New Jersey Emergency Pharmaceutical Preparedness September 28, 2005.
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Transcript of New Jersey Emergency Pharmaceutical Preparedness September 28, 2005.
New Jersey Emergency Pharmaceutical Preparedness
September 28, 2005
New Jersey’s Emergency Preparedness Pharmaceutical System
The Commissioner of Health and Senior Services has directed the development and implementation of a plan that ensures New Jersey’s healthcare system is adequately supplied with pharmaceuticals and medical supplies during any emergency.
Federally supplied materials Strategic National Stockpile CHEMPACK
New Jersey owned supplies Strategic State Stockpile
Hospital caches
Strategic National Stockpile(SNS)
Mission: To deliver pharmaceuticals and medical materiel to the site of a national emergency
Push Package vs. Managed Inventory (MI)
For unknown or multiple threat
7-8 truck loads of medical material
Prepackaged
Delivered in under 12 hours
For the known threat
Pharmaceuticals and medical materials in quantities specifically requested by the state
Delivered within 24 hours
NJ received MI during anthrax events
Oral Antibiotics
IV Supplies
Nerve Agent Antidotes
Airway supplies
Med/Surg Supplies (Clear)
SNS Push Package: 130 Containers
How SNS Assets are DeployedHow SNS Assets are Deployed
CDC Director Deploys
SNS Assets
Augments Local/State
MedicalMateriel
Resources
SNS
Need for Drugs and Medical Supplies Exceeds Local & State Resources
State Requests Federal Assistance
In consultation with the Surgeon General, Secretary of HHS, HHS Office of Emergency Preparedness, FEMS and the FBI
Distribution
PODPOD POD POD
RSSAssets Deployed
in the State
Unit of Use Medications in 12-Hr Push Package
Dispensed as unit of use 10-day Labeled Child-proof bottles Sufficient quantities to
protect 200,000 Designed for the worst case
– an anthrax response
Unit of use medications in 12-Hr Push Package
10-day regimens in Push Package (approx. 15% of containers in 12-hr PP)
88,900 bottles of ciprofloxacin (#20 tab)
88,900 bottles of doxycycline (#20 tab)
24,000 bottles of amoxicillin 250mg chewable (#30 tab) for:
Pregnant women Allergies to ciprofloxacin / doxycycline Children who cannot swallow whole tabs,
but can chew (1,600 bottles of amoxillin 500mg chew tabs (#75 tab)
IND required against anthrax
Additional Unit of Use Drugs – Managed Inventory
For large-scale events SNS has contracts to repackage -
1 million /day!
The toxic effects of nerve agents require immediate pharmaceutical intervention followed by long-term care. This pharmaceutical intervention must be supported in both the pre-hospital and hospital phase. The ability of emergency medical personnel to begin immediate treatment of individuals exposed to nerve agents will directly affect a casualty’s ability to survive the exposure.
CHEMPACK PROJECT
CHEMPACK MISSION
Implement a nationwide project for the “forward” placement of nerve agent antidotes
Provide state and local governments a “sustainable resource” that increases their capability to respond quickly to a nerve agent event
CHEMPACK Assumptions
A deliberate or accidental nerve agent release can occur anywhere
Any major release would probably require large supplies of nerve agent antidotes
The “forward” placement of CHEMPACK assets in various locations (caches) throughout an area will expedite delivery of antidotes to the disaster site
CHEMPACK Containers The CHEMPACK Project provides two types
of containers:
Emergency Medical Services (EMS) ContainerDesigned for emergency responders; material packaged mostly in auto-injectors
Hospital ContainerDesigned for hospital dispensing, with multiuse vials, for precision dosing and long term care.
CHEMPACK Formulary
Mark 1 Kits Atropine Sulfate 0.4 mg/ml 20 ml Diazepam 5 mg/ml auto-injector Pralidoxime 1 gm inj 20 ml Diazepam 5 mg/ml vial, 10 ml vial
Cities Readiness Initiative (CRI)
CRI Goals
Enhance the ability of cities to rapidly dispense life saving drugs to their population
Dispense needed drugs to 100% of each city’s population within a 48-hour timeframe
Assumptions An outside aerosolized release of anthrax.
For the purposes of first year planning “First Responders” are defined as: Public Health Services Office of Emergency Management Law Enforcement Fire Services Emergency Medical Services
Assumptions – cont….
Non-medical personnel will be allowed to distribute medications.
The NJDHSS will receive an adequate supply of oral medications.
Medications will not be available in liquid suspension form.
CRI – NJ Goals What are the goals of the program
Distribute medications to targeted population within 48 hrs.
One goal, for the 1st year of the grant is to develop a medication distribution plan targeted at a narrowly defined group of First Responders and their households members.
STRATEGIC STATE STOCKPILE (SSS)
Report: State Strategic Stockpile Subcommittee
March 22, 2004
Local Medical Inventory Considerations
Threat
Prophylactic medicines and supplies for dealing with those threats
Quantity of medicines and other items needed in local inventory
Location of local inventory convenient to essential personnel when needed
Proceedings of the State MEDPREP Committee
Resources Available in the State
Hospitals MICUs Military V.A. State Cities
Proceedings of the Committee
Possible Scenarios for Chemical, Biological, Radiation, Nuclear and Explosive Events (CBRNE)
High-Risk Locations Storage Distribution Composition Quantity Budgetary Concerns and Restrictions Final Recommendations
Quantity
To determine the quantity of antidotes needed, we estimated the number of potential victims and selected a methodology to determine the severity of an event
To determine numbers of victims we reviewed
A) the Tokyo Subway Attack (> 5500) B) the original Med Prep proposal (100,000) C) the U.S. government estimate (>10,000) D) NJ daily and emergency room visits
FACT: roughly 8,600 daily emergency room visits to NJ Hospitals
Subcommittee arbitrarily doubled this number, plus added a growth factor to come to a total of 20,000 victims for a chemical event.
DETERMINED NEED
State Stockpile for 20,000 victims for the first 48 hours after a chemical event
TASK Develop our own model by utilizing a
successfully determined model
PROBLEM: there are none
The Committee utilized the model developed by the Federal government for their ChemPak Program.
Anticipated injuries in the CHEMPAK model
30% mild 40% moderate 30% severe
AGENTS NEEDED IN A CHEMICAL EVENT
Atropine Pralidoxime Diazepam Sodium Thiosulfate
AGENTS NEEDED IN A BIOLOGICAL EVENT
Ciprofloxacin Doxycycline Clindamycin Gentamicin Amoxicillin
NOTE: All recommendations will allocate 20% of the total for pediatric patients
STORAGE OF STOCKPILE
HOSPITALSChemical -- all hospitals must maintain antidotes for a minimum of 20 patients to a maximum of 200 patients
Biological – all hospitals must have the capability of diagnosing and treating at least 2 patients and plans for cohorting and treating at least 20 patients
STORAGE OF STOCKPILE
REGIONAL STORAGE SITES
Chemical -- LINCS or PODS HOSPITALS or state-determined locale
Biological -- LINCS or PODS HOSPITALS or state-determined locale
FURTHER ACTIONS MedPrep approves actions and methodology of
subcommittee to date
State provides information on budget allocated for stockpile
Trauma/Burns subcommittee provides information on RNE needs
Subcommittee finalizes recommendations based on approved methodology and budgetary information
NJ’s SSS Formulary
Potassium Iodide Received 722,000 doses of potassium iodide (KI) for individuals who live and/or work
within ten miles of a nuclear generating station.
Established dispensing sites in the areas surrounding New Jersey’s four nuclear power plants and distributed over 75,000 doses of KI
Distributed fact sheets, medical counseling, and other information relating to nuclear emergencies
Provided area schools, colleges and daycare centers with KI pills and information regarding KI administration
Antibiotics Antibiotics for the treatment of agents associated with acts of bioterroism are stored in
state and acute care hospital facilities
Chemical Antidotes Acquired and pre-positioned in state
Infection Control Supplies Respiratory masks, thermometers and gloves in support of communicable respiratory
illness response plans
Mass Dispensing – Points of Dispensing (POD)
POD Site Considerations
Determined by: Number of people
exposed/potentially exposed
Who you must treat or prophylax
Site locations The event determines the
number and location of sites
Staffing the POD
Types of Staff Professionals Volunteers Management & Support staff
Staffing the POD
Sources of Staff
Professional Associations Licensing agencies Medical Reserve Corps (MRC)
TOPOFF 3 Lessons Learned – RSS Operations
Federal emphasis has been on Push Package, but TOPOFF emphasized Managed Inventory. NJ not prepared to receive MI in sufficient quantities
Need additional floor space for MI materials
LINCS agencies need additional space/ equipment for receiving MI
TOPOFF 3 Lessons LearnedRSS Operations
Request process for federal assets needs to be streamlined with consistent information/input needed
Must be prepared to both request and deny assets
TOPOFF 3 Lessons LearnedRSS Operations
Not enough antibiotics available in suspension formulation
Need instructions/educational materials for pediatric dosing using tablets
Hippocrates
NJ Medical Reserve Corps
To develop a prepared, trained workforce of volunteers to serve the citizens of NJ in the event of a public health emergency.
www.njmrc.nj.gov
QUESTIONS