Medical Counter Measure

Distribution & Dispensing

CBERS 2015

Objectives

• Medical Countermeasures

• Strategic National Stockpile (SNS)

Program Overview

• Receive Store and Stage (RSS) Sites

• Points of Dispensing (PODs)

• CHEMPACK Program Overview

What are MCMs?

Medical Countermeasures (MCMs) are:

– Drugs

– Vaccines

– Diagnostic tests

Designed to counter the following threats:

– Chemical

– Biological

– Radiological

– Nuclear

– Emerging infectious diseases

MCM Preparedness Issues

• MCMs for certain serious disease threats (CBRN and emerging infectious diseases) are generally not readily available – Local hospitals and pharmacies are not likely to stock

these items in sufficient quantity

– Some require special training to administer

– Many MCMs require special Emergency Use Authorization (EUA), Investigational New Drug (IND) protocols, or Emergency Declarations

• Because of these factors the Federal Government has establish stockpiles of MCMs.

• States are still required to plan for the receipt and distribution of these medications.

Strategic National Stockpile Assets

• 12-Hour Push Package

– 50 tons of pharmaceuticals

and medical supplies

– 130 cargo containers

– 12 locations nationwide

– 3% of entire SNS

• Managed Inventory

– Large quantities of specific

items, such as antibiotics,

vaccines, and ventilators

– Vendor Managed Inventory

– Stockpile Managed

Inventory

– 97% of entire SNS

SNS Formulary Contents

Capacity for Treatment (Plague, Tularemia, Anthrax)

• One 12-hour Push Package can provide:

Prophylaxis for: 357,000 people X 7 days.

Therapeutic treatment for:

6,000 people X 7 days. • The Push Package is designed to

be followed by Managed Inventory (MI)

• Number of days of medication is scenario driven

Local EOC

VA EOC

Local & Regional Resources

Exceeded

State Resources

Exceeded

CDC SNS Push Pack

Managed Inventory

Local

PODs

VA RSS

The Process:

Incident Command

Hospitals Health

Dept Hospitals Hospitals

A POD is a high thru-put clinic for providing

emergency:

Usually, people have to be seen by a physician in order to

receive a prescription, then fill at a pharmacy. PODs are

used when there is no time for that.

What is a Point of Dispensing (POD)?

• Declaration of Public Health Emergency

– Bioterrorism

– Pandemic Influenza

– Other Disease of Public Health Threat (DoPHT)

• Time is of the essence. Must protect people quickly to prevent illness

and death

• PODs provide prophylaxis, NOT treatment

• An “Open POD” is a POD that provides prophylaxis to members of the

general public, usually on a walk-in (or drive-thru) basis

• A “Closed POD” is a POD that is operated by an organization to protect

their employees (and employees’ family members), and is not open to

the general public

• VDH is responsible for protecting all Virginians

– Closed POD agreements complete this mission faster

When do we use PODs?

Medical vs. Non-medical PODs

• In a non-medical POD the treatment (pills) is given to the patient to be taken at a later time.

– This means that we use a “head of household” method, in which one person picks up enough medication for their entire household.

– This also means that anyone can distribute medications.

• In a medical POD, the treatment (typically injections), is done on-site by medical personnel.

– This means that each individual must report to a POD in-person for treatment.

– This also means that only medical personnel (MD’s and RN’s), can administer medication.

• In either case, a medical director provides

medical oversight.

Closed POD Agreements in

Virginia • VDH State Level Closed-POD Agreements:

– Virginia Department of Corrections

– Dominion Resources

– Richmond Federal Reserve

• VDH Local Health Department Agreements

– First Responder Agencies

– Hospitals/Healthcare

– Long Term Care Facilities

– Military Bases

– Large Employers

Open POD agreements

• VDH is currently working on agreements with

certain organizations to serve as Open PODs

– CVS, Rite Aid, Martins, and Walgreens Pharmacies in

Henrico County (local agreement)

– State level negotiations in progress with major

pharmaceutical chains

• Kroger/Harris Teeter, Rite Aid, Walgreens

– Agreement in place with Central Virginia Health

Services, INC

– Pilot Study with Costco in Prince William Health

District currently underway

Use of Private Pharmacies as

Open PODs: Pros and Cons • Advantages:

– Many locations in the community

– Trained personnel onsite that can dispense medications and provide vaccines

– General public already familiar with local pharmacies

• Disadvantages: – Lack of adequate parking and poor traffic flow

– Lack of staffing to handle 24/7 operations

– Internal floor layout not conducive to handling large amounts of people

– Security and traffic control resources are highly strained

• Alternate Plan: Use of Pharmacies for follow up dispensing – Days 11-60 of the 60 day regimen of Anthrax prophylaxis

POD Flow Chart

Greeting/ Initial Screening/

Forms Distribution

Forms Completion

Medical Evaluation

Form Screening

Drug Dispensing/

Vaccination/ Testing

Patient

Evacuation Exit

Forms Collection/

Recovery

Staffing Considerations

• Positions required

– Site (POD) Manager

– Operations Lead

– Logistics Lead

– Security Lead

– Greeter

– Line Floater/Monitor

– Dispenser(s)

– Reviewer(s)

– Educator

Supplies and Equipment • Medications/Vaccines provided by VDH (and/or Strategic National Stockpile)

• Examples of Admin Supplies (not an exhaustive list):

– Tables and chairs

– Forms

– Clipboards

– Pens

– Signs

– Tape

– Trashcans

– ID Badges/Uniforms

• Examples of Clinical Supplies:

– Needles

– Syringes

– Gauze

– Alcohol preps

– Hand Sanitizer

– Sharps Containers, biohazard bags

– Band-aids

– Gloves

Item Need OH Unit

Clipboard 10 Each

Pens, black (12/box) 7 Box

Pens, red (12/box) 1 Box

POD Signage 1 Set

Tape (Clear) 3 Roll

Tape (Duct) 3 Roll

Quick Dispensing Forms 100 Each

Bins (for collecting forms) 4 Each

Incident Command System (ICS) Vests 20 Each

Labels 10 Pages

Example List:

Sample POD layout in an Open

Space

Sample POD Layout in local

Pharmacy

Checkout Counter

Pharmacy Counter

Exit

Entrance

Forms Turn-In/ Quality Review

Intake/Forms Pick-Up

Form Review

Intake/Forms Pick-Up (Drive Thru)

Dispensing

Dispensing (Drive Thru) Exit (Drive Thru)

Entrance (Drive Thru)

Form Review (Drive Thru)

Key: Patient movement

Table

Store Aisles

Training

• Alert/Contact Drills

• POD Set-up Drills

• Dispensing thru-put drills

• Full-scale exercises

• Just In Time Training (JITT)

Issues/Considerations • Security: What is your building’s security plan?

• Facility Residents/Inmates: POD layout as described may not be appropriate for vaccinating or dispensing medication to residents/inmates.

• Employees and Family Members of Employees/Staff:

– Dispensing medications: Use Head of Household Policy

– Vaccinations: Need to plan for vaccinating family members of employees (entry/security protocols, total thru-put

• POD Locations:

– Gymnasiums, large conference rooms, auditoriums

– Separate entrance and exits allow for unidirectional flow

• Storage of supplies and materials

• Medical Oversight

• Receipt of Medications/Vaccines

• Cold Storage for vaccines

Resources Available

• Local Health Department Emergency

Coordinator

• VDH Closed POD workbook and other plan

templates

Implement a nationwide project for the

“forward” placement of nerve agent

antidotes. To provide state and local

governments a sustainable resource that

increases their capability to respond

quickly to a nerve agent event.

CHEMPACK Program Mission

• Nerve agent exposure requires rapid treatment

• Some states/localities don’t have nerve agent

antidote

• Hospitals have limited supplies of nerve agent

antidote

• Nerve agent antidotes have variable shelf lives

Background

• GA (Tabun)

• GB (Sarin)

• GD (Soman)

• GF

• VX

• Organophosphates

Agents

•Atropine

•Pralidoxime

•Diazepam

Auto Injectors Multi-dose Vials

Mark-I Nerve Agent Antidote Kit

(NAAK)

Pharmaceuticals

•Atropine

•Pralidoxime

•Diazepam

Two types:

• Emergency Medical Service (EMS) Container:

Mostly auto-injectors

Some multi-dose vials

• Hospital Container:

Mostly multi-dose vials

Some auto-injectors

CHEMPACK Containers

Authorization to open the

CHEMPACK

• The following individuals may order the opening of a

CHEMPACK and the removal of its contents:

– On-scene incident commander

– County/City Emergency Management Coordinator

– Hospital Emergency Department Director

– Local Health District Director

– Local CHEMPACK Coordinator (usually the local Health District

Emergency Planner)

• Inform local CHEMPACK Coordinators as soon as

possible if the CHEMPACK is opened

– This notification requirement should not delay emergency

response actions!

Questions?