CHEMM-CSI: CHEMM Clinical Syndrome Identification

• The scene is suspicious for chemical exposure and results in mass casualties.
• The tool is constructed assuming the predominate route of exposure is inhalation.
• The focus is on the severe cases.
• It does not include every possible chemical toxidrome. Exposures to other chemicals, pharmaceuticals, or toxins may not match one of the currently included syndromes.
• Results need to be interpreted carefully because exposures to other chemicals, pharmaceuticals, or toxins or other medical conditions could mimic these syndromes.
• The tool is for the basic life support (BLS) providers, advanced life support (ALS) first responders and hospital first receivers during a mass casualty chemical incident.
• Although the tool’s intended use is for large-scale chemical incidents, it may be used for other chemical exposure scenarios (e.g. industrial accidents or smaller scale hazardous materials releases), and even single patient chemical exposures, but the results should be interpreted with caution.

• CHEMM-CSI is intended to function as a structured cognitive aid — a tool that helps responders recognize patterns of signs and symptoms associated with specific syndromes caused by chemical toxins (“toxidromes”). Using certain clinical observations in the presence of a likely toxic or chemical exposure, the tool aids clinical reasoning, helps avoid reaching premature conclusions, and provides awareness of competing similar toxidromes when responders are operating under conditions of uncertainty, time CHEMM-CSI is not designed to provide definitive diagnoses or to replace clinical judgment or the execution of local evaluation and treatment protocols. It is designed to be complementary to established protocols in the event of a toxic chemical event. The “signs and symptoms” solicited are purposely narrow, direct, and agnostic of other clinical syndromes unrelated to toxic chemicals.
• Used appropriately, CHEMM-CSI outputs can provide decision support for both on-scene response and definitive care providing guidance for appropriate decontamination, early emergency care, and antidote administration. The tool helps identify clusters of signs and symptoms and patterns across multiple victims. It is designed to highlight overlapping possible syndromes, prompting consideration of alternative explanations when findings do not align cleanly with a single toxidrome sure and incomplete information.

Development History
CHEMM Clinical Syndrome Identification (CHEMM-CSI) is an advanced form of "FALCON: A Decision Support System for Hazardous Materials Incidents and Terrorism Response." FALCON was developed through "knowledge engineering" at the James Madison University as an undergraduate thesis project by student James Brandon Shreckhise (2006 undergraduate project and also described in limited detail in one publication ¹). The key expert involved in the development of FALCON is medical toxicologist Dr. Mark Kirk, who has been involved with other experts in medicine and emergency response in the development of CHEMM-CSI. Through a series of interviews by Mr. Shreckhise with Dr. Kirk during the development of FALCON, Dr. Kirk's diagnostic expertise was first modeled using decision trees. These decision trees were then engineered into IF-THEN rules and used to create an expert system. CHEMM-CSI started with the foundation of FALCON; however, CHEMM-CSI's design and implementation is very different, and its development was primarily accomplished via several group discussions of physicians and emergency responders with the facilitation by CHEMM Team. CHEMM-CSI's developers attended the group discussions to design and test CHEMM-CSI in these interactive sessions.