Chapter 39 | Mass-Casualty Incidents

Question 1

Define:

MCI

(abbreviation)

Answer 1

mass-casualty incident

Question 2

Define:

mass-casualty incident (MCI)

Answer 2

EMS incident wherein number of patients outweighs available resources

Question 3

Define:

NIMS

(abbreviation)

Answer 3

National Incident Management System

Question 4

Define:

triage

Answer 4

preliminary assessment of patients or casualties in order to determine the urgency of their need for treatment and the nature of treatment required

(used for determining most serious patient and who to treat first)

Question 5

Describe:

goal of triage

Answer 5

to afford the greatest number of people the greatest chance of survival

Question 6

List:

patient triage priorities

4 points (and describe them)

Answer 6

• priority 1: treatable life-threatening illness/injury
• priority 2: serious (but not life-threatening) illness/injury
• priority 3: walking wounded
• priority 4: dead or fatally injured

priority 4 may also be known as priority 0

Question 7

List:

patient triage priorities

4 points (and the color codes)

Answer 7

• priority 1: red
• priority 2: yellow
• priority 3: green
• priority 4: black

priority 4 may also be known as priority 0

Question 8

Define:

HAZMAT

(abbreviation)

Answer 8

hazardous materials

Question 9

Define:

hazardous materials (HAZMAT)

Answer 9

any substance or material in a form that poses an unreasonable risk to health, safety, and property when transported in commerce or kept in storage at a warehouse, port, depot, or railroad facility

Question 10

Define:

OSHA

(abbreviation)

Answer 10

Occupational Safety and Health Administration

government agency focused on workplace safety (including HAZMAT stuff)

Question 11

Define:

EPA

(abbreviation)

Answer 11

Environmental Protection Agency

government agency focused on eco-stuff (including HAZMAT stuff)

Question 12

Define:

HAZWOPER

(abbreviation)

Answer 12

Hazardous Waste Operations and Emergency Response

OSHA’s 5 levels of required trainings for HAZMAT responders

Question 13

List (in order):

OSHA’s HAZWOPER levels of training

5 points

Answer 13

1. First Responder Awareness
2. First Responder Operations
3. Hazardous Materials Technician
4. Hazardous Materials Specialist
5. On-Scene Incident Commander

Question 14

List:

places where HAZMAT incidents may be likely

4 points

Answer 14

• highway
• trucking terminals
• chemical plants
• places chemicals are used (trucks/agriculture/gardens/railways/laboratories)

being made, transport, or in use

Question 15

Fill in the blanks:

If you arrive first at the scene of a HAZMAT incident, establish [BLANK] and [BLANK].

(physical boundaries)

Answer 15

establish a danger zone and a safe zone.

Question 16

Fill in the blank:

At the scene of a HAZMAT incident, keep all people out of the [DANGER/SAFE] zone and try to convince them to leave the immediate area.

Answer 16

keep all people out of the danger zone and try to convince them to leave the immediate area.

Question 17

Fill in the blank:

At the scene of a HAZMAT incident, stay in the [DANGER/SAFE] zone until expert help arrives and makes other areas safe to enter.

Answer 17

stay in the safe zone until expert help arrives and makes other areas safe to enter.

Question 18

Fill in the blank:

At the scene of a HAZMAT incident, the safe zone should be located [BLANK].

2 points (where?)

Answer 18

the safe zone should be located on the same level as and upwind from the incident site.

Question 19

Fill in the blank:

At the scene of a HAZMAT incident, the safe zone should not be located [BLANK].

(where?)

Answer 19

At the scene of a HAZMAT incident, the safe zone should not be located in low-lying areas or downhill from the incident site.

lest risk the case of flowing liquids making your safe zone not safe

Question 20

Define:

hot zone

(HAZMAT)

Answer 20

area immediately surrounding a HAZMAT incident

extends far enough to prevent adverse effects outside zone

Question 21

Define:

warm zone

(HAZMAT)

Answer 21

area where personnel and equipment decontamination and hot zone support take place

includes control points for access corridor

Question 22

Define:

cold zone

(HAZMAT)

Answer 22

area where the Incident Command post and support functions are located

Question 23

List:

phases of decontamination

2 points

Answer 23

• gross decontamination
• secondary decontamination

Question 24

Define:

gross decontamination

Answer 24

removal or chemical alteration of the majority of the contaminant

must be assumed that some residual contaminant will remain on the host

Question 25

Define:

secondary decontamination

Answer 25

alteration or removal of most of the residual product contamination

provides a more thorough decontamination than the gross effort

Question 26

List:

mechanisms for decontamination

7 points

Answer 26

• emulsification
• chemical reaction
• disinfection
• dilution
• absorption/adsorption
• removal
• disposal

Question 27

Fill in the blank:

One way to minimize the operating difficulties of a large-scale MCI is for every EMT to be familiar with the local [BLANK].

Answer 27

One way to minimize the operating difficulties of a large-scale MCI is for every EMT to be familiar with the local disaster plan.

Question 28

Define:

ICS

(acronym)

Answer 28

incident command system

Question 29

Define:

unified command

Answer 29

command organization in which several agencies work independently but cooperatively

Question 30

Define:

single incident command

Answer 30

command organization in which a single agency controls all resources and operations

Question 31

Define:

triage supervisor

Answer 31

person responsible for overseeing triage at an MCI

Question 32

Define:

staging area

Answer 32

area where ambulances are parked and other resources are held until needed

Question 33

Define:

staging supervisor

Answer 33

person responsible for overseeing ambulances and ambulance personnel at an MCI

Question 34

Define:

surge capacity

Answer 34

measurable representation of ability of a medical facility to manage a sudden influx of patients

Question 35

Choose:

On arrival at the scene of a vehicle fire involving a large truck, you observe that the large truck has placards on each of its sides. Using the Emergency Response Guidebook, you would find that Benzene (benzol) is a chemical that:

A. damages the eyes by eliminating moisture.

B. has toxic vapors that can be absorbed through the skin.

C. is used as an industrial blasting agent.

D. is used in surgical techniques to control pain.

Answer 35

B

Question 36

Choose:

The regulations that are meant to enhance the knowledge, skills, and safety of emergency response personnel, as well as bring about a more effective response to hazmat emergencies, are found in:

A. the Ryan White CARE Act

B. FEMA 1910.1030

C. NFPA 1200

D. OSHA 29 CFR 1910.120

Answer 36

D

Question 37

Choose:

The description of a HAZWOPER level in the regulations is as follows: “Those who initially respond to releases or potential releases of hazardous materials in order to protect people, property, and the environment. They stay at a safe distance, keep the incident from spreading, and protect others from any exposures.”

What level of training does this statement describe?

A. First Responder Awareness

B. First Responder Operations

C. Hazardous Materials Technician

D. Hazardous Materials Specialist

Answer 37

B

Question 38

Choose:

A statement in CFR 1910.120 reads, “Rescuers who are likely to witness or discover a hazardous substance release. They are trained only to recognize the problem and initiate a response from the proper organizations.”

What level of training does this statement describe?

A. First Responder Awareness

B. First Responder Operations

C. Hazardous Materials Technician

D. Hazardous Materials Specialist

Answer 38

A

Question 39

Choose:

The standard that deals with competencies for EMS personnel at a hazardous materials incident is:

A. OSHA 1910.1030.

B. NFPA 472.

C. NFPA 473.

D. OSHA 1910.1200.

Answer 39

C

Question 40

Choose:

You are responding to a location in your district. The dispatcher informs you that the caller has stated that there may be hazardous materials stored at the location.

Which of the following is not likely to be a potential hazardous material location?

A. A garden center

B. A chemical plant

C. A trucking terminal

D. A pet store

Answer 40

D

Question 41

Fill in the blank:

Unless EMS personnel are trained to the level of [BLANK], they must remain in the cold zone.

Answer 41

Unless EMS personnel are trained to the level of Hazardous Materials Technician, they must remain in the cold zone.

Question 42

Fill in the blank:

All victims leaving the [BLANK] of a hazardous materials incident should be considered contaminated until proven otherwise.

(region)

Answer 42

All victims leaving the hot zone of a hazardous materials incident should be considered contaminated until proven otherwise.

Question 43

Choose:

The primary concern at the scene of a hazardous materials incident is:

A. the safety of the EMT and crew, patients, and the public.

B. stabilizing the incident as fast as possible.

C. quickly removing all exposed patients from the scene.

D. determining the extent and cost of the damage.

Answer 43

A

The primary concern at the scene of a hazardous materials incident is the safety of the EMT and crew, patients, and the public. Stabilizing the incident often takes a long time. Exposed patients need to be removed, but this too does not happen quickly because of the need to identify the hazardous material and decontaminate the parients.

Question 44

Choose:

The role of Command at a hazardous materials incident is to delegate responsibility for all the following except:

A. directing bystanders to a safe area.

B. establishing a perimeter.

C. immediately initiating rescue attempts.

D. evacuating people if necessary.

Answer 44

C

Initiating rescue attempts inside the hot zone is
delayed until the product and proper protection needs are determined.

Question 45

Fill in the blank:

You are on the scene of a hazmat incident. One of your roles is to limit the spread of the hazardous materials.

When a contaminated victim of a hazmat incident comes into contact with people who are not contaminated, this is referred to as [BLANK] contamination.

Answer 45

this is referred to as secondary contamination.

Question 46

Fill in the blank:

The designations on the sides of tanker trucks are called hazardous material [BLANK].

Answer 46

The designations on the sides of tanker trucks are called hazardous material placards.

Question 47

Choose:

The commonly used placard system for fixed facilities is called the:

A. MSDS system.

B. NFPA 704 system.

C. CHEM 369 system.

D. UN Classification system.

Answer 47

B

Question 48

Choose:

All employers are required to post, in an obvious spot, the information about all the chemicals in the workplace on a form called a(n):

A. NFPA 704.

B. MSDS.

C. OSHA chemical listing.

D. fair trade posting.

Answer 48

B

Material Safety Data Sheet

Question 49

Define:

MSDS

(abbreviation)

Answer 49

Material Safety Data Sheet

Question 50

Choose:

Resources that the EMT should use at a hazardous materials incident include all of the following except:

A. copies of NFPA rules.

B. the local hazmat team.

C. the Emergency Response Guidebook.

D. CHEM-TEL.

Answer 50

A

The NFPA rules are only guidelines and do not detail how to manage an incident. Resources that the EMT should use at a hazardous materials incident include the local hazmat team, the Emergency Response Guidebook and CHEM-TEL.

Question 51

Choose:

The Incident Commander at the hazmat incident is collecting needed information so that she can contact CHEMTREC.

What is CHEMTREC?

A. A twenty-four-hour service for identifying hazardous materials

B. An oil refinery and manufacturer

C. A national hazmat response team

D. A round-the-clock special rescue team

Answer 51

A

Question 52

Define:

CHEMTREC

(what is it)

Answer 52

a 24-hour service for identifying hazardous materials

Question 53

Choose:

EMS personnel at the scene of a hazardous materials incident are responsible for taking care of the injured and:

A. identifying and controlling the substance involved.

B. monitoring and rehabilitating hazmat team members.

C. decontaminating patients exiting the hot zone.

D. moving patients from the hot zone to the warm zone.

Answer 53

B

The responsibilities of EMS personnel are hazardous materials incident arc taking care of the injured and monitoring and rehabilitating hazrnar team mernbers.

Question 54

Choose:

Which of the following is not a characteristic of the rehabilitation operations at a hazardous materials incident?

A. They are located in the warm zone.

B. They are protected from the weather.

C. They are easily accessible to EMS.

D. They are free from exhaust fumes.

Answer 54

A

The rehabilication operations at a hazardous materials incident should be located in the cold zone, not the warm zone. They should also be protected from the weather, easily accessible to EMS, and free rrom exhaust fumes.

Question 55

Choose:

As soon as possible after a hazmat team member exits the hot zone, the EMT in the rehab operations should:

A. have the team member drink a pint of water.

B. remove the team member’s protective clothing.

C. begin the decontamination process.

D. reassess the team member’s vital signs.

Answer 55

D

As soon as possible after a hazmat team member exits the hot zone, the EMT should reassess the team member’s vital signs. Remember that hazmat team members should also have their baseline vitals taken while suiting up, and both pre-entry and exit vitals should be tracked on a flow sheet.

Question 56

Choose:

You are confronted with a patient who is at risk for causing secondary contamination in which treatment calls for irrigation with water. The hazmat team has not yet arrived. Which of the following actions is not recommended?

A. Cut the patient’s clothes off.

B. Irrigate the patient with tepid water.

C. Flush runoff water down the nearest drain.

D. Use disposable equipment for treatment.

Answer 56

C

Always try to contain the runoff water when it is necessary to decontaminate a patient before hazmat specialists arrive. Flushing water down the nearest drain could contarninate the area’s entire water supply.

Question 57

Choose:

Which of the following is not a feature of a good local disaster plan?

A. All emergency responders should be familiar with the plan.

B. The plan must be based on the actual availability of resources.

C. The plan must be rehearsed to ensure it works correctly.

D. The plan should be generic and meet national standards.

Answer 57

D

A good local disaster plan is not generic; rather, it should be written to address the events that are conceivable for a particular location (e.g., locations in Florida need to plan for hurricanes, and locations in Kansas need to plan for tornadoes).

Question 58

Choose:

On arrival of the first EMS unit at the scene of an MCI, the crew leader should do all of the following except:

A. assume command.

B. conduct a scene walk-through.

C. call for backup.

D. begin patient treatment.

Answer 58

D

On arrival of the first EMS unit at the scene of an MCI, after ensuring the scene is safe, the crew leader should assume command, conduct a scene walk-through, and
call for backup. The crew leader should not begin patient treatment on arrival. Even though this might save one or two lives. it would be at the expense of the majority of the patients because response would be delayed and disorganized.

Question 59

Choose:

Which of the following is not a principle of good communication at an MCI?

A. The person responsible for incident management should have a unique Command name.

B. Responding units should be informed that a disaster plan is in effect.

C. The majority of communications should be done via radio transmission.

D. Communications between Command and sector officers should be face-to-face.

Answer 59

C

Once units arrive at an MCI, as much face-to-face communication as possible should he used, especially between Command and area supervisors and berween area supervisors and subordinates. This will help to reduce radio channel crowding.

Question 60

Choose:

You have been assigned to the rehabilitation area at a hazardous materials incident. One of your responsibilities will be the medical monitoring of the hazmat team before and after working in their chemical-protective suits. One team member comes into your area and is anxious to get suited back up and go back to work. You take a set of vitals on him that reveal the following: respiratory rate of 20 and regular, heart rate of 120 and bounding, blood pressure of 132/84 mmHg, and Sp02 of 98%.

What should you do next with this team member?

A. Take his oral temperature.

B. Let him suit back up after drinking some fluids.

C. Have him sit for 15 more minutes.

D. Tell him that he is done for the day.

Answer 60

A

If the team member has a heart rate over 110, it is recommended that his oral temperature be taken. If his oral temperature is over 100.6°F, he should stay in the rehabilitation area or go to the hospital, as needed, but not go back into a suit.

Question 61

Choose:

You have been assigned to the rehabilitation area at a hazardous materials incident. Proper hydration is an important element in preventing heat stress and promoting optimal physical performance.

How much fluid would be reasonable to consume per hour during physical exertion?

A. 2 gallons

B. 1 gallon

C. 2 quarts

D. 1 quart

Answer 61

D

During periods of extreme physical exertion, fluid should be replaced at 1 quart per hour. Of course, there is some variability based on the person involved.

Question 62

Choose:

Some services administer different fluids in their rehab sectors. What other fluid would be appropriate to offer the team members?

A. Coffee that is cold or hot

B. Tea that is cold or hot

C. Soda or diet soda

D. Watered-down sports drink

Answer 62

D

Question 63

Choose:

Yours is the first unit to arrive at the scene of a multiple-casualty incident. A train car derailed, and there are injured people all over.

Aside from confirming the incident and calling for additional help, what is one of the first steps in beginning triage?

A. Talk to each patient and assign her or him a triage tag.

B. Use the PA system to instruct those who can walk to go to a specific location.

C. Locate the dead and have them removed from the scene.

D. Evaluate the mental status of each patient.

Answer 63

B

The first step in the START system is to announce over the PA system that individuals who can walk without becoming further injured should go to a specific nearby location. This will separate the “walking wounded” from the rest of the patients.

Question 64

Choose:

In the START system, the amount of treatment provided before tagging the patients is limited to:

A. splinting and applying a cervical collar.

B. opening an airway and applying pressure on a bleeding wound.

C. traction splinting and occlusive dressings.

D. assisting patients in taking their own pain medications.

Answer 64

B

Acceptable treatment while evaluating a patient for a START triage category includes opening an airway, inserting an OPA, and putting pressure on a bleeding wound to control bleeding.

Question 65

Fill in the blank:

You are assigned to a rehab area at a HAZMAT incident.

If a team member returning from the hot zone has a heart rate over 110, it is recommended that [BLANK].

Answer 65

it is recommended that his/her temperature be taken.

If his/her oral temperature is over 100.6°F, he/she should stay in the rehabilitation area or go to the hospital, as needed, but not go back into a suit.

Question 66

Fill in the blank:

You are assigned to a rehab area at a HAZMAT incident. If a team member returning from the hot zone has a heart rate over 110, it is recommended that his temperature be taken.

If his oral temperature is [BLANK], he should stay in the rehabilitation area or go to the hospital, as needed, but not go back into a suit.

Answer 66

If his oral temperature is over 100.6°F, he should stay in the rehabilitation area or go to the hospital, as needed, but not go back into a suit.

Question 67

Fill in the blank:

You are assigned to a rehab area at a HAZMAT incident. If a team member returning from the hot zone has a heart rate over 110, it is recommended that his temperature be taken.

If his oral temperature is over 100.6°F, he should [BLANK].

Answer 67

he should stay in the rehabilitation area or go to the hospital, as needed, but not go back into a suit.

“put me in coach” says concussed linebacker

Question 68

Choose:

Using the START triage, what is the first step/assessment made when assessing a patient of a multiple casualty incident (MCI)?

A. Assess the patient’s ability to walk.

B. Assess the airway.

C. Assess their cardiac function.

D. Assess for the presence of any bleeding.

Answer 68

A

Step 1 of the START triage technique states the patient’s ability to walk should be rapidly assessed. If a patient can walk, that indicates the patient is at least stable enough to be delayed treatment for a short period of time.

Patients that cannot walk should have the formal assessment begun which starts with an assessment of respiration (airway and breathing).

Question 69

Choose:

You respond to a motor vehicle accident but upon arrival to the scene, you find multiple other vehicles have crashed in the time since EMS was called. Of the options available, what is the first action you should take in this situation?

A. Identify the most injured patient.

B. Establish a treatment area.

C. Begin the triage process.

D. Request additional resources.

Answer 69

D

Upon arriving to a scene of a multiple casualty incident that you are not prepared for (in this case, being a single unit responding to a scene with a large number of potneital patients) the best first action is to request additional resources followd by beginning the triage process.

Question 70

Choose:

You are the first on the scene of a 25-car pileup on the interstate. What is the best first step to take after you ensure the scene is safe?

A. Treat the most serious patient first

B. Transport up to 5 patients immediately and begin workup

C. Establish a treatment area

D. Call for additional units and begin triaging patients

Answer 70

D

Of the choices offered, your first priority is to call for additional units. Once a triage officer has been identified for the incident, this triage officer can initiate a request for ADDITIONAL RESOURCES to manage the triage efforts at the incident and begin START (Simple Triage And Rapid Transport) triage. The safety of responders is of the utmost importance when responding to natural or man-made disasters. From a position of safety, responders can establish the incident command system, size up the scene, develop an incident action plan, and REQUEST ADDITIONAL RESOURCES.