Chapter 68: Disaster Nursing Essentials

Disaster Nursing Essentials on disaster nursing explores the critical adaptations of nursing knowledge and skills required to address individual and community health needs during major crises, including mass casualty incidents (MCIs), which are situations where the number of casualties exceeds the available resources. Effective disaster preparedness necessitates a robust Emergency Operations Plan (EOP) based on hazard vulnerability analysis, promoting institutional self-sufficiency for several days, and adhering to federal guidelines like the National Incident Management System (NIMS) and the Incident Command System (ICS). A fundamental shift occurs in triage during disasters, moving from prioritizing individual survival (as in standard emergency department triage) to achieving the greatest good for the greatest number of people, utilizing standardized systems like the color-coded tags (Red for Immediate, Yellow for Delayed, Green for Minimal, Black for Expectant) or the SALT methodology (Sort, Assess, Lifesaving interventions, Treatment/Transport). The disaster response is supported by various federal and local agencies, including FEMA, the CDC, and specialized National Disaster Medical System (NDMS) teams like Disaster Medical Assistance Teams (DMATs). A significant focus is placed on recognizing and managing exposure to weapons of mass destruction (WMD), which include biological, chemical, and radiological agents, in addition to injuries from blast events. Biological threats, such as weaponized Anthrax or Smallpox, require heightened surveillance, rapid identification, and specific medical interventions like prophylactic antibiotics (e.g., ciprofloxacin for anthrax) or vaccination, depending on the agent. Chemical exposures are categorized by characteristics such as volatility, persistence, and latency, including Vesicants (blistering agents), highly toxic Nerve Agents (which inhibit acetylcholinesterase, treated with atropine and pralidoxime), and Blood Agents (cyanide, which requires rapid antidote administration). Radiological threats, often involving dirty bombs, necessitate strict access restriction and rapid decontamination procedures (removal of clothing and washing with soap and water), patient categorization based on the likelihood of Acute Radiation Syndrome (ARS) development, and protective measures. Protection of health care personnel is paramount, achieved through proper donning and doffing of appropriate Personal Protective Equipment (PPE) levels, with Level C and D being the levels most often used in hospital settings, followed by thorough decontamination to prevent secondary exposure. Finally, the chapter addresses ethical conflicts arising from resource rationing during crises like the COVID-19 pandemic, moral distress among nurses, and the need for specialized psychosocial support for victims and responders through Critical Incident Stress Management (CISM).