3Overall Planning Elements SNS Plans MUST…. Be NIMS compliantAll Employees must complete IS100, IS200, IS700 within 90 days of employmentBe reviewed and updated ANNUALLY by AdministrationInclude a Multi-Disciplinary Planning TeamThis team includes Public Health, Law Enforcement, Health Care, Schools, Public Service Agencies, Tribal Partners & many others.Identify the roles and responsibilities of local response partners, ensure that these partners acknowledge their role and responsibilities, and are included in regular training and exercises.
4Include State and local policies and procedures to support local mass prophylaxis operations and/or medical supplies managementPolicies & Procedures can be found in the SNS Plan and/or the All Hazards PlanOutline legal issues to support mass prophylaxis operations and/or medical supplies management and distributionLegal Issues are outlined in the SNS Plan
5Strategic National Stockpile (SNS) Overview An outbreak is identifiedMDCH/CDC determines need for mass medication distributionSNS Plan activatedThe EOC is activated
6Strategic National Stockpile (SNS) Overview Estimate made of doses needed for CountySNS arrives at MDCHMDCH repackages SNS supplies to deliver to Local Health Department Distribution Nodes
7What might the Strategic National Stockpile include? PharmaceuticalsBurn Surge suppliesAirway suppliesVaccinesMedical suppliesMedical equipment
8Management of SNSThe Local SNS Coordinator (Jenni Zordan) and back-up (Sue Bailey) must be, trained, and the plan must provide their contact information.SNS functions are integrated within the local Incident Command System (ICS) structure and are NIMS compliantVBCDHD has a plan to annually test and exercise notification and activation of volunteers below the local level positions identified.
9At the local level and dependent upon the placement of the activities in the local Incident Command System organizational structure, the following functions have personnel (primary and back-up) identified with documented contact information.Tactical Communications/ITS SupportHospital/Alternate Care Facility Leader/ManagerPublic Information & CommunicationInventory Management CoordinationSecurity CoordinationDistribution Leader/ManagerDispensing Site Supervisor/LeaderStaffing/Volunteer CoordinationSafety CoordinationCall-down lists for the personnel identified in the positions above are maintained, current, and updated quarterly.Local jurisdiction conducts and documents call-down exercises of all personnel identified to test response rates quarterly.After completing the review of this material as well as the Job Action Guidelines you will be assigned to one ore more of the roles listed above. Signing off on this training and the Job Action Guidelines attests to being trained and available for all jobs as assigned for emergency response. Our organization is supported by all team members being cross-trained in a variety of roles. If you have additional questions, please contact Jennifer Zordan.
11Local-State SNS Requesting Procedures The following slides show the requesting process for local health departments to the State of MichiganInitial Request Flow ChartOngoing Request Flow ChartThis is an awareness section and only Administration will be required to be proficient in requesting the assets.
12Awareness only section. Received from MISNS 08/2010
13Local-State SNS Requesting Procedures What is the trigger point for reporting to local decision makers that the levels of SNS assets are low for consideration to reorder assets from the State?Trigger Points for VBCDHD will be determined on a case-by-case basis. During H1N1, we requested based on the demand we had for the product.Describe how inventory levels are determined, monitored and communicatedInventory is overseen by the Director of Nursing and delegated to other staffThe process is outlined in the CD manual for nursing staffCurrently inventory is managed by paper and online using the MCIR systemWho has the authority to place an order for SNS assets from the local level to the State?SNS Orders will be determined and signed off by the Medical Director and the Health OfficerOnly persons delegated by the Medical Director or the Health Officer will have authority to place orders for SNS assets.How is the order placed?The process for placing orders can be found in the SNS PlanPaper requests forms as well as SharePoint are approved methods
15Purpose of Communication Plan Overall purpose is to provide guidance and resources for communications during an event.Outlines who is in charge of communications and methods that are to be taken for approval of messages.Covers how joint communications will be handled in a community wide event (Joint Information Centers – JIC)Ensure message consistency
16PIO and Liaisons Public Information officer (PIO) Serves as the main point person for communications going out during an event.PIO serves as contact point for the media.Public Information LiaisonsWork to gather information from other venues, such as EOC’s (Emergency Operations Center), distribution nodes, dispensing sites and JIC’s to allow for the current and accurate information to be given to the PIO.May also be tasked with handling the media at local POD (Points of Dispensing) sites.
17Messages/Other Materials Pre-developed messages (scripts) and fact sheets on a variety of topics are available in the PIC plan.Pre-event messages to prepare the publicMessages to inform the public of the eventMessages to help the public get to the PODs and know what to bringMessages to help the public navigate through the PODsMessages for after people leave the PODsThese should be updated regularlyMay includeDispensing site locations, hours of operation, and directionsCheck on your neighbor and carpool to POD sites“Head of Household” informationAgent information sheetsInstructions to ensure medication complianceVaccine information sheetsInform public of alternate forms of dispensing
18Special Population Communication Identify special populations ahead of time (non- English speaking, hearing/visually impaired, home bound, etc)How will these populations be reached?Through the use of closed POD partners such as: United Way, Homeless Shelters, Meals on Wheels, Long Term Care Facilities, etc.Closed captioning to large businesses and employersHave pre-identified interpreters/interpreting servicesAmerican Sign LanguageForeign Language Interpreting services at VBISD2-1-1
19Dissemination Methods Have pre-established ways to contact stakeholders for a variety of eventsThese could include hospitals, schools, pharmacies, closed POD partners, and etc.Redundant Communication Capabilities, phone numbers, blast fax, etcEnsure this information is updated oftenNon-traditional dissemination methods identifiedAt-risk populations and special populationsMethods for disseminating information in a power outageWork with local media to help disseminate messages during any event.
20Tactical Communication Prior to and during an emergency, staff notification & communication are priority.The following slides highlight various aspects of the health department tactical communication system.
21Tactical Communication Lead Staff Staff Lead includes George Kilts/Cary Hindley4.1 - Review Communications/IT staff call-down list/numbersCall down lists are reviewed and updated quarterlyIt is important to keep your personal afterhours information up to date in the event we need to get a hold of you.4.2 - Review Comm./IT staff JAG’s and describe the just in time training processPlease review Job Action Guides
22Communication Pathways 4.3 – Communication pathways are established and maintained between with land lines, cell phones, 800 mHz radios, internet, etc. with the following agenciesIncident CommandLocal and State EOCLHD StaffPoint of Dispensing SitesDistribution NodeOPHPHospitalsSecurityTransportation
23Redundant Communication Systems 4.4 – Redundant communication systems that are tested quarterly and may be utilized during an event. The following is a list of communications methods used to ensure we have communications that do not fail during an event.800 MHz RadioMI-HANHealth Dept. WebsiteLandline, Cell, and Analog (during power failure) PhoneFaxE-TEAMCity Watch (Reverse 911)TV and Radio (know your Emergency Alert System station)Social Networking (Twitter and Facebook)Amateur Radio211
24SNS TAR TOOL “Security” Security is an essential component for carrying out a successful SNS emergency response. Individuals involved in these security functions must be trained to protect the following:SNS assetsLocations used to support an SNS response (DN, PODs)Staff, volunteers, and citizens at SNS operations, andThe SNS transportation infrastructure once assets transfer custody from State to local (escort vehicles).
25SNS TAR TOOL “Security” Who Should Be Trained?Staff assigned to the following SNS functional roles should attend local security training events:Security CoordinatorDN ManagerPOD SupervisorInventory ManagerVolunteer CoordinatorSafety ManagerTransportation ManagerLogistics ChiefLocal Law EnforcementVolunteers who may be assigned to assist security, if needed
26SNS TAR TOOL “Security” Security Procedures to Consider for Training Are:Transportation of SNS assetsBadging and CredentialingCommunication ProceduresDN/POD Site Security Plans:Interior physical securityExterior physical securityCommand and managementEvacuation concernsSecurity breach protocolIMPORTANT: Local law enforcement must review site specific security plans for DN’s/POD’s and have opportunity to ask questions.
28What is a Distribution Node? The primary site for delivery of SNS assets in a jurisdictionThe location of the local Distribution Node
29Distribution Node Activation The Health Department Incident Commander (IC) will notify the County Emergency Manager of activationThe IC must notify the DN facility contact person to request access to the facility, if other than an LHD siteDistribution Node staff will be activated
30Staff TrainingAll DN staff will meet to receive “Just-in- Time” training (prior to receipt of SNS assets)A Job Action Guideline will be provided for each role, detailing immediate, ongoing, and long-term job duties
31Dispensing Node Roles Examples of Roles: Distribution Node Manager Warehouse ManagerInventory ManagerPicker StaffQuality Control StaffReceiving StaffShipping StaffSecurity StaffSafety StaffCommunications
33What Happens at the Distribution Node? SNS material must be inventoried, packaged, and delivered to the dispensing sites within our jurisdictionRe-supply requests from dispensing sites/PODS and/or alternate sites are also handled at the DN
34Material HandlingMaterial handling equipment will be supplied by Emergency ManagementAnyone required to use material handling equipment will receive training prior to use
35Inventory ManagementUpon receipt of assets, Pick List (invoice) is compared with the items actually receivedAn inventory database (paper or electronic) must be created for the DN and at each dispensing siteAll requests, shipments, and deliveries must be recorded and filed for record keeping purposes
36Chain of CustodyThe signatures of individuals both relinquishing and receiving the SNS assets, who they represent and the date and time, establish a chain of custody.Chain of custody formA DEA registrant may be necessary for the receipt of controlled substances.
37Inventory Management forms Inventory SNS Ordering Forms and Inventory Pick List establish inventoryMDCH:OPHP Transfer Form for the SNS is signed when assets are transferred to the Health DepartmentDEA Form -222 is issued by the DEA and is used for the transfer of controlled substancesPOD Order FormLocal Health Department Chain of Custody Form
38MICHIGAN RSS: Inventory Pick List Delivery SiteOrder NumberShipment IDMy Junior HighXXXXXXXXXXXItem DescriptionDoxycycline 100mg oral tablet #20 tab unit of useContainerNumberItem NumberCases27R03386340Item DescriptionCiprofloxacin 500mg oral tablet #20 tab unit of useContainerNumberItem NumberCases30R0103060Date & Time:Page1of
40DeactivationAt the conclusion of the event, all unused unopened medication and durable goods will be returned to the DN from each dispensing siteReturned goods must be inventoried, and the State RSS must be contacted to arrange for the pick-up of returnable itemsAny items that are not considered durable goods (plug-in, run on batteries, etc) will remain the custody of the local jurisdiction for proper storage or disposal.
41SummaryThe Distribution Node is a central warehouse for SNS at the local level.The Inventory Management System organizes, distributes and tracks the SNS assets at the local level.SNS medication/supplies will be sent to Dispensing Sites/PODS within the community.
43This module will cover..... Purpose of a mass dispensing campaign Types of rapid dispensing techniquesStaff notification procedures and reportingPhases for dispensing medicationsSpecial considerations in mass dispensing planningModels for increasing throughput at PODs
44Purpose of Mass Dispensing Dispense medical countermeasures (MCM) in the most efficient and timely manner.Utilize rapid dispensing techniquesDispense medications to all County residents within 48 hoursProvide MCM for prophylaxis of asymptomatic individualsTriage symptomatic individuals and direct them to treatment centersDispensing can be limited in scope as well as a community-wide event
45Phases for Dispensing Medications These phases are subject to change based on the situation and LHD Plans.Phase 1: The Health Dept. staff and their household members will receive the first round of prophylaxis.Phase 2: The Health Dept. staff will open a designated dispensing site and dispense to First Responders and essential personnelPhase 3: Pre-identified ancillary facilities will provide prophylaxis to their employees, residents, occupants and household members (i.e., qualifying schools, big businesses, industrial facilities, long-term care facilities, jail, etc.)Phase 4: Designated dispensing site(s) will open to dispense medications to remaining residents
46Procedure Prior to Opening a Dispensing Site Health Department staff will be contacted to report to staging area for further instructions **Contact information should always be up-to-date**Provide staff briefing & conduct just-in-time trainingEvent information, safety information, job duties, Incident Command System, etc.Discuss dispensing phases and modalitiesPriority groups, dispensing instructions, facility identification, Emergency Use Authorizations, medication information, & etc.
47Special Considerations Addressed in Mass Dispensing Planning Number of regimens of medication that can be dispensed to an individualHandling symptomatic individualsHandling unaccompanied minorsHandling of non-English speakers/hearing impaired/visually impaired/functionally illiterate (Special populations planning)Procedures for crowd control, traffic management, security, media
48Alternate Methods for Dispensing Closed PODsDrive Through PODsMobile PODsPre-Deployment to businesses
51Tiered Approach for Dispensing to Increase Throughput at POD
52Local Public Health Distribution Node Staff Training Template
53Purpose/Function of the Distribution Node (DN) The DN serves as a functioning warehouse for receiving and shipping SNS materiel at the local level amidst a public health emergency. From the DN, the assets will further be delivery to local Points of Dispensing (PODs) sites in order to provide these life-saving assets to the public.
54Section 1 (continued)The DN distributes Strategic National Stockpile (SNS) medical countermeaures (MCM) to local POD sites.The State of Michigan delivers SNS assets directly to treatment centers throughout the State.Providing Security at the DN, POD sites, as well as for the transportation of SNS materiel, is the responsibility of local law enforcement.The location of the DN should be somewhat centrally located geographically within the jurisdiction and among the identified local POD sites.The DN is one component of the overall local emergency response
55Section II: Command and Control The planning, coordination, and management of the DN is the responsibility of local Public Health.The health department is responsible for staffing and operating the DN when activated.The DN is located within the Operations Section of the Incident Command System.The DN Manager/Leader reports to the Operations Section Chief at the health departmentDN Staff report to their perspective branch director or chief, who then reports to the DN Manager.
56Sample ICS Chart – DN is in Logistics Section Unified Incident CommandLiaison OfficerHealth and Safety OfficerPublic Information OfficerOperations SectionLogistics SectionPlanning SectionFinance/Admin SectionPatient Care BranchPreventive Svs BranchPatient Transport BranchSecurity BranchTreatment Care GroupPatient Standards GroupDispensing/ Vaccination GroupSite Triage GroupSymtomatic GroupSatellite Site/ Worried Well GroupFixed Site GroupMobile GroupCriminal Investiga-tion GroupServices BranchSupport BranchCommun. UnitFood Beverage UnitResponder Medical UnitDistribution Node UnitTransport UnitFacilities Mgt UnitDocumenta-tion UnitSitAnaly/Epi Investigation UnitPersonnel Records UnitCost UnitResources Procurement UnitDemobiliza-tion UnitResources Status UnitVolunteer Management UnitStaging Area
57Sample DN Staffing Org Chart Security LeaderWarehouse Operations LeaderShipping/Receiving/ Distribution/LeaderInventory Control / Pick TeamSite SecuritySNS Order StagingHousekeeping / maintenanceDelivery Escort SecurityDispatchAccounting / record keepingTransport DriversDistribution Node ManagerPH Liaison / Health and Safety OfficerReceiving
58Section III: Activation of the DN Local Unified Incident Command makes the decision to activate the DNThe health department is notified of decision to activate the DNThe site, staff, and various suppliers are notified of the DN activation
59Section III (continued) The DN site is readied to accept SNS materielMateriel handling and office equipment obtained - forklift, dolly, copierCommunications are setup - radios, fax, phone, etc.Organization/layout of site – loading, storage, staging and office areasCleanliness of site - breakroom, restrooms, etc.Inventory system set up – electronic or hard copyMateriel ordering system set up – ordering, picklist, manifest formsSecurity (exterior and interior) set upDN staff is briefed/updated on situation, role and procedures (Just in time training)DN Manager notifies Unified Incident Command when the DN is ready to accept delivery of SNS materiel from the State
60Section IV: Receiving SNS Materiel Accepting SNS Delivery at the DNWho is authorized to sign for the delivery – position/title, Drug Enforcement Agency (DEA) Registrant, authorized backup, etc.State Transfer form - Chain of Custody form, shipping manifest, etc.Inventory of DeliveryCheck manifest, compare to what was ordered/expected and report discrepanciesEnter received materiel into the inventory systemStorage of MaterielMove materiel to proper locationUtilize appropriate rotation system (FIFO – first in, first out)
61Section V: Processing Requests from Local PODs Filling a SNS Order from a PODAssume an initial supply is sent to all activated PODs (apportionment decision by Unified Command), this section applies to subsequent ordersLHD Order filling details here:DN receives SNS order from a PODUse pick list to fill the orderMove picked materiel to staging areain DN and perform quality controlFill out proper shipping formsVerify POD orderInform Dispatch of order readiness
62Section V: Distribution of SNS from DN to PODs (continued) Verify Route(s) for POD deliveries, provide maps, communication equipment, and etc. to driversObtain/arrange security escort for deliveryEnsure primary method for communications with driver is functioning properlyDN dispatch informs POD of delivery departure time and estimated time of arrival (ETA)Upon delivery to POD, informs DN, performs chain of custody, and provides a return ETA to the DN
63Section VI: Re-Supply of the DN Inventory Control position monitors DN supply levelsAt pre-determined inventory trigger levels, Inventory Control position notifies DN Manager of need for additional suppliesDN Manager initiates DN Re-supply processSNS order form faxed to local Emergency Operation Center (EOC)EOC faxes SNS order form to Community Health Emergency Coordination Center (CHECC)Confirmation of order is received by local EOC, ETA of SNS delivery provided to DN ManagerSNS materiel is delivered to DN. Same acceptance process as initial delivery
64Local Public Health Distribution Node Staff Training Template
65Sample LHD Process for Ordering SNS Materiel CHECC Receives SNS Order – fills order based upon State inventory and event CharacteristicsLocal EOC receives DN SNS request, relays to CHECCPublic Health Distribution Node requests SNS re-supply from local EOCLocal DN Re-suppliedPOD 1POD 3POD 2POD orders exhaust Distribution Node InventoryLocal Public Health Distribution Node Staff Training Template
66Section VII: Deactivation/Demobilization Considerations Local Unified Command will initiate the demobilization process.DN Manager monitors activity at DN and receives situation reports (sitreps) from the PODs.Conduct a walk-through and complete a facility checklist to record conditions of the facility after clean-up is completeProvide maintenance to facility and equipment as necessaryReleases DN staff as incident characteristics dictateLocal Public Health Distribution Node Staff Training Template
67Section VII (continued) Materiel at PODs returned to DN upon completion of activitiesSecurity escort of returning materiel requiredProcess of materiel pickup is similar to deliveries, but reversed. Paperwork required – chain of custody, intra- county transfer form, etc.SNS Materiel at DN is re-packaged, readied for transport as per State/Federal instructions.Some SNS materiel may need to be destroyed and/or disposed of.Prepare CDC durable goods for pick-up by the State and return to CDC (i.e. anything that plugs in, runs on batteries, etc).
68Section VIII: Key Components of DN for Review Command and Control –The role of the DN within the ICS structureCommunications network between State, PODs, and LEOCResponsibilities of agencies/entities involved in DN operationsActivation/DN Setup –Notification and activation of site and staffSetup of siteEquipment acquisitionInventory control/shipping systems functioningPaperwork trails –POD ordering systemDN Re-supplyPick listsShipment manifestsChain of custody forms.Security -Interior and exterior securityEscort vehicles for deliveries
69Next Steps Review the Job Action Guides for SNS Sign the Acknowledgement Form available in each office.If you have questions please contact Jenni Zordan at ext.382 or