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CHEMM Intelligent Syndromes Tool (CHEMM-IST 2.0) - Beta

CHEMM Intelligent Syndromes Tool - Beta
CHEMM-IST is a prototype decision support tool developed by experts in medicine and emergency response as an aid for identifying the chemical a patient was exposed to in a mass casualty incident. Toxic syndromes or toxidromes are easily identified with only a few observations. The key data points to determine toxidromes are easily identified by first responders with basic EMT training, such as:
  • Vital signs
  • Mental Status
  • Pupil size
  • Mucous membrane irritation
  • Lung exam for wheezes or crackles
  • Skin for burns, moistures, and color
Since CHEMM-IST is currently in the beta phase of development, it should not be used for patient care. This tool, once thoroughly tested and validated by a wide range of potential users via case studies, is intended for use by basic life support (BLS) and advanced life support (ALS) providers as well as hospital first receivers. The focus of CHEMM-IST is only on severe cases, and CHEMM-IST assumes that the patient has only inhaled the chemical and that the chemical has not deposited on the skin.
Feedback is welcome and encouraged. Please contact the CHEMM development team if you would like to offer comments about CHEMM-IST or encounter any issues with the tool.


Select a toxic syndrome below to display the appropriate medical management guidelines. Don't forget to assess the scene. CHEMM-ist Website
CHEMM-IST was unable to provide a proper prediction due to a lack of information that you provided. This may be due to: incomplete assessment of important signs and symptoms – please attempt to answer more questions; inability to obtain some answers – this will limit the ability of the tool to predict a toxidrome.

In addition, there can be difficulty assessing a range of presentations. While the tool performs best with moderately-severely affected patients, there can also be a range of presentations and mixed presentations, including the impact of “flight or fight” reactions. Reassessing patient groups over time (minutes-hour) may be useful in these cases CHEMM-ist Website

  • The scene is suspicious for chemical exposure and results in mass casualties.
  • The tool is constructed assuming the predominate route of exposure is inhalation
  • The focus is on the severe cases.
  • It does not include every possible chemical toxidrome. Exposures to other chemicals, pharmaceuticals, or toxins may not match one of the currently included syndromes.
  • Results need to be interpreted carefully because exposures to other chemicals, pharmaceuticals, or toxins or other medical conditions could mimic these syndromes.
  • The tool is for the basic life support (BLS) providers, advanced life support (ALS) first responders and hospital first receivers during a mass casualty chemical incident.
  • Although the tool’s intended use is for large-scale chemical incidents, it may be used for other chemical exposure scenarios (e.g. industrial accidents or smaller scale hazardous materials releases) and even single patient chemical exposures, but the results should be interpreted with caution.


Clicking on any question (hyperlinked) above in Progress will allow you to go back to the question to select a different answer. The subsequent answers will be erased.

CHEMM-IST Overview

The CHEMM Intelligent Syndromes Tool (CHEMM-IST) is an advanced form of "FALCON: A Decision Support System for Hazardous Materials Incidents and Terrorism Response." FALCON was developed through "knowledge engineering" at the James Madison University as an undergraduate thesis project by student James Brandon Shreckhise (2006 undergraduate project and also described in limited detail in one publication1). The key expert involved in the development of FALCON is medical toxicologist Dr. Mark Kirk, and Dr. Kirk has been involved with other experts in medicine and emergency response in the development of CHEMM-IST. Through a series of interviews by Mr. Shreckhise with Dr. Kirk during the development of FALCON, Dr. Kirk's diagnostic expertise was first modeled using decision trees. These decision trees were then engineered into IF-THEN rules and used to create a prototype expert system. CHEMM-IST started with the foundation of FALCON; however, CHEMM-IST's design and implementation is very different, and its development was primarily accomplished via several group discussions of physicians and emergency responders with the facilitation by CHEMM Team. CHEMM-IST's developers attended the group discussions to design and test CHEMM-IST in these interactive sessions.

What's New

2.0 Beta

  • 7 syndromes
  • Documentation updates and interface improvements

1.0 Beta

  • Initial CHEMM-IST Release
  • 4 syndromes

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  1. "Engineering a Medical Response Knowledge Base for FALCON: A Decision Support System for Hazardous Chemical Incidents." A Project Presented to the Faculty of the College of Integrated Science and Technology James Madison University In Partial Fulfillment of the Requirements for the Degree Bachelor of Arts by James Brandon Shreckhise. 2006.
  2. Frysinger SP , Deaton ML, Gonzalo AG, VanHorn AM, and Kirk MA . "The FALCON decision support system: Preparing communities for weapons of opportunity." Environmental Modelling & Software. 2007; 22:431-5.