Prehospital Emergency Care Chapter 44 EMS Response to Terrorist Incidents and High Threat and Active Shooter Incidents

1) You are teaching an EMT class about the role of the EMS response to a terror attack involving weapons of mass destruction (WMD). A student asks you what constitutes a WMD. How would you define a WMD?

A) Any agent used to cause indiscriminate death and destruction

B) Any weapon used to create fear and panic among the general population

C) Any agent that is intended to kill a specific segment of the population

D) Any biological agent that kills people and animals but does not destroy property

Answer: A

2) Which item best describes use of a weapon of mass destruction?

A) Death of 25 people following an explosion in a chemical plant caused by faulty wiring

B) Death of 57 people following nighttime tornadoes that struck a suburban area

C) Death of 49 people in a crowded mall following intentional dispersal of an unknown bacterial agent

D) Accidental release of radioactive gas from a nuclear power plant that impacts thousands of people

Answer: C

3) At the scene of a multiple-casualty incident caused by a weapon of mass destruction, what is your first priority as an EMT?

A) Identifying the agent or mechanism of the WMD

B) Establishing the number of dead and injured and needed resources

C) Establishing a communications system

D) Ensuring the safety of yourself and your partner

Answer: D

4) Multiple EMS agencies are involved in a WMD incident involving hundreds of patients. Which statement regarding the different protocols and medical direction used by those different agencies is most accurate?

A) EMTs should automatically be able to administer any medication that a paramedic can administer.

B) Most protocols involving on-line medical direction should convert to standing orders during the event.

C) On-line medical direction should be used for all treatment by EMS.

D) All on-line medical direction should be suspended.

Answer: B

5) How can an EMT best protect herself, as well as get the most appropriate resources, at the scene of a multiple-casualty incident involving a weapon of mass destruction?

A) Estimate the number of fatalities and injuries

B) Identify the specific agent or mechanism used

C) Make an overall determination of the number and types of injuries involved

D) Turn over control of the incident to the Homeland Security Department

Answer: B

6) A triage officer at the scene of a suicide bombing assigns you to a patient who has been injured from the secondary effects of the blast. Which type of injuries would you expect in this patient?

A) Fractured arm after being thrown to the ground

B) Lung injury caused by the blast's pressure wave

C) Closed head injury caused by striking a tree

D) Facial laceration caused by flying glass and debris

Answer: D

7) In planning for a response to an attack with a weapon of mass destruction involving an incendiary device, the EMT should be prepared to handle which types of injuries?

A) Fractures

B) Infection

C) Burns

D) Blast injuries

Answer: C

8) You are participating in a training exercise for an attack with a weapon of mass destruction involving the release of a nerve agent. In the triage area, you are presented with a patient who responds to painful stimuli and has an open airway. He is breathing 8 times per minute and has a weak radial pulse. He is wheezing and has pinpoint pupils. In his pocket, you see a metered-dose inhaler containing albuterol. When caring for this patient, you should first:

A) Administer positive pressure ventilation.

B) Obtain vital signs, including the patient's temperature.

C) Administer albuterol with the metered-dose inhaler.

D) Look for an injury causing shock.

Answer: A

9) A patient has an injury to his arm caused by an unknown vesicant. After assessing the patient's airway, breathing, and circulation, you should:

A) Brush the powder from the skin.

B) Apply a wet sterile dressing to the arm.

C) Flush the injured area with water.

D) Transport the patient to the hospital immediately.

Answer: C

10) A patient has inhaled cyanide gas. He is alert and complaining of shortness of breath. His airway is patent, his breathing is adequate, and his radial pulse is strong. His skin is warm and dry, and his breath sounds are clear. Given these assessment findings, what should the EMT do first?

A) Administer the antidote for cyanide

B) Monitor the patient and transport

C) Obtain vital signs with the patient in a supine position

D) Administer oxygen via a nonrebreather mask

Answer: D

11) An alert and oriented patient has been exposed to the biological toxin ricin. He presents with a fever, cough, mild dyspnea, and generalized weakness. His airway is patent and his breathing is adequate. His skin is warm and dry, and his radial pulse is weak. Which intervention is most appropriate when caring for this patient?

A) Administer oxygen to the patient

B) Apply a HEPA filter mask to the patient

C) Obtain vital signs and transport

D) Isolate the patient before administering further care

Answer: A

12) For the EMT, what is the best means of protection against acquiring a disease such as smallpox prior to any sort of exposure?

A) Antibiotics

B) Immunizations

C) Face shields

D) Iodine tablets

Answer: B

13) At a community meeting about preparations for a biological terror attack, an attendee asks you how anthrax acquired naturally differs from anthrax acquired via terrorism. What is your best response?

A) "Anthrax caused by terrorism is easier to treat than a disease acquired naturally."

B) "Anthrax caused by terrorism causes signs and symptoms different from anthrax acquired naturally."

C) "Anthrax can be acquired only by terrorism; it is not acquired naturally."

D) "Anthrax is the same regardless of whether it is intentionally inflicted or acquired naturally."

Answer: D

14) Why would iodine tablets be a benefit to administer to the general public after a nuclear bomb detonation?

A) Iodine boosts the immune system.

B) Iodine protects against all types of cancer.

C) Iodine decreases the risk for thyroid cancer.

D) Iodine helps eliminate radiation from the body.

Answer: C

15) A chemical agent used by terrorists is described as having a high volatility. You should recognize this descriptor as meaning that the chemical is:

A) Highly radioactive.

B) Easily evaporated.

C) Very explosive.

D) In liquid form.

Answer: B

16) Which chemical agent will generally kill a person most quickly?

A) Liquid vesicant that is splashed on the arm

B) Solid agent that contacts the patient's torso

C) Aerosolized vesicant agent that is inhaled into the lungs

D) Liquid agent that is splashed into the eyes

Answer: C

17) Nerve agents typically cause death by triggering which type of organ or system failure?

A) Respiratory

B) Renal

C) Cardiac

D) Liver

Answer: A

18) If a patient is exposed to a nerve agent, which assessment finding would the EMT expect?

A) Dilated pupils

B) Elevated blood pressure

C) Pulse pressure greater than 30mmHg

D) Increased salivation

Answer: D

19) Your service has acquired the antidote for a nerve agent attack. By which route will this antidote most likely be given?

A) Inhalation

B) Oral

C) Injection

D) Topical

Answer: C

20) A localized terrorist attack involves pepper spray being released at a high school dance. While you are en route to the scene, the incident commander reports approximately 50-plus people have been exposed and calls for activation of the county disaster plan. Given the nature of the weapon, what should you anticipate doing on scene?

A) Providing positive pressure ventilation

B) Decontaminating patients with diluted bleach

C) Administering an aerosolized antidote

D) Irrigating eyes with saline

Answer: D

21) Which statement concerning the biological agents used in terrorist attacks is true?

A) The biological agents used by terrorists are more potent than those that occur naturally.

B) It may take several days to weeks to realize or determine that an attack involving biological agents occurred.

C) Rain is the ideal condition to disperse a biological agent because water will spread it over a greater area.

D) The eyes are the most effective portal of entry into the human body for a biological agent.

Answer: B

22) A patient who has been exposed to an encephalitis-like agent most likely will complain of:

A) Fever and confusion.

B) Shortness of breath.

C) Blindness and nausea.

D) Pain and paralysis.

Answer: A

23) Regarding a terrorist attack involving the use of biological toxins, which statement is true?

A) The toxins are not nearly as dangerous as the organisms that produce them.

B) The toxins are living organisms and can easily multiply in the human body.

C) Biological toxins will typically kill a person within minutes of exposure.

D) Biological toxins cannot be passed from one person to another.

Answer: D

24) Which type of radiation will travel the farthest and penetrate the human body with the greatest ease?

A) Alpha

B) Beta

C) Blast

D) Gamma

Answer: D

25) Beta radiation represents the greatest threat to a person's well-being when the:

A) Person is within 30 feet of the source.

B) Person ingests it by eating contaminated food.

C) Radiation occurs in liquid form.

D) Source is heated to greater than 100°F.

Answer: B

26) In a nuclear explosion, the EMT should expect the majority of patients to complain of:

A) Nausea.

B) Headache.

C) Burns.

D) Dyspnea.

Answer: C

27) The goal of an attack using a "dirty bomb" most likely will be:

A) Blast power to destroy buildings and infrastructure.

B) Thermal forces to induce massive burns.

C) Dispersal of gamma radiation.

D) Contamination of an area with radioactivity.

Answer: D

28) Which classifications of WMD are combined in the same category when using the mnemonic B-NICE?

A) Radiological and nuclear

B) Incendiary and explosive

C) Biological and incendiary

D) Chemical and explosive

Answer: A

29) When planning for a terrorist attack, which concept makes the best use of resources that are locally available?

A) Mutual assistance

B) Cross-training

C) Warehousing

D) Rapid response

Answer: A

30) If you are first on the scene of an MCI, it is imperative that you:

A) Call for mutual aid after triaging all patients.

B) Recognize whether it is a terrorist attack early on.

C) Treat victims as quickly as possible.

D) Establish the background radiation level.

Answer: B

31) When you are first on the scene of a terrorist incident involving WMD, which role is of the utmost importance?

A) Prehospital care of the injured

B) Triage of the injured victims

C) Scene size-up

D) Identification of the responsible party

Answer: C

32) An example of a quinary effect of an explosion is:

A) Burns.

B) Toxic contaminants.

C) Fractures.

D) Electrocution.

Answer: B

33) The type of injury most commonly associated with an incendiary device is:

A) Fractures.

B) Burns.

C) Injury from building collapse.

D) Radiation exposure.

Answer: B

34) Which characteristic do hypergolic substances display when they are combined in a WMD?

A) They release a biologic toxin.

B) They promote adhesion of flammable substances to the skin.

C) They spontaneously ignite when combined.

D) They produce chlorine gas when combined.

Answer: C

35) An example of an injury that results from the primary exposure in a nuclear explosion is:

A) Blindness.

B) Flash burn.

C) Multisystem trauma.

D) Radiation injury.

Answer: C

36) The secondary radiation exposure from a nuclear blast is the result of:

A) Heat.

B) Fallout.

C) Concussion.

D) Decay.

Answer: B

37) Sheltering of patients from radiation can be accomplished with:

A) Distance.

B) 4 inches of earth.

C) 10 inches of wood.

D) Iodine.

Answer: A

38) Protection of the EMT from chemical agent exposure requires:

A) An N-95 mask.

B) Proper training and equipment.

C) Short periods of exposure.

D) Establishing the background contamination level.

Answer: B

39) Which statement is true regarding tactical EMS?

A) The TEMS curriculum is typically included in state EMT courses.

B) TEMS programs have been available since 1988.

C) Competency in core skills is typically required before responders can participate in a TEMS course.

D) TEMS is a federally structured educational program provided by the FBI.

Answer: C

40) How does the EMT's role in an "active shooter" incident vary from any other unsecured "shots fired" scene?

A) The EMT's role is the same in both types of scenes.

B) EMTs should not respond unless they are TEMS certified.

C) EMTs should respond only if they are armed.

D) The EMT's primary concern is patient rescue.

Answer: A

41) What is the primary concern with cyberterrorism?

A) Identity theft

B) Shutting down the infrastructure

C) Electronic bank robbery

D) Stock market manipulation

Answer: B

42) How can cyberterrorism impact medical equipment?

A) Equipment can be exploited electronically to cause patient harm.

B) Hardware orders can be rerouted.

C) Patients' Medicare accounts are at risk, resulting in equipment repossession.

D) Cyberterrorism does not have access to medical equipment.

Answer: A