A nurse is working in the emergency department during a mass casualty incident involving a suspected bioterrorism attack with anthrax exposure. Which nursing intervention should be the priority when caring for potentially exposed patients?

In a mass casualty incident involving a suspected bioterrorism agent like anthrax, the immediate priority is always safety—both for the patients and the healthcare providers. The foundational principle of CBRN (Chemical, Biological, Radiological, and Nuclear) casualty management is that a contaminated patient poses a direct risk of secondary exposure to staff and other patients, which can quickly disable a hospital's ability to function [3, 4]. Before any medical intervention, including diagnostics or treatment, can be safely and effectively delivered, the source of ongoing contamination must be eliminated.

The correct intervention is to implement decontamination procedures and remove contaminated clothing. Removing clothing alone can eliminate up to 80-90% of the contaminant, immediately reducing the dose of the agent the patient is absorbing and the risk of off-gassing or contact transfer to others . This step is not merely a comfort measure; it is a critical, evidence-based clinical intervention that directly mitigates the progression of toxicity and protects the treatment environment. In the context of anthrax, which does not spread from person to person via the inhalational route but can be transferred via spores on skin and clothing, this action is the definitive first step to break the chain of contamination ^[4].

• Option 1: Administering broad-spectrum antibiotics is a critical component of post-exposure prophylaxis and treatment for anthrax. However, doing so prior to decontamination is premature. If a patient is still covered in a powdered substance, the ongoing absorption of the agent continues, undermining the effectiveness of the medication. Furthermore, the act of administering medication brings healthcare workers into close proximity with a contaminated patient without first establishing safety, which contradicts standard CBRN response principles [2, 3].


• Option 2: Isolating patients in negative pressure rooms is a standard infection control practice for diseases spread via the airborne route, such as tuberculosis or measles. Anthrax is not transmitted person-to-person via the respiratory route, making negative pressure isolation unnecessary for the organism's transmission dynamics. More critically, moving a contaminated patient through a hospital to an isolation room without decontamination spreads the contaminant through hallways and contaminates the room itself, creating a larger hazard and potentially disabling critical hospital infrastructure [1, 3].


• Option 4: Collecting laboratory specimens before initiating treatment is a standard diagnostic workflow in non-disaster settings. In a CBRN incident, however, the "treat first, confirm later" paradigm often applies. Delaying decontamination to collect a specimen prolongs the patient's exposure and the risk to staff. While laboratory confirmation is important for public health and definitive diagnosis, it is a secondary priority to the immediate life-saving and risk-mitigating step of decontamination [3, 4].