State of Mississippi CHEMPACK Training Program Mississippi State Fire Academy & Mississippi State Department of Health Office of Emergency Planning & Response State of Mississippi CHEMPACK Training Program

The Mississippi CHEMPACK Training Program Module Two: CHEMPACK First Responder & Hospital Response Procedures for Nerve Agent/Organophosphate Incidents

CHEMPACK Module Two: CHEMPACK First Responder & Hospital Response Procedures for Nerve Agent/Organophosphate Incidents Covers the response procedures for nerve agent exposure. This module is targeted towards: Hospital personnel First Responders

Response Procedures for Nerve Agent Incidents Objectives: 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.

Response Considerations When responding to an incident you need to consider the area that may be affected. You will need to take in to consideration wind direction and speed. What is downwind? Schools, apartment complexes, shopping centers? Or maybe a subdivsion.

Initial Notification First Responders arrive on scene. 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. The initial notification phase of an incident requiring the Chempack deployment is critical. When dealing with nerve agents time is a critical element in saving lives. Seconds count!

Request Additional Resources Incident Requests Due to scope of the incident, command personnel from all branches of public safety may request additional resources to respond. 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 may arrive on scene. Host Hospital Activates its CHEMPACK Deployment Plan and prepares CHEMPACK assets Request additional security, transport, and escort assets. In a multi-agency response (Fire, Law Enforcement, EMS, etc.) the Unified Command Structure should be used to allow for a coordinated response by agencies involved. This will also greatly improve information sharing among agencies.

Local911 Information Sharing Local EMA ESFs MEMA Host Hospital Incident Command MEMA Responders The initial call will most likely go to the local 911 system where they will notify the local responding agencies. It may be after the responding agencies arrive on the scene before you know you have a possible nerve agent involved. If a nerve agent is suspected, time is critical to notify MEMA to get the Chempack deployed. Don’t assume the 911 dispatcher will notify MEMA, request them to make the notification!! Once the incident begins and incident command is in place the incident commander may be asked to communicate with MEMA to provide further information. You may need to communicate via MSWIN or by cell phone. In a Chempack response, there will be a designated MSWIN channel for Chempack communication only. EMS units will communicate with the receiving hospital along regular communication routes. Host Hospital Receiving Hospital ESFs Local EMA

Communications In the event of a CHEMPACK response, responders will primarily utilize the MS Wireless Information Network (MSWIN) State agencies (MHP, Health Dept., MEMA, etc.) and many local agencies are MSWIN capable MSWIN provides interoperability capabilities to multiple responding disciplines during the incident to facilitate communications. MSWIN has assigned the ST SE 2 talk group for use during Chempack emergencies All radios on the MSWIN system are required to have the ST SE 2 talk group in their radio Additional MSWIN talk groups may be assigned if needed. These will be listed on the ICS form 205 that will be developed by the MSWIN System Administrator. At the onset of a CHEMPACK crisis, news is likely to spread quickly. Therefore, it is imperative that a formal plan be in place to support the response efforts of such an event and to ensure that all necessary information is relied quickly, accurately, and effectively. Many hospitals now have MSWIN capabilities in their hospital emergency rooms The ST SE 2 Talk group is a statewide talk group so it will work all over the state If you are on MSWIN and are not familiar with this channel in your radio, take the time to find it. When the radio was programmed it may have been named differently in your radio. It is imperative that those responsible for CHEMPACK response be familiar with MSWIN, proper radio usage, and the ICS 205 form.

Important Incident Information Location (details) Hazardous material Victims Estimated number Severity of exposure Medical needs Self-evacuees Response efforts Decontamination efforts Staging area Access, best route Location: If you are able to provide GPS coordinates do so. The better the description of the location, the faster the Chempack can get there! Hazardous Material: You may not know exactly what the hazardous material is. You may only recognize the symptoms of those effected. Give any information you have that may help identify it. Poison Control can be a good source of assistance. Poison Control nationwide number: 800-222-1222 *Store this number in your phone. There will most likely be a lot of confusion and panic on the scene. However it is very important to get as much detailed information as quickly as possible to share with MEMA. This is the information that will go to the hospital providing the Chempack. NOTE: Several hospitals around the state have been provided decontamination equipment through the Mississippi State Department of Health. The MSDH Emergency Response Coordinators can assist with Decon training if requested.

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). The Incident Commander will need to consider all of this information. Hot, warm and cold zones should be established as quickly as possible by the responding units to prevent contamination of responders (Responders become victims!)

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) HOSPITALS: EXPECT self-evacuees to present at the hospital unannounced, and plan for it. The numbers vary, but various texts indicate up to 60% of patients in hazmat incidents may leave the scene prior to public safety arrival. WHAT are you isolation procedures? WHAT are your decontamination procedures?

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.

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

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. Poison Control may be able to provide guidance. Nationwide number 800-222-1222. Put it in your phone!

After-Action Process 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 After action reviews are an important part of any response. We can learn a lot from our successes and our mistakes. Chempack hot-washes will include state level agencies as well as local agencies. Federal agencies may also request to participate.

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? Answers: Notify the correct agencies! Time is CRITICAL!! We can’t stress that enough! Anytime a nerve agent is suspected Provide critical information when requesting Chempack assets Call the local 911 center and request the Chempack assets from MEMA Good records are a critical part of the after action report and hot-wash. Write it down so it is not forgotten.

Mississippi CHEMPACK Program Module Two QUESTIONS?

To request a Chempack presentation contact: Donna Dreiling Donna To request a Chempack presentation contact: Donna Dreiling Donna.Dreiling@msdh.ms.gov or Kerry Minninger- Charles.Minninger@msdh.ms.gov