Healthcare Response to Weapons of Mass Destruction: Biological, Chemical and Radiological

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1. Healthcare providers should maintain a high degree of suspicion and be alert to patterns and diagnostic clues that might indicate unusual illness outbreaks that may be indicative of an intentional release of biological, chemical or radiological weapons. Among such patterns are all the following EXCEPT:

  a. Geographic clustering of illness.

  b. Temporal clustering of illness.

  c. Declining rates of persons seeking medical care and treatment.

  d. Unusual age distribution among those affected.

2. In Nevada, in the event of a public health emergency, healthcare providers should report any suspicion of biological, chemical or radiological threat to PHP Duty Officer at (775) 684-5920 or the CDC at 770-488-7100.

  a. True

  b. False

3. Transmission of the anthrax bacteria occurs by all of the following EXCEPT:

  a. Direct skin contact with spores.

  b. Person to person transmission of inhalation anthrax.

  c. Inhalation of aerosolized spores.

  d. Consumption of undercooked or raw meat products or dairy products from infected animals.

4. Symptoms of botulism include symmetrical cranial neuropathies, generalized weakness, dysarthria, symmetric descending weakness and respiratory dysfunction, descending flaccid paralysis, intact mental state and the absence of fever.

  a. True

  b. False

5. The procedure for smallpox vaccination presented in this course calls for all the following EXCEPT:

  a. The use of a bifurcated needle.

  b. Multiple perpendicular insertions into the deltoid; 3 for primary vaccination and 15 for revaccination.

  c. The use of alcohol to prepare the vaccination site.

  d. Loosely covering the vaccination site after insertions.

6. Treatment for plague:

  a. Should begin within 24 hours after the first symptoms develop in order to reduce the risk of death.

  b. Should be considered prophylactically for healthcare workers with close contact exposure.

  c. Includes oral tetracycline and fluoroquinolone as well as intramuscular or intravenous medications, streptomycin or gentamicin.

  d. Includes all of the above.

7. Biologic agents with potential to be used as weapons, are those with ease of dissemination or transmission, potential for major public health impact due to high mortality, potential for public panic and social disruption, and special requirements for public health preparedness.

  a. True

  b. False

8. In a chemical incident situation, primary contamination refers to the potential for an exposed patient to further contaminate other patients, healthcare providers and equipment.

  a. True

  b. False

9. Gastrointestinal chemical contamination may produce secondary contamination in the form of toxic vomitus.

  a. True

  b. False

10. All the following is true about decontamination EXCEPT:

  a. It is the process of removing or neutralizing harmful materials that have gathered on patients, personnel and/or equipment during the response to a chemical incident.

  b. Removal of outer clothing can eliminate 85% to 90% of contamination.

  c. It protects all hospital personnel by sharply limiting the transfer of hazardous materials from the contaminated area into clean zones.

  d. It eliminates all possibility of harmful effects from the chemical.

11. Sheltering in place, as an intervention for a chemical attack, should not include the use of a vehicle because they are not airtight enough to prevent exposure.

  a. True

  b. False

12. Exposure to hazardous chemicals may produce a wide range of adverse health effects. The likelihood of an adverse health effect occurring, and the severity of the effect, are dependent on all the following EXCEPT:

  a. The toxicity of the chemical.

  b. The route, nature and extent of exposure.

  c. Factors that affect the susceptibility of the exposed person, such as age and the presence of certain chronic diseases.

  d. Whether or not the chemical is released overtly or covertly.

13. The Agency for Toxic Substances & Disease Registry (ATSDR), provides information regarding chemical substances, including those that may be used in a terrorist attack, to healthcare providers regarding:

  • General Information (synonyms, appearance, routes of exposure, potential for secondary contamination, sources/uses, physical properties, and exposure standards).
  • Health effects (organ systems affected by acute exposure, potential sequelae, and chronic effects).
  • Pre-hospital management (personal protection, decontamination, support, triage, and transportation, organized by hot zone, decontamination zone, and support zone).
  • Emergency department management (management and treatment).
  • Patient information sheet (information of exposure, potential effects, and follow-up instructions).

  a. True

  b. False

14. Exposure to radiation can cause:

  a. Deterministic effects which are those observable health effects that occur soon after receipt of large doses of radiation, such as hair loss, skin burns, nausea, or death.

  b. Stochastic effects are long-term effects, such as cancer.

  c. Neither A or B.

  d. Both A and B.

15. Decontamination guidelines for radiological contamination includes:

  a. Surveying the patient with radiation meter.

  b. Removing the patient’s clothing.

  c. Cleaning the patient with water and soap.

  d. All of the above.

16. The hematopoietic syndrome that results from Acute Radiation Syndrome (ARS) can start with nausea, vomiting, diarrhea and progress to bone marrow suppression, infection, hemorrhage and death.

  a. True

  b. False

17. In the event of a radiological event, The Armed Forces Radiobiology Research Institute (AFFRI) in conjunction with the Radiation Emergency Assistance Center/Training Site (REAC/TS) provides guidance to healthcare providers regarding treatment.

  a. True

  b. False

18. In the event of radiological exposure, potassium iodide is used as a treatment for the prevention of hepatic cancer.

  a. True

  b. False

19. The Health Alert Network (HAN) is a nationwide communications system that was established by the CDC, and is implemented by each state. It is designed to enable a two-way, 24/7 flow of critical health information among the Nevada State Health Division and local and rural health care professionals throughout the state, including physicians, nurses, hospitals, laboratories, clinicians, public health workers, emergency management and others. HAN provides:

  a. Ongoing surveillance activities to quickly identify potential health threats and effective protocols for reporting incidents and sharing information.

  b. Laboratory capability to perform testing to determine the threat agent.

  c. The ability to conduct disease investigations.

  d. All of the above.

20. The Strategic National Stockpile is:

  a. Designed to supplement and re-supply state and local public health agencies in the event of a national emergency anywhere and at anytime within the U.S. or its territories.

  b. Organized for flexible response by providing Push Packages, caches of pharmaceuticals, antidotes, and medical supplies designed to provide rapid delivery of a broad spectrum of assets for an ill defined threat in the early hours of an event. These Push Packages are positioned in strategically located, secure warehouses ready for immediate deployment to a designated site within 12 hours of the federal decision to deploy SNS assets.

  c. Requested by the governor of the state which needs the assistance and is deployed after determination by the federal government that such action is needed.

  d. All of the above.