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NLM Disaster-Response Tools: Helping Emergency Responders

September 30, 2010

HazMat Team DrillWith over 30 years as an emergency responder, Richard Brooks has seen more than his share of people in danger—from fires, suffocating plumes of smoke and ash, spreading puddles of unknown noxious liquids and more. No matter how low or high-tech the approach to such emergencies, he says the challenge first responders always face is how to react quickly and correctly.

"Speed can lead to error, but delay can court catastrophe. Guessing, even a good guess, can turn tragically wrong and increase casualties and spread the problem," says Brooks, who is director of the Department of Emergency Services in Cecil County, Maryland. "That is why I am a big fan of WISER®."

WISER (Wireless Information System for Emergency Responders) is the first in a trio of disaster-response tools, developed by the NLM division of Specialized Information Services. The tools are dramatically changing how local, state and federal officials, and emergency response personnel internationally, handle hazardous materials spills, radiation or chemical events and even possible terrorist incidents.

"These are tools we hope never have to be used. But if they are, they must provide the most reliable, validated information available," says Pertti (Bert) Hakkinen, NLM's Senior Toxicologist and Toxicology and Environmental Health Science Advisor, who also leads the WISER project.

WISER provides quick and easy access to information on hazardous substances. It was launched in 2004 for use on PDAs (personal digital assistants) and was one of the first mobile products to literally put information in the hands of emergency responders.

"WISER came along at a time when fire departments and emergency responders were looking for better ways to get good, valid information quickly," recalls Brooks. He says before WISER, "I would sit in the back of an emergency vehicle paging through stacks of reference manuals, checking books, CDs, DVDS. It would take 30-45 minutes to even begin working on a hazardous materials spill; now it takes 45 seconds."

The second in NLM's disaster-response triad is REMM (Radiation Emergency Medical Management). Introduced in 2007, it offers guidance to healthcare professionals on diagnosis and treatment during radiation events, says Captain Judith Bader, MD, USPHS of the National Cancer Institute (NCI). She and Captain Jeffrey Nemhauser, MD, USPHS of the Centers for Disease Control and Prevention (CDC), are the managing editors of the REMM Web site. Florence Chang, chief of the technology team, develops REMM tool enhancements for the site and for mobile users.

The third tool, CHEMM (Chemical Hazards Emergency Medical Management), a project also led by Hakkinen, is now in development and due for initial release by the end of 2010.

WISER Displayed on iPhone"The WISER, REMM, CHEMM suite of tools provide quick access to reliable, accurate HazMat and CBRN (Chemical, Biological, Radiological, Nuclear) information for the emergency preparedness and response community," notes Stacey Arnesen, head of NLM's Office of the Disaster Information Management Research Center (DIMRC). "WISER is oriented for emergency responders at the scene of an incident.  REMM and CHEMM assist emergency responders at the scene and first receivers at the hospital to make informed decisions about acute and long-term medical care," Arnesen adds.

WISER and CHEMM utilize information from NLM's Hazardous Substances Data Bank (HSDB®), a database on the Toxicology Data Network (TOXNET®) which contains comprehensive toxicity, safety and handling, environmental fate, and other information on over 5,300 hazardous substances. In addition to the NLM sources, they use validated data from other radiation, chemical and biological information resources.

These tools are accessible as Web sites and available as software downloadable to mobile devices and PCs. Most recently added are the WISER and REMM apps for the iPhone and iPod touch and mobile WISER for the BlackBerry smartphone.

As Chief of the CBRNE (Chemical, Biological, Radiological, Nuclear, Explosives) Expert Branch in the Division of Preparedness Planning in the US Department of Health and Human Services (HHS), John F. Koerner focuses on dealing with potential high-casualty disasters.

Koerner says, "It is absolutely necessary to have reliable, evidence-based information. When you are at a disaster site, you need validated information. This is not Googling all sorts of information, some of it contradictory."

The NLM disaster-response tools display evidence-based information, and everybody gets information tailored to their role. For example, an EMT worker might focus on quickly preparing victims for transfer to a hospital, while the nurses and doctors at the hospital are looking at length and level of exposure to help them determine appropriate treatment.

That WISER, REMM AND CHEMM cover a variety of users with differing information needs is by design, according to DIMRC's Stacey Arnesen. "We try to cover all aspects of the emergency or disaster from personal protective equipment needed to keep fire/rescue personnel safe during response and cleanup to detailed instructions on medical treatment options. In addition, we continue to look at emerging threats as we develop and enhance these tools."

Chip Hughes, of the National Institute of Environmental Health Sciences (NIEHS), who runs emergency response training programs, notes that the NLM disaster response tools are all intuitive and easy to use. "The beauty of these tools is once you use one, you want to get the whole department to use them. The ability to share information quickly is a huge factor in their popularity."

For first-responder Brooks, WISER became more than handy tool to help at an incident. "One of our firefighters landed in the hospital and the doctors didn't know what was making him so sick. We all scratched our heads. What could he have gotten into? Did something happen to him at an emergency response site? We went through all our emergency responses going back 60 days. Nothing. Not a clue. So I plugged his symptoms into WISER. The response came back in seconds as exposure to formaldehyde. Then, one of his friends said, ‘You know his day job is working as a mortician.'  And sure enough, that was it. We told his doctors that he worked at a mortuary and may have been exposed to excessive formaldehyde. They treated him and he walked out of the hospital in days. Just one more reason why I like WISER."

By Thomas Conuel, NLM in Focus Writer

Photo Caption (top photo): A drill performed by the Hazardous Materials Response Team, part of the Department of Emergency Services in Cecil County, Maryland. The team responds to incidents involving hazardous materials that could threaten the health and safety of citizens. Photo courtesy of the Cecil County, Maryland Department of Emergency Services.

Photo Caption (middle photo): A view of WISER for the iPhone/iPod touch, which provides full access to WISER's database of chemical, biological, and radiological substance information.