Application to Mass DispensingHot Topics in Preparedness

Northwest Center for Public Health PracticeSchool of Public Health & Community Medicine

University of WashingtonJuly 27, 2004

Andy Stergachis, Ph.D., R.Ph.Professor, University of Washington

SNS Coordinator, Region 6

Roughly how complete is your SNS plan?

A. 100%B. 75%C. 50%D. < 50%

What do you need to plan for?• Roles, responsibilities, policies• Decision-making for requesting SNS• Site selection• Set-up and design• Staffing• Public information and communication

What is theStrategic National Stockpile?

Federally managed logistical system created to supplement supplies of state and local systems during a major public health emergency:

• 12 strategically located Push Packages (12hr PP)• Vendor Managed Inventory (VMI)• Stockpile Managed Inventory (SMI)• Technical Assistance Response Unit (TARU)• Chempack Program

12-hour Push Package• 50+ tons of pharmaceuticals,

equipment, and other medical supplies.

• Color coded for ease in identifying needed material:– Biological, Chemical & Biological,

All Scenarios, Chemical Antidotes, Bandages

• Antibiotics– Unit of use 10-day courses– Suspension– Intravenous

Vendor Managed Inventory • Inventory owned by the SNS

program and managed by pharmaceutical vendors– Vendors maintain the VMI stock

as a bulge within their pipeline and rotates stock to keep it current and eliminate waste.

• Represents 90% to 95% of the SNS inventory• Used in Florida, re: anthrax attack

CHEMPACK Program• The CHEMPACK program

forward-deploys chemical antidotes

• Elements of the program:– Maintained locally and readily

available to EMS and Hospital Emergency Departments

– Remotely monitored for environment and security by the SNS Program

• Washington was one of the three pilot programs

Roles, Responsibilities, Policies

• Who has authority to request SNS?

• What are the relevant laws and authorities?

• What is the process for requesting SNS?

• How is the request coordinated with regular emergency management procedures?

?

Responsibilities

• The state is responsible for receiving, storing, staging (RSS), & distributing the SNS supplies to the points of distribution (PODs).

• Local health officials are responsible for setting up and operating dispensing or immunization clinics/sites.

Decision-Making to Request SNS

• Identify Criteria, e.g.– Suspected BT attack– Chemical agent or ionizing radiation– Hospitalization of large numbers of patients

• Determine if local supplies sufficient, e.g.– Number of casualties– Epidemiology of agent of concern

• Consultations• Notifications

Set-Up and Design• Critical Components:

– Incident Command

– Triage & Registration

– Dispensing – Express & Other

– Counseling and Education

– Record Keeping

– Security

• Throughput Model

Types of Patient Groups• No Complications – healthy

– Express dispensing

• Complications – pre-existing illnesses/allergies, pregnant, etc.

– Assess and provide more involved counseling

• Persons with acute illnesses

– Transport

• Crisis counseling and mental health intervention

Which of the following sites are you considering for mass

dispensing clinics?A. SchoolsB. Community CentersC. PharmaciesD. Other

Site Selection

• How many?

• Where?

– Familiar Locations

– Accessible

• Size and Characteristics

• Hours of Operation

• Agreements

Do you have a plan for mobilizing volunteers for

mass dispensing clinics?

A.YesB.No

Staffing• Public Health Department

• Volunteers

– Recruit

– Train

– Call-Up Procedures

• Who can dispense?

• Prescribing physician

Public Information and Communication

• Notifications to public of POD openings

• Coordinate through Public Health Information Officer and Joint Information Center (JIC)

Lessons Learned from Exercises of SNS: Planning

• Hold face-to-face meetings• Establish and solidify mutual aid agreements• Scale plans to accommodate scenarios• Harmonize SNS plans with other plans• Clarify roles• Update contact information and make it

accessible • Emphasize regional planning

ASTHO 2004

Resources• www.bt.cdc.gov/stockpile/index.asp

• Mass Prophylaxis/Vaccination Campaign Staffing Model: www.ahrq.gov/research/biomodel.htm

• www.phppo.cdc.gov/phtn/antibiotic

• Exercising the SNS: Lessons learned and tools for application, www.astho.org