You are here: Home > CHEMM Intelligent Syndromes Tool (CHEMM-IST) > More About CHEMM-IST


More About CHEMM Intelligent Syndromes Tool (CHEMM-IST)


About CHEMM-IST


What is CHEMM-IST

CHEMM-IST is a tool intended to provide quick identification of category of chemicals by signs/symptoms of toxicity. It was developed to be part of the medical advisor knowledge base of a hazardous materials decision support system called FALCON, which is an acronym for Focused Analysis Linking Chemical and community data to Operational Needs. FALCON is designed to integrate elements used by emergency response personnel for planning and real-time response, such as chemical inventories, toxicity, health care readiness and population data, into a single system with risk assessment and air dispersion models.

First responders are often not trained in the area of medicine needed to equip them with the knowledge to quickly diagnose and treat victims exposed to hazardous chemicals. FALCON’s medical knowledge data base called FALCON Medical Advisor (FMA), will be capable of assisting first responders at the scene of a hazardous chemical incident. The FMA was designed to provide first responders with on-site access to the expertise of a medical toxicologist who has specialized in diagnosis and treatment of patients exposed to hazardous chemicals. As part of the FMA, CHEMM-IST provides the first responder with a quick and efficient tool to identify symptoms of a hazardous exposure and provide a prediction of the most likely toxic syndrome associated with the observed symptoms.



Basis for CHEMM-IST Algorithms

CHEMM-IST employs a multiple branching method of diagnosis. Multiple branching or arborization is defined by Sackett (1991) as “the progression of the diagnosis process down but one of a large number of potential, present paths by a method in which the response to each diagnosis inquiry automatically determines the next inquiry to be carried out and, ultimately, the correct diagnosis”. This method was obtained by using the knowledge of a medical toxicologist, Dr. Mark Kirk, to develop a rule-base for CHEMM-IST.

  • Toxic Syndromes
    A Toxic syndrome (also known as a toxidrome) is a constellation of toxic effects comprising a set of clinical fingerprints following exposure to a specific group or class of toxic chemicals. Using these syndromes, first responders can more quickly and accurately identify the type of chemical exposure which then allows them to provide the appropriate treatment. There are seven toxic syndromes commonly observed in HAZMAT/Biochemical terrorism incidents. The five assumptions under which CHEMM-IST operates allows for four of the seven toxic syndromes to be included in the tool.

    The CHEMM-IST assumptions are:
    1. The scene is suspicious for a chemical exposure.
    2. This is an inhalation exposure that does not result in condensation on the skin.
    3. The focus is on the severe cases.
    4. The tool is for Basic Life Support (BLS) provider to use in a mass casualty incident.
    5. It can also be used by Advanced Life Support (ALS) first responders and hospital first receivers.


  • Available Toxic Syndrome Predictions via CHEMM-IST
    • “Knock-down” Syndrome
      • Also known as: Metabolic Poisoning
      • Representative Chemicals: Cyanide, Hydrogen sulfide, Phosphine
      • Symptoms: Rapid loss of consciousness, Seizures, Hypotension, Cardiac arrest
    • Pesticide Syndrome
      • Also known as: Organophosphate Insecticide Poisoning or Cholinergic Storm
      • Representative Chemicals: Organophosphate and carbamate insecticides, 
Nerve agents
      • Symptoms: Pinpoint pupils, Eye pain, Shortness of breath, Wheezing, Rales, Sweating skin, Drooling, Tearing, Vomiting, Diarrhea, Fasciculations, Coma, Seizures
    • Solvent Syndrome
      • Also known as: Acute Solvent Exposure
      • Representative Chemicals: Paint thinners, Degreasors and lubricants, Toluene, Methylene chloride, Trichloroethylene
      • Symptoms: Headache, Lightheadedness, Nausea, Mucous membrane irritation, Confusion, Syncope
    • Irritant Gas Syndrome
      • Also known as: No other known name
      • Representative Chemicals: Ammonia, Chlorine, Delayed presentation seen with phosgene and nitrogen dioxide
      • Symptoms: Eye, nose, and throat irritation, Cough, Wheezing, Shortness of breath, Chest pain,
      • Caution: may be a delayed presentation


  • Other Toxic Syndromes commonly observed in HAZMAT/Biochemical terrorism incidents
    • Chemical Burns
      • Representative Chemicals: Hydrochloric acid, Hydrofluoric acid, Hydrocarbon solvents such as degreasers and defatters
      • Symptoms: Painful burning skin, Mucous membrane irritation, Systemic effects
    • Vesicant/Blister Agent Poisoning
      • Representative Chemicals: Sulfur mustard, Lewisite,
Phosgene oxime
      • Symptoms: Conjunctivitis, Erythema, Sore throat, Cough, Corneal damage, Vesicles & bullae, Nausea, Wheezing, Stridor, Laryngeal edema, Acute lung injury
    • “The Fear Factor”
      • Representative Chemicals: Often a "fight or flight" stress response from fear of chemical exposure.
      • CAUTION: low level exposure to toxins can resemble this response!
      • Symptoms : Lightheadedness, Shortness of breath, Chest pain, Fainting, Nausea, Sweating skin, Palpitations, Tremor.

top of page

References

  1. Sackett, David L., R. Brian Haynes, Gordon H. Guyatt, and Peter Tugwell. Clinical Epidemiology: a Basic Science for Clinical Medicine. 2nd ed. Boston: Little, Brown and Company, 1991. 3-18.