casualty situations Predisaster planning for both intentional and unintentional chemical releases must take such factors into account The National Response Framework and the National Disaster Medical System, augmented if necessary by military medical assets from the Department of Defense, provide a framework for activating medical assistance at the federal level Availability of specific antidotes and medications in the context of planning for a chemical exposure event involving mass casualties is an additional challenge Stockpiling pharmaceuticals such as the Cyanokit may be prohibitively expensive HAZMAT incident planning should establish some mechanism for local or regional stockpiling of these critical medications and as a means to replenish initial stores Table 132.7 offer an attempt to quantify the amount of antidotal medications that might be needed in one ED for the management of a nerve agent or cyanide attack involving both pediatric and adult victims on a scale of the Tokyo sarin attack A biologic agent attack would place similar enormous demands on the hospital pharmacy for antibiotics, vaccines, and antitoxins A federal system for stockpiling pharmaceuticals and emergency medical supplies, managed through the CDC, has been created to augment local resources in this critical logistical arena The first large-scale deployment of this Strategic National Stockpile occurred in the hours following the September 11, 2001 attacks on New York and Washington, DC However, because prompt treatment is crucial in chemical emergencies, national stockpiles should be viewed as a resupply source and not obviate the need for each hospital to develop its own stockpile of antidotes that might be needed during the first few hours after such a mass-casualty incident