Contingency Planning And Stockpiling In Italy

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Contingency planning and stockpiling in Italy national/regional health systemsCentro di CompetenzaPresidenza del Consiglio dei MinistriDipartimento della Protezione CivileScorta Nazionale AntidotiMinistero della SaluteDifesa CivileCarlo LocatelliClinical Toxicology UnitPavia Poison Centre and National Toxicology Information Centre Maugeri Foundation IRCCS Hospital and University of Pavia, Pavia, ItalyServizio di Tossicologia Centro Antiveleni - Centro Nazionale di Informazione TossicologicaIRCCS Fondazione Maugeri e Universit degli Studi, Paviawww.cavpavia.it- survey on antidotes availability in Italy- models for availability and supplyEusem 2008, MnchenWorking programme on antidotes in Pavia PC ObjectAvailability of antidotes in the Italian NHS / RHSpre-definition of a list of antidotes (efficacy-based) and their required dose (treatment of one - 75 kg bw for 24 hrs)Methods/actionSurvey (Italian NHS Hospitals emergency services)Results and needs evaluation of the real availability of antidotes in the NHS to improve knowledge on antidotesaction ? educationalto increase availability/supplyaction ? operating systemsdata-base Hospital availability (BaNdA)stoking of specific antidotes (not available in Italian NHS H) in high-risk chemical plants stockpiles for major chemical emergencies (industry, terrorism)folic acidfolinic acidethanolamyl nitriteammonium chloridearginineatropinesodium bicarbonatemethylene blueprussian blubromocriptinecalcium chloridecalcium disodium EDTAcalcium gluconatecalcium gelactivated charcoalcyproheptadinechlorpromazinecobalt edetatecolestyraminedantrolenedeferoxaminediazepamdimercaproldisulfiram4-DMAPdobutaminedopaminedigoxin-Fabphysostigmineflumazenilfomepizoleglucagonhydroxoicobalaminipecacisoproterenolmagnesium sulphatesorbitolmethionineN-acetylcysteinenaloxoneneostigminenitroprusside sodiumobidoximeOctreotideoxygenPEG 400PEG 4000penicillin Gpenicillaminepralidoximepropranololprotaminebotulinum antitoxinantivenin, Latrodectus tredecemgutt.antivenin (other)European viper-Fabsilymarinsimethiconesodium nitritesodium sulphatesodium thiosulfatesorbitolsuccimer DMSAunithiol - DMPSfullers hearthvitamin B1vitamin B6vitamin Cvitamin K1AntidotesTherapeutic class V03AB AntidotesRegistered in other countriesData evaluation% participating hospitals / regionantidotes included in the surveyavailability / emergency servicesamount * treatment of a patient of 75 kg for 24 hoursAntidotes availability - Italian NHS HospitalsSurvey on antidotes availabilityParticipating services193 EDs 110 ICU 35 SSUEm 118 5 PCsResearch Project Istituto Superiore Sanit Pavia Poison Centre, 2002-2003pralidoximeavailability 53 %treatment of 1 patient for 24 h 3 %methylene blueavailability 34 %treatment of 1 patient for 24 h 33 %hydroxocobalamin (antidotic formulation)availability0.5 %Availability of antidotes in Italian HospitalsEDsResearch Project Istituto Superiore Sanit Pavia Poison Centre, 2002-2003pralidoximeavailability 68 %treatment of 1 patient for 24 h 2 %methylene bluavailability 98 %treatment of 1 patient for 24 h 45 %hydroxocobalamin (antidotic formulation)availability0 %Availability of antidotes in Italian HospitalsICUResearch Project Istituto Superiore Sanit Pavia Poison Centre, 2002-2003Operating system n. 1National data-base of antidotesBaNdAcontinuous up-to-date and implementation24 h available on-line to registered (emergency) servicesself-responsibility of the given informationwww.cavpavia.itactivated charcoal160 bottlesamyl nitrite7680 vialscalcium disodium edetate 300 vialscalcium gel 1200 tubesethanol 10 ml1000 vialshydroxocobalamin 103 kits liquid paraffin 1000 ml64 bottlesmethylene blue1000 vialsoxygen160 cylinders PEG 40050 bottlespenicillamine16 bottlessimethicone160 bottlessodium thiosulfate900 vialsOperating system n. 2Chemical plant-network for in situ antidotes availability44 chemical plantad hoc operating proceduresPaviaPCCAntidotes supplyPrime Minister OfficeDepartment of Civil ProtectionOperating system n. 3Ordinanza n. 3275/03 Department of Civil Protection ? responsible of all initiatives necessary to reduce at minimal level the possibility of damage to public e private safety as consequence of terrorismMinistry of HealthMinistry of Defencechemical incidentsterrorism-related CRN emergencies1st stepList of available antidotesexclusion of some antidotesunproved efficacypoor safetyAntidotes characteristicsformulationroute of administrationscenariosusefulness of the antidotes into the specific scenarion. of possible contemporary events (terrorism)n. of people