Transcript Chemical Agents - South Bay Disater Resource Center

Hospital Emergency Response
Training (HERT) for Mass Casualty
Incidents (MCI) Train-the-Trainer
Course
Course Code: B461
HERT FOR MCI
 Hospital Emergency Response Training (HERT) for Mass
Casualty Incidents (MCI) Train-the-Trainer, B461 Course
 Resident Offering at Noble Training Center, Anniston,
Alabama
 4.0 Days
 Special offerings for hospital emergency departments,
administration, and staff personnel
 Prerequisites:
 IS-195, Basic ICS
 IS-346, An Orientation to Hazardous Materials for Medical
Personnel
DHS/NTC
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What HERT for MCI is Not?
 Not a HazMat Course. Need additional training under:





OSHA’s Hazardous Waste Operations and Emergency
Response, 29 CFR 1910.120, par (q), 1990
OSHA 3152 Hospital and Community Emergency Response –
What You Need to Know, 1997
OSHA’s Best Practices for Hospital-Based First Receivers of
Victims from Mass Casualty Incidents Involving Hazardous
Substance Releases, 2004
Department of Health and Human Services, CDC
Recommendations for Civilian Communities Near Chemical
Weapons Depots: Guidelines for Medical Preparedness, 1995
USACHPPM, Technical Guide 275, PPE for Military MTF
Personnel Handling Casualties from WMD and Terrorist Events,
2003
DHS/NTC
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What HERT for MCI is Not? (Cont’d)
 Not a Hospital Emergency Incident Command System
(HEICS) Course:




HERT stresses HEICS as a valuable tool for hospitals
Recognizes all Hospital Incident Management Systems (HIMS)
HERT emphasizes a hospital IMS during emergency response
HERT integrates its HIMS into all aspects of the course
DHS/NTC
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What HERT for MCI is Not? (Cont’d)
 Not a Weapons of Mass Destruction (WMD) Course:



HERT emphasizes the handling of patients contaminated with
CBRNE agents
Recognizes attendee’s prior training and skills concerning these
agents
Attendees should receive additional training on WMD Events
from ODP
DHS/NTC
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What HERT for MCI is Not? (Cont’d)
 Not a National Incident Management System (NIMS)
Course:




HERT emphasizes the use of an incident management system to
comply with the NIMS
Recognizes attendee’s prior training in the NIMS
Has incorporated NIMS where it applies throughout the course
Participants wanting additional training should enroll in FEMA’s
Online Courses in the NIMS:
• IS 700 NIMS, An Introduction
• IS 800 NRP, An Introduction
DHS/NTC
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Unit One
Course Introduction: Origin of the
Incident Command System (ICS)
Objectives



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
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Review ICS as an incident management tool
List uses of ICS in emergency management
Describe the history of ICS
Discuss the evolution of HEICS
Define basic HEICS structure
Review ICS organizational chart
DHS/NTC
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Objectives (cont'd)





Develop an initial organizational structure
List minimum staffing requirements
Prepare an incident briefing
Participate in a planning meeting
Develop incident objectives and an Incident Action Plan
(IAP)
 Identify appropriate uses of resources
DHS/NTC
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What is ICS?
 The model incident management tool for:
 Command, control, and coordination of an emergency
response
 Providing a means to coordinate efforts of individual
agencies
 Allowing agencies to work toward a common goal for
stabilizing an incident
 Ensuring the protection of life, property, and the
environment
DHS/NTC
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When is ICS Used?




Hazardous materials incidents
Response to natural disasters
Fire and riot control
Incidents involving multiple casualties:
 Weapons of Mass Destruction
 Mass Casualty Events
 Wide-area search and rescue missions
DHS/NTC
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History of ICS
 Developed in the 1970s in response to major wild
land fires in Southern California
 Allowed for collaboration to form the:
 Firefighting Resources of Southern California Organized
for Potential Emergencies, or FIRESCOPE
DHS/NTC
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History of ICS (cont'd)
 FIRESCOPE identified several recurring problems
involving multi-agency responses, such as:
 Nonstandard terminology
 Lack of flexibility to expand or contract resources as
required
 Nonstandard and nonintegrated communications
 Lack of consolidated action plans
 Lack of designated facilities
DHS/NTC
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History of ICS (cont'd)
 Efforts to address these difficulties resulted in the
development of an ICS model
 Success of ICS has resulted directly from applying:
 A command organizational structure
 Key standardized management principles
DHS/NTC
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NIIMS versus NIMS
NIIMS (existing):
1. Incident Command System (ICS)
2. Training
3. Qualifications & Certification
4. Publications Management
5. Supporting Technology
DHS/NTC
NIMS (new):
1. Command & Incident
Management
2. Preparedness
3. Resource Management
4. Communications Information &
Intelligence Management
5. Science & Technology
Management
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Hospital Emergency Incident
Command System (HEICS)
 Modeled after FIRESCOPE
 Early work by the Northern California Hospital Council
 California authorized a grant to Orange Country EMS
for HEICS Project 91/92
 Major rewrite of HEICS documents:

Now provide the current HEICS Plan
 HEICS considered a model for hospital incident
management system
DHS/NTC
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HEICS Attributes
 HEICS attributes:
 Command, control, coordination, and intelligence





 Functional incident management system
A dependable chain-of-command
Improved communications through common language
Flexibility in section (component) activation
Prioritization of duties
Adaptable to HazMat, WMD, and MCI
DHS/NTC
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HEICS Attributes (cont'd)
 Organized documentation for improved financial recovery
 Facilitates effective mutual aid with:
 Other hospitals, and
 Agencies
DHS/NTC
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Basic HEICS Structure
 Basic units of structure:
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Incident Commander
Section Chiefs
Directors
Unit Leaders
Officers
DHS/NTC
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ICS Organizational Chart
 Represents lines of authority and communications
 Command element (IC and staff)
 Four functional sections:




Planning
Operations
Logistics, and
Finance/Administration
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ICS Organization
Incident
Command
Planning
Section
DHS/NTC
Operations
Section
Logistics
Section
B461 Course
Finance/
Administration
Section
21
Incident Commander
 Incident Commander (IC):
 Defines the mission and ensures its completion
 Has overall control of incident or emergency
response
 Can appoint a deputy commander
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Command Staff
Public Information Officer
Incident
Command
Safety Officer
Liaison Officer
DHS/NTC
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Command Staff (cont'd)
 Command Staff is:
 Public Information Officer
 Liaison Officer
 Safety Officer
 Officers can also have Assistants
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General Staff
Incident
Command
Planning
Section
DHS/NTC
Operations
Section
Logistics
Section
B461 Course
Finance/
Administration
Section
25
Planning Section
 Planning Section:
 Determines and provides for the continuance of each
response objective
 Prompts and drives all Officers to develop:
 Short-range action planning
 Long-range action planning
 Responsible for preparing the IAP
DHS/NTC
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Planning Section (cont'd)
Planning
Section
Resource
Unit
DHS/NTC
Situation
Unit
Documentation
Unit
B461 Course
Demobilization
Unit
27
Operations Section
 Operations Section:
 Carries out the objectives to the best of the staff’s ability
 Oversees and directs all response operations
 Determines needs and requests additional resources
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Operations Section (cont'd)
Operations Section
Staging
Area(s)
Medical
Branch
DHS/NTC
Rescue
Branch
Multi-Casualty
Branch
B461 Course
HazMat Group
29
Logistics Section
 Logistics Section:
 Provides a hospitable environment and materials for the
overall objectives
 Ensures service and support for responders
DHS/NTC
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Logistics Section (cont'd)
Logistics Section
Service Branch
Communications
Unit
Support Branch
Supply
Unit
Food
Unit
Medical
Unit
DHS/NTC
Ground Support
Unit
Facilities
Unit
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Finance/Administration Section
 Finance/Administration Section:
 Provides funding for present objectives
 Stresses facility-wide documentation to
maximize:
 Financial recovery, and
 Reduction of future liability
DHS/NTC
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Finance/Administration Section
(cont'd)
Finance/Admin
Section
Time
Unit
DHS/NTC
Procurement
Unit
Compensation
/Claims Unit
B461 Course
Cost
Unit
33
Future of the ICS
 Continues to expand throughout U.S.:
 Law enforcement
 Government agencies
 Hospitals and HCF
 Will be revisited to ensure:
 It remains relevant to response agencies, and
 Current with standardized ICS models
 Must be adaptable to include an ICS/UC structure for
HMI, MCI, and WMD events
 Should incorporate NIMS as adopted on March 1, 2004
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Unit Two
Hospital Incident Management
System (HIMS)
Objectives
 Describe Hospital Incident Management System for:

Planned & unplanned events
 Mass casualty incidents
 HazMat incidents
 CBRNE events
 Describe transfer of command
DHS/NTC
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HIMS – Operations Section Members
 HIMS Operations Section could consist of:
 Operations Section Chief
 Group/Division Supervisors
• CBRNE or HazMat Group
• SHED or Cafeteria Division, etc.


Team Members
Triage and Treatment Unit Leaders
• Triage and Treatment Team Members

Hospital Emergency Response Unit (HERU)
• Team Members
DHS/NTC
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HIMS – Operations Section
Organization
Operations Section
SHED Division
DHS/NTC
Cafeteria Division
B461 Course
CBRNE Group
38
Medical Care Group/Division
Members
 Medical Care Group/Division could consist of:

Medical Group/Division Supervisor:
• Triage Unit Leader

Triage personnel
• Treatment Unit Leader


Treatment Dispatcher Manager
Treatment Managers
• Immediate, Delayed and Minor

DHS/NTC
Patient Transport Group Supervisor
• Medical Communications Coordinator
• Air/Ground Ambulance Coordinator
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Medical Care Group/Division
Members (Cont’d)
 Command from the top down
 Staff from the bottom up:


Start with Team or Unit when possible
Staff up as span of control is exceeded
 Maintain unity of command
 Divisions are geographical:

DHS/NTC
North/South; East/West; 1st floor/2nd floor
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Medical Care Group/Division
Members (Cont’d)
 Groups are functional:


Security, medical care
CBRNE or HazMat
 Groups can have Units:



Triage
Treatment
Hospital Emergency Response Unit (HERU)
 Units may have Teams

DHS/NTC
Decontamination
B461 Course
41
Medical Care Group/Division
Organization
Medical Care Group
/Division Supervisor
Medical Supply
Coordinator
Triage Unit
Leader
Treatment Unit
Leader
Triage Personnel
Morgue Manager
Treatment Dispatch
Manager
Immediate Treatment
Manager
Delayed Treatment
Manager
Minor Treatment
Manager
DHS/NTC
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HazMat/CBRNE Unit Members

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
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HazMat/CBRNE Unit Leader
Entry Team Leader
Hospital Site Access Control Leader
Safe Refuge Area Manager
Decontamination Team Leader
Technical Specialist
Assistant Hospital Safety Officer – HazMat
DHS/NTC
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HazMat/CBRNE Unit Organization
HazMat/CBRNE
Unit
Entry
Hospital Access Control
Safe Refuge Area
Decontamination
Technical Specialists
DHS/NTC
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Hospital Emergency Response
Unit* (HERU)
 HERU Leader





Hospital Emergency Response Team (HERT) Leader
Initial Assessment & Triage
Immediate Treatment
Delayed Treatment
Minor Treatment
*Unit can be replaced by a Team
DHS/NTC
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HERU/HERT Organization
HERU/HERT Leader
Initial
Assessment/
Triage
DHS/NTC
Immediate
Treatment
B461 Course
Delayed
Treatment
Minor
Treatment
46
Decon Team Members

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Decontamination Team Leader
Initial Contact
Decon Triage*
Decon Site Access Control
Decon Set-up and Support
*Patient/victim is continually triaged
DHS/NTC
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Decon Team Organization
Decon Team Leader
Initial Contact
DHS/NTC
Decon Triage
Decon Site
Decon Set Up/
Access Control
Support
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Scenario Objectives
 Identify initial incident objectives
 Incident priorities



Life Safety (staff and patients)
Incident Stability
Property preservation
 Activate ICS
 Fill positions as appropriate for the event
 Key points:


DHS/NTC
Span of control (3 – 7)
Unity of command
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Scenario – Planned Event
Menu:
Noble Hospital is
planning their annual
fundraiser:


Fried catfish, Cole Slaw,
Beans, Hush Puppies,
Cornbread
Ice Cream Cones
Beer
Soda
A two day Fish Fry Festival.
Saturday and Sunday,
Noon to 10 pm
Entertainment:
8 bands, 2 magician shows
Vendors:
20 Arts & Craft booths
Children’s Play area
DHS/NTC
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Section Considerations
 Initial Incident Objectives
 What are the main functions for:

(Operations, Logistics, Planning and Finance/Admin)?
 Should the functions be divided?

If so, how?
DHS/NTC
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Scenario – Unplanned Event
 A complete, community-wide power outage has occurred
approximately 20 minutes ago. United Electric Company has
just informed you that there is a 50 mile blackout, cause is
unknown. Outage expected to last 5-7 days.
 Emergency generators functioning with enough fuel for 1.5
days at current emergency load. Emergency equipment is
working only.
 The following departments are not on emergency power:
Business office Registration
Infection Control
Administration
Physical Therapy
All offices in hospital
Pneumatic tube system
DHS/NTC
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Scenario – Unplanned Event (Cont’d)
 Departments on emergency power for critical functions:
Emergency Dept
ICU/CCU
Medical gases
Lab
XRay
Nursery
Surgery
Recovery
Nursing Units
Pharmacy
Switchboard
 Summer weather - 90°/58°
 Population 250,000
 Two hospitals, multiple clinics in area
Noble Hospital – 250 beds/85% full; total hospital staff 1800
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Section Considerations
 Initial Incident Objectives
 What are the main functions for:

(Operations, Logistics, Planning and Finance/Admin)?
 Should the functions be divided?

If so, how?
DHS/NTC
B461 Course
54
Scenario -- Mass Casualty Event
There was a stadium collapse at the fairgrounds.
Capacity of the stadium is 5000 people. Report from
EMS indicate over 300 people injured with many fleeing
the scene in private vehicles. The county Mass Casualty
Plan has been activated.





Summer weather - 90°/58°
Population 250,000
Two hospitals, multiple clinics in area
Noble Hospital – 250 beds/85% full; total hospital staff 1800
ED has 20 beds – currently has 16 patients
DHS/NTC
B461 Course
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Section Considerations
 Initial Incident Objectives
 What are the main functions for:

(Operations, Logistics, Planning and Finance/Admin)?
 Should the functions be divided?

If so, how?
DHS/NTC
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56
Scenario – Haz Mat Incident
Continuation of stadium collapse
There were 20 people that were contaminated
With Organophosphate when the holding tank
was punctured from a piece of the stadium
Some have left the scene en-route to the
hospital. EMS will be transporting 6 after
gross decontamination (clothing removed
and field shower)
DHS/NTC
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57
Section Considerations
 Initial Incident Objectives
 What are the main functions for:

(Operations, Logistics, Planning and Finance/Admin)?
 Should the functions be divided?

If so, how?
DHS/NTC
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Transfer of Command
 Transfer command to an equal or more qualified
person
 Transfer of command requires:

Briefing of incident face to face
 Notification of staff that transfer has occurred AND
the name of the new person
DHS/NTC
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Transfer of Command (Cont’d)
 Command transfers to a more qualified IC when
necessary
 The new IC will always receive a transfer-ofcommand briefing
 Hospitals and healthcare facilities must identify
and train deputy ICs
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Summary
 ICS can be used for planned AND unplanned
events involving the hospital
 Make the response fit the event – only fill the
positions that are needed
 Maintain span of control (3 – 7 people)
 Use branches and divisions as needed
 Expand and contract assignments as needed
 Transfer of Command must be done consistently
and completely
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Summary (Cont’d)
Incident priorities:
 Life safety of care providers
 Patient stability and treatment
 Property conservation
 Protect the environment
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Unit Three
Topic 3-1: Chemical and Biological
Agents in Terrorism
Objectives
 Overview of potential biological agents used in
terrorism
 Overview of potential chemical agents used in
terrorism
 Overview of common syndromes
 Define clinical management procedures for
chemical/biological agents
 Define guidelines for response plans
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Routes of Exposure
for Chemical and Biological Agents
Inhalation
Inhalation of droplets, aerosols or vapors
Absorption
Intact skin, cuts or abrasions
Mucous membranes
Injection
Intentional or unintentional
Ingestion
Specific agent ingestion
Contaminated food or water
DHS/NTC
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Bioterrorism (CDC Definition)
“Bioterrorism is the intentional or threatened use of
viruses, bacteria, fungi, toxins from living organisms
or other chemicals to produce death or disease in
humans, animals or plants.”
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Potential Bioterrorism Agents
 Bacterial Agents
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
DHS/NTC
Anthrax
Brucellosis
Cholera
Pneumonic plague
Tularemia
Q Fever
 Viruses

Smallpox
 Venezuelan Equine Encephalitis
 Viral Hemorrhagic Fever
 Biological Toxins

Botulinum
 Staph Entero-B
 Ricin
 T-2 Mycotoxins
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Mandatory Reporting Guidelines
> Know your state and local guidelines
> Include them in your plans
AND
> Train your staff
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CDC Category Definitions of
Diseases/Agents
 Category A - Highest priority




Can be easily disseminated or transmitted from person to
person
Results in high mortality rates and have the potential for
major public health impact
Might cause public panic and social disruption
Require special action for public health preparedness
 Category A – Agents

DHS/NTC
Anthrax (Bacillus anthracis); Botulism (Clostridium
botulinum toxin); Plague (Yersinia pestis); Smallpox
(variola major); Tularemia (Francisella tularensis); and Viral
hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and
arenaviruses [e.g., Lassa, Machupo])
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CDC Category Definitions of
Diseases/Agents (cont)
 Category B – Second highest priority



Moderately easy to disseminate
Result in moderate morbidity rates and low mortality rates
Require special enhancements of CDC’s diagnostic
capacity and enhanced disease surveillance
 Category B – Agents

DHS/NTC
Brucellosis (Brucella species); Epsilon toxin of Clostridium
perfringens; Food safety threats (e.g., Salmonella species,
Escherichia coli O157:H7, Shigella); Glanders
(Burkholderia mallei); Melioidosis (Burkholderia
pseudomallei); Psittacosis (Chlamydia psittaci); Q fever
(Coxiella burnetii)
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CDC Category Definitions of
Diseases/Agents (cont)
 Category B – Agents (Cont)

DHS/NTC
Ricin toxin from Ricinus communis (castor beans);
Staphylococcal enterotoxin B»Typhus fever (Rickettsia
prowazekii); Viral encephalitis (alphaviruses [e.g.,
Venezuelan equine encephalitis, eastern equine
encephalitis, western equine encephalitis]); and Water
safety threats (e.g., Vibrio cholerae, Cryptosporidium
parvum)
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CDC Category Definitions of
Diseases/Agents (cont)
 Category C – Third highest priority

Includes emerging pathogens that could be engineered for
mass dissemination in the future because of
> availability
> ease of production and dissemination
> potential for high morbidity/mortality
rates and major health impact
 Category C – Agents

DHS/NTC
Nipah virus and hantavirus
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Most Common Syndromes in
Biological Events





Flu-like illnesses
Acute respiratory symptoms with fever
Gastrointestinal symptoms/syndromes
Skin lesions (small pox)
Acute neuromuscular syndromes
Compliments of CDC/NIP/Barbara Rice
DHS/NTC
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Clues to Biological Potential Events
 Increase in the number of patients with similar
symptoms
 Large number of deaths
 Cluster of an illness from single area
 Infection that is not endemic to area
 Common infections in unusual seasons
 Increase/large number of sick/dead animals
 Intelligence from law enforcement
 Stated threat
DHS/NTC
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Priorities for Response
(All Hazards)
 Life safety


Staff
Victims
 Incident stability
 Property preservation
 Protection of the environment
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Response Considerations for
Biological Event
 Planning:

Develop policies and procedures for:
• recognition
• notification
• isolation/quarantine
 Pre-exposure:



DHS/NTC
Active immunization
Prophylaxis
Intelligence information
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Response Considerations for
Biological Event (Cont’d)
 Incubation Period:




Diagnosis
Active/passive immunization
Antimicrobial treatment
Public Health needs (isolation/quarantine)
 Active Disease Period:



Diagnosis
Treatment (guided by diagnosis & symptoms)
Public Health needs (isolation/quarantine)
DHS/NTC
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Clinical Consideration for
Biological Event
 Basic supplies/address surge capacity:




Beds/linens
Waste management
Lab supplies
Medical supplies:
• IV solutions and supplies
• Antibiotics (if needed)
• Other medications
DHS/NTC
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Clinical Consideration for
Biological Event (Cont’d)
 Additional needs:





Extended staffing plan (clinical/non-clinical)
Medical staffing plan
Mass casualty plan
Mass fatality plan
Media management plan (Joint Information Center)
• Mechanism to provide updates/info to staff
DHS/NTC
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Clinical Consideration for
Biological Event (Cont’d)
 Additional needs:





DHS/NTC
Infection Control Practitioner (from hospital)
Public Health representative
Considering activating the hospital ICS/UCS
Family support area
Pharmaceutical stockpiles
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Key Points
 Some exposures may require decontamination but
most do not
 Large events may overwhelm your system
 Assure that the right people are notified and included
in the response

Implement Incident Command System
DHS/NTC
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Reminders
 Determine alternate care sites in the Planning Phase
 Work with community partners in the Planning Phase
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Potential Chemical Agents




Nerve Agents
Blister Agents (vesicants)
Pulmonary Agents
Blood Agents (cyanides)

Toxic Industrial Chemicals
 Riot Control Agents
View from World Trade Center. Compliment of CDC.
DHS/NTC
B461 Course
83
Comparative Toxicity of Agents
6000
5000
4000
Ct50
(mg-min/m3)
3000
2000
1000
0
AGENT
DHS/NTC
CL
CG
AC
(L)
(L)
(L)
H
GB
VX
(L)
(L)
(L)
B461 Course
84
Nerve Agents
 Actions:

Interferes with the action of the nervous system
 Similar to organophosphates
 Types:





Sarin (GB)
Tabun (GA)
Soman (GD)
GF
VX
Tokyo, Japan Response to Sarin Attack.
DHS/NTC
B461 Course
85
Blister Agents
 Actions:

Cause cellular damage leading to cellular death (skin,
mucous membranes, eyes, systemic effects)
 Effects begin immediately, but blisters may be delayed
(mustard)
 Types:





Mustard aka “mustard gas” (H)
Sulfur mustard (HD)
Lewisite (L)
Mustard and Lewisite (HL)
Phosgene Oxime (CX):
• Pulmonary agent with vesicant effects
Iran Victim of Mustard Agent Attack, CDC
DHS/NTC
B461 Course
86
Pulmonary Agents
 Actions:


Damages the lining in the lung and cause fluid leakage
Delayed pulmonary edema
 Types:



Phosgene (CG)
Chlorine (CL)
Ricin
Pulmonary edema. Compliments of CDC.
DHS/NTC
B461 Course
87
Blood Agents: Cyanides
 Actions:

Blocks the use of oxygen in the cells of the body
• Causing asphyxiation in each cell

Least toxic of the “lethal” chemical agents
 Types:

AC and CK
 Toxic industrial chemicals (TIC):



Chlorine, ammonia, arsenic
Hydrocarbon (benzene)
Highly toxic, corrosive and irritating chemicals
 Likely terrorist’s targets of opportunity
DHS/NTC
B461 Course
88
Riot Agents
 Actions:

Causes irritation to eyes, mouth, throat, lungs and
skin
 Immediate symptoms are intense and cause people
to try and stop the effects
 Types:

Mace
 Pepper Spray
DHS/NTC
B461 Course
89
Clues To Potential
Chemical Exposure






Shortness of breath/respiratory difficulty
Itchy/burning/watery eyes
Runny nose
Skin irritation
SLUDGE
Patients reporting odor just prior to symptoms
DHS/NTC
B461 Course
90
Clues To Potential
Chemical Exposure (Cont)





Increase number of patients with same symptoms
Sick/dead animals and birds
Sick/affected first responders
Intelligence from law enforcement
Stated threat
DHS/NTC
B461 Course
91
Planning Considerations for
Chemical Agents
 Planning Phase









Hazard assessment
Designate Triage and Decon areas
Develop Respiratory Protection Program
Develop Decontamination Program
Implement Incident Command System
Purchase equipment
Develop policies and procedures
Train staff
Practice and exercise
DHS/NTC
B461 Course
92
Response Plan Considerations
for Chemical Agents
 Recognition
 Prevent secondary contamination
 Escort patient immediately outside/to decon area
 Initiate hospital HazMat response:
 Notify appropriate staff
 Don appropriate CPC&E
DHS/NTC
B461 Course
93
Response Plan Considerations for
Chemical Agents (Cont)
 Determine need for decontamination
 Decontaminate patients
 Provide appropriate medical care
 Decontaminate staff
 Secure area
 Decontaminate equipment, as appropriate
DHS/NTC
B461 Course
94
Antidotes Are Available for
Some Chemical Agents
 Nerve agents/organophosphates
Atropine – blocks the effects of the chemical that
causes over stimulation
 2PAMCl – neutralizes the nerve agent actions
 CANA – Convulsive Antidote, Nerve Agent

• Diazepam, when required
 Cyanide

Cyanide Kit contains
• Amyl nitrate (inhalant)
• Sodium nitrite (injectable)
• Sodium thiosulfate (injectable)
DHS/NTC
B461 Course
95
Hospital Partners for Biological &
Chemical Response Plans
PIO
ED Staff
Legal
Risk & Materials
Management
Housekeeping
HazMat Team
Patient
Laboratory
Clinical Services
Infection Control
Plant Operations
Hospital Emergency
Management
Administration
DHS/NTC
B461 Course
96
Community Partners for Biological &
Chemical Response Plans
EMS
CDC
Local Health Dept
LEPC
Local Haz Mat Team
Hospital
County Emergency
Management
State Lab
Law Enforcement
Elected Officials
Media
State Health Dept
FBI
DHS/NTC
Coroner
B461 Course
97
Key Points
 Some exposures may require decontamination but
you must determine if patient was actually
contaminated
 Large events may overwhelm your system quickly
and without notice
 Notified and included the right people in the response
DHS/NTC
B461 Course
98
Summary
 Routes of exposure for chemical and biological
agents
 Overview of some potential biological and chemical
agents used in terrorism
 Overview of common syndromes
 Guidelines for response plans
DHS/NTC
B461 Course
99