Biomedical Engineering Reference
In-Depth Information
terrorist attack. In addition, there is little informa-
tion available on the most appropriate treatment of
immunocompromised patients following a bioter-
rorist attack [4:p. 384].
Finally, health care clinicians are a vulnerable
population at risk for exposure to a bioterrorist
agent. In case of an exposure, strict isolation tech-
niques should be employed until no longer neces-
sary. Clinicians should be knowledgeable about
disaster management guidelines and protocols and
should have access to personal protective equip-
ment. If indicated, clinicians should have prophy-
lactic therapy to a suspected agent. Adequate food,
water, exercise, sleep, and time for relaxation will
enable the clinician to provide continued medical
care during such an event.
incidence, large number of patients presenting
with similar but unexplained symptoms, diseases
occurring outside a normally endemic area, those
occurring at an unusual time, increased symptom
severity or increased deaths should raise the level
of alertness of the triage nurse. Local health author-
ities will notify the FBI and state health depart-
ments. The CDC and other government agencies
may assist in investigating bioterrorist attacks but,
generally, they fall under the jurisdiction of the
FBI [3].
In the case of a large-scale bioterrorist expo-
sure, health care professionals will need to treat
as many victims as possible who have a chance
of survival. Triage will be based on the greatest
good for the most number of people in the shortest
period. Triage is a dynamic process that changes
constantly based on victim status and available
resources. Presumptions of the type of bioterrorist
exposure will guide triage decisions and manage-
ment of patients including need for quarantine or
specific isolation techniques.
Emergency medical management and triage
decisions may be based on the
14.2 Triage
An important component of preparations for
illnesses and syndromes related to a bioterrorist
attack includes some type of surveillance system to
detect and monitor an outbreak. Triage nurses are
in a unique position to collect clues to a deliberate
exposure to a biological or chemical agent. Surveil-
lance systems can detect and monitor the course of
an outbreak and decrease morbidity and mortality.
There are several systems for surveillance of
bioterrorism-related diseases or syndromes: those
that monitor the incidence of bioterrorism-related
syndromes and those that disseminate bioterrorism
detection data from environmental or clinical
samples to appropriate decision-makers [5:p. 912].
Effective surveillance for bioterrorist-related
illness depends on prompt collection and reporting
of data. Intervention is linked to rapid detection of
a related exposure to an agent. Substantial delays
in detection may result in increased morbidity and
mortality. Bioterrorism attacks are unpredictable,
so health care professionals must always be alert
for the possibility of an outbreak and be prepared
to address them in a coordinated manner. Triage
nurses can play a vital role in early recognition and
detection of exposure to bioterrorist agents.
Triage nurses who suspect an exposure to a
bioterrorist agent should notify local health author-
ities. For example, a brisk increase in disease
following
questions [2]:
•
What are the goals and objectives of triage for
the hospital?
•
What are the goals and objectives of triage for
the community?
•
What are the causes of morbidity and mortality
of the agent?
•
What are the subsequent associated public
health issues?
What are the current resources?
•
How long can the infrastructure support the
current resources?
•
What other resources can become available?
•
Does triage address water, sanitation, food,
shelter, and quality of life issues?
•
Is there a facility to treat the “worried well”?
•
Triage categorization is essential during a large-
scale bioterrorism exposure. This enables indi-
vidual victim disposition as well as being a
marker
in a potential evolving epidemic. An
