The Strategic National Stockpile Responding to Public Health Emergencies

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The Strategic National Stockpile Responding to
Public Health Emergencies

• Frank Chance
• SNS Coordinator
• San Antonio Metropolitan Health District

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Objectives

• Identify potential public health threats
• Explain the Strategic National Stockpile
• Discuss the role of Dispensing Points (PODs) and
  Alternative Dispensing Operations
• The Non-Medical Model
• The Role of the POD Worker Volunteer
• Question and Answers

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CATEGORY A THREAT AGENTS

• Anthrax
• Tularemia
• Pneumonic Plague
• Smallpox
• Viral Hemorrhagic Fevers

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NON-TERROR THREATS

• Influenza Pandemic
• Measles Outbreak
• Hazardous Material Incident

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What is theThe Strategic National Stockpile?
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Strategic National Stockpile (SNS)

• Initiated in 1999 by Congress to re-supply large
  quantities of essential medical material to
  states and communities.
• A repository of antibiotics, antidotes,
  antitoxins, and life support medications and
  equipment.
• Can be delivered to any state in U.S. within 12
  hrs of request (24-36 hrs VMI shipments).
• The medicine in the SNS is FREE for everyone.

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Requesting the SNS

• Requested by public officials in response to a
  Public Health Emergency.
• Follows a request chain from City/County, State
  to CDC EEOC.
• SNS Assets can be deployed without a Presidential
  Disaster Declaration.

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Events Justifying a SNS Deployment

• Chemical, Biological, Radiological or Explosive
  event.
• Medical emergency from a natural disaster.
• Claim of release from intelligence or law
  enforcement.
• Clinical lab or epidemiological indications.

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Clinical Considerations

• Large number of persons with similar symptoms,
  disease, or deaths.
• Unusual illness in a population.
• A failure of a common disease to respond to usual
  therapy.
• Deaths or illness among animals that precedes or
  accompanies human death.

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12 Hour Push Package

• Each treats 90,000-300,000 people and must be
  received within 12 hours of the approved request
• 50 tons, 135 containers of drugs and equipment
• Each Push Package can fill a Boeing 747
• Follow on shipments may be shipped direct to
  local communities from vendors usually with in
  24 hours of approved request.

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PUSH PACKAGE10-Day Regimens

• 75,000 Bottles of Ciprofloxacin
• 225,000 Bottles of Doxycycline
• 24,000 Bottles of Amoxicillin (anthrax
• only)

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Doxycycline

• An effective antibiotic if taken with in 4 days
  of contact.
• 87 of population can safely take.
• 100 mg unit-of-use bottles.
• Usually a 20 day supply per bottle.
• Treatment could run 60 days.
• Comes with a Direction for Use Information Sheet.
• Pediatric Dispensing Considerations.

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FORMULARY CONTENT

• Pharmaceuticals
• Antibiotics (Oral and Intravenous)
• Chemical Agent Antidotes
• Other Emergency Medications
• IV Administration Supplies

• Airway Management Supplies (Adult and Pediatric
• Items for Radiation, Burns and Blast
• Wound Care Supplies

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Goal

• To protect entire local population (1.49M)
  within
• 48 hours
• Center for Disease Control requirement

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Anthrax ExposureProportion of Population Saved
DELAY in Initiation
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Time is Critical
Days
More
Lives Lost
DELAYin Detection
Fewer
Shorter (1-2 Days)
Longer (4 Days)
Hours
DURATION of Campaign
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Concept of Operations

• Initiate prophylaxis immediately for staff and
  family members of
• First Responders/Essential Personnel
• Critical Services (City,County,Federal)
• Infrastructure (CPS, SAWS, Food, Banks)
• Volunteers

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Concept of Operations (cont)

• Initiate Dispensing Site Operations to public
• Distribute meds to local treatment and nursing
  facilities at Central Distribution
• Distribute meds to large employers
• Deliver meds to military bases
• Deliver meds to local confinement facilities

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The PUSH CONCEPT
Nursing Homes Homebound 18,226
Hospital Workers 190,000
First Responders Government Workers 99,663
COSA BC 3,460 Municipalities
Essential Federal Workers 12,000
Central Distribution Center
Military Bases 293,713
Large Employers 90,000
Incarcerated 6271
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The PULL CONCEPT
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Community Dispensing Points

• Also known as PODs
• Designed to rapidly administer vaccinations or
  medication to the public during an outbreak
• Located throughout the community to service the
  public
• Reliant on volunteers and public worker support
• Not a clinic, no treatment capability

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San Antonio and Bexar County Dispensing Sites

• 26 primary dispensing sites
• 14 backup dispensing sites
• Site Selection Criteria
• Population Centers
• Traffic Flow
• Ultimate dispensing capacity
• Accessibility
• Facility resources
• Standardized design
• Community Familiarity

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Significant Considerations

• Schools will not be in session during emergency
  period.
• Only well individuals will report to site for
  prophylaxis.
• Symptomatic individuals are instructed to go
  directly to their health care provider and not
  report to site via public health messages.
• Head of Household can pick up for oneself and
  seven others.

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POD Four Basic Areas

• 1. INTAKE
• SCREENING
• DISPENSING
• EXIT

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POD Planning Considerations

• Use of Non-Medical Model
• Simplified Forms/Collect only essential
  information
• Use of Media to convey information
• Head of Household can pick up medication for
  family members
• Streamlined flow

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Use of Mass Media

• First-line triage.
• Provide medication instructions.
• Broadcast messages in multiple languages.
• Information on POD location and status.
• Dispel rumors.
• Critical for dispensing success.
• Heavy reliance on The Family Physician to answer
  specific patient questions.
• COSA 311 line available for general information.

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Volunteers

• Public servant workers
• Volunteer Organizations
• Spontaneous volunteers

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WHY VOLUNTEER

• YOUR SUPPORT IS NEEDED
• GIVE BACK TO THE COMMUNITY
• SHARE YOUR SKILLS
• SEE A MISSION ACCOMPLISHED
• SAVE LIVES

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FYI for Volunteers

• In the event of a bioterrorism attack, all
  volunteers will be among the first to receive
  antibiotics or vaccinations.

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HOW MANY VOLUNTEERS ARE NEEDED?

• At two 12-hour shifts Bexar County will need
  4,100 to 5,000 volunteers to operate 26 multiple
  POD (Point of Delivery) sites for one day.

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VOLUNTEER ROLES
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MEDICAL VOLUNTEER ROLES

• Point of Delivery (POD)
• Dispensing Supervisor
• Medical Information Personnel
• Crisis Counselor

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NON-MEDICAL VOLUNTEER ROLES

• Greeters
• Forms Personnel
• Logistics Workers
• Runner
• Comm./Radio Operator

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VOLUNTEER TRAINING

• Basic training consists of 3 components
• Orientation
• Just in Time Job Training
• POD Site set-up, walk through and tear-down
• It is recommended volunteers complete all 3
  components

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Current Statutory Efforts to Control Volunteer
Liability Exposure

• Federal Volunteer Protection Act of 1997
• State Volunteer Protection Acts
• Good Samaritan Laws Liability for Emergency
  Care
• Charitable Immunity Liability Act of 1987 Texas
  Law
• www.texmed.org/pmt/lel/volunteerprotectionact

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Planning Challenges

• Complete Site Security Surveys.
• Identify core City and County POD workers.
• Coordinate with State on RSS delivery and
  anticipated amounts to be furnished.
• Recruit and train community volunteers.

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What You Need to Know

• First Responders and other City/County workers
  will receive meds from PUSH.
• Your Family Members are included.
• Is there anyone in my family who cannot take
  Doxycycline?
• Meds will be picked up and brought to you at your
  worksite by your chain.

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SAMHD Points of Contact

• Roger Pollok, Public Health Emergency Manager
• roger.pollok_at_sanantonio.gov , 207-8752
• Frank Chance, SNS Coordinator
• francis.chance_at_sanantonio.gov , 207-2145

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• Questions