[Federal Register Volume 60, Number 123 (Tuesday, June 27, 1995)]
[Notices]
[Pages 33308-33312]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-15657]
[[Page 33307]]
_______________________________________________________________________
Part IV
Department of Health and Human Services
_______________________________________________________________________
Centers for Disease Control and Prevention
_______________________________________________________________________
CDC Recommendations for Civilian Communities Near Chemical Weapons
Depots: Guidelines for Medical Preparedness; Notice
Federal Register / Vol. 60, No. 123 / Tuesday, June 27, 1995 /
Notices
[[Page 33308]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
CDC Recommendations for Civilian Communities Near Chemical
Weapons Depots: Guidelines for Medical Preparedness
AGENCY: Centers for Disease Control and Prevention (CDC), Public Health
Service, HHS.
ACTION: Publication of final recommendations.
-----------------------------------------------------------------------
SUMMARY: On July 27, 1994, CDC published in the Federal Register, 59 FR
38191, ``CDC Recommendations for Civilian Communities Near Chemical
Weapons Depots: Guidelines for Medical Preparedness'' and requested
public comment. Seven people sent comments; many were responding on
behalf of governments or other institutions in affected communities.
These comments are available upon request. These recommendations
incorporate changes made in response to the comments received and
constitutes CDC's final recommendations for minimum standards for
prehospital and hospital emergency medical services' readiness in
communities near the eight locations where the U.S. stockpile of lethal
chemical weapons is stored. The eight locations are: Umatilla Army
Depot Activity, Oregon; Tooele Army Depot, Utah; Pueblo Army Depot
Activity, Colorado; Pine Bluff Arsenal, Arkansas; Newport Army
Ammunition Plant, Indiana; Anniston Army Depot, Alabama; Lexington
Bluegrass Depot Activity, Kentucky; and Edgewood Area, Aberdeen Proving
Ground, Maryland.
These recommendations were prepared to assist emergency planners in
determining emergency medical services' readiness in communities near
the 8 locations where the U.S. stockpile of lethal chemical weapons is
stored. These guidelines should not be used for any purpose other than
planning for the Chemical Stockpile Emergency Preparedness Program.
FOR FURTHER INFORMATION CONTACT: Linda W. Anderson, Chief, Special
Programs Group, National Center for Environmental Health (NCEH), CDC,
4770 Buford Highway, NE., Mailstop F29, Atlanta, GA 30341-3724,
telephone number (404) 488-7071, Facsimile Number (404) 488-4127, or
Internet Address lwa3@cehod1.em.cdc.gov.
SUPPLEMENTARY INFORMATION:
CDC Recommendations for Civilian Communities Near Chemical Weapons
Depots: Guidelines for Medical Preparedness
I. Executive Summary
In 1985, Congress mandated that unitary chemical warfare agents be
destroyed in such a manner as to provide maximum protection for the
environment, the public, and personnel involved in destroying the
agents. The Centers for Disease Control and Prevention (CDC) was
delegated review and oversight responsibility for any Department of the
Army (DA) plans to dispose of or transport chemical weapons (Public Law
91-121 and 91-441, Armed Forces Appropriation Authorization of 1970 and
1971).
As part of its ongoing efforts to improve medical preparedness
within the medical sector of civilian communities surrounding chemical
agent depots, CDC has developed the following medical preparedness and
response guidelines. These guidelines represent minimum standards of
medical preparedness for civilian communities that might be exposed to
chemical warfare agents during the incineration or storage process.
These guidelines were developed in cooperation with a panel of
recognized experts in the fields of emergency medicine, disaster
preparedness, nursing, chemical warfare preparedness, and the
prehospital emergency medical system.
II. Background
In 1985, Congress mandated that unitary chemical warfare agents be
destroyed in such a manner as to provide maximum protection for the
environment, the public, and the personnel involved in destroying the
agents. This mandate was further defined in the Department of Defense
(DOD) Authorization Act of 1986, Pub. L. 99-145. Consistent with its
desire to promote the most environmentally safe method of destroying
chemical agents, the National Research Council determined that
incineration is the best method for disposing of the weapons (1). In
1988, the Authorization Act was amended to permit DA to set up a
prototype incineration facility on Johnston Island in the Pacific in
order to verify the safety of such an operation. To date, more than
700,000 pounds of chemical agent have been safely incinerated there.
CDC was delegated the responsibility of reviewing and overseeing
any DA plans to dispose of or transport chemical weapons (Pub. L. 91-
121 and 91-441, Armed Forces Appropriation Authorization of 1970 and
1971). In addition, an interagency agreement between CDC and DA
requires CDC to provide technical assistance to the DA in protecting
the public health in nearby communities during the destruction of
unitary chemical agents and weapon systems.
Currently, large quantities of chemical warfare agents are stored
in eight facilities \1\ in the continental United States. These
chemical stockpiles consist primarily of nerve agents, mustard agents,
or a combination of both. In Tooele, Utah, construction of the chemical
agent incinerator is now complete, and destruction of the weapons and
chemicals in this depot is scheduled to begin in the Fall of 1995. To
improve the ability of local health care personnel to handle
emergencies related to a chemical agent release, CDC has presented
medical preparedness courses to civilian medical personnel on sites
adjacent to the 8 chemical weapons depots on 13 occasions. Emergency
physicians, nurses, internists, surgeons, hospital administrators, and
prehospital emergency medical responders have attended these courses.
\1\ Umatilla Army Depot Activity, Oregon; Tooele Army Depot,
Utah, Pueblo Army Depot Activity, Colorado; Pine Bluff Arsenal,
Arkansas; Newport Army Ammunition Plant, Indiana; Anniston Army
Depot, Alabama; Lexington-Bluegrass Depot Activity, Kentucky; and
Edgewood Area, Aberdeen Proving Ground, Maryland.
As part of its ongoing efforts to improve medical readiness in
civilian communities surrounding chemical agent depots, CDC developed
medical preparedness and response guidelines. These guidelines
represent minimum standards for medical preparedness in civilian
communities that might be inadvertently exposed to chemical warfare
agents during the incineration or storage process. These guidelines
were developed in cooperation with a working group of recognized
experts in the fields of emergency medicine, disaster preparedness,
nursing, chemical stockpile emergency preparedness, and prehospital
emergency medical systems. These guidelines do not supersede current
medical or public health practices and requirements (e.g., precautions
for handling bodily fluids). Local health and emergency management
officials, working with Army personnel, must analyze the nature of
possible releases at each location, determine what kinds of
intoxication and what level of contamination might be possible, and
match local or regional resources to the potential task.
[[Page 33309]]
The following recommendations for civilian community response to
the release of a chemical agent are divided into prehospital and
hospital arenas. The recommendations are designed to ensure medical
preparedness for chemical agent emergencies. Appendix A is a summary of
important questions to ask when evaluating medical preparedness in the
civilian prehospital and hospital environments. The prehospital
environment encompasses all response areas which are outside both the
installation boundaries and the hospital grounds. People potentially
affected in the prehospital environment include the general public and
first responders. First responders include police, sheriff's, and fire
department personnel, hazardous materials response teams, and medical
response teams (including emergency medical technicians, paramedics,
and any other medically trained personnel responding to the site of
injury with the ambulance teams). The hospital environment includes
primarily the emergency department but encompasses outdoor areas on the
hospital grounds that might be used for triage and decontamination and
other hospital departments that might support the hospital's response.
We cannot emphasize too strongly that actions taken within the
scope of these guidelines must also comply with all other applicable
regulations. In particular, responders considered in this paper falls
under the provisions of the Occupational Safety and Health
Administration's (OSHA) Hazardous Waste Operations and Emergency
Response (HAZWOPER) regulations (29 CFR 1910.120), the respiratory
protection regulations (29 CFR 1910.134), and other regulations
pertaining to personal protective equipment (29 CFR 1910.132, 133, 135,
and 136).
III. Recommendations for Prehospital Medical Preparedness
Integrate all local medical emergency response plans
related to the release of a chemical agent into the all-hazards State
and local disaster response plans.
Provide protective equipment for all members of the local
medical response team.
Train members of the local medical response team in these
measures:
--prevention of secondary contamination from chemically exposed
patients.
--decontamination procedures.
--evaluation of the medical needs of chemically exposed patients.
--treatment of large groups of patients.
--transportation of victims to a medical facility.
1. Personal Protective Equipment (PPE)
Chemical protective clothing and respiratory protection enable
responders to care for patients exposed to chemicals while protecting
themselves from secondary contamination.
Ensure that such equipment protects the skin, eyes, and
respiratory tracts of the emergency responders.
HHS have recommended the use of DA battledress
overgarments (BDOs) and portable air-purifying respirators (PAPRs) with
a combined high-efficiency particulate (HEPA) and organic vapor
cartridge to protect civilians from chemical warfare agents. OSHA is
reviewing this matter and will make a determination when the review
process is completed. BDOs can be used for up to 24 hours in an agent-
contaminated environment at levels of up to 10 grams of agent per
square meter of surface area. This recommendation should not be
construed as discouraging civilian emergency responders from using more
protective equipment, such as completely encapsulating suits with
supplied air respirators, providing that they have and normally use
such equipment in conformity with applicable regulations and can
perform their required duties in that equipment.
Train personnel required to use personal protective
equipment when responding to chemical agent-related emergencies in
accordance with the guidelines published by OSHA.
Establish and use work practice guidelines to ensure that
responders remain outside areas where their equipment might not be
fully protective and that they leave immediately if conditions change
such that there is uncertainty about the safety of the environment.
Use new cartridges or canisters when entering an area
where agent may be present and change them before the next use of the
respirator.
Use a buddy system and provide adequate communications and
rescue capability for each responder working near a plume area. If a
worker should experience symptoms of agent exposure and require
assistance leaving the area, rescue should be accomplished using level
A protection only.
2. First Responders
Ensure that all persons (e.g., medics, paramedics, fire
fighters, or medical personnel) designated by the State or local
disaster plans as members of the initial medical team that responds to
a chemical warfare agent release have the appropriate level of PPE and
are trained in its proper use (2).
Ensure that equipment of first responders is adequately
maintained and available at all times.
Schedule frequent drills and training sessions designed to
maintain first responders' familiarity with equipment and their role in
State and local disaster plans.
3. The Public
CDC does not recommend distributing PPE (e.g., gas masks or
protective suits) to the public. In the unlikely event that a chemical
agent release threatens the civilian population adjacent to a military
facility, CDC recommends the following graded emergency response:
Evacuate the population at risk in accordance with State
or local disaster management guidelines. If no local guidelines exist,
follow the Federal Emergency Management Agency (FEMA) and DA joint
guidelines for evacuating civilian populations threatened by chemical
warfare agents (3).
Follow FEMA and DA recommendations for sheltering the
population in place (e.g., keep people in their homes, institutions, or
places of business and seal windows and doors from an external vapor
threat) if it is not practical to evacuate the population (3).
4. Decontamination
Decontamination is the careful and systematic removal of hazardous
substances from victims, equipment, and the environment. Transporting
contaminated patients exposes emergency response personnel to chemical
warfare agents and contaminates rescue vehicles. Proper decontamination
prevents secondary contamination and chemical injury to medical and
rescue personnel. Acceptable decontamination guidelines for persons who
may possibly have been exposed to chemical warfare agents are published
by FEMA and DA (3,4). Decontamination must comply with the HAZWOPER
regulation, 29 CFR 1910.120(k).
Decontamination of patients can be achieved by
mechanically removing, diluting, absorbing, or neutralizing the
chemical agent.
Decontaminate all persons who are believed to be
contaminated with a chemical warfare agent before they are transported
to a hospital.
Decontamination substances should be readily available.
Suitable decontamination substances include soap, water, and 5%
hypochlorite.
To protect the environment, include in State and local
disaster plans a [[Page 33310]] method for containing and disposing of
contaminated runoff. CDC does not recommend establishing fixed
decontamination units in prehospital areas because of the expense and
inflexibility of such units.
5. Level of Medical Preparedness Training
At a minimum, train persons designated as prehospital
medical responders in evaluating patients exposed to chemical warfare
agents, managing patients' airways (excluding intubation), transporting
patients, and decontaminating patients.
Train prehospital responders who have been designated in
State or local disaster plans to operate in environments contaminated
by a chemical warfare agent in the proper use of PPE in accordance with
OSHA guidelines (2).
Ensure that, at a minimum, physicians who have been
designated in State and local disaster plans to provide medical
supervision for prehospital emergency responders and to provide medical
care for victims of a chemical agent release receive specialized
training through continuing education in the emergency response areas
specified for prehospital responders.
6. Patient Triage
The basic premise of patient triage, to provide maximum benefit to
the greatest number of victims, is of utmost importance during a mass-
casualty event involving chemical agents.
Have the responder most experienced in evaluating patients
conduct the triage.
Base decisions regarding patient triage on local
resources, the extent of patient contamination, the type of chemical
warfare agent to which the patient is exposed, the patient's clinical
status, and the likelihood of additional traumatic injuries.
7. Public Information
Provide the Joint Information Center (JIC) with
appropriate information to inform the public accurately and rapidly
about chemical agent exposures that have or may have occurred. If
possible, monitor information coming from the JIC and assist in
ensuring the accuracy and timeliness of that information.
Establish, through the local emergency medical services
(EMS) and hospital community, a coordinated public information policy
for all chemical emergencies.
Work with public health and emergency management officials
to contact local and regional news media in advance and establish an
accurate and rapid way of disseminating critical information to the
public concerning a chemical agent emergency.
Ensure that hospital and EMS personnel coordinate their
plans to provide public information with the plans of those who have
overall responsibility for emergency response.
8. Communication
Medical personnel must have access to the emergency communication
network 24 hours a day. Such a network should link the chemical agent
depot, local and regional EMS, and all potential receiving hospitals.
During any evaluation of preparedness for a chemical warfare release
into civilian communities:
Have medical personnel demonstrate the ability to access
the emergency communications network.
Ensure that the hospitals' emergency communications system
allows hospital personnel to verify rapidly whether a chemical warfare
agent release has occurred.
9. Transporting Exposed Victims
Coordinate the transportation of chemical agent-exposed
victims with the overall disaster response plan and include a method
for tracking transported patients during an emergency response.
Transport contaminated patients only after they have been
properly decontaminated.
Transport decontaminated patients to medical facilities
(e.g., hospitals, clinics, and urgent care centers).
Formal agreements such as memorandums of understanding
(MOUs) between organizations that transport patients and the medical
facilities that receive them must be part of the planning process.
Medical facilities designated to receive these patients should be
capable of evaluating and managing those exposed to chemical agents as
described later in the hospital section (Section IV) of this document.
Base decisions regarding urgent and emergency transfers of
decontaminated patients on the capabilities of the receiving
facilities, transportation resources, demand for hospital services, and
the clinical condition of the patients. Certain medical care (e.g., for
burns, pediatric emergencies, trauma, or pulmonary complications) might
require prearrangements for patients to be transferred to a tertiary
treatment center. CDC recommends that transfer and evacuation plans for
victims exposed to chemical warfare agents call for land--rather than
air--transportation.
10. Medical Evaluation and Treatment
Train medical response personnel specifically to assess
and manage patients exposed to chemical agents stored at the nearby
military depot.
Decontaminate all exposed patients as described above.
Provide medical treatment (during or after contamination),
according to accepted treatment modalities, to patients exposed to
nerve or mustard agents. If antidotes to nerve agents are used in the
field by civilian medical responders as designated in State or local
disaster plans, CDC recommends using single-dose, pre-armed auto
injectors, unless a higher level of medical response has already been
integrated into EMS operations. Additional information on the effects
of chemical warfare agents and accepted medical protocols for caring
for patients exposed to mustard or nerve agents is available (5-14).
IV. Recommendations for Hospital Preparedness
1. Primary Receiving Hospitals
A primary receiving hospital is a hospital that is designated by
State or local disaster plans to provide initial medical care to the
civilian population in the event of a chemical warfare agent release.
Such hospitals must have established protocols detailing evaluation,
decontamination, and treatment procedures for patients exposed to
chemical warfare agents. These hospitals should include:
Evaluation, treatment, and decontamination protocols in
the hospitals' disaster plans.
Chemical warfare agent scenarios in disaster drills for
hospitals that have been designated in State or local disaster plans to
receive patients exposed to chemical warfare agents.
2. Triage Considerations
Do not allow patients exposed to a chemical warfare agent
to enter the emergency department without adequate evaluation and
decontamination. Signs of mustard agent exposure, in particular, may
require 24-48 hours before they become clinically evident.
Train medical staff designated by the hospital disaster
plan to perform triage during an emergency related to chemical warfare
agents to recognize the physical signs and symptoms of patients who
have been exposed to such agents.
Base modifications to patient triage procedures on the
extent of patient contamination, the type of chemical warfare agent to
which the patient has been exposed, the patient's clinical
[[Page 33311]] status, and the possibility of additional traumatic
injuries. Priorities for medical treatment of patients should be
determined by the most appropriately trained and experienced medical
professional.
3. Security
Address issues related to emergency department security
during disasters in the hospital disaster plan.
Restrict access to the hospital to prevent contaminated
patients from entering the hospital. During a chemical agent release,
security personnel should direct all patients to enter the hospital
only through the triage area.
4. Decontamination
Decontaminate all persons who may have been contaminated
with a chemical warfare agent. Proper decontamination prevents
secondary contamination and chemical injury to medical and rescue
personnel. Acceptable decontamination guidelines for persons exposed to
chemical warfare agents are published by FEMA and DA (3,4).
Decontamination must comply with the HAZWOPER regulation, 29 CFR
1910.120(k).
Have decontamination substances readily available.
Suitable decontamination substances include soap, water, and 5%
hypochlorite.
In the hospital disaster plan, detail a method for
catching contaminated runoff from patients whether decontamination is
done inside or outside the hospital.
At a minimum, be capable of decontaminating at least one
non-ambulatory patient.
During and after chemical agent releases that cause mass
casualties, decontaminate patients outdoors. Having indoor
decontamination facilities does not obviate a hospital's need to have
plans for decontaminating patients outdoors during mass casualty
situations. Outdoor facilities must have a means of containing the
runoff from the decontamination process until it can be tested and
disposed of safely.
Design hospital disaster plans, keeping in mind the
possibility of integrating local emergency response resources. Such
resources could include hazardous materials emergency response teams or
portable decontamination vehicles or facilities.
In cold weather, set up temporary shelters and heaters to
protect patients from extreme environmental conditions when undergoing
decontamination outdoors.
Have in place a method of controlling the flow of air in
the decontamination area to prevent such air from contaminating other
areas of the hospital.
Set up a system to allow medical personnel in the
decontamination area to be in continuous communication with other
medical personnel in the emergency department.
5. Personal Protective Equipment (PPE)
Chemical protective clothing and respiratory protection enable
responders to care for chemically exposed patients while protecting
themselves from secondary contamination. This equipment must protect
the skin, eyes, and respiratory tracts of the responders.
HHS have recommended the use of DA BDOs and PAPRs with a
combined high-efficiency particulate (HEPA) and organic vapor cartridge
to protect civilians from chemical warfare agents. OSHA is reviewing
this matter and will make a determination when the review process is
completed. BDOs can be used for up to 24 hours in an agent-contaminated
environment at levels of up to 10 grams of agent per square meter of
surface area. This recommendation should not be construed as
discouraging civilian emergency responders from using more protective
equipment such as completely encapsulating suits with supplied air
respirators, providing that they have and normally use such equipment
in conformity with applicable regulations and can perform their
required duties in that equipment.
Hospital personnel should follow Environmental Protection
Agency (EPA) and National Institute for Occupational Safety and Health
(NIOSH) guidelines when managing patients exposed to unknown chemicals.
This recommendation should not be construed as
discouraging civilian emergency responders from using more protective
equipment such as completely encapsulating suits with supplied air
respirators, providing that they have and normally use such equipment
in conformity with applicable regulations and can perform their
required duties in that equipment.
Response personnel should be trained to use PPE when
responding to a chemical agent emergency according to OSHA guidelines
(2).
6. Level of Training
Medical staff designated by the hospital disaster plan
should be trained to provide direct patient care during a chemical
warfare agent emergency to a level of medical preparedness that allows
them to assess, decontaminate, and manage the treatment of victims of
chemical warfare agent releases.
Medical staff who are required to wear decontamination
attire in decontamination procedures must receive training in the use
of PPE according to OSHA regulations (2-4).
7. Transportation of Patients to other Medical Facilities
Have prearranged written agreements with those medical
facilities that agree to accept patients who are exposed to military
chemical agents.
Do not transfer patients without notifying the hospital
and having the patient accepted by a physician.
Have standardized forms available to record patient
information and management status.
8. Specific Antidotes
Have decontaminating solutions available in the emergency
department. If nerve agents are stored adjacent to the civilian
community, have atropine in multiple-dose units available in the
emergency department and in the hospital pharmacy. In addition, have
the hospital pharmacy stock atropine and pralidoxime in sufficient
quantities to cope with the anticipated number of patients who could be
managed by that facility in response to a chemical warfare agent
release. Atropine and pralidoxime should be administered intravenously
in the emergency environment.
9. Hospital Disaster Plan
Include plans for providing medical care for patients
exposed to chemical agents in the hospital's disaster plan.
Have in place a method for using the emergency
communication system so that reports of a chemical warfare agent
release can be verified rapidly. Also, include provisions to coordinate
activities with State and local disaster plans for mass
decontamination.
Include in disaster drills scenarios in which patients
have become exposed to chemical warfare agents.
Use the hospital quality assurance program to review
disaster drills and decontamination procedures and to assist in
maintaining the professional skills of hospital personnel necessary to
treat the effects of exposure to a chemical warfare agent.
10. Tertiary Hospitals
A tertiary receiving hospital is a hospital that receives referrals
from primary receiving hospitals. Additional services such as burn
care, psychiatric service, and toxicologic consultation are available
at the tertiary level of care.
Ensure that tertiary hospitals designated by State or
local disaster plans to provide care for persons exposed to chemical
warfare agents have, at a minimum, emergency [[Page 33312]] response
capabilities similar to those of the primary receiving hospital.
Ensure that tertiary hospitals coordinate their disaster
plans with State and local disaster plans for mass decontamination of
persons exposed to chemical warfare agents.
V. References
1. National Research Council. Disposal of chemical munitions and
agents. Washington, D.C.: National Academy Press, 1984.
2. Occupational Health and Safety Administration. Hazardous waste
operations emergency response. Washington, D.C.: OSHA Instruction 2-
2.59, 29 CFR 1910.120, paragraph (q), 1993.
3. Federal Emergency Management Agency and the Department of the
Army. Planning guidance for the chemical stockpile emergency
preparedness program. Washington, D.C., FEMA, 1992.
4. United States Army Medical Research Institute of Chemical
Defense. Medical management of chemical casualties. Aberdeen Proving
Ground, MD: Department of the Army, 1992.
5. Dunn M, Sidell F. Progress in medical defense in nerve agents.
JAMA 1989;262:649-52.
6. Borak J, Sidell F. Chemical warfare agents: sulfur mustard. Ann
Emerg Med 1992;21: 303-8.
7. Sidell F, Borak J. Chemical warfare agents: II. nerve agents. Ann
Emerg Med 1992;21:865-71.
8. Wright P. Injuries due to chemical weapons. Br Med J 1991;302:39.
9. Sidell F. What to do in case of an unthinkable chemical warfare
attack or accident. Postgrad Med 1990;88:70-84.
10. Moneni A. Skin manifestations of mustard gas: a clinical study
of 535 patients exposed to mustard gas. Arch Dermatol 1992;128:775-
80.
11. Smith W. Medical defense against blistering chemical warfare
agents. Arch Dermatol 1991;127:1207-13.
12. Tafuri J. Organophosphate poisoning. Ann Emerg Med 1987;16:193-
202.
13. Merril D. Prolonged toxicity of organophosphate poisoning. Crit
Care Med 1982;10: 550-1.
14. Merrit N. Malathion overdose: when one patient creates a
departmental hazard. J Emerg Nursing 1989;15:463-5.
Dated: June 20, 1995.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
Appendix A
Summary of Important Medical Preparedness Considerations for
Communities Surrounding Chemical Agent Stockpiles
1. Do the communities that surround chemical warfare agent
depots have a disaster plan that details the role of the prehospital
and hospital medical community during a chemical warfare agent
emergency?
2. If medical personnel are designated to treat chemical warfare
agent casualties, do they have adequate training to meet minimal
standards for evaluating, decontaminating, and treating victims of a
chemical warfare agent release?
3. Do medical personnel who are designated by State, local, and
hospital disaster plans to use PPE in response to an emergency
related to chemical warfare agents have the necessary OSHA level of
training to use these devices effectively and safely?
4. If the local disaster plan has provisions to evacuate or
transfer patients to other hospitals for further treatment and
evaluation, do existing MOUs cover the transfer of chemically
contaminated patients?
5. Do hospitals named in the State or local disaster plans have
an adequate stockpile of antidotes and decontamination solutions to
provide complete medical treatment to at least one chemically
contaminated patient?
6. Are the hospitals that are designated in the State or local
disaster plans able to decontaminate at least one non-ambulatory
patient exposed to chemical warfare agent?
7. Do the disaster plans of hospitals designated to receive
patients by State and local disaster plans have specific provisions
that detail how they will control access to their medical facilities
during a chemical warfare agent emergency?
8. Are all levels of the medical community that are designated
by State or local disaster plans to respond to a chemical warfare
agent emergency able to communicate via either the State or local
disaster communication network?
Appendix B
Working Group Participants
Mr. Lawrence Gallagher, Associate Director, Plant Technology and
Management, Joint Committee on Accreditation of Health Care
Organizations, Oakbrook, Illinois.
Mr. Kenneth Gray, Fire Chief, Confederate Tribes of the Umatilla
Indian Reservation, Pendleton, Oregon
Mr. Howard Kirkwood, Jr., Chief, Emergency Response Services, Oregon
Department of Human Resources, Portland, Oregon
Mr. Denzel Fisher, Emergency Preparedness Officer, Office of the
Assistant Secretary of the Army, (Installations, Logistics, and
Environment), Washington, D.C.
John A. Grant, M.D., M.P.H., Health Officer, Kent County Health
Department, Chestertown, Maryland
Deborah Kim, M.S.N., R.N., Trauma Coordinator, University of Utah
Medical Center, Salt Lake City, Utah
Ms. Laurel Lacy, Acting Chief, Chemical Stockpile Branch, Federal
Emergency Management Agency, Washington, D.C.
Howard Levitin, M.D., F.A.C.E.P., Emergency Staff Physician, St.
Francis Hospital Beech Grove, Indiana
Carole A. Mays, M.S., R.N., C.E.N., Clinical Nurse, Saint Joseph
Hospital,Towson, Maryland
Captain Jeff Rylee, Hazardous Materials Coordinator, Salt Lake City
Fire Department, Salt Lake City, Utah
Matthew Rice, M.D. J.D.,Chief, Department of Emergency Medicine,
Madigan Army Medical Center, Tacoma, Washington
Mr. Allen Short, Health Department Emergency Coordinator, Utah
Department of Health, Salt Lake City, Utah
Yehuda L. Danon, M.D., Director, The Children's Medical Center of
Israel, Petah-Tikva, Israel
Frederick Sidell, M.D.,U.S. Army Medical Research Institute for
Chemical Defense, Aberdeen Proving Ground, Maryland
Henry J. Siegelson, M.D., F.A.C.E.P., Clinical Assistant Professor,
Emory University School of Medicine, Atlanta, Georgia
Stephen B. Thacker, M.D., M.Sc., Acting Director, NCEH, CDC,
Linda Anderson, M.P.H., Chief, Special Programs Group, NCEH, CDC,
Sanford Leffingwell, M.D., M.P.H., Medical Director, Special
Programs Group, NCEH, CDC,
Vernon N. Houk, M.D.,Former Director, NCEH (deceased), Assistant
Surgeon General, NCEH, CDC,
Thomas E. O'Toole, M.P.H., Deputy Chief, Special Programs Group,
NCEH, CDC
Scott Lillibridge, M.D., Medical Officer, Division of Environmental
Hazards and Health Effects, NCEH, CDC
Harvey Rogers, M.S., Environmental Engineer, Special Programs Group,
NCEH, CDC
Sharon Dickerson, M.P.A., Program Specialist, Special Programs
Group, NCEH, CDC
Henry Falk, M.D., M.P.H.,Director, Division of Environmental Hazards
and Health Effects, NCEH, CDC
Jose Cordero, M.D., M.P.H., Deputy Director, National Immunization
Program, CDC
Eric Noji, M.D., M.P.H., Chief, Disaster Assessment & Epidemiology
Section, Division of Environmental Hazards and Health Effects, NCEH,
CDC
[FR Doc. 95-15657 Filed 6-26-95; 8:45 am]
BILLING CODE 4163-18-P
