1. Application to Mass Dispensing Hot Topics in Preparedness Northwest Center for Public Health Practice School of Public Health & Community Medicine University of Washington July 27, 2004 Andy Stergachis, Ph.D., R.Ph. Professor, University of Washington SNS Coordinator, Region 6

2. Roughly how complete is your SNS plan? A. 100% B. 75% C. 50% D. < 50%

3. What do you need to plan for? Roles, responsibilities, policies Decision-making for requesting SNS Site selection Set-up and design Staffing Public information and communication

4. What is the Strategic National Stockpile? Federally managed logistical system created to supplement supplies of state and local systems during a major public health emergency: 12 strategically located Push Packages (12hr PP) Vendor Managed Inventory (VMI) Stockpile Managed Inventory (SMI) Technical Assistance Response Unit (TARU) Chempack Program

5. 12-hour Push Package 50+ tons of pharmaceuticals, equipment, and other medical supplies. Color coded for ease in identifying needed material: –Biological, Chemical & Biological, All Scenarios, Chemical Antidotes, Bandages Antibiotics –Unit of use 10-day courses –Suspension –Intravenous

6. Vendor Managed Inventory Inventory owned by the SNS program and managed by pharmaceutical vendors –Vendors maintain the VMI stock as a bulge within their pipeline and rotates stock to keep it current and eliminate waste. Represents 90% to 95% of the SNS inventory Used in Florida, re: anthrax attack

7. CHEMPACK Program The CHEMPACK program forward-deploys chemical antidotes Elements of the program: –Maintained locally and readily available to EMS and Hospital Emergency Departments –Remotely monitored for environment and security by the SNS Program Washington was one of the three pilot programs

8. Roles, Responsibilities, Policies Who has authority to request SNS? What are the relevant laws and authorities? What is the process for requesting SNS? How is the request coordinated with regular emergency management procedures? ?

9. Responsibilities The state is responsible for receiving, storing, staging (RSS), & distributing the SNS supplies to the points of distribution (PODs). Local health officials are responsible for setting up and operating dispensing or immunization clinics/sites.

10. Decision-Making to Request SNS Identify Criteria, e.g. –Suspected BT attack –Chemical agent or ionizing radiation –Hospitalization of large numbers of patients Determine if local supplies sufficient, e.g. –Number of casualties –Epidemiology of agent of concern Consultations Notifications

11. Set-Up and Design Critical Components: –Incident Command –Triage & Registration –Dispensing – Express & Other –Counseling and Education –Record Keeping –Security Throughput Model

12. Types of Patient Groups No Complications – healthy –Express dispensing Complications – pre-existing illnesses/allergies, pregnant, etc. –Assess and provide more involved counseling Persons with acute illnesses –Transport Crisis counseling and mental health intervention

13. Which of the following sites are you considering for mass dispensing clinics? A.Schools B.Community Centers C.Pharmacies D.Other

14. Site Selection How many? Where? –Familiar Locations –Accessible Size and Characteristics Hours of Operation Agreements

15. Do you have a plan for mobilizing volunteers for mass dispensing clinics? A.Yes B.No

16. Staffing Public Health Department Volunteers –Recruit –Train –Call-Up Procedures Who can dispense? Prescribing physician

17. Public Information and Communication Notifications to public of POD openings Coordinate through Public Health Information Officer and Joint Information Center (JIC)

18. Lessons Learned from Exercises of SNS: Planning Hold face-to-face meetings Establish and solidify mutual aid agreements Scale plans to accommodate scenarios Harmonize SNS plans with other plans Clarify roles Update contact information and make it accessible Emphasize regional planning ASTHO 2004

19. Resources www.bt.cdc.gov/stockpile/index.asp Mass Prophylaxis/Vaccination Campaign Staffing Model: www.ahrq.gov/research/biomodel.htm www.phppo.cdc.gov/phtn/antibiotic Exercising the SNS: Lessons learned and tools for application, www.astho.org