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  • Terrorism, Mass Casualty, and Disaster Nursing

Brunner and Suddarth's Textbook of Medical Surgical Nursing: In One Volume

Suzanne C. Smeltzer RNC EdD FAAN, Brenda G. Bare, Janice L. Hinkle PhD RN CNRN, Kerry H. Cheever PhD RN

Chapter 72

Terrorism, Mass Casualty, and Disaster Nursing - all with Video Answers

Educators

Chapter Questions

Problem 1

You are the triage nurse at the receiving facility for casualties after a tornado. As you prepare to set up a triage station, "walking wounded" begin to arrive on their own. Among them is a hysterical adult woman with a facial abrasion who is orherwise apparently unharmed, carrying a 7 -year-old child who has a Glasgow Coma Scale (GCS) score of 6 and is apneic. A 20-year-old man believes he has broken his arm; if fractured, it appears to be a closed fracture and the arm is warm with good pulses. As you quickly assess these patients, an ambulance arrives with an 80 -year-old man with a sucking chest wound who is apneic and with a pulse barely palpable only at the carorids. The emergency medical services (EMS) personnel were unable to intubare him. In addition, a 15 -year-old girl arrives with a cold pulseless foot from an obvious ankle fracture dislocation. How would you initially tag and triage these patients to provide optimal use of resources, remembering that this is only the first wave of injuries from multiple building collapses? Family members, members of the press, and city officials also begin arriving at the hospital in large numbers. How should the family members be managed? How should the other people be managed?

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Problem 2

A patient arrives at the triage desk of the emergency department complaining of a sudden onset of a high fever and respiratory flulike symptoms. He has recently returned from a trip to Asia. At this point, there are no skin signs that suggest disease. What signs and symptoms should you identify if you suspect a biologic warfare agent or contagious process? Which agents cause pneumonia-like signs and symptoms? What precautions should be taken to protect staff and parients? What type of isolation would be typical if you suspected a contagion that is transmitted by the respiratory tract? Would you consider the patient's recent travel to Asia an important piece of information?

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Problem 3

You are a member of the safety committee at your hospital. The committee is charged with updating the hospital's emergency operations plan (EOP). What types of disasters may occur in and around your facility? How do you determine the hazards and vulnerability of your facil. ity? How does your facility plan comply with the National Incident Management System requirements? What plan for triage will be included in the EOP? What types of personal protective equipment (PPE) will you recommend?
4 Your facility is closest to a bombing event on the mass transit system. You initiate the hospital emergency plan. What special considerarions should you address, including possible use of chemical and biological weapons? What types of blast injuries do you expect? How many phases of injury are involved with a blast effect?

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