Exposure to environmental contaminants in doses sufﬁcient to cause
adverse health effects
(These are dependent on the causative agent. Agents cause a variety
of individual organ responses as well as systemic responses.)
• Pesticides: Have dermatological, GI, neurological, pulmonary, and
renal effects. Categories include insecticides, herbicides, fungicides,
antimicrobials, and rodenticides.
• Chemicals: Have dermatological, immunological, neurological, pul-
monary, and renal effects. Categories include petroleum-based agents,
anticholinesterases, Type I agents act on proximal tracheobronchial
tract, Type II agents act on aveoli and produce systemic effects.
• Biologicals: Have dermatological, GI, neurological, pulmonary, and
• Radiation: Have dermatological, GI, neurological, pulmonary, and
renal effects. Categories include internal such as exposure through
ingestion of radioactive material or external such as direct contact
with radiological material.
• Pollution: Have dermatological and pulmonary effects. Categories
include trash, raw sewage, industrial waste.
• External: Chemical contamination of food or water, exposure to
bioterrorism, radiation, and exposure to areas of contamination.
• Internal: Extremes of age, nutritional factors, preexisting disease
states, pregnancy, previous exposure.
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Risk management
The patient/community will
• Have minimized health effects associated with contamination.
• Utilize health surveillance data system to monitor for contamina-
• Utilize disaster plan to evacuate and triage affected members.
• Minimize exposure to contaminants.
SUGGESTED NOC OUTCOMES
Anxiety Level; Community Health Status; Fear Level
INTERVENTIONS AND RATIONALES
Determine: Triage, stabilize, transport, and treat affected community
members. Accurate triage and early treatment provide the best
chance of survival to affected persons.
Monitor individuals for therapeutic effects, side effects, and com-
pliance with postexposure drug therapy. Drug therapy may extend
over a long period of time and will require monitoring for compli-
ance as well as therapeutic and side effects.
Perform: Help individuals cope with contamination incident; use
groups that have survived terrorist attacks as useful resource for vic-
tims to aid in support; those with experience can share reactions
and useful coping mechanisms.
Help individuals deal with feelings of fear, vulnerability, and grief
to minimize risk of traumatic stress.
Decontaminate persons, clothing, and equipment using approved
procedure. Victims may ﬁrst require decontamination before entering
health facility to receive care in order to prevent the spread of con-
Use appropriate isolation precautions, including universal,
airborne, droplet, and contact isolation. Proper use of isolation pre-
cautions prevents cross-contamination.
Inform: Provide accurate information on risks involved, preventive
measures, and use of antibiotics and vaccines to enhance the use of
Attend: Encourage individuals to talk to others about their fears.
Interventions aimed at supporting an individual’s coping can help
the person deal with feelings of fear, helplessness, and loss of
control that are normal reactions in a crisis situation.
Manage: Collaborate with other agencies (local health department,
emergency medical services, state and federal agencies). Communica-
tion and collaboration among agencies increase ability to handle
crises efﬁciently and correctly.
SUGGESTED NIC INTERVENTIONS
Anxiety Reduction; Crisis Intervention; Environmental Management;
Infection Control; Health Education; Triage
Chung, S., & Shannon, M. (2005). Hospital planning for acts of terrorism
and other public health emergencies involving children. Archives of Disease
in Childhood, 90(12), 1300–1307.