03.06 Disasters & Bioterrorism

Hi guys! Welcome to the Disasters & Bioterrorism lesson. We’ve talked about things that can have a negative effect on community health and managed to save the biggest threat for last. So in this lesson we’ll define what these threats mean and talk about how nurses are involved in every stage of emergency management in the community. Let’s get started!

Let’s define a disaster. It can be a natural catastrophe like a hurricane, tornado, earthquake and disease outbreaks or a man-made event like terrorism and wildfires. No matter how they occur, they are sudden events that cause massive damage and/or death.

Emergency management is where we pretty much organize the resources we would need to help in the event of one of those disasters. Resources can be anything from policy planning to manpower. Emergency management itself happens in these four phases that we’ll discuss in detail.

Disaster prevention is the first phase of emergency management. This phase is an attempt to minimize any potential damage that can be caused by an event. It’s really the same premise as disease prevention. We’re trying to raise awareness and decrease risks. The community nurse’s job is to assess the needs of a community and examine the risk potential for a disaster. For instance, I live in an area that is developing on what used to be farmland. Open areas are prone to tornadoes. Now that homes and businesses are being built in my area, the risk for tornadoes may drop, but it may not change the probability of another disaster occurring. Same thing with diseases. The more populated we get, the more open we are to disease, so maybe the outbreak potential is higher. Another nursing role here is providing immunizations as needed in preparation for potential disasters and the isolation of anyone who may exhibit effects of communicable disease, hoping we can avoid an outbreak.

At some point you’ve heard the term disaster preparedness. This just means we have a plan just in case! This is the second phase of emergency management. Here we are laying out ideas for policies and protocols that should be set in place in the event of an emergency. What we also want to do is make sure that the public is educated on what to do in the event of an emergency. You know that annoying emergency broadcast system test that comes across your TV and radio? The community needs to be aware of what to do when that alarm sounds for real. Do they know where to go in the event of a disaster and do they have what they need to survive at least 3 days if they cannot evacuate? The nurse role here is to participate in drills and also have a good understanding of the protocols in place. We also provide that education to the community.

Disaster response is probably the heaviest phase because it’s the search and rescue phase. The disaster occurred, let’s go help those affected. This is the phase where you hear about FEMA response and things of that nature. What do they do? They provide relief. They provide food, shelter, healthcare aid and protection from further danger or harm. The nurse’s role in this phase is to educate everyone to reduce fear and anxiety. We know worse things can happen when people are panicked so we want to ease people’s minds to make sure we provide as much help to as many as we can. We facilitate communication and care of those in need while assessing the mental and physical needs of everyone in the area so we can provide treatments to meet those needs.  And we assist with triaging patients. This means we help prioritize care based on the severity of injuries and we provide aid based on that severity. Now there are several methods to this but we will discuss two specifically in a few.

Disaster recovery is the final phase in emergency management. This is the phase where the community starts to clean up or rebuild and return to normal after a disaster of any kind. The nurse’s role here is to help maintain the health of the public by monitoring health changes that can stem from the disaster. We also go back to normal. We administer needs assessments as a regular role so we return to this, but we enhance it because we are looking for long term effects in the community from the disaster. Think about 9/11 and how the needs of first responders changed because of their involvement and proximity to the area. How many died years later as a result of that day? Because the effects of some disasters may linger and modify, we have to keep a close watch on those risks. So for a while, we may be monitoring a little more often and a little closer.

The two triage methods I want to highlight very quickly are START and PAM. The START method prioritizes patients by classifying them in categories: deceased, need immediate assistance, meaning the injury is life-threatening, assistance not immediate, meaning non life-threatening injuries and those with minor injuries maybe just needing first aid. We call these the “walkie-talkies.” If able to, a tagging system can be used here where the color of the tag determines priority. The START method can be used by trained community members, first responders or any emergency personnel. Even though we are not always first responders, that includes nurses too guys. The PAM method is the method where we use strategy to clear the area so we can identify priorities. An area is chosen for the wounded and those who can physically get to it, will. It’s a process of elimination process that lets us determine better who is in immediate need. This is also used by first responders.

Bioterrorism is a man-made disaster using weaponized biological agents to cause death or harm. Now I know I told you guys the environment could help or hurt us. In this case it’s used against us. These agents that are being weaponized are found in nature all the time. So we have bacterial agents like Anthrax. Probably the most popular. Definitely easy to spread. Viral agents like Ebola or smallpox. Now to my knowledge no one has used Ebola as an agent, but the point is it can be done and because it’s an infectious disease, it doesn’t take as much effort to spread as Anthrax. Then we have toxins like Botulism. The weird thing about Botulism is it’s both a bacteria and a toxin. Might be a useless fact but you never know! So the thing about bioterrorism is that it can be hard to differentiate between whether it’s an actual attack or just an outbreak, which makes it that much more difficult to prevent because we’re not always sure which way to go with it. Either way it’s an emergency but we watch trends to make the determination.

I told you bioterrorism is a disaster. Just like any other disaster nurses have a role in preparedness and prevention. Nurses provide and participate in preparedness education, assessments and medication administration. We participate in drills so we know what to do in the event of an attack. We complete assessments in the community to determine the risk of an attack and if that community is actually ready if it happens. Now with medication administration we provide vaccinations as a preparedness effort and antivirals in the aftermath for anyone exposed to the danger.

Some key points to review. Disasters can be man-made or natural. The response will likely be the same, but the effects can change our efforts to return to normal. Emergency management is all about planning. We can’t intervene or treat without a clear plan on how. Nurses have a role in every step of emergency management. If we are supposed to be protecting and promoting the health of a community, why wouldn’t we be on the front lines or behind the scenes?  No matter what the scenario, the roles will always remain the same!

That’s all for the Disasters & Bioterrorism lesson. Make sure you check out all the resources attached to this lesson. Now go out and be your best selves today. And, as always, Happy Nursing!