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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.
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
on 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)
15. START Step-4
Can’t Follow Simple
Commands
Level of Consciousness
Can Follow Simple
Commands
Yellow/ Delayed
Red/ Immediate
16.
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.
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)
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
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
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)
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
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
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
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
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)
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