Deck 73: Terrorism, Mass Casualty, and Disaster Nursing

Question 1

You are the triage nurse at the receiving facility for casualties after anearthquake.As you prepare to set up a triage station, "walking wounded" begin toarrive on their own.Among them is a crying 19-year-old woman with an armlaceration who is visibly shaking and keeps shrieking, "Why?"; a woman who is 26weeks pregnant and carrying a 3-year-old child who has a Glasgow Coma Scale scoreof 6 and is apneic; and a 20-year-old man who believes he has broken his ankle and isleaning on a friend who is supporting him and appears to be without injury. As youquickly assess these patients, an ambulance arrives with a 90-year-old man with ahead injury who is apneic and with a pulse barely palpable only at the carotids. TheEMS personnel have been unable to intubate him. In addition, a 25-year-old womanwho is 32 weeks pregnant arrives with blunt abdominal trauma.How would youinitially triage these patients to provide optimal use of resources, remembering thatthis is only the first wave of injuries from the scene? Family members, members of thepress, and city officials also begin to arrive at the hospital in large numbers, and allattempt hospital entry via your triage area.You have assistance of nonclinicalpersonnel available to you.How should the family members be managed? Howshould the other people be managed?

Answer 1

Triage refers to prioritizing or sorting patients based on their stipulation. In disaster nursing, sorting is based on the likelihood of survival and use of available resources.
Triage category:
1. Immediate (Red)
Patients with life-threatening lesions but have high chance of survival with minimal intervention.
2. Delayed (Yellow)
Patients with significant lesions that require medical care but can wait hours without care. Lesions are not threat to life or limb.
3. Minimal (Green)
Patients with minor lesions and care can be delayed hours to days.
4. Expectant (Black)
Patients with extensive lesions and unlikely to survive even with definitive care
In this situation, the patients are categorized as:
1. 25-year-old pregnant women with blunt abdominal trauma (Red)
2. 19-year-old woman with arm laceration (Green)
3. 20-year-old male with possible broken ankle (Green)
4. 3-year-old child that is apneic and with a Glasgow coma scale (GCS) score of 6 (Black)
5. 90-year-old man with head injury, apneic, and barely palpable pulse (Black)
There is a designated spokesperson when imparting information to the media. Managing media requests, area for imparting information, regular schedule for imparting updates are part of the disaster plan.
Family members of the patients are divulged with direction and information by the information officer. They are updated as soon as possible as they may have intense shock, anxiety, or grief. Family members should not be in triage and treatment areas.

Question 2

A patient arrives at the triage desk of the ED complaining of a sudden onset of ahigh fever and respiratory flulike symptoms.Three other patients with similarcomplaints arrived to the ED within the past 2 hours. The CDC has recently issued analert that the swine flu may be returning this year and to be prepared for patientswith these symptoms. What signs and symptoms should you identify if you suspect abiologic weapon may be the culprit? Which agents cause pneumonialike or flulikesigns and symptoms? What precautions should be taken to protect staff and patients?What type of isolation would be typical if you suspect a contagion that is transmittedby the respiratory tract? What other questions would you ask the patient to determinehis exposure risks?

Answer 2

Swine flu is rooted by an H1N1 virus strain that instigates respiratory disease in humans. Manifestations comprise:
• Cough
• Fever
• Sore throat
• Runny or stuffy nose
• Body pain
• Headache
• Watery, red eyes
• Diarrhea
• Fatigue
• Nausea
• Vomiting
Examples of biologic agents that instigate flu-like or pneumonia-like signs and symptoms comprise:
• Francisella tularensis
• Yersinia pestis
• SARS (Severe acute respiratory syndrome) coronavirus
Precautions to protect staff and others:
• Perform hand hygiene pre and post care
• Disinfect environment
• Place the patient in a single room
• PPE (personal protective equipment) utilization
PPE are special equipment worn to create a barrier against hazards. Equipment such as masks, gloves, eye protection, and clothing protects the eye, face, head, foot, and hand. These lessen injuries because it diminishes the likelihood of being exposed to hazards.
Isolation precautions for airborne diseases comprise placing a patient in a negative pressure room.

Question 3

You are a member of the safety committee at your hospital. The committee ischarged with updating the hospital's EOP and initiating a mass casualtysubcommittee. What types of specific disasters are more likely to occur in and aroundyour community? How do you determine the hazards and vulnerability of yourfacility? How does your facility plan comply with the NIMS requirements? What planfor triage will be included in the EOP? What types of PPE will you recommend? Whatis the strength of the evidence that supports your recommendation for the use of aparticular type of PPE?

Answer 3

Different disasters:
• Earthquake
• Flooding
• Hurricanes
• Tsunami
• Tornadoes
• Volcanic eruption
• Explosives
Facilities that are receiving preparedness funds should have a plan that adheres to the guidelines of National Incident Management System (NIMS). NIMS is directed by Federal Emergency Management Agency (FEMA).
Plans for triage that are included in emergency operations plan (EOP) include:
• Plan for coordinated patient care
• Identification of external resources
• Plan for people management and traffic flow
Personal Protective Equipment (PPE) are special equipment worn to create a barrier against hazards. Equipment such as masks, gloves, eye protection, and clothing protects the eye, face, head, foot, and hand. These lessen injuries because it reduces the chance of being exposed to hazards.