Prehospital Emergency Care Chapter 43 Multiple-Casualty Incidents and Incident Management

1) The EMT correctly defines a multiple-casualty incident (MCI) when he states:

A) "It is any event that places an excessive demand on rescue personnel and equipment."

B) "It occurs when the number of patients requiring care is greater than 10."

C) "It occurs anytime the incident requires the medical director to leave the hospital and direct activities on scene."

D) "It occurs anytime that five or more people are injured and require transport to different hospitals."

Answer: A

2) The National Incident Management System (NIMS) provides for:

A) Specific codes and terms to enhance communications among EMS, fire, and law enforcement personnel.

B) Increased funding and reimbursement for any EMS agency involved in a disaster response.

C) A consistent approach to managing a disaster by multiple responding departments and agencies.

D) The federal government's control of any disaster scene regardless of location.

Answer: C

3) You are teaching a group of EMTs about multiple-casualty incidents and the Incident Command System (ICS). Which statement about ICS is true?

A) Each EMS agency can use its own codes and terms.

B) There is a separate commander for the EMS, fire, and law enforcement resources.

C) Each individual responder is accountable to two supervisors.

D) Plain English is used for all communications in the United States.

Answer: D

4) At a drill involving the rollover of a tourist bus, you have been assigned to the transport area. Which activities will you be performing within this section?

A) Transport patients to the hospital or other appropriate facilities

B) Coordinate the transfer of patients to ambulances for transport to the hospital

C) Triage and assign priorities of EMS care and transport to the hospital

D) Triage and provide patient care prior to transport to the hospital

Answer: B

5) While responding to an MCI drill involving an explosion, you pass seven ambulances sitting in a parking lot three blocks away from the incident. You should recognize this area as the:

A) Transport unit.

B) Staging unit.

C) Treatment unit.

D) Triage area.

Answer: B

6) The EMT identifies the primary benefit of triage when she states:

A) "Triage is a process by which the number of patients is quickly estimated so the appropriate resources can be summoned."

B) "Triage is a system that can be used by the EMT to determine the number of patients who will most likely die."

C) "Triage is a system used by the EMT to assign the order of care when an incident involves more than five patients."

D) "Triage is used to determine the order in which patients will receive medical care and transport."

Answer: D

7) Approximately 15 vehicles have been involved in a "chain-reaction" collision on a freeway one foggy morning. Your unit is the first ambulance on the scene, and you begin going from vehicle to vehicle to determine the type and severity of each injury experienced by the occupants. This is an example of which kind of triage?

A) Emergency

B) Primary

C) Secondary

D) Tertiary

Answer: B

8) At a multiple-casualty incident, a crew brings you a patient with a red tag tied to his wrist. What does this tag indicate?

A) Immediate care and transport are necessary.

B) Delayed care and transport are permissible.

C) The patient has a minor injury to his wrist.

D) The patient is deceased.

Answer: A

9) Which patient triage tag indicates the lowest priority for care and transport on the scene of a multiple-casualty incident?

A) Yellow

B) Blue

C) Black

D) Green

Answer: C

10) You have been assigned to the triage unit at a multiple-casualty incident. A patient with a yellow triage tag arrives. Your immediate action should be to:

A) Change the tag to green.

B) Obtain vital signs.

C) Arrange for immediate transport.

D) Triage the patient again.

Answer: D

11) Your EMS system uses the Simple Triage and Rapid Transport (START) system for triaging patients at a multiple-casualty incident. Which item(s) should you include in your triage assessment to determine the order in which patients will receive emergency care?

A) Chief complaint and vital signs

B) Respiratory and perfusion status

C) Level of consciousness and past medical history

D) Chief complaint, vital signs, and past medical history

Answer: B

12) A bleacher at a college basketball court has collapsed, and your crew is the first EMS unit to arrive on the scene. As you enter the gym, several patients are walking around with visible injuries. Which instruction is most appropriate for these ambulatory patients?

A) "Go outside and wait by the red fire truck in the parking lot and stay there."

B) "Sit down here so that I can do a quick assessment on you."

C) "Put this yellow tag on your wrist and go outside to the red fire truck in the parking lot."

D) "Leave this gym and wait outside. I will be out in a few minutes after I check others who cannot walk.

Answer: A

13) You have responded to a bar for a fight involving approximately 8 to 10 patrons. Weapons were used in the fight, and all the patrons have varying degrees and types of injuries. You are in charge of triage and must use the Simple Triage and Rapid Transport (START) system. You find a young person lying on the floor with blood covering his shirt. Quick assessment reveals him to be breathing at 24 times per minute. What should you do next?

A) Start positive pressure ventilation

B) Check for a radial pulse

C) Determine the mental status

D) Place a yellow tag on his wrist

Answer: B

14) A natural gas explosion has destroyed an apartment building. At least five occupants of the building were killed, and another 12 are injured. You are in charge of triage. You are presented with a young woman who is breathing at a rate of 40 breaths per minute after fire department personnel carried her out from the collapse site. Using the Simple Triage and Rapid Transport (START) system for triaging, you should immediately:

A) Place a red tag on this patient and move on to the next patient.

B) Start positive pressure ventilation.

C) Apply oxygen with a nonrebreather face mask.

D) Check for a radial pulse and capillary refill.

Answer: A

15) At the scene of a multiple-casualty incident, you are triaging patients using the Simple Triage and Rapid Transport (START) system. You are presented with an unresponsive patient who is not breathing. What should you do next?

A) Place a red tag on the patient

B) Start positive pressure ventilation

C) Open the airway

D) Place a black tag on the patient

Answer: C

16) As the EMT responsible for triage at a motor vehicle collision, you find a patient who cannot walk due to his injuries; the patient is breathing 18 times per minute and has a radial pulse. What should you do next according to the START triage system?

A) Check the patient's mental status

B) Check the patient's blood pressure

C) Move the patient to the treatment area

D) Place a yellow tag on the patient

Answer: A

17) You are using the Simple Triage and Rapid Transport (START) system. Which patient should have a yellow tag applied prior to being moved to the treatment area?

A) A male with a respiratory rate of 8 breaths/min, no radial pulse, and unresponsive mental status

B) A female with a respiratory rate of 22 breaths/min, a palpable radial pulse, and who squeezes your fingers when instructed

C) A female with agonal respirations, no radial pulse, and unresponsive mental status

D) A male with a respiratory rate of 40 breaths/min, a palpable radial pulse, and who squeezes your fingers when instructed

Answer: B

18) A problem with the Simple Triage and Rapid Transport (START) system of triage is that it:

A) Is difficult to apply to young children.

B) Requires at least 10 rescuers.

C) Is used only for traumatic injuries.

D) Can be complex and difficult to use.

Answer: A

19) You are teaching some Emergency Medical Responders (EMRs) to use the JumpSTART system of triage. Which comment made by an EMR requires you to intervene and provide corrective instruction?

A) "I like the JumpSTART system because it uses the same categories of assessment as the START system of triage."

B) "If a young child is injured in a multiple-casualty incident, I will use the JumpSTART system to triage him."

C) "The JumpSTART system allows me to classify the patient according to his ability to ambulate, his breathing, his perfusion, and his mental status."

D) "The JumpSTART system is very nice because it allows me to take 2 minutes to assess each patient."

Answer: D

20) A young child involved in a multiple-casualty incident is found lying on the ground with obvious deformity to the left thigh. Using the JumpSTART system for triage, you note that he is not breathing. What should you do next?

A) Tag the patient as black, and then move to the next one

B) Provide 30 seconds of positive pressure ventilation

C) Open the airway, and then assess for a pulse

D) Tag the patient as red, and then move the patient to the treatment area

Answer: C

21) You are in charge of triage at a scene involving 32 patients exposed to carbon monoxide in a church basement. You find a 6-year-old boy who is not breathing. You open his airway and find that breathing does not return. Furthermore, you cannot locate a radial pulse. You should:

A) Provide 15 seconds of positive pressure ventilation.

B) Place a black tag on this patient and move to the next patient.

C) Provide 15 seconds of CPR and recheck for a radial pulse.

D) Apply oxygen and check the patient's mental status.

Answer: B

22) You are at the scene of a multiple-casualty incident where a church van carrying 15 parishioners overturned. You and your partner are in charge of the treatment unit and are presented with four patients. Which one will you treat first?

A) A confused 69-year-old male with a respiratory rate of 42 breaths/min and a rapid and weak radial pulse

B) An elderly female patient with a femur fracture and a yellow tag on her wrist

C) A 21-year-old male in cardiopulmonary arrest

D) A 13-year-old boy who walked to the treatment area complaining of a severe headache

Answer: A

23) In most EMS systems, a multiple-casualty incident is said to occur when the number of patients is:

A) 3 or more.

B) 10 or more.

C) 20 or more.

D) 50 or more.

Answer: A

24) When a second-story deck collapsed at an outdoor winery, several patients fell from the deck. They are now lying on the ground below. As the first emergency personnel to arrive on the scene, the initial priority for you and your partner is to determine:

A) The number of patients.

B) The number of ambulances required.

C) If the scene is safe to enter.

D) Type and severity of injuries.

Answer: C

25) Which statement made by an EMT shows a proper understanding of the EMT's role at the scene of a multiple-casualty incident?

A) "The EMT will be in charge of providing direct medical care."

B) "The role of the EMT will always be to transport patients."

C) "The EMT will always be in charge of triage and transport of patients."

D) "The role of the EMT will vary depending on the exact situation."

Answer: D

26) At the scene of a multiple-casualty incident, you note that another EMT has become overwhelmed and emotionally incapacitated after unsuccessfully trying to save a child's life. You should:

A) Monitor the EMT for improper care.

B) Remove the EMT from the scene.

C) Instruct the EMT to go home.

D) Assess the EMT for a head injury.

Answer: B

27) At the scene of a multiple-casualty drill, you have been assigned to the role of transport unit leader. In this role, one of your responsibilities is to:

A) Ensure proper care for each patient.

B) Distribute patients to each medical facility.

C) Immobilize all patients prior to transport.

D) Ensure that patients in cardiac arrest leave for the hospital first.

Answer: B

28) A large bus with 52 passengers overturned on a busy highway. At the scene, 12 people are dead and 23 others were taken to various hospitals, many with life-threatening injuries. As commander of the incident, which action is most appropriate for you to take after the last patient has left the scene?

A) Encourage rescuers to talk among themselves about any feelings or thoughts they may need to share

B) Bring all rescuers to a central point and hold a discussion to critique the rescue effort

C) Set a date and time for a mandatory stress debriefing

D) Promote lighthearted talk about the incident to decrease rescuer tension and stress

Answer: A

29) You have been selected to represent your EMS system on a disaster planning committee involving many different agencies. Regarding preparation for a possible disaster, which item is most beneficial to stress in the meeting?

A) Specific terminology and codes will need to be established to make communication effective.

B) All rescuers must be flexible and able to perform any task asked of them at a disaster.

C) The lay community should become involved in disaster planning by learning basic first aid and CPR.

D) Separate plans using the NIMS need to be developed for natural and human-made disasters.

Answer: C

30) What is the mnemonic for the standard process used during on-scene management of a disaster or MCI?

A) START

B) SALT

C) ICS

D) NIMS

Answer: C

31) Which triage system is intended to be adopted as the national standard for MCI triage?

A) START

B) SALT

C) ICS

D) JumpSTART

Answer: B

32) What determines the order in which patients are relocated from triage to treatment?

A) Priority

B) Accessibility

C) Space

D) NIMS

Answer: A

33) Who determines the order in which patients are transported to various hospitals in the area of the MCI?

A) The staging unit leader

B) The transport unit leader

C) Incident commander

D) NIMS

Answer: B

34) Dead spots represent a failure in which system at an MCI?

A) Decontamination

B) Access

C) Communications

D) Triage

Answer: C

35) When relocating local residents away from a disaster, you should:

A) Wait as long as possible to ensure that the relocation is necessary.

B) Relocate residents to hospitals and clinics as much as possible.

C) Ensure that a triage system is in place at the rendezvous point.

D) Keep residents in their social groupings as much as possible.

Answer: D

36) Public warnings are best carried out by:

A) Television.

B) Radio.

C) A PA system.

D) Any means you have available.

Answer: D

37) Disaster event victim survivors often experience all of these feelings except:

A) Fear.

B) Vulnerability.

C) Guilt.

D) Relief.

Answer: D

38) What is one of the best ways to help reduce the public's stress associated with an evacuation?

A) Assign a small number of triage members to provide psychological first aid

B) Group evacuees with strangers to help prevent cross-talk and rumors

C) Communicate-assign several rescue workers to gather information and disseminate it to local radio and television stations

D) Move as many evacuees as possible to hospital locations to take advantage of resources already in place

Answer: C

39) Which of these situations would likely result in an MCI with a mix of medical and trauma patients?

A) School bus crash

B) Explosion at a long-term care facility

C) Collapse of a sporting arena

D) Industry that had a carbon monoxide toxicity

Answer: B