1. NLM’s Free Downloadable, Online, and Smartphone
Tools for First Responders and Others.
Part 2: CHEMM (Chemical Hazards Emergency
Medical Management)
Pertti (Bert) J. Hakkinen, Ph.D.
Senior Toxicologist, and Toxicology and Environmental Health Science Advisor
Specialized Information Services, National Library of Medicine
National Institutes of Health
Also:
Adjunct Associate Professor, Biomedical Informatics Department, F. Edward
Hébert School of Medicine, Uniformed Services University of the Health Sciences
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2. NLM’s challenges
Need to compile authoritative, trustworthy information
Information needs to meet the needs of the users
Users need to have access when and where they need it
Users need easy access, e.g., during emergencies
Information evolves
Ways to deliver and access the information evolve
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3. Chemical Hazards Emergency Medical Management
(CHEMM) http://chemm.nlm.nih.gov/
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4. CHEMM was announced and released in July, 2011
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5. CHEMM – Overarching Goals
 Provide a comprehensive, user-friendly resource that will
enable first responders, first receivers, other healthcare
providers, and planners to plan for, respond to, recover
from, and mitigate the effects of a mass-casualty incident
involving chemicals
 Be available on the Internet and also for download so
that it can be used in an emergency even without an
Internet connection
 Scope – to be used for:
 Training
 Planning
 Response at time of an emergency
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6. Collaborative effort between:
U.S. Department of Health and Human Services, Office
of the Assistant Secretary for Preparedness and
Response (ASPR) - Office of Preparedness and
Emergency Operations (OPEO)
National Institutes of Health, National Library of
Medicine - Division of Specialized Information Services
(NLMSIS)
Many medical, emergency response, toxicology,
industrial hygiene, and other experts
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7. CHEMM - Audiences
 Responders
 Pre-hospital
 Hospital-based
 Emergency Department
 Critical Care
 Healthcare providers: follow-up/recovery
 Planners
 Trainers
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8. Role-based Navigation and Key Features
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9. Role-based Navigation
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10. National Library of Medicine
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11. National Library of Medicine
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12. National Library of Medicine
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13. Introduction of Key Component #1:
CHEMM-IST
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14. Toxic Syndromes Diagnostic Expert System
 CHEMM toxic syndromes diagnostic system is “CHEMM-
IST” (CHEMM Intelligent Syndromes Tool)
 “FALCON: A Decision Support System for Hazardous
Materials Incidents and Terrorism Response” is the
foundation
 Experts (physicians and EMTs) have provided extensive
technical consultation for implementation of the prototype
rule base for toxic syndrome diagnosis
 Input of symptoms identifies the chemical group or
syndrome likely to cause the symptoms so treatments can
be rapidly initiated
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15. CHEMM-IST
The CHEMM Intelligent Syndromes Tool
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16. CHEMM-IST is being validated
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17. After Two Questions
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18. After Eleven Questions. Done!
http://chemm.nlm.nih.gov/chemmist.htm
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19. Introduction of Key Component #2:
Medical Management Content
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20. • Detailed step-by-step medical management
guidelines for first responders at the scene and
providers in the hospital including the emergency
department and intensive care
• Guidelines for children, pregnant women, and elderly
patients
• Extensive input from other physicians
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21. Example of Medical Management Content:
Prehospital Management
 Agent Management
Overview
 Hot Zone
 Decontamination Zone
 Support Zone
and more
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22. Example of Medical Management Content:
Emergency Department/Hospital
Management
 Agent Management
Overview
 Hot Zone
 Decontamination Zone
 Treatment Area
and more
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23. Resource comparison tool in CHEMM version 1.0
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24. National Library of Medicine
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25. National Library of Medicine
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26. In Progress
Enhance Chemicals Content
Develop and add content to CHEMM. Goal: Include information
on all or nearly all key chemicals.
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27. In Progress
Medical Countermeasures Database Creation
Project to create a database searchable for the current
information on medical countermeasures relevant to CHEMM-
relevant hemical exposures, e.g., efficacy, relevant
publications and toxicity profiles, research in progress, FDA
and other global regulatory status…
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28. CHEMM Outreach
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29. CHEMM in the News
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30. Chemical Hazards Emergency Medical Management
(CHEMM) http://chemm.nlm.nih.gov/
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31. Providing Access (Smartphone apps will be added later)
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32. http://www.ncbi.nlm.nih.gov/pubmed/22289097
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33. Radiation Emergency Medical Management
(REMM)
http://www.remm.nlm.gov/
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34. Respond to Mass Casualty Radiation
Events
Provide:
 Guidance for health care providers about clinical
diagnosis and treatment during mass casualty
radiological/nuclear events
 Evidence-based information that makes complex
issues understandable to those without formal
radiation medicine expertise
 Web-based information that is also downloadable in
advance and available if the Internet is not accessible
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35. How can you access REMM?
 Web – www.remm.nlm.gov
 Downloadable versions for Windows and Mac
 Mobile REMM, with selected key files from the full
version of REMM
 iPhone®/iPod touch®
 BlackBerry®
 Windows Mobile®
 Android®
 Palm OS®
 Selected content included in WISER
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36. What have we learned from work on WISER,
CHEMM, and REMM?
Authoritative, trustworthy information is needed – need
many types of expertise and collaboration
That information needs to meet the needs of the users –
need to interact with users to know/confirm needs. Expert
models and mental models research (CHEMM)
The users need to have access when and where they
need it – need to keep up with devices/platforms
The users need easy access, e.g., during emergencies –
make it easy to access, and provide online,
downloadable, and in person training resources
National Library of Medicine
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37. Some of the Next Steps
 Continue sustainment and development of CHEMM,
REMM and WISER
 Engagement with experts to keep the content up to date
 Assure updates are widely available on mobile devices
 Seek to create similar tools for other scenarios
 Continue to explore and develop options for outreach and
education
 Given fiscal constraints, explore additional collaborations
and sources of help and funding
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38. How to stay informed
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39. http://disasterinfo.nlm.nih.gov/
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40. http://disasterinfo.nlm.nih.gov/dimrc/disasterapps.html
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41. " Comments?
" Suggestions?
Pertti (Bert) J. Hakkinen, Ph.D.
Senior Toxicologist, and Toxicology and Environmental Health
Science Advisor (to the Director)
Specialized Information Services, National Library of Medicine
National Institutes of Health
Bethesda, MD USA
pertti.hakkinen@nih.gov http://sis.nlm.nih.gov/
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