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What's New on CHEMM?
Version 1.2, November 2014
- CHEMM is now available as part of WISER
- Report on Toxic Chemical Syndromes: Definitions and Nomenclature
- CHEMM Chemical Toxidrome Lexicon Outreach Plan
- CHEMM-IST Evaluation and Validation Plan
- Chemical Suicides: Information for Responders
- Insight into How Potential Users Think Through and Make Decisions in a Chemical Exposure-related Mass Casualty Incident
- Updated and Enhanced CHEMM Contents
- Recent CHEMM Presentations
- The NIH CounterACT Program Funded Three CHEMM Projects
- CHEMM is Now Noted in U.S. Government Websites
- Coming Soon: CHEMM Cards! Quick Reference Cards for Toxidromes
- Other Coming Soon on CHEMM
CHEMM is now available as part of WISER
CHEMM content is now in NLM's WISER (Wireless Information System for Emergency Responders), including WISER as a download to your computer, as WebWISER, and as Smartphone and tablet apps (iOS and Android devices).
CHEMM integration brings the following new features to WISER:
- New hospital provider and preparedness planner profiles, along with a customized home screen for all WISER profiles
- Acute care guidelines for six known mass casualty agents/agent classes
- The addition of a wealth of CHEMM reference material
- CHEMM Intelligent Syndrome Tool (CHEMM-IST), a new help identify tool designed to diagnose the type of chemical exposure after a mass casualty incident
Report on Toxic Chemical Syndromes: Definitions and Nomenclature
An Interagency Agreement between the Department of Homeland Security (DHS) Office of Health Affairs (OHA) and the National Library of Medicine led to a workshop to discuss and develop a consistent lexicon to describe toxic chemical syndromes, or toxidromes. This workshop included practitioners and experts in emergency response, emergency medicine, and medical toxicology developed names and definitions for twelve unique toxidromes that describe and differentiate the clinical signs and symptoms from exposures to chemicals. These toxidromes focus on acute signs and symptoms caused by inhalation and dermal exposures, and each toxidrome is characterized by exposure routes and sources, organs/systems affected, initial signs and symptoms, underlying mode of action, and treatment/antidotes. The toxidrome names and definitions are designed to be readily understood and remembered by users since communication in a crisis requires accurate and succinct terms that can quickly convey the health conditions of patients. These toxidromes lay the foundation for a consistent lexicon for use in CHEMM and for other uses that, if adopted widely, will improve response to chemical mass exposure incidents.
Report to the Toxic Chemical Syndrome Definitions and Nomenclature Workshop (PDF - 2.01 MB) (May, 2012)
CHEMM Chemical Toxidrome Lexicon Outreach Plan
Toxidromes can be defined by a unique set of clinical observations. The toxidromes described in this plan are used in the Chemical Hazards Emergency Medical Management (CHEMM) system and are proposed as the foundation for a consistent lexicon. This document is an outreach plan whose goal is to raise widespread awareness and encourage use of the toxidromes throughout the stakeholder community.
Comments on the plan are welcome and can be sent to CHEMM at NLMCHEMM.mail.nih.gov.
CHEMM Chemical Toxidrome Lexicon Outreach Plan (PDF - 121 KB)
CHEMM-IST Evaluation and Validation Plan
This document describes an evaluation and validation plan for CHEMM-IST that, once completed, will move CHEMM-IST from its current state as a prototype to a product ready for use in an operational response environment.
Comments on the plan are welcome and can be sent to CHEMM at NLMCHEMM.mail.nih.gov.
CHEMM-IST Evaluation and Validation Plan (PDF - 159 KB)
Chemical Suicides: Information for Responders
A relatively new approach to suicide - using toxic gases generated by the combination of consumer products or common household chemicals - has unfortunately become more prevalent in recent years. The vapors, especially when trapped in an enclosed space, may exist in concentrations that can be hazardous to first responders and others.
Chemical Suicide - The Risks for Emergency Responders describes:
- The most common approaches and types of consumer products and chemicals used
- The signs to look for at the event scene and the hazards emergency responders may encounter
- Response considerations that first responders must be aware of
Insight into How Potential Users Think Through and Make Decisions in a Chemical Exposure-related Mass Casualty Incident
Work has been completed on a multi-year CHEMM research program to gain insight into how potential users think through and make decisions in a chemical exposure-related mass casualty event. This research project followed a multi-step, mental modeling research approach. Expert models have been developed by a CHEMM contractor working with the NLM project team and through a workshop with expert stakeholders to identify key influences on the effectiveness of the CHEMM. Further, mental models research interviews have been conducted examining key stakeholders' beliefs about uses of CHEMM uses, desired information quality, desired CHEMM features and functions, and desired stakeholder engagement. Contact CHEMM project leader for access to this report.
Updated and Enhanced CHEMM Contents
Recent CHEMM Presentations
October, 2014. Annual meeting of the International Society of Exposure Science (ISES), Cincinnati, Ohio. A poster presentation on "Toxidromes - A decision-making tool for early response to chemical mass exposure incidents."
October, 2014. Fall Meeting of the American Industrial Hygiene Association (AIHA), Washington, District of Columbia. A scheduled CHEMM-related group discussion.
October, 2014. North American Congress of Clinical Toxicology (NACCT), New Orleans, Louisiana. A CHEMM-related presentation to the American College of Medical Toxicology's (ACMT's) Government Section.
Several years of CHEMM-related presentations, most recently in August 2014, to physicians, industrial hygienists, faculty, and others at the Uniformed Services University of the Health Sciences (USU), F. Edward Hébert School of Medicine, Bethesda, Maryland.
Several years of training presentations, most recently in May 2014, at the International Hazardous Materials Response Teams Conferences in Baltimore, MD.
March, 2014. C. Reed Hodgin, "Recognizing and Responding to Chemical-assisted Suicides," presented at Fire-Rescue International (FRI) 2014, the International Association of Fire Chiefs' annual conference and expo.
December, 2013. Annual meeting of the Society for Risk Analysis, Baltimore, Maryland. A poster presentation on "Toxidromes - A decision-making tool for early response to chemical mass exposure incidents."
June, 2013. Annual "IAFC HAZMAT (International Hazardous Materials Response Teams Conference) training session on "WISER & CHEMM Integration - One App to Remember."
March, 2013. Annual Meeting of the Society of Toxicology, San Antonio, Texas. A poster presentation on "Toxidromes - a decision-making tool for early response to chemical mass exposure incidents."
March, 2013. Annual Meeting of the Society of Toxicology, San Antonio, Texas. A poster presentation on "Chemical Hazards Emergency Medical Management (CHEMM): Chemical Specific Acute Patient Care Guidelines for Pre-hospital and Emergency Department/Hospital Management."
December, 2012. Annual meeting of the Society for Risk Analysis, San Francisco, California. Platform presentation on "Influence of the CHEMM Tool on Emergency Response to Mass Exposure of Hazardous Chemicals. Mental Models Research Stakeholder Outreach Plan"
The NIH CounterACT Program Funded Three CHEMM Projects
The NIH CounterACT program funded three CHEMM projects. CHEMM now includes a database with information on twenty-two medical countermeasures (including efficacy, relevant publications, research in progress, FDA and other global regulatory status information). Also, after recent agreement from key stakeholders on final formatting and content, CHEMM is adding an extensive new database with content on the toxic effects and other information such as patient management for fifty possible mass casualty-related chemicals.
In addition, the CounterACT funding helped develop a prototype tool to capture feedback on possible mass casualty chemical-related events, including on-site and post event information, with the goal of gaining and accessing learning from the events. Contact CHEMM project leader for online access to prototype of the CHEMMical (CHEMM Information Capture and Learning) Tool.
CHEMM is Now Noted in U.S. Government Websites
Coming Soon: CHEMM Cards! Quick Reference Cards for Toxidromes
The first in a series of quick reference aids to allow first responders to quickly identify the cause of the symptoms of a chemical exposure by toxidrome. The cards will cover immediate and ongoing symptoms, populations sensitive to the materials, examples, and common treatment protocols.
- Irritant/Corrosive (Topical)
- Irritant/Corrosive (Inhalation)
- Irritant/Corrosive (Ingestion)
- Knockdown/Aslphyxiants
- Anticoagulants
- Cholinergic
- Cellular Asphyxia (cyanide-like)
- Convulsant
- Opioid
- Stress-response/sympathomimetic
- Anticholinergic
- Exposure to Solvents, Anesthetics, or Sedatives (SAS)
Sample Reference Card for Quick Identification of Chemicals by Toxidrome (PDF - 149 KB)
Other Coming Soon on CHEMM
An expansion of the toxidromes in CHEMM-IST, from the current four to seven. Expected in beta release by end of 2014. Contact CHEMM project leader for possible expert involvement.
New or enhanced content on 50 CHEMM-relevant chemicals expected by end of 2014, including "Just-In-Time" (JIT) content for first responders and hospital providers.. Contact CHEMM project leader for early access for chemicals of interest.
Under a partnership with NLM and NIOSH, a new online tool referred to as Dermal Exposure Risk Management and Logic (DERMaL) e-tool, which provides emergency preparedness and response professionals a resource library for information related to skin exposure from chemicals, will be coming soon to CHEMM.