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, EMTs,
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 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 (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 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!