TERRORISM, MASS CASUALTY, AND
DISASTER NURSING
TERRORISM
The Global Terrorism Database (2017)
describes three criteria:
- Criterion I: The act must be aimed at
attaining a political, economic, religious, or
social goal.
- Criterion II: There must be evidence of an
intention to coerce, intimidate, or convey
some other message to a larger audience
(or audiences) than the immediate victims.
- Criterion III: The action must be outside the
context of legitimate warfare activities.
 hazards
CHEMICAL TERRORISM
- the use of toxic nature of selected
substances to cause death or injury.
- Chemical Warfare (CW) agents may cause
injury via the respiratory route, through the
skin, or by ingestion.
● Nerve agents (e.g., sarin)
● Blood agents (e.g., cyanide)
● Lung irritants (e.g., chlorine gas)
BIOLOGICAL TERRORISM
- deliberate use of pathogens to infect
persons through respiratory and ingestion
routes causing death or injury. eg Anthrax
and smallpox
RADIOACTIVE TERRORISM
- the use of radiological weapons to cause
damage or injury. e.g. Nuclear weapons
DISASTER NURSING
- refers to a situation in which a health
professional, usually a registered nurse or
nurse practitioner, responds to a crisis
situation.
INCIDENT COMMAND SYSTEM (ICS)
- Is a command structure that implements
perimeters and areas to optimize responder
safety and patient flow, as well as the
preservation of evidence and environment.
MASS CASUALTY INCIDENT
- An incident in which emergency medical
services resources are overwhelmed by the
number and severity of casualties
- In all types of MCIs, the nurse will be
expected to exercise the following:
1. Assessment and triage of patient’s
condition for priority care
2. Provision of care, treatment, and health
protection
3. Appropriate utilization of nursing service
personnel
4. Detection of changes in the event
environment to organize
5. activities to modify or eliminate health
6. Dealing with mass casualties if
necessary
HOSPITAL INCIDENT COMMAND SYSTEM
(HICS)
- is an incident management framework that
can be used to organize a disaster plan
and response
- reflects the same basic principles of
command and control, chain of command,
predefined positions, established reporting
and communication relationships, use of
common nomenclature, expandability and
contractility of the scale of the operation,
and span of control as does the national
ICS.
HOSPITAL EMERGENCY PREPAREDNESS
PLANS
- Is a comprehensive emergency operations
plan that covers all phases of the disaster
and competent staff who know their roles in
executing the plan.
- The cornerstone of emergency
management is to first protect life, then
property, then the environment.
PHASES OF EMERGENCY PLANNING
1. Mitigation Measures
2. Preparedness Efforts
3. The Response Phase
4. Recovery Function
EMERGENCY OPERATIONS PLAN
- Essential components of the plan
● An activation response
● An internal and external communication
plan
● A plan for coordinated patient care
● Security plans
● Identification of external resources
● A plan for people management and
traffic flow
● Data management strategy
● Demobilization response
● After-action report or corrective plan
● A plan for practice drills
● Anticipated resources
● Mass casualty incident (MCI) planning
● An education for all of the above
PERSONAL PROTECTIVE EQUIPMENT
- is the clothing and respiratory gear
designed specifically to protect the
healthcare provider while he or she is
caring for a contaminated patient.
HAZARDOUS MATERIALS
- is any substance with the potential to harm
people, property, or the environment. This
includes not only chemicals but also
biological, radiological, nuclear and
explosive substances.
CLASSIFICATION
Class 1: Explosives
The explosives category includes any items or
materials that can rapidly detonate or
conflagrate as the result of a chemical reaction.
Class 2: Gases
Substances with a vapor pressure and those
that are completely gaseous.
Class 3: Flammable Liquids
They are defined as liquids, liquids containing
solids in solution or mixtures of liquids.
Class4: Flammable Solids
Self-reactive substances that may undergo
strong exothermic reactions or solid
desensitized explosives are also included in this
category
Class 5: Oxidizing Substances, Organic
Peroxides
Oxidizers are substances that may contribute to
or cause combustion by yielding oxygen as the
result of a chemical reaction.
Class 6: Toxic Substances and Infectious
Substances
Infectious substances are materials that are
known to or likely to contain pathogens such as
viruses, bacteria, parasites, fungi and other
microorganisms that can cause disease in
humans and animals.
Class 7: Radioactive Material
This class includes materials that contain
radionuclides
Class 8: Corrosives
Includes substances that disintegrate or degrade
other materials on contact by way of chemical
action
Class 9: Miscellaneous Hazardous Materials
Some hazardous materials do not fall into any of
the first eight categories.

DECONTAMINATION
- is the process of removing or neutralizing a
hazard from the environment, property, or
life form.
- Its goal is to reduce or remove the
hazardous agent while maintaining safety
and to prevent further contamination to
people & the environment.

BIOLOGICAL WARFARE
Common Biologic Weapons
- ANTHRAX
● Incubation 1-6 days
● Skin contact, GI ingestion, inhalation
● Skin lesions, fever, N&V, abdominal
pain, diarrhea
● Respiratory symptoms that mimics
influenza
● Treatment= Penicillin V, Erythrocin
 - SMALLPOX
● Virus, Incubation 12 days
● Extremely contagious; spread by direct
contact, by contact with clothing or
linens, Or by droplets person-to-person
● Manifestations: High fever, malaise,
headache, backache, and prostration;
after 1 to 2 days a maculopapular rash
appears on the face, mouth, pharynx,
and forearms
● Treatment is supportive care with
antibiotics for any additional infection
NATURAL DISASTERS
- Are catastrophic events with atmospheric,
geological, and hydrological origins that
can cause fatalities, property damage, and
social environment disruption.
- Common natural disasters:
● Earthquake
● Flood
● Droughts
● Hurricane/Tornados
 available.
STRESS REACTIONS
Post- traumatic Stress Disorder
- The development of characteristic
symptoms after a psychologically stressful
event (e.g., rape, combat, motor vehicle
crash, natural attack).
Symptoms
● intrusive thoughts and dreams,
● phobic avoidance reaction
● heightened vigilance,
● exaggerated startle reaction,
● generalized anxiety
● societal withdrawal
CRITICAL INCIDENT STRESS MANAGEMENT
Critical Incident Stress Debriefing (CISD)
- is a formalized, structured method whereby
a group of rescue and response workers
reviews the stressful experience of a
disaster
- was developed to assist first responders, it
was not meant for the survivors of a
disaster or their relatives
- was never intended as a substitute for
therapy
- It was designed to be delivered in a group
format and meant to be incorporated into a
larger, multicomponent crisis intervention
system

Debriefing
- is a formal version of providing emotional
and psychological support immediately
following a traumatic event
- its goal is to prevent the development of
post-traumatic stress disorder 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
- is often provided in groups.

NURSES’ ROLE IN DISASTER AND
EMERGENCY
- Assess the needs of the whole community,
including po- tentially at-risk populations, as
the event unfolds based on the information
- Conduct surveillance activities within the
health department as well as in cooperation
with in-hospital infection control
practitioners to control the spread of
communicable disease.
- Assure the health and safety of themselves
as well as their fellow responders.
- Maintain communication with local, state, or
federal agen- cies, assuring the accurate
dissemination of information to colleagues
and the public-at-large.
- Operate points of distribution (POD) mass
countermeasures centers as needed.
- Provide on-site triage of victims as needed.