Getting On My Nerves!!!!!!!! Mississippi Chempack Program

Getting On My Nerves!!!!!!!! Mississippi Chempack Program Chris Reid Emergency Response Coordinator Office of Emergency Response Mississippi State Department of Health

What is the CHEMPACK Program? Developed by the U.S. Centers for Disease Control and Prevention or CDC Part of its Strategic National Stockpile program Pre-positioning of nerve agent antidotes Increase state & local capacity to respond to nerve agent incidents Allows rapid deployment of nerve agent antidotes to first responders and hospital personnel to treat large numbers of victims exposed to a nerve agent incident

What is the Strategic National Stockpile (SNS)? Large quantities of medicine and medical supplies Push Packs available for rapid deployment in an emergency Managed Inventory-Vendor

Why the CHEMPACK Program? Nerve agents can cause rapid system failure Antidotes can reverse symptoms if administered in a timely manner Most hospitals & pharmacies don t stockpile nerve agent antidotes CHEMPACK antidotes are packaged to be rapidly deployed and administered

What are Nerve Agents? One of several categories of potentially harmful chemicals Can be inhaled, swallowed, or absorbed through the skin Attack the nervous system, can result in severe injury or death

Examples of Nerve Agents/Organophosphates? Chemical nerve agent weapons: Sarin Tabun Soman Cyclosarin VX Organophosphate Pesticides: Parathion Malathion Chlorpyrifos Diazinon

Nerve Agent Incidents Intentional release Tokyo, Japan in 1995 when the cult Aum Shinrikyo released Sarin Agricultural accident San Joaquin Delta in California September 2006 pesticide drift sent 34 workers to the hospital

Signs & Symptoms of Nerve Agent Exposure SLUDGEMM Salivation Lacrimation (tearing) Urination Defecation Gastrointestinal upset Emesis (vomiting) Muscle twitching Miosis (pinpoint pupils)

Nerve Agent Antidotes The 3 drugs included in CHEMPACK can reverse the effects of nerve agent exposure: Atropine Sulfate-blocks action of acetylcholine at receptors Pralidoxime Chloride (2PAM)- reactivates acetylcholinesterase Diazepam-anti-convulsant

What Exactly is a CHEMPACK? A secure container of nerve agent antidotes Prepositioned with local hospitals Monitored remotely by the CDC Maintained through the Shelf Life Extension Program (SLEP)

Mississippi CHEMPACK Allocations 14 CHEMPACKS strategically located throughout the state 10 Hospital CHEMPACKS 4 EMS CHEMPACKS 13 Host Hospital locations

CHEMPACK Configurations Two different configurations Hospital EMS Both stored at hospitals EMS containers treat up to 454 casualties 85% Auto Injectors 15% Multi-dose vials Hospital containers treat up to 1000 casualties 100% Multi-dose vials

CHEMPACK Configurations: EMS EMS CHEMPACK Container for 454 Casualties ** EMS container will contain either Mark 1 or ATNAA auto-injectors not both Quantity Unit Pack Cases Mark I auto-injector** 1200 200 6 ATNAA Auto injector with 240 kits** 1200 240 5 Atropine Sulfate 0.4mg/ml 20ml 100 100 1 Pralidoxime 1gm inj 20ml 276 276 1 Atropen 0.5 mg 144 144 1 Atropen 1.0 mg 144 144 1 Diazepam 10 mg auto-injector 300 150 2 Diazepam 5 mg/ml vial, 10ml 50 50 1 Sterile water for injection (SWFI) 20cc Vials 200 100 2 Sensaphone 2050 1 1 1 Satco B DEA Container 1 1 1 CHEMPACK container contents may occasionally vary due to availability of medications

CHEMPACK Configurations: Hospital Hospital CHEMPACK Container for 1000 Casualties Quantity Unit Pack Cases Atropine Sulfate 0.4mg/ml 20ml 1100 100 11 Pralidoxime 1gm inj 20ml 3312 276 12 Atropen 0.5 mg 144 144 1 Atropen 1.0 mg 144 144 1 Diazepam 10 mg auto-injector 150 150 1 Diazepam 5 mg/ml vial, 10ml 650 50 13 Sterile water for injection (SWFI) 20cc Vials 2800 100 28 Sensaphone 2050 1 1 1 Satco B DEA Container 1 1 1 CHEMPACK container contents may occasionally vary due to availability of medications

When are CHEMPACKS Needed? CHEMPACKs should be deployed in the event of a suspected nerve agent incident that will: Potentially overwhelm local supplies of antidotes Put multiple lives at risk Threaten the health of the community

CHEMPACK Management & Oversight CDC - owns and manages CHEMPACK assets and conducts periodic inspections. Mississippi State Department of Health - oversees/supports receipt, maintenance, and monitoring of CHEMPACKs and also serves as liaison to the CDC. Host Hospitals - ensure the proper storage and security of CHEMPACK assets.

Agencies Involved in the CHEMPACK Program Emergency Medical Services Fire & Rescue Hospitals Law Enforcement Emergency Management Public Health

The Role of Law Enforcement in CHEMPACK State and local police On-scene security Hospital security CHEMPACK Transport and/or Escort security

The Role of MEMA in CHEMPACK Receives request for CHEMPACK assets from field responders or hospitals Notify the host hospital to mobilize CHEMPACK assets to the field and nearby hospitals (See MEMA Notification Chart) Coordinates requests for additional assistance (See MEMA Notification Chart)

MEMA Notification Chart Organophosphate event occurs -- MEMA is notified MEMA Call #1 Call #2 Call #3 Call #4 Call #5 Call #6 Chempack Host Hospital notification Transporting Agency #1 2 nd nearest Chempack Host Hospital notification to place them on alert status Notify MSDH Watch Officer Notify EMA in County of incident Notify EMA in County of Host Hospital See MSDH Chempack POC Chart for POC contact information See MSDH Chempack Transportation Plan for specific Chempack Hospital to determine primary transporting agencies and POCs If Transporting Agency #1 is not available: Call Transporting Agency #2 If Transporting Agency #2 is not available: Call Transporting Agency #3 MSDH Director of Health Protection (Watch Officer Call #1) MSDH Director of OEPR (Watch Officer Call #2) MSDH Ops/Log Chief or MSDH Ops/Log Deputy (Watch Officer Call #3) MSDH Chempack Coordinator (Watch Officer Call #4) MSDH ERC in county of incident (Watch Officer Call #5)

The Role of Fire & EMS in CHEMPACK Fire and EMS establish Incident Command, and determine if CHEMPACK assets are needed EMS or Fire Department may be tasked with transporting CHEMPACK assets Paramedics administer antidotes to persons affected in the field

The Role of Hospitals in CHEMPACK Hospital personnel need to recognize nerve agent exposure signs & symptoms Host hospitals prepare CHEMPACK assets for transfer to the field and other hospitals Other hospitals prepare to receive and administer antidotes

The Role of Public Health in CHEMPACK Not involved in the request, receipt, or administration of CHEMPACK assets Involved in epidemiologic investigation Assist with risk communication, disaster mental health services, and demobilization activities

Initial Notification Incident Occurs First Responders arrive on scene Responders suspect nerve agent/organophosphate involvement Initial Notification Responders inform command staff and incident command established Command notifies 911 Dispatch 911 Dispatch notifies MEMA 24 Hour Warning Point at 800-222-MEMA (800-222-6362) CHEMPACK Activation MEMA notifies host hospital of suspected nerve agent/organophosphate incident (then following MEMA Notification Chart, notifies remaining entities) Host hospital activates CHEMPACK Deployment Plan

Request Additional Resources Incident Requests Due to scope of the incident, command personnel from all branches of public safety request additional resources to respond. Incident Resources Additional resources such as EMS strike teams, Hazmat teams, mobile decontamination units, personal protective equipment, and other personnel and supplies needed to secure the scene, rescue victims, and provide emergency medical assistance arrive on scene. Host Hospital Activates its CHEMPACK Deployment Plan and prepares CHEMPACK assets Request additional security, transport, and escort assets

Important Incident Information Incident Location (details) Hazardous material Victims Estimated number Severity of exposure Medical needs Self-evacuees Response efforts Decontamination efforts Staging area Access, best route

Important CHEMPACK Information Estimated time of delivery Number of deliveries Transportation agency/delivery unit contact information Receiving unit contact information Delivery location(s) Incident staging area(s) Receiving hospital(s) Delivery confirmation (Custody Transfer Form)

Important Hospital Information Self-evacuees possible? Decontamination established? Contact person information Delivery location Number of casualties they can accommodate Additional support needed Delivery confirmation (Custody Transfer Form)

Signs & Symptoms of Nerve Agent Exposure Mild symptoms: headache, blurred vision, tightness in chest, excessive sweating, tearing, salivation, runny nose Moderate symptoms: drooling, difficulty breathing, vomiting, fatigue, diarrhea, muscle twitching, muscle weakness, blurred vision Severe symptoms: same as moderate, plus urination, convulsions, cardiac irregularities, respiratory failure, wet lung sounds, altered mental status

Guidelines for Treating Victims of Nerve Agent Exposure The amount of antidote depends on several factors, including severity of exposure General guidelines: For mild exposure, administer 1 auto- injector For moderate exposure, administer 2 auto- injectors For severe exposure, administer 3 auto- injectors Review your agency protocols and contact medical control for specific guidance

After-Action Documentation Collaborative process, involving incident commander, dispatchers, responders, hospitals, and CHEMPACK host agency Describe incident, including timeline, location, and agencies involved Critique effectiveness of CHEMPACK deployment Inventory used and unused CHEMPACK material ICS Forms

CHEMPACK Response Procedures Review What should responders do when they recognize a potential nerve agent incident? When should responders request deployment of CHEMPACK assets? What notification procedures should be observed during the response? What steps should be taken to deploy CHEMPACK assets? What kind of after-action documentation is required?

CHEMPACK Hospital Transportation Plan In the event of a nerve agent release, time will be of the essence in getting the antidotes where they re needed Each Chempack host site needed plans in place both internally and externally to be able to quickly deploy CHEMPACK assets once Chempack Plan is activated

CHEMPACK Hospital Transportation Plan Chempack requestor should be prepared to give MEMA call center the following information: Caller name and number Brief description of incident Approx. # of causalities (adult/pediatric) County/city/address/location of incident MSWIN capabilities Specific drop point of Chempack assets

CHEMPACK Hospital Transportation Plan Information to be exchanged between MEMA and Chempack Hospital: MEMA will provide a brief summary of incident Verify exact location on hospital campus where Transportation Agency will pick up Chempack assets Name/Contact information for any additional hospital representative(s) including any special instructions involved in picking up the assets

Evaluations How valuable was this training?