The National Framework: NRF, ESF-8, Stafford Act, NDMS, EMAC, and the SNS Practice Questions

25 multiple-choice questions on The national framework: NRF, ESF-8, Stafford Act, NDMS, EMAC, and the SNS 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 National Response Framework (NRF) is best described as:

   1. A. A federal law that funds disaster rebuilding
   2. B. The command structure used at each scene
   3. C. A guide to the national all-hazards response
   4. D. A list of federal EMS treatment protocols
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   Answer: C. A guide to the national all-hazards response

   The NRF describes how local, state, tribal, federal, private, and nonprofit partners deliver a unified response to any hazard, building on NIMS. The scene command structure is ICS; the NRF sits above it as national-level guidance.

2. Under the National Response Framework, most incidents are managed:

   1. A. By FEMA once a disaster has been declared
   2. B. By the state from the very first hour
   3. C. By the military in large-scale events
   4. D. Locally, with state and federal support
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   Answer: D. Locally, with state and federal support

   The NRF is tiered: incidents are handled at the lowest jurisdictional level able to manage them, and higher levels support rather than take over. Even after a federal declaration, FEMA supports local and state command instead of replacing it.

3. Emergency Support Functions (ESFs) under the National Response Framework are:

   1. A. Groups of resources organized by function
   2. B. The phases of the disaster cycle in order
   3. C. The ranks of federal disaster declarations
   4. D. The levels of state emergency operations
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   Answer: A. Groups of resources organized by function

   The NRF bundles federal capabilities into ESFs, such as transportation, communications, mass care, and public health and medical, each with a coordinating agency. They describe what help is available, not phases of a disaster or declaration levels.

4. Under the National Response Framework, Emergency Support Function 8 (ESF-8) covers:

   1. A. Search and rescue operations
   2. B. Mass care, housing, and human services
   3. C. Public health and medical services
   4. D. Transportation and evacuation routes
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   Answer: C. Public health and medical services

   ESF-8 coordinates federal public health and medical support, including NDMS teams, patient movement, medical supplies, and mass fatality support. Search and rescue is ESF-9 and mass care is ESF-6.

5. The federal department that coordinates ESF-8 (public health and medical services) is the:

   1. A. Department of Homeland Security
   2. B. Department of Health and Human Services
   3. C. Department of Housing and Urban Development
   4. D. Department of Defense
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   Answer: B. Department of Health and Human Services

   HHS, through its Administration for Strategic Preparedness and Response (ASPR), coordinates ESF-8. Homeland Security houses FEMA, which coordinates the overall federal response but not the medical function itself.

6. After a hurricane, federal urban search and rescue task forces are deployed to search collapsed homes. Under the NRF, this work falls under:

   1. A. ESF-9, search and rescue
   2. B. ESF-8, public health and medical
   3. C. ESF-6, mass care and housing
   4. D. ESF-1, transportation
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   Answer: A. ESF-9, search and rescue

   ESF-9 covers search and rescue, including FEMA's urban search and rescue task forces. Although these teams include medical members, the mission is rescue, so it is not ESF-8.

7. A shelter opens to house and feed thousands of residents displaced by flooding. Under the NRF, this falls under:

   1. A. ESF-8, public health and medical
   2. B. ESF-3, public works
   3. C. ESF-9, search and rescue
   4. D. ESF-6, mass care
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   Answer: D. ESF-6, mass care

   ESF-6 covers mass care, emergency assistance, temporary housing, and human services, with the Red Cross as a key partner. Medical care inside shelters draws on ESF-8, but sheltering and feeding the public are mass care.

8. A tornado outbreak has overwhelmed your state's resources. A Stafford Act presidential disaster declaration must be requested by the:

   1. A. Governor of the affected state
   2. B. County EMS medical director
   3. C. Mayor of the state's largest city
   4. D. FEMA regional administrator
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   Answer: A. Governor of the affected state

   Under the Stafford Act, a state's governor asks the President for a declaration once the event exceeds state and local resources, usually after a joint damage assessment with FEMA. Mayors and county officials, including an EMS medical director, seek help through the state rather than asking the President directly. The FEMA regional administrator reviews the governor's request and forwards it with a recommendation, but does not make the request.

9. Before requesting a Stafford Act declaration, a governor must generally show that:

   1. A. At least 100 people have died or are missing
   2. B. Federal teams have already been deployed
   3. C. The event is beyond state and local means
   4. D. Each affected county has declared too
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   Answer: C. The event is beyond state and local means

   The Stafford Act provides federal help when a disaster is of such severity and size that state and local resources cannot handle it. There is no set death toll, and federal teams usually deploy after, not before, the declaration.

10. The two main types of presidential declaration under the Stafford Act are:

    1. A. Watch and warning
    2. B. Emergency and major disaster
    3. C. Local and regional emergency
    4. D. Medical and nonmedical disaster
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    Answer: B. Emergency and major disaster

    An emergency declaration gives more limited, targeted federal help, often to protect lives before or during an event, while a major disaster declaration opens broader aid programs. Watch and warning are weather alert terms, not declarations.

11. Once a major disaster is declared, federal resources are meant to:

    1. A. Take over command from local agencies
    2. B. Replace local EMS until recovery ends
    3. C. Fund rebuilding but not the response
    4. D. Support state and local response
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    Answer: D. Support state and local response

    Federal aid supplements state and local effort; local agencies keep command of their incidents. The belief that FEMA takes over is a common misconception that leads to delays while agencies wait for direction.

12. Before 2013, a tribal government needed a state governor to ask the President for a disaster declaration. Since the Sandy Recovery Improvement Act, the tribe's chief executive can:

    1. A. Issue a federal major disaster declaration itself
    2. B. Order state National Guard units to deploy
    3. C. Submit the request to the President directly
    4. D. Direct FEMA to take command of the response
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    Answer: C. Submit the request to the President directly

    The Sandy Recovery Improvement Act of 2013 amended Stafford Act sections 401 and 501 so that the chief executive of a federally recognized tribal government can ask the President directly for an emergency or major disaster declaration, through the FEMA regional administrator, as a sovereign government; a tribe may also still choose to receive aid under a state's declaration. Only the President can declare a federal emergency or major disaster, so a tribe cannot issue one itself. State National Guard units answer to the governor, not to a tribal leader. FEMA supports tribal, state, and local responders and does not take command of the response.

13. The National Disaster Medical System (NDMS) has three parts: medical response, patient movement, and:

    1. A. Public information
    2. B. Definitive care
    3. C. Mass sheltering
    4. D. Search and rescue
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    Answer: B. Definitive care

    NDMS sends medical teams to the disaster, moves patients out of the area, and places them in participating hospitals for definitive care. Search and rescue is a separate function (ESF-9).

14. After an earthquake damages local hospitals, NDMS flies stable inpatients to hospitals in other states. The receiving hospitals are:

    1. A. Federal field hospitals set up near the site
    2. B. Hospitals inside the disaster's state
    3. C. Hospitals chosen by patients' families
    4. D. Hospitals that agreed in advance to help
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    Answer: D. Hospitals that agreed in advance to help

    NDMS definitive care relies on civilian hospitals that sign agreements in advance, recruited through federal coordinating centers run by the VA and the Department of Defense; patients go wherever a participating hospital has a matching bed. Federal field hospitals or medical stations may treat patients near the disaster, but they are not where NDMS sends patients for definitive care. Hospitals inside the disaster's state are the ones that are damaged or overwhelmed, which is why patients are moved out of the area. Families do not choose NDMS destinations.

15. A Disaster Medical Assistance Team (DMAT) is best described as:

    1. A. Federal medical teams sent to disasters
    2. B. Local teams that triage patients at local MCIs
    3. C. Military units that evacuate injured troops
    4. D. Red Cross teams that run disaster shelters
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    Answer: A. Federal medical teams sent to disasters

    DMATs are NDMS teams of physicians, nurses, paramedics, and support staff who are federal employees when activated and give care at disaster sites. They are not local MCI teams and are separate from the military.

16. When a DMAT deploys, it is designed to be self-sufficient with its own supplies for about:

    1. A. 12 hours
    2. B. 2 weeks
    3. C. 30 days
    4. D. 72 hours
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    Answer: D. 72 hours

    DMATs carry enough supplies, food, and water to operate for about 72 hours before resupply, because the disaster area may have none to spare. Twelve hours would leave them dependent on a local system that is already overwhelmed.

17. After an earthquake, NDMS moves hundreds of hospital patients to other states by air. This patient movement is mainly carried out by:

    1. A. Local ambulances driving across states
    2. B. Defense Department aeromedical flights
    3. C. Red Cross buses run by volunteers
    4. D. Private air ambulances paid by FEMA
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    Answer: B. Defense Department aeromedical flights

    In NDMS, the Department of Defense is responsible for moving patients by air from the disaster area to reception sites, where local EMS takes them to participating hospitals. Local ground ambulances cannot cover these distances while still serving their own communities.

18. The Emergency Management Assistance Compact (EMAC) is an agreement that:

    1. A. Lets FEMA command local EMS agencies
    2. B. Lets hospitals share staff across a city
    3. C. Lets states share resources in disasters
    4. D. Lets nearby agencies auto-dispatch units
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    Answer: C. Lets states share resources in disasters

    EMAC is a congressionally ratified state-to-state mutual aid compact covering all states and several territories. Automatic dispatch between neighboring agencies is local automatic aid, not EMAC.

19. Your governor declares an emergency after floods, and paramedic strike teams arrive from two other states through EMAC. Regarding their paramedic licenses:

    1. A. Their home-state licenses are honored
    2. B. A temporary state license is needed first
    3. C. They work as EMTs until licensed locally
    4. D. They practice under a local paramedic's license
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    Answer: A. Their home-state licenses are honored

    EMAC provides that licenses and certifications from the sending state are recognized in the requesting state for the deployment. This avoids the delay of temporary licensing, which would defeat the purpose of rapid aid.

20. Under EMAC, the costs of an assisting state's deployed teams are generally paid by:

    1. A. The state that sent the teams
    2. B. The state that asked for help
    3. C. The deployed agencies themselves
    4. D. The Red Cross after the event
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    Answer: B. The state that asked for help

    The requesting state reimburses the assisting state under EMAC, and it may later recover costs through federal aid. Agreeing on costs in advance lets states send help without debating payment during the crisis.

21. An EMS chief in a flooded state wants ambulance strike teams from a neighboring state through EMAC. The request should go:

    1. A. Through the state emergency management agency
    2. B. Straight to the EMS agencies in the other state
    3. C. Through FEMA's ESF-8 desk in Washington
    4. D. By phone to the other state's governor
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    Answer: A. Through the state emergency management agency

    EMAC requests move between state emergency management agencies after a governor's declaration, so that resources are tracked, legally protected, and reimbursed. A local chief calling another state's agencies directly bypasses those protections.

22. The Strategic National Stockpile (SNS) exists to:

    1. A. Supply hospitals with their routine daily drugs
    2. B. Fund local EMS agencies after a disaster
    3. C. Store medical records safely off site
    4. D. Resupply states when medical stocks run out
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    Answer: D. Resupply states when medical stocks run out

    The SNS holds federally owned medicines, vaccines, antidotes, and supplies for emergencies severe enough to deplete local stocks. It supplements, and does not replace, normal supply chains.

23. The first SNS shipment, called a push package, is best described as:

    1. A. A single drug chosen for the specific agent
    2. B. A field hospital that has its own surgical teams
    3. C. A broad mix of supplies for an unknown threat
    4. D. Vaccine doses for the state's residents
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    Answer: C. A broad mix of supplies for an unknown threat

    Push packages hold a wide range of drugs, antidotes, and supplies and can arrive within 12 hours of a federal decision, before the threat is fully known. Targeted shipments of specific items follow later from managed inventory.

24. After the first push package arrives, later SNS shipments tailored to the specific threat usually come from:

    1. A. Hospital pharmacy stockpiles in the area
    2. B. Local EMS supply warehouses
    3. C. Managed inventory held by vendors
    4. D. Medical Reserve Corps caches
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    Answer: C. Managed inventory held by vendors

    Once the threat is known, the SNS sends specific drugs and supplies from managed inventory, much of it held by vendors and shipped within about 24 to 36 hours. Local hospital and EMS stocks are what the SNS is meant to back up, not its source.

25. Local hospitals are running out of key drugs after a large disaster. Strategic National Stockpile assets are requested by:

    1. A. The state, via its governor or health agency
    2. B. A hospital that runs low on supplies
    3. C. The local EMS medical director, by phone call
    4. D. The triage unit leader at the scene
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    Answer: A. The state, via its governor or health agency

    SNS deployment is requested by the state (usually the governor's office or state health department) to federal health officials, and the state then receives and distributes the assets. Individual hospitals and scene leaders request supplies through local and state channels, not directly.