CHEMPACK AS A RESOURCE

1
CHEMPACK AS A RESOURCE

• CHEMPACK Field Hospital Response Procedures for
  Nerve Agent Incidents

2
Response Procedures for Nerve Agent Incidents

• Explain what responders should do when they
  recognize a potential nerve agent incident
• Determine when to request deployment of CHEMPACK
  assets
• Describe notification procedures observed during
  the response
• List steps taken to deploy CHEMPACK assets
• Explain required after-action documentation

3
Scenario Background

• At 535 pm on Wednesday, Oct. 8th, a traveling
  freight train derails.
• 26 of the trains 79 cars are affected. MoDOT
  placards indicate that four of these cars contain
  hazardous materials.
• The cause of the accident is unknown.

4
Scenario Background

• At 536 pm, an overturned tank car from the
  derailed train is struck by a commuter train
  traveling at 35 miles per hour.
• The commuter train is carrying 297 passengers.

5
Scenario Background

• According to the MoDOT placard, the tank car
  contains organophosphate pesticides.
• The tank is breached, spilling approximately
  10,000 gallons of the chemical.

6
Scenario Background

• A number of passengers and bystanders call 911
  from their cell phones
• Between 537 pm 615 pm, multiple calls are
  received by the Missouri state and local police.

7
Situation Update

• The first patrol car arrives on scene at 544
  pm.
• As of 605 pm, most passengers have been able to
  evacuate the train on their own, though as many
  as 40 passengers in the first three cars have
  sustained serious injuries.

8
Initial Action

• What should be the initial action of a first
  responder upon arriving at the scene?

9
Initial Notification
NERVE AGENT INCIDENT OCCURS
First responder on scene calls associated
dispatch (Police/Fire/EMS) to report suspected
nerve agent incident
Dispatch informs Command staff
10
Information Communicated 9-1-1 Dispatch
Incident Scene

• Information about the incident
• Hazardous material
• Severity of exposure
• Information about the victims
• Estimated number of victims
• Common medical needs
• Information about the response efforts
• Updates on decontamination efforts
• Location of stating area at the incident scene
• Information regarding access, best route for
  approach

11
Situation Update

• As of 610 pm, the extent of potential nerve
  agent exposure is unknown.
• Several passengers evacuated from the train are
  vomiting and complaining of nausea, dizziness and
  blurred vision. Two passengers are experiencing
  seizures.

12
Command Staff Actions

• What should be the initial action of the command
  personnel when they learn of the size and scope
  of the incident?

13
Request Additional Resources
NERVE AGENT INCIDENT OCCURS
First responder on scene calls associated
dispatch (Police/Fire/EMS) to report suspected
nerve agent incident
Dispatch informs Command staff
Command Staff commits additional resources,
dispatch deploys resources to the scene.
14
Command Staff Actions

• Command personnel should commit additional
  resources to respond to the incident.
• Resources may include
• Ambulances
• Hazmat teams
• Mobile Decontamination Units (MDUs)
• Personal Protective Equipment (PPE)
• Other personnel and supplies

15
Coordinate Information Sharing
NERVE AGENT INCIDENT OCCURS
First responder on scene calls associated
dispatch (Police/Fire/EMS) to report suspected
nerve agent incident
Dispatch informs Command staff
Command Staff commits additional resources,
dispatch deploys resources to the scene.
Alert all area hospitals
Prepare CHEMPACK for transport
Transportation decisions made
16
Incident Response

• Since a suspected nerve agent incident would
  qualify as a Hazardous Material event, the
  Incident Commander would most likely be the
  ___________ ?

17
Incident Response

• Since a suspected nerve agent incident would
  qualify as a Hazardous Material event, the
  Incident Commander would most likely be the Fire
  Chief or another representative of Fire Services.

18
Initiate Incident Response
Incident Commander Deputy Incident Commander
Safety Officer
Finance Administration Section
Operations Section
Planning Intelligence Section
Logistics Section
Medical Branch
HazMat Branch
19
Initiate Incident Response
NERVE AGENT INCIDENT OCCURS
First responder on scene calls associated
dispatch (Police/Fire/EMS) to report suspected
nerve agent incident
Dispatch informs Command staff
Command Staff commits additional resources,
dispatch deploys resources to the scene.

• Additional responders arrive on scene, initiate
  incident response
• Establish ICS
• Don appropriate PPE
• Establish staging area
• Establish decon area

20
Don Appropriate Personal Protective Equipment
(PPE)
21
Situation Update

• 25 responders are on the scene, helping to
  evacuate the last victims from the train.
• Over 100 victims are complaining of headache,
  blurred vision, and tightnessin chest. A dozen
  people areexperiencing seizures.

22
CHEMPACK Configurations

• One configuration
• EMS

23
CHEMPACK Configurations EMS
EMS CHEMPACK Configuration (454 Casualties) Unit Pack Cases Quantity
Mark-1 auto-injector kit 240 5 1200
Atropine Sulfate 0.4 mg/ml 20 ml 100 1 100
Pralidoxine 1 Gm inj. 20 ml 276 1 276
Atropen 0.5 mg 144 1 144
Atropen 1.0 mg 144 1 144
Diazepam 5 mg/ml auto-injector 150 2 300
Diazepam 5 mg/ml vial, 10 ml 25 2 50
Sterile water for injection 20cc vials 100 2 200
24
Open CHEMPACK Container

1. Unlock the padlock
2. Break the plastic seal across the container
   door
3. Slide open the deadboltson either side of the
   container
4. Use the canvas strap to pull the front door
   panel upwards
5. Pull the door panel out from thebottom of the
   container and remove

25
Remove and Sort CHEMPACK Contents
26
Situation Update

• The host hospital received the request for
  CHEMPACK assets at 551 pm.
• CHEMPACK assets were ready for transfer by 612
  pm.

27
Transport CHEMPACK Assets
Designated personnel open CHEMPACK container,
remove and sort contents, prepare material for
transfer
Transport of CHEMPACK antidotes from host
facility to field and treatment hospital (if
needed)
CHEMPACK assets delivered to receiving hospitals.
CHEMPACK assets delivered to the incident scene
28
Transport of CHEMPACK Assets

• What organization picks up the CHEMPACK assets
  and transports them to the incident scene and to
  the nearby non-host hospitals?

29
Transport of CHEMPACK Assets

• EMS or Law Enforcement will pick up the CHEMPACK
  assets and transport them to the incident scene
  and to the nearby treating hospital.

30
Initiate Triage Treatment
Transport of CHEMPACK antidotes from host
hospital to field and treating hospital (if
needed)
EMS/ LE arrives to pick up antidotes for
transport to incident scene
CHEMPACK assets delivered, first responder takes
custody of material
Field responders triage and treat patients using
CHEMPACK antidotes
Local 911 dispatch works with EMS and hospitals
to coordinate transport of patients to area
hospitals
Field responders transport patients to area
hospitals
31
Treatment

• Administer one auto-injector to patients
  demonstrating the signs and symptoms of mild
  nerve agent exposure.

32
Situation Update

• CHEMPACK assets were delivered to the incident
  scene.
• All victims have been evacuated, and gross
  decontamination is underway.
• Over 150 victims are complaining of headaches,
  blurred vision, and tightness in chest.
• 3 victims are in acute respiratory distress.

33
Situation Update

• CHEMPACK assets were delivered to the non-host
  hospital at 637 pm.
• 30 victims of the crash left the scene and went
  directly to the two closest hospitals.
• An additional 150 area residents have presented
  to area hospitals with complaints of nausea and
  shortness of breath. None were within 500 yards
  of the crash.

34
7. Hospital Response
Determined quantity of antidotes needed for the
Emergency Room (ER)
Determined quantity of antidotes needed for
Emergency Room (ER) at an additional treating
hospital
ER Personnel Decon patients self-presenting from
scene
ER Personnel Decon patients self-presenting from
scene
ER Personnel treat patients transported via
ambulance
ER Personnel treat patients transported via
ambulance
ER Personnel treat patients
ER Personnel treat patients

• Host Hospital Facility

• Additional Treating Hospital

35
Situation Update

• At 1007 pm, the last of the 297 victims were
  treated and transported to area hospitals.
• 33 patients showed the signs and symptoms of
  severe nerve agent exposure. One of these
  patients died at the scene.
• 64 patients showed the signs and symptoms
  moderate nerve agent exposure.
• 200 patients were treated for mild nerve agent
  exposure.

36
After-action Documentation

• Collaborative process, involving incident
  commander, dispatchers and CHEMPACK host facility
• Describe incident, including timeline, location
  and agencies involved
• Critique effectiveness of CHEMPACK deployment
• Inventory used and unused CHEMPACK material

37
Missouri Allocations

• 38 CHEMPACKs strategically located across
  Missouri

38
Missouri Allocations
39
Response Procedures for Chemical Incidents

• What should responders do when they recognize a
  potential nerve 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?