The nurse has been assigned to the staging area of a disaster response to an act of terrorism that deployed a caustic chemical agent. A client comes to the triage area with burns to the skin, severe pain, and visible chemical residue. What is the nurse's priority action?

Question

Quizplus · Accepted Answer

In the event of a disaster involving the release of hazardous substances (eg, bioterrorism, chemical warfare agents), decontamination is vital to limit injury to the client and prevent exposure to other clients and staff (Option C). Disaster triage areas typically include a decontamination area (eg, showering station, cleansing station) that should be used to eliminate any residual hazardous materials and debris from the client. In addition to bathing the client under copious amounts of running water, the nurse should remove any clothing or personal effects and discard them appropriately to further eliminate sources of hazardous material. After clients are appropriately decontaminated, necessary activities of care (eg, full assessment, diagnosis, intervention/treatment, planning) can be safely performed. (Options A and D) As long as the chemical remains on the skin, further injury may occur. The priority remains to remove the chemical agent through decontamination methods. In addition, residual chemical on the client may be spread to staff caring for the client and cause injury. (Option B) Triaging mass casualties in a disaster may involve grouping similarly triaged clients by type and severity of illness/injury; however, this should not be done before the client is decontaminated as grouping presents the risk of exposure to other clients and staff. Educational objective: Decontamination is a priority nursing action for clients who have been exposed to a chemical or radioactive agent. During a mass casualty disaster, the nurse should assist clients with complete decontamination before providing care. Decontamination limits further client injury and prevents exposure to other clients and staff.

The Nurse Has Been Assigned to the Staging Area of a Disaster