Chapter 29: Natural and Man-Made Disasters Nies: Community/Public Health Nursing, 8th Edition

1. Which U.S. agency is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster?

a. American Red Cross (ARC)

b. The Department of Homeland Security (DHS)

c. Federal Emergency Management Agency (FEMA)

d. The National Incident Management System (NIMS)

ANS: D

Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President George W. Bush established the NIMS in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2017a). The ARC is not a governmental agency. It is chartered by Congress to provide disaster relief. It works in partnership with FEMA, DHS, the Centers for Disease Control and Prevention, and other local, state, and federal agencies to provide and manage needed services. The DHS was established to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland.

2. Which statement best describes how a disaster is the same as or different from an emergency?

a. A disaster is personal, whereas an emergency is communitywide.

b. An emergency is personal, whereas a disaster is communitywide.

c. Both emergencies and disasters are devastating.

d. Both emergencies and disasters are failures resulting in extensive insurance claims.

ANS: B

A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Emergencies differ from disasters in that the agency, community, family, or individual can manage an emergency using their own resources. However, a disaster event may be beyond the ability of the community to respond to and recover from the incident using its own resources. Disasters frequently require assistance from outside the immediate community. The type of emergency or disaster will determine the level of devastation or need for extensive insurance claims to be filed.

3. A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. Which action should the hospital take immediately?

a. Ask the governor of the state to declare the area a disaster area so state help can be obtained

b. Call surrounding hospitals to set up burn units, because there will be too many patients for one hospital to manage

c. Call in physicians and nursing staff who are experts in burn care

d. Get in touch with the American Red Cross to assist families of the victims

ANS: C

A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. Until more is known, only staff expert in burn care need be asked for assistance. Only a mass casualty event with 100 or more individuals involved requires community or state involvement.

4. Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. Which best describes how these patients are different from the first patients to arrive? a. Burn patients probably have skin damage, whereas the firefighters have lung damage. b. Burn patients will need extensive care over time, whereas the firefighters can probably stay the night with oxygen treatment and then be discharged.

c. The burn patients were direct victims, whereas the firefighters are indirect victims.

d. The second set of victims may have scarring, shortness of breath, and persistent hoarseness for the next few days.

ANS: C

Both sets of victims would have inhaled smoke and have lung damage.

5. Which do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives?

a. Create fear to intimidate and coerce to accomplish a political goal

b. Encourage others with similar beliefs to join them and their cause

c. Obtain publicity for themselves and their goals

d. Obtain increased negotiating power and respect

ANS: A

The U.S. Code of Federal Regulations defines terrorism as "violent acts or acts dangerous to human life that appear to be intended to intimidate or coerce the civilian population or to influence the policy or conduct of a government."

6. Which type of maps is crucial to be included in any disaster plan?

a. Communication map showing telephone wires and cell phone towers

b. Geographic map showing, for example, roads, highways, and train routes

c. Resource map showing potential resources in persons and supplies

d. Response maps showing sites of first responders, such as fire stations and police stations

ANS: C

A resource map is a geographic map that outlines the resources that would be available in or near the area affected by a potential disaster (e.g., potential shelter sites, potential medical sources, and location of equipment that might be needed).

7. When does disaster management begin?

a. Before a disaster occurs

b. Immediately after the disaster c. Throughout the disaster period

d. When the disaster begins

ANS: A

When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan.

8. Who is responsible for ensuring the safety and welfare of communities?

a. Federal government

b. Federal Emergency Management Agency

c. Local government

d. State government

ANS: C

The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level.

9. Which agency should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response?

a. Federal Emergency Management Agency (FEMA)

b. Office of Emergency Management

c. State Disaster Office

d. The National Disaster Relief Agency

ANS: B

The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards. There is no specific government agency called the State Disaster Office or the National Disaster Relief Agency.

10. When would the National Guard become involved in a disaster?

a. When the Federal Emergency Management Agency requests such assistance

b. When the local government requests help keeping order in the community

c. When the president has declared the area a national disaster

d. When the state has been asked to help an overwhelmed community

ANS: D

When a disaster overwhelms the local community's resources, then the state's department or office of emergency management is called for assistance. Before an event, state officials provide technical support for prevention, preparedness, response, and recovery. State officials are on scene at disaster events to facilitate coordination of state resources and to disseminate information. In some cases, the National Guard may be called in to aid the community.

11. Which best describes the mission of the U.S. Department of Homeland Security (DHS)?

a. To consolidate all existing agencies, groups, and organizations into a single department

b. To distribute federal financial aid to disaster-stricken areas

c. To enable appropriate response to assist a state having a disaster

d. To prevent terrorism and ensure resilience to disasters

ANS: D

There are five homeland security missions: prevent terrorism and enhance security, secure and manage U.S. borders, enforce and administer immigration laws, safeguard and secure cyberspace, and ensure resilience to disasters. This agency was created to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland, but this is not the mission of the agency. The Federal Emergency Management Agency distributes federal financial aid to disaster-stricken areas and is responsible to enable the appropriate response to assist a state having a disaster.

12. Which action should be taken during a biological attack?

a. Close doors and windows and turn off all ventilation

b. Seek medical attention if you become sick

c. Develop a family emergency plan

d. Keep a written record of everything that you have eaten

ANS: B

During a biological attack one should: move away quickly, wash with soap and water, contact authorities, listen to the media for official instructions, and seek medical attention if you become sick. If a chemical attack were occurring, the first action would be to close doors and windows. In the case of a biological attack, one should move quickly away from the area. A family emergency plan should be developed well in advance of a biological attack. Unless directed by the authorities, it should not be necessary in any type of an attack to keep a written record of everything that is eaten.

13. Which statement best describes how the American Red Cross (ARC) is different from the Federal Emergency Management Agency (FEMA) or the National Incident Management System?

a. Funding includes only voluntary contributions.

b. It emphasizes being prepared for emergencies, not just reacting to them.

c. It has only volunteers as staff. d. It is a nongovernmental volunteer agency.

ANS: D

The ARC is not a governmental agency. The ARC, however, is chartered by Congress to provide disaster relief. It works in partnership with FEMA, the Department of Health and Human Services, the Centers for Disease Control and Prevention, and other federal agencies to provide and manage needed services. The ARC receives federal money as well as voluntary contributions. The ARC has both paid and volunteer staff. All of these agencies focus on preparation for disasters (not emergencies) as well as reacting after they occur.

14. Who should create a disaster plan including emergency supplies and where to meet in case of an emergency?

a. All families

b. All government officials

c. All public health employees d. Members of Congress and the Supreme Court

ANS: A

The American Red Cross publishes many pamphlets and educational materials to help individuals, families, neighborhoods, schools, and businesses prepare for potential disasters. The key actions it recommends are: (1) identify potential disaster events, (2) create a disaster plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4) practice and maintain the plan. The disaster plan should include an emergency communications plan, a predetermined meeting place for family members or significant others, and plans for care of pets in the event that evacuation is required.

15. Which best describes how a community will know whether its disaster plan is adequate?

a. After a disaster occurs and reports of deaths and injuries are fairly accurate

b. By following practice drills involving various feasible scenarios as an initial step of planning

c. When federal experts have reviewed and approved the plan d. When state officials have reviewed and approved the plan

ANS: B

For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs.

16. An earthquake has hit and buildings are knocked down; people are injured and crying for help. Looters have already started grabbing essential resources. Which action should the community take first?

a. Send in ambulances to transport injured persons to medical facilities

b. Send in media personnel to share the event and begin efforts to obtain donations for the injured

c. Send in medical personnel to administer first aid and triage the injured

d. Send in law officials to secure the area and ensure the safety of the victims

ANS: D

Before search and rescue should begin, safety must be considered. In some instances, if a criminal action is suspected, law officials will be among the first to respond to secure the area and possibly gather evidence. While the area is being checked and then cleared of potential threats, a staging area can be set up at or near the site of the incident to direct onsite activities.

17. A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. Which action should be taken next?

a. Put a green tag on his shirt and he can get in line to wait his turn for medical treatment

b. Put a yellow tag on his shirt and then await transport to a medical facility

c. Put a black tag on his shirt and give him a chair to rest in until something can be done

d. Put a green tag on his shirt and ask him to use his good arm to help others make it to the staging area

ANS: B

Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g., simple fractures); red is considered top priority or immediate and is for those with life-threatening conditions but who can be stabilized and have a high probability of survival (e.g., amputations); and black is for the deceased or for those whose injuries are so extensive that nothing can be done to save them (e.g., multiple severe injuries).

18. Which step should the nurse take first when triaging a victim of a disaster?

a. Assess mental status

b. Assess perfusion

c. Assess respirations

d. Assess blood pressure

ANS: C

To assess an individual within the 1-minute guideline, the START system uses three characteristics. First, respirations are checked; then perfusion by pinching the nail bed and observing the reaction; and, last, mental status is checked by asking the individual a question. Assessing blood pressure is not part of the 1-minute guideline.

19. Which disaster would most likely cause the most long-lasting mental health concerns for its victims?

a. For the fourth year in a row a flood hit an area, demolishing several houses, but families heard the warning siren and evacuated in time.

b. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars.

c. A tsunami hit the beach with unbelievable force, water sweeping over the entire harbor, although most boats had been moved to deep water.

d. A volcano erupted and lava destroyed the main road to the village where several houses burned, but no one died in the eruption.

ANS: B

Research has identified four keys to gauging the mental health impact of such events, any two of which may result in severe, lasting, and pervasive psychological effects. The key factors are: (1) extreme and widespread property damage; (2) serious and ongoing financial problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life; and (4) when human intent caused the disaster. Because the fire was deliberately set and lives were lost, that disaster will be more disruptive than disasters when only property was damaged.

20. Which type of behaviors would a nurse expect to see when a disaster first strikes a community?

a. A sense of all being okay and that one can rebuild and go on b. Anger and despair that help being offered is insufficient, slow, and inadequate

c. Everyone trying to help strangers, as well as their neighbors, survive

d. People involved sharing their stories and reliving what occurred

ANS: C

The classic four phases of a community's reaction to a disaster are the heroic phase, honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase, nearly everyone feels the need to rush to help people survive the disaster.

21. A friend who was raped and beaten appeared to be coping well. However, she recently dropped out of school and shared with the nurse that she is having nightmares where it happens all over again, and these nightmares are becoming impossible to live with. Which would be the concern of the nurse?

a. A late psychological reaction of despair and hopelessness

b. Depression that no one rescued her and saved her from the traumatic event

c. Guilt and concern over what she could possibly have done to invite such an event

d. Posttraumatic stress syndrome disorder (PTSD)

ANS: D

PTSD is a psychiatric disorder that can occur after an individual's experiencing or witnessing a life-threatening event. People who suffer from PTSD often relive the experience through nightmares and flashbacks. The social and psychological symptoms can be severe enough, and last long enough, to significantly impair a person's daily life.

22. As a nurse and a citizen, what is the nurse's additional responsibility in relation to disasters?

a. Assume the nurse will be asked to volunteer to assist the American Red Cross with helping care for disaster victims b. Be aware if there is an unusual increase in the number of people seeking care with similar symptoms

c. Expect and plan for the possibility of being called to report to work for additional work efforts in caring for the sick and injured

d. Expect to be a role model in preparing for and reacting to a disaster

ANS: B

As a nurse, one is expected to be informed regarding the Guidelines for Early Detection for Biochemical Terrorist Incidents, including noting if there is a sudden increase in a particular disease, an unusual number of persons seeking care with similar complaints, clusters of patients from a single location, or a person presenting with an uncommon disease.

23. Which set of symptoms would be unexpected after a disaster?

a. Confusion, disorientation, indecisiveness, and memory loss b. Depression, fear, or just numbness

c. Fatigue with headaches, nausea, and dizziness

d. No unusual feelings or behavior

ANS: D

Common responses to disasters include all sorts of cognitive, emotional, physical, and behavioral symptoms. Therefore, to have no unusual feelings or behavior would indeed be unexpected.

Which describes a NATECH (natural technological) type of disaster?

A flood covering crops and recreational areas of a geographic area

A terrorism attack causing major interruption of communication technologies

A tornado resulting in flood and destruction of electrical systems for a community

A nuclear accident at a power plant causing evacuation of people in an urban community

A tornado resulting in flood and destruction of electrical systems for a community

A family of five people presented to a hospital after the flooding of their urban home. These family members are classified as

poverty victims.

displaced persons.

indirect victims.

mass casualties.

displaced persons.

Which agency has a mission to support citizens and first responders to ensure that as a nation everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all?

American Red Cross (ARC)

National Institute for Health (NIH)

Federal Emergency Management Agency (FEMA)

Centers for Disease Control and Prevention (CDC)

Federal Emergency Management Agency (FEMA)

You teach a community disaster preparedness class on how to find shelter during and after a disaster situation. This is an example of what kind of prevention?

Primary

Secondary

Tertiary

Disaster

Primary

What element of a community disaster plan investigates the citizen's reliance on telephone systems or cell phones during disasters?

Authority

Logistical

Rescue

Communication

Communication

The nurse at the disaster site is using the START triage system. What color triage tag would be provided to an ambulatory individual with a superficial cut on the left elbow and bruise to the right hand?

Red

Yellow

Black

Green

Green

Which phase of the community response to disaster includes medical personnel contributing long hours of volunteer work helping unfamiliar people after a disaster?

Honeymoon phase

Heroic phase

Reconstruction phase

Disillusionment phase

Heroic phase

Chemical warfare agents such as pulmonary agents and cyanides are classified as

weapons of mass destruction. C

computer-based attack weapons.

recovery agents.

prevention medications.

weapons of mass destruction.

Which is the purpose of the staging area in a disaster plan?

A triage area outside the hospital, supplying first aid and transport to medical facilities

A stage for entertainment to cheer up disaster victims

To provide sheltered area for displaced victims to sleep, eat, and bathe

To act as command station for disaster responders to report to and get assignments

To act as command station for disaster responders to report to and get assignments