STRATEGIC NATIONAL STOCKPILE (SNS) A Public Health and Emergency - - PowerPoint PPT Presentation

STRATEGIC NATIONAL STOCKPILE (SNS)

A Public Health and Emergency Management Agency Partnership

Paul R. Westlake, Public Health Emergency Preparedness & Response Coordinator PRW – 11/14/2018

Paul Westlake, Public Health Emergency Preparedness (PHEP) Coordinator

• 38 years in emergency

response

• Retired Fire Captain /

Paramedic

• Retired EMS Instructor
• Incident Command and

County EOC experience

• Emergency Response

Coordinator, TCHD

• Medical Reserve Corps

Coordinator

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IMAGINE THIS SCENARIO

Usually on a Friday night of a long, holiday weekend!

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Imagine This Scenario…

• In the past hour, multiple,

very ill patients are being seen in local emergency rooms.

• Fever, chills
• Shortness of breath
• Sweating profusely
• Confusion
• Cough
• Nausea, vomiting
• General malaise
• Lab tests are coming back

positive for anthrax exposure.

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Photo Credit: waisbrenmd.com

Scenario Continues…

• Emergency Departments begin to contact the Local Health

Department.

• Anthrax is a Category A disease – requires immediate notification

to local and state health agencies

• LHD’s epidemiological investigation shows that the patients

are from all over the county as well as surrounding counties.

• It is unknown where or how the persons were exposed.
• A decision is made to treat all citizens in the county and

surrounding counties.

• Prophylaxis treatment of anthrax must occur within 48 hours of

exposure for best chance of survival.

• Ciprofloxacin, Doxycycline or Amoxicillin antibiotics

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Where do you get enough medication for your county?

• All incidents begin and end locally
• Local supplies
• Pharmacies, hospitals
• State
• State RSS (Receipt, Stage & Store) warehouses
• Federal
• Strategic National Stockpile

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WHAT IS THE STRATEGIC NATIONAL STOCKPILE?

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The Strategic National Stockpile

• Large repository of medicine and medical supplies
• Available to protect the American public if there is a

public health emergency severe enough to cause local supplies to run out

• Managed by the Office of the Assistant Secretary for

Preparedness and Response (ASPR) through US Department of Health and Human Services.

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A Little Background

• The National Pharmaceutical Stockpile was created in

1999

• Ensure the nation’s readiness against potential agents of

bioterrorism

• Botulism, anthrax, smallpox, plague, viral hemorrhagic fevers, and

tularemia.

• Assemble large quantities of essential medical supplies that could

be delivered to states and communities during an emergency within 12 hours of the federal decision to use the stockpile.

• The September 11, 2001, terrorist attacks prompted

federal legislation and directives to strengthen public health emergency readiness.

• In 2003, the National Pharmaceutical Stockpile was

renamed the Strategic National Stockpile (SNS).

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What’s Available

• Biological Threats (Bioterrorism, flu pandemics, etc.)
• Antibiotics, Antivirals, Antitoxins, Vaccines
• Radiological Threats (Terrorism, nuclear powerplant accidents)
• Medications (Potassium Iodine, WBC Protagonists)
• Medical Supplies
• Burn and Blast Supplies
• Personal Protective Equipment (PPE)
• Ventilators & Respiratory Supplies
• IV Administration Supplies
• Federal Medical Stations
• Portable field hospitals
• Nerve Agent Treatment
• (CHEMPACK)

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12 Hour Push Package

• Cache of pharmaceuticals

and medical supplies designed to provide rapid delivery of a broad spectrum of assets for an ill- defined threat.

• Can be delivered to a state

receipt, stage, and store (RSS) warehouse within 12 hours of the federal decision to do so.

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Push Package Contents:

• Oral Antibiotics
• Amoxicillin, Cipro and Doxy
• Intravenous Supplies/Medications
• Gauze, gloves, tape, cannulas, IV supplies/solutions
• Cipro, Doxy, Dopamine, Morphine, Diazepam
• Respiratory Supplies
• Aerosol masks, tubes, medications
• Pediatric Sized Supplies
• Medical and Surgical Supplies
• Mostly pads and sponges

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Push Package at RSS

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Supplies Prepared for Hospital or County Drop Site

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Managed Inventory

• Second phase of

shipments

• Hazard has been

identified

• Hazard-specific

treatment

• Could be special

requests due to surge or mass casualty/fatality

• Antivirals
• Immunoglobulin
• Antitoxins (botulism)
• Vaccines
• Ventilators
• Federal Medical Stations
• Medical Supplies

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ACCESSING THE SNS

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Requesting Assets

• All emergencies, disasters and incidents begin and end

locally.

• Local assets and resources need to be used first or

assumed to be not enough before using state or federal assets.

• Request made to local Emergency Management Agency.
• Local EMA makes request to the State EMA, ESF 8 Desk.

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Ohio Department of Health Procedures

• Criteria to determine need:

1.

Epidemiological data – including laboratory data

2.

Public health information – including extent of illness

3.

Law enforcement intelligence

4.

Nature of the threat

• State EMA works with ODH and HHS to request SNS.
• HHS arranges for shipment of SNS from various locations

around the state/country.

• Medical Countermeasures (MCM) arrives within 12 hours
• f request

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LHD sees increase in EPI data and/or confirmed biologic release Multiple sick people presenting at local emergency departments. County EMA receives request for supplies Monitor resource status Will LHD supplies be exhausted in next 24 hours? Forward request to State EMA EOC Will state supplies be exhausted in next 24 hours? Forward request to ODH DOC ODH request medical countermeasures from HHS HHS release supplies NO NO YES YES

Local Supplies/Resources First

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LHD sees increase in EPI data and/or confirmed biologic release Multiple sick people presenting at local emergency departments. Monitor resource status Will LHD supplies be exhausted in next 24 hours? NO

Local Supplies Exhausted

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County EMA receives request for supplies Will LHD supplies be exhausted in next 24 hours? Forward request to State EMA EOC YES

State Supplies/Resources

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Monitor resource status Will state supplies be exhausted in next 24 hours? NO

State Supplies/Resources Exhausted

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Will state supplies be exhausted in next 24 hours? Forward request to ODH DOC ODH request medical countermeasures from HHS HHS release supplies YES

SNS Distribution

• ODH coordinates with ESF-1 (ODOT is lead agency) for

transportation to and from State RSS (Receipt, Stage, Store) warehouse.

• Materials are transported to reach the largest population

in most efficient way.

• Distribution method depends on size of the affected area.
• Three models:

1.

PODs and Hospitals

2.

County Drop Sites (CDS)

3.

Regional Drop Sites (RDS)

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Model 1: PODs and Hospitals

• Preferred method
• Direct shipment to

Open PODs and hospitals.

• Closed POD supplies

must come from Open PODs.

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Model 2: County Drop Sites (CDS)

• Direct shipment to CDS,

PODs and hospitals.

• If transportation assets

limited, may ship to CDS only.

• LHD responsible for

distribution to PODs and staffing CDS.

• LHD may request

transportation and manpower resources from local EMA.

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Model 3: Regional Drop Sites (RDS)

• Direct shipment to RDS,

CDS, PODs, hospitals.

• If transportation assets

become more limited, may ship to RDS only.

• RHCC & LHD

responsible for distribution and staffing RDS.

• May request

transportation and manpower resources from local EMA

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SCENARIO CONTINUES…

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How does the MCM Get to public?

• State RSS gets SNS MCM within

12 hours of request.

• ODH sorts, inventories,

processes and ships the MCM to the county sites within another 12 hours.

• Means that LHD may have less

than 24 hours to dispense MCM.

• With a 48 hour goal
• LHD activates Open and Closed

Point of Dispensing sites (PODS).

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What is a Point Of Dispensing Site? (POD)

• Pre-determined location(s) used to dispense mass medical

counter measures (vaccines, antibiotics, etc.) to the public.

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Two Types of POD Sites (PODS)

Open Closed

• Serves pre-determined

population only (i.e. staff and their family members

• nly)
• Extended and Skilled

Care Facilities

• Hospitals
• Schools
• Businesses
• Serves the public
• Often in schools,

churches, public buildings

• Requires people to get to

the POD

• LHD usually staff along

with volunteers

• Manpower intensive

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Four Basic Steps of a POD

Triage/Greeting

Registration/Forms Completion

Screening Dispensing & Education

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Triage/Greeting

• Greet people as they arrive and provide directions.
• Need to triage anyone who is symptomatic.
• Those who are ill or symptomatic should not be allowed

to enter the PODS.

• Refer to doctor/hospital for TREATMENT.
• Medication provided at the PODS is for PREVENTION only.

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Registration/Form Completion

• Public Health Name Address and Personal History

(NAPH) form

• Can be completed on line prior to arriving at PODS
• If forms are completed before arrival at POD, speeds up process,

increases throughput

• If person completes a Dispense Assist form online, skip

registration/forms completion and screening and go directly to dispensing. http://dispenseassist.net/default.html

• Head of Household
• Can pick up 10 additional regimens plus their own (11 total)
• NAPH form must show every person receiving meds or one

Dispense Assist form per person

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Screening

• NAPH form will be reviewed to determine the following:
• That all sections of the form have been properly completed
• Antibiotic to be administered
• Ciprofloxacin, Doxycycline or Amoxicillin
• If further medical examination is necessary
• Form is self explanatory and follows a logical flow.

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Dispensing & Education

• Head of household will be given the

appropriate amount of antibiotics for the household along with information/directions for taking the antibiotic.

• Insert pamphlets on drug information

and dosage, including how to dispense the drug to those who are unable to swallow pills (i.e. young children)

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PREPAREDNESS & PLANNING

What should Emergency Management Agencies be prepared to do?

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Material Handling Equipment

q Based upon needs at each site q Forklifts

§ Essential if no docks § 3k-5k pound capacity

q Pallet Jacks

§ Can replace forklifts at sites with docks § Determine how many pallet jacks or forklift needed to service each expected truck or for each team

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RDS/CDS Space Requirements

• Balance temporary storage with long-term storage

needs

• 10-foot wide aisles assists two-way traffic
• Incorporate administrative areas
• Incorporate staging areas
• Resource to your plan!

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Palletized Product Space Needs

• Most SNS-provided pallets are 48” long x 40” wide
• 1 pallet = 16 square feet
• With 10’aisle = 36 square feet

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Palletized Product Space Needs

Image created by Richard Bishop, DSNS RSS Course Manager

Pallet with 10’Aisle:

Pallet Length: 4’ + 5 (1/2 aisle width) =9’ Sq Ft: 9’X 4’(pallet width) = 36 Sq Ft

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Palletized Product – Anthrax Scenario

Each pallet:

• 96 cases of doxy /

cipro per “standard” pallet

• 100 bottles per case
• 9,600 bottles per

pallet

• 22 pallets to a truck

with 53’ trailer

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Do the math for CDS

Tuscarawas County

• Population ≈ 93,000
• 93,000/9600 ≈ 10 pallets
• Trucks needed for

Tuscarawas County: ½ of a 53’ semi-trailer

Standard Truck/Trailer Sizes

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• 20 – 8 pallets
• 40 – 16 pallets
• 45 – 18 pallets
• 48 – 19 pallets
• 53 – 22 pallets

SNS Planning for EMA

• Transportation needs
• Material handling equipment needs
• Security needs
• Volunteer needs (VRC)
• Mutual aid from other counties unless it’s a regional incident
• Working relationship with local health department

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Resources/Bibliography

• Presentation reviewed by Ohio Department of Health, Office of Health Preparedness
• 5 Medical Countermeasure Management/Medical Materiel and Asset Management

Coordination Concept Plan, Northeast Central Ohio Region

• Strategic National Stockpile Guidance, Ohio Department of Health
• Medical Countermeasures Annex – 11/15/2016 (Draft), Ohio Department of Health
• Introduction to SNS Operations Course Manual – August 2018, Centers for Disease Control

and Preparedness

• Receiving, Distributing and Dispensing Strategic National Stockpile Assets, Version 11,

Centers for Disease Control and Prevention

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Contact Information

Paul Westlake, PHEP Coordinator Tuscarawas County Health Department 897 E. Iron Ave. Dover, OH 44622 330-343-5555, ext 178 pwestlake@tchdnow.org

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QUESTIONS?

Thank you for the opportunity to speak with you!

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