Metro Region Division of Strategic National Stockpile DSNS Program Chempack Project Presentation for

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Metro RegionDivision of Strategic National
Stockpile (DSNS) ProgramChempack
ProjectPresentation forResponders
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Thank YOU! For developing the Metro Chempack
Plan

• MMRS ChemPack Team Membership
• Major Allen Autry 55th Civil Support Team
  Chris Kummer HCMC EMS and WMRCC
• Ginny Baresch MDH SNS Coordinator Jeff
  Lanenberg Allina EMS/ Bloomington FD
• Mary Burfeind Metro Hospital Compact/RHRC Mark
  Lappe HCMC EP/Security and Metro RHRC
• Dave Burke MAC Fire Department Denzil Mellors
  Fairview System
• Tim Butler St. Paul Fire/EMS EM Kevin
  Miller Dakota County EMS
• Jeff Czyson North Memorial Ambulance Penny
  Mills North Memorial Medical Center
• Sheri Fox Regions Hospital Jon
  Muller Lakeview EMS
• Dave Gammell Regions EMS and EMRCC Sharon
  Richmond Fairview Ridges
• Doug Gesme HCMC EMS Kristi Rollwagen
  Minneapolis Fire
• Kent Griffith Regions EMS Ulie Seal
  Minneapolis Fire/Bloomington Fire
• Katherine Grimm HealthEast System Lance Ross
  Metro Region EMS, MESB
• Kris Herold HealthEast Medical Transportation
  Kevin Sell MDH/HCMC Pharmacist
• John Hick, MD HCMC and MDH-OEP
• Sue Jacobson St. Paul Fire Department
• Scott Tomek Woodbury Public Safety and Lakeview
  EMS
• Tom Ward HCMC EMS
• Special thanks to Kevin Sell, Dr. John Hick and
  Lance Ross for their dedication and leadership on
  the guidelines and procedures for local
  implementation of this plan.

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Objectives

• Provide an overview of the Division of Strategic
  National Stockpile (DSNS) and Chempack project
• Discuss the field indications for releasing the
  Chempacks
• Provide an Overview of the Metro Region Chempack
  Activation Plan
• Educate Personnel on how they can activate a
  Chempack

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• Division of Strategic National Stockpile
• (DSNS)
• Program Mission
• Deliver critical medical assets
• to an event of a national
• significance

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What types of items are in the DSNS Push Package?
Oral Antibiotics
IV Supplies
Nerve Agent Antidotes
Airway Supplies
Pediatric Supplies
Med/Surg Supplies
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DSNS Response Track Record

• 9/11/01 response to NYC
• Delivered 50 tons of medical supplies, including
  prophylaxis and intravenous fluids to NYC within
  7 hrs of attack on World Trade Centers
• Oct 15 Dec 30, 2001 response to anthrax attack
• Delivered 3.79 million tablets of antibiotics for
  post-exposure preventive treatment of postal
  workers, mail handlers, and other occupants of
  affected buildings, the first within 8 hrs

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Public Health Threats

• Anthrax - 728 Anthrax samples were tested by the
  WSLH between Oct 01 May 02
• Severe Acute Respiratory Syndrome (SARS)
• Monkeypox
• West Nile Virus
• Pandemic Influenza
• Tuberculosis
• Hepatitis
• Pertussis (Whooping Cough)
• 5,641 cases in 2004 (CDC)
• 697 cases in 2003 (CDC)
• Food borne Waterborne Outbreaks
• Bioterrorism

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Background

• DSNS Program has a 12-hour response time, too
  long in the event of a nerve agent attack
• Some state and local governments dont have any
  nerve agent antidote stocks
• Hospitals carry limited supplies of treatments
  for nerve agent exposures
• Nerve agent antidotes have variable shelf lives
  (are not an easily sustainable resource)

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Chempack Project Mission

• Implement a nationwide project for the forward
  placement of nerve agent antidotes. To provide
  state and local governments a sustainable
  resource that increases their capability to
  respond quickly to nerve agent event.
• State participation in the CHEMPACK Project is
  voluntary

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Why?

• Due to the availability of chemical weapons,
  terrorist organizations may be able to obtain and
  deploy chemical weapons to create a weapon of
  mass destruction (WMD) Event. These chemicals
  are commonly referred to as choking, blister,
  blood and nerve agents.

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Why?

• Agricultural accidents, mishandling of
  insecticides, or other accidents involving
  organophosphate or carbamate pesticides could
  also result in releases that threaten human
  health.

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Where?
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For Real!

• Iraq-Iran War (1980-1988)
• Matsumoto, Japan (1994)
• Tokyo subway system (1995)

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What are nerve agents?

• Nerve agents are extremely toxic
  organophosphate-type chemicals including
• GA (tabun), GB (sarin), GD (soman), GF
  (cyclosarin), and VX,
• They attack the nervous system and interfere with
  chemicals that control nerves, muscles, and
  glands.
• They are odorless and invisible and can be
  inhaled, absorbed through the skin, or swallowed.

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Symptoms that might be seen in a Nerve Agent
Poisoning
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Casualty Assumptions

• 30 will have a mild exposure
• 40 will have a moderate exposure
• 30 will have a severe exposure
• May overwhelm pre-hospital and hospital health
  care system

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Signs and Symptoms of Nerve Agent MILD Exposure

• Headache
• Blurred vision from pinpoint pupils (miosis) must
  be present
• Tight chest (smooth muscle constrictions)
• Excessive sweating
• Tearing (lacrimation)
• Salivation
• Unexplained runny nose

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Signs and Symptoms of Nerve Agent MODERATE
Exposure

• Drooling
• Difficulty Breathing
• Vomiting
• Fatigue
• Diarrhea
• Muscle Twitching
• Muscle Weakness
• Blurred vision from pinpoint pupils (miosis) must
  be present

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Signs and Symptoms of Nerve Agent SEVERE Exposure

• SAME AS MODERATE
• Urination
• Convulsions
• Cardiac Irregularities
• Respiratory Failure
• Wet Lung Sounds
• Altered Mental Status
• Blurred vision from pinpoint pupils (miosis) must
  be present

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What is a Chempack?
?
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CHEMPACK Cache Storage Location
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Standard Containers

• The CHEMPACK Project provides two types of
  containers
• Emergency Medical Service (EMS) Container
• Designed for emergency responders material
  packaged mostly in auto-injectors.
• Hospital Container Designed for hospital
  dispensing, with multiuse vials, for precision
  dosing and long term care.

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CHEMPACK CONTENTS
Mark I, Kit Nerve Agent Antidote Kit
Diazepam Auto-Injector
ATROPINE, PRALIDOXIME, AND DIAZEPAM MULTI-DOSE
VIALS
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EMS Chempack up to 454 Treated
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EMS Ancillary Supplies
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Hospital Chempack 1000 Treated
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Hospital Ancillary Supplies
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Great How Do I Request a Chempack?
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What you need to know
Bad Day! HELP!!!
Dispatch Or PSAP
Incident
IC or EMS Branch Command
Chempack Agencies
MRCCs
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If Agency PSAP has Chempack/s they can Send
theirs and then Contact MRCCs
Process for an Agency to Request Chempacks 2/2006
Agency PSAP

• Determines
• Signs/Symptoms of victims
• Treatment supplies limited
• Deployment of Chempack is appropriate.
• Requests Chempack/s to be deployed to scene

First Responder Agency ie LE, Fire,
EMS or IC/EMS Branch Dir.
Response to Scene
Incident
Responding Agency can request
Chempack/s through their PSAP or MRCC. If
PSAP is contacted they need to contact MRCC
to activate the EMS Chempack plan.
MRCCs
Agency PSAP

• Responding Chempack Agency
• Contacts requesting PSAP or IC/EMS Brh Dir. for
  incident information

Utilizes appropriate communications to
alert/activate EMS Chempack Plan
Responding EMS Chempack/s
All CHEMPACK agencies to standby and monitor
designated TG/Freq. for instructions
Requests FASTEST/CLOSEST CHEMPACK/s, relays
dispatch info
MDO
Contacts MDO of activation of their Chempack/s
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CHEMPACK Response

• Initial First responders arrive on scene with a
  small amount of chemical antidotes in vehicle
  (15 min)
• NOT TRUE FOR ALL AGENCIES
• Secondary First responders call for regional
  nerve agent antidote assets and have them
  delivered to scene (30-60 min) CHEMPACK
• Tertiary Federal stockpile of chemical antidotes
  are requested and arrive in-state in about 12 hrs

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Okay Its Here Now What?
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• What should I do if Ive been exposed?
• Get OUT of the Hot Zone
• Upwind upgrade
• Decontaminate
• Communicate
• Protect other responders
• Call for additional resources
• Try and give an approximate number of those
  affected
• Consider Treatment Areas

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You are 1
Self administer the Mark I Auto-injectors!
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1. Determine patients condition

• MODERATE Difficulty Breathing, Drooling,
  Vomiting, Fatigue, Diarrhea, Muscle
  Twitching, and Muscle Weakness
• SEVERE SAME AS ABOVE and Urination,
  Convulsions, Cardiac Irregularities, Respiratory
  Failure, Wet Lung Sounds

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Determine weight/age of patient, use appropriate
15 to 40 pounds (6 months to 4 years)
Over 90 pounds (10 years to Adult)
40 to 90 pounds (4 to 10 years old)
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Transport
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