Receiving, Distributing, and Dispensing SNS Assets

Document Overview:Receiving, Distributing, and Dispensing SNS Assets A Guide to Preparedness Version 11

Jim Sowards, WV SNS CoordinatorHumbert Zappia, CDC Public Health Advisor1AssumptionsEveryone 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 caseThe federal government has medical countermeasures available for use in events exceeding local capacityThe materiel is available in several configurationsPushpack, Managed Inventory, Forward deployed, Purchasing PowerThe materiel available is used for major healthcare emergencies that overwhelm local resourcesBoth natural and manmadeReceiving, Distributing, and Dispensing SNS Assets Version 112GoalProvide awareness of new guidance and highlight some of the changes for your use in future plan review and revisionThe document contains many references and hyperlinks to supporting federal documents and resources

Receiving, Distributing, and Dispensing SNS Assets Version 113BackgroundThe 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 yearsReceiving, Distributing, and Dispensing SNS Assets Version 1144Some of the workgroup revisions that show up in the guidance: Broader focus on MCMs in generalDe-emphasis on 48 hour dispensingBetter description of the federal response structureEnhanced explanation of the federal request processReceiving, Distributing, and Dispensing SNS Assets Version 115BackgroundBackgroundSome of the workgroup revisions that show up in the guidance: Broader dispensing guidanceMore information on handling and dispensing vaccinesCold chain managementInclusion of specialized populationsAgent by agent formulary items

Receiving, Distributing, and Dispensing SNS Assets Version 116Version 11 Major ChangesInclusion of formulary itemsConsideration of various SNS response capabilitiesLess focus on12 Hour Push Package48 Hour dispensing scenarioDispensing solely related to oral antimicrobials

Receiving, Distributing, and Dispensing SNS Assets Version 117Version 11 Major ChangesMore focus onBroader MCM responseLonger MCMDD operationsDispensing MCMs via other than oral routesSpecialized populationsDemobilizing operationsAnnual Guidance Update PlannedNew appendices throughout the yearAnnual update to overall document

Receiving, Distributing, and Dispensing SNS Assets Version 118Version 11 OrganizationChapters no longer mirror the Technical Assistance Review (TAR)Functional areas listed in order from initial request through dispensingMore comprehensive guidance on how to develop each section of the MCMDD planChapters are designed to stand aloneAll acronyms definedLinks to other documents or resources with hyperlinked addressesFooter reflects document title, chapter title, and page numbersReceiving, Distributing, and Dispensing SNS Assets Version 119Version 11 Chapter OrganizationOverviewCore PlanningFunctionalAncillaryInformational Appendices

Receiving, Distributing, and Dispensing SNS Assets Version 1110Version 11 Chapter OrganizationOverviewIntroductionThe Strategic National Stockpile FormularyCore PlanningConcept of MCM Operations Chapter 1Developing an MCM Plan - Chapter 2Management of MCM Operations - Chapter 3 Receiving, Distributing, and Dispensing SNS Assets Version 1111Version 11 Chapter OrganizationMCMDD Functional AreasRequesting SNS Assets - Chapter 4Receiving, Staging, and Storing SNS Assets Chapter 5Controlling MCM Inventory Chapter 6Distributing SNS Assets Chapter 7Dispensing Oral Medications Chapter 8

Receiving, Distributing, and Dispensing SNS Assets Version 1112Version 11 Chapter OrganizationAncillary Planning AreasPublic Information and Communication Chapter 9Strategic and Tactical Communications Chapter 10Securing Assets, Staff, and Operations Chapter 11Hospital and Treatment Center Coordination Chapter 12Training, Exercising, and Evaluating Plans Chapter 13AppendicesFederal Medical Stations Appendix AVentilators Appendix BCHEMPACK Appendix CDTPA Appendix DCold Chain Management Appendix EReceiving, Distributing, and Dispensing SNS Assets Version 1113Chapter by Chapter OverviewReceiving, Distributing, and Dispensing SNS Assets Version 1114Introduction to theStrategic National StockpileIntroduction provides:Brief history of the SNSInformation on DSNS and DSLRTips for using Version 11Overview of readiness reviews at state and local levelsReceiving, Distributing, and Dispensing SNS Assets Version 1115SNS Formulary SectionThe 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 threatCategorization of SNS response capabilitiesSNS response strategiesReceiving, Distributing, and Dispensing SNS Assets Version 1116Concept of Medical Countermeasure Operations Chapter 1This chapter replaces the Command and Control Chapter from the previous guidanceInformation/references regarding federal strategies, guides, and systems to assist in national emergenciesNational Preparedness GoalNational Preparedness SystemNational Planning FrameworksNational Incident Management System (NIMS)Incident Command SystemUnified CommandProvides guidance to assist local planners in integrating plans with federal response plansReceiving, Distributing, and Dispensing SNS Assets Version 1117Developing a MCM Response Plan Chapter 2Outlines:State and local planning functionsRecommends integration into existing state and local plansMCM planning requires many agencies and organizations involvementWhen accomplished properly, planning provides a methodical way to work through the entire life cycle of a potential crisis.Receiving, Distributing, and Dispensing SNS Assets Version 1118Developing a MCM Response Plan Chapter 2One new change in the guidance is the promotion of regionalization of response planning.Regionalization allows resource pooling to benefit all in the affected areaAlso allows for cost savings in drills and exercisesThere is an expectation in the guidance that all CRI jurisdictions will consider one basic response plan with overarching guidance from the stateIndividual planning nuances may be captured in planning annexesMore to follow as further information is released!Receiving, Distributing, and Dispensing SNS Assets Version 1119Developing a MCM Response Plan Chapter 2Military InstallationsReiterates that we need to include these facilities in our planningStaff, family membersDOD 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 departmentsReceiving, Distributing, and Dispensing SNS Assets Version 1120Developing a MCM Response Plan Chapter 2Employees of Federal AgenciesEmployees and their families need to be included in local plansAt-risk PopulationsHHS defines at-risk populations as people with needs in five areasMaintaining independenceCommunicationTransportationSupervisionMedical CarePAHPA also recognizes children, senior citizens, and pregnant womenReceiving, Distributing, and Dispensing SNS Assets Version 1121Developing a MCM Response Plan Chapter 2CollaborationMultidisciplinary Advisory GroupScalableOperational in all types of incidentsPolicies and proceduresTailored, owned, and understoodShare the plan among partnersDelineate state and local responsibilitiesInclude regulatory and legal considerationsContinuity of Operations Plan (COOP)Be sure to involve partner organizationsReceiving, Distributing, and Dispensing SNS Assets Version 1122MCM ResponseReceiving, Distributing, and Dispensing SNS Assets Version 1123

Management of MCM Operations Chapter 3This 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 structureProvides sample dispensing site ICS structureAlert Notification ProcessInclude Ops team membersManaging MCM operationsInitial, sustained, and recoveryMaintaining MCM Management capabilitiesMeetings, workshops, training, exercise

Receiving, Distributing, and Dispensing SNS Assets Version 1124Requesting SNS AssetsChapter 4Explores the methodology, rationale, process for requesting assetsGuidance moves away from calling CDC directlyIntegrates other federal partners into the processOutlines request processes based on federal declarationIn 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

Receiving, Distributing, and Dispensing SNS Assets Version 1125Requesting SNS AssetsChapter 4At the local level all plans should include processes for requesting MCMs from the stateThe request planning processes should include;Who can make the requestNames and contact information in an annexJustification/rationale outlinesInitial request and resupply request processesInclude 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.

Receiving, Distributing, and Dispensing SNS Assets Version 1126Receiving, Staging, and Storing MCMs Chapter 5Provides floor space calculations based on population and planning for managed inventoryIn WV, we need a facility in the 25,000 to 35,000 square foot rangeSupplies information on numbers of unit of use bottles per palletProvides information on DEA registrationProvides information on cold chain managementVerifying and re-verifying RSS facilitiesInitial verification involves CDC officials and must be re-verified every three years

Receiving, Distributing, and Dispensing SNS Assets Version 1127

Managing MCM InventoryChapter 6Inventory management processes are critically important to the success of the overall mission start to finish!

Receiving, Distributing, and Dispensing SNS Assets Version 1128Managing MCM InventoryChapter 6Describes the systems needed to track materialSome specialty MCM IMS issuesChain of custodyCold chain managementControlled substancesDetermining data collection and tracking elementsThe ability to know where a product is at any given time is an important component of the processTracking receipt, on-hand balances, orders and reordersDispensing dataHealth Insurance Portability and Accountability Act (HIPPA)

Receiving, Distributing, and Dispensing SNS Assets Version 1129Managing MCM InventoryChapter 6This chapter also includes information onCDCc national level Countermeasure Tracking System (CTS)Countermeasure Inventory Tracking (CIT) Dashboard;Countermeasure and Response Administration (CRA) system;Inventory Management and Tracking System (IMATS); andCommunications Portal (CP)Receiving, Distributing, and Dispensing SNS Assets Version 1130Distributing Medical Countermeasures Chapter 7Receiving, Distributing, and Dispensing SNS Assets Version 1131

Distributing Medical Countermeasures Chapter 7Provides more route planning informationIncludes consideration for distributing MCMs requiring cold chain managementOffers information on DEA registration for distributionOffers information onDeveloping distribution networksIdentifying transportation resourcesIdentifying security resourcesDetermining distribution models

Receiving, Distributing, and Dispensing SNS Assets Version 1132Dispensing Medical Countermeasures Chapter 8Provides information on liability coveragePublic Readiness and Emergency Preparedness (PREP) ActOffers planning considerations beyond the open/public POD structureGives specific labeling and Shelf-life Extension Program (SLEP) informationLists specific SNS formulary items and administration routesReceiving, Distributing, and Dispensing SNS Assets Version 1133Dispensing Medical Countermeasures Chapter 8Provides information for dispensing life-cycleActivation through demobilizationOffer considerations for vaccination campaignsIncludes guidance on how Emergency Use Authorization (EUA) or Investigational New Drug (IND) protocol may effect dispensingReceiving, Distributing, and Dispensing SNS Assets Version 1134Public Information and Communication Chapter 9Provides more information on reaching at risk populationsOffers guidance on social media in messaging campaignsIncludes information based on communication researchProcesses related to crafting messages and getting the best resultsProvides further considerations for 60 day or other long term dispensing campaignsReceiving, Distributing, and Dispensing SNS Assets Version 1135Strategic and Tactical Communications Chapter 10While 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 frameworkShould enable coordinated communication with neighboring jurisdictions, and any partner agencies and organizationsReceiving, Distributing, and Dispensing SNS Assets Version 1136Strategic and Tactical Communications Chapter 10To support a coordinated MCM response planners should develop a communications plan (CP) that:Integrates jurisdictional tactical and strategic communicationsEnables communication between all partner organizations and agenciesReceiving, Distributing, and Dispensing SNS Assets Version 1137Securing Assets, Staff and Operations Chapter 11Outlines federal-level resources to support the security functionSuch as PPDs 7 and 8, Homeland Security Act 2002, National Infrastructure Protection Plan, etc.Provides more detail for developing identification badging proceduresOffers detailed guidance for site specific plansDescribes security operations in an ICS structureReceiving, Distributing, and Dispensing SNS Assets Version 1138Hospital and Treatment Center Coordination Chapter 12Defines alternate care facilities (ACFs) and treatment centersDescribes processes for incorporating hospitals and treatment centers into the MCM distribution and communication processesProvides guidance regarding administration feesReceiving, Distributing, and Dispensing SNS Assets Version 1139Training, Exercising, and Evaluating Plans Chapter 13Builds on the HSEEP programApplies HSEEP principles to MCMDD planningProvides information on developing a corrective action plan (CAP)Offers information to assist in building a jurisdictional multi-year training and exercise calendarReceiving, Distributing, and Dispensing SNS Assets Version 1140Federal Medical Stations (FMS)Appendix ADuring a large scale natural or man-made disasterCasualties and displaced individuals could rapidly overwhelm medical response resourcesAn FMS could augment response activitiesAn FMS is a flexible, scalable asset designed to:Provide bedsMedical EquipmentAn FMS is designed for:Non-acute careSpecial needs careQuarantine operationsSupplementing local healthcare infrastructure

Receiving, Distributing, and Dispensing SNS Assets Version 1141Federal Medical Stations Appendix AThis appendix includes:Developing the Federal Medical Station ConceptUnderstanding the Federal Medical Station ConceptPreparing for FMS Arrival and SustainmentStaffing the FMSDemobilizing the FMS

Receiving, Distributing, and Dispensing SNS Assets Version 1142VentilatorsAppendix BThe SNS contains a limited supply of mechanical ventilatorsAvailable for use in a public health emergencySize and scope of an event may limit availabilityLocal event vs. nationwideThis appendix contains the following topics:Using SNS VentilatorsRequesting SNS VentilatorsReturning SNS Ventilators

Receiving, Distributing, and Dispensing SNS Assets Version 1143CHEMPACK Appendix CCHEMPACKIs 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 overwhelmedDeployed nationwideWV has several containers placed geographically and population basedTwo formulationsHospital treats 1000 peopleEMS treats 455 peopleThis appendix covers the following topics:Understanding the CHEMPACK FormularyPlanning for CHEMPACK

Receiving, Distributing, and Dispensing SNS Assets Version 1144Management of Forward Deployed DTPA Appendix DInternal contamination with radioactive materials can result in exposure to life threatening doses of ionizing radiationRemoving radioactive material is the best way to reduce exposureDTPA has been forward deployed nationwide in a one time opportunityWV has 530 doses available (expires 11/2014)Used for ingestion of americium, curium, and plutoniumThis appendix covers:Understanding Radiological ThreatsCaching DTPA in Project AreasUsing DTPA as a Chelating Agent

Receiving, Distributing, and Dispensing SNS Assets Version 1145Questions/Comments?Please feel free to contact us:

jim.sowards@wv.govorhumbert.zappia@wv.gov

Receiving, Distributing, and Dispensing SNS Assets Version 1146