The Strategic National Stockpile Emergency Managements Role Ashley

The Strategic National Stockpile: Emergency Management’s Role Ashley Ward Peluso, Pharm. D, MSCR Pharmacist, Cities Readiness Initiative Region Division of Public Health, Public Health Preparedness & Response NC Department of Health & Human Services

Disclaimer The following presentation on the Strategic National Stockpile and involved partners is for educational purposes only. Local Emergency Management will perform a variety of roles dependent on the scenario of the public health event and also the emergency plans and agreements in place with county partners. If you have specific questions about EM’s role in your county’s Medical Countermeasures Plan, please contact the Preparedness Coordinator at your local health department. 2

Topics • Overview of NC Public Health Preparedness & Response • CDC’s Strategic National Stockpile Program (SNS) • Purpose • Components • Requesting Assets • Deployments • Program Oversight • Requesting, Receiving, Distributing, and Dispensing the SNS • State Emergency Management’s Role • Local Health Department’s and PHP&R’s Role • NC’s H 1 N 1 Response in 2009 3

Overview of North Carolina Public Health Preparedness & Response 4

NC Public Health Preparedness & Response • Epidemiology Section of the Division of Public Health • Responsibilities: assists with identifying, preventing, protecting against, responding to, and recovering from public health emergencies when local capabilities will likely be overwhelmed • Programs and Services • Regional PHPR Teams (4) • Hospital Based Epidemiologists & Disaster Epidemiology • NC DETECT & NC HAN • Biological Agents Registry • SNS and other Medical Countermeasures • Training and Capabilities Assessments 5

NC Public Health Preparedness & Response Epidemiology Section Chief: Megan Davies, MD PHP&R Director: Dr. Julie Casani, MD, MPH Regional Office Staff • Planning Consultant, Training and Exercise Coordinator, Industrial Hygienist, Pharmacist, Program Support 6

NC Public Health Preparedness & Response Medical Countermeasures Group • State Pharmacist • Medical Logistician • Program Manager • Regional Pharmacists (4) http: //arlingtonva. s 3. amazonaws. com/wp-content/uploads/sites/25/2013/12/mrctrainings 2. jpg Responsibilities: • Provides guidance & technical assistance to partners for mass dispensing to impacted populations • Serve as a liaison between the CDC and local jurisdictions to implement the Strategic National Stockpile 7

The Strategic National Stockpile Program 8

The Strategic National Stockpile: Purpose • Large cache of life-saving medications and medical supplies • Supplies available for specific or illdefined threats • Strategically located around the country • Capacity sufficient to protect people in several large cities at once • Designed to supplement and resupply state and local public health assets • Started in 1998 with funds from Congress • Managed by the Division of the Strategic National Stockpile (DSNS) within the Centers for Disease Control and Prevention (CDC) • 6 billion dollar asset • Free to everyone 9

The Strategic National Stockpile: Purpose Includes life-saving medications and medical supplies for: • Chemical, biological, radiological threats • Category A biological threats- pose highest risk to public health and national security • Smallpox • Anthrax • Botulism • Plague • Tularemia • Viral Hemorrhagic Fevers 10

The Strategic National Stockpile Pharmaceuticals • Radiation countermeasures • Antibiotics (oral & IV) • Nerve agent antidotes • Vaccines and anti-toxins http: //www. iaff. org/ET/Smallpox/PHIL_2674_lores. jpg https: //chemm. nlm. nih. gov/chempack. htm • Antivirals Medical Supplies • IV Administration • Airway Management • Wound Care • Burn& Blast Care • Personal Protective Equipment (PPE) Bottom images available from Push Package Catalog 2. 01. 2012 11

Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide to Preparedness, Version 11 12

The Strategic National Stockpile Components Include: • 12 hour Push Package • Managed Inventory • Chem. Pack Vendor Managed Inventory • Federal Medical Stations Additional SNS Programs • Federal Purchasing Power • Stockpile Services Advance Group (SSAG) • Cities Readiness Initiative 13 12 hr Push Package CHEMPACK Program

SNS Components 12 -hour Push Package • 12 push-packages housed in 10 undisclosed locations • First Line of Support: • Broad spectrum for Ill-defined threat • Delivered within 12 hours to the state • Consist of 130 containers, weighs 50 tons • Use world-class transport partners • Fits into a wide-body cargo aircraft • Contents: • 500, 000 10 -day oral antibiotic regimens • IV antibiotics and supplies • Respiratory medications and supplies • Pediatric supplies • Medical/Surgical supplies 14

SNS Components Managed Inventory • Stored and maintained by DSNS or commercial partners • Also strategically located • Used as additional supply to the PP or in response to a specified threat • Represents 97% of SNS assets • Delivered within 24 -36 hours to the state 15

SNS Components Chem. Pack • Prepositioning of chemical agent antidotes • 1300 Chem. Pack containers across the US • 57 containers with a 454 person capacity located in 43 hospitals in NC • Ensure availability to state and local emergency responders • Allows for immediate response to a large-scale chemical exposure Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide to Preparedness, Version 11 Federal Medical Station • 250 bed mobile hospital • Parceled 50 bed units • 3 day supply of pharmaceuticals, equipment, and supplies • Requires site, staffing and set-up from the jurisdiction 16

Additional SNS Programs Federal Purchasing Power • Defense Logistics Agency • Variety of item and transportation vendors • Possibly longer response time • Subject to market availability SSAG • Specialized group of responders • Can be deployed with the SNS http: //www. etbrooking. com/portfolio-items/finding-efficienciesbusiness-defense-reducing-fuel-cost-defense-logistics-agency/ • Provide expertise on SNS assets & incoming supplies • Can request additional supplies if needed 17

Additional SNS Programs Cities Readiness Initiative • Goal is to enhance preparedness in large population centers • Local health departments develop and implement plans to dispense antibiotics to the entire population within 48 hours • Originally based upon worst- case scenario of a large scale anthrax attack • East state has at least one CRI Region • NC CRI Region is Charlotte/Mecklenburg 18 Image modified from http: //epi. publichealth. nc. gov/phpr/regions. html

Request for SNS Assets When is requesting SNS assets justified? • When an incident impacts a local jurisdiction and has the potential to overwhelm available local resources • Scenario • Overt release • Claim of release or possible attack • Supported by intelligence/law enforcement • Laboratory confirmation • Unexplained increases • EMS requests • Use of antibiotics/non-prescription products • ED surveillance and other epidemiological indicators • Evidence of Pandemic Influenza 19

SNS Deployments Medication and Supplies: • New York City 9/11 Attacks and the Anthrax Attacks, 2001 • Gulf Coast after Hurricane Katrina, 2005 • H 1 N 1 Response, 2009 FMS Modules: • • http: //thelede. blogs. nytimes. com/2008/08/13/daschle-is-persuaded-on-the-anthrax -case/? _r=0 Katrina, 2005 Rita Dean Gustav Ike Isaac North Dakota Floods, 2009 & 2010 • Totals more than 14, 000 beds http: //www. thenation. com/article/august-29 -2005 -hurricane-katrina-strikes-the-gulfcoast/ 20

SNS Program Oversight DSNS’s Mission: to prepare and support partners and provide the right material at the right time to secure the nation’s health • Operates & maintains the Strategic National Stockpile (SNS) • Collaborates with federal partners to ensure appropriate medical countermeasures are available for a variety of public health threats • Coordinates with partners to encourage integrated response planning between public health, healthcare and emergency management • Ensures rapid delivery of countermeasures to an affected area • Provides technical assistance and guidance pertaining to receiving, distributing, and dispensing medical countermeasures 21

Requesting, Receiving, Distributing, and Dispensing the SNS 22

Overview- Request, Receipt, Distribution, and Dispensing SNS Assets Will the threat potentially exhaust local supplies? Public Health Threat 23 Local Health Department Use Available Local Supplies

Overview- Request, Receipt, Distribution, and Dispensing SNS Assets Yes, the threat will likely exhaust local supplies. County EM 24 Submits SNS Request NC SPARTA Received by State EM

Overview- Request, Receipt, Distribution, and Dispensing SNS Assets Are supplies available from traditional resources? Yes Request Reviewed by SERT Resources Available Public Health: LRS is a Local Receiving Site 25 Deployed to County LRS

Overview- Request, Receipt, Distribution, and Dispensing SNS Assets Are supplies available from traditional resources? No Request Reviewed by SERT 26 Resources Unavailable EM Director Submits Request to CDC

Overview- Request, Receipt, Distribution, and Dispensing SNS Assets Will SNS Assets Deployed? If yes…. Request Reviewed by CDC/ Federal Partners 27 Request Approved Requested SNS Assets Deployed

Overview- Request, Receipt, Distribution, and Dispensing SNS Assets Deployed to Affected County Assets Transported to RSS Assets Repackaged per County Request Public Health: Receipt, Stage, & Storage Site 28 Assets Shipped to County LRS

Overview- Request, Receipt, Distribution, and Dispensing SNS Assets Getting Assets to the People LRS Repackages Supplies for Dispensing Sites Assets Transported to Local PODs Public/Patients Receive Countermeasures Public Health: PODs are Points of Dispensing EM: PODs are Points of Distribution When assets are within 24 hours of being depleted and still needed, the request process is repeated. 29

Requesting SNS Assets • Local EM’s Role: • Coordinate with health department and activate EOC • Assists with decision to request SNS resources • Submits request to state emergency management • Local Health Department’s Role • Activation and set-up of LRS, POD(s), staff, partners • PHPR’s Role: • SERT reviews request • State EM • Overall coordination of response and recovery programs by implementing the NCEOP as directed by the Governor • State EM Director submits request to the CDC 30

Requesting SNS Assets What information is needed for the request? • Description of situation • Status of and specimen testing • Target population, including estimated numbers of population who will receive medical countermeasures • Quarantine measures taken • Relevant local SNS plan information • LRS location • Number of PODs • Number of residents • Number of first responders • Internal capabilities • Items needed 31

Receiving SNS Assets • State EM’s Role: • State EOC is activated (Level 4) when it is determined NC will receive assets • Notify transportation companies and law enforcement • PHPR’s Role: • Prepare and activate RSS • Coordinate repackaging of SNS assets • Local Health Department and EM: • Logistics • Resources • Staffing, volunteers • Operations NC Eagle Down Exercise, 2012 32

Distributing SNS Assets • State EM’s Role: • Maintains transportion of SNS Plan • Contracts • Routing • Security • NCEM will notify NCSHP to enact the RSS transportation security plan • PHPR’s Role: • Coordinate distribution of assets to county • Local Health Department • Repackage and distribute assets to PODs • Local EM: • Can coordinate secure transport or perform escort of assets to LRS/POD 33 NC Eagle Down Exercise, 2012

Dispensing SNS Assets • Local Health Department’s Role • Provide medication to their entire population as quickly as possible • Local EM: • Coordination of external partners as requested for staffing and equipment for example • American Red Cross • Communications • Law Enforcement • EMS • Partners Behavioral Health Management • EOC • Requesting SNS Resupply when less that a 24 hour supply remains 34 Cleveland County, Dust in the CRI Wind Exercise, 2015

NC’s H 1 N 1 Response in 2009 35

H 1 N 1 Response What actually happened. . • Request process not used-CDC “Pushed” supplies to states • State EOC Activated • Shipments • April/May 2009 - Antivirals and PPE • 214 orders total to 86 sites • October 2009 • Tamiflu suspension sent from private warehouse to local health departments • N 95 s • 214 orders to 86 sites • RSS opened • November 2009 • Tamiflu suspension sent from private warehouse to local health departments 36

H 1 N 1 Response What actually happened. . • Transportation Plan utilized • Security Plan utilized • Amounts of supplies received • More than 20 tractor trailer loads total • Antivirals • Approximately 300, 000 regimens • PPE • Over 6 million N 95 s • Gowns, gloves, and surgical masks also received • Most counties received supplies at health department 37

Summary • Overview of NC Public Health Preparedness & Response • CDC’s Strategic National Stockpile Program (SNS) • Purpose • Components • Requesting Assets • Deployments • Program Oversight • Requesting, Receiving, Distributing, and Dispensing the SNS • State Emergency Management’s Role • Local Health Department’s and PHP&R’s Role • NC’s H 1 N 1 Response in 2009 38

Thank you Local and State EMPublic Health could not do this without you! 39

References 1. North Carolina Epidemiology. http: //epi. publichealth. nc. gov/about. html 2. North Carolina Public Health Preparedness & Response. http: //epi. publichealth. nc. gov/phpr/ 3. NC PHPR/Strategic National Stockpile. http: //epi. publichealth. nc. gov/phpr/sns. html 4. Office of Public Health Preparedness and Response: Division of the Strategic National Stockpile Fact Sheet. http: //www. cdc. gov/phpr/documents/dsns_fact_sheet. pdf 5. Public Health Emergency Medical Countermeasure Enterprise. http: //www. phe. gov/Preparedness/mcm/phemce/Pages/default. aspx 6. SNS Push Package Catalog; February 1, 2012 7. Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide to Preparedness, Version 11. 40

Questions 41