NCM

118 LEC – Terrorism, Mass Casualty, Disaster Nursing

Terrorism Phases of Emergency Planning
• The Global Terrorism Database (2017) describes three criteria 1. Mitigation measures
o Criterion I – the act must be aimed at attaining a a. Structural mitigation – efforts that include those that
political, economic, religious, or social goal the hospital performs through thr construction or
o Criterion II – there must be evidence of an intention alteration of the physical environment through
to coerce, intimindate, or convey some other engineered solutions
message to a larger audience/s than the immediate i. Disaster resistant construction
victims ii. Structural modifications
o Criterion III – the action must be outside the context iii. Detection systems (radiation monitors)
of legitimate activities b. Non-structural mitigation – those that the hospital
undertakes by modifying human behaviors or
Chemical Terrorism – the use of toxic nature of selected substances processes
to cause death or injury i. Regulatory measures
• Chemical Warfare (CW) agents may cause injury via the ii. Staff awareness
respiratory route, skin, or by ingestion iii. Educational programs
• Nerve agents (sarin) 2. Preparedness efforts – develop and maintain a
• Blood agents (cyanide) comprehensive effective emergency management plan
• Lung irritants (chlorine gas) a. This will help hospitals to prepare disaster and
emergency situation
Biological Terrorism – deliberate use of pathogens to infect persons 3. The response phase – measures taken with an emergency
through respiratory and ingestion routes causing death or injury incidental course and may involve care for patients, staff, and
• Ex. Anthrax and small pox visitors to limit injuries, loss of life, and damage to the physical
environment
Radioactive Terrorism – the use of radiological weapons to cause 4. Recovery function – after the disaster, the primary goal of
damage or injury recovery efforts is to restore core services and normal
• Ex. Nuclear weapons operations

Disaster Nursing – refers to a situation in which a health professional, Emergency Operations Plan
usually a registered nurse or nurse practitioner, responds to a crisis • Essential components of the plan
situation o An activation response
o An internal and external communication plan
Incident Command System (ICS) – a command structure that o A plan for coordinated patient care
implements perimeters and areas to optimize responder safety and o Security plans
patient flow, as well as the preservation of evidence and environment o Identification of external resources
o A plan for people management amd traffic flow
Mass Casualty Incident – an incident in which emergency medical o Data management strategy
services resources are overwhelmed by the number and severity of o Demobilization response
casualties o After-action report or corrective plan
• In all types of MCIs, the nurse will be expected to exercise the o A plan for practice drills
following o Anticipated resources
o Assessment and triage of patient’s condition for o Mass casualty incident (MCI) planning
priority care o An education for all of the above
o Provision of care, treatment, and health protection
o Appropriate utilization of nursing service personnel Personal Protective Equipment (PPE) – is the clothing and respiratory
o Detection of changes in the event environment to gear designed specifically to protect the healthcare provider while
organize activities to modify or eliminate health they are caring for a contaminated patient
hazards
o Dealing with mass casualties if necessary The type of PPE used will vary based on the level of precautions
required such as standard and contact, droplet or airborne infection
Hospital Incident Command System (HICS) – is an incident isolation precaution. The procedure for putting on and removing PPE
management framework that can be used to organize a disaster plan should be tailored to the specific type of PPE
and response
• Reflects the same basic principles of command and control, 1. Gown
chain of command, predefined positions, established a. Fully cover torso from neck to knees, arms to end of
reporting and communication relationships, use of common wrists, and wrap around the back
nomenclature, expandability and contractility of the scale of b. Fasten in back of neck and waist
the operation, and span of control as does the national ICS 2. Mask or respirator
a. Secure ties or elastic bands at middle of head and
Hospital Emergency Preparedness Plans – is a comprehensive neck
emergency operations plan that covers all phases of the disaster and b. Fit flexible band to nose bridge
competent staff who know their roles in executing the plan c. Fit snug to face and below chin
d. Fit-check respirator
• The cornerstone of emergency management is to protect LIFE,
3. Goggles or face shield
then PROPERTY, then the ENVIRONMENT
a. Place over face and eyes and adjust to fit
4. Gloves
a. Extend to cover wrist of isolation gown



Byeang
 NCM 118 LEC – Terrorism, Mass Casualty, Disaster Nursing

Hazardous Materials – is any substance with the potential to harm Biological Warfare
people, property, or the environment. This includes not only • Anthrax
chemicals but also biological, radiological, nuclear, and explosive o Incubation: 1-6 days
substances o Skin contact, GI ingestion, inhalation
• Class 1: Explosives – includes any items or materials that can o Skin lesions, fever, N/V, abdominal pain, diarrhea
rapidly detonate or conflagrate as the result of chemical o Respiratory symptoms that mimics influenza
reaction o Treatment: Penicillin V, Erythrocin
• Class 2: Gases – substances with a vapor pressure and those • Smallpox
that are completely gaseous o Virus
• Class 3: Flammable Liquids – liquids containing solids in o Incubation: 12 days
solution ir mixtures of liquids o Extremely contagious
• Class 4: Flammable Solids – self-reactive substances that may o Spread by direct contact, by contact with clothing or
undergo strong exothermic reactions or solid desensitized linens, or by droplets person to person
explosions are also included in this category o Manifestations: high fever, malaise, headache,
• Class 5: Oxidizing Substances, Organic Peroxides – oxidizers backache, prostration; after 1-2 days, a
are substances that may contribute to or cause combustion by maculopapular rash appears on the face, mouth,
yielding oxygen as the result of a chemical reaction pharynx, and forearms
• Class 6: Toxic Substances and Infectious Substances – o Treatment: supportive care with antibiotics for any
infectious substances are materials that are known to or likely additional infection
contain pathogens such as viruses, bacteria, parasites, fungi,
and other microorganisms that can cause disease in humans Blast Injuries
and animals 1. Primary – results from pressure wave
• Class 7: Radioactive Material – materials that contain a. Pulmonary barotraumas: pulmonary contusions
radionuclides b. Head injuries: concussion, severe brain injuries,
• Class 8: Corrosives – substances that disintegrate or degrade tympanic membrane rupture, middle ear injury
other materials on contact by way of chemical action c. Abdominal hollow organ perforation, hemorrhage
• Class 9: Miscellaneous Hazardous Materials – some hazardous 2. Secondary – results from debris from the scene or shrapnel
materials do not fall into any of the first eight categories from the bomb
a. Penetrating trunk, skin, and soft tissue injuries
Decontamination – is the process of removing or neutralizing a hazard b. Fractures, traumatic amoutations
from the environment, property, or life form 3. Tertiary – results from pressure wave that causes the victim
• Its goal is to reduce or remove the hazardous agent while to be thrown
maintaining safety and to prevent further contamination to a. Head injuries
people and environment b. Fractures, including skull
4. Quarternary – results from pre-existing conditions
Decontamination Methods exacerbated by the force of the blast or by postblast injury
1. Physical Removal complications
a. Remove clothing – encourage victims to remove a. Severe injuries with complex injury patterns: burns,
clothing at least to their undergarments crush injuries, head injuries
b. Flush with water or aqueous solutions b. COPD, asthma, cardiac conditions, diabetes, and
c. Absorb contaminating agent with absorbent materials hypertension
(rub with flour followed by wet tissues or use military
M291 resin kits for spot decontamination of skin only) Natural Disasters – are catastrophic events with atmospheric,
d. Scrape bulk agent with a wooden stick (tongue geological, and hydrological origins that can cause fatalities, property
depressor/popsicle stick) damage, and social enviornment disruption
e. Note: follow all of these actions with full • Commo natural disasters
decontamination at a medical treatment facility o Earthquake
2. Chemical Deactivation o Flood
a. Water/soap wash – chemical warfare agents have a o Droughts
generally low solubility and slow rate of diffusion in o Hurricane/tornados
both freshwater and seawater
i. Therefore, the major effect of water and Stress Reactions
water combined with soap (esp. alkaline • PTSD – development of characteristic symptoms after a
soap) is a slow breakdown of the compound psychologically stressful event
(hydrolysis) or through dilution of the agent o Symptoms
and the mechanical force of the wash § Intrusive thoughts or dreams
ii. When other chemical deactivation means are § Phobic avoidance reaction
not available, washing with water or soap and § Heightened vigilance
water is a good alternative § Exaggerated startle reaction
b. Chemical solutions – in the event of an emergency, § Generalized anxiety
you may be directed to perform decontamination § Societal withdrawal
with other chemical deactivation agents
i. These vary depending on the chemical
warfare agent and may include alkaline
solutions or hypochlorite
3. Hydrolyzing agents
a. Alkaline hypochlorite is effective for hydrolizing VX
and G agents
Byeang
 NCM 118 LEC – Terrorism, Mass Casualty, Disaster Nursing

Critical Incident Stress Management
• Critical Incident Stress Debriefing (CISD) – is a formalized,
structured method whereby a grouo of rescue and response
workers reviews the stressful experience of a disaster
o Developed to assist first responders, it was not meant
for the survivors of a disaster or their relatives
o Was never intended as a substitute for therapy
o It was designed to be delivered in a grouo format and
meant to be incorporated into a larger,
multicompnent crisis intervention system

Debriefing – is a formal version of providing emotional and
psychological support immediately following a traumatic event
• Goal: to prevent the development of PTSD and other negative
sequelae
• Mostly involve a single session which might last between one
and three hours, in the days immediately following a
traumatic event
• Often provided in groups

Nurses Role in Disaster and Emergency
1. Assess the needs of the whole community, including
potentially at-risk populations, as the event unfolds based on
the information available
2. Conduct surveillance activities withij the health department
as well as in cooperation with in-hospital infection control
practitioners to control the spread of communicable disease
3. Assure the health and safety of themselves as well as their
fellow responders
4. Maintain communication with local, state, or federal agencies,
assuring the accurate dissemination of information to
colleagues and the public at large
5. Operate points of distribution mass counter measures as
needed

Byeang