1. State of Mississippi CHEMPACK Training Program
The Mississippi State Fire Academy [MSFA] & MSDH Office of Emergency Planning & Response [A Partnered Program]
State of Mississippi CHEMPACK Training Program
Sponsored by: Mississippi State Department of Health
- Office of Emergency Planning & Response

2. Mississippi CHEMPACK Training Program
Module One:
Introduction and Overview

3. Video

4. CHEMPACK Module One: Introduction & Overview
This module is targeted towards:
Hospital personnel
First Responders (Police, Fire, EMS)
Public Health professionals
Emergency Management professionals

5. CHEMPACK Objectives: Describe the CHEMPACK Program.
Determine which situations require CHEMPACK assets.
List the agencies involved in CHEMPACK.
Explain the role each agency plays in CHEMPACK.

6. What is the CHEMPACK Program?
Part of the Strategic National Stockpile program.
Developed by the U.S. Centers for Disease Control and Prevention or “CDC”.
Provides pre-positioning of nerve agent antidotes for faster response during an emergency.
Increases state & local capacity to respond to nerve agent incidents.
Allows for the rapid deployment of nerve agent antidotes to first responders and hospital personnel to treat large numbers of victims exposed to a nerve agent incident.
The CHEMPACK program is an ongoing initiative of CDC's Division of Strategic National Stockpile (SNS) launched in The CHEMPACK program provides antidotes (three countermeasures used concomitantly) to nerve agents. CHEMPACK containers are for pre-positioning by State, local, and/or tribal officials throughout the U.S. The CHEMPACK Program is envisioned as a comprehensive capability for the effective use of medical countermeasures in the event of an attack on civilians with nerve agents. In addition CHEMPACK can be used in cases where an accidental organophosphate exposure occurs.

7. What is the Strategic National Stockpile (SNS)?
Provides large quantities of medicine and medical supplies.
Includes “12 Hour-Push Packs” available for rapid deployment in an emergency.
Vendor Managed Inventory
CHEMPACK
Federal Medical Stations
The Strategic National Stockpile (SNS) is the United States' national repository of antibiotics, vaccines, chemical antidotes, antitoxins, and other critical medical equipment and supplies. The locations of these warehouses are secret. They contain an inventory of over $7 Billion Dollars.

8. SNS Push Packs First line of support Strategically located
Delivered within 12 hours after decision to deploy.
Contains pharmaceuticals, antidotes, and medical supplies.
Used for an ill defined threat in the early hours of an incident.
If a community experiences a large-scale public health incident in which the disease or agent is unknown, the first line of support from the stockpile is to send a 12-hour Push Package. Push packages contain a broad-range of pharmaceuticals and medical supplies. Contents are pre-packed and configured in transport-ready containers for rapid delivery anywhere in the United States within 12 hours of the federal decision to deploy. Each package contains 50 tons of emergency medical resources.
All states have plans to receive and distribute push packages quickly to local jurisdictions.
**Mississippi was the first state to request, receive, and distribute a SNS Push Pack. This was after Hurricane Katrina when the pharmaceutical infrastructure had been heavily impacted.

9. SNS Managed Inventory (MI)-Vendor
Stored and managed by medical vendors.
Arrives within hours.
Medications and medical supplies.
May be requested after the 12 hour-Push Pack has arrived when an agent has been identified.
Used when an agent is well defined.
Vendor managed inventory (VMI) can be used to provide additional specific items following a previously deployed 12-hour Push Package or as an initial response, depending on the situation. When it is obvious that a 12-hour push package alone will not meet the needs of the affected jurisdiction, CDC may deploy managed inventory following a previously deployed push package.

10. Why the CHEMPACK Program?
Nerve agents can cause rapid system failure.
Antidotes can reverse symptoms if administered in a timely manner.
Most hospitals & pharmacies don’t stockpile nerve agent antidotes.
CHEMPACK antidotes are packaged to be rapidly deployed and administered.
It’s a terrifying but plausible scenario. You’re in an enclosed crowded place—perhaps a subway or a mall—and a terrorist organization releases lethal quantities of a nerve agent such as sarin into the air. The gas sends your nervous system into overdrive. You begin having respiratory distress and convulsions. EMTs rush to the scene while you go into respiratory failure. If they have nerve agent antidotes with them, you may have a greater chance of living. If they don’t, you may be more likely to die. Will you survive?
Thanks to CDC’s Strategic National Stockpile CHEMPACK program, the answer is more likely to be yes.
CHEMPACKs are deployable containers of nerve agent antidotes that work on a variety of nerve agents.
Traditional stockpiling and delivery would take too long because these antidotes need to be administered quickly.

11. What are Nerve Agents?
One of several categories of potentially harmful chemicals.
Can be inhaled, swallowed, or absorbed through the skin.
Attack the nervous system, can result in severe injury or death.
Nerve agents, sometimes also called nerve gases, are a class of organic chemicals that disrupt the mechanisms by which nerves transfer messages to organs.

12. Examples of Nerve Agents/Organophosphates?
Chemical nerve agent weapons:
Sarin
Tabun
Soman
Cyclosarin VX
Organophosphate Pesticides:
Parathion
Malathion
Chlorpyrifos
Diazinon
There are 5 classes of nerve agents:
G-series - the first and oldest- Sarin is a G-series nerve agent
V-series - Invented in the 1950s- VX is an example of a V-series nerve agent
Novichok Agent - Developed by the Russians- it is a series of organophosphates
Carbamates - Developed by the Russians and the US during the cold war. Also used in insecticides
Insecticides - Some insecticides, including carbamates and organophosphates such as dichlorvos, malathion and parathion,
are nerve agents

13. Agricultural accident
Nerve Agent Incidents
Intentional release
Tokyo, Japan in 1995 when the cult Aum Shinrikyo
released Sarin.
Agricultural accident
San Joaquin Delta in California September 2006 pesticide drift sent 34 workers to the hospital.
The Tokyo subway sarin attack (Subway Sarin) was an act of domestic terrorism perpetrated on 20 March 1995, in Tokyo, Japan, by members of the cult movement Aum Shinrikyo.
In five coordinated attacks, the perpetrators released sarin on three lines of the Tokyo Metro (then part of the Tokyo subway) during rush hour, killing 12 people, severely injuring 50 (some of whom later died), and causing temporary vision problems for nearly 1,000 others.

14. Mississippi is an agriculture state
Mississippi is an agriculture state. The use of organophosphates (pesticides) is commonly used in farming operations.

15. Signs & Symptoms of Nerve Agent Exposure
“SLUDGEMM”
Salivation
Lacrimation (tearing)
Urination
Defecation
Gastrointestinal upset
Emesis (vomiting)
Muscle twitching
Miosis (pinpoint pupils)
Depending on the amount of exposure and the time of exposure, you may witness varying symptoms in stages with victims.

16. Nerve Agent Antidotes
The 3 drugs included in CHEMPACK can reverse the effects of nerve agent exposure:
Atropine Sulfate-blocks action of acetylcholine at receptors.
Pralidoxime Chloride (2PAM)-reactivates acetylcholinesterase.
Diazepam-anti-convulsant.
Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings by blocking the acetylcholine receptors to reduce symptoms such as salivation, bronchial and lung secretions, involuntary urination and ultimately convulsions and possibly death.
Pralidoxime injection is used with atropine. Pralidoxime reactivates acetylcholinesterase to treat poisoning caused by organic phosphorus pesticides (e.g., Diazinon, Malathion, Mevinphos, Parathion, and Sarin) and by organophosphate chemicals (“nerve gases”) used in chemical warfare.
Diazepam is used to treat muscle spasms from injury, inflammation, or nerve disorders.

17. What Exactly is a CHEMPACK?
A secure container of nerve agent antidotes.
Prepositioned with local hospitals for faster response.
Monitored remotely by the CDC.
Maintained through the Shelf Life Extension Program (SLEP).
Provides local control of critical life-saving assets
CHEMPACKs are deployable containers of nerve agent antidotes that work on a variety of nerve agents and can be used even if the actual agent is unknown.
The containers are remotely monitored 24/7 by CDC for container entry and temperature.

18. CHEMPACK Management & Oversight
CDC - owns and manages CHEMPACK assets and conducts periodic inspections.
Mississippi State Department of Health- oversees/supports receipt, maintenance, and monitoring of CHEMPACKs and also serves as liaison to the CDC.
Host Hospitals- ensure the proper storage and security of CHEMPACK assets.

19. Mississippi CHEMPACK Allocations
14 CHEMPACKS strategically located throughout the state:
10 Hospital CHEMPACKS
4 EMS CHEMPACKS
13 Host Hospital locations
Although not as secret as it once was, the locations of the CHEMPACKS are on a “need to know” basis.
However, as long as you have the number to request the pack you are set. The closest pack to you will be deployed to the location of the incident (EMS) or hospital.

20. CHEMPACK Configurations
Two different configurations:
Hospital (geared to clinical care environment)
EMS (geared to first responders)
Both stored at hospitals.
EMS containers treat up to 454 casualties:
85% Auto Injectors
15% Multi-dose vials
Hospital containers treat up to 1000 casualties:
100% Multi-dose vials

21. CHEMPACK Configurations: EMS
EMS CHEMPACK Container for 454 Casualties
** EMS container will contain either Mark 1 or ATNAA auto-injectors – not both 
Quantity
Unit Pack
Cases
Mark I auto-injector**
1200
200 6
ATNAA Auto –injector with 240 kits**
240 5
Atropine Sulfate 0.4mg/ml 20ml
100 1
Pralidoxime 1gm inj 20ml
276
Atropen 0.5 mg
144
Atropen 1.0 mg
Diazepam 10 mg auto-injector
300
150 2
Diazepam 5 mg/ml vial, 10ml 50
Sterile water for injection (SWFI) 20cc Vials
Sensaphone® 2050
Satco B DEA Container
The amount of container contents deployed will be based on the incident size and number of victims. This is true for both the EMS and Hospital packs. Casualty capacity estimates (454 for EMS, 1000 for Hospital) are best-case scenarios, as severely exposed patients may require more doses of the various drugs found in the Chempack.
CHEMPACK container contents may occasionally vary due to availability of medications

22. CHEMPACK Configurations: Hospital
Hospital CHEMPACK Container for 1000 Casualties
Quantity
Unit Pack
Cases
Atropine Sulfate 0.4mg/ml 20ml
1100
100 11
Pralidoxime 1gm inj 20ml
3312
276 12
Atropen 0.5 mg
144 1
Atropen 1.0 mg
Diazepam 10 mg auto-injector
150
Diazepam 5 mg/ml vial, 10ml
650 50 13
Sterile water for injection (SWFI) 20cc Vials
2800 28
Sensaphone® 2050
Satco B DEA Container
Casualty capacity estimates (454 for EMS, 1000 for Hospital) are best-case scenarios, as severely exposed patients may require more doses of the various drugs found in the Chempack.
CHEMPACK container contents may occasionally vary due to availability of medications

23. When are CHEMPACKS Needed?
CHEMPACKs should be deployed in the event of a suspected nerve agent incident that will:
Potentially overwhelm local supplies of antidotes.
Put multiple lives at risk.
Threaten the health of the community.
There are 5 classes of nerve agents:
G-series - the first and oldest- Sarin is a G-series nerve agent
V-series Invented in the 1950s- VX is an example of a V-series nerve agent
Novichok Agent - Developed by the Russians- it is a series of organophosphates
Carbamates - Developed by the Russians and the US during the cold war. Also used in insecticides
Insecticides - Some insecticides, including carbamates and organophosphates such as Dichlorvos, Malathion and Parathion,
are nerve agents

24. Agencies Involved in the CHEMPACK Program
Emergency Medical Services
Fire & Rescue
Hospitals
Law Enforcement
Emergency Management
Public Health

25. The Role of Fire & EMS in CHEMPACK
Fire and EMS establish Incident Command, and determine if CHEMPACK assets are needed.
EMS or Fire Department may be tasked with transporting CHEMPACK assets.
Paramedics administer antidotes to persons affected in the field.

26. The Role of Hospitals in CHEMPACK
Hospital personnel need to recognize nerve agent exposure signs & symptoms.
Host hospitals prepare CHEMPACK assets for transfer to the field and other hospitals.
Other hospitals prepare to receive and administer antidotes.

27. The Role of Law Enforcement in CHEMPACK
State and local police
On-scene security
Hospital security
CHEMPACK Transport and/or Escort security

28. The Role of MEMA in CHEMPACK
Receives request for CHEMPACK assets from field responders or hospitals.
Notify the host hospital to mobilize CHEMPACK assets to the field and nearby hospitals (See MEMA Notification Chart).
Coordinates requests for additional assistance (See MEMA Notification Chart).

29. MEMA Notification Chart
Organophosphate event occurs -- MEMA is notified
MEMA
Call #1
Chempack Host Hospital notification
Call #2 Transporting Agency #1
Call #3
2nd nearest Chempack Host Hospital notification to place them on alert status
Call #4
Notify MSDH Watch Officer
Call #5
Notify EMA in County of incident
Call #6
Notify EMA in County of Host Hospital
See MSDH Chempack Transportation Plan for specific Chempack Hospital to determine primary transporting agencies and POCs
See MSDH Chempack POC Chart for POC contact information
If Transporting Agency #1 is not available: Call Transporting Agency #2
MSDH Director of Health Protection
(Watch Officer Call #1)
MSDH Director of OEPR
(Watch Officer Call #2)
MSDH Ops/Log Chief or MSDH Ops/Log Deputy
(Watch Officer Call #3)
MSDH Chempack Coordinator
(Watch Officer Call #4)
MSDH ERC in county of incident
(Watch Officer Call #5)
If Transporting Agency #2 is not available: Call Transporting Agency #3

30. The Role of Public Health in CHEMPACK
Not involved in the request, receipt, or administration of CHEMPACK assets.
Involved in epidemiologic investigation.
Assist with risk communication, disaster mental health services, and demobilization activities.

31. Mississippi CHEMPACK Program
Module One QUESTIONS?

32. Donna.Dreiling@msdh.ms.gov To request a Chempack presentation contact: