National Emergency Stockpile System BC Ministry of Health Emergency Management Branch

1. National Emergency Stockpile System BC Ministry of Health Emergency Management Branch EP Conference Vancouver, October 2005 Christopher Smith, MA, CBCP Manager, Planning and Programs Emergency Management Branch BC Ministry of Health

2. What is the NESS? • National Emergency Stockpile System • Program established in 1950’s • Mission of NESS  • To have sufficient quantities of supplies in support of the provision of Provincial Health and Social Services in their efforts to alleviate pain and suffering, and to save the lives of Canadians and others who are affected by natural and human caused disasters • Public Health Agency of Canada leads NESS program through CEPR • NESS resources held centrally, in Federal Reserve and are pre-positioned in P/Ts

3. NESS Resources • Inventory: • 200 Bed Emergency Hospitals • Advanced Treatment Centres • Casualty Collection Units • Mini-Clinics • Isolation Unit – accommodates 300 people • Bulk Medical and accommodation items • Pharmaceuticals in Federal Reserve • Vendor managed pharmaceutical agreements where HC owns and maintains specific level of products which are rotated through system to maintain best possible dating

4. Past NESS Deployment • Between 1981 to 2005 over 115 NESS Deployments (48 Since 2000) • 1985 Mexico City Earthquake • Operating Theaters and X-Ray Units • 1998 Provinces of Ontario and Quebec Ice Storms • Blankets, Generators (3 & 10KW), First Aid Kits, Propane Cylinders, Batteries, Wound Dressing, Flashlights, Towels, Litters etc • 2001 Halifax, Whitehorse, Gander, Moncton, St. John’s (US Terrorist Attacks) • Beds, Litters, Towels, Blankets, Cots • 2005 SEA Tsunami • Generators (4 & 5KW), Water Bladders, Amoxicillin, Ciprofloxacin, Doxycycline Tablets and Capsules, Tetracycline, Penicillin, Lidocaine Hydrochloride, Acetaminophen, Morphine Injection and Meperidine Hydrochloride

5. Current NESS Deployment Hurricane Katrina: • 2000 Bandage, Self Adherent Wrap • 1000 Bandage, Muslin, Triangular • 3600 Dressing, Surgical, Combination • 50000 Sponge, Surgical, Gauze, Sterile, 4" • 20000 Sponge, Surgical, Gauze, Sterile, 2" • 900 Plaster, Adhesive • 3000 Bandage, Absorbent • 20000 Gloves, Examination, Nitrile, Med • 6000 Gloves, Examination, Nitrile, Large • 1000 Depressor, Tongue • 5000 Gown, Isolation, Yellow • 1800 Cloth, Face • 1700 Towel, Bath • 2000 Needle, Angioclath • 100 Cannula • 360 Cot, Folding, Aluminum Frame • 1440 Blanket, Wool and Synthetic Fibre • 3000 Blanket, Resue, Mylar • 7000 Blanket, Disposable, Yellow • 1600 N.V.A Batteries, ‘D’ Cell

6. BC NESS Deployment • BC NESS Deployment: • 1997 Extreme Weather: Sooke, Blankets • 2003 SARS: Vancouver, Thermometer, Clinical • 2003 Forest Fires: Cranbrook portions of EH (temporary infirmary) • 2003 Forest Fires: Kelowna, Inquiry Cards • 2004 AI: Lower Mainland Tamiflu

7. Location of NESS Resources By Health Authority • Units are typically stored in BCAS Stations, Fire Departments, Public Works Yards, Hospitals, Airports, Recreation Centers and Schools

8. CCU – Purpose & Inventory • Designed to provide first aid treatment for 500 casualties at the rescue site and to control casualty evacuation to the supporting ATC • 20 Line items packed into 44 cases and consuming 231 cubic feet of space • Bandages • Wound Dressings • First Aid Haversacks • Blankets • Spine boards and Stretchers • Intended to be: • Deployed and operated by trained EMS/Fire Service Personnel • Managed and administered by Municipalities

9. ATC – Purpose & Inventory • Designed to provide early life-saving care to the seriously injured and to control the equitable distribution of the injured among the available treatment facilities. The unit has two principal functions: • The triage (sorting) of casualties for immediate treatment andfor transportation to other facilities for continuing casualty care • The provision of emergency medical care to ensure the survival of the most seriously injured until they reach definitive care facilities. Each unit has an initial capability to treat 500 casualties. The emergency medical care is limited to: •  airway maintenance • control of hemorrhage • control of shock • relief of pain • control of infection

10. ATC – Purpose & Inventory Con’t • Functions dependant on the local situation and the assigned tasks: • Treatment of minor injuries • Sustaining care for the injured awaiting evacuation • Radiological decontamination of casualties • Reception, sustaining care and patient handling at transportation points such asair fields, ports, rail-heads and road-heads • Reception and distribution of casualties in major communities • These units are organized to support the rescue and first aid activities of emergency responders in major urban areas

11. ATC – Purpose & Inventory Con’t • The Advanced Treatment Centre consists of 143 line items, packed into 81 cases and one (1) cylinder • Reception & Sorting • Resuscitation • Minor Treatment • Major Treatment • Holding • Supply • Evacuation • Unit consumes 326 cubic feet of space and weighs 4000lbs

12. EH – Purpose & Inventory • To support Health system for acute, short term sub-acute care • To support ESS system for reception and housing • Requires minimum 18,000 square feet for deployment (school, arena) with 30,000 square feet preferred • Transport requires 2 X 48 foot trailers or 3 deep sea containers • 673 line items packed into 571 cases and 25 cylinders • Consumes 3100 cubic feet and weighs 42,000 lbs

13. EH – Purpose & Inventory • Functional Packaging and Color Coding: • Admission and Discharge • Pre-operative Resuscitation • Operating Rooms • Recovery • Eight General Wards • X-Ray • Central Supply • Pharmacy • Service Utilities

14. EH – Purpose & Inventory • Workload & Operating Requirements: • The hospital contains sufficient expendable supplies to last for seven days • 80 professional, technical and auxiliary personnel are required to operate hospital at minimum level

15. EH – Purpose & Inventory • Some of the Equipment: • 10 kilowatt generator • 3 kilowatt generator • 1500 gallon portable water tank and electrically operated water pump • 200 folding beds • Two large portable autoclaves and water boiling sterilizer • 5 X 40lb propane and 20 oxygen cylinders • Surgical instruments and operating equipment • 490 wool and synthetic and 100 wool blankets • Dressing & Sutures • Fracture Appliances • Field medical equipment

16. Public Health Agency of Canada • Public Health Agency of Canada, Centre for Emergency Preparedness & Response (CEPR), Office of Emergency Response own supplies • Central Federal Depot located in Ottawa • 9 Federal Reserves located across Canada • Chilliwack, BC • Edmonton, AB • Winnipeg, MB • Brampton, ON • Shawinigan, QUE • Quebec, QUE • Montreal, QUE • Dartmouth, NS • St. John’s, NFLD • 60% held in Federal Reserve • 40% of NESS resources are pre-positioned with primary management responsibility assigned to provinces and territories (1300 sites)

17. NESS Strategic Direction & Objectives • Strategic Direction: • Enhance capacity to respond effectively and efficiently to threats caused by natural and human caused disasters • Objectives: • Compile a stockpile of pharmaceuticals, medical devices and medical supplies to countermeasure terrorist threats, CBRN&E • Upgrade and refurbish NESS to ensure its state of readiness for Emergency Response • Compile a stockpile of pharmaceuticals, vaccines and antivirals to respond to epi/pandemic events • Communication and collaboration with provinces/territories on NESS Program • Undertake strategic review of NESS

18. NESS Strategic Review • Multi-phase process to ensure NESS can meet requirement of strategic direction • Mandate of Strategic Review: • Develop comprehensive risk and threat analysis • Develop a gap analysis to evaluate the current NESS response capability and capacity • Review the NESS program to evaluate capacity and capability to support natural disasters, including major disease outbreaks like SARS and PI • Assess the contents of NESS specifically for CBRNE capacity • Evaluate NESS transportation and deployment capabilities in conjunction with the NETS review

19. BC NESS –Management • BC Ministry of Health directly responsible for managing BC NESS Resources under MOA with PHAC. • One staff position in Ministry of Health providing 40-50% NESS support • NESS resources pre-positioned in over 100 communities • Intended to be used as a last resort • Manage resources on behalf of Public Health Agency of Canada including: • Maintaining inventories • Ensuring appropriate storage and security • Providing emergency planning advice • Inspecting supplies • Facilitating resource acquisition & disposal • Support training requests • Regional Health Authorities, BCAS and local/regional government support many aspects of managing NESS

20. BC Challenges • Are NESS resources strategically positioned and sufficient to meet all manner of threats? • Do we have the right resources in the right places? • Do current unit configurations meet existing threats? • Local and regional HRV’s used in planning for NESS resources. • How and who decides adequate resource capability? • Are resources incorporated into local, regional and provincial emergency plans? • Who leads planning? • How do we move resources? • Where to deploy? • Who deploys? • How do we support and sustain operation?

21. BC Challenges • Activation of NESS resources • What is the role, if any, for local EOC, PREOC, PECC in planning and response? • How do we challenge stakeholders to consider NESS resources as an integral part of their integrated disaster preparedness strategy? • There is an assumption that these resources are old and have no value • How do we do a better job in communicating that these resources can be very valuable to a communities disaster preparedness? • There is a need to build capacity through training • Who should be trained? • How do you access training?

22. BC Challenges - Emergency Planning • Emergency planning: • Plans to support with medical consumables, provision for food, water and sanitation services • How will you support the operation of the unit? • What is your human resource and staffing plan? • Pre-positioning and storage location strategies • Who is the population you are serving? • What are the risks and consequences of disaster? • Plans should be effectively integrated with all stakeholders • Municipal Emergency Coordinator, Provincial Emergency Program, Emergency Social Services, Public Works, Ministry of Health Services, BC Ambulance Service and others provincial, private and local agencies as required

30. Conclusion • Ultimately, these resources are pre-positioned for the benefit of community and regional health authority citizens • They are made available to assist with meeting surge capacity requirements or providing temporary support where existing facilities are damaged and/or inaccessible • The NESS resource is ideally suited to be deployed and operated in non-traditional settings • Not deployed often but past experience has demonstrated the value of the resource