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AACT Antidote Collective Subcommittee Interest Form
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What is your full name?
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What is your preferred email address?
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Please indicate the area of the country in which you practice.
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Are you interested in serving on the subcommittee of the AACT Antidote Collective aimed towards achieving the following goals?

Goal #1: Create communications regarding the importance of continued manufacturing 

Open letters to drug manufacturers

Build governmental relations (reach out to toxicologists within companies/governmental agencies)/FDA drug shortage task force/ASHP

Enhance communication related towards specific companies in providing timely information regarding shortages

Gather details regarding regulations surrounding sharing medications/antidotes interstate and inter-institution

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Are you interested in serving as a leader of the subcommittee aimed towards achieving Goal #1?
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Are you interested in serving on the subcommittee of the AACT Antidote Collective aimed towards achieving the following goals?

Goal #2: Provide consensus and peer-reviewed expert guidelines on alternatives, rational use, populations with special health care needs, and expiration extensions for antidote shortages, specifically:

Physostigmine

BAL

CaNaEDTA

Succimer

Others

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For those interested in achieving goal #2:

Rank in order of preference which specific antidote(s) you would like to participate in composing evidence-based consensus guidelines for alternatives, rational use, populations with special health care needs, and expiration extensions.
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Physostigmine
BAL
CaNaEDTA
Succimer
First choice
Second choice
Third choice
Fourth choice
Are you interested in serving as a leader of the subcommittee for Goal #2?
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