What is the most critical action for a nurse when preparing to receive victims of a bioterrorism attack: ensuring appropriate isolation precautions are in place, notifying public health departments (PHD) after victims' arrival, or preparing additional intravenous (IV) supplies for incoming victims?

Most Critical Action for Nurses Preparing for Bioterrorism Attack Victims

Ensuring appropriate isolation precautions is the most critical action for a nurse when preparing to receive victims of a bioterrorism attack. 1

Rationale for Prioritizing Isolation Precautions

• Hospitals should develop pre-event plans to augment usual or modified airborne infection isolation capacity for critically ill victims of a bioattack with a contagious pathogen 1
• Healthcare facilities must stockpile enough personal protective equipment (PPE) to care for mass casualties of a bioterrorist attack for at least the first 48 hours 1
• Proper isolation precautions protect both healthcare workers and other patients from potential contagious agents, preventing further spread and additional casualties 1
• Without appropriate isolation measures in place first, both healthcare providers and other patients are at risk of exposure, potentially creating a cascade of additional victims 1

Secondary Actions in Order of Priority

1. Notification of Public Health Departments

• While notification of public health departments is important, it should occur as soon as possible but not at the expense of establishing isolation precautions first 1
• The immediate establishment of expert teams that can be called upon at national, regional, and local levels is imperative, but isolation must be established before victims arrive 1

2. Preparation of IV Supplies

• While hospitals should plan to administer IV fluid resuscitation and stockpile sufficient equipment for hemodynamically unstable victims 1, this is secondary to isolation precautions
• IV supplies are important for treatment but do not prevent the spread of biological agents to healthcare workers and other patients 1

Implementation of Isolation Precautions

• All hospital clinical staff should receive initial and periodic training on principles of healthcare delivery using PPE 1
• Hospitals should develop pre-event plans that include:
  • Augmenting airborne infection isolation capacity 1
  • Training staff on appropriate use of personal protective equipment 1
  • Establishing decontamination protocols 1

Additional Critical Preparedness Measures

• Triage protocols must be established to guide decisions regarding the provision of critical care when resources are limited 1
• Hospitals should plan for modified staffing models when critical care needs exceed available specialized staff 1
• Mental health support should be available, as psychological reactions may be severe during bioterrorism events 1

Common Pitfalls to Avoid

• Delaying the implementation of isolation precautions while focusing on treatment supplies 1
• Failing to recognize the potential for contagious spread among healthcare workers and patients 1
• Underestimating the importance of staff training on infection control measures specific to bioterrorism agents 1
• Waiting until after victims arrive to notify public health authorities, which delays coordinated response 1

Nursing bioterrorism preparedness requires continuous education and practice to ensure proper recognition and response to an attack 2. While all three actions (isolation precautions, notification of public health departments, and preparing IV supplies) are important components of bioterrorism response, establishing appropriate isolation precautions must take precedence to protect both healthcare providers and the broader community from further harm.