Presentation on theme: "SNS Planning and Capabilities Update"— Presentation transcript:
1SNS Planning and Capabilities Update Greg BurelDirector, Division of Strategic National StockpileOffice of Public Health Preparedness and Response, CDC2011 Public Health Preparedness ConferenceJune 29th, 2011
2Agenda Mission Technical Assistance Executive Order 13527 PAHPA ReauthorizationNovel Distribution and Dispensing ModelsChallenges
3Strategic National Stockpile Mission Deliver critical medical assetsto the site of a national emergencyStockpiling the assets and delivering them is important workThat work is wasted if the capabilities and resources don’t exist at the state and local level to utilize the assetsCollaboration is key to making the SNS a continuing resource to the nation
5DSNS Modeling Support Distribution TourSolver Optimized Distribution Routing software396 registered users (as of 4/10/2009)CERAModeled RSS capabilities in 36 citiesTwo year contract ended 12/2008DispensingRealOptOptimization tool for designing PODs and treatment clinic planning and operationsModeling Forum (snsmodeling.org)Purpose of promoting the exchange of ideas, models and simulations designed to improve emergency response efforts and public health74 registered usersTourSolver for distribution:TourSolver is a software that enables planners to quickly generate optimized distribution routes for their entire fleet of vehicles, It can be used to help deliver supplies from receive, store and stage (RSS) facilities or regional distribution nodes, to points of dispensing (PODs) and alternate care facilities. Users may customize parameters to reflect local conditions, run multiple scenarios, and ask “what if” questions that will simulate real world events. Planners, using multiple or as few constraints as desired, can then quickly assess the impact of these conditions on the overall distribution operation.RealOpt for dispensing:RealOpt is a modeling and optimization software tool for designing PODs and treatment clinic planning and operations. This software was developed by the Center for Operations Research in Medicine and HealthCare, School of Industrial and Systems Engineering, Georgia Institute of Technology.RealOpt uses time study data collected from POD and alternate care facility exercises to allow planners to analyze POD/clinic designs. Using the models created with RealOpt will help POD and clinic planners identify and eliminate bottlenecks, maximize throughput and minimize the average time patients spend in the POD or clinic. This software provides project areas with the ability to:Design customized and efficient POD floor plans using an automatic graph-drawing toolDetermine optimal labor resources and most efficient staff allocationEqualize utilization across POD/clinic stationsAssess current resources and determine minimum needs for the regional populationConduct large-scale virtual drills and performance analysesIn addition to the software, DSNS has a contract in place to allow for students from the Georgia Institute of Technology to collect motion and time study data during POD exercises. This service would be at no cost to the project area. Funds for this project are limited, so only a certain number of project areas will be able to participate at this time. For more information about this service, contact the DSNS Program Services Consultant for your project area.CERA for RSS and distribution modeling:DSNS has established a contract with the Center for Emergency Response Analytics (CERA) to obtain logistical modeling and simulation services for a limited number of jurisdictions with a population of over 500,000.CERA has developed tools to evaluate a jurisdiction’s RSS capability, test operational alternatives, and measure RSS and distribution vulnerability to a variety of risk factors. CERA’s tools simulate the jurisdiction’s response to a bioterrorism attack, measuring the ability to provide PODs with an uninterrupted supply of materiel.CERA explores operational alternatives by varying the number of POD deliveries and varying the number of pallets that are loaded on delivery trucks of different sizes. CERA simulates each alternative and selects the most promising for sensitivity analysis that measures vulnerability to risk factors such as:A shortage of delivery trucks or driversLoss of a loading dockTrafficUse of non-professional crews in the RSSDelays in the delivery of SNS materiel to the RSSTo date, CERA has modeled 36 CRI cities and MSAs. CDC contracted CERA to simulate the emergency distribution operations of 36 jurisdictions across the country. This is the RSS Analysis Project Final Report (exit). At present, no additional MSAs are being evaluated, pending the initial assessments. Please view the CERA Fact Sheet (PDF, 422k) for more information.Modeling Forum (snsmodeling.org)DSNS also maintains the SNS Modeling Forum (snsmodeling.org), a web site with the purpose of promoting the exchange of ideas, models and simulations designed to improve emergency response efforts and public health. The initial focus is on modeling the response efforts required in the aftermath of an aerosolized anthrax attack on a U.S. population; however dialogue is encouraged among all who are modeling various aspects of emergency response and other public health missions
6Sharing and Improving Practices Collaboration with partnersFederal Executive BoardASTHONACCHOSharing promising practicesSNS ListServs (2)SNS ExtranetSNS Mass Dispensing Satellite Broadcast Series10 broadcasts since 2004October 2009: Legal IssuesContinuing Education credits offeredRegional CRI/SNS WorkshopsNational SNS Training SummitFund NACCHO/ASTHO SNS Advisory GroupsFund NACCHO’s STOCK-BoxMAD broadcastsIn January, we had our 10th in the series of MAD broadcasts. The next one is tentatively scheduled for October. The topic has yet to be determined and we want your input on it. We have a form in the back where you can include your suggestions. We are also working on getting continuing education credits for each of the past broadcasts in the series. So far, 5 in the series offer credits, but we should have 3 or 4 more by the end of the year.
7Webinar Series Second Wednesday Webinars Revolving Topics and PresentersArchive available on SNS ExtranetRecent Topics:Integrating SNS, PHEP, and HPP Exercises with HSEEP (May 11, 2011)DEA Considerations in SNS Planning (April 2011)Executive Order 13527: Updates on Federal Planning (March 2011)Closed POD (February 2011)
8Division of Strategic National Stockpile Deployable Teams Stockpile Services Advance Group (SSAG)Experts on Strategic National Stockpile response and state/local capabilityProvides short-term technical assistanceMembers represent DSNS at Emergency Operations Center, Incident Response Coordination Team, etc.Receiving, Staging and Storing (RSS) Task ForceAssists with receipt, staging, onward movement and re-supplyFederal Medical Station (FMS) Strike TeamHelps state/local officials set up, re-supply and recover
9Composite MeasureAddress the need for more accurate preparedness and response indicatorSolution - link the functions and capabilities of dependent governmental sectors in the form of a composite measureMedical Countermeasure Distribution and Dispensing (MCMDD) composite measureDeveloped to serve as a collective indicator of preparedness and operational capabilityMeasure states, directly funded cities, Cities Readiness Initiative (CRI) planning jurisdictions, U.S. territories and freely associated statesDerived from results of state TARs conducted by DSNS staff, CRI TARs conducted by DSNS and state staffs, drill submissions, a single full-scale exercise, and compliance with programmatic standards
10State by State Preparedness Report Developed by CDC Office of Preparedness and Emergency Response (OPHPR)Data and Content from DSNS, Division of State and Local Readiness (DSLR), and Division of Select Agents and Toxins (DSAT)Provide visibility and measurability to Congress and the White House on the value of investments in preparednessRelatable stories and successes are key to communicating our accomplishments and identifying our needsShare your story with your SNS Program Services Consultant
11Benefits Beyond Terrorism Response 10 years of SNS planning, training and exerciseEstablished nationwide capability to receive and dispense SNS MCMsBenefits beyond this target capability:Red River Flooding 2009 and Fargo, NDTactical communications plans, public information messaging, incident management team protocols and procedures, and distribution networks developed through CRI planning efforts used to coordinate successful evacuation, mass care and sheltering of thousands of citizens2009 H1N1 Response - NationwideState and local health departments around the country utilized their CRI plans to receive, distribute and dispense H1N1 vaccines and antiviral drugs, and many MSAs reported using their plans to set up PODs for vaccination clinics, recruit volunteers, establish closed-POD partnerships and reach vulnerable populations.Examples of state and local public health departments usage of Strategic National Stockpile plans to guide preparation and responses to real-world events or public health emergencies.The Democratic National Convention in August 2008 (Denver-Aurora-Broomfield MSA) and the Republican National Convention (Minneapolis-St. Paul-Bloomington MSA) were each a 12-day national special security event coordinated by the U.S. Secret Service. The collaborative planning approach began more than a year prior between local, state and federal agencies to organize the implementation of public health incident management teams, the establishment of strike teams to coordinate and resource multiple point of dispensing (POD) sites, and the development of public information messages. This planning effort further strengthened partnerships between government and non-governmental agencies that have collaborated on CRI planning since The local health departments used this opportunity to effectively plan for CBRNE-type activities during these important national events.Political National ConventionsPolitical and Special EventsThe Miami-Fort Lauderdale-Pompano Beach MSA, in conjunction with Biowatch, used its CRI planning efforts to prepare for the 2010 Superbowl and Probowl in January and February 2010, respectively, in Miami, Fla. The 2010 Superbowl and Probowl – played a week apart – each attracted more than 70,000 fans.Sporting EventsCRI planning for the Washington-Arlington-Alexandria MSA has facilitated collaboration between local health departments to plan for large-scale national events such as the inauguration of President Barack Obama in Washington, D.C. These planning efforts also have assisted in implementation for state funerals, marathons and other events in the region. CRI activities promote cross-jurisdictional planning for all-hazard emergency responses to include both private industry and government agencies such as the U.S. Department of Defense. CRI plans were put into action with hazardous materials responses during mercury spills in the District of Columbia school system when PODs were called down and staffed for collecting information and conducting testing. Additionally, CRI planning has helped provide a concept of operations to screen people who needed medications due to being placed in shelters during evacuations of high rise apartments and during the blizzard of 2010.National Capital RegionExtreme flooding of the Red River in 2009 and 2010 forced the evacuation of thousands of citizens and vulnerable populations as well as those in health care facilities (hospitals, nursing homes). Local health departments in the Fargo MSA used their tactical communications plans, public information messaging, incident management team protocols and procedures, and distribution networks developed as part of their CRI planning efforts to coordinate the successful evacuation, mass care and sheltering of thousands of citizens on both the North Dakota and Minnesota sides of the Red River Valley region.Red River FloodingNatural and Man-made DisastersAmerican Samoa used parts of its SNS plan to respond to an earthquake and tsunami on September 29, The command center was already open for the H1N1 response, so island public health staff was able to easily transition to the tsunami response.Pacific Earthquake and Tsunami2008 Illinois FloodingDuring the major flooding of 2008, Illinois used SNS plans to distribute needed supplies, such as bottled water, to areas of need. Regional distribution centers and the distribution network were used and the state was able to test the communications, inventory management and command and control functions of its SNS plan.States along the New Madrid fault line are in preparations for a national-level, full-scale exercise, scheduled for May 2011, to test earthquake-related emergency response plans. For instance, Missouri will be exercising its local and state SNS plans at full scale across the state for the national exercise. The state’s RSS will be activated and SNS assets will be delivered to the affected areas with orders will be placed by HAMM radio operations. Missouri reports that it has the capability to conduct an exercise of this size as a result of the extensive SNS planning over the past years.New Madrid Earthquake ExerciseFlorida used SNS/RSS personnel to arrange hospital placement for the injured transportation in from Haiti. The state also used the procurement system and messaging/requesting system outlined in its SNS plan to arrange for goods and services for responder health and safety.Haiti EarthquakeFlorida used its SNS plan to guide its response to the Deep Water Horizon oil spill in In addition to using its procurement system and messaging/requesting system to secure goods and service for responder health and safety, the state also used its plan to procure caution signs for beaches. Deep Water Horizon Oil SpillH1N1 operations dominated CRI activities for much of the past year. Most notably, relationships between state and local health departments and emergency management, fire rescue, and law enforcement grew stronger as PODs were planned and executed based on prior collaborative CRI planning. State and local health departments around the country utilized their CRI plans to receive, distribute and dispense H1N1 vaccines and antiviral drugs, and many MSAs reported using their plans to set up PODs for vaccination clinics, recruit volunteers, establish closed-POD partnerships and reach vulnerable populations.2009 H1N1 ResponsePandemics and Disease OutbreaksIn the National Capital Region, public health officials put CRI plans into action to call down and staff actual POD sites to collect information and provide testing during investigations of a tuberculosis outbreak.TuberculosisMeasles, West Nile, Valley Fever, HepatitisThe Phoenix-Mesa-Glendale MSA has used its all-hazards approach to CRI planning to effectively respond to an outbreak of measles and hepatitis in 2009, an outbreak of Valley Fever and a current outbreak of West Nile Virus. In addition, the Phoenix-Mesa-Glendale MSA has used its CRI planning to execute childhood vaccination clinics in 2008 and 2009 and coordinate its seasonal flu vaccinations in 2009.Providence-New Bedford-Fall River MSA used its CRI planning efforts to respond to a fatal mycoplasma infection in an elementary school student in Warwick, RI. The school where the event occurred was used as a POD to issue information to concerned parents, students and staff, which tested the public information strategy and POD setup portion of the CRI plan and helped restore faith that the school was safe for children to return.MycoplasmaIn response to a mumps outbreak in a tradition-observant Jewish male boarding school in Pennsylvania, the Philadelphia Department of Public Health used its SNS plan to open and conduct a mass vaccination clinic to this closed population to limit disease transmission. The objectives of the clinic were to 1) vaccinate students and staff against the mumps and 2) estimate throughput rates for a vaccination operation with a two-vial mixing step to improve planning for a variety of future mass vaccination activities. In this closed population, 155 were vaccinated in 2.4 hours with no adverse effects.Measles-Mumps-Rubella Mass Vaccination
13Executive Order 13527 Signed on December 30, 2009 Charged the federal government with establishing capability for the timely provision of medical countermeasures (MCM) following a biological attackThree sections identified specific requirementsSection 2: US Postal Service delivery of MCMSection 3: Federal rapid responseSection 4: Continuity of operations
14EO 13527: Section 2 Postal Model Collaboration with HHS and USPS since 2004Proof of Concept Drills inEO reaffirms support for postal modelAugments traditional PODs, does not replaceCritical requirement for execution: Security Planning
15EO 13527: Section 3Federal Rapid Response…develop the capacity to anticipate and immediately supplement the capabilities of affected jurisdictions to rapidly distribute MCM following a biological attackInteragency effort evaluated requirements based on state/local gaps and federal capabilitiesThree approaches identified:Supplemental manpowerFederal closed PODsFederal open PODsOngoing efforts to explore:Supplemental manpower (including security)Use of online medical screening to support PODsDecreasing MCM deployment timelines
16EO 13527: Section 4 Continuity of Operations Protection of federal workforce to maintain government servicesInteragency effortGreat challenges to overcomeEngagement of state and local leaders to leverage resources and integrate plans
18PAHPA Reauthorization Pandemic and All Hazards Preparedness ActSigned in 2006Being addressed by Congress this yearDraft bill currently working in House Energy and CommerceCDC engaged with HHS, ASTHO, and NACCHO to identify needsProposals developed, reviewed and finalized through HHSParticipated in series of briefings to educate staff on Senate HELP Committee on key topics to PAHPA:SNSBARDA and Advanced Development of MCMState and Local Perspectives
20Innovative Approaches to Mass Dispensing: Examples from the States Boy Scouts – used to deliver medication during an event.CERT Door-to-Door DeliveryClosed POD (utilities, businesses, faith based organizations, military installations, etc.)Drive through bank dispensingDrive through POD's (colleges and Universities)Grocery Store – used for dispensing
21Innovative Approaches to Mass Dispensing: Examples from the States Home Owner Associations - Fort Lauderdale (Broward County) use Home Owners Associations to facilitate mass dispensing to the public along with traditional POD models.Large and Small closed PODsLong Term Care Facility pharmacies – used for dispensingMass Transit Stations – dispensingMega POD - to facilitate mass dispensing in highly congested areas that is conducive to traffic grid-lock.
22Innovative Approaches to Mass Dispensing: Examples from the States Mobile POD trailersPrivate physicians office Closed PODRetail PharmacySchool Bus DeliveryTele-pharmacy dispensing operationsTiered POD system (with most needed and highest population PODs opened first)USPS Dispensing
23Partnerships Between State and Local Health Departments and Department of Defense Sample Partnership - North DakotaClosed POD MOAs in place with Minot AFB and Grand Forks AFB. Agreements first brokered by state health officials, then involved local health departments. Agreements cover active duty military, contractors and family living on base. Air Force medical staff will operate the PODs.Sample Partnership - MissouriMOU is in place with Fort Leonard Wood. In addition, four local public health agencies are engaged in planning activities with Whiteman AFB.AL Center for Emergency Response and Terrorism has initiated quarterly meetings with military and VA partners. Meetings include state and local public health agencies and cover a variety of planning topics, including interoperable comms and closed PODs for dispensing with federal military partners.
24Case: Marriott Closed POD Pilot DSNS conducting pilot project with Marriott hotels to establish closed PODs for hotel properties in local jurisdictions16 local public health jurisdictions will be invited to participate, totaling 60 Marriott property locationsCurrent outreach to eight public health jurisdictions, totaling 37 property locations. Six of the eight jurisdictions agreed to participate, one decision is pending and one declined.To date, most work has been done in Washington, D.C., and San Diego County, Orange County and Riverside County, CA
25Case: Internal Revenue Service Closed POD Program ObjectiveTo assist the states in establishing multiple closed POD sitesTo further enable the mass distribution of pill-form medicines during a regional or national emergencyTo provide these necessary medicines as a service to IRS employees, IRS contractors, and their family members in an efficient and expeditious mannerTo alleviate burden on public PODsAuthorityHomeland Security Presidential Directive-21 (HSPD-21) authorized CDC to partner with other federal agencies and the 50 states to establish open and closed PODs to dispense medicines during a declared national or regional emergency.
26IRS Closed POD Overview Can currently service 321,700 IRS employees, contractors and family members104 IRS facilities across the country are planned to be serviced through the closed POD program33 facilities actually serve as closed PODsThese 33 facilities also service an additional 71 IRS locations within commuting distanceIRS facilities with 500+ employees are targeted as actual closed POD sites
27Developing Volunteer Capabilities One time funding opportunity announcementPilot project between CDC/DSNS, state and local public health agenciesFund a nationally recognized community volunteer and support organization to develop plans to recruit, train, and maintain volunteersSupport state and local public health agencies during a dispensing campaignCreate an exportable model that can be applied by other organizations and agenciesFOA open April 4th – June 4th, 2011
29Dispensing Challenges Liability issuesPREP ActNon-medical dispensing concernsEUA IssuesPotential for delay in distributionStaffing IssuesVolunteer poolsHigh turnover rate at state and local levelsMandatory furloughs and work force reductionsLimited and shrinking fundsLogistics of achieving high throughputExercise Needs
30Fiscal Challenges Reductions in PHEP funding Adding requirements at the state and local levelCarrying the message:State and local preparedness/state and local resources are key to effective responseOPHPR Director Ali Khan’s testimony to House Homeland Security subcommittee on 5/17/2011:“Effectively using the SNS requires a collaborative effort by state, local, tribal, territorial, and federal partners on everything from MCM development to development of diagnostics to detection of an event to distribution and dispensing of MCM.”