Biomedical Engineering Reference
In-Depth Information
disaster plan manual and be accessible to charge
pharmacists on every shift.
Development and maintenance of hospital phar-
maceutical stockpiles must be accomplished in
coordination with state and local public health
planners, state hospital and pharmacy associ-
ations, the institution's Pharmacy and Thera-
peutics Committee, and contract suppliers. Care
must be taken to develop and maintain stock-
piles that are relevant, manageable, reasonable,
and sufficient to meet projected needs of the
community for at least the first 72 hours of an
emergency. The CDC has identified and published
a list [5] of biological agents with application as
WMDs. Anthrax, Plague, Small pox, Botulism, and
Tularemia are some of the disease states possible
in this context. Typical antibiotics include tetracy-
clines, fluoroquinolones, and penicillin analogues
[6]. Quantities sufficient to provide prophylaxis
for hospital staff, public officials, public health
personnel, and emergency responders and their
families (staff support), will need to accommo-
dated. The Federal Government has made funds
available to hospitals to establish these stockpiles
through the Health Resource Services Adminis-
tration (HRSA) and the CDC. Additionally, some
state and city governments have allocated funding
for this purpose. Funding issues and sources evolve
rapidly. Hospital administrators and pharmacy
managers need to stay close to their state/national
hospital and pharmacy associations for updates and
application information.
With regard to public health emergencies precip-
itated by chemical agents, again, the CDC list
is exhaustive [5]. Based utility and efficacy, the
nerve agents have been characterized as being
among the most attractive chemical WMDs to
terrorist groups. Indeed, in recent years nerve
agents have been inflicted upon civilian popula-
tions in Japan and Iraq [7,8]. An attack by a
nerve agent will be relatively overt in nature,
resulting in casualties rapidly. Typical nerve agents
include Sarin, Tabun, and Vx. Depending upon the
specific nerve agent and dose, immediate nervous
system failure and death can result. Antidotes
include:
Atropine sulfate: an anti-cholinergic,
•
Pralidoxime
chloride
(2PAM):
an
acetyl
•
cholinesterase reactivator,
Diazepam: a benzodiazepine used in this
context as an anti-convulsant employed to
reduce the severity of acetylcholine-induced
convulsions.
•
To be successful, exposure to nerve agents
must be rendered promptly. To this end, the
CDC has developed and forward deployed their
CHEMPACK (Figure 15.1), containerized anti-
dote kits at the community level as part of
the Strategic National Stockpile (SNS) [9,10].
These CHEMPACK containers are available in two
configurations each designed to treat about 1000
patients:
Emergency Medical Service (EMS) Container
Most items packaged as auto-injectors, most
useful for first responders.
•
Hospital Container
some auto-injectors included but the majority
of doses in multi-dose vials to facilitate Emer-
gency Room and patient unit use.
•
It is to be noted that, at present, the CHEMPAK
containers do not contain ophthalmics needed to
deal with the visual disturbances and painful eye
symptoms associated with the miosis (constricted
pupils) seen with exposure nerve agents. These
ophthalmic symptoms are best treated with
commercially available ophthalmic dosage forms
Figure 15.1
Typical CHEMPACK container.
