An Garda Síochána

BackgroundChemical, biological, radiological and nuclear (CBRN) incidents either by accidental or deliberate release has been cited as affecting as many as 9.7M globally in 2016¹. ASSERT Centre, UCC and An Garda Síochána (Police) collaborate on a pilot project to assess the suitability of high fidelity simulation to CBRN training for emergency responders.Summary of workThe busy ED simulation, involved combination of simulated patients, trained actors, and human simulators, where Gardaí had to maintain the safety of patients and staff in a rapidly escalating situation, including the containment and management of a potentially dangerous biohazard which incapacitated several people.The learning objectives were to assess initial response and actions to suspected CBRN incident, review safety protocols and scene management of CBRN team, and to develop CBRN awareness prompt card and guidance document. A further aim of the project was to share knowledge between organisations and build inter-agency collaboration. Key stakeholders from all the emergency services, military, voluntary services, health service and pre-hospital care were invited, to view live, and evaluate the training exercise. The stakeholders remotely viewed in real-time, this was followed by an expert-led debrief and discussion. The exercise was evaluated using Kirkpatrick’s training evaluation model², with the view to acceptability and transferability of training, to inter-agency training on a larger scale.Summary of results96% evaluated the training as highly realistic, while 100% rated the objectives succeeded in raising CBRN awareness. 98% agreed that there was learning in the simulation transferable to their own organisation, and 89% increased their knowledge and learning as a result. The most frequently cited remarks on new learning were the benefits of inter-agency collaboration, communication and teamwork. 65% stated that their behaviour to their job will change. 72% stated that it is very likely that the simulation exercise will improve work practices within their organisations, while 91% anticipated an improvement in the collective response of the responding agencies.DiscussionThe threat of CBRN exposure to our populations is ever increasing. However, globally the availability of courses is not widely accessible to all front-line staff, especially in healthcare². There is an increasing need for inter-agency interoperability to strengthen the ability to detect, prepare for, respond to, mitigate and recover from such emergencies.ConclusionsThis pilot demonstrated that high fidelity simulation training is acceptable to CBRN training. Furthermore, the wide inter-agency evaluation of the training suggests that the training is transferable across first-responding agencies.ReferencesKako, M., Hammad, K., Mitani, S., & Arbon, P. (2018). Existing Approaches to Chemical, Biological, Radiological, and Nuclear (CBRN) Education and Training for Health Professionals: Findings from an Inttegrative Literature Review. Prehospital and Disaster Medicine;33(2). 182–190.Kirkpatrick, D. (1994). Evaluating Training Programs: The Four Levels. Berrett-Koehler: San Francisco.

The availability of new psychoactive substances (NPS) on the recreational drug market continues to create challenges for scientists in the forensic, clinical and toxicology fields. Phenmetrazine (3-methyl-2-phenylmorpholine) and an array of its analogs form a class of psychostimulants that are well documented in the patent and scientific literature. The present study reports on two phenmetrazine analogs that have been encountered on the NPS market following the introduction of 3-fluorophenmetrazine (3-FPM), namely 4-methylphenmetrazine (4-MPM), and 3-methylphenmetrazine (3-MPM). This study describes the syntheses, analytical characterization, and pharmacological evaluation of the positional isomers of MPM. Analytical characterizations employed various chromatographic, spectroscopic, and mass spectrometric platforms. Pharmacological studies were conducted to assess whether MPM isomers might display stimulant-like effects similar to the parent compound phenmetrazine. The isomers were tested for their ability to inhibit uptake or stimulate release of tritiated substrates at dopamine, norepinephrine and serotonin transporters using in vitro transporter assays in rat brain synaptosomes. The analytical characterization of three vendor samples revealed the presence of 4-MPM in two of the samples and 3-MPM in the third sample, which agreed with the product label. The pharmacological findings suggest that 2-MPM and 3-MPM will exhibit stimulant properties similar to the parent compound phenmetrazine, whereas 4-MPM may display entactogen properties more similar to 3,4-methylenedioxymethamphetamine (MDMA). The combination of test purchases, analytical characterization, targeted organic synthesis, and pharmacological evaluation of NPS and their isomers is an effective approach for the provision of data on these substances as they emerge in the marketplace.

The human T developmental gene has been implicated in the etiology of neural tube defects (NTDs) on the basis both of mouse studies of its homologue, T (Brachyury), and of allelic association in a Caucasian population. We have investigated the frequency of the T allelic variant TIVS7-2 in 218 Irish NTD case-parent triads. This population showed the same trend as previously reported, with an excess of the TIVS7-2 allele among cases. Log-linear modeling of case and maternal genotypic effects within families indicated that TIVS7-2 was elevated in cases (relative risk, RR = 1.36) but not in mothers (RR = 0.91). The TIVS7-2 allele is markedly associated with cases born before 1980 (RR = 2.09; CI = 1.23-3.55; corrected p = 0.030), but not with more recent cases (RR = 0.92). Cases carrying a TIVS7-2 allele did not show any increased tendency to be homozygous for the thermolabile variant of the folate-dependent enzyme 5,10-methylene tetrahydrofolate reductase, which is an established genetic risk factor for NTDs. Since the incidence of NTDs has declined markedly in Ireland over the last few decades, we suggest that the T-associated risk is potentiated by nutritional or environmental risk factor(s), the impact of which have been diminishing over time.