Chapter 39 Incident Management

According to the START triage system, what should you do if a patient is found to have a respiratory rate of 24 breaths/min? A. Assess for bilateral radial pulses. B. Triage the patient as delayed. C. Assess his or her neurologic status. D. Administer high-flow oxygen.

A. Assess for bilateral radial pulses.

According to the START triage system, what should you do if you encounter an unresponsive patient who is not breathing? A. Open the airway and reassess breathing status. B. Assign the patient in the "immediate" category. C. Ventilate the patient for 2 minutes and reassess. D. Triage the patient as "expectant" and move on.

A. Open the airway and reassess breathing status.

Which of the following is NOT a responsibility of the treatment supervisor? A. Primary assessment B. Secondary triage C. Patient packaging D. Communication with the medical branch director

A. Primary assessment

As the first-arriving senior EMT at the scene of an incident, you should perform a scene size-up and then: A. establish command. B. begin the triage process. C. call for additional resources. D. quickly identify the walking wounded.

A. establish command.

Placards and labels on a storage container are intended to: A. give a general idea of the hazard inside that particular container. B. advise responders of the appropriate neutralizing measures. C. broadly classify chemicals as being explosive or nonexplosive. D. provide specific information about the chemical being carried.

A. give a general idea of the hazard inside that particular container.

A supervisor who has more than seven people reporting to him or her: A. has exceeded an effective span of control and should divide tasks and delegate the supervision of some tasks to another person. B. is more beneficial to the overall effort than a supervisor with fewer personnel because his or her team can accomplish more tasks. C. should regularly report to the incident commander (IC) to inform him or her of the functions that his or her team is performing. D. should assign a specific task to each person reporting to him or her and regularly follow up to ensure that the tasks were carried out

A. has exceeded an effective span of control and should divide tasks and delegate the supervision of some tasks to another person.

Upon arriving at a scene in which the incident command system has been activated, you should expect to: A.be passed from sector to sector, as needed, in between assignments. B.report directly to the incident commander in between assignments. C.be assigned a specific responsibility for the duration of the incident. D.be given general directions and allowed to function independently.

Answer: A Rationale: The incident commander establishes sectors of responsibility and sector officers. When functioning at an incident in which the incident command system has been activated, you should report to the appropriate sector officer, carry out your assignment, and report back to the sector officer. In many cases, you will be asked to report to a different sector.

Which of the following patients would have the HIGHEST treatment priority at the scene of a mass-casualty incident? A.24-year-old man who is unconscious, has snoring respirations, and severe burns B.32-year-old woman who is pulseless and apneic with an abdominal evisceration C.29-year-old woman who is in full cardiac arrest with massive open chest trauma D.32-year-old man with an open head injury, exposed brain matter, and no carotid pulse

Answer: A Rationale: Three of the four patients (B, C, and D) are dead. Triage efforts are aimed at providing the greatest amount of good for the greatest number of people. Attempting to resuscitate a patient in traumatic cardiac arrest is futile in almost all cases.

Which of the following situations MOST likely involves a hazardous material? A.Milk truck that overturned and is leaking fluid B.Tractor trailer rig that is emitting a visible cloud C.Moving van that collided head-on with a small car D.Pickup truck from the gas company that struck a tree

Answer: B Rationale: A crash does not need to occur for a spill or leak to happen. A vehicle that is emitting a visible cloud should make you suspicious that a hazardous material is involved—especially if the vehicle is a tractor trailer rig. In such cases, you should stay uphill and upwind and notify the fire department or HazMat team.

Which toxicity level would you assign a hazardous material spill that could cause a person temporary damage or residual injury unless prompt medical treatment is given? A.Level 1 B.Level 2 C.Level 3 D.Level 4

Answer: B Rationale: Level 2 toxicity includes materials that could cause temporary damage or residual injury unless prompt medical treatment is provided. Level 1 toxicity includes materials that would cause little, if any, health hazard. Level 3 toxicity includes materials that are extremely hazardous to health and requires full protective gear. Level 4 toxicity includes materials that are so hazardous that even minimal contact will cause death.

When EMS responds to a disaster, as part of their response within the ICS, EMS would start with a scene size-up. What is the next step for the first-responding units? A.Communicating with additional units B.Establishing command C.Caring for any injuries D.Stabilizing the incident

Answer: B Rationale: The first EMS unit to arrive needs to function within the ICS. Once you have performed a good scene size-up and answered the three basic questions to complete a scene size-up, command should be established by the most senior official, notification to other responders should go out, and necessary resources should be requested.

A large tanker truck has overturned on a highway. When you arrive, you see a clear liquid leaking from the rear of the tanker. The driver, who appears to be unconscious, is still in the vehicle and is bleeding heavily from the face. You should: A.immediately notify law enforcement for traffic control. B.fully assess the situation and request the appropriate assistance. C.put on gloves, a gown, and a mask and quickly remove the driver. D.go to the rear of the tanker and determine what type of fluid is leaking.

Answer: B Rationale: Upon arriving at the scene of a possible HazMat incident, you must first step back and assess the situation. This can be very stressful—especially if you see a patient. However, rushing into such a situation puts your own life in jeopardy. Once you have properly assessed the scene, you should request the appropriate assistance, such as the fire department or hazardous materials team.

When dealing with a hazardous materials incident, where should you set up your decontamination area? A.Inside the hazard zone B.Inside the treatment area C.Between the hazard zone and treatment area D.Between the treatment and transportation zone

Answer: C Rationale: The decontamination area should be set up between the hazard zone and the treatment area. This way, patients cannot bring any hazardous materials into the treatment area and contaminate anyone else.

Which of the following statements BEST describes a mass-casualty incident? A.At least half of the patients are dead. B.Either a bus or an airplane has crashed. C.You have more than two critical patients. D.The patient count exhausts your resources.

Answer: D Rationale: A mass-casualty situation is one that places such a great demand on available equipment or personnel that the system is stretched to its limits or beyond. While bus accidents and plane crashes are classic examples of MCIs, they are not the only situations that can exhaust your resources.

How does a disaster differ from a mass-casualty incident? A.Disasters may not involve personal injuries. B.In a disaster, EMS may be on the scene for days or weeks. C.Only an elected official can declare a disaster. D.All of the above.

Answer: D Rationale: Many disasters, such as droughts that cause widespread crop damage, do not involve personal injury. An MCI generally lasts no longer than a few hours, but emergency responders may be on the scene for days or weeks in a disaster. Although you can "declare" an MCI, only an elected official can declare a disaster.

What is the purpose of the incident command system (ICS)? A.Ensuring responder and public safety B.Achieving incident management goals C.Ensuring the efficient use of resources D.All of the above.

Answer: D Rationale: The purpose of the ICS is ensuring responder and public safety, achieving incident management goals, and ensuring the efficient use of resources.

In preparing for a disaster, EMS systems should have enough supplies for at least a ______ period of self-sufficiency. A. 96-hour B. 72-hour C. 24-hour D. 48-hour

B. 72-hour

Which of the following is probably NOT a multiple-casualty incident? A. A rollover crash of a school bus with eight children who have injuries of varying severity B. A motor vehicle crash with two critically injured patients and two ambulances C. A loss of power to a hospital or nursing home with ventilator-dependent patients D. An apartment fire with one patient and the possibility of others trapped in the building

B. A motor vehicle crash with two critically injured patients and two ambulances

Which of the following is NOT a common role of the EMT at the scene of a HazMat incident? A. Rehabilitation B. Decontamination C. Transportation D. Triage and treatment

B. Decontamination

Which of the following statements regarding transport of patients from a multiple-casualty incident or disaster site is correct? A. Delayed-priority patients should be transported five at a time. B. Immediate-priority patients should be transported two at a time. C. Walking wounded patients should be taken to the closest hospitals. D. Patients who are in cardiac arrest should clearly be transported first.

B. Immediate-priority patients should be transported two at a time.

Upon arriving at the scene of a possible hazardous materials (HazMat) incident involving several patients, you should: A. retrieve all critical patients. B. carefully assess the situation. C. divert traffic away from the scene. D. rope off the entire perimeter.

B. carefully assess the situation.

A carboy is a container that would MOST likely be used to store and transport: A. explosives. B. corrosives. C. flammable liquids. D. combustible materials.

B. corrosives.

A 49-year-old man has been removed from his overturned tanker, which was carrying a hazardous material. The tank ruptured and he was exposed to the material. When rescue personnel bring him to the decontamination area, they note that he is unconscious and has slow, shallow breathing. They should: A. decontaminate the patient as they would any other patient and then move him to the area where EMTs are waiting. B. cut away all of the patient's clothing and do a rapid rinse to remove as much of the contaminating matter as they can. C. defer the decontamination procedure and bring the patient directly to awaiting EMS personnel for immediate treatment. D. request that EMS personnel don standard precautions, enter the warm zone, and begin immediate treatment of the patient.

B. cut away all of the patient's clothing and do a rapid rinse to remove as much of the contaminating matter as they can.

You and your partner are the first to arrive at the scene of a motor vehicle accident. As you approach the scene, you can see multiple patients, some walking and others who are still in their vehicles. You should: A. establish an incident command post until you are relieved of your duties. B. declare a multiple-casualty incident and request additional resources. C. begin rapidly triaging all patients before requesting additional help. D. immediately move all ambulatory patients to a designated area.

B. declare a multiple-casualty incident and request additional resources.

The process of removing or neutralizing and properly disposing of a hazardous material is called: A. neutralization. B. decontamination. C. antidotal treatment. D. chemical containment.

B. decontamination.

During a motor vehicle collision involving multiple patients, the incident commander would MOST likely: A. maintain responsibility for all of the command functions. B. designate a safety officer, but retain other command functions. C. delegate all of the command functions to the appropriate personnel. D. relinquish command when a senior EMS provider arrives at the scene.

B. designate a safety officer, but retain other command functions.

The purpose of the incident command system (ICS) is to: A. reduce overall mortality and morbidity from large-scale mass-casualty incidents and to restore key infrastructure. B. ensure responder and public safety, achieve incident management goals, and ensure the effective use of resources. C. quickly and efficiently respond to natural disasters and terrorist incidents, regardless of the complexity of the incident. D. protect the public from the effects of large- and small-scale disasters and to minimize the financial impact from such incidents.

B. ensure responder and public safety, achieve incident management goals, and ensure the effective use of resources.

Injuries or conditions that would be classified as first priority (red tag; immediate) include all of the following, EXCEPT: A. severe medical problems. B. fractures of multiple long bones. C. any airway or breathing difficulty. D. uncontrolled or severe hemorrhage.

B. fractures of multiple long bones.

The term used when individual units or different organizations make independent, and often inefficient, decisions regarding an incident is called: A. logistical chaos. B. freelancing. C. undermining. D. single command.

B. freelancing.

Unlike a multiple-casualty incident, a natural disaster: A. is typically short-lived and does not require as much manpower. B. often requires personnel to remain on scene for several days. C. usually does not require the incident command system process. D. exists when there are more than 100 critically injured patients.

B. often requires personnel to remain on scene for several days.

You and your partner arrive at the scene where a truck has crashed into a small building, injuring eight people. You immediately request additional ambulances and begin the triage process. The first patient that you triage is a young female who is unconscious and apneic. She has an open head injury and her pulse is weak and thready. You should: A. assess the severity of her open head injury. B. place a red tag on her and continue triaging. C. begin ventilating her with a bag-valve mask. D. assign her a low priority and continue triaging.

B. place a red tag on her and continue triaging.

Which of your senses can be safely used to identify a HazMat incident? A. Sight and touch B. Sound and smell C. Sight and sound D. Smell and sight

C. Sight and sound

As a triage supervisor, you: A. are responsible for providing initial treatment to all patients. B. must prepare patients for transport before they leave the triage area. C. must not begin treatment until all patients have been triaged. D. should communicate with area hospitals regarding their capabilities.

C. must not begin treatment until all patients have been triaged.

The function of the National Incident Management System (NIMS) is to: A. prepare for the potential of a nuclear attack against the United States. B. educate city and county governments regarding foreign terrorist attacks. C. prepare for, prevent, respond to, and recover from domestic incidents. D. facilitate a standard method of incident command for natural disasters.

C. prepare for, prevent, respond to, and recover from domestic incidents.

You have a critically injured patient in the back of your ambulance, ready to be transported. There are other injured patients at the scene and it will be approximately 10 minutes before other ambulances will arrive. Law enforcement personnel are at the scene. You should: A. transport the critically injured patient to a trauma center. B. direct a police officer to monitor the patients as you transport. C. remain at the scene until at least one other ambulance arrives. D. assign the least injured patient the task of caring for the others.

C. remain at the scene until at least one other ambulance arrives.

According to the JumpSTART triage system, infants or children not developed enough to walk or follow commands, including children with special needs: A. are treated immediately in the primary triage area and then transported. B. are initially triaged on the basis of whether or not they have distal pulses. C. should be taken to the treatment area for immediate secondary triage. D. are the first to be transported, regardless of the severity of their injuries.

C. should be taken to the treatment area for immediate secondary triage.

Interoperability, an important feature of the NIMS, refers to the ability of: A. the federal government to intervene during any large- or small-scale incident involving terrorism. B. EMS systems and fire departments in the same jurisdiction to effectively work as a team. C. county and state law enforcement agencies to acquire information and pass it along to EMS personnel. D. agencies of different types or from different jurisdictions to communicate with each other.

D. agencies of different types or from different jurisdictions to communicate with each other.

General principles for approaching a potential HazMat incident include: A. parking the ambulance in a location that is upwind and downhill. B. taking standard precautions before entering any HazMat scene. C. asking for wind direction from dispatch and entering downwind. D. maintaining a safe distance and viewing the scene with binoculars.

D. maintaining a safe distance and viewing the scene with binoculars.

The FIRST step in the START triage system is to: A. focus on the patients who are unconscious. B. scan the area for patients with severe bleeding. C. get a quick head count of all the patients involved. D. move all walking patients to a designated area.

D. move all walking patients to a designated area.

A Level 4 hazardous material: A. causes temporary damage or injury unless prompt medical care is provided. B. requires protective gear to ensure that no part of the skin's surface is exposed. C. is mildly toxic but still requires the use of a self-contained breathing apparatus. D. requires specialized gear designed for protection against that particular hazard.

D. requires specialized gear designed for protection against that particular hazard.

The reference used as a base for your initial actions at a HazMat incident is: A. the bill of lading. B. your local EMS protocols. C. the material safety data sheet (MSDS). D. the Emergency Response Guidebook.

D. the Emergency Response Guidebook.

The MOST appropriate location to park your ambulance at a HazMat incident is: A. downwind at least 200 feet from the scene. B. downhill at least 100 feet from the incident. C. uphill at least 25 feet from the incident site. D. upwind at least 100 feet from the incident.

D. upwind at least 100 feet from the incident.