MCMs and other effective treatments can significantly reduce the harm caused by many chemical incidents, mitigating resulting injuries and saving lives. In many instances, chemical exposures can be treated using locally-held MCMs, although challenges to administering those treatments remain. In particular, some countermeasures must be applied very soon – within an hour – after exposure to save lives, meaning that earlier intervention can improve clinical outcomes. Therefore, first responders should be equipped to administer such countermeasures whenever possible. Further, large quantities of appropriate antidotes may not be at the ready. Many hospitals stock only enough of these types of drugs to treat a few patients, and are not adequately supplied and equipped to treat mass chemical casualties. Unfortunately, for some chemical exposures, no immediate, specific medical treatment or therapeutic will be available locally.
Thus, even smaller-scale chemical incidents may result in the need for more chemical-specific MCMs or other resources than are present in a single community. This further challenges a jurisdiction’s ability to provide lifesaving treatments quickly. For particular chemicals, the CHEMPACK component of the Strategic National Stockpile (SNS) program represents an efficient mode for the nearly immediate provision of extra MCMs to affected areas.
CHEMPACKs are containers of nerve agent antidotes placed in secure locations in local jurisdictions around the country to allow rapid response in the event of an attack on civilians with nerve agents. Most are located in hospitals or fire stations selected by local authorities to support a rapid HazMat response and can be accessed quickly when needed. Even so, CHEMPACKs face challenges to their effective use. Firstly, their usefulness is more or less restricted to response to nerve agent attacks, including poisoning with organophosphate or carbamate pesticides. Further, CHEMPACKs do not include supplies for responder workforce protection; therefore, implementing specific plans for the co-deployment of a cache of PPE and other supplies would augment the ability of responders to quickly and safely leverage CHEMPACKs in a mass casualty treatment scenario. Moreover, while more than 90 percent of the U.S. population is within 1 hour of a CHEMPACK location,82 the lack of effective logistics plans in most jurisdictions may hinder their timely deployment. Given the rapid onset of most nerve agent (and similar) exposures, any delays in treatment can present a challenge to lifesaving capabilities.
Depending on the size, scope, and type of chemical involved in an incident, additional MCMs and other supplies may be available for delivery from the SNS (non-CHEMPACK) to the affected area. The SNS, which is managed by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR), holds stocks of pharmaceuticals (medications, antibiotics, IVs) and medical supplies (e.g., equipment, surgical items, PPE, etc.) that may be required to control and/or respond to a public health emergency. However, activation of the SNS is generally too slow a process to effectively aid in the initial treatment of chemical casualties, as the governor of the affected state must request SNS resources, and delivery times (not including distribution to area hospitals for support of patient care) are 12 hours in the best case. When the MCM has no treatment benefit after the day of exposure, planners should assume that the main use of the SNS is to replenish local stocks.
The non-pharmaceutical interventions discussed in KPF 4, Control the Spread of Contamination (evacuation or sheltering-in-place, facility closure, food recall, and isolation of goods and materials), may be used as a stopgap measure to bridge the time not only between recognition of the incident and containment of the released substance, but also between event recognition and the arrival of additional therapeutics, or as the predominant intervention when therapeutics to treat the exposure do not exist.
Footnotes
82. U.S. Department of Health and Human Services. (2017, September 9). Calling on NDMS. Public Health Emergency, Office of the Assistant Secretary for Preparedness and Response.