Pre-hospital operational environments: DipIMC practice questions
PHEM curriculum unit 1.2 · Theme 1: Working in Emergency Medical Systems
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 1.2, Understand pre-hospital operational environments.
Below are 2 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 7 questions on this unit.
Question 1 · Scene Safety & Extrication · Moderate
A paramedic asks why a Hazardous Area Response Team (HART) has been requested to a collapsed casualty at the bottom of a disused mine shaft rather than an ordinary crew with fire service support. Which statement about HART is correct?
AA fire and rescue capability, carrying NHS clinicians under fire service command
BAn ambulance team sent only to declared major incidents, never to single patients
CAn ambulance team whose remit is limited to CBRN decontamination at the scene
DAn ambulance team that stays in the cold zone, advising crews forward by radio
EAn ambulance team giving NHS paramedic care to people in hazardous environments
Show answer
Answer: E
An ambulance team giving NHS paramedic care to people in hazardous environments
Hazardous Area Response Teams are an NHS ambulance service capability, not a fire service one. The Oxford Handbook describes them as ambulance service teams trained to provide care in the hot zone at hazardous or major incidents, including CBRN incidents, building collapse, shootings, explosions and weather-related events. A current ambulance trust HART deployment procedure states that HART is commissioned to provide NHS paramedic care to patients in hazardous environments, within the inner cordon, and lists its commissioned tactical capabilities: hazardous materials, CBRN, high consequence infectious disease, marauding terrorist attack, safe working at height, confined space, unstable terrain, water operations, all-terrain vehicle operations and support to security operations. A collapsed casualty at the bottom of a mine shaft combines confined space, working at height and possibly a hazardous atmosphere. HART responds to any incident that needs the capability, single patients included, its remit is far wider than decontamination, and its purpose is to take NHS care to the patient in the hazardous area rather than wait in the cold zone.
Where this comes from
Oxford Handbook of Pre-Hospital Care
Ch. 1 An approach to pre-hospital care · The Ambulance Service: Hazardous Area Response Teams · p. 47“Ambulance services also provide Hazardous Area Response Teams (HARTs).”
Ch. 1 An approach to pre-hospital care · The Ambulance Service: Hazardous Area Response Teams · p. 47“trained to provide care in the hot zone at hazardous or major incidents”
scene-073 · Scene Safety & Extrication · Scene Safety · Moderate · v3
Question 2 · Scene Safety & Extrication · Moderate
You are the medical planner for a two-day outdoor music festival with standing audiences and on-site camping. The organiser suggests that because last year's classical concert in the local indoor arena needed only two first aiders for a similar attendance, the same cover will do. Which statement best reflects the approach in the ABC of Prehospital Emergency Medicine?
AExpected attendance is the only validated predictor, so cover is set from the head count alone
BIndoor seated events produce more patients, so the indoor concert is the more demanding benchmark
CThe nature of the event matters as much as attendance, so a joint risk assessment is required
DOn-site treatment facilities increase the resources needed, by drawing in extra presentations
EOnly performers and staff need planned cover; the audience is served by routine 999 response
Show answer
Answer: C
The nature of the event matters as much as attendance, so a joint risk assessment is required
The ABC is explicit that planning medical cover for a mass gathering is not simply a matter of the expected attendance: a thorough risk and vulnerability analysis is needed, done with the event organiser and the safety and security agencies. The factors it lists are the nature of the event, the nature of the venue, whether the audience is seated or standing, the spectator profile, the history of similar events, the expected numbers, the duration (including queuing time), the season and weather, the proximity and profile of hospitals, and additional hazards. The nature of the event is described as just as important as the number of spectators: a rock concert with a younger audience and alcohol or drugs produces more patients than a classical concert. Indoor events produce fewer patients than similar outdoor events, seated audiences carry a lower risk than standing ones, longer events and hot weather increase presentations, and on-site facilities such as suturing or minor surgery reduce the resource requirement because they mitigate the need for transport. The Oxford Handbook defines a mass gathering as a collection of 1,000 people or more. Cover for the audience is part of the event's medical plan, not something left to routine 999 response.
Where this comes from
ABC of Prehospital Emergency Medicine
Ch. 35 Emergency Preparedness: Mass Gatherings · Planning: risk and vulnerability analysis · p. 190“a thorough risk and vulnerability analysis needs to be undertaken.”
Ch. 35 Emergency Preparedness: Mass Gatherings · Planning: risk and vulnerability analysis · p. 190“in conjunction with the event organizer and other relevant safety and security role players”
Ch. 35 Emergency Preparedness: Mass Gatherings · Nature of the event · p. 191“just as an important risk factor as the number of spectators”
Ch. 35 Emergency Preparedness: Mass Gatherings · Nature of the venue · p. 191“Indoor events have been shown to produce lower patient numbers”
Ch. 35 Emergency Preparedness: Mass Gatherings · Seated or unseated · p. 191“A seated audience represents a lower risk that an unseated one.”
Ch. 35 Emergency Preparedness: Mass Gatherings · Proximity and profile of hospitals: on-site facilities · p. 192“On-site medical facilities can be a mitigating factor.”
Oxford Handbook of Pre-Hospital Carepp. 612–613Ch. 10 Major incident management and triage · Mass gathering medicine“A mass gathering is defined as a collection of 1,000 people or more.”
scene-074 · Scene Safety & Extrication · Scene Safety · Moderate · v2