The CHEMM Intelligent Syndromes Tool (CHEMM-IST [1]) is an online decision support tool created by experts in medicine and emergency response as an aid for determining what chemical agent a patient may have been exposed to in a mass casualty incident.

The tool as it stands is a still a prototype, but once out of its testing phase, the U.S. Department of Health and Human Services (HHS) says the tool will be intended for use in basic and advanced life support operations as well as by first responders diagnosing patients in an emergency involving widespread chemical exposure.

"The whole intent behind the CHEMM Web site in general is really to provide that quick and easy access for responders at the point that they need it," said John Koerner, CBRNE Branch chief at the Divison of Preparedness and Planning at HHS. "Particularly in chemical incidents, we run into the challenge that the health events happen very quickly. One of the important things is that we have valid reliable information with very quick access so that the responders can make informed decisions as to what to do."

CHEMM-IST, developed by Dr. Mark Kirk from the Department of Homeland Security Office of Health Affairs, can aid responders in quickly diagnosing the type of chemical exposure after an attack or chemical spill. "What he's done is devise a sytem that looks at syndromic predictions," Koerner said of Kirk.

"CHEMM-IST assumes that the patient has undergone an exposure via the air, with potential toxic effects from what is inhaled from the air and also possible skin-related toxic effects from what might be deposited onto the skin from the air,” reads the CHEMM Web site.

The online tool uses an interactive flow chart to guide the user through dozens of potential symptoms and based on “Yes” or “No” questions provides a prediction of the most likely syndrome a patient is experiencing.

It breaks syndromes down into four categories, including "knockdown syndrome," which commonly causes unconsciousness after exposure to blood agents like cyanide or hydrogen sulfide, and "pesticide syndrome," which can cause eye pain and seizures after exposure to pesticides or nerve agents. The other categories are "acute solvent syndrome," which causes headaches, confusion, and light headedness after exposure to chemical agents, used paint thinners, and solvents, and "irritant gas syndrome," which commonly causes ear, nose, and throat irritation after exposure to choking agents like chlorine, hydrochloric acid, and pepper spray.

For each syndrome, CHEMM-IST provides links to detailed information about each class of chemical agents [2], additional symptoms to expect, patient first aid, and suggested personnel protective equipment.

CHEMM-IST has been in development since late 2008 and was released in June.

"What we're doing now is conveining various working groups and actually doing testing with the user community, first responders, to test their ability to use the tool and to make sure the alogrithims are accurate and predictive, and to make sure the tool is set up to be usable in those first few minutes when you really need it," Korener said. 

The tool is projected to be validated and ready for use by the end of next year. The final version of CHEMM-IST will be accesible via smartphone in the field.

"CHEMM-IST is really a first of its kind," Koerner said. "There's never been an approach to looking at emergency response like this. Normal procedure is to try and identify the chemical to the best of our ability while casualties are already moving through the emergency medical system. A lot of your confirmation of what the material is can lag behind the medical management that is required for a specific toxilogical syndrome."

Using CHEMM-IST, Koerner hopes first responders can save more lives by reducing the time it takes to find out what caused the conditon and began the neccesary treatment.
 

photo by Georgia National Guard/flickr [3]

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