Major incident management and triage: DipIMC practice questions
PHEM curriculum unit 6.2 · Theme 6: Supporting Emergency Preparedness and Response
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 6.2, Respond to emergencies at operational (bronze) level.
Below are 3 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 36 questions on this unit.
Question 1 · Major Incident & Triage · Easy
In the M/ETHANE major incident message, what does the letter H represent?
AHospital capacity and location
BHazards, present and potential
CHelicopter landing requirements
DHistory of the incident so far
EHeadcount of casualties so far
Show answer
Answer: B
Hazards, present and potential
M/ETHANE is the reporting framework in JESIP joint doctrine: Major incident, Exact location, Type of incident, Hazards, Access, Number of casualties and Emergency services. JESIP asks for the hazards that are known to be present or suspected and those that could potentially arise; the Oxford Manual, Oxford Handbook and ABC print the same letter as hazards encountered or potential, hazards present and potential, or simply hazards. None of the other options is part of the message: casualty numbers and severity sit under N, and hospital capacity and helicopter requirements are not reported by this framework. The leading M is conditional. Where the incident is below the major incident threshold the message is sent as an ETHANE message, and the situation is reviewed regularly in case the incident escalates. Where the M is used, the person reporting should be explicit about whether this is a major incident declaration or a standby. The books also print the CHALET(S) mnemonic, which the Oxford Handbook says some emergency services use; the JESIP framework is M/ETHANE.
Where this comes from
JESIP — M/ETHANEJoint Emergency Services Interoperability Principles (JESIP)·H — Hazards“Include the hazards that are known to be present or suspected”Open at this sentence
JESIP — M/ETHANEJoint Emergency Services Interoperability Principles (JESIP)·M/ETHANE and ETHANE“For incidents falling below the major incident threshold”Open at this section
JESIP — M/ETHANEJoint Emergency Services Interoperability Principles (JESIP)·M — Major Incident“regularly review the situation in case the incident escalates”Open at this sentence
Oxford Manual of Major Incident Managementp. 10Ch. 1 An Introduction to Major Incident Management · Nomenclature relating to major incidents: METHANE report“H: Hazards encountered or potential”
Oxford Handbook of Pre-Hospital Carep. 578Ch. 10 Major incident management and triage · Box 10.4 METHANE“Hazards present and potential”
ABC of Prehospital Emergency Medicinep. 180Ch. 33 Emergency Preparedness: Major Incident Management · Table 33.3 METHANE and CHALETS mnemonics“Table 33.3 METHANE and CHALETS mnemonics”
Oxford Handbook of Pre-Hospital Carep. 578Ch. 10 Major incident management and triage · Box 10.4 METHANE; CHALET“Some emergency services use the mnemonic CHALET”
mi-001 · Major Incident & Triage · Major Incident · Easy · v6
Question 2 · Major Incident & Triage · Easy
What is the role of the attendant on the first ambulance to arrive at a major incident?
ABegin treating the most seriously injured casualty found at the scene
BTriage every casualty personally before any other crews arrive
CTake command of the scene rather than treat any individual casualty
DTransport the first priority 1 casualty to the nearest hospital
ESet up the casualty clearing station close beside the incident
Show answer
Answer: C
Take command of the scene rather than treat any individual casualty
The ABC of Prehospital Emergency Medicine is explicit that, for the first crew at a mass casualty incident, the first priority is to take command of the scene: survivors are best served by an informed and coordinated response rather than by the immediate treatment of one or two. The first crew makes a fast initial scene assessment so that further resources can be tasked, and communicates it clearly; it is best not to enter the scene itself unless relieved by a more senior clinician. The Oxford Manual of Major Incident Management likewise gives the first emergency services responder the initial rapid assessment of the scene and the report back to ambulance control. Treating the worst casualty, triaging everyone single-handed, conveying the first P1 or setting up the casualty clearing station all commit the only command resource on scene to a single task and leave the incident unmanaged.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 33 Emergency Preparedness: Major Incident Management · First on scene · p. 180“The first priority is to take command of the scene.”
Ch. 33 Emergency Preparedness: Major Incident Management · First on scene · p. 180“rather than by the immediate treatment of one or two”
Oxford Manual of Major Incident Managementp. 23Ch. 1 An Introduction to Major Incident Management · Assessment: scene“should be carried out by the first emergency services responder”
mi-002 · Major Incident & Triage · Major Incident · Easy · v4
Question 3 · Major Incident & Triage · Moderate
A police officer is carrying out first-pass triage at a marauding terrorist attack, before any NHS clinical resource has reached the casualties. One casualty is not walking, has no catastrophic external bleeding, is not talking and is not breathing. Applying Ten Second Triage, what category does the officer assign?
APriority 1 (red band), with rescue breaths given before moving on
BDead (black tag), moving straight on to the next casualty
CNot breathing (silver band), death to be confirmed by a clinician
DPriority 2 (amber band), to be reassessed when a clinician arrives
ENo category or band, leaving the casualty for the clinical team
Show answer
Answer: C
Not breathing (silver band), death to be confirmed by a clinician
Ten Second Triage is the UK first-pass tool for any responder at a multi-casualty incident, clinical or not, and it deliberately has no Dead category. A casualty who is not breathing despite having the airway opened is placed in the recovery position and categorised Not breathing, marked with the silver band. NHS England's guidance is explicit that it is not appropriate for any responder to recognise a casualty as dead in a rapid assessment during the initial response; those with silver bands are reassessed later by healthcare professionals, and only then is a black Dead tag applied where resuscitation would be futile. The priority interventions remain stopping severe bleeding and opening the airway: cardiopulmonary resuscitation (CPR) may be performed if resources allow, but resuscitation must not detract from those more important life-saving interventions, so stopping to give rescue breaths is wrong. This is the clearest doctrinal break from the triage sieve, which labelled the same casualty Dead. Every triaged casualty is banded, so leaving one uncategorised is also wrong.