Disaster Phases
Preparedness: planning, training, stockpiling supplies, drills. Response: immediate actions during and after — search and rescue, triage, medical care. Recovery: restoring services, rebuilding, mental health support. Mitigation: long-term measures to reduce future impact (building codes, vaccination programs). Nurses participate in all phases.
Triage
Mass casualty triage differs from everyday triage — goal is "greatest good for greatest number." START (Simple Triage and Rapid Treatment): Green (minor, walking wounded), Yellow (delayed), Red (immediate), Black (deceased/expectant). Everyday triage (ESI 5-level): most acute first. Reverse triage in mass casualty: lowest priority patients may be sent home to treat more critical patients.
Mass Casualty Incidents
MCI: number of patients exceeds available resources. Hospital Incident Command System (HICS): structured management. Surge capacity: extra beds, staff, supplies. Decontamination: if chemical/biological/radiological contamination. Mental health support: for patients, families, responders. Communication: family reunification, public information.
Biological/Chemical/Radiological
Biological: anthrax (Cipro/doxycycline), plague, botulism (antitoxin), smallpox, viral hemorrhagic fevers. Chemical: nerve agents (atropine + pralidoxime), cyanide (hydroxocobalamin), mustard gas (decontamination). Radiological: time, distance, shielding; KI (potassium iodide) for thyroid protection. Universal precautions plus appropriate PPE.
Nurse's Role
Personal preparedness: family plan, go-bag, emotional resilience. Professional: know facility disaster plan, role assignment, emergency credentials. Volunteer: Medical Reserve Corps, DMAT (Disaster Medical Assistance Team), American Red Cross. Ethical: duty to care vs. personal safety, resource allocation, end-of-life decisions during scarcity.
Important Notes
- In mass casualty triage, the goal shifts from "greatest good for the individual" to "greatest good for greatest number."
- Nerve agents (sarin, VX): atropine + pralidoxime (2-PAM) — auto-injectors (DuoDote) available in emergency kits.
Clinical Tips
- START triage mnemonic: RPM — Respirations, Perfusion (pulse/cap refill), Mental status. If respirations absent after airway positioning → Black (expectant).
Summary
Disaster nursing requires preparedness, triage skills, and understanding of mass casualty principles. Nurses are essential responders at every phase — from planning through recovery.
