Nurses on the Frontline: Online Tutorial
Amber E. Rhodes
NURS 446
Community/ Public Health Nursing
San Francisco State University
Rebecca Carabez Ph.D., RN,
March 14, 2012
CBRNE
A chemical, biological, radiological, nuclear, explosive, or CBRNE event can cause major destruction to communities. An example of a chemical event occurred during a terrorist attack in Tokyo, Japan when sarin gaswas released into the subway system. (Nurses on the Frontline, 2005). An example of a biological event would be a white powder substance known as anthrax. In 2001, anthrax was intentionallysentthrough the United States Postal Service as a biological weapon. An example of a radiological and nuclear event took place in 1986, when an explosion at the Chernobyl Nuclear Power Plant lead to long-term problems such as Thyroid Cancer in children. An example of an explosive event was the intentional bombing of the Alfred Murrah Federal Building in Oklahoma City in 1995.
SEPIA
The term SEPIA stands for structural damage, exposure risk, perpetrators, items, and abilities. This mnemonic is used to help nurses assess the safety of a scene and if he or she is capable of responding. During a CBRNE event, it is important to assess for structural damage such as wires sparking or weak structures. Exposure risk refers to the possibility of coming in contact with a harmful agent, therefore one should assess for unusual smells or notice that people are suddenly becoming ill or unconscious. Perpetrators may be at the scene so the nurse should keep an eye out for anyone behaving suspiciously, or taking pictures or videotaping at the scene. The nurse should look for items such as unattended boxes, packages, or suitcases that look out of place. The nurse should be aware of his or her abilities to provide care during a disaster. If the nurse is lacking anyskills, it is important to wait for first responders to arrive so the nurse and victims are not put at risk.
TRIAGE and MASS
The ability to triage is an extremely important skill during a CBRNE event. Triaging is based on four categories to ensure that those with emergent needs are treated first. The first category is a red tag that needs immediate treatment for patients with uncontrolled bleeding or abdominal trauma. A yellow tag means treatment can be delayed with patients that who might have an amputated finger, but they will decompensate if not treated soon. A green tag means minimal wounds such as a contusion. A black tag means that the patient is expected to die, therefore they are not treated.
The MASS method provides guidelines for triaging. MASS stands for move, assess, sort, and send. An announcement should be made asking everyone who is able to move to go to a specific area. Those who are able to walk there should get a green tag. Another announcement should be made asking those who can hear to move their arm or leg so they can get a yellow tag. The next step is to assess those who do not move and see if their wounds are fatal. If they can be saved, they should get a red tag. Those who won’t survive unfortunately get a black tag. The next step is to sort out all patients according to tag color so they can be treated according to priority. Patients should then be decontaminated and transported to the appropriate level of care such as hospitals or primary care physician.
Zones of Contamination
There are 3 zones of contamination. The hot zone is where the contamination is located, and everyone must wear necessary personal protection. The warm zone is the triage, treatment, and decontamination area. The cold zone is the outermost part of the zone that is not contaminated. The nurse should ensure that everyone is in the appropriate zone including herself to ensure safety.
Affect on Nursing Practice
The nurse who is skillfully trained to handle a CBRNE event can improve outcomes and ensure safety in her community. As a nurse, I feel that I would be able to confidently assess a scene and provide details for first responders. Once I find a career in nursing and become more confident in my skills, I may be the first available responder to a scene who would have the ability to skillfully triage patients and provide care based on the level of urgency. CBRNE events can happen at any time, and it is crucial that all health care workers have knowledge on handling these types of events.
References
Nurses on the frontline: Preparing for and responding to emergencies and disasters
[Video file]. (2005). Retrieved from