Terrorism Operations: Command, Evidence, Hospital Surge, and Mental Health Practice Questions

25 multiple-choice questions on Terrorism operations: command, evidence, hospital surge, and mental health 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. At a terrorist incident in the United States, the lead federal agency for the criminal investigation is the:

   1. A. Federal Bureau of Investigation
   2. B. Federal Emergency Management Agency
   3. C. Centers for Disease Control and Prevention
   4. D. Department of Transportation
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   Answer: A. Federal Bureau of Investigation

   The FBI leads the law enforcement response to terrorism, including the crime scene and investigation. FEMA is tempting because it is the best-known federal disaster agency, but it coordinates relief and recovery, not the criminal case.

2. FBI agents arrive at a bombing that local fire, EMS, and police are still managing. Command of the incident should now:

   1. A. Pass to the FBI agent in charge
   2. B. End, with FEMA taking direct control
   3. C. Move to the state emergency operations center
   4. D. Become a unified command including the FBI
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   Answer: D. Become a unified command including the FBI

   Under NIMS, the FBI joins local commanders in a unified command so the investigation and the life-safety response are coordinated at one post. Local agencies do not hand over command, because fire, rescue, and patient care remain their responsibilities.

3. Investigators usually set the outer boundary of a bombing crime scene:

   1. A. At the edge of the blast crater itself
   2. B. Well beyond the farthest debris found
   3. C. At the outer border of the triage area
   4. D. Wherever the EMS staging area was set
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   Answer: B. Well beyond the farthest debris found

   Fragments can be thrown hundreds of feet, so the perimeter is extended past the farthest piece found, often about 1.5 times that distance. Limiting it to the crater would leave evidence unprotected, which is why EMS routes and staging may be restricted.

4. While treating a bombing victim, you notice a piece of wire and part of a battery on the ground near her. You should:

   1. A. Pick it up and hand it to the first officer
   2. B. Kick it aside to make room for the stretcher
   3. C. Leave it, note where it is, and tell police
   4. D. Put it in a bag and take it to the hospital
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   Answer: C. Leave it, note where it is, and tell police

   Bomb components are key evidence, and moving them destroys information about the device and its location; tell police and document what you saw. Handing it to an officer seems helpful but still moves it and breaks the record of where it lay.

5. Local police, the FBI, and other agencies investigate terrorism cases together through:

   1. A. Joint Terrorism Task Forces
   2. B. Regional healthcare coalitions
   3. C. Medical Reserve Corps units
   4. D. Rescue task force teams
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   Answer: A. Joint Terrorism Task Forces

   Joint Terrorism Task Forces are FBI-led teams of federal, state, and local investigators assigned to terrorism cases. Rescue task forces are fire, EMS, and police teams that reach patients at hostile events, not investigative units.

6. Some fire and EMS agencies appoint a terrorism liaison officer, whose main role is to:

   1. A. Command the EMS branch at attacks
   2. B. Run the decon corridor at a release
   3. C. Link the agency with threat intelligence
   4. D. Speak for the agencies to the news media
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   Answer: C. Link the agency with threat intelligence

   A terrorism liaison officer passes threat information between the agency and fusion centers or law enforcement and forwards suspicious activity reported by crews. Speaking to the media belongs to the public information officer.

7. A caller tells your dispatcher that a bomb will go off at a shopping mall in an hour. The dispatcher should:

   1. A. Hang up and call the mall security office
   2. B. Tell him the call is being traced now
   3. C. Transfer him at once to the local FBI
   4. D. Keep him talking and record every detail
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   Answer: D. Keep him talking and record every detail

   DHS/CISA bomb threat guidance is to stay calm, keep the caller on the line as long as possible, and record his exact words and details such as the stated location and timing, background noises, and voice traits, while others notify police and the site. Hanging up ends the chance to learn where and when the device is said to be. Telling the caller the call is being traced may make him hang up. Transferring the call risks losing him; the dispatcher stays on the line while police and the FBI are notified.

8. Attackers have listened to scanner traffic during past attacks. At a terror incident, details such as the staging location should be passed:

   1. A. Over open radio so that units hear it
   2. B. Over secure channels, not open radio
   3. C. Through crew posts on social media
   4. D. After the incident has ended
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   Answer: B. Over secure channels, not open radio

   Unencrypted radio and social media can tell an attacker where responders are gathering, so locations and tactics go over secure channels or face to face. Waiting until the incident ends would leave arriving units without what they need.

9. Your agency writes a terrorism preplan for a downtown arena. The plan is most useful when it names:

   1. A. Backup approach routes and hospitals
   2. B. The employees who work in the arena
   3. C. A single nearest hospital for patients
   4. D. The arena's event schedule and ticket prices
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   Answer: A. Backup approach routes and hospitals

   A useful preplan lists backup approach routes, alternate sites, and several receiving hospitals, so command can adapt when one route is blocked or unsafe and can spread patients so that no single hospital is overwhelmed. Sending patients to a single nearest hospital overloads it and is what happens when plans are missing. A list of the employees who work in the arena changes constantly and does not guide the response. The event schedule matters for timing, but ticket prices have no operational use.

10. Hospitals receiving victims of a possible chemical attack often lock down their entrances in order to:

    1. A. Prevent the media from filming patients
    2. B. Stop EMS from bringing more patients
    3. C. Keep staff from leaving their shifts
    4. D. Keep contaminated walk-ins out of the ED
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    Answer: D. Keep contaminated walk-ins out of the ED

    Controlling entry points lets the hospital send arriving victims through decon before they contaminate the ED and its staff. Lockdown is not meant to stop EMS, which is directed to designated entrances.

11. To open beds quickly for victims of a terror bombing, a hospital may use reverse triage, which means:

    1. A. Discharging stable inpatients early
    2. B. Sending the worst patients elsewhere
    3. C. Treating the least injured patients first
    4. D. Turning away private-vehicle arrivals
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    Answer: A. Discharging stable inpatients early

    Reverse triage identifies inpatients who can safely go home or to a lower level of care, freeing beds, staff, and operating rooms for casualties. It does not mean treating minor injuries first, which would reverse disaster triage priorities.

12. In the first hours after a terror bombing, the blood transfused into victims comes mostly from:

    1. A. Donors who give blood that day
    2. B. Units already on hospital shelves
    3. C. Military blood flown in by jet
    4. D. Family members of the injured
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    Answer: B. Units already on hospital shelves

    Donated blood must be tested and processed, which takes many hours, so early transfusions depend on existing inventory. Same-day donations help restock the supply but do not reach the first wave of patients.

13. During a nerve agent attack, local ambulance antidote supplies run low. The fastest source of large amounts of additional antidote is usually:

    1. A. A Strategic National Stockpile shipment
    2. B. A nearby military installation
    3. C. A local CHEMPACK container
    4. D. A regional drug wholesaler
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    Answer: C. A local CHEMPACK container

    CHEMPACK caches are prepositioned at hospitals and EMS sites so large numbers of antidote doses can be opened within minutes to an hour. A Strategic National Stockpile shipment takes many hours to arrive, far too slow for nerve agent poisoning. Military installations and drug wholesalers cannot supply antidote in the quantity and time needed.

14. A hospital organizes its own response to a terror attack, including staffing, beds, and decon, using the:

    1. A. National Disaster Medical System
    2. B. Hospital Incident Command System
    3. C. Joint Terrorism Task Force
    4. D. Metropolitan Medical Response System
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    Answer: B. Hospital Incident Command System

    HICS applies ICS principles inside the hospital, with defined positions and job action sheets, so the hospital can link to field command. NDMS is a federal system of medical teams and patient movement, not a hospital's internal command structure.

15. Public messages after a chemical attack tell victims who left the scene before decon to:

    1. A. Undress and wash as soon as they can
    2. B. Wait until symptoms begin to appear
    3. C. Drive to the ED with the windows up
    4. D. Return to the scene for team decon
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    Answer: A. Undress and wash as soon as they can

    Removing clothing and washing early limits absorption and keeps the agent out of cars, homes, and emergency departments. Driving with the windows up traps vapor around the victim and carries contamination into the hospital.

16. After a terrorist attack, the number of people with psychological effects, compared with the number with physical injuries, is usually:

    1. A. About the same
    2. B. Much smaller
    3. C. Much greater
    4. D. Hard to predict
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    Answer: C. Much greater

    Terrorism is designed to spread fear, and psychological casualties, including the worried well, often outnumber physical injuries many times over. 'Hard to predict' is tempting, but the pattern of many more psychological casualties is consistent.

17. Twenty minutes after a letter with white powder is opened in an office, a dozen workers report itching, nausea, and dizziness. All have normal vital signs, normal pupils, and clear lungs. This most likely reflects:

    1. A. Early inhalational anthrax from spores
    2. B. A nerve agent mixed into the powder
    3. C. Rapid ricin poisoning from the dust
    4. D. Anxiety spreading among the workers
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    Answer: D. Anxiety spreading among the workers

    Vague symptoms within minutes in many frightened people with normal findings fit anxiety spreading through the group (mass psychogenic illness), which is common after white powder incidents. Inhalational anthrax takes days to cause symptoms, inhaled ricin takes hours, and a nerve agent would cause pinpoint pupils, secretions, and twitching. Each person is still assessed, the room stays isolated, and the powder is tested, because a real agent cannot be ruled out in the field.

18. State and regional fusion centers support terrorism prevention mainly by:

    1. A. Running decon for mass casualties
    2. B. Storing antidotes for local EMS use
    3. C. Training citizens in bleeding control skills
    4. D. Sharing threat information among agencies
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    Answer: D. Sharing threat information among agencies

    Fusion centers gather, analyze, and share threat information among federal, state, local, and private partners, including fire and EMS. Antidote caches are the role of CHEMPACK, not fusion centers.

19. Responders at terror attacks may suffer more lasting stress than at other disasters mainly because:

    1. A. The harm was done to innocents on purpose
    2. B. Terror scenes tend to have far more patients
    3. C. Terror victims refuse more treatment
    4. D. Crews get no breaks during the event
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    Answer: A. The harm was done to innocents on purpose

    Deliberate harm to innocent people, including children, is especially hard to process and is linked to more lasting stress reactions. Terror events do not always have more patients than natural disasters, so that distractor is wrong.

20. Which group has the highest risk of long-term post-traumatic stress after a terror attack?

    1. A. People who watched it on the TV news
    2. B. Injured survivors and the bereaved
    3. C. Residents of unaffected states
    4. D. Responders assigned to staging
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    Answer: B. Injured survivors and the bereaved

    Direct exposure, injury, and the death of loved ones are the strongest predictors of lasting post-traumatic stress. Heavy media viewing does cause stress reactions, which makes that choice tempting, but the long-term risk is far lower.

21. During a terror bombing, command receives a credible threat that the attackers may target the trauma center next. EMS should:

    1. A. Keep it private for now so the public will not panic
    2. B. Divert the patients out of the region
    3. C. Share it at once with the hospital and police
    4. D. Stop transports until police respond
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    Answer: C. Share it at once with the hospital and police

    Hospitals have been targeted in secondary attacks, so threats must be passed immediately to the hospital and law enforcement so security can be increased. Keeping it quiet to avoid panic leaves the hospital unprotected.

22. After an attack blamed on a foreign group, your partner makes hostile remarks about a patient of that ethnicity. You should:

    1. A. Let it go, since feelings are raw today
    2. B. Stop the remarks; care must be equal
    3. C. Hand the patient to a different crew
    4. D. Report the patient to police as a suspect
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    Answer: B. Stop the remarks; care must be equal

    Backlash against people who share an attacker's ethnicity or religion often follows terror attacks, and every patient is owed the same standard of care. Treating a patient as a suspect because of ethnicity is discrimination, not scene safety.

23. A father asks how to help his young children after a terror attack in their city. The best advice is to:

    1. A. Limit their repeated viewing of news coverage
    2. B. Keep them home from school for a month
    3. C. Avoid talking with them about what has happened
    4. D. Have them watch footage to understand it
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    Answer: A. Limit their repeated viewing of news coverage

    Repeated exposure to graphic media coverage is linked to more stress symptoms in children, while honest, age-appropriate conversation and normal routines help. Avoiding all discussion leaves children to fill in the gaps with fear.

24. After working at a suspected bioterrorism scene, responders should:

    1. A. Assume they were protected by PPE
    2. B. Begin antibiotics before an agent is known
    3. C. Watch for and report any new symptoms
    4. D. Report symptoms if they last a week
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    Answer: C. Watch for and report any new symptoms

    Exposure may be discovered only after the agent is identified, so responders report symptoms early and follow public health guidance on prophylaxis. Assuming PPE worked perfectly is tempting but delays treatment if there was a breach. Waiting a week can miss the window for early treatment, and starting antibiotics before the agent is known may mean the wrong drug; public health directs who receives prophylaxis.

25. Years after the September 11 attacks, responders who worked at the World Trade Center site have shown high rates of:

    1. A. Tuberculosis caught at the site
    2. B. Chronic lead poisoning from the debris
    3. C. Hepatitis B from human remains
    4. D. Chronic airway disease and cancers
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    Answer: D. Chronic airway disease and cancers

    Dust containing pulverized concrete, glass, and asbestos led to asthma, chronic sinus and airway disease, and several cancers, now followed by the WTC Health Program. Tuberculosis, chronic lead poisoning, and hepatitis B are not among the conditions that stand out in these responders.