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Regional Pharmaceutical Resources

Colleen Terriff, PharmD, BCPS (AQ-ID), MPH (soon) has played a pivotal role in pharmaceutical coordination for bioterrorism and chemical terrorism preparedness in Eastern Washington. Her extensive history includes response efforts during significant crises such as the 2001 anthrax letters and 9/11. Key initiatives she has led encompass mass vaccination and dispensing exercises, inventory management, stockpiling medications, and disaster response. With ongoing involvement in the CHEMPACK program and community pharmacy collaboration, Colleen continues to enhance local health preparedness to address pharmaceutical needs in emergencies.

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Regional Pharmaceutical Resources

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  1. Regional Pharmaceutical Resources Colleen Terriff, PharmD, BCPS (AQ-ID), MPH (soon) Clinical Associate Professor Washington State University College of Pharmacy Deaconess Hospital and Rockwood Health Systems November 21, 2013

  2. History of Involvement • 1999 hoax anthrax letter • Y2K preparation for hospitals • Poster at Midyear and AJHP publication • MMRS Spokane City/County Pharmaceutical Coordinator (2000- present) • Sept 11, 2001 • Participation in variety of exercises: • Mass vaccination • Mass dispensing • Mass casualty

  3. Pharmaceutical Coordinator • CDC CHEMPACK med exchanges • Assist with public health • Stockpiling: • Decisions: location, medications, ancillary supplies • Distribution • Dosing and preparation information • Inventory • Destruction

  4. Pharmaceutical Resources • MMRS Stockpiles • CHEMPACKS • SNS Antiviral Cache • VA Cache • HRSA Employee Cache • Hospital Inventory for SRHD • Community Pharmacy Inventory as needed

  5. Bioterrorism Planning

  6. Local BioterrorismPharmaceutical Plan (MMRS) • Agents • Levaquin IV/PO, doxycycline IV/PO, gentamicin IV • Others • dosing syringes, sterile water for injection • Considerations • pediatrics, pregnancy, elderly, immunocompromised • first-responders and healthcare professionals • prophylaxis vs. treatment

  7. Chemical Terrorism Planning

  8. Local Chemical TerrorismPharmaceutical Plan (MMRS) • Nerve agent antidotes: • 2004: • MARK-1 and diazepam autoinjectors with “sprinklings” of 2-PAM vials, diazepam carpujects • ALS transport (AMR and Medstar) and non-transport (fire) • 2009: • Duodotes • Cyanide antidotes (hydroxocobalamin) • fire chief rigs • Expired: AMR

  9. CHEMPACK Program • Nerve agent antidotes • antidotes more readily available • improve local response time • treat thousands of patients (including peds) • Federally owned cache • decrease cost to local areas: initial and replacement • Shelf-Life Extension Program (SLEP)

  10. Shelf-Life Extension Program • Previously- military • SNS in conjunction with the FDA may extend shelf-life of meds (expiration date) • Strict criteria: • storage and security • Meds from CHEMPACK: • regardless of dating on vials/packages…. • ensured potency!! • Just implemented for Tamiflu susp.

  11. CHEMPACK DistributionEastern Washington • Hospital: • Deaconess • Holy Family • Sacred Heart • Valley • EMS: • AMR (x2) • Valley Hospital • Colville • Pullman

  12. Strategic National Stockpile Program • CDC/Federal Government assistance • Stockpile (4 components): • 12 hour push package • antibiotics (IV and PO) and antidotes • fluids, bandages, IV supplies, supportive care meds • Vendor Managed Inventory- drug or equip.-specific • Vaccine and Antitoxin • CHEMPACK program- pilot: NY, SD, WA • Additional resources: personnel, $$

  13. Antivirals Spring 2009 • CDC released 25% of SNS antivirals • DOH received antivirals and then distributed to sites identified by local HD • Local: • Hospitals • Retail/chain with expanded access • Issues: • storage (physical) • short expiration of suspension • different packaging

  14. Antiviral Issues Continued… • Locals now own stockpile • Who is the “gatekeeper” of access? • Need to use up local supply (in pharmacies) first, then can utilize SNS • Ancillary supplies…

  15. VA Stockpile • Large facilities • Small facilities: • Spokane • Mass casualty • Color coded • Includes supportive care meds • 2008 Directive

  16. HRSA Employee Cache • Ciprofloxacin • Doxycycline • For employees and families and hospital-based EMS providers • Maintained by area hospitals

  17. Deaconess Stockpiles • MMRS- ill patients (i.e. IV meds) • ED provider can access • MMRS- POD • SRHD or Spokane EOM- to be sent to POD • CHEMPACK plus expired meds • Antiviral SNS cache • Employee cache • Antibiotics and antivirals • HRSA grants

  18. Hospital Pharmacy Inventory • Deaconess and Shriners • Holy Family and Deer Park • Sacred Heart • Valley • VA • Antibiotics, chemical exposure treatment, antivirals • Estimation • SRHD listed resource

  19. Community Pharmacy Inventory • Enroll help of: • WSU College of Pharmacy Drug Information Center • Spokane Pharmacy Association • Limited meds • Dispensing to community

  20. MOU’s with Pharmacy • State-wide initiative community pharmacies: • Chains • Independents • SRHD with WSU COP: • Mass dispensing • Mass vaccination

  21. Medication Destruction • Partnering with law enforcement (SPD) • Coordinating stockpile destruction with other incineration needs for LE • Mainly MMRS chemical terrorism meds

  22. Moving Forward • MMRS defunct • CHEMPACK program will continue until ? • Local stockpiles expired • Keep expired meds until funding changes

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