chapter 072 disaster nursing
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Chapter 72
Terrorism, Mass Casualty,and Disaster Nursing
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Question
Is the following statement True or False?
Health care facilities are required by the Joint Commissionto create a plan for emergency preparedness and topractice this plan once a year.
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Answer
False
Health care facilities are required by the Joint Commissionto create a plan for emergency preparedness and topractice this plan twice a year, not once a year.
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Emergency Operations Plan (EOP)
Essential components of the plan:
A data management strategy
Deactivation response
Post-incident response
A plan for practice drills
Anticipated resources
Mass causality incident planning
An education for all of the above
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Question
What is the name for the triage category where injuries aresignificant and require medical care, but can wait hours
without threat to life or limb?A. Delayed
B. Expectant
C. Immediate
D. Minimal
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Answer
A
Delayed injuries are significant and require medical care,but can wait hours without threat to life or limb.Expectant injuries are extensive and chances of survivalare unlikely even with definitive care. Immediate
injuries are life threatening but survivable with minimalintervention. Minimal injuries are minor and treatmentcan be delayed hours to days.
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Triage
The sorting of patients to determine priority health careneeds and the proper site of treatment.
In nondisaster situations healthcare workers assignhighest priority and allocate most resources to the mostcritically ill.
In disaster situations with large numbers of casualties
decisions are based on the likelihood of survival and theconsumption of resources
Triage categories
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Question
Is the following statement True or False?
Critical incident stress management programs includeeducation, field support, defusing, debriefing,demobilization and follow-up components.
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Answer
True
Critical incident stress management programs includeeducation, field support, defusing, debriefing,demobilization and follow-up components.
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Managing Short- and Long-Term
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
Critical incident stress management (CISM)
Programs that include education, field support, defusing,debriefing, demobilization and follow-up components
Persons with ongoing stress reactions should be referred tomental health specialists
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Question
What is level A protective equipment?
A. Self-contained breathing apparatus (SCBA) and vapor-
tight chemical resistant suit, gloves and boots
B. High level of respiratory protection (SCBA) but lesser skinand eye protection; chemical resistant suit
C. Air-purified respirator, coverall with splash hood, chemical
resistant gloves and bootsD. Typical work uniform
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Answer
A
Level A: self-contained breathing apparatus (SCBA) andvapor-tight chemical resistant suit, gloves and boots.Level B: high level of respiratory protection (SCBA) butlesser skin and eye protection; chemical resistant suit.Level C: air-purified respirator, coverall with splash hood,
chemical resistant gloves and boots. Level D: typical workuniform
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Personal Protective Equipment (PPE)
Purpose: To shield the health care provider from chemical,physical, biological, and radiological hazards that may existwhen caring for contaminated patients.
Categories of protective equipment:
Level A: self-contained breathing apparatus (SCBA) andvapor-tight chemical resistant suit, gloves and boots
Level B: high level of respiratory protection (SCBA) butlesser skin and eye protection; chemical resistant suit
Level C: air-purified respirator, coverall with splash hood,chemical resistant gloves and boots
Level D: typical work uniform
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Physical Injuries After Blast Events
Blast Lung
Tympanic Membrane Rupture
Abdominal and Head Injuries
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Isolation Precautions for BiologicalTerrorism Agents Biological agents may be delivered or spread in a number
of ways.
Due to modern travel, spread of infection may occur in
areas thousands of miles apart. Health care providers need to be aware of potential signs
of biological weapon dissemination. Signs and symptomsare similar to those of common disease process.
Isolation practices depend upon the infecting agent.
Always use Standard Precautions
Some agents require Transmission-Based Precautions.
Terminal disinfection and disposal of wastes is dependentupon the infecting agent.
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Chemical Weapons Chemical substances that quickly cause injury and/or death
and cause panic and social disruption
Agents
Nerve agents Blood agents
Vesicants
Pulmonary agents
Agents vary in volatility, persistence, toxicity, and period oflatency
Limitation of exposure is essential with evacuation anddecontamination as soon possible and as close to the scene ofthe incident as possible
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Nerve Agents
Sarin, soman organophosphates
Inhibit cholinesterase causing cholinergic symptomsprogressing to loss of consciousness, seizures, copioussecretions, apnea, and death
Treatment: supportive care, atropine, benzodiazepineand pralidoxime
Decontaminate with copious amounts of soap and wateror saline for at least 20 minutes
Blot, do not wipe off
Plastic equipment will absorb sarin gas
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Vesicants
Lewisite, sulfur mustard, nitrogen mustard, phosgene
Cause blistering and burning
Respiratory effects can be serious and cause death
Decontamination with soap and water, do not scrub oruse hypochlorite solutions
Eye exposure requires copious irrigation
Treatment for lewisite exposure: dimercaprol IV ortopically
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Radiation Decontamination
Triage outside the hospital
Cover floor and use strict isolation precautions to prevent
the tracking of contaminants
Air ducts and vent are sealed
Waste is double bagged and labeled radiation waste
Staff protection
Water resistant gowns, two pairs of gloves, caps,goggles, masks, and booties
Dosimetry devices
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Radiation Decontamination Patients are surveyed for radiation and directed to the
decontamination area
Decontaminate each patient outside the ED with ashower
Water, tarps, towels, soap, gowns, all patientbelongings, etc. must be collected and contained
Patients are resurveyed and reshowered as necessary
Showering should be performed to not contaminateclean areas with runoff from the showering
Biologic samplesnasal and throat swabs, blood
Internal contamination requires additional treatment
catharsis, gastric lavage with chelating agents
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Radiation Injuries Acute radiation syndrome (ARS): dose of radiation
determines if ARS will develop
All body systems are affected by ARS
Presenting signs and symptoms determine predictedsurvival
Probable survivors have no initial symptoms or onlyminimal symptoms.
Possible survivors present with nausea and vomiting thatpersists for 2448 hours
Improbable survivors are acutely ill with nausea,vomiting, diarrhea, and shock. Neurologic symptoms
suggest lethal dose. Survival time is variable
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