PHEM curriculum unit A.6 · Cross-cutting theme A: Operational Practice
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit A.6, Provide scene management.
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 10 questions on this unit.
Question 1 · Scene Safety & Extrication · Easy
You arrive as a BASICS doctor at a lorry that has overturned onto a car, spilling an unidentified liquid across the carriageway. A bystander shouts that the car driver is trapped and bleeding. According to the '1-2-3 of safety' used in UK pre-hospital and major incident teaching, whose safety is your first consideration?
AThe trapped driver first, then the scene, then your own safety
BThe bystanders first, then the trapped driver, then your own safety
CThe scene first, then your own safety, then the survivors
DYour own safety first, then the scene, then the survivors
EYour team's safety first, then the survivors, then the scene
Show answer
Answer: D
Your own safety first, then the scene, then the survivors
The Oxford Handbook's major incident chapter sets out the '1–2–3 of safety' as self, scene, survivors, in that order. The Oxford Manual of Major Incident Management describes safety under the same three headings: personal safety is of primary importance and includes appropriate personal protective equipment (PPE) and knowledge of the hazards; scene safety is achieved through command and control, cordons and safe distances from hazards such as fire or a toxic chemical spill; and survivor safety depends on preventing escalation and protecting casualties. ABC of Prehospital Emergency Medicine frames the rule as your own, your team's and your patient's safety, notes that fire and rescue retain primacy regarding scene safety, and says that if the scene is not safe you may need to stand off until it can be made safe for you to approach. In this vignette the unidentified liquid means standing off until the hazard is identified and the scene has been made safe; a rescuer who becomes a casualty adds to the problem and removes a resource.
Where this comes from
Oxford Handbook of Pre-Hospital CareCh. 10 Major incident management and triage · Major incident response: safety — the 1–2–3 of safety“The ‘1–2–3 of safety’ is:”
Oxford Manual of Major Incident Managementp. 22Ch. 1 An Introduction to Major Incident Management · Safety: self, scene, survivors“Personal safety is of primary importance”
ABC of Prehospital Emergency Medicine
Ch. 4 Scene Safety and Assessment · Safety · p. 13“your own, your team’s and your patient’s safety”
Ch. 4 Scene Safety and Assessment · Introduction · p. 13“fire and rescue retain primacy regarding scene safety”
Ch. 4 Scene Safety and Assessment · Safety · p. 13“If the scene is not safe, you may need to stand off”
scene-063 · Scene Safety & Extrication · Scene Safety · Easy · v3
Question 2 · Scene Safety & Extrication · Hard
At a train derailment the police tactical commander has taken overall responsibility for the scene and is coordinating requests for resources between the fire, ambulance and police services at the outer cordon. In the terminology used by the Oxford Manual of Major Incident Management, this police officer is exercising which function?
ACommand, the vertical transmission of authority within a single service
BStrategic (gold) command, exercised on scene across all three services
COperational (bronze) command of the area inside the inner cordon
DMedical advice, given to the police by the ambulance medical adviser
EControl, the horizontal transmission of authority across the services
Show answer
Answer: E
Control, the horizontal transmission of authority across the services
The Oxford Manual distinguishes command from control. Command is the vertical transmission of authority within each emergency and support service: operational (bronze) commanders report to tactical (silver) commanders, who report to strategic (gold) commanders. When overall responsibility falls to one service at the scene, for example the police at the outer cordon, that service has control, the horizontal transmission of authority across the emergency and support services, which lets requests for resources pass between services in a coordinated way; each incident has one individual in overall control of the scene. The Oxford Handbook puts it in one line: command is a vertical process, control a horizontal one. Strategic (gold) command is normally located in a regional or national command centre rather than exercised at the cordon, and the operational (bronze) zone lies inside the inner cordon, so neither describes this officer's role.
Where this comes from
Oxford Manual of Major Incident Management
Ch. 1 An Introduction to Major Incident Management · Command and control: control · p. 21“Control therefore refers to the horizontal transmission of authority”
Ch. 1 An Introduction to Major Incident Management · Command and control: command · p. 21“Command is therefore the vertical transmission of authority”
Ch. 1 An Introduction to Major Incident Management · Nomenclature: strategic (gold) · p. 12“It is usually located in a regional or national command centre.”
Oxford Handbook of Pre-Hospital CareCh. 10 Major incident management and triage · Major incident response: command“Command is a vertical process; control a horizontal one.”
scene-064 · Scene Safety & Extrication · Scene Safety · Hard · v2