EMS System Preparedness: Continuity, Personal Readiness, Surge, and Crisis Standards Practice Questions

25 multiple-choice questions on EMS system preparedness: continuity, personal readiness, surge, and crisis standards for paramedic and EMT students, from Chapter 52 (Disaster Response). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A continuity of operations plan (COOP) for an EMS agency mainly ensures that:

   1. A. Each call still gets its usual full response
   2. B. Crews are paid overtime during disasters
   3. C. Patients are triaged by a single method
   4. D. Essential services go on despite the disaster
   Show answer

   Answer: D. Essential services go on despite the disaster

   A COOP identifies the agency's essential functions and how to keep them running when staff, buildings, or systems are lost. It does not promise a normal response to every call; during disasters, low-priority services may be suspended so essential ones continue.

2. A storm injures your EMS director, and both deputies cannot be reached. A sound COOP plan covers this through:

   1. A. Mutual aid agreements with neighbors
   2. B. Orders of succession and delegation
   3. C. The state's EMAC request process
   4. D. The incident action plan for that day
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   Answer: B. Orders of succession and delegation

   Orders of succession and delegations of authority name who leads, and what they may decide, when leaders are lost. Mutual aid brings outside resources but does not decide who has authority inside the agency.

3. Flooding forces your EMS headquarters and dispatch center to close. Your COOP should already have named:

   1. A. A hospital that will take over the 911 calls
   2. B. A set date when the building should reopen
   3. C. A vendor to replace damaged ambulances
   4. D. An alternate site to run operations from
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   Answer: D. An alternate site to run operations from

   Alternate facilities are a core COOP element, so operations and dispatch can move quickly to a backup site with power, radios, and records. Hospitals are not set up to process 911 calls, and a reopening date cannot be known in advance.

4. Federal continuity guidance expects an organization's essential functions to be running within 12 hours of a disruption and to be sustainable for up to:

   1. A. 72 hours
   2. B. 30 days
   3. C. 7 days
   4. D. 6 months
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   Answer: B. 30 days

   FEMA continuity planning calls for essential functions to resume within 12 hours and to be sustained for up to 30 days, or until normal operations resume. Planning for only 72 hours underestimates how long disaster disruptions last.

5. An EMS agency wants more of its staff to report for duty when a disaster strikes. Besides family preparedness, the step most likely to help is:

   1. A. Training staff on their disaster roles
   2. B. Threatening discipline for no-shows
   3. C. Keeping disaster plans confidential
   4. D. Promising bonuses after the event
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   Answer: A. Training staff on their disaster roles

   Responders are more willing to report when they know what they will be asked to do and feel trained and protected to do it. Threats of discipline do little to overcome fear or family duty, and secret plans leave staff unsure of their roles.

6. A paramedic is writing her family disaster plan. Which element is most useful if local phone lines are jammed?

   1. A. A landline phone at the family home
   2. B. A list of local hospital phone numbers
   3. C. An out-of-area contact for everyone
   4. D. A plan to meet at the EMS station
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   Answer: C. An out-of-area contact for everyone

   Long-distance connections often work when local lines are overloaded, so each family member checks in with one contact outside the area. Meeting at the station puts the family at a busy work site and does not help them reach each other.

7. A home emergency kit should store at least how much drinking water per person per day?

   1. A. About 1 gallon (3.8 L)
   2. B. About 1 cup (240 mL)
   3. C. About 1 quart (1 L)
   4. D. About 3 gallons (11 L)
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   Answer: A. About 1 gallon (3.8 L)

   Ready.gov advises 1 gallon (3.8 L) per person per day for drinking and basic hygiene, for at least several days. One quart covers only part of daily drinking needs, especially in heat.

8. Your agency asks each crew member to keep a personal go-bag at work in case of disaster callback. The most important contents include:

   1. A. A week of canned food and bottled water
   2. B. Extra tourniquets and trauma dressings
   3. C. Family papers such as deeds and policies
   4. D. Prescription meds, clothing, and ID
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   Answer: D. Prescription meds, clothing, and ID

   A personal go-bag lets a responder work several days away from home: their own medicines, clothes, hygiene items, chargers, and identification. Food and water for several days belong in the household kit, agency supplies such as tourniquets are stocked on the units, and family documents are kept safe at home as part of the family plan.

9. The four elements of surge capacity are often summarized as staff, stuff (supplies), space, and:

   1. A. Speed
   2. B. Security
   3. C. Systems
   4. D. Shelter
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   Answer: C. Systems

   Surge planning addresses staff, stuff, space, and systems (the policies, command, and communications that tie them together). Adding beds and supplies without systems to manage them does not create usable capacity.

10. Surge capability, as opposed to surge capacity, refers to the ability to:

    1. A. Add more beds and stretchers very quickly
    2. B. Manage patients who need specialized care
    3. C. Call back off-duty staff within an hour
    4. D. Move patients to other regions by air
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    Answer: B. Manage patients who need specialized care

    Surge capacity is volume (more patients); surge capability is the ability to care for patients with special needs, such as burns, pediatrics, or contamination. Adding beds increases capacity, which is why it is the tempting wrong answer.

11. During a flood, your county's 911 call volume triples. Which step best expands EMS surge capacity?

    1. A. Send full ALS crews to low-acuity calls
    2. B. Staff reserve units with callback crews
    3. C. Hold units at the hospitals to save travel
    4. D. Require medical control before each transport
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    Answer: B. Staff reserve units with callback crews

    Bringing reserve ambulances into service with called-back staff adds units to meet volume. Sending full ALS to every call uses more resources per call, which shrinks capacity rather than expanding it.

12. An alternate care site set up in a school gym during a disaster is mainly intended for:

    1. A. Lower-acuity patients, freeing hospital beds
    2. B. Trauma patients who need emergency surgery soon
    3. C. Patients needing ICU-level ventilator care
    4. D. Patients awaiting chemical decontamination
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    Answer: A. Lower-acuity patients, freeing hospital beds

    Alternate care sites take patients who need nursing or basic medical care but not hospital resources, freeing hospital beds for the critically ill. They lack the staff and equipment for surgery or intensive care.

13. Conventional, contingency, and crisis care in a disaster surge are best described as:

    1. A. Fixed tiers that are set once for the whole disaster
    2. B. Levels of training for disaster responders
    3. C. Points on a continuum that shifts with demand
    4. D. Categories of patients sorted at triage
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    Answer: C. Points on a continuum that shifts with demand

    Conventional, contingency, and crisis care are points on a continuum: as demand outstrips resources, care shifts from usual practice toward adapted and then significantly changed care, and it shifts back toward conventional as resources recover. They are not fixed tiers that are set once for the whole disaster, because a region can move between levels as conditions change. They describe the standard of care that resources allow, not levels of training for disaster responders, and not categories of patients sorted at triage.

14. During a supply shortage, crews clean and reuse some equipment that is normally single-use, and patient care is still functionally the same. This is:

    1. A. Conventional care
    2. B. Crisis care
    3. C. Palliative care
    4. D. Contingency care
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    Answer: D. Contingency care

    Contingency care adapts spaces, staff, and supplies while keeping outcomes about the same as usual. Crisis care begins only when the change is large enough that patients may get less than the usual standard.

15. Which change is an example of crisis-level care rather than contingency care?

    1. A. Substituting an equivalent drug that is in stock
    2. B. Treating patients in a converted recovery area
    3. C. Calling in off-duty staff for extra shifts
    4. D. Allocating scarce ventilators by likely benefit
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    Answer: D. Allocating scarce ventilators by likely benefit

    Crisis care means resources are so short that the usual standard cannot be met, so scarce items such as ventilators are allocated to the patients most likely to benefit. Substituting an equivalent drug that is in stock adapts supplies while care stays functionally the same, which is contingency care. Treating patients in a converted recovery area adapts space, and calling in off-duty staff for extra shifts adapts staffing; both keep care functionally equivalent, so they are contingency measures as well.

16. Crisis standards of care in a region generally go into effect when:

    1. A. A crew judges that resources are short
    2. B. A hospital reaches 90% of its bed use
    3. C. State or health authorities declare them
    4. D. The first federal DMAT team arrives
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    Answer: C. State or health authorities declare them

    Crisis standards require a formal declaration by state or public health authorities, which also gives legal and ethical cover. Individual crews cannot shift to crisis standards on their own judgment.

17. During declared crisis standards of care, a paramedic working under altered protocols should still:

    1. A. Document care and decisions carefully
    2. B. Follow her normal protocols, not the altered ones
    3. C. Transport each patient as she normally would
    4. D. Record care later, from memory
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    Answer: A. Document care and decisions carefully

    Crisis protocols change what care is given, not the duty to document it; clear records of findings and decisions support quality review and legal protection. Declared altered protocols replace her usual ones, so she follows them rather than her normal treatment and transport habits, and notes rebuilt from memory after a shift are less accurate than records made at the time.

18. Crisis standards of care plans should be written in advance and made public, mainly so that:

    1. A. Crews can work with less medical direction
    2. B. Decisions are fair, consistent, and trusted
    3. C. Each crew can set its own triage rules
    4. D. Patients can pick their own triage level
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    Answer: B. Decisions are fair, consistent, and trusted

    Transparent, preplanned crisis standards apply the same rules to everyone, which builds public trust and protects providers. Letting each crew decide creates the inconsistency the plans are meant to prevent.

19. The Medical Reserve Corps (MRC) is made up of:

    1. A. Federal paramedics on active duty
    2. B. Military medics serving in reserve units
    3. C. Local volunteer health professionals
    4. D. Paid hospital staff on standby
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    Answer: C. Local volunteer health professionals

    MRC units are community-based volunteers, such as nurses, physicians, and paramedics, organized locally to support public health and disaster response. They are not federal or military personnel.

20. Volunteer nurses and paramedics register before a disaster in their state's ESAR-VHP system so that:

    1. A. Their credentials are checked in advance
    2. B. They receive federal pay when deployed
    3. C. They can deploy without first being requested
    4. D. They are exempt from local protocols
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    Answer: A. Their credentials are checked in advance

    ESAR-VHP is a state-based registry that verifies volunteer health professionals' identity, licenses, and credentials before a disaster, so they can be used quickly and safely. It does not authorize self-deployment.

21. Community Emergency Response Team (CERT) members are best described as:

    1. A. Paramedics who staff disaster shelters
    2. B. Trained citizens who help in their area
    3. C. Federal staff who run dispensing sites
    4. D. Police officers trained in disaster triage
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    Answer: B. Trained citizens who help in their area

    CERT trains residents in basic disaster skills, such as fire safety, light search and rescue, and basic first aid, so they can help neighbors until responders arrive. Members are volunteers, not paid public safety staff.

22. A regional healthcare coalition brings together:

    1. A. Hospitals in one health system along with their insurers
    2. B. Federal response teams and their state offices
    3. C. EMS agencies and the vendors that supply them
    4. D. Hospitals, EMS, public health, and emergency managers
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    Answer: D. Hospitals, EMS, public health, and emergency managers

    Healthcare coalitions, supported by the federal Hospital Preparedness Program, link hospitals, EMS, public health, emergency management, and other partners in a region to plan and share resources. A single hospital system and its insurers is too narrow.

23. Dispatch, the EOC, and hospital command centers practice coordinating a simulated earthquake in real time, but no field units move. This is a:

    1. A. Full-scale exercise
    2. B. Tabletop exercise
    3. C. Seminar
    4. D. Functional exercise
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    Answer: D. Functional exercise

    A functional exercise tests coordination and command functions in real time without deploying field resources. A full-scale exercise adds actual crews, vehicles, and simulated patients in the field.

24. A hurricane will make landfall in 48 hours. Which staffing step is most important now?

    1. A. Set crews in shifts with planned rest
    2. B. Put the whole staff on duty for landfall
    3. C. Send staff home until the storm passes
    4. D. Wait to call staff in until afterward
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    Answer: A. Set crews in shifts with planned rest

    Disaster operations last days to weeks, so staffing must be set in rotating shifts with rest built in. Putting everyone on duty at once leaves no rested relief when the long recovery demand arrives.

25. A hurricane is 2 days away. Which pre-landfall step best protects EMS response capability?

    1. A. Park the units together at the main hospital
    2. B. Stage units near the coast for fast rescue
    3. C. Fuel units and move them out of flood zones
    4. D. Fill units with fuel after the storm passes
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    Answer: C. Fuel units and move them out of flood zones

    Fueling vehicles and staging them on high ground protects them from storm surge and fuel shortages. Parking all units in one spot risks losing the entire fleet to a single flood or wind event. Units staged near the coast sit in the surge zone, and waiting to fuel until after the storm risks stations that are closed or without power.