Previous SAQs Flashcards
1
Q
Relief (humanitarian) agencies usually classified under 4 broad headings. List any two of them.
A
International
National or Governmental
Non Governmental (NGO)
Military
2
Q
List 4 leading NGOs involved in relief work
A
MSF Doctors without Borders MERLIN RedR Save The Children CAFOD CARE OXFAM (vital needs) MdM War Child Leonard Cheshire Mercy Corps (rebuild capacity, employment, economy)
3
Q
In 2005 the United Nations introduced a new disaster response initiative aimed at enhancing international relief efforts following disasters and complex humanitarian emergencies. What was this initiative?
A
The United Nations Cluster Systems.
Extra: Aimed to eliminate gaps in the humanitarian response, improving efficiency. Each cluster is a minisector that operators during a humanitarian disaster, lead by a cluster lead who acts as the provider of last resort and is responsible for policy setting and ensuring readiness by building technical capacity e.g. WFP may take lead for food and nutrition.
4
Q
Specifically what was the 2005 United Nations disaster response initiative intended to achieve. List three improvements.
A
- Improved liaison and co-ordination with Government of affected country
- Allocation of responsibilities to named agencies agreed in advance
- Named agencies to be “providers of last resort”
- Prevention of duplication of effort by expatriate relief agencies
- Cluster leads responsible for improving training and preparedness for future disasters
5
Q
Describe briefly the elements of an ‘‘initial assessment’’ as part of MSFs ‘‘Top 10 priorities for intervention’’.
A
This involves establishing health priorities based on a rapid collection and analysis of data concerning population at risk, age ranges, endemic and emerging health threats and needs in terms of human and material..
6
Q
What are MSF’s ‘‘top 10 priorities for intervention’’, during an emergency..
A
Measles immunization Water and sanitation Food and nutrition Shelter and site planning Health Care Control of communicable disease and epidemics Public health surveillance Human resources and training Coordination of effort
7
Q
List some life threatening communicable diseases commonly observed during an emergency.
A
Measles
Diarrhoeal diseases
Acute respiratory infections
Malaria
8
Q
During the MSF Top 10 priorities for intervention, there is a requirement for an urgent mass vaccination programme. What is the most likely disease, and which age group should be vaccinated?
A
Malaria - 6 months to 15 years.
9
Q
What vitamin is commonly given with a measles vaccination?
A
Vitamin A.
10
Q
During the initial phase of a crisis what is the recommended absolute minimum water volume required by an adult for survival? As agencies differ on this a range is accepted
A
The range varies from 3 to 7 litres per day (WHO recommends 5 litres)
11
Q
As the crisis develops there will be an additional need for water for food preparation, personal hygiene and clothes washing. What is the water volume range recommended for this?
A
The range now is from 7 to 20 litres (Sphere suggests 7 to 15 litres)
12
Q
With time water needs will rise almost exponentially during a disaster or conflict. There are many situations and places causing this rise in need. List three.
A
Medical Centres Hospitals (Operating theatres and ITUs make huge demands) Cholera and diarrhoea treatment areas Public Laundries Public toilets – hand washing and cleaning Feeding (Malnutrition) Centres Farms and livestock Perineal cleaning
13
Q
In crises local water supplies are often contaminated and water requires to be treated. List 3 ways in which may be treated to make it safe for drinking.
A
Sedimentation in a tank or large container
Exposure to UV rays
Filtration
Added chemicals – typically use of halogens
Boiling
Reverse osmosis
14
Q
What are the legal consequences of failing to identify the dead, during a disaster?
A
Inheritance of property/money – 1 mark
Relatives unable to claim compensation - 1 mark
Life insurance not paid – 1 mark
Marital state of surviving next of kin – I mark
If foreigners involved – there will be repatriation and diplomatic issue – I mark
15
Q
Are there health implications surrounding dead bodies in sudden impact disaster? Write two short sentences to support your answer
A
In most situations the answer is no.
Few pathogenic microorganisms survive death of the host person
Decay and smell from cadavers due to non-pathogenic bacteria.
Those most at risk are those handling the deceased (body handlers)
Most risk of disease comes from the living
16
Q
What precautions should body handlers take during a disaster?
List 3 measures taken to reduce risk
A
Hepatitis B vaccination
Wearing of Gloves
Wearing of Gowns
Use of Eye protection
Disposal/disinfection of gloves, gowns and eye protectors
Hand washing after handling and before eating
Wash down/disinfection of vehicles and equipment
17
Q
There is a generally agree code of practice when handling dead bodies
List any two of the recommendations
A
Treat the dead with dignity and respect
Work within local religious and cultural mores
Where possible use body bags
Do not use disinfects (Lime for example)
New burial sites sited at least 250 m from drinking water sources and 0.7 m above saturated zone
18
Q
what is the goal of fluid resuscitation for trauma?
A
The goal of fluid resuscitation for trauma is to restore cellular and organ
Perfusion [3 marks]
19
Q
List four commonly used resuscitation fluids.
A
Isotonic or Normal Saline [1 mark]
Hartmann’s Solution or Lactated Ringers solution [1 mark]
Gelatin solutions – (Haemaccel for example) [1 mark]
Dextrans [1 mark]
Starch solutions [1 mark]
Albumin [1 mark]
Fresh Frozen Plasma[1 mark]
Fresh whole blood [1 mark]
Stored packed red blood cells (PRBC) [1 mark]
20
Q
It is common practice to give a shocked trauma victim an initial fluid bolus of warmed (if possible) isotonic electrolyte solution such as Ringer Lactate or Normal Saline. What is the initial dose range for an adult? What is the usual dose for a child?
A
For an adult the initial bolus is one or two litres [2 marks]
For a child the amount of initial bolus is calculated by the formula 20 ml per kilogram body weight [2 marks
21
Q
List five considerations in choosing between alternate sources for water supply for the refugees [5 marks]
A
Volume available [1 mark] Reliability of supply [1 mark] Quality of supply [1 mark] Contamination risk [1 mark] Water rights of local people [1 mark] Speed at which supply can be made operational (ready for use) [1 mark] Simplicity of technology needed [1 mark] Ease of maintenance [1 mark] Cost [1 mark]
22
Q
List three potential sources of water in the refugee setting [3 marks]
A
Rainwater [1 mark] Spring water [1 mark] Surface water [1 mark] Dug wells [1 mark] Bore holes [1 mark] Municipal supplies [1 mark] Private supplies [1 mark] Commercially available bottles water [1 mark]
23
Q
List 2 methods you might use to ensure water is safe for drinking {2 marks]
A
Pre-chlorination [1 mark] Filtration [1 mark] Disinfection [1 mark] Aeration [1 mark] Sedimentation [1 mark]
24
Q
What is the definition of a refugee in international law?
A
A refugee is someone who has been forced to flee his or her country because of persecution (e.g. race, religion, nationality, political views), war, or violence – and is unable to return based on these factors
25
What is definition of an Internally Displaced Person (IDP) in international law?
Persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized border.
26
Why is the distinction between refugee and internally displaced person important, under international law?
IDP have no protection under the 1951 Refugee convention
27
Which UN Organisation is charged with maintaining the rights of refugees?
UNHCR – UN high commissioner for refugees
28
Please define triage.
Triage is the prioritization process of patients for transport, medical treatment and management, based on and in proportion to need, but also on prognosis and resources required.
29
What does triage have as its main aim?
Triage aims to do the most for the most, by providing the right care to the right person at the right time
30
What do the following triage allocations mean?
- yellow or orange label
- delayed group
- white or black label
- T1 or P1
Yellow or orange label – urgent patients or major injury, but can tolerate a moderate delay in treatment (2 hours)
Delayed group- minor injuries who can tolerate a indefinite delay on treatment
White or black label – deceased patient
T1 or P1 – patients who require immediate life and limb saving treatment
31
In the context of triage what is the difference between a ‘Multiple Casualty’ and a ‘Mass Casualty’ situation’? Please describe in one sentence
Multiple casualty is when the resources of the health care system can cope, while mass casualty is when the hospital is overwhelmed and resources are saturated due such high numbers of patients.
32
Viral Haemorrhagic Fever (VHFs) are not frequently encountered in disaster settings and are widely feared. WHFs encompass a wide range of different diseases. List any three.
Lassa Fever, Rift Valley Fever, Yellow Fever.
33
What vectors can transport Viral Haemorrhagic Fevers? Give two examples.
Mosquito's and Monkeys
34
A lethal triad of pathologies is present in severe cases of Viral Haemorrhagic fevers. List the three aspects of this triad.
- Impaired cardiac function
- capillary permeability
- impaired coagulation
35
What are the five preventative measures used to prevent or control/mitigate an outbreak of Viral Haemorrhagic Fever?
- Isolation of patients
- Vaccination (yellow fever)
- Hygiene and health education
- Control of reservoirs/vectors
36
What sequence of activities comprise the primary survey?
```
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Environment
```
37
Following a successfully completed Primary Survey and concurrent resuscitation activities management continues by performing a Secondary Survey. List the sequence of activities that comprise this survey.
Full history, full physical examination, full neurological exam, Event/mechanism of injury, other examinations such as CT, re-evaluation of patient
38
There are many factors which predispose to an outbreak of GI disease. List three of them.
Infrastructure damage – water/sanitation/health, contamination of water supplies, overcrowding, break down of hygiene
39
Medical staff working during an outbreak of GI disease refer to the big three – Cholera, Dysentery and Typhoid (Also called Enteric fever). What is the cause of Cholera, what are its main symptoms and what is the cornerstone of therapy for most victims?
Cause of cholera is a bacteria called Vibrio. Main symptoms is sudden onset profuse diarrhoea, N V, and cramps. Therapy is based on rehydration, then in severe cases antibiotics.
40
How is Cholera transmitted?
Through feco-oral route, e.g. contaminated food/water, or unclean environment
41
How is Cholera diagnosed in a refugee/IDP camp?
Acute watery diarrhoea leading to severe dehydration or death
42
What measures can be taken to prevent mosquito bites?
Long sleeved shirt between dusk and dawn
Long trousers as above
Anti mosquito screens for doors and windows
Use of impregnated bed nets
Accommodation well clear of water sources
Insect repellents
43
What measures can be taken to reduce mosquito numbers?
```
Residual spraying
Fogging (Swing fog)
Physical destruction of breeding sites
Larvicides
Stocking water sources with fish
```
44
Is there any additional measure an expatriate humanitarian volunteer can use to prevent malaria?
Chemoprophylaxis treatment
| The area or region deployed will determine which medication is used.
45
The Private Military and Security Companies (PMSCs) are involved in a wide range of activities in the current operational environment. List two of them.
specialist security provision and close protection capabilities
provision of advice and training packages,
training of local police forces,
logistical support, including medical provision,
specialist advice with de-mining and monitoring roles in peace keeping.
46
PMSCs broadly breakdown into 2 groups – Private Military Companies and Private Security Companies. Provide a short definition for each
Private military companies (PMCs) – corporate entities providing offensive services designed to have a military impact in a given .situation that are generally contracted by governments (2 marks)
Private security companies (PSCs) – corporate entities providing defensive services to protect individuals and property, frequently used by multinational companies in the extractive sector, humanitarian agencies and individuals in situations of conflict or instability (2 marks)
47
There are compelling reasons who Governments employ PMSCs rather than use their Military Forces. List 2 reasons.
Use of PMSCs is cheaper that employing soldiers
Dead and injured PMSCs provoke little or no outcry from the media and the public
Using PMSCs lowers overall mortality and morbidity among the Military
Use of PMSCs creates economic opportunities in war afflicted countries
48
PMSCs are growing in number and size. List any 2.
```
Executive outcomes
Blackwater
Aegis
DynCorp
Sandline
Kellog, brown and root
```
49
List 3 major threats to women’s health in conflicts and catastrophes.
- Female genital mutilation or female circumcision
- Early marriage
- Early age at childbirth/first pregnancy
- Multiparity
- Vulnerability to abduction and rape
Malnutrition (lack of food/water)
50
Childbirth is particularly dangerous during in conflicts and catastrophes. List three common complications likely to be seen by carers?
- Obstetric fistula
- Perineal injury/tears
- Uterine prolapse
- Incontinence
- Puerperal infection/sepsis
- Unrecognised hypertension
- Death from haemorrhage
- Depression/suicide
51
List two factors related to increased maternal mortality in conflicts and catastrophes?
- Violence
- no access to ante-natal care
- Lack of access to education
- no access to general health care
- early marriage and adolescent pregnancy
52
Obstetric fistula is a very common finding in conflict and catastrophe settings. Please list 2 particular features of this obstetric complication?
- Urine and or faeces per vagina
- 2 million women live with fistula
- early death
- readily treatable by gynaecologists
- 20:1 morbidity to death ratio
- social exclusion 'better off dead'
- limited or no access to healthcare
53
Acting as a leader in Disaster Medicine you are asked to prepare a brief on the topic. You should use authoritative sources of information. List two of these sources.
UK Foreign and Commonwealth Office Travel Warnings
US State Dept Travel Advice
ICRC handbook on Staying Alive
Aid workers Network guide to field security
National Travel Network and Centre
RedR’s Safety & Security Advice
54
Trainers in the field of Disaster Medicine use the seven 'P's in the planning process. The first three are Prior Preparation Planning.. list the next four.
Prevents Pathetically Poor Performance
55
Basic survival kits are vital on deployment for disaster medicine. What are the 7 essential skills needed?
- Food and water hygiene
- Personal hygiene
- sanitation
- protection against the elements
- stress management
- sleep drills/ discipline
- defensive driving
56
Considering personal security there is a widely agrees list of do's and do not's, please list any three.
- do not display expensive goods or clothing
- do not be too loud or noticeable
- do not make promises
- do look like the least military person possible
- do dress modestly
- do ask for and follow local advice
- do secure belongings
57
ATLS recommends a number of agreed standard precautions to be taken when managing a trauma patient. The precautions also include the wearing of five items of protective clothing. List any two.
- cap
- face shield
- overshoes
- mask
- gown
58
What is the Secondary Survey in ATLS. One sentence only please?
The secondary survey is a complete history and physical examination of a trauma victim.
59
The Secondary Survey has five components. List any three.
```
History
Head to toe physical examination
Neurological evaluation
Special investigations such as CT, MRI, and Angiography
Re-evaluation
```
60
A number of therapeutic adjuncts are permitted during the Primary Survey phase of ATLS management. Please list any three.
```
fast scan
ABGs
urinary output monitoring
chest, pelvis and neck x-rays
vital signs monitor
ECG
Urinary and Naso gastric tubes
```
61
We live in an increasingly dangerous environment characterised by global intra state conflict, forced migration, ethnic cleansing and a rise in terrorist outrages. This new environment has many adverse impacts on the health of affected communities. List any three.
```
Difficult access to health care
Corruption
Mis-management
Unreliable data
Damage to health infrastructure
Departure of skilled staff
Breakdown in surveillance & reporting
Danger to staff & patients
```
62
We live in an increasingly dangerous environment characterised by global intra state conflict, forced migration, ethnic cleansing and a rise in terrorist outrages. This new environment has many social consequences for affected communities. List any three.
Social structures degraded
Social networks destroyed
Social infrastructure destroyed – homes, schools, transport, communication
Flight of key personnel – police, judiciary, lawyers, teachers, civil servants
Lack of security
Small arms proliferation
Normalisation of violence
63
The new environment faced by a refugee or IDP is complex and multifaceted in terms of providing assistance with many urgent and competing priorities. List two of these urgent priorities.
Provision of a safe and secure environment
Repair of infrastructure
Restoration of water supply, sanitation and power
Control of communicable disease
64
Humanitarian organisations face new and unique difficulties in providing aid in the new environment n which migration and movement of people keeps increasing. List two of these difficulties.
```
Complexity humanitarian issues
Difficult environment
Dangerous for carers
Open ended commitment
Expensive
Prospect of failure
```
65
There are many types of disaster. Provide a definition.
“A disruption of the human ecology, which the affected community cannot overcome with its own resources”
*must include that there is a need for external assistance.
66
What are the consequences of a Disaster?
```
External assistance required
Dead and injured
Long term disability results
Disease threats
Food & resource scarcity
Population displacement
Economic & development costs
```
67
Disasters are artificially divided into two groups. What are they?
Natural and man made
68
Give three examples of each type of disasters.
Manmade: war, terrorism, transport, technological, air pollution, chemical releases, fires, nuclear incidents.
Natural: geophysical, earthquakes, volcanoes, weather related, hurricanes, tornadoes, floods, drought.
69
Bacterial species are a major cause of gastrointestinal disease in war and disasters. Please list two of the species commonly implicated.
```
Salmonella
Campylobacter
E – coli
Shigella
Vibrio
Clostridia
```
70
Medical staff dealing with gastrointestinal disease outbreaks commonly refer to “the Big Three”. What are “The Big Three” diseases?
Cholera
Dysentery
Typhoid (Enteric fever)
71
There are many non bacterial causes of gastrointestinal disease in these environments. List any two.
```
Rotavirus
Hepatitis A
Norovirus
Giardia
Adenovirus
Amoebiasis
Cryptosporodiosis
Toxoplasmosis
```
72
There are many factors in war and disasters that predispose to gastrointestinal disease outbreaks. List three.
Breakdown of infrastructure – especially of water purification systems
Contamination of water supplies
Breakdown of hygiene in food preparation
Breakdown of personal hygiene
Breakdown of environmental health systems
Displacement
Overcrowding
73
List three examples of weather related disasters.
Hurricane, Tornado, typhoon, flooding, cyclone, drought, extreme heat wave, extreme cold weather.
74
95% of disasters occur in the unprepared developing countries. List three significant consequences for these societies
```
Health problems
Homelessness
Malnutrition
Involuntary migration
Economic setbacks
Debt
Inflation
Unemployment
Disillusionment & anger
```
75
There are many agreed qualities required of a good leader. List two of these qualities
```
Clear vision
Team builder
Clear strategy
Self knowledge
Decision maker
Integrity
Risk taker
Motivator
Life long learner
Good communicator
```
76
Not all leaders are the same. There are many different leadership styles recognized. List three
```
Charismatic
Participative
Situational
Transactional
Transformational
Quiet
Servant
```
77
Writers and commentators have written of the ’seven secrets’ of successful leadership. Can you list three of these?
```
Sensitive to followers
Treats followers with respect
Meets staff expectations
Avoids arrogance
Supportive to staff
Positive & inspirational
Good listener
```
78
The late US President, Dwight Eisenhower and the late French Emperor Napoleon Bonaparte have left apt and pithy definitions of leadership. Can you remember one these definitions?
Eisnehower “…Art of getting someone else to do something you want done because he wants to do it”
Napoleon “A leader is a dealer in hope”
79
Malaria is a vector borne disease caused by a parasite of the genus Plasmodium. What is the vector?
Mosquito (1 extra mark for female, Anopheles mosquito)
80
Five varieties/species of the Plasmodium parasite can cause malarial disease in man. List any three.
```
P Vivax
P Ovale
P Falciparum
P Malariae
P Knowlesi
```
81
What is the route of transmission of malaria ?
Disease is transmitted when an infected mosquito bites a human and injects malaria parasite into the victim’s bloodstream.
82
What are the characteristic symptoms of malaria? List four.
- chills
- fever
- nausea
- drenching sweats
- shaking
- headache
- muscular pains
83
There is no single definition of what constitutes a major incident. The NHS defines these incidents in clinical terms. What is the essence of the NHS definition?
The NHS definition underlines two important points. The first is the threat to the health of the community and second, the need for special arrangements to be in place to meet the challenge
84
The NHS, including our major hospitals generally prepare for a wide variety of threat scenarios. On the Department of Health’s website there are 8 scenarios listed. List any three of them/
```
Rising tide
Cloud on the horizon
Headline news
CBRN
Internal incidents
Mass casualty event
Pre-planned major event
```
85
In the context of major incidents what do the letters CBRN stand for?
C - chemical
B - biological
R - Radiation
N - Nuclear
86
Preparation for major incidents is now a statutory requirement. This involves training and exercises. A wide variety of exercise types are used throughout the NHS. List any three.
Table top exercise
Radio use/voice procedure exercise
Communication and information cascade exercise
Triage exercise
Practical exercise without casualties
Practical exercise with simulated casualties
Multi-agency exercises
87
There are many factors associated with disasters, which increase the risk of gastrointestinal disease outbreaks. List any three
```
Breakdown of water purification system
Contamination of the water supply
Breakdown in hygiene
Breakdown of the Environmental Health System
Population displacement
Overcrowding
```
88
When caring for symptomatic patients there are ‘6 key things to do’. List three of them
Treat the patient – this means rehydration
Confirm the diagnosis
Know when to use antimicrobials
Know when to use other medications – antimotility agent
Try to find the source
89
You can make your own Oral Rehydration Salts. There are 4 ingredients. List them and include roughly the quantities required (one mark for each correct ingredient)
1 litre of water
Sugar – 8 tea spoons
Salt – one level tablespoon
Half a cup of orange juice or half a mashed banana
90
In measuring the impact of the crisis there are many recognized determinants of severity. List any 2.
Numbers killed
Number of survivors
On-going daily mortality rate compared to the international standard
91
After measuring the impact of a humanitarian crisis, what are the next immediate priorities and needs. List three
```
Drinking water provision
Food
Sanitation
Shelter
Address emerging health threats
```
92
During the acute phase of a crisis there are well recognized triggers which demand urgent intervention. List two.
```
Crude mortality rate >1/10,000/day
Mortality in children <5 >4/10,000/day
<1500 kcal/day in adults
<100 kcals/kg/day in infants and children <5 years
Reduced MUAC in 10% of children <5 years
Reduced Z score
Wasting >15% of normal body weight
```
93
In considering the need to provide shelter during the acute phase of a crisis there are a number of agreed guidelines to be considered. List any three.
3.5 m2 minimum floor space per person
Use of plastic sheeting
At worst, out of wind and rain
Beware booby trapped buildings
Quickly transition to permanent shelter – avoid creating shanty towns
Know of the major logistic burden involved
Try to avoid creating permanent camps
94
Care in an austere setting may be less than ideal. List three areas where care in an austere area may differ from what may be possible in ideal scenario – St George’s for example
You may be alone caring for more than one casualty
Standard safety precautions may not be possible
Very unlike to have full range of adjuncts
Spinal immobilisation may be difficult
Radiology may not be available
A Secondary survey may be precluded by adverse environment
95
There are many adjuncts available to help with decision making in the Primary Survey phase of care. While accepting that many of these may not be available in some austere situations list three that you would like to have available
```
ECG
Vital signs monitor
Pulse oximeter
CO2 monitor
Arterial blood gas measurement
FAST or other ultrasound capacity
```
96
Performance of the Secondary Survey may be problematic in the austere environment. Nevertheless list 4 components of this survey that should be attempted.
```
Patient history
Scene history and mechanism of injury
Head to toe physical examination
Full neurological assessment
Special diagnostic tests such as CT or other radiology
Re-evaluation
```
97
Define Triage in one short sentence (2)
Triage is a system to help allocate clinical priorities when faced with multiple casualties.
98
In assessing injured casualties and applying a triage score a number of methods or approaches may be employed. Three are in common use. List any two.
Use of physiological parameters
Use of observed anatomical injury
Use of a combination of both
99
Using the T or Treatment triage system it is customary to define 5 patient groups. List 4 of them
T1 Immediate treatment needed
T2 Urgent treatment but can tolerate modest delay
T3 Able to tolerate indefinite delay
T4 Expectant
T5/T0 Dead
100
Blast injuries are by convention classified into five groups. These are Primary, Secondary, Tertiary, Quaternary and Quinternary. List 2 injuries described as Quaternary.
```
Flash burns
Flame burn injury
Smoke inhalation
Ingestion of noxious chemicals and toxins
Crush injury
Psychological disorders
```
101
A key feature following a bomb blast is the formation of a blast wave. It has two components. List them.
Shock wave
| Dynamic overpressure
102
Air containing organs are particularly vulnerable following exposure to a blast wave. List four common lung conditions that may present following exposure.
```
Primary blast lung injury or simply blast lung
Pulmonary contusion injury
Lung laceration
Pneumothorax
Haemothorax
Haemopneumothorax
Air embolisation
```
103
What is the leading cause of death and injury caused by terrorist bombing?
Penetrating injuries caused by fragments
104
What is the most significant type of malaria endemic in sub-Saharan west Africa?
Plasmodium falciparum
105
List five types of injury potentially associated with blast in this scenario. [5 marks].
```
Tympanic membrane rupture. [1 mark].
Blast lung. [1 mark].
Bowel injury. [1 mark].
Fragment injuries. [1 mark].
Burns. [1 mark].
Crush injuries. [1 mark].
Psychological sequelae. [1 mark].
Traumatic amputations. [1 mark].
```
106
Define the triage categories you would expect to be used by your receiving department in the situation of a bomb blast. [5 marks]
Category 1 – Critical [1 mark] and unable to tolerate delay [1 mark].
Category 2 – Urgent [1 mark] but delay 30-60 minutes tolerable [1 mark].
Category 3 – Less serious [1 mark], delay unlikely to affect outcome [1 mark].
Category 4 – Severe multi-system injury [1 mark], survival unlikely [1 mark], treat as expectant case [1 mark].
107
In the aftermath of a flood in south east Asia, list three immediate needs of the affected population. [3 marks].,
The immediate needs of the affected population are clean water, [1 mark] food, [1 mark] shelter [1 mark] and sanitation [1 mark]. [Maximum of 3 marks].
108
In the aftermath of a flood in south east Asia, list four potential short term disease risks to the affected population. [4 marks].
The potential short term disease risks to the affected population are enteric diseases such as dysentery, cholera and typhoid [1 mark for each] followed by other infectious diseases such as measles [1 mark]. They are also at increased risk from any endemic disease such as malaria [1 mark]. [Maximum of 4 marks].
109
In the aftermath of a flood in south east Asia, list three particularly vulnerable groups of individuals. [3 marks].
The most vulnerable groups of individuals are the very young, [1 mark] the very old [1 mark], those already sick [1 mark] and pregnant or nursing mothers [1 mark for each]. [Maximum of 3 marks].
110
List three types of heat injury/illness. [3 marks].
```
Sunburn. [1 mark].
Heat syncope. [1 mark].
Prickly heat. [1 mark].
Heat stress/heat exhaustion. [1 mark].
Heat stroke. [1 mark].
```
111
List three measures to prevent heat injury/illness. [3 marks
Adequate acclimatisation. [1 mark].
Adequate water intake. [1 mark].
Monitoring water intake. [1 mark].
Appropriate clothing. [1 mark].
Exclusion of personnel with previous heat illness. [1 mark].
Avoid work during hottest part of day. [1 mark].
Sunscreens. [1 mark].
112
List two signs of heat stroke. [2 marks].
```
Core temperature above 41 degrees C. [1 mark].
Severe Headache. [1 mark].
Loss of consciousness. [1 mark].
Dryness of skin. [1 mark].
Evidence of dehydration. [1 mark].
```
113
What is the emergency treatment of heat stroke? [2 marks].
Lower temperature by tepid bathing [1 mark] and fanning [1 mark].
IV rehydration. [1 mark].
114
Name two adjuncts/additional equipment that might help to improve an obstructed airway. (2 marks)
Naso pharyngeal airway
| Ora pharyngeal air way
115
What is meant by a definitive airway? Name two methods that can be used to establish a definitive airway. (3 marks)
Patient intubated for airway protection and patent airway
Definitive airway requires: tube present in trachea, cuff inflated, tube connect to some form of oxygen enriched assisted ventilation and the airway is secured in place.
Two methods: surgical airway cricothyroidototomy, oral/nasal tracheal tube.
116
Give one clinical indication for a surgical airway. What are the anatomical landmarks for a surgical airway? What are the limitations of a surgical airway, once established? (3 marks)
When a patient cant be properly intubated and cant place tubes through the chords.
Landmarks: skin incision that extends through the crico-thyroid membrane
Limitation: infection, damage to criocoid cartilage
117
A bomb, made by packing firework explosive into a jam jar and with nails taped to the circumference has exploded in a busy London pub at 18:00 on a Friday evening.
a)
Briefly describe the blast physics of the explosive event. (2 marks)
An initial combination of shock wave (high vibration traveling faster than sound >330m/s), followed by dynamic overpressure.
Explosive when detonated, rapidly chemically decomposed into large volumes of gaseous products at high pressure and temperature which forms a blast shock wave. The wave rapidly expands as a sphere of hot gasses, with instantaneous rise to peak pressure that travels at super-sonic speed.
118
Primary blast injury typically occurs to those closest to the detonation and especially in confined spaces. What is the cause of this primary blast injury and what are the clinic-pathological findings? Why is this form of injury often worse when the explosive event occurs in a confined space? (3 marks)
The cause: overpressure associated with shock blast wave.
shockwave that propagates through the tissues dumping energy at gas/tissue interfaces.
Pathological findings: injury to the tympanic membrane, blast lung, air embolism, bowel injury and sudden death.
Confined space: shock reflection results in multiple frequency loads as the energy has no elsewhere to dissipate.
119
What is Secondary Blast Injury? (2 marks)
High velocity energised fragments causing multiple penetrative and non-penetrative wounds (shrapnel – blunt force)
120
What is Tertiary Blast Injury? (2 marks)
Cause: blast wind (dynamic overpressure) that displaces the body and tears limbs and impact injuries.
e) Some authors have described “quaternary blast injury” as other injurious sequelae of the blast event. What forms might this take? (1 mark)
Crush injuries, psychological problem (PTSD)
121
Give 4 functions of the UK Disasters and Emergencies Committee (DEC)? (0.5 marks each, 2 marks)
- Coordinate fundraising and….
- ….Increase awareness for appeal
- Avoid duplication of humanitarian aid
- Save money on advertising
122
Give two reasons why it is necessary to conduct health assessments in conflicts and catastrophes. (2 marks)
This involves establishing health priorities based on a rapid collection and analysis of data concerning population at risk, age ranges, endemic and emerging health threats and needs in terms of human and material.
123
Describe one currently used tool for gathering health information in crisis or refugee contexts. (3 marks)
Initial Assessment (and explain).
124
d) Give two key reasons why health assessments carried out by different aid agencies differ so greatly, despite the introduction of SPHERE minimum standards? (2 marks)
Different motives and can possibly conflict with other NGOs to gain media attention which is essentially a fight for funding, uses different health assessment tools.
Eg MSF- impartial and neutral vs. Samaritans Purse- faith based NGO.
125
a) By what name are the statutes that codify International Humanitarian Law (IHL) commonly known? (1 marks)
The law of Genève
| The law of Hague
126
b) To which groups of people does International Humanitarian Law principally apply? (3 marks)
- I Treatment of wounded & sick armed forces in the field
- II Wounded, sick & shipwrecked armed forces at sea
- III Treatment of Prisoners of War
- IV Protection of civilians in War
127
The Red Cross/Red Crescent emblem has specific status under International Humanitarian Law. What protection does this emblem afford? (1 mark) Give two examples of those permitted to use the emblem (0.5 marks each)
- A symbol of neutrality and protection in armed conflict.
| - IFRC/ICRC and armed forces medical services, Civilian hospitals, Other agencies with authorisation
128
d) Under IHL, how is a “war crime” described? (1 mark) Give four examples of acts that are considered “war crimes” under IHL. (0.5 marks each)
Define: Serious violations of IHL committed during international and non-international conflicts
- Wilful killing of a protected person, Torture or inhuman treatment, Wilful injury or suffering, Deliberate attacks on civilians, Use of prohibited weapons, Misuse of emblem, Pillage of private property
129
Is International Humanitarian Law still applicable in civil wars, low intensity or asymmetric conflicts and for acts of terrorism? Give an illustration of how IHL might relate to a present day example of such a conflict. (1 mark)
Human Rights (applicable in all scenarios) and IHL (ONLY applicable in armed conflicts).
IHL is dependent on the form of conflict, in the case of civil wars it is mildly applicable but regarding terrorism, IHL is not applicable because modern day act of terrorism is not defined as an armed conflict e.g. 9/11
130
The “new operational environment” in 21st century conflicts/catastrophes is uniquely challenging to humanitarian actors in comparison to the 20th century. Which factors contribute to this situation?
a)There are numerous characteristics which are said to define this “new operational environment”. List two of them. (2 marks)
Rise in terrorism Intra-state conflict
Forced migration Ethnic cleansing
Failed and failing states
Unsafe environment for aid workers.& carers
131
How do you treat a tension pneumothorax, caused by a bomb?
Vented chest seal and debridement
132
Define shock:
The body’s reaction to inadequate tissue perfusion and oxygenation
133
Describe a scoring system used to estimate the severity of shock. (2 marks)
The volume of blood loss and BP
4 classes of shock: indicators inc. HR, Systolic BP, Pulse pressure, cap refill, resp rate, urine output, cerebral function.
134
d)The patient is judged to require a tube thoracostomy. Describe the anatomical landmarks for chest tube
Mid axillary line, 4th/5th intercostal space
135
what virus causes measles?
paromyxovirus
