Receiving, Distributing, and Dispensing SNS Assets

Receiving, Distributing, and Dispensing SNS Assets

Document Overview: Receiving, Distributing, and Dispensing SNS Assets A Guide to Preparedness Version 11 Jim Sowards, WV SNS Coordinator Humbert Zappia, CDC Public Health Advisor Assumptions Everyone attending this presentation has existing knowledge of the Strategic National Stockpile program and its purpose. Everyone has been actively involved or aware of the continuing preparation for receipt and use. Just in case

The federal government has medical countermeasures available for use in events exceeding local capacity The materiel is available in several configurations Pushpack, Managed Inventory, Forward deployed, Purchasing Power The materiel available is used for major healthcare emergencies that overwhelm local resources Both natural and manmade 2 Receiving, Distributing, and Dispensing SNS Assets Version 11 Goal Provide awareness of new guidance and highlight some

of the changes for your use in future plan review and revision The document contains many references and hyperlinks to supporting federal documents and resources 3 Receiving, Distributing, and Dispensing SNS Assets Version 11 Background The guidance that this new document replaces was last updated in 2006 (Version 10.2) Parts of the old guidance have fallen victim to the progress made in overall preparedness planning. There have been various groups both at the federal and

state levels working to make revisions over the past several years 4 Receiving, Distributing, and Dispensing SNS Assets Version 11 Background Some of the workgroup revisions that show up in the guidance: Broader focus on MCMs in general De-emphasis on 48 hour dispensing Better description of the federal response structure Enhanced explanation of the federal request process

5 Receiving, Distributing, and Dispensing SNS Assets Version 11 Background Some of the workgroup revisions that show up in the guidance: Broader dispensing guidance More information on handling and dispensing vaccines Cold chain management Inclusion of specialized populations Agent by agent formulary items 6

Receiving, Distributing, and Dispensing SNS Assets Version 11 Version 11 Major Changes Inclusion of formulary items Consideration of various SNS response capabilities Less focus on 12 Hour Push Package 48 Hour dispensing scenario Dispensing solely related to oral antimicrobials 7 Receiving, Distributing, and Dispensing SNS Assets Version 11 Version 11 Major Changes

More focus on Broader MCM response Longer MCMDD operations Dispensing MCMs via other than oral routes Specialized populations Demobilizing operations Annual Guidance Update Planned New appendices throughout the year Annual update to overall document 8 Receiving, Distributing, and Dispensing SNS Assets Version 11 Version 11 Organization

Chapters no longer mirror the Technical Assistance Review (TAR) Functional areas listed in order from initial request through dispensing More comprehensive guidance on how to develop each section of the MCMDD plan Chapters are designed to stand alone All acronyms defined Links to other documents or resources with hyperlinked addresses Footer reflects document title, chapter title, and page numbers 9 Receiving, Distributing, and Dispensing SNS Assets Version 11

Version 11 Chapter Organization Overview Core Planning Functional Ancillary Informational Appendices 10 Receiving, Distributing, and Dispensing SNS Assets Version 11 Version 11 Chapter Organization Overview

Introduction The Strategic National Stockpile Formulary Core Planning Concept of MCM Operations Chapter 1 Developing an MCM Plan - Chapter 2 Management of MCM Operations - Chapter 3 11 Receiving, Distributing, and Dispensing SNS Assets Version 11 Version 11 Chapter Organization MCMDD Functional Areas Requesting SNS Assets - Chapter 4

Receiving, Staging, and Storing SNS Assets Chapter 5 Controlling MCM Inventory Chapter 6 Distributing SNS Assets Chapter 7 Dispensing Oral Medications Chapter 8 12 Receiving, Distributing, and Dispensing SNS Assets Version 11 Version 11 Chapter Organization Ancillary Planning Areas Public Information and Communication Chapter 9 Strategic and Tactical Communications Chapter 10 Securing Assets, Staff, and Operations Chapter 11 Hospital and Treatment Center Coordination Chapter 12 Training, Exercising, and Evaluating Plans Chapter 13

Appendices Federal Medical Stations Appendix A Ventilators Appendix B CHEMPACK Appendix C DTPA Appendix D Cold Chain Management Appendix E 13 Receiving, Distributing, and Dispensing SNS Assets Version 11 Chapter by Chapter Overview 14

Receiving, Distributing, and Dispensing SNS Assets Version 11 Introduction to the Strategic National Stockpile Introduction provides: Brief history of the SNS Information on DSNS and DSLR Tips for using Version 11 Overview of readiness reviews at state and local levels 15 Receiving, Distributing, and Dispensing SNS Assets Version 11 SNS Formulary Section

The section covers: Formulary development using the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) and the Biomedical Advanced Research and Development Authority (BARDA) A listing of current medications available by threat Categorization of SNS response capabilities SNS response strategies 16 Receiving, Distributing, and Dispensing SNS Assets Version 11 Concept of Medical Countermeasure Operations Chapter 1

This chapter replaces the Command and Control Chapter from the previous guidance Information/references regarding federal strategies, guides, and systems to assist in national emergencies National Preparedness Goal National Preparedness System National Planning Frameworks National Incident Management System (NIMS) Incident Command System Unified Command Provides guidance to assist local planners in integrating plans with federal response plans 17

Receiving, Distributing, and Dispensing SNS Assets Version 11 Developing a MCM Response Plan Chapter 2 Outlines: State and local planning functions Recommends integration into existing state and local plans MCM planning requires many agencies and organizations involvement When accomplished properly, planning provides a methodical way to work through the entire life cycle of a potential crisis. 18

Receiving, Distributing, and Dispensing SNS Assets Version 11 Developing a MCM Response Plan Chapter 2 One new change in the guidance is the promotion of regionalization of response planning. Regionalization allows resource pooling to benefit all in the affected area Also allows for cost savings in drills and exercises There is an expectation in the guidance that all CRI jurisdictions will consider one basic response plan with overarching guidance from the state Individual planning nuances may be captured in planning annexes

More to follow as further information is released! 19 Receiving, Distributing, and Dispensing SNS Assets Version 11 Developing a MCM Response Plan Chapter 2 Military Installations Reiterates that we need to include these facilities in our planning Staff, family members DOD Directive 6200.3 requires military commanders to designate a public health emergency officer (PHEO)

Role is to maintain close contact and seek close coordination with local and state health departments 20 Receiving, Distributing, and Dispensing SNS Assets Version 11 Developing a MCM Response Plan Chapter 2 Employees of Federal Agencies Employees and their families need to be included in local plans At-risk Populations HHS defines at-risk populations as people with needs in five areas

Maintaining independence Communication Transportation Supervision Medical Care PAHPA also recognizes children, senior citizens, and pregnant women 21 Receiving, Distributing, and Dispensing SNS Assets Version 11 Developing a MCM Response Plan Chapter 2 Collaboration Multidisciplinary Advisory Group

Scalable Operational in all types of incidents Policies and procedures Tailored, owned, and understood Share the plan among partners Delineate state and local responsibilities Include regulatory and legal considerations Continuity of Operations Plan (COOP) Be sure to involve partner organizations 22 Receiving, Distributing, and Dispensing SNS Assets Version 11

MCM Response 23 Receiving, Distributing, and Dispensing SNS Assets Version 11 Management of MCM Operations Chapter 3 This chapter outlines MCM planning, operational roles, and types of people to fill those roles. Provides sample ICS Chart to fit various MCM roles into the ICS structure Provides sample dispensing site ICS structure Alert Notification Process Include Ops team members

Managing MCM operations Initial, sustained, and recovery Maintaining MCM Management capabilities Meetings, workshops, training, exercise 24 Receiving, Distributing, and Dispensing SNS Assets Version 11 Requesting SNS Assets Chapter 4 Explores the methodology, rationale, process for requesting assets Guidance moves away from calling CDC directly

Integrates other federal partners into the process Outlines request processes based on federal declaration In most instances a local request will go through state processes, and ultimately the Governor or his designee before reaching the federal request level. However, A request process is in place for isolated, time critical incidents involving individuals or small groups of anthrax, botulism, or smallpox exposure 25 Receiving, Distributing, and Dispensing SNS Assets Version 11 Requesting SNS Assets Chapter 4

At the local level all plans should include processes for requesting MCMs from the state The request planning processes should include; Who can make the request Names and contact information in an annex Justification/rationale outlines Initial request and resupply request processes Include PODs in process This chapter also covers the methodology related to DSNS activation during deployment of assets. Also covers how additional assets will be ordered. 26

Receiving, Distributing, and Dispensing SNS Assets Version 11 Receiving, Staging, and Storing MCMs Chapter 5 Provides floor space calculations based on population and planning for managed inventory In WV, we need a facility in the 25,000 to 35,000 square foot range Supplies information on numbers of unit of use bottles per pallet Provides information on DEA registration Provides information on cold chain management Verifying and re-verifying RSS facilities Initial verification involves CDC officials and must be reverified every three years

27 Receiving, Distributing, and Dispensing SNS Assets Version 11 Managing MCM Inventory Chapter 6 Inventory management processes are critically important to the success of the overall mission start to finish! 28 Receiving, Distributing, and Dispensing SNS Assets Version 11 Managing MCM Inventory Chapter 6 Describes the systems needed to track material

Some specialty MCM IMS issues Chain of custody Cold chain management Controlled substances Determining data collection and tracking elements The ability to know where a product is at any given time is an important component of the process Tracking receipt, on-hand balances, orders and reorders Dispensing data Health Insurance Portability and Accountability Act (HIPPA) 29 Receiving, Distributing, and Dispensing SNS Assets Version 11

Managing MCM Inventory Chapter 6 This chapter also includes information on CDCc national level Countermeasure Tracking System (CTS) Countermeasure Inventory Tracking (CIT) Dashboard; Countermeasure and Response Administration (CRA) system; Inventory Management and Tracking System (IMATS); and Communications Portal (CP) 30 Receiving, Distributing, and Dispensing SNS Assets Version 11 Distributing Medical Countermeasures

Chapter 7 31 Receiving, Distributing, and Dispensing SNS Assets Version 11 Distributing Medical Countermeasures Chapter 7 Provides more route planning information Includes consideration for distributing MCMs requiring cold chain management Offers information on DEA registration for distribution Offers information on Developing distribution networks Identifying transportation resources Identifying security resources

Determining distribution models 32 Receiving, Distributing, and Dispensing SNS Assets Version 11 Dispensing Medical Countermeasures Chapter 8 Provides information on liability coverage Public Readiness and Emergency Preparedness (PREP) Act Offers planning considerations beyond the open/public POD structure Gives specific labeling and Shelf-life Extension Program (SLEP) information

Lists specific SNS formulary items and administration routes 33 Receiving, Distributing, and Dispensing SNS Assets Version 11 Dispensing Medical Countermeasures Chapter 8 Provides information for dispensing life-cycle Activation through demobilization Offer considerations for vaccination campaigns Includes guidance on how Emergency Use Authorization (EUA) or Investigational New Drug (IND) protocol may

effect dispensing 34 Receiving, Distributing, and Dispensing SNS Assets Version 11 Public Information and Communication Chapter 9 Provides more information on reaching at risk populations Offers guidance on social media in messaging campaigns Includes information based on communication research Processes related to crafting messages and getting the best results

Provides further considerations for 60 day or other long term dispensing campaigns 35 Receiving, Distributing, and Dispensing SNS Assets Version 11 Strategic and Tactical Communications Chapter 10 While previous versions of this guidance may have been focused on counting pieces of communication equipment, CDC now recommends that planners develop communication capabilities as elements of the critical infrastructure. The CP should be part of the overall Emergency Operations

Plan (EOP) Should remain part of any existing interoperability framework Should enable coordinated communication with neighboring jurisdictions, and any partner agencies and organizations 36 Receiving, Distributing, and Dispensing SNS Assets Version 11 Strategic and Tactical Communications Chapter 10 To support a coordinated MCM response planners should develop a communications plan (CP) that: Integrates jurisdictional tactical and strategic communications

Enables communication between all partner organizations and agencies 37 Receiving, Distributing, and Dispensing SNS Assets Version 11 Securing Assets, Staff and Operations Chapter 11 Outlines federal-level resources to support the security function Such as PPDs 7 and 8, Homeland Security Act 2002, National Infrastructure Protection Plan, etc. Provides more detail for developing identification

badging procedures Offers detailed guidance for site specific plans Describes security operations in an ICS structure 38 Receiving, Distributing, and Dispensing SNS Assets Version 11 Hospital and Treatment Center Coordination Chapter 12 Defines alternate care facilities (ACFs) and treatment centers Describes processes for incorporating hospitals and treatment centers into the MCM distribution and communication processes

Provides guidance regarding administration fees 39 Receiving, Distributing, and Dispensing SNS Assets Version 11 Training, Exercising, and Evaluating Plans Chapter 13 Builds on the HSEEP program Applies HSEEP principles to MCMDD planning Provides information on developing a corrective action plan (CAP) Offers information to assist in building a jurisdictional multi-year training and exercise calendar

40 Receiving, Distributing, and Dispensing SNS Assets Version 11 Federal Medical Stations (FMS) Appendix A During a large scale natural or man-made disaster Casualties and displaced individuals could rapidly overwhelm medical response resources An FMS could augment response activities An FMS is a flexible, scalable asset designed to: Provide beds Medical Equipment An FMS is designed for:

Non-acute care Special needs care Quarantine operations Supplementing local healthcare infrastructure 41 Receiving, Distributing, and Dispensing SNS Assets Version 11 Federal Medical Stations Appendix A This appendix includes: Developing the Federal Medical Station Concept Understanding the Federal Medical Station Concept Preparing for FMS Arrival and Sustainment

Staffing the FMS Demobilizing the FMS 42 Receiving, Distributing, and Dispensing SNS Assets Version 11 Ventilators Appendix B The SNS contains a limited supply of mechanical ventilators Available for use in a public health emergency Size and scope of an event may limit availability Local event vs. nationwide This appendix contains the following topics:

Using SNS Ventilators Requesting SNS Ventilators Returning SNS Ventilators 43 Receiving, Distributing, and Dispensing SNS Assets Version 11 CHEMPACK Appendix C CHEMPACK Is a forward deployed asset for responding to a nerve agent release, may also be used in pesticide releases causing same effects if existing assets are overwhelmed Deployed nationwide WV has several containers placed geographically and population

based Two formulations Hospital treats 1000 people EMS treats 455 people This appendix covers the following topics: Understanding the CHEMPACK Formulary Planning for CHEMPACK 44 Receiving, Distributing, and Dispensing SNS Assets Version 11 Management of Forward Deployed DTPA Appendix D

Internal contamination with radioactive materials can result in exposure to life threatening doses of ionizing radiation Removing radioactive material is the best way to reduce exposure DTPA has been forward deployed nationwide in a one time opportunity WV has 530 doses available (expires 11/2014) Used for ingestion of americium, curium, and plutonium This appendix covers: Understanding Radiological Threats Caching DTPA in Project Areas Using DTPA as a Chelating Agent 45

Receiving, Distributing, and Dispensing SNS Assets Version 11 Questions/Comments? Please feel free to contact us: [email protected] or [email protected] 46 Receiving, Distributing, and Dispensing SNS Assets Version 11

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