This document discusses emergency preparedness for biological agents, chemical weapons, radiological/radioactive agents, and disaster nursing. It covers: 1) The four main biological agents of concern: anthrax, botulism, plague, and smallpox. It describes their transmission methods and key signs/symptoms. 2) Chemical weapons like nerve agents and choking agents. Nerve agents cause effects like rhinorrhea, salivation, and convulsions. Choking agents can cause ocular and respiratory irritation. 3) Radiological/radioactive agents from dirty bombs which can contaminate victims. Acute radiation syndrome causes illness from high dose radiation exposure. 4) Disaster nursing roles

1. EMERGENCY PREPAREDNESS

2. CLINICAL PREPAREDNESS Biological Agents Chemical Weapons Radiological/Radioactive Agents Disaster Nursing Levels of Disaster Triage

3. Biological Agents Four top agents for potential bioterrorism: Anthrax- durable spore that lives in the soil Transmitted by inhalation, contact with spore, or ingestion of contaminated food S/S include: flu-like symptoms, respiratory failure, hemodynamic collapse, localized itching leading to papular lesion that develops black eschar in 2-6 days, abd pain, N&V, fever, bloody diarrhea, emesis Vaccine available Standard isolation precautions until client is sick, then no person to person transmission Botulism- transmitted by ingestion of toxin, manmade aerosols S/S include: drooping eyelids, weakened jaw clench, difficulty speaking or swallowing, blurred vision, double vision, arm paralysis followed by respiratory and leg paralysis, respiratory depression Vaccine available, type specific No isolation precautions

4. Biological Agents Plague- most likely to be aerosolized in terrorist event S/S include: fever, cough, chest pain, bloody sputum, bronchopneumonia No proven vaccine Droplet isolation precautions Smallpox- Transmission person to person S/S include: prodrome of fever, myalgia, vesicles on distal limbs Vaccine created in 1700s. Eradicated in 1979 Droplet precautions

5. Chemical Weapons Nerve agents(aka organophosphate esters) are the most likely to be implemented among all chemical agents, and they are also the most incapacitating and severe. Muscarinic and Nicotinic effects: Initial: rhinorrhea, salivation, miosis and headache Severe poisoning: bronchospasm, vomiting, incontinence, muscle fasciculation, convulsions, respiratory failure, death. Antidote: Atropine at high doses and pralidoxime Choking Chemical Agents Chlorine gas and Phosgene S/S: ocular, nasal, and respiratory irritation, cough, suffocation

6. Radiological and Radioactive Agents Dirty Bombs-radioactive dispersal device that combines an explosive with a radioactive material. Major concern in the hospital setting are clients coming in contaminated with a radioactive material. PPE essential. Acute Radiation Syndrome- illness caused by irradiation of the entire body or most of the body by a high dose of penetrating radiation in a very short period of time. See Table 26-2 for signs and symptoms

7. Disaster Nursing Implementation of the public health levels of prevention Primary public health prevention focuses on preparedness. Nursing responsibilities include knowledge of the disaster plans of the community and the facility and educating clients on disaster kits and family emergency response plans. Secondary public health prevention focuses on response. Nursing responsibilities include efficient execution of nursing practice while maintaining professionalism and metal support to the afflicted community and clients. Tertiary public health prevention focuses on recovery. In this stage the nurse must learn to cope with sudden losses of personnel and clients as well as managing the mental health issues in individuals related to the disaster.

8. Levels of Disaster Level I – Working with local emergency medical systems. (auto accidents, house fires) Level II – Working with regional agencies, state health and emergency management agencies (train derailments, building collapses, tornadoes) Level III – Working with local, state, and federal resources (earthquakes, hurricanes, and tsunamis)

9. Triage The core concept that ED nurses face in natural disasters brought to wide attention by the California emergency medical services in response to the earthquakes in the 1990s. The START system: simple method of triage that divides injured persons into four separate groups. Deceased(Black): injured persons who are beyond the scope of medical assistance. Tagged deceased only if not breathing and attempts to resuscitate have been unsuccessful. Immediate(Red): injured persons who can be assisted or their health aided by advanced medical care immediately or within one hour of care. Delayed(Yellow):injured persons who can be assisted after immediate persons are medically cared for first. Delayed persons are medically stable but require medical assistance. Minor(Green): injured persons who can be assisted after immediate and delayed persons have been medically attended to. Persons tagged minor will not need medical care for at least several hours and can usually walk with assistance. The triage leader must consider bed availability issues for optimal utilization of resources to provide safe care to all clients.

10. Public Health Preparedness and Administrative Efforts Health Resources and Services Administration (HRSA) Hospital Emergency Incident Command System (HEICS) National Incident Management System (NIMS) National Preparedness Goal-aims to develop and maintain the capabilities to prevent, protect against, respond and recover from major events: Interoperable communication systems Bed tracking system Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Facility management plans Hospital evacuation plans

12. Strategic National Stockpile CDC stores large quantities of medicine and medical supplies in the United States in preparation for public health emergencies. This stockpile consists of antibiotics, chemical antidotes, antitoxins, airway maintenance supplies, and other medical equipment. Will be delivered to any state or U.S. territory within 12 hours. CHEMPACK A federal program designed to supplement the medical response in the event of a chemical nerve agent release, specifically targeted to organophosphates. These CHEMPACK containers are stored in geographically strategic locales, and possess EMS and hospital caches. They contain items like chemical antidotes, atropine injectors, PAM kits, diazepam, and sterile water. Other Emergency Resources The Emergency System for Advance Registration of Volunteer Health Professionals Medical Reserve Corps Disaster Medical Assistance Teams

14. Disaster Mental Health Traumatic events effect those who witness the event, as well as survivors, rescue workers, and friends and relatives of victims. Nurses should be aware of the onset of psychological reactions in persons suffering from disaster mental health symptomology. (See table 26-3) (Guidelines for the community health nurse responding to clients after a disaster are listed on pages 583-585.)

15. Individual and Family Preparedness Issues The development of family communications and evacuation plans should include: Recognizing potential disasters in the family’s community Primary and secondary meeting places in the event of evacuation A designated emergency contact person that is out of the area in case the disaster overwhelms local communication resources Disaster Preparedness Kit A list of recommended items to include in a basic emergency supply kit are listed in box 26-3