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 PRW – 11/14/2018
IMAGINE THIS SCENARIO Usually on a Friday night of a long, holiday weekend! PRW – 11/14/2018
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 Photo Credit: waisbrenmd.com positive for anthrax exposure. PRW – 11/14/2018
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 PRW – 11/14/2018
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 PRW – 11/14/2018
WHAT IS THE STRATEGIC NATIONAL STOCKPILE? PRW – 11/14/2018
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. PRW – 11/14/2018
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). PRW – 11/14/2018
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) PRW – 11/14/2018
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. PRW – 11/14/2018
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 PRW – 11/14/2018
Push Package at RSS PRW – 11/14/2018
Supplies Prepared for Hospital or County Drop Site PRW – 11/14/2018
Managed Inventory • Second phase of • Antivirals shipments • Immunoglobulin • Hazard has been • Antitoxins (botulism) identified • Vaccines • Hazard-specific • Ventilators treatment • Federal Medical Stations • Could be special • Medical Supplies requests due to surge or mass casualty/fatality PRW – 11/14/2018
ACCESSING THE SNS PRW – 11/14/2018
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. PRW – 11/14/2018
Ohio Department of Health Procedures • Criteria to determine need: Epidemiological data – including laboratory data 1. Public health information – including extent of illness 2. Law enforcement intelligence 3. Nature of the threat 4. • 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 of request PRW – 11/14/2018
LHD sees increase in EPI data Multiple sick people presenting at and/or confirmed biologic release local emergency departments. Will LHD NO supplies be Monitor resource exhausted status in next 24 hours? YES HHS release County EMA supplies receives request for supplies Forward request to State EMA EOC Will state ODH request YES supplies be NO medical Forward request to exhausted ODH DOC countermeasures in next 24 from HHS hours? PRW – 11/14/2018
Local Supplies/Resources First LHD sees increase in EPI data Multiple sick people presenting at and/or confirmed biologic release local emergency departments. Will LHD NO supplies be Monitor resource exhausted status in next 24 hours? PRW – 11/14/2018
Local Supplies Exhausted Will LHD supplies be exhausted in next 24 hours? YES County EMA receives request for supplies Forward request to State EMA EOC PRW – 11/14/2018
State Supplies/Resources Monitor resource status Will state supplies be NO exhausted in next 24 hours? PRW – 11/14/2018
State Supplies/Resources Exhausted HHS release supplies Will state ODH request YES supplies be medical Forward request to exhausted ODH DOC countermeasures in next 24 from HHS hours? PRW – 11/14/2018
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: PODs and Hospitals 1. County Drop Sites (CDS) 2. Regional Drop Sites (RDS) 3. PRW – 11/14/2018
Model 1: PODs and Hospitals • Preferred method • Direct shipment to Open PODs and hospitals. • Closed POD supplies must come from Open PODs. PRW – 11/14/2018
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. PRW – 11/14/2018
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 PRW – 11/14/2018
SCENARIO CONTINUES… PRW – 11/14/2018
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). PRW – 11/14/2018
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. PRW – 11/14/2018
Two Types of POD Sites (PODS) Open Closed • Serves the public • Serves pre-determined population only (i.e. staff • Often in schools, and their family members churches, public buildings only) • Requires people to get to • Extended and Skilled the POD Care Facilities • LHD usually staff along • Hospitals with volunteers • Schools • Manpower intensive • Businesses PRW – 11/14/2018
Four Basic Steps of a POD Triage/Greeting Registration/Forms Completion Screening Dispensing & Education PRW – 11/14/2018
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