Online resources provide just-in-time, evidence-based clinical information
In a mass-casualty chemical or radiation disasters, first responders and emergency physicians need to be able to triage patients accurately and treat them appropriately and efficiently. Most first responders, however, aren’t trained as experts in this field.
To help bridge the information gap, ASPR collaborated with the subject matter experts from the National Cancer Institute (NCI) and information technology experts from the National Library of Medicine (NLM). Initially we wanted to create a web-based resource to provide just-in-time, evidence-based clinical information about diagnosing and managing patients in radiation incidents.
REMM: Radiation Emergency Medical Management
The collaboration between ASPR, NIC and NLM began in late 2005, and in 2007 the partners launched the Radiation Emergency Medical Management (REMM) website. In 2009, they created Mobile REMM, a smartphone app with core information from the REMM website. Current versions are available for iOS and Android operating systems. Since the launch, content for REMM online and Mobile REMM has been updated and expanded regularly, reflecting ASPR’s and NLM’s long-standing commitment to health preparedness and response.
REMM underwent a redesign in October 2015 and now includes not only information for clinicians and first responders, but also information for other audiences including people involved in behavioral health, public information, response planning, radiation safety, public health, and veterinary medicine, among others. REMM also includes a library of peer-reviewed literature as well as official guidance documents relevant to radiation injury and response.
REMM has been used widely in the United States and around the world for responding to actual incidents, training, and exercises. On the first day following the 2011 nuclear power plant disaster in Fukushima, Japan, REMM was accessed 170,000 times, and hundreds of thousands of times throughout the incident. In an effort to assist our Japanese partners, portions of the REMM site also were translated into Japanese following the disaster.
CHEMM: Chemical Hazards Emergency Management
Three years after the launch of REMM, ASPR and NLM launched a parallel website for chemical incidents: Chemical Hazards Emergency Management (CHEMM). CHEMM is designed for emergency physicians and medical first responders to use during a mass casualty chemical incident and provides detailed information about the health effects and medical treatment for patients exposed to chemicals.
CHEMM uses information from the NLM’s Hazardous Substances Data Bank, which contains comprehensive toxicology, safety and handling, environmental impacts, and other information on more than 5,300 hazardous substances. The interactive tool also uses validated data from other radiation, chemical and biological information resources.
First responders or emergency physicians can enter information about patients’ symptoms into CHEMM and determine which chemical the patients likely were exposed to and how to treat that chemical exposure.
REMM and CHEMM data have been incorporated regularly into responder and receiver training and exercises and used on a daily basis to inform real-world incidents. In fact, since CHEMM data was added to NLM’s Wireless Information System for Emergency Responders, or WISER, in 2013, there have been nearly 500,000 downloads of the WISER app, Android and iOS versions combined. The online version of WISER has been accessed more than 3 million times since 2013.
By entering a few key patient observations, a new CHEMM-related tool called the CHEMM Intelligent Syndromes Tool, or CHEMM-IST, helps first responders recognize signs or symptoms that patients have been poisoned. This helps ensure that patients who have suffered a potentially hazardous chemical exposure receive proper treatment and that medical staff can take protect their own health while they treat the patient.
Tools for mass casualty preparedness and response
While REMM, CHEMM and WISER were developed with a national emergency in mind, they have proven useful in preparing for mass casualty incidents and in responding to industrial accidents and other incidents day-to-day. ASPR and NLM staff continually update these resources to ensure they contain current information that emergency physicians, first responders, and others can rely on to best care for their patients should a radiation or chemical incident occur.
