Influences ofthe CHEMM Tool on Planning, Preparedness, and Emergency Response to Hazardous Chemical Exposures: User Perspective
The User Perspective CHEMM Expert Model is presented in Fig. 8.8. As with the previous model, this model starts in the upper left corner with the Drivers or initiating influences on the system. In this model, the Drivers relate to the accidents and incidents where CHEMM would be useful along with associated training, planning, and preparedness activities.
The Desired Outcomes include (Fig. 8.9):
- • Meets Information Needs;
- • Effective Training, Planning, and Preparedness;
- • More Efficient Response (Less Duplication of Effort); and
- • More Effective Response (Increased Capacity and Improved Outcomes).
CHEMM Users include (Fig. 8.10):
- • First Receivers
- - ER Doctors
- - ER Nurses
- • First Responders
- - Ambulance, EMT
- - Fire, Police
- - Hazmat Responders
- • Other Users
- - Accident/Incident Coordinators
- - Second Responders and Receivers (e.g., decontamination workers, operating room or ICU staff, and mortuary personnel)
- - Communicators
- - Planners (e.g., those in the preparedness community)
- - Trainers (e.g., educators and trainers of emergency response and medical personnel)
The type of user, and their responsibilities in an event, influences their initial needs and assessment of the situation. This initial assessment includes (or is influenced by) the information that has been reported to them and their own observations on the scene. This assessment, by user type, influences how CHEMM will be accessed.
CHEMM is designed to be accessed through multiplatform Access Modes including: desktop and laptop computers, along with handheld devices (e.g., PDAs, cell phones/smart phones)
Fig. 8.8 CHEMM expert model—user perspective
Influence of the CHEMM Tool on Planning. Preparedness...
Fig. 8.9 Desired Outcomes
Fig. 8.10 CHEMMUsers
CHEMM itself is represented by the system of nodes found in the center of the Model. These nodes represent a process flow describing how the Tool is used.
Once accessed, the user will start the process by utilizing a particular Entry Point designed in a way that will result in the customization of the Tool interface to highlight options most frequently needed in order to optimize the user experience and help them get to the needed information quickly. The anticipated Entry Points include:
- • Type of User: (e.g., EMT, ER Nurse, ER Doctor, etc.);
- • Chemical Agent-,
- • Type of Incident: (e.g., terrorist incident, transportation accident, industrial facility accident); and
- • Information Need.
After specifying the Entry Point, users will be able to navigate through the Tool by specifying Navigation Criteria, including:
- • Type of User/Incident if not specified as the initial entry point.
- • The Stage of the Response (e.g., preparing to go to scene, first arrival on scene);
- • Information that has been Reported to them (e.g., type of incident, reported chemicals); and
- • User Observations (e.g., odors, symptoms, etc.).
After specifying the Navigation Criteria, the user then specifies their Information Needs, including:
- • Personal and Facility Protection including decontamination procedures;
- • Event Characterization (e.g., scope, size of incident; incident site, facility, or area/perimeter control guidance to support Logistical decisions);
- • Casualty Handling (e.g., Triage, Assessment, Treatment, Handling, and Decontamination);
- • Chemical Agent Identification and Information;
- • Post Incident Activities including Decontamination; and
- • Communication.
Note: The Tool interface may be able to be designed in a flexible way to allow inputs to be specified in an order other than indicated earlier (e.g., starting directly with an informational need) although such options should be tested to assess the potential impact on Tool usability (e.g., does increased flexibility add confusion and cause difficulty in training.) 
- - Is Usable, Actionable and has a Decision-Making Focus (e.g., time sensitive, and provides data relevant to specific time frames of incident response and predictive information about what to look out for based on current knowledge);
- - Acknowledges and Addresses Uncertainties and Adapts to New Information, and provides both plausible options given current data and options for reducing uncertainty;
- - Is Clear and Understandable, in a language level appropriate for the intended audience (e.g., Tool users and/or the lay public if the information is intended to be passed on to them);
- - Comes from Trusted, Authoritative Sources that are credible, validated, and cre- dentialed (e.g., experience-, evidence-, and consensus-based and peer reviewed);
- - Is Aligned with other Resources
- - Is Up-to-Date; and
- - Is Comprehensive, Precise, and Accurate.
- • Quality of CHEMM Tool Usability:
The quality of the CHEMM Tool Usability will be measured by the following
criteria identified by research participants, including whether the information:
- - Has flexible Access Modes rendering it readily available whether the user is connected to the Internet or is accessing an off-line database in a computer or handheld device;
- - Is Accessible,Available, andReliable;
- - Is Useable, well Organized, and Easily Navigable; with readily understandable navigation options at appropriate language levels;
- - Is Aligned with Needs and is robust, customizable, and effective for a wide range of contexts and entry points; and
- - Provides data Quickly and Timely (e.g., “just in time” delivery with very low “downtime”);
- - Is Updatable, “evergreen,” and is continuously improved with feedback from users and experts.
- • General Tool Qualities:
The following are criteria, suggested by research participants, by which the quality of the Tool can be evaluated:
- Alignment with other Tools and Sources of Information that are designed to be used for related information needs, including:
WISER and REMM Tools
CDC Epidemic Information Exchange (Epi-X)
HHS Secretary’s Operations Center (SOC)
FEMA National Incident Management System (NIMS)
NFF Near Miss Reporting System Poison Control Centers CAMEO CHEMTREC
- - That it is Well Marketed resulting in a High Level of Awareness (and adoption) by the targeted Users; and
- - That Tool Users are Well Trained and Practiced on the Tool enabling them to obtain the information that they need.
The overall quality of the Tool then influences Outputs that include:
- • Internalization of chemical hazards information by Tool users as measured by their correct interpretation and understanding of information provided by the Tool.
- • Application of Information, including:
- - Short-term (Acute) Actions. For example:
Preparatory checklists for first responders on the way to the scene and for receivers before the ill or wounded arrive;
Recognizing short-term exposure indications;
Triage and treatment of acute illness or injuries, and mental health treatment; Procedures for personal protection and the protection of others, and equipment needs;
Site and area control procedures, including safety perimeters and decontamination procedures;
Assessment and diagnostic procedures, including chemical identification and chemical information; and
Communications, including alerting of other officials, and communications to family members, media, public, and others.
- Guidance on Longer Term Actions. For example:
Long-term treatment and mental health treatments;
Recognizing long-term exposure indications;
What to communicate at a later time; and Decontamination procedures.
Over time, Tools users may obtain new information that allows them to reassess the situation and use this new information to return to the Tool and update their actions based on new information. This is represented by the Adaptive Management node, which is influenced by the Quality of the Tool and influences the Internalization of Information.
The Desired Outcomes of the Tool’s use include:
- • Meeting Tool User Information Needs;
- • Effective Training, Planning, & Preparedness;
- • More Efficient Response with Less Duplication of Effort; and
- • More Effective Response, including Increased Capacity and Improved Outcomes.
-  Potential Functional Needs of the Tool identified by workshop participants andwhich may be added to the Tool at a future time, include: - Data Storage (e.g., incident and/or patient information, local information,case studies); - Live Expert Access; and - Data Sharing (e.g., among other Users on scene, incident coordinators, firstreceivers, peers, etc.). The overall quality of CHEMM is influenced by the nodes in the lower left:Quality of Information Content, which represents the quality of the informationcontained in and provided by the Tool, and Quality of CHEMM Usability, whichrepresents the ability of the user to access that information. The overall quality isalso influenced by the node in the upper right, the General Tool Qualities, its context in relation to other tools. • Quality of Information Content: Workshop participants identified the following criteria as measures of the qualityof information provided by the Tool, including whether the information: