Disaster Nursing

Bioterrorism and Weapons of

Mass Destruction

By: Brittney Mathis

 Objectives
• Identify the necessary components of an emergency operations plan.
• Discuss how triage in a disaster differs from triage in an emergency based
upon clinical judgment and decision making skills.
• Develop a plan of patient-centered care for a patient experiencing short or
long-term psychological effects after a disaster. Evaluate the different
levels of personal protection and decontamination procedures that may be
necessary during an event involving mass causalities or weapons of mass
destruction.
• Describe isolation precautions necessary for bioterrorism agents.
• Identify the differences among the various chemical agents used in
terrorist events, their effects, and the decontamination and treatment
procedures that are necessary.
• Determine the injuries associated with varying levels of radiation or
chemical exposure and the associated decontamination processes.
• Utilize information management in developing plan of care for patients
exposed to bioterrorism agents or in a disaster setting.
• Appraise the need for professional growth and lifelong learning needed to
care for individuals and self during exposures to bioterrorism or weapons
of mass destruction.
Mass Casualty Incident begins at the local level with
emergency responders and volunteers

Incident Command Center-local organizations that

coordinates personal, facilities, equipment, and
communication in emergency
Hospital Emergency Preparedness Plans
• Required by Joint Commission and must cover
eight essential areas
• Patient tracking and triage are priorities
• Clear communication is imperative
• Nurses may be required to practice outside the
normal scope
 Triage in Disasters
• Triage under normal circumstances includes:
resuscitation, emergent, urgent, non-urgent,
and minor
• Triage during MCI: greatest good for the
greatest number of people
Red Triage Tag (“Immediate” or Priority 1): Patients whose lives are in
immediate danger and who require immediate treatment

Yellow Triage Tag (“Delayed” or Priority 2): Patients whose lives are not in
immediate danger and who will require urgent, not immediate, medical care

Green Triage Tag (“Minimal” or Priority 3): Patients with minor injuries who
will eventually require treatment

Black Triage Tag (“Expectant” or No Priority): Patients who are either dead or
who have such extensive injuries that they can not be saved with the limited
resources available.
(Lee, 2010)
 Natural Disasters
• Preparation is key, due to the unpredictability
of natural disasters
• The majority of the immediate casualties are
trauma-related
• Later cases often involve excessive exposure
to the natural elements and the need for food
and water
 Psychological Effects
• Families friends arriving in
search of loved ones may
be experiencing extreme
grief, anxiety, or even
shock
• Must be kept in separate
area from triage
• Refer patients and families
to therapists and social
workers
• Discourage media replays
and news articles
 Critical Incident Stress Management

• Preventing and treating emotions trauma of

emergency responders
– Defusing
– Debriefing
– Demobilization
– Follow-up
 Biological Agents

• Biologic weapons are weapons that spread

disease
• Anthrax and smallpox are two of the agents most
likely to be used or weaponized
 Personal Protection (PPE)

• Level A

• Level B

• Level C

• Level D-work uniform that may include gloves,

glasses, or face shield
Decontamination
 Category A
Agents/Diseases
• Anthrax (Bacillus anthracis)
• Botulism (Clostridium botulinum
toxin)
• Plague (Yersinia pestis)
• Smallpox (variola major)
• Tularemia (Francisella tularensis)
• Viral hemorrhagic fevers (filoviruses [e.g., Ebola,
Marburg] and arenaviruses [e.g., Lassa, Machupo])
 Anthrax
• Inhaled spores
• Found in the soil naturally
• Initial symptoms resemble common cold
• Progress to severe breathing problems and
shock
 Smallpox
• DNA Virus
• Symptoms: rash, fever, malaise, headache,
backache, and fatigue. 2-3 days later, flat red
rash. Then they fill with pus that form crusts by
week 2.
• Hemorrhagic smallpox
causes death by day 5
or 6
Prevention: vaccine
 Category B
Agents/Diseases
• Brucellosis (Brucella species)
• Epsilon toxin of Clostridium perfringens
• Food safety threats (e.g., Salmonella species, Escherichia coli
O157:H7, Shigella)
• Glanders (Burkholderia mallei)
• Melioidosis (Burkholderia pseudomallei)
• Psittacosis (Chlamydia psittaci)
• Q fever (Coxiella burnetii)
• Ricin toxin from Ricinus communis (castor beans)
• Staphylococcal enterotoxin B
• Typhus fever (Rickettsia prowazekii)
• Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis,
eastern equine encephalitis, western equine encephalitis])
• Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
 Category C
Agents
• Emerging infectious diseases such as Nipah
virus and hantavirus
 Biological Agents
• Severe Acute Respiratory Syndrome (SARS)
– 2003 outbreak was an example of a mass casualty biologic
event that was not terrorist-based
• Chemical agents: Effects are more apparent and
occur more quickly than those caused by biologic
weapons
• Nerve Agents: The most toxic agents in existence:
– Result in a cholinergic crisis
• Blood agents: Have a direct effect on cellular
metabolism, resulting in asphyxiation
– Examples include hydrogen cyanide and cyanogen
chloride
What is the later cause of casualties after natural
disasters?
A. Repeat natural disasters
B. Exposure to elements with need of food and water
C. Electrocution from lightening
Answer B

Rationale-Later cause often involve

excessive exposure to the natural elements
causing hypothermia/hyperthermia and the
need for food and water.
An individual who has become infected with
anthrax is most likely to exhibit which of the
following signs and symptoms?
A. Signs of cardiogenic shock
B. Severe respiratory distress
C. Skin lesions and hemorrhage
D. Neurological deficits
Answer-B severe respiratory distress

Rationale-anthrax is typically ingested by inhalations

and results in respiratory distress leading to respiratory
arrest. Neurological, cardiac, and integumentary effects
are not central manifestation of the disease.
You are in charge of triaging patients after a
massive tornado has taken out most of the town
causing massive casualty. The hospital is already
full with many people still untreated. A woman
flags you over to her collapsed husband whom
has a large wound to his chest caused by debris
making it difficult for him to breath. What color
tag do you place on this man?
A. Green
B. Black
C. Red
D. Yellow
Answer C-Red- due to patients whose lives
are in immediate danger and who require
immediate treatment like sucking chest
wounds
You have been caring for a patient in the ER whos
breathing has progressively gotten worse until a
physician makes a diagnosis of Anthrax poisoning
based off his new chest x-ray. Due to being exposed,
what is the next step you must take?
A. Remove all your clothing and rinse with soap and
water
B. Call Employee Health for the vaccination
C. Call Infection Control to quarantine everyone that
came in contact with the patient
D. Continue providing the best level of care to the
patient with no change on your behalf
Answer D-Anthrax is infective only in the spore
form and cannot be spread from person to person.
Level D universal precautions only are needed.
Due to the emotional toll responding to massive
casualties, natural disasters, and emergency
response can have on responders, what is the
name of the group that can help with the follow
up process to ensure emotional health?
A. Critical Incident Stress Management
B. National Incident Management System
C. Federal Emergency Management Administration
(FEMA)
D. American Red Cross
Answer A
Feuerstein, C. (2012, November 6). Disaster nursing [Video file].
Retrieved from http://www.youtube.com/watch?v=W-
S2BXTPKHs

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12(6), 466-470. Retrieved from http://virtualmentor.ama-
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