Recognizing a Terrorist Event, Threat Advisories, and Scene Safety Practice Questions

25 multiple-choice questions on Recognizing a terrorist event, threat advisories, and scene safety for paramedic and EMT students, from Chapter 51 (Terrorism Response). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. You are dispatched to a subway station for 'several people down, trouble breathing.' The first unit reports that riders near one platform are vomiting, drooling, and twitching. This combination should make you suspect:

   1. A. Carbon monoxide from a train engine
   2. B. A deliberate chemical release
   3. C. Heat illness in a crowded station
   4. D. Food poisoning among riders
   Show answer

   Answer: B. A deliberate chemical release

   Several people with the same sudden signs in one location is a classic indicator of a chemical attack, and drooling with twitching points to a nerve agent. Carbon monoxide causes headache and confusion, not secretions and muscle twitching.

2. Which set of dispatch details carries the strongest indicators of a possible terrorist event?

   1. A. Many victims with the same signs at a landmark
   2. B. One older patient with chest pain at a busy mall
   3. C. A single fall from a ladder at a city park
   4. D. Two teens with minor injuries at a concert
   Show answer

   Answer: A. Many victims with the same signs at a landmark

   Caroline's indicators include the type of location (symbolic or public), the type of call, the number of patients, and victims' statements. Many people with the same signs at a symbolic site fits several at once; one patient at a public place fits only the location.

3. In 2011, the DHS National Terrorism Advisory System (NTAS) replaced the color-coded threat levels with:

   1. A. A five-color threat scale
   2. B. Daily numeric risk scores
   3. C. Bulletins and dated alerts
   4. D. County-level outdoor warning sirens
   Show answer

   Answer: C. Bulletins and dated alerts

   NTAS uses bulletins to share broad threat trends and alerts (elevated or imminent) when there is credible information, and alerts carry an expiration or 'sunset' date. The five-color scale is the old Homeland Security Advisory System that NTAS replaced.

4. An NTAS 'imminent threat' alert means DHS has:

   1. A. Specific, credible word of an impending attack
   2. B. Broad concerns about trends in terrorism
   3. C. Credible information but no specific target named
   4. D. Proof that an attack has already occurred
   Show answer

   Answer: A. Specific, credible word of an impending attack

   An imminent alert warns of a credible, specific, and impending threat. Credible information without specifics is an 'elevated' alert, which is the most tempting confusion; broad trends are shared in bulletins.

5. DHS issues an NTAS elevated threat alert that covers your region but names no specific target. Your agency's best response is to:

   1. A. Cancel ambulance standby at events
   2. B. Post units outside local schools
   3. C. Review plans and raise crew awareness
   4. D. Wait until the alert is made imminent
   Show answer

   Answer: C. Review plans and raise crew awareness

   An elevated alert calls for heightened awareness, review of response plans, and readiness, not drastic changes in service. Waiting for an imminent alert wastes the lead time the alert is meant to give.

6. Your agency's preplan names one parking lot as the staging area for every stadium event. After a bombing there, command moves staging to a different, unannounced site because:

   1. A. Parking lots sit too far from the triage areas
   2. B. Preplanned sites confuse mutual-aid crews
   3. C. The original lot is poorly lit at night
   4. D. Known staging sites can be secondary targets
   Show answer

   Answer: D. Known staging sites can be secondary targets

   Attackers can study public preplans and place a device where responders are sure to gather. Distance from triage is not the issue; the danger is a predictable gathering point.

7. While triaging at a bombing, you notice a backpack sitting alone beside the casualty collection point. You should:

   1. A. Open it carefully to look for wires or a timer
   2. B. Move away, warn others, and notify command
   3. C. Carry it away from the patient area
   4. D. Cover it with a blanket and go on working
   Show answer

   Answer: B. Move away, warn others, and notify command

   A suspicious object at a bombing must be treated as a possible secondary device: clear the area, warn others, and report its location. Moving it is the tempting error, because handling a device can set it off.

8. Near a suspected unexploded device, responders should avoid:

   1. A. Speaking in loud voices near the area
   2. B. Idling an engine for over 5 minutes
   3. C. Using flashlights or headlamps nearby
   4. D. Keying radios and using cell phones
   Show answer

   Answer: D. Keying radios and using cell phones

   Radio and cell transmissions can trigger some devices, so crews move a safe distance away before transmitting. Engine noise and flashlights are not known triggers in the way radio signals are.

9. As your partner walks toward several collapsed people in a mall food court, he says his vision is dim and his nose is running. You should:

   1. A. Back out with him and report a chemical attack
   2. B. Keep going in and treat the closest patient first
   3. C. Give him oxygen and continue the triage
   4. D. Have him wear a surgical mask and go on
   Show answer

   Answer: A. Back out with him and report a chemical attack

   Symptoms in a responder mean the hazard is still present, so the crew must withdraw, report the event, and request resources. Continuing in to treat patients is the tempting error that turns rescuers into victims.

10. Before you reach a park where people are reported short of breath, a bystander says many pigeons have fallen dead on the grass. This finding suggests:

    1. A. A biologic agent with a long incubation
    2. B. An airborne toxic chemical
    3. C. An avian flu outbreak
    4. D. A hidden radiation source nearby
    Show answer

    Answer: B. An airborne toxic chemical

    Sudden deaths of birds or small animals in an area are an indicator of a toxic chemical release. A biologic agent would take days to cause illness, so animals and people would not collapse at the same time.

11. Unlike a chemical attack, a covert biological attack is most likely to be recognized when:

    1. A. A vapor cloud is seen at once
    2. B. Responders smell a strong odor
    3. C. Many people fall ill days later
    4. D. Victims collapse within minutes
    Show answer

    Answer: C. Many people fall ill days later

    Biologic agents have incubation periods, so the first sign is often a cluster of ill people at clinics and EDs days after a silent release. Immediate collapse and visible clouds point to a chemical agent.

12. After you confirm a possible terrorist attack, your first radio report to dispatch should include:

    1. A. Detailed vital signs for each patient seen
    2. B. A full suspect description for the police
    3. C. The type of event, hazards, and resources needed
    4. D. Each patient name and the planned destination hospital
    Show answer

    Answer: C. The type of event, hazards, and resources needed

    An early size-up report tells dispatch what happened, what hazards exist, the safe approach, and what to send. Patient-level details come later; a suspect description is useful but is a police priority, not the first EMS report.

13. A patient at a train station says he heard a pop and saw a man spray something from a bottle just before people began coughing. This statement:

    1. A. Matters less than the patients' signs
    2. B. Can wait until lab tests confirm an agent
    3. C. Suggests a cleaning product mishap
    4. D. Is a key sign of an intentional release
    Show answer

    Answer: D. Is a key sign of an intentional release

    Victim and witness statements, such as seeing someone spray a substance just before people became ill, are a main indicator of a terrorist event and should go to command and police at once. Witness reports often give the earliest warning, before a pattern of signs is clear, so they deserve as much weight as the clinical findings. Waiting for lab confirmation would delay protection of responders and the public by hours. A cleaning product mishap does not explain a man deliberately spraying a bottle just before many people began coughing.

14. Every suspected terrorist event should be managed as:

    1. A. An MCI, with evidence left to police
    2. B. A crime scene as well as an MCI
    3. C. A crime scene, where evidence comes before care
    4. D. A routine MCI, nothing more
    Show answer

    Answer: B. A crime scene as well as an MCI

    A terrorist attack is a federal crime, so EMS cares for patients while protecting evidence and working with law enforcement. Evidence is not left to police alone, because EMS crews handle patients, clothing, and debris first, and lifesaving care comes before evidence once the patient area is safe to enter. Hazmat precautions are added when signs point to a chemical, biologic, or radiologic agent, but many attacks use firearms or conventional explosives.

15. Your crew has set up triage at a bombing scene, and the area looks secure. Scene safety should now be:

    1. A. Reassessed throughout the incident
    2. B. Considered complete for the incident
    3. C. Rechecked when triage moves
    4. D. Checked again if a second blast occurs
    Show answer

    Answer: A. Reassessed throughout the incident

    Hazards change during a terrorist event: secondary devices, structural collapse, shifting vapor, or a returning attacker. Treating the initial size-up as final is the trap that injures responders later in the incident. Rechecking when the triage area moves or after a second blast is too late, because secondary devices and other hazards must be watched for the whole time.

16. Which call carries the strongest location-and-timing indicator of possible terrorism?

    1. A. Chest pain at a hospital ED on a very busy holiday
    2. B. An explosion at a federal plaza on a symbolic date
    3. C. A collapse at a county fair on a rainy day
    4. D. A crash at a highway rest stop late at night
    Show answer

    Answer: B. An explosion at a federal plaza on a symbolic date

    Government buildings, landmarks, and anniversaries of past attacks or historic events carry symbolic value for attackers. A busy holiday at a hospital has crowds but no attack indicator in the call itself.

17. A caller reports an abandoned garden sprayer leaking mist near a concert stage. No one is ill yet. You should:

    1. A. Shut off the sprayer and carry it outside the venue
    2. B. Have security sweep it into a trash bag
    3. C. Isolate the area and request hazmat and police
    4. D. Wait for patients before taking action
    Show answer

    Answer: C. Isolate the area and request hazmat and police

    An unexplained spray device in a crowd is a possible dispersal device for a chemical or biologic agent, so it must be isolated and handled by trained teams. Waiting for patients forfeits the chance to prevent exposure.

18. A caller reports a small explosion in a trash can at a busy plaza; no one seems hurt. The best EMS approach is to:

    1. A. Stage at a distance until police clear it
    2. B. Rush in to search for hidden victims
    3. C. Park right beside the can to take a quick look
    4. D. Stage at the plaza entrance to be close by
    Show answer

    Answer: A. Stage at a distance until police clear it

    A small first blast can be a lure to draw responders close to a larger device. Even with no reported injuries, crews stage at a safe distance until the scene is cleared; parking next to the blast site is the classic mistake. Staging at the plaza entrance still leaves crews within range of a second device and is a likely place for one.

19. Police find a car parked in a fire lane outside an arena with its rear sagging on its springs and wires visible through the window. This most suggests:

    1. A. A stolen car with a dead battery
    2. B. A worn suspension on an old car
    3. C. A car hauling stolen copper wire
    4. D. A vehicle-borne explosive device
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    Answer: D. A vehicle-borne explosive device

    A vehicle riding low from a heavy load, parked in an odd spot near a crowd, with visible wiring, is a warning sign of a vehicle-borne IED. Responders should stay far back and let bomb technicians evaluate it.

20. At a suspected chemical attack, a standard EMS uniform with an N95 mask:

    1. A. Protects for up to 30 minutes
    2. B. Gives almost no chemical protection
    3. C. Is enough if you stay upwind
    4. D. Blocks the vapors but not the liquid droplets
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    Answer: B. Gives almost no chemical protection

    Work uniforms and particulate masks do not stop chemical vapors or liquids; crews without proper chemical PPE must stay out of the hot zone. Staying upwind reduces exposure but does not make an N95 protective inside the contaminated area.

21. Before your crew moves closer to a suspected terrorist incident, each member should know:

    1. A. The hospitals' current bed counts
    2. B. The location of the nearest trauma center
    3. C. The patient count reported by dispatch
    4. D. An escape route and a rally point
    Show answer

    Answer: D. An escape route and a rally point

    If a secondary device, gunfire, or vapor shift occurs, crews need a planned way out and a place to regroup and be accounted for. Bed counts, the nearest trauma center, and the expected number of patients help with triage and transport planning but do not protect the crew.

22. A small plane sprays a fine mist over a stadium crowd and flies off. Thirty minutes later no one is ill, and air monitors detect no chemical. The best next step is to:

    1. A. Declare the scene safe and release the crowd
    2. B. Release the crowd; tell them to call if ill
    3. C. Treat it as a possible biologic release
    4. D. Give antibiotics to the front rows now
    Show answer

    Answer: C. Treat it as a possible biologic release

    Biologic agents cause no signs for a day or more and are not detected by chemical monitors, so a deliberate aerosol release with no immediate illness must be handled as a possible biologic attack: notify police and public health, keep the area isolated, record who was exposed, and follow public health direction on decontamination, sampling, and prophylaxis. Declaring the scene safe because no one is ill yet ignores incubation periods and loses track of people who may need prophylaxis. Releasing the crowd with advice to call if ill also loses track of exposed people, and starting antibiotics before an agent is identified may use the wrong drug on the wrong people; public health chooses prophylaxis once the threat is assessed.

23. While you stand by outside a stadium, your personal radiation detector alarms as you walk past a parked delivery van. No placards are visible. You should:

    1. A. Move back until it stops and report it
    2. B. Ignore it, since the van has no placards
    3. C. Open the van to look for the source
    4. D. Stay by the van and wait for police
    Show answer

    Answer: A. Move back until it stops and report it

    A personal radiation detector alarm near an unplacarded vehicle at a crowded venue may mean a hidden source or a radiological device, so you increase distance (dose falls quickly with distance), keep others back, and notify command and law enforcement so trained teams with survey meters can investigate. Lack of placards does not rule out radioactive material, because an illicit source would not be labeled. Opening the van increases your exposure and could disturb a device or evidence. Waiting beside the van keeps you close to a possible source, when your dose falls quickly as you move away.

24. Over several days, a stadium guard sees the same man photographing air intakes and asking staff when guard shifts change. This behavior is best described as:

    1. A. Possible preattack surveillance
    2. B. A fan taking photos
    3. C. A sign of a biologic release in progress
    4. D. A building inspector's routine survey
    Show answer

    Answer: A. Possible preattack surveillance

    Attackers often watch a target, photograph security features, and ask about routines before striking, so this should be reported to law enforcement. It is not a release in progress; it is a pre-incident indicator that gives time to prevent an attack.

25. The responders at greatest risk at a terrorist incident are often those who:

    1. A. Arrive with the second wave of units
    2. B. Work in the cold zone at triage
    3. C. Stay in staging until assigned
    4. D. Rush in before the hazard is known
    Show answer

    Answer: D. Rush in before the hazard is known

    The urge to help leads first-arriving crews into secondary devices, vapor, or gunfire before the scene is sized up. Crews in staging or the cold zone are protected by distance and the information already gathered.