( By A Study Guide (Pan American Health Organization (PAHO) )

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Final exam package - B Final examination

Multiple Choice

Circle the correct answer(s):

1. Drainage, filling, and overturning receptacles are measures taken to:

a. dispose of human waste in modified soakage pits
b. eliminate vector breeding sites
c. establish temporary camps for displaced persons
d. provide displaced persons with cleaning and bathing facilities
e. clean out tanks used for transport and storage of drinking water

2. Flooding can lead to:

a. proliferation of vector breeding sites
b. contamination of food
c. contamination of water
d. damage to civil engineering structures
e. transportation failure
f. all of the above
g. none of the above

3. Diseases that can be transmitted by vectors include all except:

a. malaria
b. yellow fever
c. typhus
d. infectious hepatitis
e. tularemia

4. To assess the potential vulnerability of an area, one must first: (select two)

a. determine priorities of need according to minimum essential lifeline services
b. conduct hydrological, geological, and topographical studies of disaster prone areas
c. identify and describe the components of the entire environmental health service systems
d. gauge nutritional and medical needs of the population
e. determine the extent to which environmental health personnel have received the appropriate vaccinations
f. chart the characteristics of those natural disasters that might occur
g. monitor food and public water supplies for microbial contamination
h. inventory equipment, supplies, and other materials necessary for the emergency

5. Provision of safe food and water, adequate waste disposal, and shelter should be considered:

a. prior to a disaster and during the emergency warning period
b. during and immediately after the disaster
c. during the consolidation and rehabilitation phases of a disaster
d. during all phases of a disaster

6. To avert health problems related to food and water contamination, it is especially important to:

a. launch vector control campaigns
b. create a national committee of representatives of all local and government services
c. inform the public of hazards of consuming contaminated food and water and of methods to ensure their safety
d. conduct technical surveys
e. ship mobile purification units to stricken areas

7. Vector-borne means that a disease agent has been transmitted by:

a. insects and rodents
b. contaminated water and food
c. viruses and bacteria
d. humans and livestock
e. sewage and solid waste

8.Match a lifeline facility or service with the most appropriate protective measure associated with it.

_____civil engineering structures
_____water supplies

a. develop means to allow for using large dilution capacities to reduce the strength of contaminants

b. conduct soil, engineering, and meteorologic studies to locate sites that are not vulnerable to a disaster's impact

c. make agreements with local distributors to ensure that a minimum five day supply of certain items exists at ail times.

d. determine the feasibility of using gravity flow

9. Deciding which emergency steps to take should be based largely on:

a. the type of disaster
b. the level of disease endemicity in the region
c. emergency calls received from stricken populations
d. assessment of damages, calculating needs, and matching with estimated resources and personnel remaining
e. establishment of mutual aid agreements and other cooperative arrangements with related services

10. All emergency, consolidation, and short-term rehabilitation measures should be carried out within_______ of the occurrence of a disaster.

a. three days
b. three weeks
c. three months
d. six months
e. one year

11. Which of the following occurs commonly as a result of deterioration in sanitation and personal hygiene?

a. an increase in diarrheal disease
b. transportation failures
c. water shortages
d. overchlorination of the water supply

12. List the following phases in the order that they occur and match them with their appropriate time span:

Time span


a. consolidation period



b. long-term rehabilitation period



c. predisaster



d. immediate emergency period



e. short-term rehabilitation period


1. 0 days after the disaster
2. between 1 and 3 days after the disaster
3. between 1 and 7 days after the disaster
4. between 2 and 12 days after the disaster
5. between 3 and 21 days after the disaster
6. 14 days and beyond

13. Select the three primary areas of environmental health surveillance and list them in order of their importance

a. transportation

b. sanitation

Order of primary areas

c. communication lines


d. power


e. water quality


f. food supplies

g. shelter

For each numbered statement from 14-36, select the lettered heading(s)that is (are)most closely associated with it.

a. measures taken before a disaster strikes
b. emergency warning measures
c. disaster occurrence measures
d. immediate post disaster emergency measures
e. consolidation measures
f. short-term rehabilitation measures

____14. Unclog sewer lines and manholes.

____15. Conduct search and rescue operations.

____16. Notify all essential environmental health services to carry out protective and emergency readiness measures.

____17. Make systematic surveys of the availability of water and food in affected areas.

____18. Establish a program for cleaning and disinfecting wells.

____19. Conduct disaster simulation drills.

____20. Decide on whether and where to set up temporary camps.

____21. Inventory and distribute relief supplies.

____22. Conduct public education campaigns.

____23. Sink bore-hole wells at undamaged locations.

____24. Broadcast disaster watch bulletins, informing the population of what to expect and emergency steps to take.

____25. Salvage local resources, such as leftover building material or bamboo, to use for building temporary shelters.

____26. Evaluate the strengths and weaknesses of the emergency operations action plan.

____27. Determine disaster prone areas and capacity of local environmental health services in those areas to meet needs of affected communities.

____28. Organize immediate distribution of perishable and rain-soaked food.

____29. Assess damages.

____30. Mobilize emergency personnel of critical environmental health services.

____31. Develop routine measures for protecting critical components of water and sanitation systems.

____32. Create a national committee.

____33. Specify emergency measures.

____34. Specify measures to restore lifeline services.

____35. Survey latrine construction projects.

____36. Request that stricken population store ample quantities of water in clean containers.

37. Careful siting, design, and layout of tent camps is particularly critical because:

a. it is extremely difficult to convince people to move away from family and friends
b. camps could, and occasionally do, develop into permanent settlements
c. once people are settled in an area, it is difficult to ask them to move again
d. contamination of the groundwater should be avoided at all costs

38. Accommodating displaced persons in tent camps should be considered:

a. when public water and sanitation systems have been disrupted
b. only as a last resort
c. if there is easy access to canvas, tents, camping equipment, and chemical toilets
d. only when displaced persons cannot stay with family or friends

39. The_______ should be determined before any disinfectant is distributed to individual Users.

a. chlorine residual
b.E. coli count
c. nitrate level
d. turbidity
e. pH

40. All of the following are concerns of the warning period except:

a. maps and engineering plans
b. personnel
c. plants and equipment
d. community action liaison
e. public information

41. An area has a history of earthquakes. It is found that the public drinking water reservoir lies directly over a fault. What would be the preferred protective measure?

a. relocate reservoir at a protected site away from the fault line
b. reinforce structures to withstand the impact
c. establish an alternate gravity flow system of water supply
d. increase the protection of structures, equipment, and personnel
e. identify standby or portable water processing or treatment units for use if the system fails

42. Disinfecting tablets, powders, or liquids should never be distributed to the general public unless:

a. people are warned of the hazards associated with drinking contaminated water
b. people are instructed on how to use them
c. each household is visited by an environmental health specialist
d. vector control activities are instituted at the same time
e. people are instructed on how to monitor water for indicators of contamination

43. Disease-carrying rodents and flies may proliferate in:

a. uncovered wells
b. gasoline cans
c. overturned receptacles
d. broken mains
e. garbage

44. Mosquitoes can proliferate in:

a. garbage
b. soiled clothing
c. spoiled food
d. tanks Used for transporting and storing drinking water
e. human waste


Indicate T or F:

____45. Water supplies can become contaminated after earthquakes, floods, and cyclones.

____46. Pathogens can be transmitted through overcrowding and poor sanitation in temporary settlement camps.

____47. If the public water supply is determined to be contaminated, mobile treatment units automatically become a high priority item on the needs list for emergency relief supplies.

Disaster Development Problem

(B) Earthquake

After reading about the disaster described below, you are to make decisions and answer questions relating to this disaster. For each question, record your responses on the answer sheet provided (see page 9)before going on to the next question.


This Central American region has a population of about 4,000,000. Half the population lives in the regional capital city. The rest of the population lives in 20 towns and 35 small villages, or in scattered rural sites.

The southern third of the region is flat agricultural land, and its main industry is growing and processing fruits and vegetables for export. The central portion consists of low hills, rising to high hill country in the north.

One town and two villages are located in the southern section, one town and a village in the central hills, and a village in the north. Good roads connect all of the communities except the village in the north, which is reached by a poorly maintained road. A railroad serves both the capital city and the town in the south. There is an international airport in the south and an air strip in the north. Two radio stations, one in the capital and one in the town in the central hills, are the main communication systems for the region.

Earth tremors have been reported 100 miles to the south, but are not of concern to the people of the region. Although a fault runs through the region, there have been no major earthquakes for the past ten years. There is no national guidance in disaster management.

With no advance warning, an earthquake measuring 5.6 on the Richter scale strikes the southern half of the region.

Problem (B-1)

Since there has been no earthquake damage or other disaster for ten years, development of a disaster management plan has been a low priority. There is no comprehensive disaster management plan.

However, there is a strong, well-organized government and an environmental health unit within the Ministry of Health. Disaster management of environmental health is assigned immediately to this ministry.

What is the most essential service that must be assured immediately after the disaster?

Check the one correct answer on the answer sheet before turning to the next page.

____Provide adequate shelter.
____Provide safe drinking water.
____Remove human excrete and liquid and solid waste.
____Control vectors that transmit disease.
____Ensure food supplies.

Problem (B-2)

The population in the southern part of the region and in the centrally-located capital city have a plentiful supply of drinking water, provided by deep wells. The towns and villages in the central and northern areas rely on wells and cisterns for their water supplies.

Immediate reports reveal that the main well in the capital has been damaged, and there are breaks in the water mains. However, at least two high-volume irrigation wells near the capital are undamaged and can supply adequate potable water for the urban population. There are no reports yet from other communities.

In what order should the official in charge of environmental health address the following?

Rank the options 1 through 4 on your answer sheet, with 1 being the highest priority and 4 the lowest.

____Assess the need for drinking water in all communities affected by the disaster.
____Request mobile water purification plants from relief agencies.
____Assure drinking water for victims and relief workers in hospitals and treatment centers.
____Repair the main well and broken water mains

Problem (B-3)

Reports of extensive damage to housing have come from the northern section of the capital city. Damage to buildings in the industrial area has also been reported. Other communities in the central and southern regions report minor damage to housing. No report has been received from the remote northern village. There is little damage to roads and transportation systems.

What action(s) should be taken for the homeless people in the northern section of the capital city?

One or more actions could be correct, depending on the circumstances and the amount of time that has passed since the earthquake struck.

On your answer sheet check all of the options that might be appropriate during the immediate postdisaster period (1-3 days).

____Use existing public buildings such as schools, meeting halls, and churches.
____Encourage people to stay with other family members or friends.
____Establish tent camps to provide shelter.
____Encourage people to construct temporary shelter on their own property.

Problem (B-4)

Those responsible for food supply and transportation have asked the Ministry of Health for advice and assistance. The industrial area contains canning factories and packing plants for fresh fruits and vegetables, as well as warehouses for temporary storage. While there was much damage in the area, the food stored in the warehouses is an important source of emergency food supplies. The Ministry of Transportation has assigned military personnel and vehicles, and distribution points have been established in areas most damaged by the disaster.

In what order should the following problems be addressed?

Rank the problems 1, 2 and 3 on your answer sheet, with 1 being the highest priority and 3 the lowest.

____While warehouses storing perishable food have not been damaged, damaged power lines have put many refrigeration units out of operation.

____Rats now have access to much of the food in storage because of damage to some warehouses.

____Some food supplies may have become contaminated and it is not known if the food is safe for distribution.

Problem (B-5)

By the end of the third day following the disaster, all immediate emergency problems appear to be under control, at least temporarily.

Fortunately, most of the people were able to solve their own problems concerning water, food and shelter. Major damage in the northern part of the capital city and minor damage in the town in the southern area will be main concerns during the rehabilitation period.

What is the first short-term measure that should be taken in order to restore all lifeline services to their predisaster level?

Check the one correct answer on the answer sheet.

____Conduct technical surveys for evaluating and planning the restoration of lifeline services.
____Create a national committee to plan, monitor, and coordinate all reconstruction activities.
____Restore essential environmental health - surveillance activities.

Problem (B-6)

The final step during the rehabilitation phase following a disaster is to evaluate comprehensively all of the activities that have taken place.

Such an evaluation demonstrates that the major failure was the lack of any emergency operations action plan for the region. Had such a plan existed, advance protective measures might have reduced the impact of the disaster on the population.

Protective measures might have prevented, solved, or at least reduced problems encountered in which of the following areas:

On your answer sheet check each of the areas where protective measures might have prevented, solved, or reduced the severity of problems encountered during this disaster.

____Damage to civil engineering structures
____Contamination of food and water supplies
____Power outages
____Transportation failure
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