CHEMPACK OVERVIEW New Mexico Department of Health Bureau of Health Emergency Management Strategic National Stockpile/CHEMPACK
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 a nerve agent event.
BACKGROUND • Some state and local governments may not have nerve agent antidote stocks • Hospitals carry limited supplies of treatments for nerve agent exposures • Nerve agent antidotes have variable shelf lives and are not easily sustainable resources • Strategic National Stockpile Program has a 12 hour response time, too long in the event of a nerve agent event
CHEMPACK Benefits • Pre-deployed nerve agent antidotes • Antidotes quickly and more readily available • Quicker administration of antidotes (helps to save lives) • Can treat up to 1000 patients (including pediatrics) • Federally Owned Cache • Decrease cost to local areas • Shelf Life Extension Program (SLEP)
Extended Shelf Life Program The Food and Drug administration has approved nerve agent antidotes purchased by the federal government to qualify for the Shelf Life Extension Program (SLEP). SLEP Requirements are: • Federal Government owns the product • Ensure environmental stability • Certify the product has not been exposed to unknown environmental conditions • Provide evidence that required environmental conditions have been maintained • If a container seal is broken, the product will no longer be SLEP eligible. The shelf life can be extended to the point the medications no longer meet FDA requirements, or the container is opened. If the medication does not meet FDA requirements and the container has not been opened, CDC will replace the expired medications. The CDC and SNS Programs will be responsible for obtaining new lot expiration numbers and drug replacement.
Why? • Because of the availability of chemical weapons, terrorist organizations may be able to obtain and deploy chemical weapons. These chemicals are commonly referred to as choking, blister, blood and nerve agents.
Why? • Agricultural accidents, mishandling of insecticides, cargo crashes or other incidents involving organophosphate or carbamate pesticides could also result in releases that threaten human health
What are nerve agents? Nerve agents are extremely toxic organophosphate-type chemicals including: GA (tabun), GB (sarin), GD (soman), GF (cyclosarin) and VX They are odorless and invisible and can be inhaled, absorbed through the skin, or swallowed They attack the nervous system and interfere with chemicals that control nerves, muscles and glands
For Real!!! • Iran-Iraq War (1980-1988) • Matsumoto, Japan (1994) • Tokyo Subway System (1995)
There have been 12 Hospital CHEMPACK containers situated throughout the state of New Mexico.
Who Monitors The Container? The Centers for Disease Control and Prevention (CDC) monitors the product through the Sensaphone 24/7 for temperature deviations and container entry. CDC and BHEM Strategic National Stockpile (SNS) will conduct site visits every 12-16 months. At this time they will conduct product sampling and replace medications as needed.
Sensaphone The Sensaphone is used to monitor temperature and container breach by the CDC in Atlanta, Georgia.
What is in a CHEMPACK? • Mark 1 Kit • Diazepam Auto Injector • Atropine, Pralidoxime and Diazepam Multi-Dose Vials
When Would CHEMPACKBe Used? • CHEMPACK would be activated and used in the event of a nerve agent incident. This could be an act of terrorism or an agricultural accident. • CHEMPACK is to be used as a secondary resource for these types of incidents and would be used only when all local resources have been exhausted or overwhelmed.
How Is CHEMPACK Requested? • Responders will contact the Incident Commander and request CHEMPACK. • Incident Command will contact medical control and dispatch. • Dispatch will contact CHEMPACK Hospital Point of Contact by phone and/or other appropriate available communications.
Incident Commander (IC) on scene Known or suspected nerve agent or organophosphate exposure OR SLUDGEM Signs and Symptoms present Incident Command contacts Medical Control NO YES CHEMPACK NEEDED? Utilize appropriate local protocols IC contacts dispatch & requests CHEMPACK Host hospital notified Dispatch identifies closest CHEMPACK host hospital CHEMPACK resources delivered to staging area Closest law enforcement agency (LEA) dispatched to host hospital LEA transports CHEMPACK resources NMDOH State Emergency Operations Center Representative (EOCR) notified Dispatch contacts Local Emergency Manager (LEM) Additional CHEMPACK Resources coordinated by LEM and EOCR re
How Will The Antidotes Be Distributed? The materials in each CHEMPACK container have been color coded for ease of distribution. Boxes with a green labelare auto injectors and will be sent out into the field for first responder use. Boxes with a pink or purple label will be used by hospitals other than the host facility. These are multi-dose vials. The host facility may also use these materials. Boxes with a red label are for use by the host facility. These are also multi-dose vials.
Who will receive the antidotes? • The current plan is to move all Mark 1 Kits and auto injectors to the responders in the field when CHEMPACK is requested. These will be used for responders and community members who have moderate to severe symptoms. • Any victims receiving antidotes in the field will have to be gross decontaminated at a minimum and transported to the hospital for additional treatment. • The multi dose vials will be used for patients and personnel in the hospital who have moderate to severe symptoms.
Qualifications for Persons Administering Antidotes • In the hospital the individual would have to be licensed and able to administer the antidotes Any state/federal licensing requirements would be applicable. • In the field, the responder must be a currently licensed New Mexico emergency medical technician. The individual must meet all EMS licensing requirements. Authorization to administer the medications is covered in the state EMS Treatment Guidelines.
Nerve Agent Antidote Dosing Guidelines • MARK-I Auto injector 2 mg atropine and 600 mg 2-PAM; Diazepam Auto injector 10 mg; Diazepam Carpuject 5 mg/ml (2 ml) • MDV Multi dose Vials • Preferred injection site for infants, children and adults for IM auto injector or syringe—anterolateral thigh. • Antidote Dosing Based on Symptoms *Infant, child/frail elderly MARK-I dosing—if MDV not available, IV route not established and/or IV route nor established and/or precise dosing impossible—consider administration of MARK-I. **As quickly as possible, both drugs from auto injector, one right after another. SLUDGEM + RA : Salivation, Lacrimation, Urination, Defecation, GI, Emesis, Miosis, Respirations, Agitation
How Will First Responders Be Protected? First responders are trained to assess scene safety before they arrive. Responders should strongly consider having PPE available and ready for use, plan to establish a safe zone, and alert HazMat to respond. If a first responder is exposed to a nerve agent, they should be given treatment like any other victim. They would be given antidotes only if they were symptomatic of a moderate to severe exposure. If they are asymptomatic or had a minor exposure they should be subject to gross decontamination and assessment.
Will There Be Enough For Everyone? • Each Hospital CHEMPACK container treats up to 1000 patients. • The antidotes will be given to moderate to severe exposure victims, both in the field and in the hospital. • If supplies are running low, the Incident Commander or hospital can request that additional antidotes be secured and transported to the required site through the Local Emergency Manager.
Requesting Additional Antidotes • The Incident Commander or hospital can request additional resources from the Local Emergency Manager. • The Local Emergency Manager, in coordination with the State Emergency Operations Center, will secure additional resources and arrange for their transport to thesite.
Training Available We are in the process of developing training presentations, on-line training (www.NMsphere.org) and information on the NMDOH Bureau of Health Emergency Management website. This training will be made available to Hospitals, Fire Services, EMS, Dispatch and Law Enforcement.
For More Information Contact: Jerry Lazzari, State SNS Coordinator 1301 Siler Road, Building F Santa Fe, NM 87507 505 476-8231 Loretta Sanchez, Assistant State SNS Coordinator CHEMPACK Coordinator 1301 Siler Road, Building F Santa Fe, NM 87507 505 476-8258