Public Health in Disasters: Shelters, Water and Food, Disease, and Chronic Illness Practice Questions

25 multiple-choice questions on Public health in disasters: shelters, water and food, disease, and chronic illness 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. The most common infectious disease outbreaks in crowded disaster shelters are:

   1. A. Bloodborne infections such as HIV and hepatitis
   2. B. Tick-borne illnesses such as Lyme disease
   3. C. Wound infections such as tetanus and gangrene
   4. D. Gastrointestinal and respiratory illnesses
   Show answer

   Answer: D. Gastrointestinal and respiratory illnesses

   Crowding, shared toilets, and limited handwashing make norovirus-type diarrhea and respiratory infections the usual shelter outbreaks. Bloodborne and tick-borne diseases need routes of spread that shelters do not usually create.

2. In a shelter, 20 evacuees develop sudden vomiting and diarrhea over 2 days. The best control measure is to:

   1. A. Give antibiotics to the evacuees in the shelter
   2. B. Close the shelter and send evacuees home
   3. C. Isolate the sick and push soap-and-water washing
   4. D. Add alcohol gel stations in place of the sinks
   Show answer

   Answer: C. Isolate the sick and push soap-and-water washing

   This pattern suggests norovirus, which spreads fast in shelters and is not reliably killed by alcohol gel; separating ill people, handwashing with soap and water, and bleach cleaning control it. Antibiotics do not treat viral gastroenteritis.

3. A medical needs (special needs) shelter is intended for evacuees who:

   1. A. Need medical support but not hospital care
   2. B. Have injuries that will likely need surgery
   3. C. Are at risk of violence in their homes
   4. D. Have no identification or insurance cards
   Show answer

   Answer: A. Need medical support but not hospital care

   Medical needs shelters serve people who need help with oxygen, power-dependent devices, medications, or personal care that a general shelter cannot give, but who do not need acute hospital care. Patients needing surgery belong in a hospital.

4. At a general shelter intake, which evacuee should be referred to a medical needs shelter?

   1. A. A diabetic woman who brought her insulin pen
   2. B. A man with ALS who needs frequent suctioning
   3. C. A 9-year-old boy with a minor sprained wrist
   4. D. A woman who arrives with her service dog
   Show answer

   Answer: B. A man with ALS who needs frequent suctioning

   A patient who needs regular suctioning, powered equipment, and skilled monitoring needs the staff and power of a medical needs shelter. A well-equipped diabetic, a minor injury, and a person with a service animal can be supported in a general shelter.

5. A boil-water advisory is in effect. Water should be brought to a full rolling boil for at least:

   1. A. 5 seconds
   2. B. 1 minute
   3. C. 30 minutes
   4. D. 2 hours
   Show answer

   Answer: B. 1 minute

   A rolling boil for 1 minute (3 minutes at elevations above about 2,000 m or 6,500 ft) kills disease-causing organisms. Bringing water just to a boil for a few seconds is the common mistake.

6. If water cannot be boiled, clear water can be disinfected by adding unscented 6% household bleach at about:

   1. A. 8 drops per gallon, then drinking it at once
   2. B. 1 teaspoon per gallon, then waiting 30 minutes
   3. C. 2 drops per gallon, then waiting 30 minutes
   4. D. 8 drops per gallon, then waiting 30 minutes
   Show answer

   Answer: D. 8 drops per gallon, then waiting 30 minutes

   CDC advises 8 drops (about 1/8 teaspoon) of 6% unscented bleach per gallon (3.8 L) of clear water, then a 30-minute wait. A full teaspoon is about eight times that dose and makes the water too strong to drink safely, 2 drops is too little to disinfect it reliably, and drinking right away skips the contact time the bleach needs to kill organisms.

7. After a power outage, food in a refrigerator that stays closed remains safe for about:

   1. A. 1 hour
   2. B. 12 hours
   3. C. 4 hours
   4. D. 3 days
   Show answer

   Answer: C. 4 hours

   A closed refrigerator keeps food cold for about 4 hours; after that, perishables above 4 °C (40 °F) for 2 hours or more should be thrown out. A full, closed freezer holds safe temperatures much longer, about 48 hours.

8. After 2 days without power, a family asks whether chicken in their refrigerator that 'still feels cool' is safe to eat. You should advise them to:

   1. A. Discard it; when in doubt, throw it out
   2. B. Cook it well, since heat makes it safe
   3. C. Smell it, and eat it if it still smells fine
   4. D. Rinse it well and refrigerate it again
   Show answer

   Answer: A. Discard it; when in doubt, throw it out

   Bacteria can grow, and some make heat-stable toxins, in meat held above 4 °C (40 °F) for over 2 hours; spoiled food may look and smell normal. Thorough cooking does not destroy those toxins.

9. After a flood with many deaths, officials want to bury the dead quickly in mass graves to prevent epidemics. This plan is:

   1. A. Correct; bodies quickly spread cholera
   2. B. Correct; burial within 24 hours is the law
   3. C. Wrong; the bodies must be burned instead
   4. D. Wrong; trauma deaths rarely spread disease
   Show answer

   Answer: D. Wrong; trauma deaths rarely spread disease

   People killed by trauma or drowning rarely pose an epidemic risk, so hasty mass burial is not needed and makes identification impossible, harming families. Bodies should be identified and stored properly; cholera spreads from contaminated water, not from bodies of trauma victims.

10. Weeks after major flooding, mosquito numbers surge in a town. The most effective community control measure is:

    1. A. Draining standing water where they breed
    2. B. Giving antibiotics to residents with bites
    3. C. Keeping evacuees indoors throughout the day
    4. D. Burning debris piles to drive them away
    Show answer

    Answer: A. Draining standing water where they breed

    Floodwater left in containers, tires, and low ground breeds mosquitoes that can spread West Nile virus and dengue, so removing standing water is the core control step, along with repellent. Antibiotics do not prevent viral mosquito-borne disease.

11. A hemodialysis patient's center is closed after a hurricane, and she may miss treatments for several days. Kidney care groups advise her to:

    1. A. Drink extra water to help flush out the toxins
    2. B. Follow a strict low-potassium, low-fluid diet
    3. C. Limit fluids but eat potassium-rich fruit
    4. D. Follow a high-protein, high-salt diet
    Show answer

    Answer: B. Follow a strict low-potassium, low-fluid diet

    Emergency dialysis diets limit potassium, fluid, and salt to slow the buildup of potassium and fluid until dialysis resumes. Extra water would worsen fluid overload and pulmonary edema in a patient who cannot make urine. Potassium-rich fruit such as bananas raises a potassium level her kidneys cannot clear, and salt drives thirst and fluid gain; the emergency diet limits protein, salt, potassium, and fluid together.

12. During a 4-day power outage, a man with COPD tells you his oxygen concentrator has stopped and his last small cylinder is almost empty. His SpO2 is 90% on it. The best plan is to:

    1. A. Advise him to turn the flow down to save it
    2. B. Raise the flow to bring his SpO2 to 96%
    3. C. Move him to a site with power and oxygen
    4. D. Leave him home and ask a neighbor to check on him
    Show answer

    Answer: C. Move him to a site with power and oxygen

    Electricity-dependent patients lose their therapy when the power fails, so this man needs transport to a hospital, medical needs shelter, or other site with power and oxygen before his last cylinder runs out. Turning down the flow risks dangerous hypoxemia in a COPD patient who is already at 90% and does not solve the problem, while raising the flow to reach 96% overshoots the 88-92% target for a patient at risk of CO2 retention and empties the cylinder faster. Leaving him at home with a neighbor checking in sets up an emergency at a time when help may be delayed.

13. Before a hurricane, local health officials use HHS emPOWER data mainly to:

    1. A. Track open hospital beds across the region
    2. B. Find residents who rely on powered devices
    3. C. Predict the storm's track by neighborhood
    4. D. List shelters that have backup generators
    Show answer

    Answer: B. Find residents who rely on powered devices

    The HHS emPOWER program uses Medicare data to show how many residents in an area rely on electricity-dependent equipment, such as ventilators and oxygen concentrators, so planners can prepare outreach and power. It is not a bed-tracking or forecasting tool.

14. A diabetic evacuee's insulin has been kept at room temperature, out of the sun, for 5 days without refrigeration. You should advise her to:

    1. A. Discard it; insulin spoils within just a few hours
    2. B. Keep using it, but cut each dose in half
    3. C. Keep using it; most insulin lasts about 28 days
    4. D. Discard it unless it was kept in a cooler
    Show answer

    Answer: C. Keep using it; most insulin lasts about 28 days

    Most insulins stay effective for about 28 days at room temperature if kept away from heat and direct sun. Five days unrefrigerated is well within that window, so a cooler is not required, and cutting doses in half is not needed and would leave her blood sugar high. Freezing, by contrast, does destroy insulin.

15. In the weeks after a major disaster, a large share of emergency department visits are due to:

    1. A. Chronic illness worsened by lost care
    2. B. Injuries from the disaster's initial impact
    3. C. New outbreaks of rare infectious disease
    4. D. Burns from fires that start after impact
    Show answer

    Answer: A. Chronic illness worsened by lost care

    After the first days, missed medications, dialysis, oxygen, and follow-up care drive much of the demand on EMS and EDs. Acute injuries peak early, while chronic disease visits continue for weeks.

16. In a declared disaster, uninsured evacuees who lost their medications can get replacements through:

    1. A. The Strategic National Stockpile push package
    2. B. The CHEMPACK caches at local hospitals
    3. C. The Medical Reserve Corps mail-order service
    4. D. The Emergency Prescription Assistance Program
    Show answer

    Answer: D. The Emergency Prescription Assistance Program

    The federal Emergency Prescription Assistance Program (EPAP) lets uninsured people in declared disaster areas fill prescriptions and replace some medical equipment at participating pharmacies. Push packages and CHEMPACK serve mass emergencies, not individual refills.

17. A man has waded through floodwater for days to reach his home. He now has fever, severe calf muscle pain, and red eyes. You should suspect:

    1. A. Lyme disease
    2. B. West Nile virus
    3. C. Leptospirosis
    4. D. Tetanus
    Show answer

    Answer: C. Leptospirosis

    Leptospirosis spreads through water contaminated by animal urine and causes fever, muscle pain (especially the calves), and conjunctival redness, with outbreaks after floods. West Nile virus also follows floods but through mosquito bites, usually without calf pain or red eyes.

18. The most important sanitation step for preventing disease in a large shelter is:

    1. A. Daily preventive antibiotics for residents
    2. B. Spraying insecticide inside the shelter
    3. C. Placing each family in a separate room
    4. D. Enough toilets and handwashing stations
    Show answer

    Answer: D. Enough toilets and handwashing stations

    Adequate toilets, handwashing with soap, safe water, and clean food handling prevent most shelter outbreaks. Preventive antibiotics have no role and add drug resistance.

19. After a flood, residents ask whether everyone should get vaccines against typhoid and cholera. Public health guidance generally holds that:

    1. A. Clean water and sanitation matter more
    2. B. Mass vaccination should begin right away
    3. C. Residents need a hepatitis A shot first
    4. D. Cholera vaccine is the key step here
    Show answer

    Answer: A. Clean water and sanitation matter more

    Mass typhoid and cholera vaccination is not usually recommended after floods in the United States; safe water, sanitation, and hygiene prevent these diseases. Routine vaccines, such as tetanus for wounds, follow standard guidance.

20. A 4-year-old with fever, cough, red eyes, and a spreading rash arrives at a crowded shelter. He has not been vaccinated. Your best step is to:

    1. A. Keep him on his cot with a surgical mask
    2. B. Isolate him and notify public health
    3. C. Give acetaminophen and recheck tomorrow
    4. D. Move him to a quiet corner of the shelter
    Show answer

    Answer: B. Isolate him and notify public health

    These findings suggest measles, which is highly contagious and can spread through a crowded shelter with many unvaccinated or vulnerable people. Isolation and rapid reporting allow vaccination and exposure follow-up; a corner of the same room does not stop airborne spread.

21. An evacuee on daily methadone cannot reach his flooded clinic. On day 2 in the shelter, he has yawning, sweating, abdominal cramps, and dilated pupils. The best response is to:

    1. A. Give naloxone to confirm the diagnosis
    2. B. Tell him to wait until his own clinic reopens
    3. C. Treat symptoms and arrange emergency dosing
    4. D. Report him to police for seeking drugs
    Show answer

    Answer: C. Treat symptoms and arrange emergency dosing

    Opioid withdrawal is common when disasters cut off treatment programs, and public health and clinic networks arrange emergency methadone dosing. Naloxone would worsen withdrawal and has no diagnostic role here.

22. After wading through floodwater, a woman notices that a small cut on her hand has been soaked. She should first:

    1. A. Rinse it off with the floodwater itself
    2. B. Wash it well with soap and clean water
    3. C. Seal it at once with a liquid bandage
    4. D. Leave it uncovered so that it can dry
    Show answer

    Answer: B. Wash it well with soap and clean water

    Floodwater carries sewage, chemicals, and bacteria, so wounds should be washed with soap and clean water, kept clean and covered, and watched for infection; tetanus status should be checked. Sealing a dirty wound traps bacteria inside.

23. Residents bring home-cooked casseroles to donate to a large shelter. The safest food policy is to:

    1. A. Accept any food that is still warm
    2. B. Serve donated food within 1 day
    3. C. Reheat all donated food before serving
    4. D. Serve food only from approved sources
    Show answer

    Answer: D. Serve food only from approved sources

    Home-prepared food has unknown handling and storage and has caused shelter foodborne outbreaks, so shelters serve food from inspected kitchens and approved suppliers. Reheating does not destroy toxins that some bacteria have already made.

24. A shelter manager plans for evacuees who will arrive with dialysis needs, oxygen, and daily medicines. The most useful early step is to:

    1. A. Screen arrivals and arrange care partners
    2. B. Wait for evacuees to report their own needs
    3. C. Turn away anyone with a chronic condition
    4. D. Send these evacuees to the nearest ED
    Show answer

    Answer: A. Screen arrivals and arrange care partners

    Intake screening finds medical needs early so staff can arrange dialysis slots, oxygen, and medicine refills before a crisis. Sending all of them to the ED overwhelms the hospital with patients who need support, not emergency care.

25. A heat wave hits while a large shelter has no working air conditioning. The best step to protect residents is to:

    1. A. Give salt tablets to residents daily
    2. B. Move high-risk residents to a cooled site
    3. C. Give everyone electric fans to use
    4. D. Check temperatures of residents twice a day
    Show answer

    Answer: B. Move high-risk residents to a cooled site

    Heat illness risk is highest in older adults, young children, and those with chronic illness or on certain medicines, so they should be moved to cooled spaces, with fluids and monitoring. Salt tablets are not recommended and can be harmful. Electric fans do little to prevent heat illness once air temperatures reach the high 30s °C (high 90s °F), and checking temperatures without cooling finds heat illness only after it starts.