Ch. 20 EMS & Disaster Med

Question 1

Which act authorized the dept of transportation to develop prehospital services?

Answer 1

Highway Safety Act (1966)

Question 2

Which Act provided government funding and training to encourage development
of regional, county, and local EMS systems and identified essential components of an EMS system?

Answer 2

Emergency Medical Services System Act (1973)

Question 3

Which act requires a medical screening
examination and stabilization of any emergent medical condition (including active labor) for any patient who presents to a hospital with an emergency department?

Answer 3

Emergency Medical Treatment and Active Labor Act (EMTALA) 1985

Question 4

Which act authorized government funds to states for development of trauma
systems?

Answer 4

Trauma Care Systems Planning and Development Act (1990)

Question 5

In medical terms, how is a “disaster” defined?

Answer 5

any event where the needs exceed
the available resources

Question 6

How is a “mass gathering” defined?

Answer 6

an event of over 1000 people gathered at a specific location for a specific amount of time (eg, sporting event, music festival)

Question 7

Per JCAHO, How often must all hospitals perform disaster preparedness drills?

Answer 7

twice yearly

Question 8

What are the four phases of disaster preparedness?

Answer 8

mitigation, preparedness, response (activation, implementation), and recovery

Question 9

What are the Simple Triage and Rapid Treatment (START) four color designations?

Answer 9

■ Red (immediate): Critical or immediate life-threatening illness or injury (eg, tension pneumothorax, hypovolemic shock)
■ Yellow (delayed): Serious but not immediately life-threatening illness or
injury (eg, most long bone fractures)
■ Green (minor): The walking wounded (eg, anxiety attack after witnessing event, minor burns)
■ Black (dead/dying, or expectant): Dead or resource-intensive victims (eg, 100% TBSA burn)

Question 10

How long is antibiotic therapy for anthrax?

Answer 10

60 days

Question 11

What is the treatment for anthrax in toxic patients or with inhalational disease?

Answer 11

1. Requires triple antibiotic therapy
   with ciprofloxacin or doxycycline plus 2 additional antibiotics (eg, rifampin,
   clindamycin, aminoglycoside, imipenem).
   x60 days
   PLUS
2. Vaccination - 3 doses (days 0, 14, and 28)

Question 12

What is treatment for plague (y pestis)?

Answer 12

Antibiotics: Options include streptomycin, gentamycin, doxycycline, ciprofloxacin,
and chloramphenicol (do not use chloramphenicol or streptomycin in pregnant patients)

Question 13

What organism causes smallpox?

Answer 13

Variola sp, a genus of large DNA viruses.

Question 14

How is small pox spread?

Answer 14

via aerosol

Question 15

How does rash of smallpox and chickenpox differ in their spread?

Answer 15

Smallpox starts in the face and forearms
and spreads inward (centrifugal), whereas
chickenpox starts in the trunk and spreads
outward (centripetal).

Question 16

How long are people with smallpox contagious?

Answer 16

until all scabs fall off

Question 17

What type of isolation is required for small pox?

Answer 17

airborne isolation

Question 18

What type of isolation is required for tularemia?

Answer 18

isolation is NOT required

Question 19

What is treatment for tularemia?

Answer 19

Antibiotic: Streptomycin is drug of choice. Gentamycin also effective.

Question 20

What are names of four nerve agents (organophosphates)?

Answer 20

sarin, tabun, soman, and VX

Question 21

What is the mechanism of action of organophosphates/nerve agents?

Answer 21

Nerve agents inhibit acetylcholinesterase,
producing a cholinergic toxidrome.

Question 22

What are antidotes for organophosphates/nerve agents?

Answer 22

Atropine and pralidoxime, available in
Mark 1 autoinjector kit.

Question 23

How does mustard injury occur?

Answer 23

induces blistering due to cellular damage – resembles second degree burns

Question 24

What is treatment for mustard injury?

Answer 24

Supportive care, skin and mucous membrane decontamination with irrigation,
topical care for burns and eye injuries (do not require aggressive fluid resuscitation as not a typical burn), intubation for severe respiratory exposures

Question 25

What is the treatment for radiation exposure?

Answer 25

■ Immediate decontamination.
■ Remove clothing (rids approximately 90% of radiation), wash skin.
■ Enhance elimination of ingested particles (cathartics, lavage etc).
■ Blocking agents, eg, potassium iodine for radioiodine exposure.
■ Chelating agents, eg, calcium disodium edetate and penicillamine for
radioactive lead exposure.
■ Ferric hexacyanoferrate (Prussian blue) for Cesium-137 and thallium
exposure.
■ Ca- and Zn-diethylenetriamine pentaacetate (DTPA) for plutonium,
americium, curium exposure.
■ Supportive care, bone marrow stimulating factors, treatment of fever and
neutropenia with antibiotics.

Question 26

In radiation exposure, what lab value can be used to predict survival?

Answer 26

Absolute lymphocyte count at 48 hours