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Chapter 17
Being Prepared: Disasters and
Terrorism
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Characteristics of Disasters
• Causation
– Natural or manmade
• Casualties
– Number of humans injured or killed by or as a
direct result of an incident
– Multiple-casualty incident: >2 but <100
– Mass-casualty incident: >100
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Characteristics of Disasters (cont.)
• Scope
– Range of its effect, either geographically or in
terms of the number of victims
• Intensity
– The level of destruction and devastation it
causes
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Victims of Disasters
• Direct victims: people experiencing event; dead and
survivors
– Displaced persons: forced to leave to escape
effects of disaster; usually temporary
– Refugees: people forced to leave homeland due
to war or persecution
• Indirect victims: relatives or friends of direct victims
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Factors Contributing to the Potential for
Disaster
• Host factors
– Age, general health, mobility, psychological
factors, and even socioeconomic factors
• Agent factors
– Natural or technologic element that causes
the disaster
• Environment factors
– Those that could contribute to or mitigate a
disaster
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Question
Which of the following would be considered a masscasualty incident?
a. 26 victims
b. 54 victims
c. 78 victims
d. 110 victims
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
d. 110 victims
• A mass-casualty incident is one in which there are
>100 victims. A multiple-casualty incident is one in
which there are >2 but <100 victims.
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Agencies and Organizations for Disaster
Management
• Red Cross
• Federal Emergency Management Agency (FEMA)
• WHO’s Emergency Relief Operations
• Pan American Health Organization
• Doctors Without Borders
• International Medical Corps
• Operation Blessing
• Military
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Phases of Disaster Management
• Prevention
– No disaster expected or anticipated
– To identify community risk factors and to
develop and implement programs to prevent
disasters from occurring
• Preparedness
– Improving community and individual reaction
and responses so that the effects of a disaster
are minimized
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Phases of Disaster Management (cont.)
• Response
– Rescue, triage, on-site stabilization,
transportation of victims, and treatment at local
hospitals
• Recovery
– Repair, rebuild, or relocate damaged homes and
businesses and restore health and economic
vitality to the community
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Role of the CHN
• Preventing disasters
– Primary level
– Secondary level
– Tertiary level
• Preparing for disasters
– Disaster planning; personal preparation;
assessment for risk factors and disaster history
– Establishing authority, communication, and
transportation
– Mobilizing, warning, and evacuating
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement true or false?
• Rescue and triage occur during the recovery phase
of a disaster.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
– Rescue and triage occur during the response
phase of a disaster.
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Role of the CHN (cont.)
• Responding to disasters
– Rescue
– Triage (see Fig. 17.2)
– Immediate treatment and support
– Care of bodies; family notification
• Supporting recovery
– Long-term treatment
– Long-term support
– Need for self-care (critical incident stress debriefing
[CISD])
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Psychological Consequences
• Acute stress disorder, depression, post-traumatic
stress disorder (PTSD)
• Education, screening, assessment & referral by CHN
– Primary prevention: resilience
– Secondary prevention: crisis intervention
– Tertiary prevention: referral for treatment
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Levels of Prevention Applied to Terrorism
• Primary prevention
– Alert to signs of possible terrorist activity
– Knowledge base of terrorism pathogens or chemical
weapons
• Secondary & tertiary prevention
– Be prepared to act safely, access information rapidly, and
use resources effectively
– Provide direct care to victims, volunteer as a hospitalcommunity liaison, set up and administer mass
immunizations, make home visits to affected families, or
serve on committees responding to terrorist acts
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Terrorism
• Unlawful use of force and violence against persons
or property to intimidate or coerce a government,
the civilian population, or any segment thereof, in
furtherance of political or social objectives (U.S. FBI)
• Agents for terrorism
– Bioweapons (mustard gas, sarin and VX gas,
anthrax)
– Nuclear agents
– Chemical warfare
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Question
Is the following statement true or false?
• Anthrax is an example of a chemical agent used for
terrorism.
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Answer
• False
– Anthrax is considered a bioweapon agent used
for terrorism.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Role of CHN
• Primary prevention
– Community surveillance; signs of possible
terrorist activity
• Secondary and tertiary prevention
– Preparation for safe action, quick information
access, and resource use; ensuring current
disaster plan (one of most effective strategies to
minimize injury and mortality from terrorism)
– Response to terroristic acts: direct care; dealing
with groups, families, including the aftermath
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Internet Resources
• Community Emergency Response Teams (CERT):
http://www.citizencorps.gov/cert/index.shtm
• Disaster Preparedness Information (American Red
Cross): http://www.prepare.org/
• Emergency Preparedness & Response (CDC):
http://www.bt.cdc.gov/
• Nursing Emergency Preparedness Education Coalition:
http://www.nursing.vanderbilt.edu/incmce/
• World Health Organization [Emergency Preparedness and
Response Commitments in Emergencies]:
http://www.searo.who.int/en/Section1257/Section2263/
Section2299.htm
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