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No. 03 - 01
Date: 17 March 2003 Re: Mark I Kits Pages: 6 |
Use of “Mark I kits” (AtroPen® Auto-Injector & Pralidoxime
Chloride Injector)
PURPOSE:
To provide advanced life support
(ALS) 911
BACKGROUND:
In
2002, The State Emergency Medical Advisory Committee (SEMAC) and State
Emergency Medical Services Council (SEMSCO) established guidelines in regards
to the use of “Mark I kits” by pre-hospital providers. Subsequently the New York State Department of
Health Bureau of Emergency Medical Services (NYSDOH BEMS) issued policy
statement No. 02-08, superceded by updated Policy No. 03-05, presenting the
basic guidelines by which “Mark I kits” could be employed in pre-hospital
operations.
This
Westchester Regional Emergency Medical Advisory Committee (WREMAC) policy
statement will:
·
clarify the key
provisions found in the NYS DOH policy
·
explain the
regional authorization process for ALS agency possession and use of “Mark I
kits”
·
outline minimum
required ALS provider training
·
emphasize the
need for decontamination of patients exposed to a nerve agent by trained
personnel equipped with the proper personal protective equipment (PPE)
·
give basic
guidelines for the administration of a “Mark I kit”
·
discuss the
proper documentation and reporting of the use of a “Mark I kit”
CLARIFICATION OF KEY NYS DOH POLICY PROVISIONS:
According
to NYS DOH policy No. 03-05, the use of the “Mark I kits” by MUST adhere to
five (5) outlined provisions:
- An
2. The decision to utilize the “Mark I” antidote must be
done under the authority of medical control.
Use of the “Mark I kits” will be used under the offline medical control
provided in WREMAC policy and protocol.
3. An
4. The “Mark I kit” is not to be used for
self-administration or prophylaxis. A “Mark
I kit” is only to be used on patients or individuals who have been exposed and
exhibit signs and symptoms (i.e. SLUDGEM).[2] Contrary to the current WREMAC Special
Procedure Protocol, they are NOT to be self-administered. An
5. Use of the “Mark I kit” is
to be based on signs and symptoms of the patient. The suspicion or identified
presence of a nerve agent is not sufficient reason to administer these
medications. The
“Mark I kits” are only to be used on symptomatic patients. Prophylactic administration of “Mark I kit”
medications is NOT authorized.
AUTHORIZATION:
A
Westchester Regional 911 ALS agency wishing to possess and utilize “Mark I
kits” in their operations, must submit:
1.
A completed
WREMAC application to provide “Mark I kits”
2.
A signed
collaborative agreement with the agency Medical Director which shall at a
minimum include:
·
agency
participation in an MMRS, local municipal or the Westchester County Emergency
Management Office (WC OEM) response plan
·
adherence
to any NYS DOH or WREMAC policies, protocols and advisories regarding the
administration of Mark I Auto-injector Kits
·
outline of the minimum initial training and continuing
education required of ALS providers to use the Mark-I
Kits
·
written policy
and procedure for acquisition, storage, accounting, and proper disposal of used
auto-injectors.
·
immediate
reporting of the use of a “Mark I kit” to the Medical Director, the WREMAC and
WC OEM.
3.
Proof of
involvement in an MMRS or a municipal response plan (e.g. a letter from the
municipality confirming participation with a copy of the plan), or WC OEM
Community Response Plan (e.g. a copy of signed agreement).
Applications
will be reviewed by the Westchester Regional EMS (WREMS) office for completeness
and presented to the WREMAC for approval.
TRAINING:
A
paramedic working for an authorized ALS agency under this policy MUST receive
at a minimum the following training to posses and administer a “Mark I kit”:
1.
A WMD awareness
course from a national training program or modeled after one of the training
programs developed by the Department of Defense (DOD), Department of Justice
(DOJ) or Federal Emergency Management Agency (FEMA). Courses taken within two (2) years prior to
the effective date of this policy may be used.
Online courses from recognized institutions are also valid. Certificates of attendance must be on file
with the authorized ALS agency.
2.
An in-service
regarding the use of a Mark I auto-injector that includes:
·
general types and
categories of chemical weapons
·
general
characteristics of nerve agents
·
pathophysiology
of nerve agent exposure
·
signs and
symptoms of nerve agent exposure (i.e. SLUDGEM)
·
antidote
mechanism of action and adverse reactions
·
antidote dosing
schedules
·
WREMAC policy
and protocol regarding administration of a Mark I auto-injector
·
directions of
use of the auto-injectors
·
patient
re-evaluation and on-going assessment and treatment
The
training DOES NOT have to be agency specific.
The paramedic is responsible for filing copies of course completion
certificates and/or WREMAC CMA Student Attendance Forms with the authorized ALS
agency. The authorized ALS agency is
responsible for maintaining the WMD and “Mark I kit” training records for all
of their ALS providers and submitting a roster of all trained personnel to the
WREMS office, with updates as necessary.
After
the initial qualification period, paramedics will maintain the ability to
posses and administer a “Mark I kit” by repeating the training outlined above
prior to the renewal of WREMAC credentialing.
The
WREMAC reserves the right to have training records audited by the WREMS office
with or without advance notice.
PERSONAL
PROTECTION:
Triage should be initiated in the “Hot Zone”[3],
continued in the “Warm Zone”, and performed only by trained personnel who are
wearing appropriate personal protective equipment (PPE) for the scene, as
determined by the Incident Commander.
Patient decontamination may be simultaneous with and/or prior to treatment.
GUIDELINES FOR
PARAMEDIC ADMINISTRATION OF A “MARK I KIT”:
“Mark
I kits” are to be used only:
1)
When specific signs and symptoms of exposure are
present
(i.e. SLUDGEM)
AND
2)
The scene has been identified as the site of a nerve
agent release by a competent authority (e.g. HAZMAT Team, WC DOH, NYS DOH,
on-line Medical Control, regional poison control center, WMD Trained EMT-P)
AND
3)
Under the authority of off-line Medical Control
provided by the WREMAC Paramedic Treatment Protocols and any necessary interim
advisories.
a.
The Mark 1 injectors are not to be used as a
prophylaxis for personal protection.
b.
There is to be no self-administration of antidote.
DOCUMENTATION:
In the event that a “Mark I kit” is administered by a paramedic
as part of patient care, documentation on the PCR or ACR should at a minimum
include:
·
If known, the
nerve agent the patient was exposed to
- What
authority identified and/or declared the release of a nerve agent
- Patient
exposure symptoms upon arrival of
(i.e. SLUDGEM) - What
decontamination of the patient was performed and by whom
- The
number of “Mark I kits” administered to the patient
- Re-evaluation
of patient condition post administration
- Other
medical treatment provided
Even at
a mass casualty incident (MCI), when a patient has received
treatment with the use of a “Mark I kit”(s) there must be a method to record
such information so persons providing subsequent care are aware, at a minimum, the
treatment provided and the amount of medication given. If the resources are present it is
recommended that a triage tag be placed on each patient and that any treatment
given be recorded on that tag. If
treatment occurs prior to decontamination, care should be taken to replace
triage tags or transfer any otherwise recorded information onto a new (dry) tag
following the procedure.
REPORTING:
Administration of a “Mark I kit” by a paramedic must be
verbally reported within twenty-four (24) hours by the ALS agency to the WREMAC
and the WC OEM, if not already notified.
The WREMAC and WC OEM may be contacted through the
Issued and Authorized by:
Dr.
Nicholas DeRobertis, MD, FACEP
Chair,
Attachments:
·
WREMAC Advisory March 2003
(Mark I Kits)