Chapter 47 - Incident Management and MCI

16. If responders at a major incident require additional medical equipment and supplies, they should notify the: A) logistics section. B) planning section. C) operations section. D) liaison officer.

A) logistics section.

4. A closed, or contained, multiple-casualty incident is a situation that: A) does not have the potential to grow in size or complexity. B) involves no more than 10 patients who are critically injured. C) does not require mutual aid assistance from other agencies. D) is not expected to produce more patients than initially present.

D) is not expected to produce more patients than initially present.

49. According to the JumpSTART triage system for pediatric patients, infants or children not developed enough to walk or follow commands should be: A) quickly moved to a designated area of the triage section and monitored closely. B) taken to the treatment sector as soon as possible for immediate secondary triage. C) labeled with a red tag and transported immediately to a pediatric trauma center. D) assigned the same triage category as the walking wounded and evaluated later.

B) taken to the treatment sector as soon as possible for immediate secondary triage.

25. Preparedness in a given area should involve decisions and planning about: A) major disasters, such as tornadoes and earthquakes. B) the most likely disasters for the area, among other disasters. C) international terrorist attacks and catastrophic natural disasters. D) the most common disasters encountered throughout the world.

B) the most likely disasters for the area, among other disasters.

61. Upon arriving at the scene of a multiple vehicle crash, you call for additional resources and begin triaging patients using the START triage system. The first patient you assess is a young male who is unconscious and apneic. After manually opening his airway, you note that he starts breathing shallowly. You should: A) categorize him as an immediate patient. B) assess the rate and quality of his radial pulse. C) secure his airway with an ET tube. D) place a yellow tag on him and continue triage.

A) categorize him as an immediate patient.

46. The FIRST step in the START triage system involves: A) directing all the walking wounded to an easily identifiable landmark. B) quickly removing the obviously dead victims to a predesignated area. C) identifying the nonambulatory patients and assessing their breathing. D) obtaining an estimate of the total number of critically injured victims.

A) directing all the walking wounded to an easily identifiable landmark.

15. Broadly speaking, the finance section chief is responsible for: A) documenting all expenditures at an incident and seeking reimbursement. B) tracking all personnel overtime and ensuring that they are compensated. C) determining what impact the incident will have on the economy of the affected area. D) predetermining how much a major incident would affect the system's finances.

A) documenting all expenditures at an incident and seeking reimbursement.

21. If an incident is such that it warrants evacuation of people, the incident commander would MOST likely request that the _______________ disseminate that information as well as evacuation directions. A) safety officer B) liaison officer C) operations chief D) public information officer

D) public information officer

20. The ______________ has the authority and responsibility to stop an emergency operation if he or she believes a rescuer is in danger. A) logistics chief B) rescue officer C) triage officer D) safety officer

D) safety officer

35. Communicating with area hospitals to determine their capabilities and resources is a responsibility of the: A) treatment officer. B) individual paramedic. C) chief medical officer. D) transportation officer.

...D) transportation officer.

26. When sizing up the scene of a multiple-casualty incident, the LEAST of your initial concerns should be: A) the nature of the incident. B) requesting additional help. C) how you will react initially. D) why the incident occurred.

D) why the incident occurred.

9. Which of the following duties is NOT a responsibility of the incident commander? A) Assessing the entire incident scene B) Developing a plan to manage the incident C) Establishing strategic objectives and priorities D) Authorizing medical treatment interventions

D) Authorizing

8. Command functions include all of the following, EXCEPT the: A) triage officer. B) safety officer. C) liaison officer. D) public information officer.

A) triage officer.

6. _____________ is the process in which individual units or different organizations make independent decisions about the next appropriate action. A) Freelancing B) Sole command C) Unified command D) Effort duplication

A) Freelancing

3. Which of the following events would MOST likely cause an open, or uncontained, multiple-casualty incident? A) Tornado B) Bus wreck C) Small explosion D) Two-car collision

A) Tornado

52. Which of the following statements regarding critical incident stress management at the scene of a multiple-casualty incident is correct? A) Critical incident stress management should begin only after all patients have been cared for appropriately. B) At a multiple-casualty incident, rescuers are unable to self-heal and they lose their resiliency to cope with the stress. C) Rescuers should be encouraged, but not forced, to report to the rehabilitation sector for a stress debriefing. D) Critical incident stress management is a crucial and mandatory part of any disaster and should be enforced.

C) Rescuers should be encouraged, but not forced, to report to the rehabilitation sector for a stress debriefing.

47. According to the START triage system, a nonbreathing patient should be triaged as immediate if: A) he or she is in need of immediate intubation. B) the airway is completely blocked by swelling. C) a manual airway maneuver restores breathing. D) he or she does not respond to two rescue breaths.

C) a manual airway maneuver restores breathing.

12. A single command system: A) involves multiple agencies that share the responsibility for management of the incident. B) generally increases an individual's span of control to include as many as 10 to 15 people. C) is one in which a single person is in charge, even if multiple agencies respond to the incident. D) is ideally used for long-duration, complex incidents that require the services of a single agency.

C) is one in which a single person is in charge, even if multiple agencies respond to the incident.

59. While triaging patients at a multiple-casualty incident, you rapidly assess a patient and determine that he is conscious and alert, but cannot feel or move anything below his umbilicus. You should: A) apply full spinal motion restriction precautions at once. B) conduct a more in-depth neurologic exam of the patient. C) place a yellow tag on him and move on to the next patient. D) categorize him as an immediate patient and continue triage.

C) place a yellow tag on him and move on to the next patient.

7. An individual's span of control: A) should be self-assigned and dependent on the incident size. B) is the degree of responsibility assigned by a higher authority. C) represents the number of personnel who report to him or her. D) limits his or her autonomy to delegate tasks to another person.

C) represents the number of personnel who report to him or her.

34. The primary function of the treatment section is to: A) expediently move patients to the transportation area. B) rapidly assess each patient to determine injury severity. C) separate and treat patients based on their triage category. D) treat each patient in the order in which he or she presents.

C) separate and treat patients based on their triage category.

43. Which of the following statements regarding triage during a multiple-casualty incident is correct? A) Unless hypotension is present, patients with other signs of shock should be given a yellow tag. B) Any patient with burns should be assigned a higher priority than patients with severe medical problems. C) A patient with a back injury with spinal cord involvement should be placed in the immediate category. D) If your resources are limited, apneic patients with a pulse may be placed in the expectant category.

D) If your resources are limited, apneic patients with a pulse may be placed in the expectant category.

51. Patients who are hysterical and disruptive to rescue efforts: A) may need to be made an immediate priority and transported out of the disaster site, even if they are not seriously injured. B) should immediately be directed to the rehabilitation section, where rehabilitation personnel can provide emotional support. C) must be removed from the incident by law enforcement officials and detained in a separate area until they can be properly triaged. D) should be assigned as a delayed patient and directed to the treatment section where they can be medically and psychologically evaluated.

A) may need to be made an immediate priority and transported out of the disaster site, even if they are not seriously injured.

27. If your unit is the first to arrive at an incident, you should keep yourself safe, size up the scene, and then: A) notify dispatch, identify your unit, apprise dispatch of the situation, and assume command. B) request additional help and then begin triaging patients, treating the most critically injured first. C) immediately contact medical control and request authorization to function as the medical officer. D) quickly categorize all patients according to the severity of their injuries and request additional resources.

A) notify dispatch, identify your unit, apprise dispatch of the situation, and assume command.

13. Prior to implementing any plans or operations at the scene of a multiple-casualty incident, you should FIRST: A) notify your supervisor or the incident commander. B) make sure the assigned safety officer is present. C) move any unnecessary personnel away from the area. D) acquire the assistance of at least seven other rescuers.

A) notify your supervisor or the incident commander.

33. As soon as the treatment officer receives patients from the triage section, he or she should: A) perform secondary triage and begin treatment. B) immediately tend to the most critically injured. C) obtain the names and addresses of each patient. D) make radio contact with the transportation officer.

A) perform secondary triage and begin treatment.

22. The National Incident Management System is designed to: A) prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. B) provide a consistent template to enable state, federal, and local governments to respond safely to any act of terrorism. C) educate state, federal, and local governments, as well as private-sector organizations, to effectively prevent a domestic incident. D) maximize the capabilities of each state in the United States to manage a large-scale disaster effectively, regardless of the cause.

A) prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity.

60. You are caring for numerous patients in the treatment section at the scene of a school shooting. During secondary triage, you encounter a patient wearing a yellow tag. Her level of consciousness is markedly diminished and she is breathing inadequately. You should: A) recategorize her as an immediate patient, begin treatment, and notify the transportation officer. B) downgrade her triage status to expectant because of the numerous other patients that also require treatment. C) remove the yellow tag, replace it with a red tag, and continue secondary triage of the other patients in the section. D) provide aggressive basic airway management for 5 minutes and recategorize her as an expectant patient if she does not improve.

A) recategorize her as an immediate patient, begin treatment, and notify the transportation officer.

55. Your unit is the first to arrive at the scene of a bus crash. As you approach the scene, you see multiple patients, some of them lying on the ground not moving and others walking around in a dazed state. You should: A) remain aware of the potential for hazards. B) immediately request additional ambulances. C) establish incident command and begin triage. D) move the walking patients away from the bus.

A) remain aware of the potential for hazards.

39. Because extrication and rescue are medically complex: A) the officers responsible for these functions usually function under the EMS branch of the incident command system. B) no lengthy extrication or rescue operation should commence until an emergency physician is present at the scene. C) the position of extrication or rescue officer should always be assumed by an experienced EMT or paramedic. D) anyone who requires extrication or rescue should be triaged and receive basic lifesaving care before being extricated or rescued.

A) the officers responsible for these functions usually function under the EMS branch of the incident command system.

11. Which of the following statements regarding the unified command system is correct? A) A unified command system is difficult to establish before an incident and is activated when the resources of one agency are significantly overwhelmed. B) In a unified command system, multiple agencies from multiple jurisdictions work together to develop a plan that involves shared responsibilities. C) A unified command system functions optimally if one incident commander from each agency is identified before a multiple-casualty incident actually occurs. D) The response plan developed by a unified command system should focus only on major events such as building collapses, plane crashes, and terrorist attacks.

B) In a unified command system, multiple agencies from multiple jurisdictions work together to develop a plan that involves shared responsibilities.

38. Which of the following statements regarding the rehabilitation section is correct? A) Ideally, the rehabilitation section should be located within view of the scene so that responders can return to the incident quickly if they are requested to do so by a section officer. B) In addition to meeting the responders' needs for rest, fluids, and food, the rehabilitation officer must be prepared to conduct a defusing session if a responder shows signs of stress. C) The primary purpose of the rehabilitation section is to conduct brief physical examinations on all responders before they actively engage in functions that are required by the incident. D) Victims of a major incident who are not physically injured should report to the rehabilitation section for food, water, rest, protection from the elements, and psychological support.

B) In addition to meeting the responders' needs for rest, fluids, and food, the rehabilitation officer must be prepared to conduct a defusing session if a responder shows signs of stress.

44. Which of the following injuries or conditions should be assigned the HIGHEST triage priority? A) Full-thickness burns B) Respiratory distress C) Cardiopulmonary arrest D) Multiple long bone fractures

B) Respiratory distress

58. You are triaging four patients who were involved in a motor vehicle crash. Victim 1 has bilateral femur fractures, is in severe pain, and is conscious and alert. Victim 2 is unresponsive, apneic, and pulseless. Victim 3, who is profusely diaphoretic, is wearing a medical alert bracelet identifying her as a diabetic. Victim 4 is responsive to pain only and is in obvious respiratory distress. How should you categorize these patients? A) Victim 1, immediate; victim 2, immediate; victim 3, delayed; and victim 4, delayed B) Victim 1, delayed; victim 2, expectant; victim 3, immediate; and victim 4, immediate C) Victim 1, delayed; victim 2, immediate; victim 3, delayed; and victim 4, immediate D) Victim 1, immediate; victim 2, expectant; victim 3, immediate; and victim 4, delayed

B) Victim 1, delayed; victim 2, expectant; victim 3, immediate; and victim 4, immediate

37. If an emergency physician is present at the scene of a multiple-casualty incident, he or she would be the LEAST likely to: A) make initial and secondary triage decisions. B) assume control over complex rescuer operations. C) decide which patients require immediate transport. D) provide on-scene medical direction for paramedics.

B) assume control over complex rescuer operations.

30. When functioning at the scene of a major incident, communication should: A) incorporate signals for privacy purposes. B) be face to face to minimize radio traffic. C) involve the use of codes to limit air time. D) occur via radio to keep everyone updated.

B) be face to face to minimize radio traffic.

19. Occlusive dressings and large-bore IV catheters for thoracic decompression are supplies used to address ____________ issues at a multiple-casualty incident. A) disability B) breathing C) circulation D) airway control

B) breathing

62. You are assessing the circulation status of an injured patient using the START triage system. The patient, a 33-year-old man, has strong radial pulses bilaterally. You should: A) assign him a triage category of delayed. B) control any bleeding and assess his mental status. C) identify him with a red tag and continue triaging. D) ask him if he can get up and walk to another area.

B) control any bleeding and assess his mental status.

48. According to the START triage system, if a patient has a strong radial pulse, you should: A) place him or her in the delayed category. B) control bleeding and assess mental status. C) assess his or her ability to follow commands. D) determine whether the pulse rate is slow or fast.

B) control bleeding and assess mental status.

5. Using the incident command system provides a modular organizational structure that: A) is overseen by the most experienced paramedic. B) depends on the size and complexity of the incident. C) requires a uniform approach to any major incident. D) remains static in all incidents involving mass casualties.

B) depends on the size and complexity of the incident.

54. You are caring for a patient with non-life-threatening injuries in the treatment section of a multiple-casualty incident when you are approached by several TV reporters who are seeking details regarding the incident. You should: A) provide a brief overview of the current situation. B) direct the reporters to the public information officer. C) firmly tell the reporters to leave the scene immediately. D) ignore the reporters' questions and continue patient care

B) direct the reporters to the public information officer.

32. The primary duty of the triage officer is to: A) quickly remove the deceased from the triage area. B) ensure that every patient receives a primary assessment. C) immediately identify the most critically injured patients. D) evacuate patients to the most appropriate treatment area.

B) ensure that every patient receives a primary assessment.

24. Two MOST important underlying principles of National Incident Management System are: A) compliance and funding. B) flexibility and standardization. C) personnel training and certification. D) interoperability and public awareness

B) flexibility and standardization.

42. In contrast to primary triage, secondary triage: A) requires a more rapid assessment. B) is performed in the treatment area. C) is typically performed by a physician. D) involves initial placement of triage tags

B) is performed in the treatment area.

17. At a very large incident, the operations section is responsible for: A) locating food, shelter, and health care for you and the other responders present at the incident. B) managing the tactical operations job usually handled by the incident commander on routine EMS calls. C) ensuring that there is ample lighting and functional communications equipment during the incident. D) obtaining data regarding problems that may arise at the incident and revising the plan to solve the problem.

B) managing the tactical operations job usually handled by the incident commander on routine EMS calls.

10. During a small-scale incident, the incident commander: A) will likely not respond to the scene. B) may perform all the command functions. C) primarily assumes the role of safety officer. D) delegates all authority to the senior paramedic

B) may perform all the command functions.

1. A single command system is one in which: A) the incident commander assumes all functional roles. B) one person is in charge, even if multiple agencies respond. C) one person is in charge, unless multiple agencies respond. D) one person from each responding agency assumes command.

B) one person is in charge, even if multiple agencies respond.

23. The National Incident Management System standard incident command structures are based on: A) a unified command system, multijurisdictional cooperation, and continuous public education. B) U.S. military oversight, coordination among multiple public and private agencies, and a warning system. C) an incident command system, multiagency coordination systems, and public information systems. D) a single command system, cooperation between state and local governments, and a mechanism to warn the public.

C) an incident command system, multiagency coordination systems, and public information systems.

40. If a disaster situation requires a morgue officer, it is MOST important for the person who is assigned the function of morgue officer to: A) work directly with law enforcement officials to positively identify the deceased as soon as possible. B) leave all of the dead victims in their original locations until a coroner or mortician is at the scene. C) be aware that some multiple-casualty incidents involving numerous fatalities may be crime scenes. D) quickly remove the bodies from the scene, even if a storage and removal plan has not been established.

C) be aware that some multiple-casualty incidents involving numerous fatalities may be crime scenes.

53. During an incident involving a building collapse, a paramedic is assigned eight rescuers to function under his authority. However, as the incident progresses, the paramedic finds that he is unable to effectively manage the personnel assigned to him. He should: A) send two of the rescuers to the triage section since this is where they will most likely be needed. B) transfer authority to one of the rescuers assigned to him and then follow that person's directions. C) divide tasks and delegate supervision of some tasks to one or more of the rescuers assigned to him. D) release half of the rescuers assigned to him and instruct them to report directly to the incident commander.

C) divide tasks and delegate supervision of some tasks to one or more of the rescuers assigned to him.

18. Multiple-casualty equipment and supplies needed for airway control include all of the following, EXCEPT: A) gloves, face shields, and a HEPA or N-95 mask. B) oral and nasal airways, ET tubes, and Combitubes. C) large-bore IV catheters for thoracic decompression. D) rigid and flexible suction catheters and suction devices.

C) large-bore IV catheters for thoracic decompression.

29. Initial command of an incident should be assumed by the: A) police chief or his or her designee. B) first paramedic to arrive at the scene. C) most experienced public safety official. D) highest-ranking individual at the scene.

C) most experienced public safety official.

2. A multiple-casualty incident is MOST accurately defined as an event in which: A) mutual aid from other agencies is required to care for numerous patients. B) there are at least 25 patients, more than half of whom are critically injured. C) the number of patients exceeds the resources available to the initial responders. D) there are more patients who require advanced life support than patients who do not.

C) the number of patients exceeds the resources available to the initial responders.

41. The goal of doing the greatest good for the greatest number of people mandates that: A) life-threatening injuries should be treated during the triage phase. B) there should be one triage officer for every 10 victims of a disaster. C) triage assessment is brief and patient condition categories are basic. D) every victim should receive a detailed physical exam during triage.

C) triage assessment is brief and patient condition categories are basic.

28. After ensuring your own safety, you should consider the safety of, in order: A) your partner, the patient, other rescuers, and any bystanders. B) the patient, other rescuers, any bystanders, and your partner. C) your partner, other rescuers, the patient, and any bystanders. D) the patient, your partner, any bystanders, and other rescuers.

C) your partner, other rescuers, the patient, and any bystanders.

31. Which of the following is the MOST difficult aspect of being a triage supervisor? A) Communicating with the EMS branch on your progress B) Ensuring the movement of all patients to a treatment area C) Documenting all the activities that occur in the triage area D) Not initiating treatment until all patients have been triaged

D) Not initiating treatment until all patients have been triaged

36. The staging supervisor is responsible for: A) tracking the number of vehicles transporting patients. B) supervising all responders who are providing treatment. C) requesting additional medical supplies as they are needed. D) coordinating with all incoming and outgoing ambulances.

D) coordinating with all incoming and outgoing ambulances.

14. The transfer of incident command should occur: A) when the most experienced paramedic arrives. B) over the radio so all involved personnel can hear. C) at least every hour throughout the entire incident. D) face to face, if possible, and in an orderly manner.

D) face to face, if possible, and in an orderly manner.

50. According to the JumpSTART triage system, if an infant or child is not breathing, you should: A) deliver five rescue breaths. B) manually open the patient's airway. C) categorize the patient as expectant. D) immediately assess for a pulse.

D) immediately assess for a pulse.

56. During an incident involving an explosion, you determine that two critically injured patients should be transported to a trauma center by air. After stabilizing the patients' conditions to the best of your ability, you should: A) call the receiving trauma center and update them on the patients' conditions. B) contact the incident commander and request permission to utilize air transport. C) request air transport immediately and determine where you will land the helicopter. D) notify the transportation supervisor and request that he or she establish a landing zone.

D) notify the transportation supervisor and request that he or she establish a landing zone.

63. A man stormed into a daycare center and opened fire with a semiautomatic rifle. The scene has been secured by law enforcement, and you are in the process of triaging the injured children. The first child you assess, a 4-year-old boy, is unresponsive and apneic but has a pulse. After manually opening his airway, he remains apneic. You should: A) consider him nonsalvageable and place a black tag on him. B) assist his ventilations while closely monitoring his pulse rate. C) categorize him as an immediate patient and continue triaging. D) provide five rescue breaths and reassess his respiratory status.

D) provide five rescue breaths and reassess his respiratory status.

57. Upon arriving at the scene of a major incident, you can clearly see that there are numerous patients, some of whom are receiving care and others of whom are walking around unattended. Your MOST appropriate action should be to: A) immediately triage the unattended patients. B) move the walking patients to a separate area. C) notify dispatch and request air medical transport. D) report to the staging area for further instructions.

D) report to the staging area for further instructions.

45. Triage tags that have tear-off receipts are MOST useful to the: A) triage supervisor. B) treatment supervisor. C) incident commander. D) transportation supervisor.

D) transportation supervisor.