1. Disaster Nursing

2. Bioterrorism and Weapons of Mass Destruction By: Brittney Mathis

3. Objectives Identify the necessary components of an emergency operations plan. Discuss how triage in a disaster differs from triage in an emergency based upon clinical judgment and decision making skills. Develop a plan of patient-centered care for a patient experiencing short or long-term psychological effects after a disaster. Evaluate the different levels of personal protection and decontamination procedures that may be necessary during an event involving mass causalities or weapons of mass destruction. Describe isolation precautions necessary for bioterrorism agents. Identify the differences among the various chemical agents used in terrorist events, their effects, and the decontamination and treatment procedures that are necessary. Determine the injuries associated with varying levels of radiation or chemical exposure and the associated decontamination processes. Utilize information management in developing plan of care for patients exposed to bioterrorism agents or in a disaster setting. Appraise the need for professional growth and lifelong learning needed to care for individuals and self during exposures to bioterrorism or weapons of mass destruction.

4. Mass Casualty Incident begins at the local level with emergency responders and volunteers Incident Command Center-local organizations that coordinates personal, facilities, equipment, and communication in emergency

5. Hospital Emergency Preparedness Plans Required by Joint Commission and must cover eight essential areas Patient tracking and triage are priorities Clear communication is imperative Nurses may be required to practice outside the normal scope

6. Triage in Disasters Triage under normal circumstances includes: resuscitation, emergent, urgent, non-urgent, and minor Triage during MCI: greatest good for the greatest number of people

7. Red Triage Tag (“Immediate” or Priority 1): Patients whose lives are in immediate danger and who require immediate treatment Yellow Triage Tag (“Delayed” or Priority 2): Patients whose lives are not in immediate danger and who will require urgent, not immediate, medical care Green Triage Tag (“Minimal” or Priority 3): Patients with minor injuries who will eventually require treatment Black Triage Tag (“Expectant” or No Priority): Patients who are either dead or who have such extensive injuries that they can not be saved with the limited resources available. (Lee, 2010)

8. Natural Disasters Preparation is key, due to the unpredictability of natural disasters The majority of the immediate casualties are trauma-related Later cases often involve excessive exposure to the natural elements and the need for food and water

9. Psychological Effects Families friends arriving in search of loved ones may be experiencing extreme grief, anxiety, or even shock Must be kept in separate area from triage Refer patients and families to therapists and social workers Discourage media replays and news articles

10. Critical Incident Stress Management Preventing and treating emotions trauma of emergency responders – Defusing – Debriefing – Demobilization – Follow-up

11. Biological Agents Biologic weapons are weapons that spread disease Anthrax and smallpox are two of the agents most likely to be used or weaponized

12. Personal Protection (PPE) Level A Level B Level C Level D-work uniform that may include gloves, glasses, or face shield

13. Decontamination

14. Agents/Diseases Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo]) Category A

15. Anthrax Inhaled spores Found in the soil naturally Initial symptoms resemble common cold Progress to severe breathing problems and shock

16. Smallpox DNA Virus Symptoms: rash, fever, malaise, headache, backache, and fatigue. 2-3 days later, flat red rash. Then they fill with pus that form crusts by week 2. Hemorrhagic smallpox causes death by day 5 or 6 Prevention: vaccine

17. Category B Agents/Diseases Brucellosis (Brucella species) Epsilon toxin of Clostridium perfringens Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudomallei) Psittacosis (Chlamydia psittaci) Q fever (Coxiella burnetii) Ricin toxin from Ricinus communis (castor beans) Staphylococcal enterotoxin B Typhus fever (Rickettsia prowazekii) Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis]) Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

18. Category C Agents Emerging infectious diseases such as Nipah virus and hantavirus

19. Biological Agents Severe Acute Respiratory Syndrome (SARS) – 2003 outbreak was an example of a mass casualty biologic event that was not terrorist-based Chemical agents: Effects are more apparent and occur more quickly than those caused by biologic weapons Nerve Agents: The most toxic agents in existence: – Result in a cholinergic crisis Blood agents: Have a direct effect on cellular metabolism, resulting in asphyxiation – Examples include hydrogen cyanide and cyanogen chloride

20. What is the later cause of casualties after natural disasters? A.Repeat natural disasters B.Exposure to elements with need of food and water C.Electrocution from lightening

21. Answer B Rationale-Later cause often involve excessive exposure to the natural elements causing hypothermia/hyperthermia and the need for food and water.

22. An individual who has become infected with anthrax is most likely to exhibit which of the following signs and symptoms? A.Signs of cardiogenic shock B.Severe respiratory distress C.Skin lesions and hemorrhage D.Neurological deficits

23. Answer-B severe respiratory distress Rationale-anthrax is typically ingested by inhalations and results in respiratory distress leading to respiratory arrest. Neurological, cardiac, and integumentary effects are not central manifestation of the disease.

24. You are in charge of triaging patients after a massive tornado has taken out most of the town causing massive casualty. The hospital is already full with many people still untreated. A woman flags you over to her collapsed husband whom has a large wound to his chest caused by debris making it difficult for him to breath. What color tag do you place on this man? A.Green B.Black C.Red D.Yellow

25. Answer C-Red- due to patients whose lives are in immediate danger and who require immediate treatment like sucking chest wounds

26. You have been caring for a patient in the ER whos breathing has progressively gotten worse until a physician makes a diagnosis of Anthrax poisoning based off his new chest x-ray. Due to being exposed, what is the next step you must take? A.Remove all your clothing and rinse with soap and water B.Call Employee Health for the vaccination C.Call Infection Control to quarantine everyone that came in contact with the patient D.Continue providing the best level of care to the patient with no change on your behalf

27. Answer D-Anthrax is infective only in the spore form and cannot be spread from person to person. Level D universal precautions only are needed.

28. Due to the emotional toll responding to massive casualties, natural disasters, and emergency response can have on responders, what is the name of the group that can help with the follow up process to ensure emotional health? A.Critical Incident Stress Management B.National Incident Management System C.Federal Emergency Management Administration (FEMA) D.American Red Cross

29. Answer A

30. Feuerstein, C. (2012, November 6). Disaster nursing [Video file]. Retrieved from http://www.youtube.com/watch?v=W- S2BXTPKHshttp://www.youtube.com/watch?v=W- S2BXTPKHs Lee, C. H. (2010). Disaster and mass casualty triage. Virtual Mentor, 12(6), 466-470. Retrieved from http://virtualmentor.ama- assn.org/2010/06/cprl1-1006.htmlhttp://virtualmentor.ama- assn.org/2010/06/cprl1-1006.html Pellico, L. H. (2013). Nursing management: Patients with chest and lower respiratory tract disorders. In Focus on adult health medical-surgical nursing3 (pp. 312-322). China: Wolters Kluwer: Lippincott Williams & Wilkins.