Strategic National Stockpile (SNS)

1. Strategic National Stockpile(SNS) 2011 Training & Updates SNS Training MUST take place ANNUALLY.

2. Overall PlanningElements SNS Plans

3. Overall Planning ElementsSNS Plans MUST…. • Be NIMS compliant • All Employees must complete IS100, IS200, IS700 within 90 days of employment • Be reviewed and updated ANNUALLY by Administration • Include a Multi-Disciplinary Planning Team • This team includes Public Health, Law Enforcement, Health Care, Schools, Public Service Agencies, Tribal Partners & many others. • Identify the roles and responsibilities of local response partners, ensure that these partners acknowledge their role and responsibilities, and are included in regular training and exercises.

4. Include State and local policies and procedures to support local mass prophylaxis operations and/or medical supplies management • Policies & Procedures can be found in the SNS Plan and/or the All Hazards Plan • Outline legal issues to support mass prophylaxis operations and/or medical supplies management and distribution • Legal Issues are outlined in the SNS Plan

5. Strategic National Stockpile (SNS)Overview • An outbreak is identified • MDCH/CDC determines need for mass medication distribution • SNS Plan activated • The EOC is activated

6. Strategic National Stockpile (SNS) Overview • Estimate made of doses needed for County • SNS arrives at MDCH • MDCH repackages SNS supplies to deliver to Local Health Department Distribution Nodes

7. What might the Strategic National Stockpile include? • Pharmaceuticals • Burn Surge supplies • Airway supplies • Vaccines • Medical supplies • Medical equipment

8. Management of SNS • The Local SNS Coordinator (Jenni Zordan) and back-up (Sue Bailey) must be, trained, and the plan must provide their contact information. • SNS functions are integrated within the local Incident Command System (ICS) structure and are NIMS compliant • VBCDHD has a plan to annually test and exercise notification and activation of volunteers below the local level positions identified.

9. At the local level and dependent upon the placement of the activities in the local Incident Command System organizational structure, the following functions have personnel (primary and back-up) identified with documented contact information. • Tactical Communications/ITS Support • Hospital/Alternate Care Facility Leader/Manager • Public Information & Communication • Inventory Management Coordination • Security Coordination • Distribution Leader/Manager • Dispensing Site Supervisor/Leader • Staffing/Volunteer Coordination • Safety Coordination • Call-down lists for the personnel identified in the positions above are maintained, current, and updated quarterly. • Local jurisdiction conducts and documents call-down exercises of all personnel identified to test response rates quarterly.

10. SNS Requesting Procedures

11. Local-State SNS Requesting Procedures • The following slides show the requesting process for local health departments to the State of Michigan • Initial Request Flow Chart • Ongoing Request Flow Chart

12. Received from MISNS 08/2010

13. Local-State SNS Requesting Procedures • What is the trigger point for reporting to local decision makers that the levels of SNS assets are low for consideration to reorder assets from the State? • Trigger Points for VBCDHD will be determined on a case-by-case basis. During H1N1, we requested based on the demand we had for the product. • Describe how inventory levels are determined, monitored and communicated • Inventory is overseen by the Director of Nursing and delegated to other staff • The process is outlined in the CD manual for nursing staff • Currently inventory is managed by paper and online using the MCIR system • Who has the authority to place an order for SNS assets from the local level to the State? • SNS Orders will be determined and signed off by the Medical Director and the Health Officer • Only persons delegated by the Medical Director or the Health Officer will have authority to place orders for SNS assets. • How is the order placed? • The process for placing orders can be found in the SNS Plan • Paper requests forms as well as SharePoint are approved methods

14. Public Information and Communication

15. Purpose of Communication Plan • Overall purpose is to provide guidance and resources for communications during an event. • Outlines who is in charge of communications and methods that are to be taken for approval of messages. • Covers how joint communications will be handled in a community wide event (Joint Information Centers – JIC) • Ensure message consistency

16. PIO and Liaisons • Public Information officer (PIO) • Serves as the main point person for communications going out during an event. • PIO serves as contact point for the media. • Public Information Liaisons • Work to gather information from other venues, such as EOC’s (Emergency Operations Center), distribution nodes, dispensing sites and JIC’s to allow for the current and accurate information to be given to the PIO. • May also be tasked with handling the media at local POD (Points of Dispensing) sites.

17. Messages/Other Materials • Pre-developed messages (scripts) and fact sheets on a variety of topics are available in the PIC plan. • Pre-event messages to prepare the public • Messages to inform the public of the event • Messages to help the public get to the PODs and know what to bring • Messages to help the public navigate through the PODs • Messages for after people leave the PODs • These should be updated regularly • May include • Dispensing site locations, hours of operation, and directions • Check on your neighbor and carpool to POD sites • “Head of Household” information • Agent information sheets • Instructions to ensure medication compliance • Vaccine information sheets • Inform public of alternate forms of dispensing

18. Special Population Communication • Identify special populations ahead of time (non-English speaking, hearing/visually impaired, home bound, etc) • How will these populations be reached? • Through the use of closed POD partners such as: United Way, Homeless Shelters, Meals on Wheels, Long Term Care Facilities, etc. • Closed captioning to large businesses and employers • Have pre-identified interpreters/interpreting services • American Sign Language • Foreign Language Interpreting services at VBISD • 2-1-1

19. Dissemination Methods • Have pre-established ways to contact stakeholders for a variety of events • These could include hospitals, schools, pharmacies, closed POD partners, and etc. • Redundant Communication Capabilities • E-mail, phone numbers, blast fax, etc • Ensure this information is updated often • Non-traditional dissemination methods identified • At-risk populations and special populations • Methods for disseminating information in a power outage • Work with local media to help disseminate messages during any event.

20. Tactical Communication Prior to and during an emergency, staff notification & communication are priority. The following slides highlight various aspects of the health department tactical communication system.

21. Tactical Communication Lead Staff • Staff Lead includes George Kilts/Cary Hindley • 4.1 - Review Communications/IT staff call-down list/numbers • Call down lists are reviewed and updated quarterly • It is important to keep your personal afterhours information up to date in the event we need to get a hold of you. • 4.2 - Review Comm./IT staff JAG’s and describe the just in time training process • Please review Job Action Guides

22. Communication Pathways • 4.3 – Communication pathways are established and maintained between with land lines, cell phones, 800 mHz radios, internet, etc. with the following agencies • Incident Command • Local and State EOC • LHD Staff • Point of Dispensing Sites • Distribution Node • OPHP • Hospitals • Security • Transportation

23. Redundant Communication Systems • 4.4 – Redundant communication systems that are tested quarterly and may be utilized during an event. The following is a list of communications methods used to ensure we have communications that do not fail during an event. • 800 MHz Radio • MI-HAN • Health Dept. Website • Landline, Cell, and Analog (during power failure) Phone • Fax • E-TEAM • City Watch (Reverse 911) • TV and Radio (know your Emergency Alert System station) • Social Networking (Twitter and Facebook) • Amateur Radio • 211

24. SNS TAR TOOL “Security” Security is an essential component for carrying out a successful SNS emergency response. Individuals involved in these security functions must be trained to protect the following: SNS assets Locations used to support an SNS response (DN, PODs) Staff, volunteers, and citizens at SNS operations, and The SNS transportation infrastructure once assets transfer custody from State to local (escort vehicles).

25. SNS TAR TOOL“Security” Who Should Be Trained? Staff assigned to the following SNS functional roles should attend local security training events: Security Coordinator DN Manager POD Supervisor Inventory Manager Volunteer Coordinator Safety Manager Transportation Manager Logistics Chief Local Law Enforcement Volunteers who may be assigned to assist security, if needed

26. SNS TAR TOOL“Security” Security Procedures to Consider for Training Are: • Transportation of SNS assets • Badging and Credentialing • Communication Procedures • DN/POD Site Security Plans: • Interior physical security • Exterior physical security • Command and management • Evacuation concerns • Security breach protocol IMPORTANT: Local law enforcement must review site specific security plans for DN’s/POD’s and have opportunity to ask questions.

27. Distribution Node

28. What is a Distribution Node? • The primary site for delivery of SNS assets in a jurisdiction • The location of the local Distribution Node

29. Distribution Node Activation • The Health Department Incident Commander (IC) will notify the County Emergency Manager of activation • The IC must notify the DN facility contact person to request access to the facility, if other than an LHD site • Distribution Node staff will be activated

30. Staff Training • All DN staff will meet to receive “Just-in-Time” training (prior to receipt of SNS assets) • A Job Action Guideline will be provided for each role, detailing immediate, ongoing, and long-term job duties

31. Dispensing Node Roles Examples of Roles: • Distribution Node Manager • Warehouse Manager • Inventory Manager • Picker Staff • Quality Control Staff • Receiving Staff • Shipping Staff • Security Staff • Safety Staff • Communications

32. Distribution Node Site Preparation • Staffing • Office equipment • Communication equipment • Signage • Forklifts, pallet jacks, dolly carts • Computers, printer, copier • Forms

33. What Happens at the Distribution Node? • SNS material must be inventoried, packaged, and delivered to the dispensing sites within our jurisdiction • Re-supply requests from dispensing sites/PODS and/or alternate sites are also handled at the DN

34. Material Handling • Material handling equipment will be supplied by Emergency Management • Anyone required to use material handling equipment will receive training prior to use

35. Inventory Management • Upon receipt of assets, Pick List (invoice) is compared with the items actually received • An inventory database (paper or electronic) must be created for the DN and at each dispensing site • All requests, shipments, and deliveries must be recorded and filed for record keeping purposes

36. Chain of Custody • The signatures of individuals both relinquishing and receiving the SNS assets, who they represent and the date and time, establish a chain of custody. • Chain of custody form • A DEA registrant may be necessary for the receipt of controlled substances.

37. Inventory Management forms • Inventory SNS Ordering Forms and Inventory Pick List establish inventory • MDCH:OPHP Transfer Form for the SNS is signed when assets are transferred to the Health Department • DEA Form -222 is issued by the DEA and is used for the transfer of controlled substances • POD Order Form • Local Health Department Chain of Custody Form

38. Pick List

39. Transfer Form -Chain of Custody

40. Deactivation • At the conclusion of the event, all unused unopened medication and durable goods will be returned to the DN from each dispensing site • Returned goods must be inventoried, and the State RSS must be contacted to arrange for the pick-up of returnable items • Any items that are not considered durable goods (plug-in, run on batteries, etc) will remain the custody of the local jurisdiction for proper storage or disposal.

41. Summary • The Distribution Node is a central warehouse for SNS at the local level. • The Inventory Management System organizes, distributes and tracks the SNS assets at the local level. • SNS medication/supplies will be sent to Dispensing Sites/PODS within the community.

42. Dispensing Prophylaxis

43. This module will cover..... • Purpose of a mass dispensing campaign • Types of rapid dispensing techniques • Staff notification procedures and reporting • Phases for dispensing medications • Special considerations in mass dispensing planning • Models for increasing throughput at PODs

44. Purpose of Mass Dispensing • Dispense medical countermeasures (MCM) in the most efficient and timely manner. • Utilize rapid dispensing techniques • Dispense medications to all County residents within 48 hours • Provide MCM for prophylaxis of asymptomatic individuals • Triage symptomatic individuals and direct them to treatment centers • Dispensing can be limited in scope as well as a community-wide event

45. Phases for Dispensing Medications These phases are subject to change based on the situation and LHD Plans. Phase 1: The Health Dept. staff and their household members will receive the first round of prophylaxis. Phase 2: The Health Dept. staff will open a designated dispensing site and dispense to First Responders and essential personnel Phase 3: Pre-identified ancillary facilities will provide prophylaxis to their employees, residents, occupants and household members (i.e., qualifying schools, big businesses, industrial facilities, long-term care facilities, jail, etc.) Phase 4: Designated dispensing site(s) will open to dispense medications to remaining residents

46. Procedure Prior to Opening a Dispensing Site • Health Department staff will be contacted to report to staging area for further instructions**Contact information should always be up-to-date** • Provide staff briefing & conduct just-in-time training • Event information, safety information, job duties, Incident Command System, etc. • Discuss dispensing phases and modalities • Priority groups, dispensing instructions, facility identification, Emergency Use Authorizations, medication information, & etc.

47. Special Considerations Addressed in Mass Dispensing Planning • Number of regimens of medication that can be dispensed to an individual • Handling symptomatic individuals • Handling unaccompanied minors • Handling of non-English speakers/hearing impaired/visually impaired/functionally illiterate (Special populations planning) • Procedures for crowd control, traffic management, security, media

48. Alternate Methods for Dispensing • Closed PODs • Drive Through PODs • Mobile PODs • Pre-Deployment to businesses

49. Sample Open POD Model

50. Sample Drive Through Model