Major incidents/CBRN Flashcards
(250 cards)
1
Q
What acronym is used to give structure to a MI?
A
CSCATT
2
Q
Describe the components of CSCATTT
A
Command & Control
Safety
Communications
Assessment
Triage
Treatment
Transportaion
3
Q
Describe the Command part of CSCATT? (3)
A
- Ambulance Incident Commander (Tactical) will appoint:
- Operational Commander
- Primary Triage Officer
- Ambulance Parking Officer
- Loading Officer - Co-locate
- Action cards
4
Q
Describe the aspects of Safety in CSCATT (4)
A
- Safety of yourself - PPE
- Safety of scene - cordons/barrier tape
- Survivors - move to place of safety
- Remember STEP 123 +
5
Q
Describe Communication in terms of CSCATTT? (3)
A
- METHANE
- Talk groups
- Start a log
6
Q
Describe the Assessment aspect of CSCATTT (3)
A
- Jointly understand risk
- Carry out assessment
- Request resources via METHANE to EOC
7
Q
Describe the Triage, Treatment and Transportation part of CSCATTT
A
Triage
1. TST -best to work in pairs
2. Set up casualty clearing station (with medical advisor)
Treatment
Commence extended treatment once TST completed
Transportation
8
Q
Describe METHANE
A
MI standy/declare
Exact location
Type of incident
Hazards
Access/egress
Number of casualties/severity
Emergency services on scene/required
9
Q
Describe the command structure within the ambulance service at a MI
A
10
Q
What tabard does the fire incident commander wear?
A
All white with ‘Fire Incident Commander’ (sometimes red/white check top part)
11
Q
What colour tabard does a fire operations commander wear?
A
All red
12
Q
What colour tabard does the police incident commander wear?
A
Blue/white check top part and white bottom
13
Q
What colour do the various agencies incident commanders tabards have in common?
A
White bottom half
14
Q
What colour tabard is the Ambulance Incident Commander (Tactical commander)
A
Green/white check top
White bottom
15
Q
What colour is the ambulance operational commander (and most of the other tabards for ambulance service e.g. section commanders/parking officer)
A
Green white check top
Yellow bottom
16
Q
What colour are the Coastguard tabards for:
1. Incident commander
2. Officer in charge (operational commander)
A
Both have a yellow/block block pattern bottom and tops halves are
1. white
2. red
17
Q
What colour are the check pattern on MI tabards for:
1. Fire
2. Police
3. Ambulance s
A
- Red/white
- Blue/white
- Green/white
18
Q
What colour is the bottom part (top is normal white/green check) of the tabard for:
- doctors
- safety officer
- decontamination officer?
- Tactical advisor/NILO
A
- Red
- Blue
- Purple
- Green
19
Q
Describe Ten Second Triage
A
20
Q
Describe MITT
A
21
Q
What is the difference between TST and MITT?
A
TST designed to be quick and used by anyone, wheres MITT generally requires healthcare staff and is longer.
22
Q
What is POWER used for and what does it mean?
A
Safety at scene at railway
Power off - should be confirmed in person, EOC if any doubt
Off tracks unless patient appears viable
Wear PPE
Ensure EOC and ambulance commander know you are entering/leaving trackshide
Rapidly move patients off trackside and treat where is safe
23
Q
Who are the 3 groups that need to be aware of any incident occurring on the rail network at all times?
A
- Network Rail Control
- British Transport Police (will be told by network rail)
- EOC
24
Q
Following identification of an incident occuring trackside, what will Network Rail Control / EOC do initially? (3)
A
- Agree site identification name
- Agree incident number
- Network rail will send RIO and give ETA
25
Who should emergency services wait for ideally following an incident on the tracks?
Rail Incident officer (RIO)
26
When might emergency services act before RIO arrives?
To save life
27
How do ambulance personel request trains caution/stop/power off?
Via EOC to Network Rail Control
28
What do some tracks have that can lead to additional risk?
Third (ground level) conductor energised to 750 V DC
29
With regards to electricity on underground, what different to overground trains?
- all rails carry power
- main 'positive' power rail is 420 V DC and furthest away from platform edge
- middle rail is 'negative' live rail and is 200V DC
30
What are the issues with regards to overhead line equipment on the railways? (2)
1. Not routinely switched off
2. 25,000 V AC
31
How far away should we keep of overhead lines on the rail network?
2.75m
32
How many lanes should be shut following an RTC?
Lane involved and lane either side (unless it is the outside lane ie. lane 3 just needs lane 2 + 3 shutting)
33
In relation to pre-determined response to an airport incident was is a category:
1. A
2. B
3. C
1. Planes that fall into CAA category 5,6,7,8,9 + 10 e.g. large passenger aircraft
2. CAA category 3 +4 - smaller aircraft or large passenger carrying helicopter
3. CAA category 1 + 2 - light aircraft, gliders, small helicopterW
34
What is the difference in the initial response of the ambulance service to the different category airport incidents?
Category A + B send 1 x DCA + 1 x manager + 1 x HART, in addition to making NILO/tactical advisor aware
Category C HART don't get sent automatically
35
What are the 4 categories of crowd density in the NARU guidelines?
V = very low density (4 persons to 4m2)
L = low density (8 persons to 4m2) (can move freely but some movement maybe limited)
M - medium density (16 persons to 4m2) - difficult to move through crowd
H = high density crowds (24 persons to 4m2), almost impossible to move through crowd
36
What are the 5 crowds types described by NARU
1. Casual = not organised, will accept authority
2. Cohesive = crowd together for specific purpose, no leadership
3. Expressive - common purpose, loose leadership. Some mild anti-social elements, may need involvement of authorities
4. Anti-social = some elements involved in civil disobedience and direct action.
5. Incident = crowd reacting to, or retreating from, a dangerous situation. Panic.
37
What is at the:
1. top
2. middle
3. bottom
of hazard warning panels?
1. Emergency Action Code (tells FRS/police what initial actions to take)
2. UN number
3. 24 hour telephone helpline
38
What are the parts of a hazard warning panel?
1. Emergency Action Code (tells FRS/police what initial actions to take)
2. UN number
3. 24 hour telephone helpline
4. Hazard warning diamond
5. Company logo
39
What are the different hazard warning diamonds?
40
Describe the 3 zones in a CBRN incident
1. Hot zone = contaminated area, HART and life saving tx only
2. Warm zone = decontaminating area
3. Cold zone = clean area, no PPE
41
When should dry decontamination be done ideally?
At scene concurrently i.e. as cutting off clothes
42
How should management of suspected gas contamination be managed?
1. Disrobe and place in sealed bag (can 'off gas' over time leading to secondary poisoning)
2. Face upwind
43
How should liquid and solid contamination be decontaminated?
Disrobe and dry decontamination
If caustic then copious irrigation (can be done at hospital)
44
What is the percentage decontamination achieved at various stages?
Initial = 100% contaminated
Following disrobing = 10%
Following dry decon = 1 %
Following gross decontamination = 0.1%
45
When should wet decon ideally be performed and why?
If caustic then ideally at hospital as slower and more dangerous
46
What are the 3 parts of the National CBRN Initial Operational Response guideline?
1. React
2. Recognise
3. Assess
47
In the National CBRN Initial Operational Response guideline, what does the 'React' part entail? (3)
Remove - themselves from area and find fresh air. If skin itchy/painful find water source
Remove - outer clothing (not overhead if possible and not if stuck to skin)
Remove - the substance from skin (decon)
48
In the National CBRN Initial Operational Response guideline, what does the 'Recognise' part mean? (3)
Evaluate the signs/symptoms of patient to identify toxidrome
49
In the National CBRN Initial Operational Response guideline, what does the 'Assess' part entail? (5)
1. What CBRN factors are present?
2. Where are the casualties located?
3. Where are other people located? (keep seperate and look for evac routes)
4. Identify unaffected routes for evacuating people
5. Are there any secondary threats?
50
The National CBRN Initial Operational Response guidelines suggest what acronym should be used for substance assessment?
BADCOLDS
Behaviour
Appearance
Dissemination
Colour
Odour
Likeness
Deliberate
Symptoms
51
The National CBRN Initial Operational Response guidelines suggest what acronym should be used for casualty assessment?
CRESS
Consciousness
Respiration
Eyes (may be delayed)
Secreations
Skin
52
With regards to the 'third rail'
1. What is it?
2. What is the current?
3. How common is it?
4. What must happen before you go trackside?
1. Live rail that provides power to the trains via a conductor placed alongside the rail
2. 750 DC
3. 30% of rail network
4. Must be isolated
53
Overhead cables powering trains:
1. what is voltage?
2. how big is the arc?
3. must they be switched off before you enter the track?
1. 25,000 V
2. 2.75 - 3.0m
3. Usually not because they power large areas of the network
54
In rail incidents what is:
1. RIO
2. TOLO
3. SIO
4. RCM
1. Rail Incident Officer - network rail on site 'tactical' commander
2. Train Operating Liaison Officer - represents train company
3. Station Incident Officer - Represents interest of the train station facility owner
4. Route Control Manager - Network Rail 'off-site' tactical incident commander, located within control
55
What does 3 blasts of a whistle mean?
Immediately evacuate the area
56
What do the following light colours used by FRS/USaR mean?
1. Red
2. Green
3. Orange
4. White
5. Blue
1. Hazard
2. Safe route
3. area of interest
4. illumination
5. structural monitoring equipment
57
Describe:
1. Surface water flooding
2. River flooding
3. Groundwater flooding
4. Coastal flooding
5. Canal flooding
1. Heavy rain overwhelms drainage system
2. Prolonged/heavy rain causes water to overflow onto neighbouring flood plains
3. Due to the water table rising up to the surface, during prolonged wet periods
4. Stormy weather and low pressure out to sea combine with high tides to breach sea defences
5. Level of water in the canal too high and overtops - rare
58
What is the neutral plane with regards to fire, and what influences it (3)?
Boundary between heat gases, smoke and the cooler air.
Depends on:
1. ventilation
2. height of ceiling
3. layout + size of container fire is in
59
In fires, what affect does a lower neutral plane have on the risk of flashover?
Increases risk
60
What are common fire gases? (5)
1. Carbon monoxide
2. Nitrogen dioxide
3. Carbon dioxide
4. Hydrogen cyanide
5. Ammonia
61
Describe the 5 stages of a fire?
1. Incipient - small, smoke still slows visibly in room. Emission of heat is low, can easily be extinguished
2. Growth - defined layer of smoke above fire, room temperature increases.
3. Flashover - near simultaneous ignition of most of the directly exposed combustible materials in the enclosed area
4. Fully developed - Energy at greatest (700-1200 degrees C). Black and dense smoke, blackened windows. Backdraft results from sudden introduction of air
5. Decay - Flame starts to lose fuel/oxygen. Limiting fire to one compartment will limit the fuel available.
62
What is are the steps for water rescue for first responders? (4)
1. Reach - branch/oar/towel to pull patient to safety. If not available lie on dock and grab hand and pull
2. Throw - flotation aid
3. Row - row to patient and use paddle to pull victim to stern
4. Go - if no life saving training should not swim, go for help
63
Describe the FRS decision making tool for water rescue?
1. 30-60-90 clock
2. Multi agency meeting every 30 mins
3. Water >6 degrees and submerged unlikely to survive 30 mins
4. Water < 6 degrees and submerged unlikely to survive after 60mins
5. Consider extending to90 mins for a child
64
How often should a secondary triage officer carry of MITTS on the CCS?
At least every 15 mins
65
What is the Tactical Communications Officer and what colour is their tabard?
- Advise on best use of communications
- technical experts
- useful for multi-agency comms
66
What colour tabards to the Strategic Advisor, Tactical Advisor and NILo wear?
Green and white check top
Green bottom
67
What colour tabard is an Ambulance Entry Control Officer?
Green and yellow check all over
68
What colour tabard is:
1. Loggist
2. Any support role e.g press officer
1. Green and white check top with orange bottom
2. All orange
69
What can be done to help police with forensics in an MI? (7)
1. Record injuries/take photos
2. If patient is suspect then if possible looked after by separate clinical team
3. If treating multiple patients change gloves
4. Avoid cuts through existing cuts/tears to fabrics
5. Don't clean patients shoes etc of blood
6. Avoid putting multiple blood stained clothes in one bag
7. If handling knife use gloves and handle area that isn't usually used (e.g. not handle)
8. Bullets from patient can go into a plastic bag, otherwise dont touch as could be live - inform police
70
In MITT + TST what age of child should be managed as P1?
<2 yrs / not walking or talking
71
If a patient is walking but clearly has significant ie. catastrophic injury, how should they be triaged?
Sit down and make P1
72
Who takes overall responsibility of the risk assessment and safety of staff/attendees at events?
The organisers
73
When organising a large event who is it mandatory to consult and who is advised?
Mandatory: Local authority and local emergency services
Advised: Safety Advisory Groups (SAGs)
74
What is a Safety Advisory Group (SAG)?
These are groups of multi-agency representatives for events. They have no legal power and are just there to give expert advice and guidance
75
How is a venue capacity calculated?
Conisder p factors (physical condition of the venue) and s factors (quality of safety management).
76
How many people can exit a 1.2m wide exit in 1 minute on:
1. Steps
2. Flat exit
1. 79
2. 100
77
What colour stripes fire extinguishers indicates the following, what fires should they and should they not be used on?
1. 2 white stripes
2. Blue stripe
3. Single white stripe
4. Single black stripe
1. Water
- wood/paper/textile/solid material fires
- not liquid/electrical or metal fires
2. Powder
- liquid and electrical fires
- not metal
3. Foam
- liquid fires
- not electrical or metal
4. Carbon dioxide
- liquid and electrical fires
- not metal fires
78
Re: fire alarms at events (Purple Guide):
1. maximum distance from person to alarm at all times
2. height off ground
3. how often should they be checked?
1. 45m
2. 1.4m off ground
3. at least weekly
79
When organising an event and planning FRS (purple top):
1. How big does the road need to be
2. How much load should it be able to take
3. How far from this road can the event be
1. 3.7m wide and high
2. 12.5 tonnes
3. 50m
80
What are the five parts of a MI?
1. Emergency Services Response
2. Incident Management
3. Crisis Management
4. Business continuity
5. Recovery
81
What are the five tiers of event medical resource as set out by the Purple Guide?
Tier 1: <500 ppl
Low risk event (no drugs/alcohol)
= 1-2 responders and a defib
Tier 2: 500-2000 ppl
Social EtOH, < 24 hrs
= 2-4 responders, a defib and a paramedic crewed ambulance.
Tier 3: 2000-5000 ppl
ETOH likey and recreational drug use. Moderate injury risk. Hospital admissions likely to occur as a result. >24 hours
= 4 first responders, a defib, 2 paramedics, 2 nurses, a doctor crewed ambulance
Tier 4: 5000-10000 ppl
Etoh likely and recreational drug ise. Hospital admissions likely. Event lasting 2-3 days
= 6 first responders, a defib, 2 paramedics, 2 nurses, paramedic crewed ambulances and a doctor on site as clinical lead.
Tier 5:
Complex events with >10,000 people
= 8 first responders, a defib, 3 nurses, at least 2 paramedic crewed ambulances and a doctor on site as clinical lead PLUS control staff
82
What is the minimum level of training for responders at a registered event?
FREC (First Responder Emergency Care) level 3
83
What are the 4 types of ionising radiation and their characteristics?
Alpha- heavy and highly charged and interact strongly with atoms. Can only travel short distances and cannot penetrate human skin. Hazardous only when ingested, injected or absorbed through a wound.
-
Beta- charged but less interaction than alpha therefore travel further and penetrate more. Including through skin, clothes and standard PPE. Can cause skin injury with prolonged exposure. Hazardous to internal organs only when inhaled, ingested or absorbed through wounds
-
Gamma and X-rays- uncharged and do not interact with atoms therefore can travel meters in air. Easily penetrate human body and cause organ damage. Attenuated by lead or concrete shielding.
-
Neutrons- uncharged, travel far and penetrate everything (except water). Highly damaging but only likely to be present in nuclear detonation or accident.
84
What are the 2 types of hazard caused by radiation? (JRCALC)
1. Radiation -radiation travels through air to body but patient does not become 'radioactive.' Makes patient ill but no risk to others
2. Contamination (not XR) - radioactive dust/liquid/gas attaches to clothes/body and continues to emit radiation. Risk to others
85
What is sealed vs unsealed radioactive substances?
Sealed contained in solid material (usually metal) and can emit radiation but will not lead to contamination
Unsealed = powders/liquid/gas and can be released into enviroment and cause contamination
86
What does JRCALC recommend with regards to radiation and:
1. P1
2. P2 +3
1. Don't delay life saving tx (risk to healthcare staff is low), manage and then remove clothes and leave on scene until they can be dealt with safely
- dress open wounds
2. Decontaminate as much as possible on scene. If not able wrap in sheet or blanket before conveying
87
Who can respond to radiation emergencies in ambulance service with correct PPE?
1. HART (and can measure radiation)
2. SORT can bring PPE for anyone to use
88
What is the radiation dose to cause:
1. Acute Radiation Sickness
2. LD50/60 (would kill 50% population in 60 days)
3. LD100
1. 1.0 sievert
2. 4.5 sievert
3. 10 sieverts
89
What is the affect on a patient of radiation at:
1. 1 sievert
2. 1-8 sievert
3. 6-20 sievert
4. > 20 sieverts
1. usually mild or asymptomatic
- N&V 48hrs
- depressed WCC at 2-4 weeks
- counselling if pregnant but often no foetal effects.
2. symptoms usually 1-4 hours after exposure (N&V, fatigue)
- Latent period 2 days- 4 weeks.
- Then haematopoietic syndrome- BM depression, infection, bruising, bleeding. Hair loss at 2-3 weeks. LD50/60 is 4.5 sieverts without treatment.
3. Severe GI symptoms.
- Latent period hours-1 week. - BM depression.
- LD100 is about 10 sieverts usually within 2 weeks.
4. May be lucid interval but otherwise collapse, projectile vomiting, headache, LOC, burning skin.
- Death within 2-3 days.
90
What are the 2 broad sections of the Civil Contingencies Act?
1. Local arrangements for civil protection
2. Emergency Powers
91
In terms of the Civil Contingencies Act what are:
1. Category 1 responders
2. Category 2 responders
1. Subject to a range of statutory duties, including risk assessment, emergency planning
e.g local authority, emergency services, NHS trusts, enviroment agency and transport authority
2. Not legally obligated to the same extent as Category 1 responders but still have an important role in emergency preparedness and response and expected to work with cat 1 responders.
e.g. utility companies, transport operators, telecommunication providers
92
What are Local Resilience Forums (LRF)?
Category 1 and 2 responders come together to co-ordinate planning and response to emergencies.
93
What are the emergency powers set out in part 2 of the civil contingencies act? (6)
1. Emergency Regulations
2. Discretionary Powers
23. Seizure of Property
34. Direction and Control:
Allow officials to direct and control resources, facilities, and services
5. Allocation of Resources
6. Public Health Measures
e.g quarantine, vaccinations
94
What does the CCA define as an emergency?
'An event or situation that threatens or causes serious damage to human welfare, the environment or security in the UK’
95
What are the 6 planning principles making up the Integrated Emergency Management?
A-A-P-P-R-R
1. Anticipation (horizon scanning);
2. Assessment (of the risks);
3. Prevention (pre-event actions)
4. Preparation (development of contingency plans)
5. Response
6. Recovery
96
Who provides a link between local authorities and the military?
Joint (military) regional liason officers
97
How should local authorities request MACA:
1. Routinely
2. Immediate need for assistance
1. Defence Minister
2. Local military commanders
98
What are the following incidents:
1. Rising tide
2. Cloud on the horizon
3. Headline news
1. Developing infectious disease epidemic or a capacity/staffing crisis or industrial action.
2. Cloud on the horizon – a serious threat such as a significant chemical nuclear release
3. Public or media alarm about an impending situation
99
What does NHS England define as:
1. Critical incident
2. Major incident
3. Business continuity incident
1. Localised incident where the level of disruption results in an organisation temporarily or permanently losing its ability to deliver critical services. Principally an internal escalation response to increased system pressures/disruption to services
2. situation with a range of serious consequences that require special arrangements to be implemented by one or more emergency responder
3. An event or occurrence that disrupts, or might
disrupt, an organisation’s normal service delivery, to below acceptable predefined levels.
100
What are the expectations of category 1 responders in relation to MI? (6)
1. assess the risk of emergencies
2. put in place emergency plans
3. put in place business continuity management arrangements
4. arrange communication with public re: planning and to warn if incident likely/occuring
5. share information with other local responders to enhance coordination
6. co-operate with other local responders to enhance coordination and efficiency
101
What does NHS England EPPR set out as mandatory for Ambulance Services in relation to Tactical Medical Advisors? (4)
1. Ensure their provision and that they are subject matter experts.
2. They will be appropriately equipped and competent to give appropriate advice to the ambulance Tactical Commander and, if necessary, the ambulance Strategic Commander.
3. Tactical Advisers can also be called on to give advice on responding to unusual incidents.
4. May be required to attend the scene of the incident or
emergency, a tactical coordinating group (TCG) and/ or a strategic coordinating group
(SCG).
102
What does NHS Englaned EPRR state with regards to medical teams and MI?
The NHS ambulance service must have in place arrangements for the provision of medical support in the event of a mass casualty incident.
103
How often should NHS funded organisations do the following in preparation for MIs?
1. Communication systems exercise
2. Table top exercise
3. Live play exercise
4. Command post exercise
1. every 6 months
2. every 12 months
2. every 3 years
3. every 3 years
Minimum
104
Describe the NARU command structure
105
Outline the JESIP principles of joint working
1. Co-locate
2. Communicate: clear, no jargon
3. Co-ordinate: Identify the following;
- lead organisation
- priorities and capabilities
- limitations
- timing of next meeting
4. Jointly understand risk:
- share information on likelihood and potential impact of threat
- agree control measures
5. Shared situational awareness:
- METHANE
- Joint decision model
106
What is the NARU model for human factors?
STOP
Situation: weather/senior officers/experience
Task: should be trained
Organisation: culture/policies/procedures
Person: individual skill/attributes/weakness
107
How does NARU define:
1. Command
2. Control
1. Exercise of vested authority associated with a role within an organisation to give direction to achieve defined objectives
2. Application of authority combined with capability t manage resources to achieve defined objectives
108
Describe the JESIP joint decision model (JDM)
VIAPOAR
1. Gather information and intelligence
2. Assess threats and deliver working strategies
3. Consider powers/policies and procedures
4. Identify options and contingencies
5. Take action and review
Values
Information
Assessment
Powers/policies/procedures
Options
Action
Review
109
How does NARU suggest developing a working strategy (6)
1. Identify hazards:
All info from all agencies should be disseminated to all 1st responders/control rooms/agencies
2. Dynamic risk assessment
3. Identify tasks
Specific to each agency
4. Apply risk control measures:
co-ordinated approach
5. Have and integrated multi-agency operational response plan:
Hazards + DRA considered + agree priorities
6. Record decisions
110
What is the role of the strategic commander? (4)
1. Directly represents interest of Ambulance Trust Board
2. Must be able to perform without further authority
3. Provide strategy for Tactical Commander
4. Attend Strategic Co-ordinating Group (SCG)
111
In an MI, how quickly should the Strategic Co-ordinating Group (SCG) meet?
< 2 hours and ideally face to face
112
Who is the strategic advisor?
Will vary depend on nature of incident
113
Where should the Tactical Commander be during a MI?
Single location:
Co-locate in person close to scene if single incident + Tactical Co-ordination Group should be attended by Tactical representative (e.g. NILO)
Multiple locations:
Attend TCG in person
114
Who is the Tactical Advisor?
- In depth knowledge of MI plans/special teams
- will provide Tactical Commander with the relevant SOPs etc. during MI
115
What is a NILO?
National Interagency Liaison Officer
Tactical Advisor but has had specific national training
116
Who is the Operational Commander and where should they be during a MI?
Responsible officer on scene
Should co-locate at Forward Command Post (FCP)
117
What does the Strategic Medical Advisor do? (3)
1. Monitors overall NHS system capacity
2. Ensures patient safety throughout wider ambulance trust is acceptable
3. Ensures tactical has the clinic resources needed e.g. mutual aid
118
What is the role of the Tactical Medical Advisor? (2)
1. Casualty distribution from incident
2. Support tactical and strategic commanders to transfer casualties to appropriate medical facilities
119
What is the role of the Operational Medical Advisor?
Single POC if multiple advanced clinical assets deployed to a MI
120
Who gives permission for HEMS teams to enter inner cordon in an MI?
Ambulance Commander
121
Who is responsible to ensuring all medical advisors are credible and trained?
Excecutive Medical Officer (Chief Medical Officer) of ambulance service
122
What is the difference between the following in terms of MI
1. Simple or compound
2. Compensated and uncompensated
1. Simple = critical infrastructure intact
Compound = damage to infrastructure
2. Compensated = extraordinary capacity can deal with casualties
Uncompensated = even with extraordinary capacity unable to cope with number of casualties
123
What does ‘span of command’ and ‘span of control’ mean?
Span of command: Hierarchy of command and control in each service
Span of control: Number of lines on communication one individual can realistically maintain
124
What do the following refer to?
1. Operation CONSORT
2. Operation CARBON STEEPLE
3. Operation PLATO
4. Operation WAYPOINT
5. Operation CITIDEL
1. Royalty/VIP under close police protection being attacked
2. As above
3. MTA (only police can declare)
4. National system coordinated by Maritime and Coastguard Agency designed to provide early warning for masscal in UK waters
5. Siege situation
125
Who should have their lights on at a MI?
Scene commanders from each service
126
What are the roles specific to the police force at a MI? (6)
1. Securing a scene
2. Investigation of incident
3. Prevention of a crime
4. Identification of dead on behalf of coroner
5. Collection and distribution of casualty information
6. Family liaison
127
Re: span of control in a major incident - what is the optimum number of communication or direct reporting lines for one person to manage?
5
128
When should a patient have a re-triage following TST? (4)
1. Casualty doesn't appear to match their triage band
2. Condition clearly changes
3. Healthcare professional with time re-assesses 'silver' and decides either P1/dead
4. Every 15 mins (if possible)
129
What does the outside of the TST bands look like?
White checked border
130
With regards to TST what should be considered in a talking patient?
Are they confused - if so should be P1
131
What areas of the body are considered 'torso/back' in regards to TST? (7)
'neck to knees'
1. Neck
2. Armpit
3. Chest
4. Abdomen
5. Back
6. Groin
7. Buttocks
132
How long should a wound that has been packed have direct pressure placed on it (TST)?
3 mins
133
Who decides when to switch from TST to MITT, and when is this usually?
Ambulance scene commander - most senior on scene
Occurs when TST completed and casualties evacuated to CCS
134
What do the MITT wristbands look like
Block colour with no checked pattern
Space for notes
135
Who is responsible for coordinating triage using MITT?
Secondary triage officer
136
What are the 5 duty of care requirements to be considered at a MI?
1. Duty of care of staff - statutory requirements under Health and Safety at Work Act 1974
2. Duty of care to the patient - common law
3. Article 2 Right to Life - balance of duty of care to staff and patients
4. Dynamic risk assessment
5. Multi-agency joint Doctrine
137
What are the 3 unique roles for HM Coastguard at a MI?
1. Co-ordinate UK SAR Helicopter capability
2. Co-ordinate civil SAR in the UK Search and Rescue Region
3. Protect maritime environment
138
Outline the UK Terrorist threat levels
Low - attack highly unlikely
Moderate - possible but not likely
Substantial - likely
Severe - highly likely
Critical - highly likely in the near future
139
What is the breakdown of P1/P2/P3 expected at a MI?
25/25/50 %
Higher P1s likely in MTA
140
What is the recommended minimum cordon distance from an IED to use:
1. Airwave radio/phones
2. Car radio
1. 15m
2. 50m
141
What is the minimum cordon distance from:
1. Unknown device
2. Smaller item IED
3. Medium item IED
4. Large item IED
1. 100m
2. 100m
3. 200m
4. 400m
142
What is considered:
1. Smaller item IED
2. Medium item IED
3. Large item IED
1. bag, briefcase, person borne
2. suitcase, wheelie bin, car
3. van, lorry, HGV
143
In order to risk stratify suspicion items, describe the principles we should use?
HOT
is it Hidden?
is it Obviously suspicious?
is its presence Typical?
144
Once and object has been declared suspicious what is the appropriate sequence of events?
4 C approach
Confirm - Confirm suspicious using the HOT principle
Clear - move to at least 100m, cordon, find something to hide behind
Communicate - inform control ensuring minimum safe distance
Control - access to cordon, keep eyewitnesses on hand for information
145
What is the Guide to Safety at Sports Grounds called?
Green Guide
146
According to the JESIP IOR for CBRN response, what should be achieve in the first 15 mins? (3)
1. Evacuate
2. Disrobe
3. Decontaminate
147
What should indicate wet decontamination over dry? (3)
1. Caustic agent suspected
2. Known biological agent
3. Known radiological incident
148
What is the dose/combination of medication in DuoDote autoinjector?
2.1mg atropine and 600mg pralidoxime
149
When should DuoDote be given (as a minimum)?
At least 2 mild symptoms of NA poisoing
150
What is the lower limit of weight that DuoDote safety has been established?
41 kg
151
What makes a P1 in a CBRN priority grading? (5)
1. Unconscious
2. Seizure
3. Cyanosis
4. Respiratory distress or arrest
5. HR < 40bpm
152
What is a P2 in CBRN incident? (5)
1. Not walking
2. Excessive secretions
3. Confusion
4. Wheezing
5. Incontinence
4 Ws
Wet - secretions/incontinence
Wheezy
Whacky
not Walking
153
What is a P3 in a CBRN incident? (4)
1. Walking
2. Pinpoint pupils
3. Dimmed vision
4. Eye pain
154
What are the two main blistering (vesicant) chemical warfare agents?
1. Mustards
2. Arsenic containing Lewisite
155
What is the antidote to Lewisite?
Dimercaprol 3mg/kg IM
156
Describe the characteristics of Sulphur mustard (HD) (5)
1. Reacts chemically with bleach
2. Combustible
3. Products of combustion toxic
4. Vaporises at room temperature, increases in moist environment
5. Lipophilic
157
How can sulphur mustard be removed from skin?
Warm detergent solution
158
If contaminated with liquid sulphur mustard, what should be ensured?
Remove within minutes and if some residual noted later also remove as it will off-gas vapour
159
What are the systemic complications of sulphur mustard poisoning?
Crude alkylating agent which can damage DNA and result in suppression of bone marrow, sepsis and death.
160
What is the smell of sulphur mustard and why is this relevant clinically?
Garlic or mustard
Olfactory threshold below that which toxicity occurs and therefore is an early warning to exposure
161
Describe the characteristic of Chlorine gas (2)
1. 2.5 x heavier than air
2. Gas at room temperature
162
What are the clinical features of chlorine gas? (4)
1. Mild - mucous membrane irritation
2. Bronchospasm
3. Acute lung injury / ARDS
4. Skin/eye irritation in high concentration and burns in very high
163
How does chlorine gas cause damage?
Partially dissolves in water to form hydrochloric acid and hypochlorous acid - deposits onto mucous membranes/skin/airways.
164
How should chlorine toxicity exposure be managed? (3)
1. Inhalational injury - oxygen, bronchodilators
2. Irrigate to skin PH >4.5
3. Ocular irrigation until normal PH
165
What treatment should be carried out in the hot zone of a CBRN incident? (3)
1. Cat haemorrhage management
2. Simple airway manouvres
3. Antidotes
166
Where should advanced medical care be carried out in a CBRN incident?
Cold zone - Casualty Clearing Station
167
What is the clean dirty line in a CBRN incident?
Line between warm and cold zone
168
How long after a major incidents are notes kept for?
At least 25 years
169
Who has overall responsibility for the deceased at a major incident?
Coroner (police will on their behalf)
170
When should bodies by moved in a major incident? (2)
1. To access live casualty
2. Likely to deteriorate to environmental factor e.g fire
171
If you have to move a body at a major incident what must be done?
Make effort to record the casualty location
172
Where will deceased patients taken from scene at a major incident be moved to?
Body holding area, usually adjacent to casualty clearing station
173
If a patient dies following leaving scene where should they be taken?
Continue to hospital where they can be certified as dead
174
What should the immediate initial treatment of nerve agent poisoning be for:
1. P1
2. P2
3. P3
1. 3 autoinjectors
2. 1 autoinjector every 15 mins
3. Nil but will get pralidoxime IV/IO
175
In addition to the 3 initial autoinjectors, what should P1 patients suffering suspected NA poisoning get?
1. 5-10mg atropine IV (toxbase says 3mg)
2. 2g pralidoxime IV/IO over 5 mins
3. Re-assess for signs of toxicity every 5mins and further 5mg (3mg) IV/IO atropine as needed
176
What should all patients (P1-3) with suspected NA poisoning get?
Proxlidoxime 2g IV/IO over 5 mins
177
If a patient with suspected NA poisoning is seizing (therefore P1) what should be the sequence treatment?
1. Autoinjector IM (will have 3)
2. Benzo IV/IO every 5 mins until stops
3. Pralodoxime
178
What is the dose of paeds:
1. Atropine
2. Pralidoxime
in NA poisoning?
1. 0.02mg/kg
2. 30mg/kg
179
What is the role of the safety officer? (NARU card) (7)
1. Identify hazards and advise sector/operational commander on protective measures
2. Ensure everyone wearing PPE
3. Along with parking officer assist with briefing prior to deployment to incident site
4. Manage and record ingress/egress of all medical staff through inner cordon
5. Monitor for signs fatgiue/stress and ensure all staff have necessary rest/refreshments
6. Alert section/operational commander of need to evacuate and the agreed signal
7. Seek advise from NILO/TA on correct decon procedures if needed
180
What is the role of the primary triage officer? (NARU card) (6)
1. Responsible for co-ordination of all triage assets including HART
2. With forward doctor and operational commander identify sectors requiring triage
3. Obtain triage packs
4. Liase with FRS and HART re: triage in inner cordon
5. Keep operational commander updated with casualty numbers
6. Redirect triaging staff to CCS when appropriate (co-ordinate with CCS officer)
181
What is the role of the Casualty Clearing Officer? (NARU cards) (8)
1. Liase with operational commander and locate area for CCS and ambulance loading point
2. Request appropriate medical assistance and ensure appropriate levels healthcare staff at CCS
3. Ensure adequate protection exists (liase safety officer)
4. Ensure separate triage area and areas for each priority (P1-3) marked out and seperated
5. Ensure records (patient ID) are kept in Casualty Clearing Log via loading officer
6. Appoint secondary triage officer
7. Appoint equipment officer
8. With medical advisor and loading officer ensure effective transportation to hospital
182
What is the role of the secondary triage officer? (NARU cards) (3)
1. Manage MITT in CCS
2. Keep CCS officer update on numbers
3. Ensure 15 mins triage
183
What is the role of the parking officer? (NARU cards) (4)
1. Establish appropriate place to park further resources attending and inform EOC
2. Liase with police to ensure safety and the access/egress is maintained
3. Manage arriving vehicles and brief crew on on specific routes to/from CCS + hazards
4. Record call signs, level of staff (para etc) and vehicle ID
184
What is the role of the loading officer? (NARU cards) (5)
1. Establish loading point with consideration for access/egress and use police if needed
2. Liase with EOC and parking officer to ensure adequate supply of DCA
3. With CCS/CCS medical lead ensure appropriate packaging and dispatch patients in priority order
4. With CCS medical lead identify patients appropriate for air assets
5. Ensure log of patients leaving CCS maintained in Loading Point Log
185
To what distance should an RVP be checked for IEDs at a MI?
1. 5m if on scene limited time with limited resources
2. 20m if extended scene time +/- number of resources on scene
186
Which facemask is available to HART for CBRN?
FM35
187
What are the 3 types of nerve agent?
1. G agents - invented in Germany 1930s. Sarin, soman and tabun
2. V agents (VX + VG)
3. Novichocks 'newcomer'
188
Once 'atropinisation' achieved, what rate should the infusion be set at?
20% of the total dose that achieved atropinisation /hr
189
What are the appropriate initial steps for first on scene to a major incident (attendant/solo)? (9) (NARU card)
1. Park upwind/uphill/safely and adjacent to Police & Fire Forward CP and initial report to Ambulance control
2. Assume role of OPERATIONAL COMMANDER
3. Don PPE
4. Stay focused on role (DO NO RESCUE OR RX ANY CASUALTIES)
5. Assess scene & METHANE
6. Consider need for specialist teams (e.g. HART)
7. Initially identify RVP, Ambulance Parking Point & Ambulance Control point, Ambulance Circuit, Location of casualty Triage/Collection/Clearing points, Casualty Loading Points and CBRN/HAZMAT decontamination if required
8. Arrival of additional staff designate further command & roles.
9. Prepare brief (IIMARCH) for first Ambulance Commander.
190
What are the initial steps for the driver first on scene at MI? (NARU card) (7)
1. Park upwind/uphill/safely and adjacent to Police & Fire Forward CP and initial report to Ambulance control.
2. Leave blue lights ON, keys in ignition (engine running)
3. don PPE.
4. Assume the role of COMMUNICATIONS link between Emergency Operations Centre (EOC) and the “Attendant.”
5. Instigate a LOG.
6. Remain with vehicle (DO NOT RESCUE or TREAT casualties).
7. Complete a debrief report.
191
What are the first and second line abx for suspected anthrax/plague and tularemia (national CBRN guidelines)
First = ciprofloxacin
Second = doxycycline
192
Describe the role of the strategic medical advisor? (NARU card) (11)
***Note Strategic Medical Advisor NOT ON SCENE***
1. Once MI declared/standby co-locate with STRATEGIC COMMANDER (SC) if requested and start a LOG.
2. In liaison with SC establish communications with MEDICAL ADVISOR (MA).
3. In consultation with SC and MA establish need for additional medical resources on site.
4. Discuss with SC implementation of TRIAGE guidelines. Consider need to permit EXPECTANT (P4)
5. Consider of liaison with SC to cease routine work under force majeure.
6. Where possible use Trauma Network Tool. Consider use of wider casualty regulation outside region.
7. Interpret STAC/specialist
advice & guidance on PPE and infection control.
8. Arrange relief rota for Strategic Medical Advisor, Medical Advisor and CCS Medical Lead.
9. If CBRNE a possibility consider early request for Mass CRBN Prophylaxis supply (through NACC).
10. Liaising with Police Incident Commander and DVI Team Manager make arrangements for certification of deceased and location of body holding area. Coroner boundaries must be identified and where possible confirmation of death should only occur in one area.
11. Complete a report for CEO and attach all documentation related to incident.
193
Who needs to agree to implement the expectant category at MI?
Needs authorisation of Trust Medical Director or Associate Medical Director in liaison with NHS Accountable & commissioning body.
194
Describe the role of the medical advisor at a major incident? (NARU action cards) (14)
1. Don hi-vis stating “Medical Advisor”
2. Check communications & start a LOG.
3. Liaise with Ambulance Incident Commander (obtain full briefing)
- Open dialogue with receiving hospital(s).
- Request permission from Strategic Medical Advisor to invoke expectant (P4) category if indicated.
4. Co-locate with Ambulance Incident Commander or Operational Commander. Regularly brief the Strategic Medical Advisor.
5. Establish communications between all BASICS Doctors operating at incident.
6. Check all doctors ID’s.
7. Appoint Doctors to operational areas: Forward (work with Operational Commander), CCS and Body Holding Area (confirm life extinct).
8. With Casualty Clearing Officer (CCO) ensure effective throughput & evacuation of casualties and be aware of hospital(s) bed states and distribute accordingly.
9. In consultation with Ambulance Incident Commander & Strategic Medical Advisor consider all means to evacuation possible.
10. Ensure receiving hospital(s) aware of type of casualties they will be receiving and monitor bed state & acceptance status. 11. Liaise with Ambulance Incident Commander to ID specialist hospital treatment centres if needed.
12. Arrange for relief of medical staff.
13. Provide technical medical advice to all services and agencies at the site.
14. Ensure all medical staff present at HOT debrief.
15. Compile a report for the AIC & attached all documentation.
195
What else is the medical advisor called?
Tactical Medical Advisor
196
Describe the flood incident commanders tabard
Red/white check top
Orange bottom
197
What is the hierarchy of rescue?
1. Self
2. Team
3. Casualty
198
What is a :
1. Conditional rescue
2. True rescue
1. Relies on victim doing something themselves
2. Requires no assistance from victim
199
Describe the 4 different types of teams in water/flood rescue
A - Amalgamation
B - Rescue Boat Team - power boats
C - Rescue Technician Team - non powered boats
D - Rescue First Responder Team - mainly bank based safety and search
200
What colour helmet is any team commander in a water/flood rescue?
White
201
What colour light do both commanders and Rescue First Responders have (team D) have at flood/water rescue?
Yellow
202
What colour lights do both commanders and team members use in team type B + C of water rescue?
Red
203
What colour light is used in flood rescue to show:
1. Equipment and throw lines
2. Hazards
1. Green
2. Blue
Annoyingly different to USAR!
204
Describe the hand signals used in water rescue
205
What do the various whistle blasts mean at a water rescue?
206
How many columns are there in the casualty clearing log sheet and loading point log sheets have?
9
207
If RIO not yet in attendance but access to rail needed to save life/limb, what should be done?
EOC contacted who will liase with National Rail Control Centre who can confirm if power off and advice best way to enter track
208
What are the options for signalling to stop a train? (3)
1. Wave red flag
2. Raise both arms vertically above your head
3. Night - shine red light or wave any colour light vigorously
209
What is the minimum rest period in breathing apparatus?
Ambient conditions 30 minutes with 500mls of water intake
Hot and humid conditions 60 minutes with 1000ml water intake.
210
How should casualties be advised to peform dry decon?
1. Remove clothes but not over head (e.g. cut off), if stuck to skin keep in place
2. Supply clean material throughout the process
3. Wipe hands, then hair, blow their nose
4. work down their body (starting at face working all the way down to feet).
211
How should Sarin/soman/tabun/VX and VG be managed?
As per organophosphates e.g. atropine/praloxidime/seizure control
212
What are the end points recommended for stopping giving atropine every 5 mins?
1. secretions are minimal +
2.“atropinsed” (lungs are clear, heart rate is >80/min and BP is adequate).
213
What should deceased patients at a MI have documented?
Triage/assessment card attached with:
1. Identified as dead
2. Time identified as dead
3. Identity of HCP making decision
214
What is the rationale for switching from triage sieve/sort to TST (2) and MITT? (3)
TST:
1. Greater focus on providing life saving interventions
2. Simpler - no physiological parameters so can be completed by anyone (care gap Manchester Arena)
MITT:
1. Same for paeds/adults
2. Increased sensitivity and reduced under triage
3. Better at identifying life threatening injuries
215
Describe the UN hazard classes and warning diamonds
1. Explosive substances
2.1 Flammable gas
2.2 Non-flammable gas
2.3 Toxic gas
3. Flammable liquid
4.1 Flammable solid
4.2 Liable to spontaneous combustion
4.3 Flammable on contact with water
5.1 Oxidising agent
5.2 Organic peroxide
6.1 Toxic
6.2 Infectious substance
7. Radioactive material
8. Corrosive
9. Miscellaneous
216
What does a RIOs tabard look like?
Orange with black/yellow diamond pattern panels
217
What is the third rail?
The 'live' rail - 750 V
(1+2 in picture)
218
What is a rail detonator?
- Placed on tracks in 3s approx 20 metres apart.
- small explosives designed to alert driver to upcoming serious hazard
219
How far should staff be away from a rail detonator that is about to be detonated?
30m
220
What is an Entry Control Officer?
- Designated firefighter or crew member responsible for managing and coordinating the use of breathing apparatus (BA) during emergency responses involving hazardous entry
221
What colour is an Entry Control Officers tabard?
Black + yellow check
222
What is ATEX lighting?
ATEX = “ATmosphere Explosive”
Two European Directives for controlling explosive atmospheres.
Zone 1: explosive atmosphere likely to occur in normal operation occasionally.
Zone 2: explosive atmosphere not likely to occur in normal operation but, if it does occur, persists for a short period only.
223
What type of lighting should be used when responding to mine incidents?
ATEX
224
To what swift water rescue level are HART trained?
Level 3
225
What does the Purple Guide describe as the factors involved in deciding capacity for an event?
1. The time it takes to get into the venue;
2. The time it takes to get out of the venue;
3. Emergency evacuation time
4. Accommodation capacity.
226
What is the HSE 5 stage risk assessment?
STEP 1: Look for the hazards.
STEP 2: Decide who might be harmed and how.
STEP 3: Evaluate the risks and decide whether the existing precautions are adequate or whether more should be done.
STEP 4: Record your findings.
STEP 5: Review your assessment and revise it if necessary.
227
When planning an event, after what number of staff does the Purple Guide state you should keep notes of everything done in the planning phase?
> 5
228
Who are the core responders (cat 1) in CCA? (6)
Blue light services:
1. PHE
2. NHS hospital trusts
3. HM Coastguard
4. Port health authorities
5. Environmental agency
229
What does the Green Guide mandate in terms of first aid rooms? (3)
1. Should be >15sqm
2. If crowd >15,000 should be >25sqm
3. Should have at least 1 couch/bed
230
Describe the prodromal phase of radiation sickness? (5)
The typical picture starts with a prodromal phase lasting about 12 hours:
Nausea
Vomiting
Weakness
Fatigue
Neurological signs
231
How long is the latent period between prodromal phase and obvious illness in radiation sickness?
5-7 days
232
What does the obvious illness phase of radiation sickness present like? (6)
1. Gingival bleeding
2. Epistaxis
3. Petechiae
4. Systemic infections and gastrointestinal symptoms
- Lasts up to 4 weeks
- The risk of infection is highest at 25-35 days due to marrow suppression.
233
Who can declare a CBRN incident?
Police Senior National Coordinator
(HazMat in terms of ambulance/FRS until then)
234
Who has overall responsibility of a CBRNe incident?
Police
235
Who has responsibility for safe working at a CBRNe incident?
FRS
236
Who will advise on safe RVP in CBRNe incident?
The Met Office Hazard Manager service
237
What are the 'limits of exploitation?'
The furthest points to which emergency responders will
operate in warm or hot zones
238
If a 'snatch rescue' is required into the hot zone and there are no ambulance staff in appropriate PPE initially, who should perform this?
FRS with full breathing apparatus
239
Where should an FCP be placed in a CBRNe incident and what should be ensured?
In cold zone but close enough to help maintain situational awareness.
Need signal to relocate if change in wind etc. and must be different to evacuation signal for rescuers
240
What are the entry points into warm and hot zones called in terms of CBRNe?
Inner Cordon
Gateway Control (ICGC)
241
What should the path of a patient in a CBRNe incident look like?
Hot zone - triaged (NARU toxic triage process) and life saving measures
Warm zone - moved to CCP and decontaminated
Cold zone - CCS and then onwards to hospital
242
If patients are cold following decontamination what might FRS have that can be helpful?
Re-robe packs
243
What is the Purple Guide definition and recommendation for Tier 1 events?
- Small simple events <500 people
- Low risk drugs/alcohol
1-2 responders, first aid kit with defib
244
What is the Purple Guide definition and recommendation for Tier 2 events?
- 500-2000 people
- Social alcohol
- < 24 hours
- 2-4 responders
- Paramedic crewed ambulance
- Defib
*dedicated first aid resource with HCP
245
What is the Purple Guide definition and recommendation for Tier 3 events?
- 2000-5000 people
- alcohol/drugs likely
- moderate injury risk
- hospital admissions likely
- > 24 hours
- 4 first responders
- 2 paramedics
- 2 nurses
- Doctor crewed ambulance
- Defib
* dedicated medical resource
246
What is the Purple Guide definition and recommendation for Tier 4 events?
- 5000-10,000 people
- likely drugs/alcohol/injury/hospital
- 2-3 days
- Doctor on site as clinical lead
- 2 paramedics
- 2 nurses
- 6 first responders
- crewed ambulance
- defib
* dedicated medical resource
247
What is the Purple Guide definition and recommendation for Tier 5 events?
- >10,000 people
- complex events
- 2 doctors
- 3 nurses
- 2 paramedics
- 8 first responders
- crewed ambulance
- control
- defib
* dedicated medical team and control
248
What level of radiation is acceptable for patients before being deemed contaminated?
1 Sv
249
How big is a TST band?
300mm x 50mm
250
Describe the TST band colours and writing
