emergency and disaster nursing lecture ncm 121

1. NCM 106: DISASTER AND EMERGENCY
NURSING
IAN VAN V. SUMAGAYSAY, RN, MAN

2. DISASTER and EMERGENCY
NURSING
Learning Outcomes:
At the end of the topic, the students will be able to:
1. Define what is triage.
2. Identify when and why to triage.
3. Perform triage properly when the need arises.

3. DISASTER and EMERGENCY
NURSING
WHAT is TRIAGE?
Trier (French). To Sort out or
choose.

4. DISASTER and EMERGENCY
NURSING
TRIAGE – A method of quickly identifying
victims of a mass casualty incident (MCI) who
my have immediately life-threatening injuries
and those who have the best chance of
surviving.

5. DISASTER and EMERGENCY
NURSING
Why TRIAGE?
- Goal is to identify the sickest patients
in order to assess and provide
treatment to them first, before providing
treatment to others who are less ill.

6. DISASTER and EMERGENCY
NURSING
TRIAGE is done by:
- Trained individuals
- Paramedical personnel (Medics, EMR’s,
EMT’s)
- Medical personnel (Doctors, NURSES,
etc.)

7. DISASTER and EMERGENCY
NURSING
How to be an Effective Triage
Nurse:
- Clinically experienced
- Good judgment and leadership skills
- Calm and cool
- Decisive
- Knowledgeable of available resources

8. DISASTER NURSING
 S.T.A.R.T. (Simple Triage and Rapid Treatment) is
a simple triage system that can be performed by
lightly trained lay and emergency personnel in
emergencies. It is not intended to supersede or
instruct medical personnel or techniques. It has been
(2003) taught to California emergency workers for
use in earthquakes. It was developed at Hoag
Hospital in Newport Beach, California for use by
emergency services. It has been field-proven in
mass casualty incidents such as train wrecks and
bus accidents, though it was developed for use
by community emergency response teams (CERTs)
and firefighters after earthquakes.

9. DISASTER NURSING
 S.T.A.R.T. (Simple Triage and Rapid Treatment)
system:
1. All patients who can walk are categorized as
Delayed (Green) and are asked to move away from
the incident area to a specific location.
2. The next group is assessed quickly by evaluating
RPM: Respiration, Perfusion and Mental Status and
then tagged accordingly.

10. DISASTER NURSING
CATEGORY (COLOR) RPM INDICATORS
CRTICAL (RED) R – >30 BPM
P – CAPILLARY REFILL > 2
SEC.
M – DOES NOT OBEY
COMMANDS
URGENT (YELLOW) R - < 30 BPM
P - < 2 SEC.
M – OBEYS COMMAND
EXPECTANT, DEAD OR
DYING (BLACK)
R – NOT BREATHING

11. DISASTER NURSING
 (Red)Immediate: The casualty requires immediate
medical attention and will not survive if not seen soon.
Any compromise to the casualty's respiration,
hemorrhage control, or shock control could be fatal.
 (Yellow)Delayed: The casualty requires medical
attention within 6 hours. Injuries are potentially life-
threatening, but can wait until the Immediate casualties
are stabilized and evacuated.
 (Green)Minimal: "Walking wounded," the casualty
requires medical attention when all higher priority
patients have been evacuated, and may not require
stabilization or monitoring.
 (Black)Expectant: The casualty is expected not to reach
higher medical support alive without compromising the
treatment of higher priority patients. Care should not be
abandoned, spare any remaining time and resources

12. START First Step
Can the Patient Walk?
YES NO
Green
(Minor)
Evaluate Ventilation
(Step-2)

13. START Step-2
Ventilation Present?
YES
NO
> 30/Min < 30/min
Evaluate Circulation
(Step-3)
Open Airway
Ventilation Present?
NO YES
Black
Red/ Immediate
Red/ Immediate

14. START Step-3
Circulation
Absent Radial Pulse
Control Hemorrhage
Present Radial Pulse
Evaluate Level of
Consciousness
Red/ Immediate

15. START Step-4
Can’t Follow Simple
Commands
Level of Consciousness
Can Follow Simple
Commands
Yellow/ Delayed
Red/ Immediate

17. DISASTER and EMERGENCY
NURSING
Tagging is an activity
that should occur
simultaneously to the
primary triage
process, one a patient
is classified it should
be tagged so that
rescue technicians
identify those that
need to be transported
and treated.

18. DISASTER and EMERGENCY
NURSING

19. DISASTER and EMERGENCY
NURSING
“TRIAGE is a process which places the right patient in
the right place at the right time to receive the right
level of care”
(Rice and Abel, 1992)

20. DISASTER AND EMERGENCY
NURSING
IAN VAN V. SUMAGAYSAY, RN, MAN

21. DISASTER NURSING
 Disaster – any destructive event that
disrupts the normal functioning of a
community
 Medical disaster
 Natural disaster
 Man-made disaster
 Complex emergencies
 Technologic disasters
 Synergistic emergencies
 Onset, impact and duration

22. DISASTER NURSING
 Effects of a disaster:
 Premature death, illnesses and injuries
 Destroy local health care infrastructure
 Environmental imbalances, increase risk of
communicable diseases and
environmental hazards
 Affect the psychological, emotional and
social well-being of a population
 Cause shortages of food and water
 Large population movement

23. DISASTER NURSING
 Disaster continuum or emergency
management cycle:
 Preimpact, impact, post impact
 Basic phases of disaster management:
 Preparedness, mitigation, response, recovery
and evaluation

24. DISASTER NURSING

25. DISASTER NURSING
 Preparedness
 Proactive planning
 Risk assessment, warning
 Mitigation
 Measures taken to reduce the harmful effects of
a disaster
 Response
 Implementation of a disaster plan
 Recovery
 Stabilization and returning to preimpact phase
 Evaluation

26. DISASTER NURSING
 Challenges to disaster planning:
 Communication
 Distribution of all types of resources
 Advance warning systems
 Evacuation
 Mass media
 Comprehensive disaster plan
 Information system

27. DISASTER NURSING
 Common reactions of disaster survivors:
 Emotional: depression, sadness, irritability,
anger, resentment, anxiety, fear, despair,
hopelessness, guilt, self-doubt
 Behavioral: sleep problems, cry easily,
excessive activity level, hypervigilance
 Cognitive: confusion, disorientation,
nightmares
 Physical: fatigue, exhaustion, GI distress,
appetite changes

28. DISASTER NURSING
 Privacy issues
 Reporting of diseases
 Disclosure of health information
 Quarantine, isolation
 Vaccination
 Screening and Testing
 Professional Licensing
 Resource allocation, provision of adequate
care
 Professional liability

29. DISASTER NURSING
 Essential Elements for Hospital Disaster
Management:
 Infrastructure
 Competency of the staff
 Disaster plan
 Pre-existing relationships and partnerships
 Response

30. DISASTER NURSING
 Hospital Incident Command System (HICS)
– an emergency management system that
is comprised of specific disaster response
functional role positions within an
organizational chart

31. Hospital Incident Command
System
Incident commander
Operations section
chief
Planning section chief Logistics section chief
Finance/
administration section
chief
Public information
officer
Liaison officer
Safety officer
Medical/technological
specialist

32. DISASTER NURSING
 Triage; french (trier): to sort out or choose
 A process of prioritizing which patients
should be treated first and is the
cornerstone of good disaster management
in terms of judicious use of resources
 Airway, breathing, circulation
 Vital signs (TPR/BP)
 Visual inspection
 Level of Consciousness

33. DISASTER NURSING
Priority Military Disaster
1 Immediate care
Shock, airway, chest
injury, amputation, open
fx
Class I (emergent) red
Critical; life threatening
2 Minimal care
Little or no treatment
needed
Class II (urgent) yellow
Major illness or injury;
treatment within 20min to
2 hours
3 Delayed care
Treatment may be
postponed; simple fx,
non-bleeding
Class III (non-urgent)
green
Care maybe delayed
more than 2 hours or
more
4 Expectant care
No treatment needed
Class IV (expectant)
black

34. DISASTER NURSING
 Managing emergencies outside the hospital:
 Type of Event
 Duration of the event
 Characteristics of the crowd
 Weather and environmental influences
 Alcohol and drug use
 Crowd mood
 Site layout
 Medical and nursing aid stations
 Transportation and communication
 Staffing and documentation

35. DISASTER NURSING
 Weapons of Mass Destruction (WMD) or
Weapons of Terror (WOT)
 Biological Warfare
 Chemical Warfare
 Nuclear Warfare
 Decontamination
 Mass Casualty Incident (MCI)
 Material Safety Data Sheet (MSDS)

36. DISASTER NURSING
 Natural Disasters
 Tornadoes, hurricanes, floods, avalanches,
tidal waves, earthquakes and volcanic
eruptions
 Chemical Weapons
 Vesicants, Nerve agents, Blood agents,
Pulmonary agents
 Biological Disasters
 Anthrax, Small pox, SARS
 Nuclear Radiation Exposure

37. DISASTER NURSING
 The National Disaster Risk Reduction &
Management Council (NDRRMC) or formerly
called National Disaster Coordinating
Council (NDCC) is an agency of the Philippine
government under the Department of National
Defense, responsible for ensuring the
protection and welfare of the people
during disasters or emergencies.

38. DISASTER NURSING
 In February 2010, the National Disaster Coordinating
Council (NDCC) was renamed, reorganized, and
subsequently expanded. The following composes the
NDRRMC:
 Chairperson - Secretary of Department of National
Defense
 Vice Chairperson for Disaster Preparedness -
Secretary of Interior and Local Government
 Vice Chairperson for Disaster Response - Secretary
of Department of Social Welfare and Development
 Vice Chairperson for Disaster Prevention and
Mitigation - Secretary of the Department of Science
and Technology
 Vice Chairperson for Disaster Rehabilitation and
Recovery - Director-General of the National Economic

39. DISASTER NURSING
 In February 2010, the National Disaster Coordinating
Council (NDCC) was renamed, reorganized, and
subsequently expanded. The following composes the
NDRRMC:
 Chairperson - Secretary of Department of National
Defense
 Vice Chairperson for Disaster Preparedness -
Secretary of Interior and Local Government
 Vice Chairperson for Disaster Response - Secretary
of Department of Social Welfare and Development
 Vice Chairperson for Disaster Prevention and
Mitigation - Secretary of the Department of Science
and Technology
 Vice Chairperson for Disaster Rehabilitation and
Recovery - Director-General of the National Economic

40. DISASTER NURSING
 INCIDENT COMMAND SYSTEM (ICS)
 Center of operations for organization, planning and
transport of patients in the event of a specific MCI
 Headed by an INCIDENT COMMANDER
 HOSPITAL EMERGENCY PREPAREDNESS
PLANS

41. DISASTER NURSING
 COMPONENTS OF THE EMERGENCY
OPERATIONS PLANS:
 Activation Response
 Internal/External Communication Plan
 Plan for coordinated patient care
 Security Plans
 Identification of External Resources
 Plan of people management and traffic
flow
 Data management strategy

42. DISASTER NURSING
 COMPONENTS OF THE EMERGENCY
OPERATIONS PLANS:
 Deactivation Response
 A Post-Incidence Response
 A Plan for Practice Drills
 Anticipated Resources
 MCI Planning
 An Educational Plan for All of the Above

43. DISASTER NURSING
 Initiating the Emergency Operations Plan
 Identifying patients and documenting patient
information
 Triage
 Managing internal problems
 Communicating with the media and the family

44. DISASTER NURSING
 TRIAGE
 Simple Triage
 Simple triage is usually used in a scene of an
accident or "mass-casualty incident" (MCI), in order
to sort patients into those who need critical attention
and immediate transport to the hospital and those
with less serious injuries. This step can be started
before transportation becomes available. The
categorization of patients based on the severity of
their injuries can be aided with the use of
printed triage tags or colored flagging.

45. DISASTER NURSING
 S.T.A.R.T. (Simple Triage and Rapid Treatment) is
a simple triage system that can be performed by
lightly trained lay and emergency personnel in
emergencies. It is not intended to supersede or
instruct medical personnel or techniques. It has been
(2003) taught to California emergency workers for
use in earthquakes. It was developed at Hoag
Hospital in Newport Beach, California for use by
emergency services. It has been field-proven in
mass casualty incidents such as train wrecks and
bus accidents, though it was developed for use
by community emergency response teams (CERTs)
and firefighters after earthquakes.

46. DISASTER NURSING
 S.T.A.R.T. (Simple Triage and Rapid Treatment
 Triage separates the injured into four groups:
 The expectant who are beyond help
 The injured who can be helped
by immediate transportation
 The injured whose transport can be delayed
 Those with minor injuries, who need help less
urgently

47. DISASTER NURSING
 United States military
 Triage in a non-combat situation is conducted much
the same as in civilian medicine. A battlefield
situation, however, requires medics and corpsmen to
rank casualties for precedence
in MEDEVAC or CASEVAC. The casualties are then
transported to a higher level of care, either a Forward
Surgical Team or Combat Support Hospital and re-
triaged by a nurse or doctor. In a combat situation,
the triage system is based solely on resources and
ability to save the maximum number of lives within
the means of the hospital supplies and personnel.
The triage categories (with corresponding color

48. DISASTER NURSING
 (1)Immediate: The casualty requires immediate medical
attention and will not survive if not seen soon. Any
compromise to the casualty's respiration, hemorrhage control,
or shock control could be fatal.
 (2)Delayed: The casualty requires medical attention within 6
hours. Injuries are potentially life-threatening, but can wait
until the Immediate casualties are stabilized and evacuated.
 (3)Minimal: "Walking wounded," the casualty requires medical
attention when all higher priority patients have been
evacuated, and may not require stabilization or monitoring.
 (4)Expectant: The casualty is expected not to reach higher
medical support alive without compromising the treatment of
higher priority patients. Care should not be abandoned, spare
any remaining time and resources after Immediate and
Delayed patients have been treated.

49. DISASTER NURSING
Afterwards, casualties are given an evacuation priority
based on need:
 Urgent: evacuation is required within two hours to save
life or limb.
 Priority: evacuation is necessary within four hours or the
casualty will deteriorate to "Urgent".
 Routine: evacuate within 24 hours to complete
treatment.
In a "naval combat situation", the triage officer must weigh
the tactical situation with supplies on hand and the
realistic capacity of the medical personnel. This process
can be ever-changing, dependent upon the situation and
must attempt to do the maximum good for the maximum

50. DISASTER NURSING
Field assessments are made by two methods: primary
survey (used to detect & treat life-threatening injuries)
and secondary survey(used to treat non-life threatening
injuries) with the following categories:
 Class I Patients who require minor treatment and can return
to duty in a short period of time.
 Class II Patients whose injuries require immediate life
sustaining measures.
 Class III Patients for whom definitive treatment can be
delayed without loss of life or limb.
 Class IV Patients requiring such extensive care beyond
medical personnel capability and time.

51. DISASTER NURSING
 Roles of Nurses in Disaster Response Plans:
 Nurses may perform roles outside of his or her
expertise and responsibilities
 Triage Officer
 Documentation
 Crisis intervention
 Shelter

52. DISASTER NURSING
 Cultural and Ethical Considerations:
 Language Difficulties
 Religious Practices
 Specific Places/Times for Prayer
 Rituals in handling the dead and timing of funeral
 Rationing care
 Futile therapy
 Consent
 Duty
 Confidentiality, Resuscitation, Assisted Suicide

53. DISASTER NURSING
 Critical Stress Management
 An approach to preventing and treating the
emotional trauma that can affect emergency
responders as a consequence of their jobs and
that can also occur to anyone involved in a
disaster or MCI.
 Education before the incident
 Field support during the incident
 Defusing, debriefing, demobilization and
follow-up after the incident

54. DISASTER NURSING
 Preparedness and Response
 Recognition and Awareness Principles:
Unusual increase in the number of people
seeking care for fever, respiratory or
gastrointestinal symptoms
Take note of any clusters of patients presenting
the same unusual illness from a single location
Be suspicious of a large number of rapidly
fatal cases, especially within 72 hours post
admission
Any increase in disease incidence in a normally
healthy population

55. DISASTER NURSING
 Patient assessment
Exposure history
Work history
Environmental history
Admission history

56. DISASTER NURSING
 Personal Protective Equipment
 Purpose: To shield health care workers from
chemical, physical, biologic, and radiologic
hazards
 Level A: Highest level of respiratory, skin, eye
and mucous membrane protection (SCBA, Suit,
Gloves, Boots)
 Level B: Highest level of respiratory protection
but less of skin and eye protection (SCBA and

57. DISASTER NURSING
 Level C: Air-purified respirator and chemical
resistant coverall with splash hood, gloves,
boots
 Level D: Common working uniform

58. PERSONAL PROTECTIVE
EQUIPMENTS:

59. PERSONAL PROTECTIVE
EQUIPMENTS:

60. PERSONAL PROTECTIVE
EQUIPMENTS:

61. DISASTER NURSING
 Decontamination
 Process of removing accumulated
contaminants, is critical to the health and
safety of health care providers by preventing
secondary contamination
 Two steps of decontamination:
Stripping and Rinsing
Soap and Water Wash

62. Fire, Water, Earth, Wind Emergencies
NATURAL DISASTER

63. DISASTER NURSING
 Natural disasters – occur anytime and anywhere;
results to a mass casualty incident
 Tornadoes, hurricanes, floods, avalanches, tidal
waves, earthquakes and volcanic eruptions
 Loss of communication, electricity and potable
water
 Electrocution is the major cause of injury
 Food and water; Shelter
 PPE’s

64. DISASTER NURSING
 Natural Disasters can be categorized as:
 Acute onset – avalanche, blizzard, earthquake,
fire, flood, heat wave, hurricane, typhoon,
tsunami, volcanic eruptions, wildfire
 Slow or Gradual Onset – deforestation,
desertification, drought, pest infestation

65. DISASTER NURSING
 Heat Wave
 Heat stroke – body temperature reaches 40.4
degrees Celsius
 Rapid progression of lethargy, confusion and
unconsciousness
 Heat exhaustion
 Heat syncope
 Heat cramps
 Prevention: Cool environment, cool beverages,
loose and light cotton clothing

66. DISASTER NURSING
 Cyclones, hurricanes and typhoons
 Cyclones are large scale storms with low pressure
in the center; over tropical or sub-tropical waters
 Hurricanes – storms formed in the Atlantic ocean
 typhoons – storms formed in the Pacific ocean and
the China seas
 Normal wind speeds reach up to 74 mph or more
 Storm surge – a distinctive characteristic of
hurricanes

67. DISASTER NURSING
 Risk of Morbidity and Mortality:
 Failure to evacuate
 Food and water safety
 Shelter
 Drowning, electrocution, lacerations
 Risk reduction: early detection

68. DISASTER NURSING
 Drought
 Result of too little rain, desertification,
deforestation and unskilled irrigation
 Causes disease because of stress, crowding and
unsanitary conditions

69. DISASTER NURSING
 Earthquake
 Measured using a Richter scale
 Injury and death occurs from being trapped in the
rubble
 Injuries include cuts, broken bones, crush injuries,
dehydration
 Prevention: seismic safety into construction of
structures

70. DISASTER NURSING
 Flood
 Rain of one inch per hour
 Causes 30% of the world’s disasters per year
 Caused by deforestation, urbanization and El Niño
 Deaths are commonly caused by flash floods
 Morbidity is caused by crowded living conditions,
low personal hygiene, contamination of water
sources
 Waterborne diseases, vector borne diseases, food
shortages

71. DISASTER NURSING
 Tornado
 Wind velocity of 200mph and travels as far as
20kms
 Severity of damage is measured by a Fujita scale;
F0(no damage) – F5(total destruction)
 Morbidity: STI, head injuries
 Prevention: early warning and protective shelters

72. DISASTER NURSING
 Thunderstorms
 Lightning strikes are the major cause of deaths
 A bolt of lightning could reach 50,000 degrees
fahrenheit
 Prevention: avoid open spaces and high spots;
natural lightning rods

73. DISASTER NURSING
 Tsunami
 Signs of an approaching tsunami:
 Recent submarine earthquake
 Sea appears to be boiling
 Water is hot, smells of rotten egg or stings the
skin
 Audible thunder or booming sound followed by a
roaring or whistling sound
 Water recede a great distance from the coast
 Red light might be visible near the horizon

74. DISASTER NURSING
 Early warning devices and animals moving to
higher grounds
 Flood gates and barriers
 Morbidity and mortality: same as of flooding

75. DISASTER NURSING
 Winter/Ice storm
 Wind chill is a combination of extremely low temperature
and wind speed
 Winter storm watch
 Winter storm warning
 Blizzard warning – wind speeds of 35mph
 Risk for injuries: winter driving, frostbite, hypothermia,
carbon monoxide poisoning, STI

76. DISASTER NURSING
 Wildfires
 Types:
 Surface fire – forest floor
 Ground fire – caused by lightning; forest floor to
the mineral soil
 Crown fire – tree tops; affected by the wind
speed
 Cause of injuries:
 Burn, inhalation injuries, respiratory
complications, MI

77. DISASTER NURSING
 Prevention:
 Build fires away from trees and bushes
 Be prepared to extinguish fire quickly and
completely
 Never leave a fire unattended
 Develop a wildfire evacuation plan

78. WEAPONS OF MASS
DESTRUCTION

79. BIOLOGIC WEAPONS

80. DISASTER NURSING
 Weapons of Mass destruction: biological,
chemical and radioactive weapons
 Biologic weapons – weapons used to spread
disease
 Biological warfare is a covert method of effecting
objectives by inflicting significant morbidity and
mortality
 Applied to food or drinks; or by inhalation/ direct
contact

81. DISASTER NURSING
 Biologic Agents
 Anthrax – Bacillus Anthracis; replicates if exposed to
air and infective in their spore state only.
 Infects through direct contact or inhalation
 Odorless and invincible; can travel great distances
before disseminating
 8000 to 50,000 spores must be inhaled to be infected
 1500 BC (Egypt); 1979 (Russia); 1995 (Japan); 2001
(US)

82. DISASTER NURSING
 S/Sx:
 Causes hemorrhage, edema and necrosis
 Incubation time: 1-6 days
 Skin, Inhalation and Gastrointestinal
 Skin lesions are the primary infection; develops to a
ulcer with 1-3mm vesicles and lastly a painless
eschar falls off after 1-2weeks
 GI: fever, nausea, vomiting, abdominal pain, bloody
diarrhea and ascites; attacks the terminal ileum and
cecum

83. DISASTER NURSING
 URT: flulike symptoms and not treated by antibiotics
 Incubation: 60 days
 Cough, headache, fever, vomiting, chills, weakness,
mild chest discomfort, dyspnea, syncope
 Brief recovery followed by a second stage within 1-3
days
 Fever, severe respiratory distress, stridor, hypoxia,
cyanosis, diaphoresis, hypotension and shock
 Mediastinitis on CXR (Hallmark sign)
 Mortality at 100% 24 to 36 hours after onset of the
second stage

84. DISASTER NURSING
 Treatment:
 Penicillin sensitive
 Penicillin, Erythromycin, Gentamicin, Doxycycline
 In MCI: Doxycycline; Ciprofloxacin for 60 days
 Death: cremation is recommended
 No vaccine available to the public except the military

85. DISASTER NURSING
 Small pox (Variola)
 A DNA virus
 Approx. 12 days incubation period
 Extremely contagious; spread by direct contact,
contact with vectors or by droplets
 Rashes will appear after the fever state; 30% case
fatality rate
 Smallpox survives in a cool and low humidity
environment up to 24H

86. DISASTER NURSING
 S/Sx:
 Initial: high fever, malaise, headache, backache
 After 1-2 days: maculopapular rash appears from the
face to the trunk
 Smallpox is contagious after the appearance of the
rash
 Treatment:
 Isolation, antibiotics, decontamination
 Cremation; virus survives in scabs for 13 years

87. DISASTER NURSING
 Severe Acute Respiratory Syndrome (SARS)
 SARS-CoV
 Incubation period: 2-10 days
 Started in China as an ‘atypical’ pneumonia (Feb.
2003)
 S/Sx: SOB, Dry Cough, Pneumonia or ARDS in CXR;
Evident of 7-10 days
 Tx: Droplet precaution; support; antiviral drugs

88. CHEMICAL WEAPONS

89. DISASTER NURSING
 Chemical weapons – used in chemical warfare; overt
agents
 Results in major mortality or morbidity, panic, social
disturbance
 These chemicals are:
 Nerve Agents
 Blood Agents
 Vesicants
 Heavy metals
 Volatile Toxins
 Pulmonary Agents
 Corrosive Acids

90. DISASTER NURSING
 Characteristics of Chemicals:
 Volatility – tendency of a chemical to be a vapor;
most chemicals are heavier than air; most volatile
are phosgene and cyanide
 Persistence – Less likely to vaporize and disperse;
most industrial chemicals are not persistent
 Toxicity – potential of a chemical to cause injury to
the body
 Latency – time from absorption to the appearance
of s/sx; sulfur mustards and pulmonary agents

91. DISASTER NURSING
 Lethal dose (LD50)
 Effective dose (ED50)
 Concentration time (CT):
 Concentration x time of exposure = mg/min

92. DISASTER NURSING
 Vesicants
 Cause blisters and results in burning,
conjunctivitis, bronchitis, pneumonia,
hematopoietic suppression and death
 Lewisite, phosgene, nitrogen mustard and sulfur
mustard
 Liquid sulfur is the most commonly used
vesicant
 Highly incapacitating
 S/Sx: superficial to partial thickness burns in
warm and moist areas, stinging and erythema,

93. DISASTER NURSING
 Eye: photophobia, lacrimation and decreased
vision
 Respiratory: airway obstruction
 GI: nausea, vomiting, upper GI bleeding
 Tx: decontamination, avoid scrubbing, eye
irrigation, intubation and bronchoscopy,
Dimercaprol IV for Lewisite exposure

94. DISASTER NURSING
 Nerve agents
 Most toxic agents
 Sarin, Soman, Tabun, VX and
organophosphates(pesticides)
 Inexpensive, effective in small quantities and
easily dispersed
 Usually evaporates to a colorless and odorless
vapor
 Effects begin at 30min to 18 hours after exposure

95. DISASTER NURSING
 S/Sx: cholinergic crisis, visual disturbances,
increased GI motility, nausea and vomiting,
diarrhea, substernal spasm, indigestion,
bradycardia
 Insomia, forgetfulness, impaired judgement,
depression, LOC, seizures, copious secretions,
flaccid muscles, apnea
 Tx: decontamination with soap and water or
saline solution for 8-20min, blotted dry, maintain
airway patency, suctioning, Atropine 2-4mg IV,

96. DISASTER NURSING
 Blood agents
 Hydrogen cyanide, cyanogen chloride
 Directly affects cellular metabolism and results to
asphyxiation
 also emitted during house fires during
combustion of plastic, rugs, furniture and other
construction materials
 Ingested, inhaled or absorbed
 S/Sx: respiratory muscle failure, respiratory
arrest, cardiac arrest, flushing, tachypnea,
bradycardia, stupor and coma

97. DISASTER NURSING
 Pulmonary Agents
 Chlorine, Phosgene
 Causes: pulmonary edema, SOB
 Mask is used for protection

98. DISASTER NURSING
 Tx: Administration of Amyl nitrate, sodium nitrate
and sodium thiosulfate
 intubation
 Hydroxocobalamin (Vit. B12a) binds to cyanide to
form cyanocobalamin (Vit. B12)

99. Nuclear Radiation Exposure

100. DISASTER NURSING
 Radiologic weapon or “dirty bomb”
 Weapon grade plutonium or uranium
 Nuclear fuel or medical nuclear supplies
 Types of radiation:
 Alpha particles – cannot penetrate the skin;
ingestion, inhalation and injection; local
damage
 Beta particles – moderately penetrate the skin;
skin damage
 Gamma radiation – short wavelength
electromagnetic energy; penetrating; X-ray

101. DISASTER NURSING
 Measurement:
 rad – 0.01 joule of energy/kg of tissue; basic
unit of measurement
 rem (roentgen equivalent man) – reflects the
type of radiation and the potential of damage;
normal exposure per year is at 360mrem (1
rem = 1000mrem)
 Half-life – amount of time for a radioactive
product to lose half of its radioactivity
 Detected by: a Geiger counter or Geiger-Mueller
survey meter

102. DISASTER NURSING
 Exposure:
 External Irridation – physical exposure
 Contamination – exposure to gases, liquids
and solids
 Incorporation – uptake of cells, tissues and
organs
 Decontamination:
 Done outside the ER
 Survival:
 Probable – no s/sx
 Possible – nausea and vomiting for 1-2 days

103. DISASTER NURSING
Phase Time of Occurrence Signs and Symptoms
Prodromal Phase
(presenting s/sx)
48-72H after exposure Nausea, vomiting, loss of
appetite, diarrhea, fatigue
Latent Phase (no s/sx) After prodromal phase up
to 3 weeks or shorter
Decreased lymphocytes,
leukocytes, thrombocytes
and RBC’s
Illness Phase After latent phase Infection, F/E imbalance,
bleeding, diarrhea, shock
Recovery Phase or After illness phase Weeks to months for full
recovery
Death After illness phase Increased ICP