Attachment_25_DuoDote_Auto_Injector.pdf

Training Operations and Support

Services – COBRATF

Attachment 25

DuoDote Auto Injector Procedure

FOR OFFICIAL USE ONLY

STANDARD OPERATING PROCEDURE

Organization: Center for Domestic Preparedness Date: October 15, 2012

Title: DuoDote Auto Injector

CDP-COBRATF- 1.24.8

I. Purpose

Establish procedures for issuing, tracking, storing, turning in, and using the DuoDote Auto-

Injector (atropine and pralidoxime chloride injection)

II. Supersession

This SOP supersedes:

SOP 1.24.7, DuoDote Auto Injector (Atropine and Pralidoxime Chloride Injection), Effective

02/06/2012

III. Authority

COBRATF Standards Documents

IV. References

A. U.S. Army Medical Research Institute of Chemical Defense: Medical Management of

Chemical Casualities Handbook

B. Meridian Medical Technologies “DuoDote” Instructions For Use

V. Definitions

A. AED - Automated External Defibrillator

B. APR - Air Purifying Respirator

C. CERP - Contractor/Employee Reliability Program

D. CPR - Cardiopulmonary Resuscitation

E. DuoDote - Atropine and Pralidoxime Chloride Injection Auto-Injector

F. LCD - Lightweight Chemical Detector

G. PPE - Personal Protective Equipment

H. TOS - Training Operations Specialist

I. TRC - Training Records Coordinator

VI. Responsible Office

Training Operations Specialists

VII. Standard Operating Procedures

NOTE: DuoDote training is conducted as part of Phase 1 training.

A. Who Administers DuoDotes

CDP-COBRATF-1.24.8

FOR OFFICIAL USE ONLY 2

1. In the event that an individual shows signs and symptoms of nerve agent poisoning and must be administered a DuoDote, it will be given by:

a. A staff member if the casualty is a student

b. Self or buddy if the casualty is a staff member

2. All personnel involved with toxic agent work/training who exhibit severe signs and symptoms of nerve agent poisoning are administered three (3) DuoDotes in rapid succession. Any additional treatment will be administered by medical personnel.

B. Symptoms for Use of the DuoDote

NOTE: Miosis is only present in a vapor agent exposure, not a liquid agent exposure, unless the liquid agent is actually in the eyes.

1. Mild/Moderate intoxication for vapor exposure includes:

a. Miosis (pinpointing of the pupils and dimness of vision)

b. Unexplained sudden headache

c. Rhinorrhea (unexplained runny nose)

d. Coughing

e. Lacrimation (tearing)

f. Salivation (sudden drooling)

g. Dyspnea (tightness in the chest or difficulty breathing)

2. Mild/Moderate intoxication for liquid exposure includes:

a. Muscle twitching at site of exposure

b. Rhinorrhea (unexplained runny nose)

c. Salivation (sudden drooling)

d. Nausea

e. Abdominal cramps

f. Dyspnea (tightness in the chest or difficulty breathing)

g. Tachycardia (abnormal heartbeat with a rate over 100 bpm) followed by bradycardia (slow heart rate with a rate under 60 bpm)

3. The initial treatment required for mild/moderate intoxication is removal from the agent environment. One (1) DuoDote may be needed, and only then if symptoms worsen.

WARNING: If within five (5) to ten (10) minutes after administering the first injection the heart begins to beat rapidly and the mouth becomes very dry, no more injections are administered without medical approval.

4. Severe intoxication for vapor exposure includes:

a. All the above signs of mild/moderate intoxication

FOR OFFICIAL USE ONLY 3

b. Severe miosis (pinpointing of the pupils and dimness of vision) and red eyes with tearing

c. Sudden loss of consciousness

d. Strange/confused behavior

e. Respiratory arrest (not breathing)

f. Seizures/convulsions

g. Involuntary urination/defecation

h. Vomiting

5. Severe intoxication for liquid exposure includes:

a. Severe muscular twitching and general weakness

b. Sudden loss of consciousness

c. Strange/confused behavior

d. Respiratory arrest (not breathing)

e. Seizures/convulsions

f. Involuntary urination/defecation

g. Vomiting

6. Severe symptoms require the immediate administration of three (3) DuoDotes.

Treatment is administered IAW section VII.C.1-2 below.

C. Treatment

1. Prepare to administer one (1) DuoDote to self or casualty.

a. Obtain one (1) DuoDote.

b. Hold the DuoDote injector in front of you at eye level.

c. Check the injection site (thigh or buttocks) for buttons or objects in the pockets that may interfere with the injection.

NOTE 1: The injection can be given in any part of the lateral thigh muscle from a hand’s width above the knee or a hand’s width below the hip joint. Very thin personnel should be injected in the buttocks.

2. Administer the DuoDote.

a. Grasp the DuoDote in the palm of your hand.

NOTE 2: DO NOT cover or hold the needle end (green) with any part of your hand.

You may accidentally inject yourself. An accidental injection into the hand does NOT deliver an effective dose of antidote.

b. Using the opposite hand, carefully remove the gray cap (see Figures 1 and 2 for cap location and removal). The auto injector is now armed.

FOR OFFICIAL USE ONLY 4

c. Place the needle (green) end of the DuoDote against the injection site, thigh or buttock. DO NOT inject into areas close to the hip, knee, or thighbone (see figure 3).

NOTE 3: If injecting in the buttock: there is a nerve that crosses the buttocks; hitting this nerve can cause paralysis; therefore, you must only inject into the upper outer quadrant of the buttocks.

d. Apply firm, even pressure (not jabbing motion) to the injector until it functions.

e. Hold the injector in place for at least 10 seconds.

f. Carefully remove the auto injector from the injection site.

g. Place the expended DuoDote(s) in a “sharps” container located in the toxic agent area. If not in the toxic agent area, expended DuoDotes are placed in the

“sharps” container in the medical room of the training building or the administrative building medical area.

D. Notification Process

1. If in the toxic agent area, notify the Training Controller of the time that you administered the DuoDote and move the casualty to the medical anteroom.

2. If not in the toxic agent area, notify a medical authority.

E. TOS Lead (or designated representative)

1. Prepares a master inventory list(s) for all DuoDotes assigned to the COBRATF by lot numbers and expiration dates.

2. Ensures select individuals are issued three (3) DuoDotes after the individual receives an APR.

a. Individuals sign for DuoDotes.

b. Supervisors of areas that have a DuoDote box, sign for that box.

3. Ensures the DuoDote boxes located in toxic agent area have a control seal on them.

4. Ensures spare DuoDotes are maintained in a secure location with minimal access.

5. Ensures a serviceability inspection and physical inventory is performed when any of the following occur:

a. Upon initial receipt of new DuoDotes

b. When DuoDotes are issued

c. When an individual who has access no longer requires access

d. When a key to the DuoDote storage area is compromised

6. Coordinates with the COBRATF Supply Technician for DuoDote purchase requisitions.

a. DuoDotes should be requisitioned six months in advance.

b. TOS keeps a small quanity to issue to new personnel.

FOR OFFICIAL USE ONLY 5

c. The COBRATF Supply Technician maintains the bulk supply of DuoDotes in the supply storage area.

7. At a minimum, DuoDotes are inventoried semi-annually.

F. If the injectors become frozen, it is recommended by the manufacturer that they not be used.

G. All Personnel Receiving DuoDotes

NOTE: Supervisors inform the TOS Lead of any change in employee status.

1. Ensure DuoDotes are issued after receiving an APR.

2. Store DuoDotes inside the APR carrier.

3. Are familiar with how to administer the DuoDote.

4. Ensure DuoDotes are exchanged prior to the expiration date.

5. Ensure DuoDotes are turned in to TOS personnel when out processing.

FOR OFFICIAL USE ONLY 6

Figure 1

Figure 2

FOR OFFICIAL USE ONLY 7

Figure 3

VIII. Forms Prescribed

None noted

FOR OFFICIAL USE ONLY 8

APPROVED BY:

Gary L. Milner Date

Assistant Director, COBRATF

Center for Domestic Preparedness

Quality Review Date Chemical Hygiene Review Date