1. Strategic National Stockpile (SNS)
2011 Training & Updates
SNS Training MUST take place ANNUALLY.

2. Overall Planning Elements
SNS Plans

3. Overall Planning Elements SNS Plans MUST….
Be NIMS compliant
All Employees must complete IS100, IS200, IS700 within 90 days of employment
Be reviewed and updated ANNUALLY by Administration
Include a Multi-Disciplinary Planning Team
This 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.

4. Include State and local policies and procedures to support local mass prophylaxis operations and/or medical supplies management
Policies & Procedures can be found in the SNS Plan and/or the All Hazards Plan
Outline legal issues to support mass prophylaxis operations and/or medical supplies management and distribution
Legal Issues are outlined in the SNS Plan

5. Strategic National Stockpile (SNS) Overview
An outbreak is identified
MDCH/CDC determines need for mass medication distribution
SNS Plan activated
The EOC is activated

6. Strategic National Stockpile (SNS) Overview
Estimate made of doses needed for County
SNS arrives at MDCH
MDCH repackages SNS supplies to deliver to Local Health Department Distribution Nodes

7. What might the Strategic National Stockpile include?
Pharmaceuticals
Burn Surge supplies
Airway supplies
Vaccines
Medical supplies
Medical equipment

8. Management of SNS
The 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 compliant
VBCDHD has a plan to annually test and exercise notification and activation of volunteers below the local level positions identified.

9. At 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 Support
Hospital/Alternate Care Facility Leader/Manager
Public Information & Communication
Inventory Management Coordination
Security Coordination
Distribution Leader/Manager
Dispensing Site Supervisor/Leader
Staffing/Volunteer Coordination
Safety Coordination
Call-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.

10. SNS Requesting Procedures

11. Local-State SNS Requesting Procedures
The following slides show the requesting process for local health departments to the State of Michigan
Initial Request Flow Chart
Ongoing Request Flow Chart
This is an awareness section and only Administration will be required to be proficient in requesting the assets.

12. Awareness only section.
Received from MISNS 08/2010

13. Local-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 communicated
Inventory is overseen by the Director of Nursing and delegated to other staff
The process is outlined in the CD manual for nursing staff
Currently inventory is managed by paper and online using the MCIR system
Who 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 Officer
Only 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 Plan
Paper requests forms as well as SharePoint are approved methods

14. Public Information and Communication

15. Purpose 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

16. PIO 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 Liaisons
Work 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.

17. Messages/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 public
Messages to inform the public of the event
Messages to help the public get to the PODs and know what to bring
Messages to help the public navigate through the PODs
Messages for after people leave the PODs
These should be updated regularly
May include
Dispensing site locations, hours of operation, and directions
Check on your neighbor and carpool to POD sites
“Head of Household” information
Agent information sheets
Instructions to ensure medication compliance
Vaccine information sheets
Inform public of alternate forms of dispensing

18. Special 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 employers
Have pre-identified interpreters/interpreting services
American Sign Language
Foreign Language Interpreting services at VBISD
2-1-1

19. Dissemination Methods
Have pre-established ways to contact stakeholders for a variety of events
These could include hospitals, schools, pharmacies, closed POD partners, and etc.
Redundant Communication Capabilities
, phone numbers, blast fax, etc
Ensure this information is updated often
Non-traditional dissemination methods identified
At-risk populations and special populations
Methods for disseminating information in a power outage
Work with local media to help disseminate messages during any event.

20. Tactical 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.

21. Tactical Communication Lead Staff
Staff Lead includes George Kilts/Cary Hindley
4.1 - Review Communications/IT staff call-down list/numbers
Call down lists are reviewed and updated quarterly
It 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 process
Please review Job Action Guides

22. Communication Pathways
4.3 – Communication pathways are established and maintained between with land lines, cell phones, 800 mHz radios, internet, etc. with the following agencies
Incident Command
Local and State EOC
LHD Staff
Point of Dispensing Sites
Distribution Node
OPHP
Hospitals
Security
Transportation

23. Redundant 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 Radio
MI-HAN
Health Dept. Website
Landline, Cell, and Analog (during power failure) Phone
Fax
E-TEAM
City Watch (Reverse 911)
TV and Radio (know your Emergency Alert System station)
Social Networking (Twitter and Facebook)
Amateur Radio
211

24. SNS 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 assets
Locations used to support an SNS response (DN, PODs)
Staff, volunteers, and citizens at SNS operations, and
The SNS transportation infrastructure once assets transfer custody from State to local (escort vehicles).

25. SNS TAR TOOL “Security”
Who Should Be Trained?
Staff assigned to the following SNS functional roles should attend local security training events:
Security Coordinator
DN Manager
POD Supervisor
Inventory Manager
Volunteer Coordinator
Safety Manager
Transportation Manager
Logistics Chief
Local Law Enforcement
Volunteers who may be assigned to assist security, if needed

26. SNS TAR TOOL “Security”
Security Procedures to Consider for Training Are:
Transportation of SNS assets
Badging and Credentialing
Communication Procedures
DN/POD Site Security Plans:
Interior physical security
Exterior physical security
Command and management
Evacuation concerns
Security breach protocol
IMPORTANT: Local law enforcement must review site specific security plans for DN’s/POD’s and have opportunity to ask questions.

27. Distribution Node

28. What is a Distribution Node?
The primary site for delivery of SNS assets in a jurisdiction
The location of the local Distribution Node

29. Distribution Node Activation
The Health Department Incident Commander (IC) will notify the County Emergency Manager of activation
The IC must notify the DN facility contact person to request access to the facility, if other than an LHD site
Distribution Node staff will be activated

30. Staff Training
All 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

31. Dispensing Node Roles Examples of Roles: Distribution Node Manager
Warehouse Manager
Inventory Manager
Picker Staff
Quality Control Staff
Receiving Staff
Shipping Staff
Security Staff
Safety Staff
Communications

32. Distribution Node Site Preparation
Staffing
Office equipment
Communication equipment
Signage
Forklifts, pallet jacks, dolly carts
Computers, printer, copier
Forms

33. What Happens at the Distribution Node?
SNS material must be inventoried, packaged, and delivered to the dispensing sites within our jurisdiction
Re-supply requests from dispensing sites/PODS and/or alternate sites are also handled at the DN

34. Material Handling
Material handling equipment will be supplied by Emergency Management
Anyone required to use material handling equipment will receive training prior to use

35. Inventory Management
Upon receipt of assets, Pick List (invoice) is compared with the items actually received
An inventory database (paper or electronic) must be created for the DN and at each dispensing site
All requests, shipments, and deliveries must be recorded and filed for record keeping purposes

36. Chain of Custody
The 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 form
A DEA registrant may be necessary for the receipt of controlled substances.

37. Inventory Management forms
Inventory SNS Ordering Forms and Inventory Pick List establish inventory
MDCH:OPHP Transfer Form for the SNS is signed when assets are transferred to the Health Department
DEA Form -222 is issued by the DEA and is used for the transfer of controlled substances
POD Order Form
Local Health Department Chain of Custody Form

38. MICHIGAN RSS: Inventory Pick List
Delivery Site
Order Number
Shipment ID
My Junior High
XXXXXXXXX XX
Item Description
Doxycycline 100mg oral tablet #20 tab unit of use
Container
Number
Item Number
Cases 27
R03386
340
Item Description
Ciprofloxacin 500mg oral tablet #20 tab unit of use
Container
Number
Item Number
Cases 30
R01030 60
Date & Time:
Page 1 of

39. Transfer Form - Chain of Custody

40. Deactivation
At the conclusion of the event, all unused unopened medication and durable goods will be returned to the DN from each dispensing site
Returned goods must be inventoried, and the State RSS must be contacted to arrange for the pick-up of returnable items
Any 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.

41. Summary
The 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.

42. Dispensing Prophylaxis

43. This module will cover..... Purpose of a mass dispensing campaign
Types of rapid dispensing techniques
Staff notification procedures and reporting
Phases for dispensing medications
Special considerations in mass dispensing planning
Models for increasing throughput at PODs

44. Purpose of Mass Dispensing
Dispense medical countermeasures (MCM) in the most efficient and timely manner.
Utilize rapid dispensing techniques
Dispense medications to all County residents within 48 hours
Provide MCM for prophylaxis of asymptomatic individuals
Triage symptomatic individuals and direct them to treatment centers
Dispensing can be limited in scope as well as a community-wide event

45. Phases 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 personnel
Phase 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

46. Procedure 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 training
Event information, safety information, job duties, Incident Command System, etc.
Discuss dispensing phases and modalities
Priority groups, dispensing instructions, facility identification, Emergency Use Authorizations, medication information, & etc.

47. Special Considerations Addressed in Mass Dispensing Planning
Number of regimens of medication that can be dispensed to an individual
Handling symptomatic individuals
Handling unaccompanied minors
Handling of non-English speakers/hearing impaired/visually impaired/functionally illiterate (Special populations planning)
Procedures for crowd control, traffic management, security, media

48. Alternate Methods for Dispensing
Closed PODs
Drive Through PODs
Mobile PODs
Pre-Deployment to businesses

49. Sample Open POD Model

50. Sample Drive Through Model

51. Tiered Approach for Dispensing to Increase Throughput at POD

52. Local Public Health Distribution Node Staff Training Template

53. Purpose/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.

54. Section 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

55. Section 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 department
DN Staff report to their perspective branch director or chief, who then reports to the DN Manager.

56. Sample ICS Chart – DN is in Logistics Section
Unified Incident Command
Liaison Officer
Health and Safety Officer
Public Information Officer
Operations Section
Logistics Section
Planning Section
Finance/Admin Section
Patient Care Branch
Preventive Svs Branch
Patient Transport Branch
Security Branch
Treatment Care Group
Patient Standards Group
Dispensing/ Vaccination Group
Site Triage Group
Symtomatic Group
Satellite Site/ Worried Well Group
Fixed Site Group
Mobile Group
Criminal Investiga-tion Group
Services Branch
Support Branch
Commun. Unit
Food Beverage Unit
Responder Medical Unit
Distribution Node Unit
Transport Unit
Facilities Mgt Unit
Documenta-tion Unit
SitAnaly/Epi Investigation Unit
Personnel Records Unit
Cost Unit
Resources Procurement Unit
Demobiliza-tion Unit
Resources Status Unit
Volunteer Management Unit
Staging Area

57. Sample DN Staffing Org Chart
Security Leader
Warehouse Operations Leader
Shipping/Receiving/ Distribution/
Leader
Inventory Control / Pick Team
Site Security
SNS Order Staging
Housekeeping / maintenance
Delivery Escort Security
Dispatch
Accounting / record keeping
Transport Drivers
Distribution Node Manager
PH Liaison / Health and Safety Officer
Receiving

58. Section III: Activation of the DN
Local Unified Incident Command makes the decision to activate the DN
The health department is notified of decision to activate the DN
The site, staff, and various suppliers are notified of the DN activation

59. Section III (continued)
The DN site is readied to accept SNS materiel
Materiel handling and office equipment obtained - forklift, dolly, copier
Communications are setup - radios, fax, phone, etc.
Organization/layout of site – loading, storage, staging and office areas
Cleanliness of site - breakroom, restrooms, etc.
Inventory system set up – electronic or hard copy
Materiel ordering system set up – ordering, picklist, manifest forms
Security (exterior and interior) set up
DN 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

60. Section IV: Receiving SNS Materiel
Accepting SNS Delivery at the DN
Who 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 Delivery
Check manifest, compare to what was ordered/expected and report discrepancies
Enter received materiel into the inventory system
Storage of Materiel
Move materiel to proper location
Utilize appropriate rotation system (FIFO – first in, first out)

61. Section V: Processing Requests from Local PODs
Filling a SNS Order from a POD
Assume an initial supply is sent to all activated PODs (apportionment decision by Unified Command), this section applies to subsequent orders
LHD Order filling details here:
DN receives SNS order from a POD
Use pick list to fill the order
Move picked materiel to staging area
in DN and perform quality control
Fill out proper shipping forms
Verify POD order
Inform Dispatch of order readiness

62. Section V: Distribution of SNS from DN to PODs (continued)
Verify Route(s) for POD deliveries, provide maps, communication equipment, and etc. to drivers
Obtain/arrange security escort for delivery
Ensure primary method for communications with driver is functioning properly
DN 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

63. Section VI: Re-Supply of the DN
Inventory Control position monitors DN supply levels
At pre-determined inventory trigger levels, Inventory Control position notifies DN Manager of need for additional supplies
DN Manager initiates DN Re-supply process
SNS 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 Manager
SNS materiel is delivered to DN. Same acceptance process as initial delivery

64. Local Public Health Distribution Node Staff Training Template

65. Sample LHD Process for Ordering SNS Materiel
CHECC Receives SNS Order – fills order based upon State inventory and event Characteristics
Local EOC receives DN SNS request, relays to CHECC
Public Health Distribution Node requests SNS re-supply from local EOC
Local DN Re-supplied
POD 1
POD 3
POD 2
POD orders exhaust Distribution Node Inventory
Local Public Health Distribution Node Staff Training Template

66. Section 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 complete
Provide maintenance to facility and equipment as necessary
Releases DN staff as incident characteristics dictate
Local Public Health Distribution Node Staff Training Template

67. Section VII (continued)
Materiel at PODs returned to DN upon completion of activities
Security escort of returning materiel required
Process 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).

68. Section VIII: Key Components of DN for Review
Command and Control –
The role of the DN within the ICS structure
Communications network between State, PODs, and LEOC
Responsibilities of agencies/entities involved in DN operations
Activation/DN Setup –
Notification and activation of site and staff
Setup of site
Equipment acquisition
Inventory control/shipping systems functioning
Paperwork trails –
POD ordering system
DN Re-supply
Pick lists
Shipment manifests
Chain of custody forms.
Security -
Interior and exterior security
Escort vehicles for deliveries

69. Next 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