury and/or
death and cause panic and social disruption• Agents: see Table 72-3
– 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 © 2008 Lippincott Williams & Wilkins.
Nerve AgentsNerve 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
Copyright © 2008 Lippincott Williams & Wilkins.
VesicantsVesicants
• 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
Copyright © 2008 Lippincott Williams & Wilkins.
Radiation ExposureRadiation 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
Copyright © 2008 Lippincott Williams & Wilkins.
Radiation Exposure (cont.)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
Copyright © 2008 Lippincott Williams & Wilkins.
Radiation DecontaminationRadiation 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
Copyright © 2008 Lippincott Williams & Wilkins.
Radiation Decontamination (cont.)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
Copyright © 2008 Lippincott Williams & Wilkins.
Radiation InjuriesRadiation 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