REVIEWER Terrorism

• It refers to unlawful use of violence and acts against people to coerce and to
EMERGENCY AND DISASTER NURSING intimidate.
• It involves dispensing of disease pathogens (bioterrorism) or other agents
DEFINITION OF TERMS
(chemical, nuclear, radioactive and explosive devices) for the purpose of
Disaster causing harm.

• Any destructive events that disrupts normal functioning. PATIENT ASSESSMENT IN EMERGENCY SITUATIONS
• Ecologic disruptions or emergencies of a severity and magnitude that result in
Primary Survey
deaths, injuries, illness and property damage that cannot be effectively
• Done to rapidly identify immediate threats to life and effectively manage
managed using routine procedures or resources that require outside
them.
assistance.
• ABCDE Assessment Approach
Disaster Preparedness 1. Airway
- Open and clear airway
• It refers to any measures taken to prepare for and reduce the effects of disasters. o Jaw-thrust maneuver
• Any measures used to predict and if possible, prevent disasters, mitigate their o Suctioning, removal of foreign body, insertion of a
impact on vulnerable populations and respond to and effectively cope with their nasopharyngeal or oropharyngeal airway, and endotracheal
consequences at local, nation and international levels. intubation
- Asses for compromised airway/respiratory distress:
First Aid o Dyspnea, restlessness, inability to vocalize, presence of foreign
body in the airway, and trauma to the face or neck.
• The immediate and temporary care given to the victim - The cervical spine must be stabilized and immobilized
Rescue o Cervical collar, backboard, towel rolls,
2. Breathing
• To free from danger or violence. - Assess ventilation
o Count respiratory rate and auscultate lungs
Shelter o Dyspnea, paradoxical or asymmetric chest wall movement, feel
for air being expelled.
• A temporary place where disaster victims are housed until they are able to - Note color of nail beds, mucous membranes, and skin
establish their own living quarters. - Assess for jugular vein distention
- Give supplemental O2
Warning signs
3. Circulation
• Official public information concerning impending disaster for precautionary - Palpate pulse for quality and rate
measures. o Absence of pulse: Cardiopulmonary resuscitation and life-
support measures
Emergencies - Measure blood pressure
- Note capillary refill and altered mental status
• Sudden and unlooked for conditions requiring immediate action. o Signs of shock: Two large-bore IV catheters should be inserted
and aggressive fluid resuscitation initiated using normal saline
Triage
or lactated Ringer’s solution
• Used to identify those patients whose conditions are most seriously - Assess color, temperature and moisture of the skin
compromised so that they are the first to receive medical intervention - Assess for external bleeding
• The process of rapidly determining patient acuity. 4. Disability
• It is one of the most important assessment skills needed by emergency nurses. - Neurological assessment
• The triage process is based on the premise that patients who have a threat to o Level of consciousness – verbal or painful stimuli
life, vision, or limb should be treated before other patients. AVPU mnemonics
• A triage system identifies and categorizes patients so that the ost critical are ▪ A – alert
treated first. ▪ V – verbal
▪ P – pain
▪ U – unresponsive
o Pupil size and response to light

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 o Glasgow Coma Scale
- Identify deformities
o Inspect extremities for obvious deformities
o Determine strength and range of movements
- Pain assessment
o PQRST
5. Exposure
- Undress the patient – cutting articles of clothing
o To identify areas of wounds or injury
Secondary Survey
• Exposure and Environmental Control – remove clothing for proper examination;
keep patient warm (blankets, warmed IV fluids)
• Full Set of Vital Signs – obtain vital signs
• Give Comfort Measures - assess pain and anxiety; provide emotional support
• History and Head-to-Toe Assessment – gather details of the incident/illness;
determine patient’s health needs and problems
• Inspect Posterior Surfaces – logroll, and inspect and palpate back for
deformity, bleeding and bruises
AIRWAY OBSTRUCTION
• Airway is partially or completely occluded
o Cause: aspiration od foreign objects, anaphylaxis, infection, inhalation of
chemicals
o Complete obstruction: permanent brain injury or death will occur within 3
– 5 minutes secondary to hypoxia
• Manifestations: Choking, refusing to lie flat, stridor, labored breathing, use of
accessory muscles, restlessness, nasal flaring; complete obstruction – cannot
speak, breathe or cough.
• Late signs: Cyanosis and loss of consciousness
• Interventions
o Establish an airway
▪ Reposition head – prevent tongue from obstructing the pharynx
▪ Head-tilt/chin-lift, jaw thrust maneuver, insertion of specializes equipment
- Head-tilt Maneuver
1. Place the patient on a firm, flat surface.
2. Open the airway by placing one hand on the victim’s forehead, and
apply firm backward pressure with the palm to tilt the head back
3. Place the fingers of the other hand under the bony part of the lower
jaw near the chin and lift up.
4. Bring the chin and teeth forward to support the jaw.
- Jaw-thrust Maneuver
1. Place the patient on a firm, flat surface.
2. Open the airway by placing one hand on each side of the victim’s
jaw, followed by grasping and lifting the angles, thus displacing the
mandible forward.
▪ Assess effectiveness: rise and fall of the chest, listening and feeling for air
movement. Note: Cervical spine must be protected in all maneuvers
HEMORRHAGE
• Bleeding that may be external, internal or both
• Management:
o Fluid Replacement
- Two large-bore IV catheters are inserted to provide a means for fluid and
blood replacement, and blood samples are obtained for analysis, typing,
& cross-matching.
- Isotonic solutions (LRS, NSS), colloid, and blood component therapy.
o Control External Hemorrhage
- Physical assessment: identify area of hemorrhage – cut clothing
- Apply direct, firm pressure over bleeding area or the involved artery
(proximal to wound)
- Apply firm pressure dressing
- Elevated injured part to stop venous & capillary bleeding if possible
- If the injured area is an extremity, immobilized to control blood loss.
- Tourniquet
▪ Last resort
▪ Apply proximal to the wound and tied tightly enough to control
arterial blood flow
▪ Tag the client with a “T” stating the location and the time applied
(skin marking pencil or adhesive tape on FOREHEAD)
▪ No arterial bleeding: remove tourniquet, apply pressure dressing
▪ Traumatically amputated: tourniquet remains in place until the OR
o Control of Internal Hemorrhage
- Watch out for tachycardia, hypotension, thirst, apprehension, cool and
moist skin, or delayed capillary refill
- Packed RBC administered at a rapid rate, and the patient is prepped for
OR
- Arterial blood is obtained to evaluate pulmonary perfusion & to establish
baseline hemodynamic parameters
- Patient is maintained in a supine position and closely monitored.
• HYPOVOLEMIC SHOCK
o Loss of effective circulating blood volume followed by inadequate tissue
and organ perfusion
o Anticipate possibility of shock: assess patient immediately.
WOUNDS
• A type of physical trauma wherein the skin is torn, cut or punctured (open
wound), or where blunt force trauma causes a contusion (closed wound)
• Management:
o Properly document wound characteristics
o Wound cleansing
▪ Cleanse with normal saline solution or polymer agent
- Do not use antibacterial agents such as povidone-iodide (Betadine) or
hydrogen peroxide
o Primary closure
▪ Wound closure depends on the nature of the wound, time of injury,
degree of contamination and vascularity
▪ Suture or staple (usually be physician)
• TRAUMA
o Unintentional or intentional wound inflicted on the body from a mechanism
that the body cannot protect itself
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TRIAGE SYSTEM: Color Code • Preparedness
➢ Plans on how the community will responds if disaster occurs.
Black Unresponsive patients with penetrating head wounds, severe spinal ➢ Planning for rescue, evacuation and treating of the victims, training disaster
cord injuries, wounds involving multiple organs, 3 rd degree burns in excess personnel, and gathering resources, equipment and materials needed in
of 60% body surface area, profound shock with multiple injuries, no pulse, case of a disaster.
no respirations, fixed dilated pupils. ➢ Mock disaster drills, creating location for providing food, water, clothing,
shelter and medicines, verifying functioning of emergency equipment, and
Red First priority because of emergent signs and symptoms developing an emergency medical system.
These victims have a reasonable chance of survival if they received • Response
initial treatment. ➢ These are efforts to minimize the hazards created by a disaster.
These patients have sucking chest wounds, airway obstruction ➢ It includes putting disaster plans into action to save lives, provide safety, and
secondary to mechanical cause, shock, hemothorax, tension prevent further damage.
pneumothorax, asphyxia, unstable chest and abdominal wounds, • Recovery
incomplete amputations, open fractures of long bones, and 2 nd or 3rd ➢ It includes actions needed to return the community to a normal situation
degree burns of 15%-40% total body surface area. following the disaster.
➢ Preventing debilitating effects and restoring personal, economic and
Yellow Second priority with serious or urgent signs and symptoms. environmental stability and health to the affected areas of the community.
These victims can wait for transportation after they received initial
emergency treatment. EMERGENCY PLANS AND SUPPLIES
This classification is given to patients who require treatment and whose
injuries have complications that are not life threatening provided that • Planning
initial treatment is done within 1 to 2 hours after the incident. ➢ Plan a meeting place for family members.
These patients have stable abdominal wound without significant ➢ Identify safe places to evacuate if necessary.
haemorrhage, soft tissue injuries, maxillofacial wound without airway ➢ Determine how and when to turn off gas, electricity and water at main
compromise, vascular injuries with adequate collateral circulation, GU switches.
tract disruption, and fractures requiring open reduction, debridement and ➢ Stay alert for emergency broadcasts.
external fixation. ➢ Make a family emergency supply kit.
• Supplies
➢ Water supply for 3 day, 1 gallon or 2 liters per person per day
Green Minimal priority with non-urgent signs and symptoms.
➢ Foods that would not spoil such as canned goods, energy bars and dried
Victims are ambulatory and have minimal tissue injuries. They can be
foods
treated by non-professionals and held for observation if necessary.
➢ Battery-operated flashlight and radio
Upper extremity fractures, minor burns, sprains, small lacerations without
➢ Clothing and blankets
significant bleeding, behavioural disorders or psychiatric disturbances.
➢ First aid kit
➢ Important family documents
PHASES OF DISASTER MANAGEMENT ➢ Adequate supply of medications that require prescription
➢ Cash, credit cards or checks
• Mitigation ➢ Sanitation supplies such as soap and napkin
➢ Actions or measures that can ➢ Special items for infants, elderly and disabled
prevent the occurrence of ➢ Whistle to attract attention
disaster or reduce its effects.
➢ Determining the hazards and risks ENVIRONMENTAL EMERGENCIES
in the community, awareness of
available resources in the • Heat Related
community, building codes and o Heat Cramps
zoning to minimize chaos and - Cramps in fatigued muscles – brief, intense and occurs during rest
confusion if a disaster occurs, and - Accompanied by: nausea, tachycardia, pallor, weakness and diaphoresis
determination of available - Interventions:
resources for infants, elderly, ▪ Rest
disable and people with chronic ▪ Sodium and water replacement
illness. ▪ Elevation, gentle massage, analgesia

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 o Heat Exhaustion • Submersion Injuries
- Due to prolonged exposure to heat o Occurs when one becomes hypoxic due to being submerged in a
- Manifestations: fatigue, nausea and vomiting, altered mental status, substance (commonly water)
tachypnea, tachycardia, dilated pupils, ashen color, diaphoresis o Drowning – death form suffocation after submersion
- Hypotension and increase in temperature → Due to dehydration - Hypoxia secondary to aspiration and swallowing of fluid
- Interventions: - Aspirate fluid into the pulmonary tree → pulmonary edema
▪ Place patient in cool area; remove constrictive clothing o Ineffective breathing, dyspnea, crackles, rhonchi, cough with pink-frothy
▪ Monitor ABCs sputum, cyanosis, tachy/bradycardia, hypotension, panic, exhaustion,
▪ Fluid and electrolyte imbalance; NaCl of oral solutions are not coma,
tolerated • Bites and Stings
▪ Moist heat over the patient to decrease core temperature – o Bites from animals, insects and spiders
evaporative heat loss o Morbidity results from direct tissue damage or lethal toxins
o Heatstroke o Death results from blood loss, allergic reactions, or lethal toxins
- Failure of the hypothalamic thermoregulatory processes • Poisonings
- Manifestations: increased sweating then function of sweat glands top o Chemical that harms the body
leading to hot and dry skin, vasodilation (hypotension), tachypnea, o Management:
hyperthermia, altered mental status - Decrease absorption, enhance elimination and implement toxin-specific
- Neurologic manifestations: hallucinations, loss of muscle coordination, interventions
cerebral edema, hemorrhage ▪ Gastric lavage, activated charcoal, dermal cleansing, eye irrigation
- Interventions: ▪ Most effective: administration of activated charcoal orally or via gastric
▪ Monitor ABCs tube within 60 minutes of poison ingestion
▪ High flow oxygen – non-rebreather mask • Many toxins adhere to charcoal → excreted in the GI tract rather
▪ Fluid replacement and establish IV access than absorbed
▪ Cool environment
▪ Rapid cooling measures (remove clothing, wet sheet over patient) AGENTS OF TERRORISM
- Shivering – increase core body temperature
BIOTERRORISM
• Cold Related
o Frostbite PATHOGEN AND SIGNS AND TRANSMSSIBILITY TREATMENT
- “True tissue freezing”; formation of ice crystals in the tissues and cells which DESCRIPTION SYMPTOMS
may result to edema and blisters then necrosis and gangrene. Inhalation • Dyspnea Spread through • Ciprofloxaxin,
- Initial response to cold stress: peripheral vasoconstriction which may Anthrax • Cough direct contact Penicillin and
decrease blood flow and vascular stress Bacillus • Chest pain with bacteria and Doxycycline to
- Ice crystals form in the intracellular spaces, intracellular sodium and chloride anthracis • Diaphoresis its spores prevent
increases, cell membrane is destroyed • Spores • Septicemia systemic
- Superficial: skin and subcutaneous tissue (ears, nose, fingers, toes); multiply in • Shock manifestations
- Deep: muscle, bone and tendon the lungs • Meningitis • Postexposure
- Interventions: • Causes prophylaxis for
▪ Remove constricting clothing hemorrhag 30 days
▪ Immerse affected area in a water bath (38.9°C to 42.2°C) e and
▪ Elevate affected extremity destruction
o Hypothermia of lung
- Core temperature less than 35°C tissue
- Heat produced cannot compensate for heat load to the environment Cutaneous • Small Spread through • Ciprofloxaxin,
- Mild: 34°C to 36°C; Moderate: 30°C to 34°C; Profound: less than 30°C anthrax papule direct contact Penicillin and
- Manifestations: Shivering, hypoventilation, hypotension, altered mental Bacillus resembling with bacteria and Doxycycline to
status, areflexia, cyanotic skin anthracis insect bite its spores prevent
- Intervention: • 95% of • Depressed systemic
▪ Remove patient from the cold environment and rewarm patient anthrax black ulcer manifestations
▪ Keep patient’s head covered with warm, dry towels to limit loss of heat infections • Swollen • Postexposure
▪ Manage and monitor ABCs • Spores lymph nodes prophylaxis for
▪ Monitor O2 saturation; provide high flow oxygen via non-breather mask enters 30 days
through skin

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• Toxins Vesicant agents
destroy Sulfur mustard Blistering agents Superficial to Soap and water
surrounding Phosgene partial thickness Blot, do not rub dry
tissues burn with vesicles
Smallpox • Fever • Highly • No known cure that coalesce
Variola major • Myalgia contagious • Cidofovir Pulmonary agents
and minor • Papules to • Direct person • Vaccine Chlorine Seperation of Pulmonary edeme Airway
viruses pustular to person immune Phosgene alveoli from Bronchospasm management
• Global vesicles contact globulin capillary bed Ventilator support
eradication • Headache • Through air Bronchoscopy
declared in • Malaise droplets OTHER DISASTERS/EMERGENCIES
1980
Botulism • Abdominal • Air or food • Antitoxin • Accidents
Clostridium cramps • Contaminate • Induce o Home – falls, fires, poisoning
botulinum • Diarrhea d wound vomiting o Community – vehicular accidents
• Spore • Nausea and • Improperly • Enemas o Hospitals – falls, fire
forming vomiting canned food • Heating foods • Fire
anaerobe • cranial or drink for 10 ➢ Class A Fires
• Found in soil nerve palsies minutes to ✓ Composed of normal solid elements
• Lethal (diplopia, inactivate ✓ Paper, wood, textiles, rubber
bacterial dysarthnia, toxins ➢ Class B Fires
neurotoxin dysphonia, • Penicillin ✓ Consists of elements whose vapors are set off at normal temperature or
• Can die in dysphagia) when heated
24hrs • Respiratory ✓ CO2, dry powder
failure ➢ Class C Fires
Hemorrhagic • Fever • Through • NO treatment ✓ Results from electric power and lead to the ignition of close flammable
fever • Conjunctiviti rodents and • Isolate objects
• Cause by s mosquitoes • Ribavirin ✓ CO2
Ebola virus • Hemorrhage • Virus can be (effective at ✓ Never use water or foam because they convey electricity
or Lassa of tissues aerolized times) ➢ Class D Fires
virus and organs ✓ Metal or dry powder
• Nausea and ✓ Direct flow of extinguisher at the base of flame
vomiting
How to use an extinguisher
• Hypotension
CHEMICAL AGENTS P: Pull the pin.
AGENT ACTION SIGNS AND DECONTAMINATIO
SYMPTOMS N AND TREATMENT A: Aim extinguisher nozzle at the base of the flame.
Nerve agents
Sarin Inhibition of Increased Soap and water S: Squeeze trigger while holding the extinguisher upright.
Soman cholinesterase secretions Benzodiazepine
S: Sweep the extinguisher from side to side, covering the area with the
GI motility Atropine sulfate
extinguisher agent.
Diarrhea
bronchospasm • Earthquake
Blood agents ➢ Associated with multiple aftershocks
Cyanide Inhibition of Tachypnea Na nitrite ➢ Buildings require tethering in earthquake prone areas
aerobic Tachycardia Na thiocyanate ➢ Injuries: physical injuries, dehydration, pulmonary problems
metabolism Coma Amyl nitrate
Seizures
Cardiac arrest
Respiratory failure
Death

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Safety measures during earthquake REFERENCEs:

✓ DROP down onto your hands and knees before the earthquake would knock Day, R.A., and Brunner, L.S. (2014). Brunner & Suddarth’s textbook of Canadian
you down. This position protects you from falling but still allows you to move if medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.
necessary.
✓ COVER your head and neck (and your entire body if possible) under the Quiambao-Udan, J. (2017). Medical Surgical Nursing: Concepts and Clinical
shelter of a sturdy table or desk. If there is no shelter nearby, get down near Application. APD Educational Publishing House Ermita, Manila.
an interior wall or next to low-lying furniture that won't fall on you, and cover
your head and neck with your arms and hands. Try to stay clear of windows
or glass that could shatter or objects that could fall on you.
✓ HOLD ON to your shelter (or to your head and neck) until the shaking stops.
Be prepared to move with your shelter if the shaking shifts it around.
✓ Wherever you are, do not panic, be calm.
✓ Do not try to get out of premises. Stay away from buildings utility wires,
sinkholes, and fuel and gas lines.
• Tsunami
➢ As with flooding but with much more rapid onset resulting in immediate large
volume of water on land.
➢ Injuries: physical injuries from debris, vector-borne diseases, cholera
• Flooding
➢ Can accompany other natural disasters
➢ Results in home and community destruction
➢ Injuries: nonfatal drowning, waterborne and vector diseases, (E. coli,
infection, hepatitis, leptospirosis, malaria and dengue fever), physical injury
from debris

Causes of Floods
o Uncontrolled urbanization
o Deforestation
o Effects of El Nino
Safety Rules

✓ Avoid walking, swimming, or driving in flood waters.

✓ Stay away from high water, storm drains, ditches, ravines,. If it is moving
swiftly, even water six inches deep can knock you off your feet.
✓ Climb to higher ground
✓ Do not let children play near storm drains

PRINCIPLES OF EMERGENCY MANAGEMENT

✓ Remain calm
- Think before acting
✓ Early response
- Do rapid assessment to identify priority interventions
- Carry our life saving measures as needed
- Victim lying down – keep on same position; avoid unnecessary moving
of the victim
- Perform head-to-toe assessment prior to initiating general aid
measures
- Do not transport victim until first aid measures are done
✓ Triage
✓ Assess and intervene: Primary and Secondary Survey