NCM 121

Disaster Nursing

Arranged by:
MLTominez
Body Substance Isolation, Biosafety MCI
on Chemical and Biological Concerns
 Body Substance Isolation

• is a practice of isolating all body substances

(blood, urine, feces, tears, etc.)
• HAZMAT – Hazardous Materials, Toxic
Chemicals
MASS CASUALTY INCIDENTS OF
CHEMICAL Various Agents
 Key Factors
 HAZMAT incidents may result from accidental
exposure. (Transport, industrial, terrorist act)
 MCI HAZMAT INCIDENTS will create social
disruption
 There are a lot of factors to consider in assessing
patients with HAZMAT injuries (presentations
can be the same)
 Key Factors

 Chemical contamination can be recognized by odors emanating by the

victims, reports from first responders, all of the components involve are
irritants to the eyes and skin.
 It is a common trend that the people involve may come in the treatment
facility in multiple waves
 Nurses need to be able to recognize and treat the exposures to the
chemical agents of concern, and a rapid decision making must be made to
protect the hospital from secondary contamination.
 Key factors
 Managing the basics (ABC) is
the key to survival.
 Storage and checking the E –
Cart and chemical antidotes are
crucial to the successful
treatment of many chemical
weapon victims
 HAZMAT
• Hazardous Material – any substance with the
potential harm to people, property or the
environment (chemicals, biological,
radiological, nuclear and any other explosive
materials.
• Used as WMD during a war or a terror attack.

Weapons of mass destruction (WMD

 HAZMAT

• A COMPONENT OF ICBM (Intercontinental

Ballistic Missile)
Chemical agents and other common industrial chemicals of concern

1. Chemical Asphyxiants (Blood Agents)

2. Incapacitating Agents
3. Nerve Agents
4. Pulmonary irritants
5. Riot control agents
6. Vesicants (Blister Agents)
 Chemical agents and other common industrial chemicals of concern

Systemic asphyxiants have also been called blood agents because they are
systemically distributed via the blood. However, their site of action is not the blood
but rather at the cellular level throughout the body. Cyanide compounds and Hydrogen
sulfide.
Incapacitating agent is a chemical or biological agent which renders a person unable to
harm themselves or others, regardless of consciousness. The QNB is an
anticholinergic agent that affects both the peripheral and CNS resulting in confusion and
hallucination symptoms Quinuclidinyl benzilate (QNB) is an odorless and bitter-tasting
military incapacitating agent.
Nerve agents are the most toxic of the known chemical warfare agents. VX, like all nerve
agents, interferes with the operation of an enzyme that stops muscles from contracting. VX,
short for "venomous agent X", is one of the best known of the V nerve agents and
originated from pesticide
 Chemical agents and other common industrial chemicals of concern

Pulmonary Irritants Any substance which can cause inflammation or other adverse
reactions in the respiratory system (lungs, nose, mouth, larynx and trachea). tobacco
smoke, ozone, sulphur dioxide or nitrogen oxides.

Riot control agents (sometimes referred to as “tear gas”) are chemical compounds that
temporarily make people unable to function by causing irritation to the eyes, mouth, throat,
lungs, and skin.

Blistering agents, also known as vesicants, are man-made chemical warfare agents.
Exposure to these chemicals can cause skin blisters and burns, as well as irritation to the
eyes and lungs. Examples of blistering agents are mustard agents, such as sulfur mustard
(mustard gas) and nitrogen mustard.
 HAZMAT INCIDENTS
Occurred in fixed facilities – (not during transport)
Majority of incidents involved release of on chemical
Inhalation of chemicals are the most common type of
poisoning
Employees are the most common individuals affected
Thermal burns produced the majority of fatalities in a
chemical scare.
Hazmat Indicators
 Use of Senses

• Odor, vapor clouds, presence of dead animals.

• Dermal and ocular irritations
Chemical Warfare Agents
• Detection of the
chemical
• Stealth attack

A stealth attack is a cyber

attack in which the
attacker's main objective is
to remain undetected while
conducting their operations.
 Aum Shirinkyo

• Japanese cult group

• Released deadly nerve
agent
• Tokyo subway station Sarin (military designation GB) is a nerve

• Sarin – vapor gas agent that is one of the most toxic of the
known chemical warfare agents. It is
generally odorless and tasteless.
Exposure to sarin can cause death in
minutes. A fraction of an ounce (1 to 10
mL) of sarin on the skin can be fatal.
 Hazmat Emergency Response
• Supervised by various
organizations
• Occupational Safety and Health
Administration (OSHA)
• Bureau of Quarantine
The HAZMAT Team
routinely responds to assist
emergency responders with
fuel spills, oil spills, and any
other incident where there
is a known or unknown
hazardous substance.
 Hazardous Materials Training Levels

 First responder awareness – witness/discovers a hazardous substance release

and who have been trained to initiate an emergency response
 First Responder Operations – responded to the release of chemicals, defensive
fashion but not able to stop the release – Containment measures
 Hazardous Materials Technician – stopping the spread and release of the
substance
 Hazardous Material Specialist – Provide support and logistics to the team
PPE
 Chemical Agents and Their Countermeasures
Antimuscarinics – Physostigmine
Carbon Monoxide – Normobaric Oxygen/Hyperbaric oxygen
Carbon tetrachroride – NAC (hepatic injury)
Cyanides – hydroxocobalamine, sodium nitrate plus sodium thiosulfate
Flouride compounds – calcium, magnesium
Hydrazines – beta blockers
Lewistes – Dimecraprol
Methemoglobinemia – methylene blue
Mustards – granulocyte colony – stimulating factor (Bone marrow suppression)
Nerve agents – Atropine, diazepam
Radioactive cesium – Prussian blue
 Chemical Agents and Their Countermeasures

Radio Active Iodine – potassium iodide

Radioactive Thalium – Prussian blue
Opiods – Naloxone
Simple Asphyxiants – Normobaric Oxygen
Transuranic Metals – Diethylenetriamine penta
acetae (DTPA)
 Assessment Hazardous Material Poisoning

• A – Airway – oropharyngeal airway apparatus,

intubation, cricothyroidotomy
• B – Breathing – advance airway via BVM
• C – Circulation – CPR, ACLS if IVF is available
• D – Disability – Mental Status
• E – Exposure – victims clothing should be
removed (gas exposure by trap fumes)
 Medication

• determine what medication the victim is

prescribed, current medications meds that
can be given to preexisting illnesses
 Past Medical HX

• Current illness (asthma airway disease)

• Allergies
 LMP / OB GYN HX

• Assess for potential toxic exposures

• Ask for updated vaccinations and tetanus
shots (if with open wounds)
 Events
• Determine events surrounding the hazmat
incident
• Number of people to be rescued
• TIME of the Hazmat leak?
• Type of the chemical?
• How long have been the patients exposed?
 Nerve Agents

• Most potent/deadly
• Dicovered during the nazi regime
• Classified into 2 groups “G” and “V”
• G agents tabun, soman and sarin
• V agents – more pernicious amigon
effects

Nicotinic s/sx mydriasis,

tachycardia, weakness,
hypertension and muscle
fasciculations
Fasciculation (pronounced “fass-ick-you-lay-shun”) is a
visible, involuntary twitching of an individual muscle.
 Characteristics Of Nerve Agents

• Sarin – clear, colorless odorless

• Soman – clear, colorless, camphor
• Tabun - clear, odorless, faint fruity ordorless
• Vx – clear, amber color - odorless
 Diagnostics

• Cbc
• Serum cholinesterase
 Patient management

• Do not approach contaminated victims unless

wearing proper PPE.
• Provide supportive therapy and assisted
ventilation if needed.
 Treatment
• Inhalation – “severe” Mark 1 injectors and
atropine at 3-5 mins interval with mechanical
or artificial ventilation
• Skin – decontaminate with soap and water
• Eyes – flush with NSS for 10-15 min
• Ingestion – do not induce vomiting!
Mark 1 Injectors contains antidotes to be used in instances of exposure to a nerve or
organophosphate agent.
 Vesicating/Blister Agents

• Agents that blister the eyes, resp. tract and

skin.
• Sulfur mustard WW1, IRAN and Iraq
• Can be in gas form :mustard Gas”
• Can penetrate rubber
 Management

• Same as burn patient

 Blood Agents
• Affects the body by being absorb in the
circulation
• Arsine, carbon monoxide, cyanide agents
• Developed in WWII but not used in the
battle
• Inhalation is the primary route
 s/sx
• Syncope, seizures, dysrhythmias, resp. failure,
hepatomegaly, multiple organ failure

Management
• Supportive – symptomatic tx only
 Treatment

• Inhalation – 02 therapy, bronchodilators

• Renal shutdown – dialysis
• Skin/Eyes – irrigation with leakwarm NSS
• Anemia due to hemolysis – BT
 Pulmonary/choking agents

• Severe irritation and swelling to the lungs

• Pulmonary damage = impairing oxygen
delivery
• Ammonia, bromine, chlorine, hydrogen
chloride, phosgene
 Duration/Mortality

• Depends on the amount of exposure and the

patient’s characteristics
 Riot Control Agents

• Includes chemical compounds that temporarily inhibits the person’s ability to

function.
• Spray, fine droplet or particles
• Chloroacetophenone, diphenylaminearsine
• No specific TX, sx may go on 30min – 1 hour
 Effects

• Tearing eyes
• Runny nose
• Blisters in the skin
• Sore throat
 REFERENCES
DISASTER NURSING AND EMERGENCY PREPAREDNESS – TENER GOODWIN VEENEMA
NDRMMC IMPACT RESPONSE GUIDELINES

https://www.youtube.com/watch?v=8qz0PpzFGJc
Thank you!