MCI Recognition and Initial Actions Practice Questions

25 multiple-choice questions on MCI recognition and initial actions 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. A mass-casualty incident (MCI) is best defined as any event that:

   1. A. Overwhelms the resources normally available
   2. B. Involves more than 100 injured patients
   3. C. Has been declared a disaster by the governor
   4. D. Requires at least one helicopter for transport
   Show answer

   Answer: A. Overwhelms the resources normally available

   An MCI is defined by the mismatch between patients and the resources available, not by a fixed number. A rural unit with three critical patients may have an MCI, while a city system could handle the same call routinely.

2. A single rural ambulance crew of two arrives at a pickup rollover with four critically injured patients. The nearest backup is 30 minutes away. This incident:

   1. A. Is an MCI for this crew and should be declared
   2. B. Is not an MCI since there are under ten patients
   3. C. Becomes an MCI once a fifth patient is found
   4. D. Is not an MCI unless a hospital declares one
   Show answer

   Answer: A. Is an MCI for this crew and should be declared

   Four critical patients for a two-person crew with distant backup overwhelms local resources, so it meets the definition of an MCI. Declaring early triggers mutual aid and the right structure even though the patient count is small.

3. An 'open' (uncontained) MCI is one in which:

   1. A. Every patient has already been found and counted
   2. B. The scene is outdoors rather than inside a building
   3. C. Local hospitals have plenty of beds available
   4. D. Patients may still be added as the event goes on
   Show answer

   Answer: D. Patients may still be added as the event goes on

   In an open incident, more patients may be created or found, as in an ongoing fire, shooting, or flood. In a closed (contained) incident, such as a bus crash, the number of patients is fixed and can be counted.

4. A tour bus has crashed and all 32 passengers are accounted for, with no ongoing hazard. This is best described as a:

   1. A. Open (uncontained) incident
   2. B. Closed (contained) incident
   3. C. Hostile event in the warm zone
   4. D. Natural disaster with an open scene
   Show answer

   Answer: B. Closed (contained) incident

   When the number of patients is known and no more will be created, the incident is closed. A building fire with people still inside or an ongoing shooting would be open, because the patient count may grow.

5. The main reason to declare an MCI early, even before all patients are found, is that:

   1. A. It hands command to the county EOC
   2. B. It triggers federal disaster funding for the agency
   3. C. It gets resources and the MCI plan going
   4. D. It allows crews to skip formal triage
   Show answer

   Answer: C. It gets resources and the MCI plan going

   Declaring early gets resources rolling, activates the MCI plan, and alerts hospitals while they still have time to prepare. It is easier to downsize a response than to catch up after falling behind. Declaring an MCI does not hand command to the emergency operations center, does not by itself trigger federal disaster funds, and does not let crews skip triage.

6. En route to a reported commuter train derailment, your dispatcher says many callers describe dozens of people injured. You should:

   1. A. Wait to confirm the numbers on your arrival
   2. B. Ask for more resources before you arrive
   3. C. Cancel other units until you size up the scene
   4. D. Request a helicopter for the first patient
   Show answer

   Answer: B. Ask for more resources before you arrive

   Dispatch information that suggests many patients is reason to request resources and alert the MCI plan while still en route, because units released later cost little but units called late arrive after patients deteriorate. Waiting to confirm on arrival loses critical minutes.

7. You are first on scene at an apartment fire with many injured residents. Before approaching patients, your first action should be to:

   1. A. Begin START triage on the nearest patient
   2. B. Call the closest hospital with an estimate
   3. C. Make sure the scene is safe to enter
   4. D. Set up the treatment area tarps in the lot
   Show answer

   Answer: C. Make sure the scene is safe to enter

   Scene safety comes first at every MCI; injured or trapped responders become more patients and cut resources further. Triage, hospital notification, and treatment areas come after the hazard is assessed.

8. A size-up report from the first-arriving unit at an MCI should include:

   1. A. Incident type, patient estimate, and hazards
   2. B. The names of each patient seen during the walk
   3. C. A full assessment of the most injured patient
   4. D. The planned route to each receiving hospital
   Show answer

   Answer: A. Incident type, patient estimate, and hazards

   A good size-up describes the nature of the incident, the estimated number and severity of patients, hazards, the access route, and the resources needed. Names and detailed assessments come later.

9. During size-up of a bus crash, you estimate 25 patients. When requesting resources, you should:

   1. A. Ask for what you can confirm right now
   2. B. Wait to request until triage is finished
   3. C. Ask dispatch to decide what to send you
   4. D. Ask for more than you think you need
   Show answer

   Answer: D. Ask for more than you think you need

   Request resources early and generously, because units can be released from staging if not needed, but units requested late arrive after patients have deteriorated. Waiting until triage is done wastes critical time.

10. The METHANE report used in some MCI systems stands for major incident, exact location, type of incident, hazards, access, number of casualties, and:

    1. A. Emergency services present and needed
    2. B. Equipment carried by the first unit
    3. C. Estimated time to clear the scene
    4. D. Evacuation route for the uninjured public
    Show answer

    Answer: A. Emergency services present and needed

    METHANE ends with emergency services: which agencies are on scene and which are needed. It gives dispatch and incoming units a quick, standard picture of the incident.

11. You arrive at a gas explosion at a strip mall. Smoke is still rising and people are running away from the building. Your best initial position for the ambulance is:

    1. A. Upwind but as close as you can get
    2. B. Downwind, in a lot across the street
    3. C. As close as possible to the fire lane
    4. D. Upwind and uphill at a safe distance
    Show answer

    Answer: D. Upwind and uphill at a safe distance

    Staging upwind and uphill at a safe distance protects the crew from smoke, toxic gases, and secondary explosions while still allowing you to see the scene. Being upwind does not help if you are close enough to be hit by a secondary explosion, a downwind lot puts smoke on the crew, and parking near the fire lane blocks fire apparatus.

12. Ten minutes after you declare an MCI at a highway crash, a second unit arrives. As IC, the most useful assignment is usually to:

    1. A. Have them set up the treatment area first
    2. B. Have them take on the triage role
    3. C. Have them stage and wait for orders
    4. D. Have them transport the first patient
    Show answer

    Answer: B. Have them take on the triage role

    The second unit is usually assigned to triage, so patients are found and sorted while the IC keeps command; staging, treatment, and transport go to units that arrive later. Setting up treatment before patients are found and sorted puts the second crew on a later step, and holding them in staging wastes them when triage is the immediate need. Transporting the first patient before triage sends out someone who may not be the most urgent and leaves the scene short.

13. Which question is most important for the IC to answer during the initial size-up of an MCI?

    1. A. Which hospital has the shortest drive time?
    2. B. Which units have already arrived on scene?
    3. C. How many patients, and how badly hurt?
    4. D. What caused the crash or the explosion?
    Show answer

    Answer: C. How many patients, and how badly hurt?

    The number and severity of patients drive every resource decision. Hospital choice comes after triage, and fault is an investigation question, not an EMS priority.

14. A school bus overturns with 40 students on board. You are the first paramedic on scene. Which request best supports patient care in the first minutes?

    1. A. Ask each parent to drive their child to care
    2. B. Have the first ambulance transport two kids
    3. C. Delay calling the hospitals until triage ends
    4. D. Alert hospitals early through the region
    Show answer

    Answer: D. Alert hospitals early through the region

    Early notification through the regional medical coordination system lets hospitals activate disaster plans and call in staff. Parents driving children leads to untracked patients and overwhelms the closest hospital.

15. Many systems have the first unit declare an MCI using a set term, such as 'MCI level 2.' The main value of a set term is that it:

    1. A. Tells the media how bad the event is
    2. B. Starts a preplanned set of resources
    3. C. Lets crews skip triage of minor patients
    4. D. Moves command to the closest hospital
    Show answer

    Answer: B. Starts a preplanned set of resources

    Tiered MCI levels in a written plan link each level to an automatic package of ambulances, supervisors, and hospital alerts, so one radio call starts the right response. The term does not change triage duties or move command off the scene.

16. At an MCI, a paramedic should be pulled into a specific ICS role and wear an identifying vest so that:

    1. A. Others can see who holds each role
    2. B. It shows each provider's level of training
    3. C. It shows which agency the provider is from
    4. D. It marks which providers may enter the hot zone
    Show answer

    Answer: A. Others can see who holds each role

    Colored, labeled vests show at a glance who is the IC, triage leader, or transport leader, so responders know who to report to. Role vests identify the job, not the wearer's training level, home agency, or clearance to enter a hazard zone.

17. Bystanders at a crash scene begin pulling patients from wrecked cars before the triage team arrives. The IC should:

    1. A. Order them all to leave the scene at once
    2. B. Ignore them and focus on the tagged patients
    3. C. Direct them to safe tasks in the effort
    4. D. Assign each bystander to transport patients
    Show answer

    Answer: C. Direct them to safe tasks in the effort

    Bystanders can be useful if directed to a safe task, such as guiding walking wounded to the green area, but they must be kept out of hazards. Ignoring them risks more injuries and untracked patients.

18. A key early decision at an MCI is choosing a triage system. This decision should be based mainly on:

    1. A. The system the region has adopted
    2. B. The personal preference of the first medic
    3. C. The system used by the closest hospital
    4. D. The system the IC used at the last MCI
    Show answer

    Answer: A. The system the region has adopted

    Everyone on scene should use the triage system the region has adopted and practiced, so tags and categories mean the same thing to all responders and hospitals. Mixing systems on one scene causes confusion.

19. The term 'surge capacity' refers to:

    1. A. The number of ambulances on duty at one time
    2. B. A hospital's ability to divert its incoming units
    3. C. A system's ability to expand to meet more demand
    4. D. The number of beds a hospital keeps empty daily
    Show answer

    Answer: C. A system's ability to expand to meet more demand

    Surge capacity is the ability of a health care or EMS system to expand quickly beyond normal operations, such as calling in staff, opening extra beds, and using MCI caches. Planning for it is a key part of MCI preparedness. It is not the number of units normally on duty or beds normally left open, and diversion moves patients away rather than expanding to take them.

20. Planners expect 60,000 people at an outdoor music festival next month. To prepare EMS for a possible MCI, the most useful step is to:

    1. A. Wait until the day of the event to plan
    2. B. Preplan access, staging, and an MCI response
    3. C. Rely on attendees to call 9-1-1 for help
    4. D. Let venue security plan the medical response
    Show answer

    Answer: B. Preplan access, staging, and an MCI response

    Mass gatherings are predictable MCI risks, so EMS should plan ahead with the event and the other agencies: on-site medical posts, access and egress routes, staging areas, communications, an ICS structure, and hospital notification. Waiting until event day leaves no time to set up resources or train for the plan. Attendee 9-1-1 calls alone overload dispatch and cannot reach patients in a dense crowd. Venue security has a role in the plan, but it cannot design or run the medical response.

21. An MCI with 6 patients occurs in a city with 30 ambulances on duty. Compared with a rural MCI of the same size, it is most likely to need:

    1. A. A larger and more complex structure
    2. B. A federal unified command post
    3. C. Activation of area command at once
    4. D. A smaller, simpler ICS structure
    Show answer

    Answer: D. A smaller, simpler ICS structure

    ICS is scaled to the incident and the resources available, so a city with ample units may need only a few roles. The same incident in a rural area might need mutual aid and a larger organization.

22. The first-arriving paramedic at an MCI tells the dispatcher: 'Medic 7 is on scene and establishing Highway 12 Command.' The purpose of naming command is to:

    1. A. Show which agency owns the incident
    2. B. Assign a radio channel to each unit
    3. C. Give units one clear point of contact
    4. D. Tell the hospital which crew will call
    Show answer

    Answer: C. Give units one clear point of contact

    Naming command (often after the location) tells every incoming unit who is in charge and what radio identity to use. It does not establish legal ownership or a media point.

23. At an MCI, the IC should consider requesting a medical director or physician on scene mainly to:

    1. A. Help with complex medical decisions
    2. B. Replace the IC in the command post
    3. C. Provide care for responders in rehab
    4. D. Sign the death certificates on scene
    Show answer

    Answer: A. Help with complex medical decisions

    An on-scene physician can help with difficult medical decisions, such as expectant care or amputation in entrapment, and may advise on destination. Command stays with the IC.

24. At a crash scene with eight patients, the IC sees that one car is leaking fuel and a power line is down nearby. The IC should first:

    1. A. Begin triage of the nearest patients
    2. B. Have crews drag patients clear of the fuel
    3. C. Cover the fuel spill with a tarp
    4. D. Request fire and power company help
    Show answer

    Answer: D. Request fire and power company help

    Hazards must be controlled to make the scene safe for both responders and patients, so the IC requests the right resources early. Approaching patients near a live power line or fuel risks responder lives. Dragging patients near a downed line puts crews at risk before the hazards are controlled, and a tarp does not contain fuel vapor or make the spill safe.

25. After the first patients are transported from an MCI, the IC should reassess the incident mainly to:

    1. A. Begin the after-action review now
    2. B. Adjust the resources and structure
    3. C. Release the units still on scene
    4. D. Move the command post closer to the patients
    Show answer

    Answer: B. Adjust the resources and structure

    Size-up continues for the whole incident. As patients leave and conditions change, the IC adds or releases resources and adjusts the ICS structure to match. The after-action review comes after the incident is over, not while patients remain. Releasing units early leaves the remaining patients without care or transport. Moving the command post closer to the patients brings command into the work area without improving how the incident is managed.