Disaster Nursing

• Hazardous Materials


  Any material which because of its quantity, concentration, physical or infectious characteristics may pose a substantial health hazard to humans or the environment when released or spilled
• Types of HazMat


  • Chemicals: toxic, corrosive, flammable, and reactive substances
  • Biological: infectious agents
  • Radiological: Radioactive materials
  • Physical: explosives, compressed gases, and other materials
• Routes of exposure


  • Inhalation
  • Ingestion
  • Absorption
  • Injection
• Health Hazards


  Chemical, physical or biological factors in our environment that can have negative impacts on our short- or long-term health
• Environmental Hazard


  Extreme events or substances in the Earth and its ecological system that may cause adverse consequences for humans and things they value
• PPE classification system


  • LEVEL A
  • LEVEL B
  • LEVEL C
  • LEVEL D
• Decontamination


  1. Remove gross decontamination from the patient

  2. Treat patient's medical needs

  3. Fully clean the patient

  4. Decontaminate staff after treatment is complete

  5. Decontaminate facility
• Chemical Weapons


  Any chemical which through its chemical action on life processes can cause death, temporary incapacitation or permanent harm to humans or animals
• Types of Chemical Weapons

  • Nerve Agents
  • Bloody Agents
  • Choking/Pulmonary Agents
  • Blistering Agents
• Nerve Agents


  Most toxic agent, sometimes also called nerve gases, it disrupt the mechanisms by which nerves transfer messages to organs, by blocking the enzyme called Acetylcholinesterase (AChE)
• Nerve Agents


  • G- Series: Tabun, Sarin, Soman, Cyclosarin
  • V Series: Russian VX, VE or Amiton, VG, VM
• Nerve Agents: Signs and Symptoms

  Cholinergic crisis, visual disturbances, increased GI motility, nausea and vomiting, diarrhea, substernal spasm, indigestion, bradycardia, Insomia, forgetfulness, impaired judgement, depression, LOC, seizures, copious secretions, flaccid muscles, apnea
• Nerve Agents: Treatment


  Decontamination with soap and water or saline solution for 8-20min, blotted dry, maintain airway patency, suctioning, Atropine 2-4mg IV, Pralidoxine IV and Diazepam
• Bloody Agents


  Directly affects cellular Metabolism result to asphyxiation, can also be emitted during house fires during combustion of plastics, rugs, furnitures and other construction materials
• Bloody Agents: Signs and Symptoms

  Respiratory muscle failure, respiratory arrest, cardiac arrest, flushing, tachypnea, bradycardia, stupor and coma
• Pulmonary Agents


  Chemicals that cause severe irritation or swelling of the respiratory tract (lining of the nose, throat, and lungs)
• Pulmonary Agents


  • Ammonia, Chlorine, Phosgene
• Pulmonary Agents: Signs and Symptoms

  Pulmonary edema, SOB
• Blistering Agents


  Blister agents or vesicants are chemicals that produce severe irritated skin often resulting in blisters, swelling and inflammation, and general destruction of tissues
• Vesicants: Mustard Agent


  A human-made chemical warfare agent that causes blistering of the skin and mucous membranes on contact
• Vesicants: Signs and Symptoms

  Superficial to partial thickness burns in warm and moist areas, stinging and erythema, pruritus and vesicle formation at 2-18 hours, eye: photophobia, lacrimation and decreased vision, respiratory: airway obstruction, GI: nausea, vomiting, upper GI bleeding
• Nursing Responsibilities


  • Immediate Triage and Treatment
  • Decontamination
  • Symptom Management
  • Psychological Support
  • Coordination of Care
  • Education and Prevention
  • Long-term Rehabilitation
• Routes of Exposure


  • Eye contact
  • Skin contact
  • Inhalation
  • Ingestion
  • Injection
• Principles of Chemical Weapons

  • Prevention
  • Prohibition
  • Protection
  • Response
  • Accountability
• Nuclear radiation


  Energy released as high-speed charged particles or electromagnetic waves, can come from natural and manufactured sources
• Types of nuclear radiation

  • Alpha Radiation
  • Beta Radiation
  • Gamma Radiation
  • X-ray Radiation
  • Cosmic Radiation
• Causes of nuclear radiation exposure


  • Natural Sources: Cosmic radiation, Terrestial radiation
  • Medical procedures: Diagnostic imaging, Radiation therapy
  • Industrial activities: Nuclear Power Plants, Industrial Radiography
  • Environmental Contamination: Nuclear Accidents, Nuclear Weapons Testing
  • Occupational Exposure
• Acute Radiation syndrome or "radiation sickness"


  Occurs shortly after a high dose of radiation exposure, can be severe and potentially fatal at very high doses, characterized by nausea, vomiting, diarrhea, fatigue, fever, and loss of hair
• Chronic effects of radiation exposure

  Leukemia, thyroid cancer, breast cancer, lung cancer, and other solid tumors, birth defects or an increased risk of genetic disorders in offspring, acute radiation burns to chronic radiation-induced fibrosis, organ dysfunction, and tissue necrosis, cataracts, cardiovascular disease, immune system suppression, hormonal imbalances, and chronic inflammatory conditions
• Principles of Nuclear Radiation Exposure

  • ALARA Principle
  • Time, Distance, and Shielding
  • Biological Effects
  • Risk Communication
  • Radiation Protection
  • Regulations and Standards
  • Education and Training
  • Monitoring and Surveillance
• Chain of Survival


  1. Prevent and prepare

  2. Early Recognition
• Preparedness for Nuclear/Radiological Emergencies requires coordination among different service groups of the nuclear facility and authorities at district, state and central levels
• Nuclear Radiation Nursing Responsibilities

  • Triage
  • Minimizing radiation exposure
  • Conducting decontamination
  • Treating life-threatening trauma injuries
  • Providing first-aid, and coordinating care for patients