Special Considerations: Radiation, Clandestine Drug Labs, Transport, and Notification Practice Questions

25 multiple-choice questions on Special considerations: radiation, clandestine drug labs, transport, and notification for paramedic and EMT students, from Chapter 50 (Hazardous Materials). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Alpha particles can be stopped by a sheet of paper or the outer layer of skin. They are most dangerous when the radioactive material is:

   1. A. Held about 3 meters (10 feet) away
   2. B. Inside a sealed lead container
   3. C. Carried on the outside of clothing
   4. D. Inhaled, swallowed, or in a wound
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   Answer: D. Inhaled, swallowed, or in a wound

   Alpha particles travel only a few centimeters in air and cannot pass through skin, but inside the body they deposit all their energy in nearby tissue. That makes internal contamination the main alpha hazard.

2. Gamma radiation is the hardest type to shield against. Effective shielding requires:

   1. A. Dense materials, such as lead or concrete
   2. B. A sheet of paper or a layer of clothing
   3. C. A thin sheet of aluminum or plastic
   4. D. A standard chemical splash suit with hood
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   Answer: A. Dense materials, such as lead or concrete

   Gamma rays are high-energy electromagnetic waves that pass through the body and need dense, thick materials to reduce them. Chemical suits keep radioactive particles off the skin but do not block gamma rays.

3. Beta particles from a spilled radioactive material can cross a short distance of air. Compared with alpha particles, beta particles:

   1. A. Pass through lead and need several feet of concrete
   2. B. Cannot leave the body even after they are inhaled
   3. C. Are stopped by a single sheet of thin paper
   4. D. Can burn skin but are stopped by thin plastic
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   Answer: D. Can burn skin but are stopped by thin plastic

   Beta particles penetrate farther than alpha particles and can injure skin and eyes, but a thin layer of aluminum, plastic, or glass stops them. Thick concrete or lead is the shield for gamma rays.

4. You are 2 meters from a gamma source. If you move back to 4 meters, the dose rate you receive will fall to about:

   1. A. One-half of the original
   2. B. Two-thirds of the original rate
   3. C. One-quarter of the original
   4. D. One-eighth of the original
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   Answer: C. One-quarter of the original

   Radiation intensity follows the inverse square law: doubling the distance cuts the dose rate to 1/2 squared, or one-quarter. One-half is the tempting answer, but the decrease is greater than linear.

5. A responder at a radiation incident wears a personal dosimeter. Its purpose is to:

   1. A. Shield the wearer's chest from gamma rays
   2. B. Record the total dose the wearer receives
   3. C. Find contamination on a patient's skin
   4. D. Warn of toxic chemical vapors in the air
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   Answer: B. Record the total dose the wearer receives

   A dosimeter measures the cumulative radiation dose received by the wearer, which is tracked against exposure limits. A survey meter, such as a Geiger counter, is used to find contamination on people and surfaces.

6. A plant worker says, 'I don't feel anything, so the leak can't be radioactive.' You should explain that:

   1. A. Radiation causes warmth on the skin
   2. B. Radiation can't be seen, smelled, or felt
   3. C. Radiation sickness starts within seconds
   4. D. Radiation gives off a faint metallic odor
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   Answer: B. Radiation can't be seen, smelled, or felt

   Human senses cannot detect radiation, so a survey meter is needed to find it. The lack of symptoms says nothing about the dose received.

7. A worker was exposed to a high-activity radiation source. He began vomiting about 1 hour later. Early onset of vomiting after radiation exposure suggests:

   1. A. A low dose that needs no follow-up
   2. B. Anxiety, not a radiation effect
   3. C. Contamination with a chemical too
   4. D. A high dose and a worse prognosis
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   Answer: D. A high dose and a worse prognosis

   In acute radiation syndrome, the time to onset of nausea and vomiting is a rough guide to dose; vomiting within 1 to 2 hours suggests a high, possibly lethal dose. Late or absent vomiting suggests a lower dose.

8. Potassium iodide is given after some radiation releases because it:

   1. A. Blocks thyroid uptake of radioactive iodine
   2. B. Flushes radioactive material out of the body
   3. C. Shields the bone marrow from gamma radiation
   4. D. Treats skin burns from beta particle exposure
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   Answer: A. Blocks thyroid uptake of radioactive iodine

   Potassium iodide saturates the thyroid with stable iodine so radioactive iodine is not absorbed, reducing later thyroid cancer risk. It does not protect any other organ or treat other isotopes.

9. A contaminated worker with radioactive dust on his clothes has a life-threatening injury and must be transported before full decon. To limit the spread of contamination, you should:

   1. A. Wait for the hazmat team to scrub his whole body
   2. B. Leave his clothing on and cover him with a blanket
   3. C. Remove his outer clothing and wrap him in a sheet
   4. D. Hold transport until a survey meter clears him
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   Answer: C. Remove his outer clothing and wrap him in a sheet

   Removing outer clothing removes most radioactive contamination, and wrapping the patient in a sheet or blanket contains what remains while care continues. Leaving the clothing on keeps most of the contamination with him. Life-threatening injuries come first, so neither a full scrub nor a clean survey reading should delay transport; a contaminated patient is rarely a significant radiation hazard to the crew.

10. A package in a crashed delivery truck carries a 'Radioactive Yellow-III' label. Compared with White-I and Yellow-II labels, this label means:

    1. A. The highest surface dose rate of the three
    2. B. A low-level source that is safe to handle by hand
    3. C. A package that contains alpha emitters
    4. D. Fissile material that could go critical
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    Answer: A. The highest surface dose rate of the three

    DOT radioactive labels are assigned by the radiation level at the package surface and the transport index (49 CFR 172.403). White-I has almost no measurable surface radiation, Yellow-II more, and Yellow-III the most, so Yellow-III marks the highest dose rate of the three. The package is still built to keep its contents shielded, but responders should limit time, increase distance, and use shielding until radiation specialists survey it. White-I, not Yellow-III, is the low-level label, and no package should be handled bare-handed before a survey. The labels do not say whether the material emits alpha, beta, or gamma radiation. Fissile material carries a separate FISSILE label with a criticality safety index.

11. In a garage, you notice a propane tank whose brass valve has turned blue-green. This finding suggests the tank has been used to store:

    1. A. Propane that has been stored too long
    2. B. Carbon dioxide used to make dry ice
    3. C. Chlorine for a home swimming pool
    4. D. Anhydrous ammonia for drug production
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    Answer: D. Anhydrous ammonia for drug production

    Anhydrous ammonia, used in some meth production methods, corrodes the brass fittings of propane tanks and turns them blue-green. Such a tank may leak or rupture and should not be touched.

12. While treating a patient at a home, you realize you are in an active drug lab. The safest action is to:

    1. A. Turn off the heat under the reaction to stop it
    2. B. Get out with the patient and call for help
    3. C. Open windows and switch on fans to clear fumes
    4. D. Gather the containers so police can test them
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    Answer: B. Get out with the patient and call for help

    Crews should leave, removing the patient if it is safe to do so, without touching anything or operating switches, which can spark an explosion or trigger traps. Police and hazmat teams handle the lab, and the crew should be checked for contamination.

13. The red phosphorus method of making methamphetamine is especially dangerous to responders because it can release:

    1. A. Anhydrous ammonia, a corrosive gas
    2. B. Phosgene, a delayed lung irritant
    3. C. Phosphine, a highly toxic gas
    4. D. Chlorine, an airway irritant
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    Answer: C. Phosphine, a highly toxic gas

    Heating red phosphorus with other reagents can produce phosphine gas, which causes severe lung injury and can be fatal. Fire, solvents, and corrosive acids add to the danger. Anhydrous ammonia is the hazard of the lithium-ammonia method rather than the red phosphorus method, and phosgene and chlorine are not typical products of the red phosphorus reaction.

14. In a car, police find a plastic soda bottle containing a layered liquid with tubing attached, along with stripped lithium batteries and cold packs. This 'one-pot' meth lab should be:

    1. A. Opened slowly to release the pressure safely
    2. B. Left for hazmat; it can ignite or burst
    3. C. Rinsed with water to stop the chemical reaction
    4. D. Carried to the ambulance to keep as evidence
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    Answer: B. Left for hazmat; it can ignite or burst

    One-pot (shake-and-bake) bottles contain lithium, solvents, and reactive chemicals under pressure and can burst into flame when opened, moved, or exposed to water. Lithium reacts violently with water.

15. A 3-year-old is found living in a home with an active meth lab. She is alert and well appearing. Care should include:

    1. A. Returning her to the home after police leave
    2. B. Transport with her toys and clothing for comfort
    3. C. Decon and evaluation, leaving belongings
    4. D. No evaluation, since she has no symptoms now
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    Answer: C. Decon and evaluation, leaving belongings

    Children found in drug labs may be contaminated and need decon, medical evaluation, and protection, and items from the home should not travel with them. Law enforcement and child protective services are notified.

16. Butane hash oil (BHO) extraction of marijuana in a home is a hazard to responders mainly because it can cause:

    1. A. Cyanide poisoning from the burning plants
    2. B. Asphyxia as butane displaces the room's oxygen
    3. C. Frostbite from liquid butane on the skin
    4. D. Explosions and flash burns from butane vapor
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    Answer: D. Explosions and flash burns from butane vapor

    Butane is heavier than air and very flammable, so vapor building up indoors can ignite from a spark, causing explosions and flash burns. Patients often have facial and hand burns. Butane can displace oxygen, and liquid butane can freeze the skin, but the vapor becomes flammable at about 1.8% in air, far below the level that causes asphyxia, so fire and explosion are the main threat.

17. Police ask EMS to stand by while they enter a suspected fentanyl pill-press operation where loose powder may be in the air. Entry crews should wear at least:

    1. A. A fit-tested respirator, gloves, and eye protection
    2. B. A surgical mask and a single pair of exam gloves
    3. C. Standard uniform, since the powder cannot be inhaled
    4. D. Gloves, with hand gel used after leaving the site
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    Answer: A. A fit-tested respirator, gloves, and eye protection

    Airborne fentanyl powder is the main exposure risk in a clandestine operation, so responders who must enter wear at least an N95 or higher respirator (often P100 or air-purifying respirator), nitrile gloves, and eye protection, with a higher level when large amounts are present. Alcohol gel can increase skin absorption; wash with soap and water.

18. When notifying a hospital that you are bringing a patient from a hazmat incident, the report should include:

    1. A. The shipper's name and the tanker's license
    2. B. The size of the spill in gallons and pounds
    3. C. Agent, decon status, symptoms, and ETA
    4. D. The zone layout and the hazmat team's roster
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    Answer: C. Agent, decon status, symptoms, and ETA

    The hospital needs to know the agent, the number of patients, whether and how they were decontaminated, their condition and care, and the ETA so it can prepare decon, isolation, and antidotes. Details of the shipper or the zone layout do not change hospital care.

19. You arrive at the ED with a patient whose decon was only partial because of a fast-changing scene. You should:

    1. A. Take the patient straight to a resuscitation bay
    2. B. Stop outside and let staff decide on decon
    3. C. Bring the patient in through the main ambulance door
    4. D. Leave the patient in the ambulance bay without report
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    Answer: B. Stop outside and let staff decide on decon

    A patient who may still be contaminated should be held outside until hospital staff can decontaminate or clear them, so the ED is not contaminated and closed. Bringing the patient straight in risks exposing staff and other patients.

20. Before transporting a decontaminated patient from a hazmat incident, preparation of the ambulance should include:

    1. A. Closing the vents to keep fumes contained
    2. B. Placing the bagged clothing on the bench
    3. C. Stocking extra supplies in open cabinets
    4. D. Removing equipment that won't be needed
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    Answer: D. Removing equipment that won't be needed

    Taking out or covering gear not needed for the transport limits what can be contaminated and must later be cleaned or discarded. Bagged clothing should not ride with the patient, and vents should stay open to clear any off-gassing.

21. During transport of a decontaminated pesticide patient, you and your driver both develop burning eyes and a headache. You should:

    1. A. Pull over, ventilate, and get out of the unit
    2. B. Open the windows and continue to the hospital
    3. C. Put on surgical masks and finish the transport
    4. D. Stop and rinse your eyes, then drive on
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    Answer: A. Pull over, ventilate, and get out of the unit

    Crew symptoms mean off-gassing or residual contamination, so the ambulance should stop safely, be ventilated, and be vacated while help is requested. Opening windows while driving, or rinsing your eyes and driving on, keeps the crew in a contaminated cab, and surgical masks do not filter vapors. A driver who continues while impaired endangers everyone.

22. In large chemical releases, hospitals must be ready for contaminated patients because many victims:

    1. A. Go to the hospital on their own without decon
    2. B. Are decontaminated before they leave the site
    3. C. Wait at the scene until EMS transports them
    4. D. Have no symptoms and do not seek care
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    Answer: A. Go to the hospital on their own without decon

    In past chemical incidents, most victims left the scene and arrived at hospitals by private vehicle, contaminated and unannounced, exposing ED staff. EMS should alert hospitals early so they can set up decon.

23. OSHA uses the term 'first receivers' to describe:

    1. A. The first fire company to arrive at a release
    2. B. Dispatchers who take the first 911 call reports
    3. C. Hospital staff receiving contaminated patients
    4. D. Hazmat technicians who make the first entry
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    Answer: C. Hospital staff receiving contaminated patients

    First receivers are hospital workers who receive and decontaminate patients at a site away from the release, and OSHA guidance addresses their PPE and training. Responders at the scene are first responders.

24. After transporting a patient from a hazmat incident, your crew discovers residue from the patient on the stretcher. The ambulance should be:

    1. A. Wiped and returned to service
    2. B. Out of service until decontaminated
    3. C. Driven back to the station to wash with a hose
    4. D. Kept in service as long as windows stay open
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    Answer: B. Out of service until decontaminated

    A contaminated ambulance must be taken out of service and decontaminated, often with the help of the hazmat team, before it is used again, and the crew should be checked as well. Quick wipes can miss the agent and spread it.

25. After a patient has been properly decontaminated at the scene, the transport crew can usually protect themselves with:

    1. A. A fully encapsulating Level A suit
    2. B. An SCBA worn for the entire transport
    3. C. A powered air-purifying respirator
    4. D. Standard precautions, such as gloves
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    Answer: D. Standard precautions, such as gloves

    Thorough decon removes the agent so that, in most cases, standard precautions are enough for transport, with attention to off-gassing. Wearing a Level A suit or SCBA during care is impractical and is not needed after decon.