NCLEX-RN: Disaster Nursing: Bioterrorism

Disaster Nursing: Bioterrorism: Disaster Management

Focus topic: Disaster Nursing: Bioterrorism

Disaster Nursing: Bioterrorism: Hospital Evacuation Plans

Focus topic: Disaster Nursing: Bioterrorism


A. Every hospital must have an evacuation plan in place with a designated authority in charge.
B. Types of evacuation.

  • Shelter in place—keeping everyone where they are may be the safest plan.
  • Moving occupants either up (flooding) or down (protection from air attack).
  • Removing all persons from building and relocating to a safe area. Communication

Disaster Nursing: Bioterrorism: Characteristics

Focus topic: Disaster Nursing: Bioterrorism
A. Communication systems are likely to be overwhelmed in a disaster.

  • Establishing backup and redundant communication systems is essential.
  • Communication coordination is an important component in the infrastructure system.

B. There must be communication among the triage team (out-of-hospital) for establishing victim care priorities, the hospital or treatment staff (in-hospital), and state and federal agencies.

  • The local communication structure should appoint one community-identified person or small group to be in command and act as liaison agent.
  • The state and federal response teams will be integrated into the communication system.
  • The Incident Command System (ICS) is an example of a local system.
    a. Specific roles and positions carry specific duties and responsibilities.
    b. The ICS tells people how and with whom to communicate.
    c. Each position has a prioritized list of tasks that are checked off as they are completed.
    d. This system organizes emergency responses in five categories: command, planning, operations, logistics, and administration.

C. Hospitals must have an ongoing, open channel of communication with emergency response teams, who will have been notified first of a mass casualty incident.

  • A community-wide network, all using the same channel of communication, is necessary.
    a. A single communication site for obtaining victim and locator information should be established.

b. A clear and open information system, using both telecommunication and a position-to-position cßascade in the event of the primary system being overloaded, is necessary.

  • Adequate equipment, such as cell phones, walkie-talkies, even runners, must be available if current phone land lines are overwhelmed.

Disaster Nursing: Bioterrorism: Implementation

Focus topic: Disaster Nursing: Bioterrorism
A. Understand lines of communication. (When lines of communication are compromised, effective triage and intervention cannot take place.)

  • Mass casualty incident occurs.
  • Local public health official notifies FBI—lead agency for crisis plan.
  • FBI notifies the Department of Health and Human Services (HHS), the CDC, and Federal Emergency Management Agency (FEMA).
  • State health agency requests CDC to deploy response teams if needed.

B. Understand the network of communication that will be activated in response to a suspected or actual bioterrorism event.

  • Emergency response team.
    a. Local and state public health officials.
    b. Infection control personnel in notified facilities.
    c. FBI field offices.
    d. CDC.
    e. Local emergency medical services (EMS).
    f. Local police and fire departments. Once the local emergency response system is activated, the local health officer commander is notified first and he/she in turn notifies the FBI field office, HHS, and the CDC.
  • n turn, the Federal Response Plan will be activated.

C. Activate Federal Response Plan. (When the local area cannot cope with the disaster, federal assistance is available.)

  • Department of Health and Human Services (HHS) is primary agency.
  • Office of Emergency Preparedness is action agency.
  • Emergency Support Function N8 coordinates federal assistance to supplement state and local resources (directed by HHS).
  • Implemented when state requests assistance and FEMA agrees.

D. Establish a viable communication system.

Disaster Nursing: Bioterrorism

Disaster Nursing: Bioterrorism: Treating Life-Threatening Conditions

Focus topic: Disaster Nursing: Bioterrorism

Disaster Nursing: Bioterrorism: Implementation

Focus topic: Disaster Nursing: Bioterrorism
A. Implement simple triage and rapid treatment (START), the first step for treating multiple casualties in a disaster.
B. Gather all equipment needed for interventions.

  • Check breathing immediately.
    a. Open airway. (If airway is obstructed, victim cannot get oxygen.)
    b. Move fast—time is critical. (Heart function will be affected within minutes, and brain damage is possible after 4 minutes.)
    c. Check if tongue is obstructing airway. (This is the most common airway obstruction, especially when victim is positioned on back).
  • Use head-tilt/chin-lift method if victim is not breathing and airway is not obstructed.
    a. Touch victim and shout “CAN YOU HEAR ME?”
    b. If victim does not respond, place one hand on forehead, two fingers of other hand under chin, and tilt jaw upward and head back slightly.
    c. Look for chest to rise, listen for air exchange, and feel for abdominal movement.
    d. If no response (victim does not start breathing) repeat procedure. (If AED is available, may apply to victim.)
    e. If victim does not respond after 2nd attempt, move on to next victim. (Goal of disaster intervention is to do the greatest good for the greatest number of victims.)
    f. If the victim begins breathing, maintain airway (hopefully with a volunteer holding airway open) or place soft object under victim’s shoulders to elevate them, keeping airway open.
  • Control bleeding. (If bleeding is not controlled within a short period of time, victim will go into shock—loss of l liter of blood (out of a total of 5 in the human body) will present risk of death.
  • Identify type of bleeding.
    a. Arterial bleeding (spurting blood).
    b. Venous bleeding (flowing blood).
    c. Capillary bleeding (oozing blood).
  • Choose appropriate method to control bleeding.
    a. Direct local pressure—place direct pressure over wound (using clean or sterile pad) and press firmly. (About 95% of bleeding can be controlled by direct pressure with elevation.)
    b. Maintain compression by wrapping wound firmly with pressure bandage.
    c. Elevate wound above level of heart.
    d. Use pressure point to slow blood flow to wound, brachial point for arm, femoral point for leg.
  • Use tourniquet if bleeding cannot be controlled by other methods (consider this a last resort, as tourniquets can pose serious risks to affected limbs).
    a. Incorrect material or application can cause more damage and bleeding; if the tourniquet is too tight, nerves, blood vessels, or muscles may be damaged.
    b. If tourniquet is left in place too long, limb may be lost.
    c. If tourniquet is applied, leave in plain sight and affix label to victim’s forehead, stating time tourniquet was applied.
    d. Notify physician to remove tourniquet.
  • Recognize and treat shock.
    a. Body will initially compensate for blood loss, so signs of shock may not be observable.
    b. Continually evaluate victim’s condition.
  • Observe for signs/symptoms of shock.
    a. Rapid, shallow breathing (> 30 breaths/ minute).
    b. Cold, pale skin (with capillary refill > 2 seconds).
    c. Failure to respond to simple commands.
  • Administer treatment for shock.
    a. Position victim supine with feet elevated 6–10 inches.
    b. Maintain open airway.
    c. Maintain body temperature (cover ground and victim).
    d. Avoid rough or excessive handling, and do not allow victim to eat or drink.

Disaster Nursing: Bioterrorism: PostTriage Interventions

Focus topic: Disaster Nursing: Bioterrorism

Disaster Nursing: Bioterrorism: Assessment

Focus topic: Disaster Nursing: Bioterrorism
A. Perform head-to-toe assessment, always in the same order. This will enable you to complete it more quickly and accurately: head, neck, shoulders, chest, arms, abdomen, pelvis, legs, back.
B. Complete assessment before beginning any treatment—to prioritize treatment interventions, a complete assessment must be done.
C. Observe for any sign/symptom that indicates major injury.

  • Assess how person received injury (mechanism of injury).
  • Airway obstruction.
  • Signs of shock.
  • Labored or difficult breathing.
  • Excessive bleeding.
  • Swelling/bruising.
  • Severe pain.

Disaster Nursing: Bioterrorism: Implementation

Focus topic: Disaster Nursing: Bioterrorism
A. Provide immediate treatment. Reclassify victim during treatment, if necessary.
B. Evaluate that victim is not in immediate danger.

  • If available staff, continue to assess for signs of head, neck, and spinal injury.
    a. Change in level of consciousness (unconscious, confused).
    b. Unable to move body part.
    c. Severe pain in head, neck, back.
    d. Tingling or numbness in extremities.
  • Continue to assess other signs and symptoms.
    a. Difficulty breathing or seeing.
    b. Heavy bleeding/blood in eyes or nose.
    c. Seizures.
    d. Nausea, vomiting.

C. Immobilize head, neck, or spine by keeping spine in straight line, putting cervical collar on neck, or placing victim on board—if equipment is available.
D. Document person’s identity and relevant medical information.
E. Care for those who died.

  • Victims pronounced DOA (dead on arrival) must be tagged.
    a. Add special tag “not to remove personal effects.”
    b. Incorporate special instructions for people performing autopsies, preparing bodies for burial or transportation.
  • Place bodies in cordoned off area for field triage. (Decontamination may have to be completed before transport.)
  • Notify those performing postmortem care of victim’s diagnosis to protect staff handling postmortem care.
    a. Autopsies performed carefully using all personal protective equipment and standard precautions, including use of masks and eye protection.
    b. Incorporate any special instructions about biological– chemical–radiological agent present.
  • Complete a record for all bodies including identification, name of person declaring death, diagnosis, if known, name of agency removing body, etc.

F. Care for clients with psychological reactions.

  • Expect major psychological reactions of fear, panic, anger, horror, paranoia, etc., following a bioterrorism event.
  • Plan prior to such an event for professional and educated volunteers to be on site.
  • Minimize fear and panic in staff.
    a. Provide educational materials that include
    risks to healthcare workers, accurate information on bioterrorism facts, plans for protecting workers, and use of personal protection equipment.
    b. Encourage team participation in disaster drills, as experience in handling a disaster will build confidence and allay anxiety.
  • Cope with psychological reactions of fear and anxiety.
    a. Minimize panic by clearly explaining the care given.
    b. Offer rapid evaluation and treatment and avoid isolation, if possible.
  • Treat major anxiety reactions in unexposed persons with factual information, reassurance, and medication, if indicated. (Anxiety is communicable; prompt intervention will allay group anxiety. “Worried well” persons could overwhelm hospitals if they leave area and go to closest healthcare facility.)
  • Prevent postterrorism trauma.
    a. Gather victims into a group with a skilled therapist soon after event (within 24 hours) to prevent a major posttrauma reaction.
    (1) Early opportunity for catharsis will help prevent suppression of traumatic event emotions.
    (2) Group victims according to age and experience.
    b. Follow initial group meeting with subsequent meeting within 1 week to discuss feelings about event. (Research has found that group meetings following traumatic event has eliminated 80% of posttraumatic stress disorder.)

G. Identifying posttraumatic stress disorder.

  • Recognize possibility of existing condition.
    a. Traumatic event occurs and is re-experienced as flashbacks, dreams, or memory state.
    b. Abreaction occurs: vivid recall of painful experience with original emotions.
    c. Individual cannot adjust to event.
  • Assess signs and symptoms of anxiety and depression.
    a. Emotional instability, withdrawal, and isolation.
    b. Nightmares, difficulty sleeping.
    c. Feelings of detachment or guilt.
  • Assess aggressive or acting-out behavior; may be explosive or impulsive behavior.
  • Assist client to go through recovery process.
    a. Recovery: Reassure client that he is safe following experience of the traumatic event.
    b. Avoidance: Client will avoid thinking about traumatic event; support client.
    c. Reconsideration: Client deals with event by confronting it, talking about it, and working through feelings.
    d. Adjustment: Client rehabilitates and adjusts to environment following event; client functions well and is able to view future positively.




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