Active Shooter/hostile Events and MCIs Involving Children Practice Questions

25 multiple-choice questions on Active shooter/hostile events and MCIs involving children for paramedic and EMT students, from Chapter 48 (Incident Management and Mass-Casualty Incidents). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. NFPA 3000 is a national standard that addresses:

   1. A. Ambulance design and patient compartment safety
   2. B. Hazardous materials training for EMS crews
   3. C. Minimum staffing for fire suppression crews
   4. D. Active shooter/hostile event response programs
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   Answer: D. Active shooter/hostile event response programs

   NFPA 3000, the Standard for an Active Shooter/Hostile Event Response (ASHER) Program, guides communities in planning, responding to, and recovering from these events, and it builds EMS into the response. Hazmat training and ambulance design fall under other standards.

2. At a school shooting, dozens of uninjured and wounded people run out of the building toward the casualty collection point. Before they enter it, they should be:

   1. A. Triaged first and searched if they seem odd
   2. B. Screened by police for weapons or attackers
   3. C. Sent home to make room in the area
   4. D. Held in the warm zone until it ends
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   Answer: B. Screened by police for weapons or attackers

   An attacker or accomplice may leave a building mixed in with fleeing victims, so law enforcement directs evacuees (often hands visible) and screens them before they reach the casualty collection point or treatment areas. This protects patients and EMS. Triaging first and searching only people who seem odd could let an armed person into the CCP. Sending people home loses track of the wounded and of witnesses. Holding them in the warm zone keeps them near the threat.

3. NFPA 3000 guides communities through which three phases of an ASHER program?

   1. A. Planning, response, and recovery
   2. B. Prevention, protection, and mitigation
   3. C. Triage, treatment, and transport
   4. D. Preparedness, response, and evacuation
   Show answer

   Answer: A. Planning, response, and recovery

   NFPA 3000 takes a whole-community approach to active shooter/hostile events: planning and preparedness before the event, a unified, integrated response during it, and recovery afterward. Prevention, protection, and mitigation are mission areas from the National Preparedness Goal, not the three NFPA 3000 program phases, and evacuation is one response task rather than a phase. Triage, treatment, and transport are only part of the response phase.

4. During a hostile event, the 'hot zone' is an area where:

   1. A. The threat has moved on but is not cleared
   2. B. A direct and immediate threat is present
   3. C. Patients are treated before transport
   4. D. Police are holding the arrested suspect
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   Answer: B. A direct and immediate threat is present

   The hot zone has an active, direct threat, such as a shooter; only law enforcement working to stop the threat normally enters. The warm zone has a potential but not direct threat, and the cold zone has no expected threat.

5. In a hostile event, the 'warm zone' is best described as an area:

   1. A. Where the shooter is still firing at people
   2. B. Where the command post and staging are placed
   3. C. Cleared or isolated by police, still risky
   4. D. Where no further threat of any kind is expected
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   Answer: C. Cleared or isolated by police, still risky

   The warm zone has been cleared or isolated by law enforcement but still carries an indirect threat. Rescue task forces work here with police protection. The command post and staging belong in the cold zone.

6. A rescue task force (RTF) is a team of:

   1. A. Police officers trained to treat gunshot wounds
   2. B. SWAT officers who enter the hot zone to arrest
   3. C. Hospital staff sent to triage patients on scene
   4. D. EMS or fire personnel with police protection
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   Answer: D. EMS or fire personnel with police protection

   An RTF pairs fire or EMS providers, typically wearing ballistic protection, with law enforcement officers who provide security, so care and evacuation can begin in the warm zone. Police-only teams make up the contact teams that engage the threat.

7. The main purpose of a rescue task force at an active shooter incident is to:

   1. A. Find and engage the shooter inside the site
   2. B. Set up the unified command post for the event
   3. C. Give early bleeding control and rapid removal
   4. D. Count the dead for the medical examiner's office
   Show answer

   Answer: C. Give early bleeding control and rapid removal

   Most preventable deaths in shootings come from bleeding, so RTFs bring hemorrhage control and rapid evacuation into the warm zone while police deal with the threat. Engaging the shooter is the role of the law enforcement contact team.

8. Before entering the warm zone as part of a rescue task force, EMS personnel should be wearing:

   1. A. Dark tactical clothing in place of armor
   2. B. Turnout gear with no body armor needed
   3. C. Air-purifying respirators and splash suits
   4. D. Ballistic vests and helmets as available
   Show answer

   Answer: D. Ballistic vests and helmets as available

   RTF members wear ballistic protection, such as body armor and helmets, because the warm zone still carries a threat. Respirators and splash suits are for chemical hazards, and neither turnout gear nor tactical clothing stops bullets.

9. The Hartford Consensus THREAT acronym begins with 'threat suppression' and 'hemorrhage control.' The next step is:

   1. A. Assessment by medical staff
   2. B. Rapid extrication to safety
   3. C. Resuscitation with fluids
   4. D. Retriage of every patient
   Show answer

   Answer: B. Rapid extrication to safety

   THREAT stands for threat suppression, hemorrhage control, rapid extrication to safety, assessment by medical providers, and transport to definitive care. Large-volume fluid resuscitation is not part of early care for penetrating trauma in these events.

10. In tactical emergency casualty care (TECC), the care allowed during 'direct threat care' is mainly:

    1. A. Moving to cover and applying a tourniquet
    2. B. Full primary survey and spinal stabilization
    3. C. Opening an airway with an advanced device
    4. D. Starting IV access and fluid resuscitation
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    Answer: A. Moving to cover and applying a tourniquet

    Under direct threat, the priorities are stopping the threat, moving the casualty to cover, and controlling life-threatening limb bleeding with a tourniquet. Airway care, IVs, and full assessment wait until the indirect threat (warm zone) phase.

11. In the warm zone, a man with a leg tourniquet in place is unconscious and snoring but breathing 14 times a minute. Under TECC indirect threat care, the RTF should next:

    1. A. Use a nasal airway or the recovery position
    2. B. Intubate him in the room before he is moved
    3. C. Put on a cervical collar before moving him
    4. D. Start bag-mask ventilation at 20 a minute
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    Answer: A. Use a nasal airway or the recovery position

    In TECC indirect threat care, an unconscious casualty without airway obstruction is managed with simple steps: a chin lift or jaw thrust, a nasopharyngeal airway, and the recovery position, then rapid movement to the CCP. Intubation in the warm zone takes time and equipment and is not needed for a man who is breathing. Spinal motion restriction is not routine after penetrating trauma and delays evacuation. He is breathing at an adequate rate, so bag-mask ventilation is not indicated.

12. In the warm zone, a woman shot in the abdomen is pale with a weak radial pulse and no limb bleeding. The RTF's best plan is to:

    1. A. Pack the abdominal wound tightly first
    2. B. Apply a tourniquet high on her thigh
    3. C. Give fluids until her pulse is strong
    4. D. Move her quickly toward surgical care
    Show answer

    Answer: D. Move her quickly toward surgical care

    Bleeding inside the torso cannot be compressed in the field, so only surgery stops it. Rapid evacuation to the CCP and transport to a trauma center is the priority. Wound packing is for junctional and extremity wounds, not for packing into the abdomen. A tourniquet does nothing without limb bleeding. Large fluid volumes raise blood pressure and dilute clotting factors, which worsens internal bleeding. TECC uses permissive hypotension, giving small amounts only to keep a radial pulse or mentation.

13. A rescue task force reaches a hallway where three wounded students can still walk. The best plan is usually to:

    1. A. Keep them in the hallway until it ends
    2. B. Direct them out by the secured route
    3. C. Treat each one fully first
    4. D. Carry them out one at a time to the CCP
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    Answer: B. Direct them out by the secured route

    RTFs limit their time in the warm zone. Casualties who can walk are directed, with police guidance, to leave along the cleared or protected corridor to the casualty collection point, while the RTF focuses on those who cannot move. Leaving them in the hallway keeps them near the threat and delays care. Full treatment in the warm zone wastes time; only lifesaving steps are done there. Carrying patients who can walk ties up rescuers who are needed for nonambulatory casualties.

14. In indirect threat care, an RTF has controlled a man's bleeding with a tourniquet. On a cool night, he is pale and shivering. TECC guidance is to:

    1. A. Leave him exposed to watch the wound
    2. B. Cool him to slow oxygen use
    3. C. Cover him to prevent heat loss
    4. D. Start a large IV fluid bolus first
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    Answer: C. Cover him to prevent heat loss

    Hypothermia worsens trauma-induced coagulopathy, so TECC calls for limiting exposure and insulating every bleeding casualty once hemorrhage is controlled, even in mild weather. The tourniquet and wound can still be checked under the covering, so leaving him exposed is not needed. Cooling makes clotting worse and is not a goal of care. A large bolus of unwarmed fluid chills him further and dilutes clotting factors; TECC limits fluids to permissive hypotension.

15. During an active shooter event, patients removed from the warm zone are often brought to a:

    1. A. Hospital helipad directly
    2. B. Casualty collection point
    3. C. Command post for review
    4. D. Media staging location
    Show answer

    Answer: B. Casualty collection point

    A casualty collection point is a secure location where RTFs bring patients for triage, further care, and handoff to transport. Taking patients to the command post or helipad bypasses triage.

16. Many children need mass decontamination after a chemical release at a school. The best approach is to:

    1. A. Use high-pressure cold water to finish quickly and safely
    2. B. Separate young children from their parents during decon
    3. C. Delay decontamination of children until adults are done
    4. D. Use warm, low-pressure water and keep families together
    Show answer

    Answer: D. Use warm, low-pressure water and keep families together

    Children lose body heat quickly, so mass decon for them uses warm water at low pressure, with blankets or warm clothing afterward. Keeping a child with a parent or caregiver, or assigning a responder, reduces fear and the risk of losing track of the child. Young children cannot decon themselves and need help.

17. During an MCI with a fire or other spreading hazard, young children are less able than adults to escape mainly because they:

    1. A. Are less likely to hide from danger
    2. B. Wake more easily to smoke alarms
    3. C. Lack the judgment or skills to flee
    4. D. Tire too fast to run very far
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    Answer: C. Lack the judgment or skills to flee

    Young children may not recognize danger, may hide instead of fleeing, and depend on adults to move them, so rescuers must search for them actively, including under beds and in closets. They are more likely, not less likely, to hide. Many children sleep through smoke alarms rather than waking more easily, and stamina is rarely what keeps them from getting out; the problem is recognizing danger and knowing what to do.

18. Children are at greater risk than adults from a heavier-than-air toxic gas at an MCI mainly because:

    1. A. Their breathing zone is closer to the ground
    2. B. Their lungs absorb less of most toxic gases
    3. C. They breathe more slowly than adults do
    4. D. Their thinner skin keeps out more of the toxins
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    Answer: A. Their breathing zone is closer to the ground

    Children are shorter, so their breathing zone is closer to the ground where heavy gases collect, and they breathe faster than adults. These factors raise their exposure.

19. At a school bus crash, a 7-year-old who is walking around and crying is separated from his family. After tagging him green, you should:

    1. A. Let him wait alone in the green area
    2. B. Have a bystander take him to a parent
    3. C. Keep him with a responder and track him
    4. D. Send him home with the first adult found
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    Answer: C. Keep him with a responder and track him

    Unaccompanied children must be kept in a supervised, safe area and tracked until they can be reunited with a verified parent or guardian. Releasing a child to an unverified adult risks harm and lost children.

20. Family reunification after an MCI involving children is best handled by:

    1. A. A planned center with identity checks
    2. B. Releasing children at the scene on request
    3. C. Letting parents search the treatment areas
    4. D. Posting children's photos on social media
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    Answer: A. A planned center with identity checks

    A planned reunification center lets officials match children with verified parents or guardians, protecting the children and keeping parents out of treatment areas. Posting photos violates privacy and risks the child's safety.

21. At a daycare fire with many children, you find that you are short on pediatric equipment. The best approach is to:

    1. A. Use adult equipment for all the children
    2. B. Request MCI caches with pediatric supplies
    3. C. Wait for the gear before triaging children
    4. D. Hold the children until a pediatric team arrives
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    Answer: B. Request MCI caches with pediatric supplies

    Pediatric-sized equipment, such as BVMs, airways, and blood pressure cuffs, should be part of MCI caches and requested early. Adult equipment may not fit children and can cause harm. Triage needs no special equipment and should not wait, and holding children for a pediatric team delays care that the crews on scene can start.

22. Responders at an MCI involving children often overtriage them mainly because:

    1. A. JumpSTART puts every child in the red group
    2. B. Children usually have more severe injuries
    3. C. Hospitals ask EMS to send children first
    4. D. Strong emotions push them to upgrade kids
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    Answer: D. Strong emotions push them to upgrade kids

    Emotional reactions lead many responders to upgrade children regardless of findings, which uses up red resources. Using JumpSTART consistently helps keep triage objective.

23. At an active shooter event, police are clearing the building. The fire and EMS commanders should:

    1. A. Set up their own command away from police
    2. B. Join police in a unified command post
    3. C. Enter the building to look for patients
    4. D. Wait at their stations until called again
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    Answer: B. Join police in a unified command post

    NFPA 3000 and current practice call for unified command with law enforcement so EMS can be brought in quickly and safely. Independent command posts and self-deployment are major causes of poor coordination.

24. A 10-year-old at a concert shooting is walking but has blood soaking her jeans from a leg wound. The best action during triage is to:

    1. A. Tag her green and send her to the minor area
    2. B. Tag her red because she is a child
    3. C. Control the bleeding, then tag by her status
    4. D. Wait for her parents before giving any care
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    Answer: C. Control the bleeding, then tag by her status

    Life-threatening bleeding should be controlled during triage, even in a patient who can walk, and her tag should reflect her condition after bleeding control and reassessment. Tagging her green without a second look could miss serious hemorrhage.

25. In TECC, the phase of care that begins once the patient is moved to the cold zone for transport is called:

    1. A. Direct threat care
    2. B. Contact team care
    3. C. Indirect threat care
    4. D. Evacuation care
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    Answer: D. Evacuation care

    TECC phases are direct threat care (hot zone), indirect threat care (warm zone), and evacuation care, which covers care during and after movement to the cold zone and transport. More advanced interventions are added as the threat decreases.