chapter 072 disaster nursing

8/13/2019 Chapter 072 Disaster Nursing

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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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


7/23Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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.



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



Question

Is the following statement True or False?

Critical incident stress management programs includeeducation, field support, defusing, debriefing,demobilization and follow-up components.



Answer

True

Critical incident stress management programs includeeducation, field support, defusing, debriefing,demobilization and follow-up components.



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



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



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



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



Physical Injuries After Blast Events

Blast Lung

Tympanic Membrane Rupture

Abdominal and Head Injuries



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.



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



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



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

chapter 072 disaster nursing

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