Medical Counter Measure
Distribution & Dispensing
CBERS 2015
Objectives
• Medical Countermeasures
• Strategic National Stockpile (SNS)
Program Overview
• Receive Store and Stage (RSS) Sites
• Points of Dispensing (PODs)
• CHEMPACK Program Overview
What are MCMs?
Medical Countermeasures (MCMs) are:
– Drugs
– Vaccines
– Diagnostic tests
Designed to counter the following threats:
– Chemical
– Biological
– Radiological
– Nuclear
– Emerging infectious diseases
MCM Preparedness Issues
• MCMs for certain serious disease threats (CBRN and emerging infectious diseases) are generally not readily available – Local hospitals and pharmacies are not likely to stock
these items in sufficient quantity
– Some require special training to administer
– Many MCMs require special Emergency Use Authorization (EUA), Investigational New Drug (IND) protocols, or Emergency Declarations
• Because of these factors the Federal Government has establish stockpiles of MCMs.
• States are still required to plan for the receipt and distribution of these medications.
Strategic National Stockpile Assets
• 12-Hour Push Package
– 50 tons of pharmaceuticals
and medical supplies
– 130 cargo containers
– 12 locations nationwide
– 3% of entire SNS
• Managed Inventory
– Large quantities of specific
items, such as antibiotics,
vaccines, and ventilators
– Vendor Managed Inventory
– Stockpile Managed
Inventory
– 97% of entire SNS
SNS Formulary Contents
Capacity for Treatment (Plague, Tularemia, Anthrax)
• One 12-hour Push Package can provide:
Prophylaxis for: 357,000 people X 7 days.
Therapeutic treatment for:
6,000 people X 7 days. • The Push Package is designed to
be followed by Managed Inventory (MI)
• Number of days of medication is scenario driven
Local EOC
VA EOC
Local & Regional Resources
Exceeded
State Resources
Exceeded
CDC SNS Push Pack
Managed Inventory
Local
PODs
VA RSS
The Process:
Incident Command
Hospitals Health
Dept Hospitals Hospitals
A POD is a high thru-put clinic for providing
emergency:
Usually, people have to be seen by a physician in order to
receive a prescription, then fill at a pharmacy. PODs are
used when there is no time for that.
What is a Point of Dispensing (POD)?
• Declaration of Public Health Emergency
– Bioterrorism
– Pandemic Influenza
– Other Disease of Public Health Threat (DoPHT)
• Time is of the essence. Must protect people quickly to prevent illness
and death
• PODs provide prophylaxis, NOT treatment
• An “Open POD” is a POD that provides prophylaxis to members of the
general public, usually on a walk-in (or drive-thru) basis
• A “Closed POD” is a POD that is operated by an organization to protect
their employees (and employees’ family members), and is not open to
the general public
• VDH is responsible for protecting all Virginians
– Closed POD agreements complete this mission faster
When do we use PODs?
Medical vs. Non-medical PODs
• In a non-medical POD the treatment (pills) is given to the patient to be taken at a later time.
– This means that we use a “head of household” method, in which one person picks up enough medication for their entire household.
– This also means that anyone can distribute medications.
• In a medical POD, the treatment (typically injections), is done on-site by medical personnel.
– This means that each individual must report to a POD in-person for treatment.
– This also means that only medical personnel (MD’s and RN’s), can administer medication.
• In either case, a medical director provides
medical oversight.
Closed POD Agreements in
Virginia • VDH State Level Closed-POD Agreements:
– Virginia Department of Corrections
– Dominion Resources
– Richmond Federal Reserve
• VDH Local Health Department Agreements
– First Responder Agencies
– Hospitals/Healthcare
– Long Term Care Facilities
– Military Bases
– Large Employers
Open POD agreements
• VDH is currently working on agreements with
certain organizations to serve as Open PODs
– CVS, Rite Aid, Martins, and Walgreens Pharmacies in
Henrico County (local agreement)
– State level negotiations in progress with major
pharmaceutical chains
• Kroger/Harris Teeter, Rite Aid, Walgreens
– Agreement in place with Central Virginia Health
Services, INC
– Pilot Study with Costco in Prince William Health
District currently underway
Use of Private Pharmacies as
Open PODs: Pros and Cons • Advantages:
– Many locations in the community
– Trained personnel onsite that can dispense medications and provide vaccines
– General public already familiar with local pharmacies
• Disadvantages: – Lack of adequate parking and poor traffic flow
– Lack of staffing to handle 24/7 operations
– Internal floor layout not conducive to handling large amounts of people
– Security and traffic control resources are highly strained
• Alternate Plan: Use of Pharmacies for follow up dispensing – Days 11-60 of the 60 day regimen of Anthrax prophylaxis
POD Flow Chart
Greeting/ Initial Screening/
Forms Distribution
Forms Completion
Medical Evaluation
Form Screening
Drug Dispensing/
Vaccination/ Testing
Patient
Evacuation Exit
Forms Collection/
Recovery
Staffing Considerations
• Positions required
– Site (POD) Manager
– Operations Lead
– Logistics Lead
– Security Lead
– Greeter
– Line Floater/Monitor
– Dispenser(s)
– Reviewer(s)
– Educator
Supplies and Equipment • Medications/Vaccines provided by VDH (and/or Strategic National Stockpile)
• Examples of Admin Supplies (not an exhaustive list):
– Tables and chairs
– Forms
– Clipboards
– Pens
– Signs
– Tape
– Trashcans
– ID Badges/Uniforms
• Examples of Clinical Supplies:
– Needles
– Syringes
– Gauze
– Alcohol preps
– Hand Sanitizer
– Sharps Containers, biohazard bags
– Band-aids
– Gloves
Item Need OH Unit
Clipboard 10 Each
Pens, black (12/box) 7 Box
Pens, red (12/box) 1 Box
POD Signage 1 Set
Tape (Clear) 3 Roll
Tape (Duct) 3 Roll
Quick Dispensing Forms 100 Each
Bins (for collecting forms) 4 Each
Incident Command System (ICS) Vests 20 Each
Labels 10 Pages
Example List:
Sample POD layout in an Open
Space
Sample POD Layout in local
Pharmacy
Checkout Counter
Pharmacy Counter
Exit
Entrance
Forms Turn-In/ Quality Review
Intake/Forms Pick-Up
Form Review
Intake/Forms Pick-Up (Drive Thru)
Dispensing
Dispensing (Drive Thru) Exit (Drive Thru)
Entrance (Drive Thru)
Form Review (Drive Thru)
Key: Patient movement
Table
Store Aisles
Training
• Alert/Contact Drills
• POD Set-up Drills
• Dispensing thru-put drills
• Full-scale exercises
• Just In Time Training (JITT)
Issues/Considerations • Security: What is your building’s security plan?
• Facility Residents/Inmates: POD layout as described may not be appropriate for vaccinating or dispensing medication to residents/inmates.
• Employees and Family Members of Employees/Staff:
– Dispensing medications: Use Head of Household Policy
– Vaccinations: Need to plan for vaccinating family members of employees (entry/security protocols, total thru-put
• POD Locations:
– Gymnasiums, large conference rooms, auditoriums
– Separate entrance and exits allow for unidirectional flow
• Storage of supplies and materials
• Medical Oversight
• Receipt of Medications/Vaccines
• Cold Storage for vaccines
Resources Available
• Local Health Department Emergency
Coordinator
• VDH Closed POD workbook and other plan
templates
Implement a nationwide project for the
“forward” placement of nerve agent
antidotes. To provide state and local
governments a sustainable resource that
increases their capability to respond
quickly to a nerve agent event.
CHEMPACK Program Mission
• Nerve agent exposure requires rapid treatment
• Some states/localities don’t have nerve agent
antidote
• Hospitals have limited supplies of nerve agent
antidote
• Nerve agent antidotes have variable shelf lives
Background
• GA (Tabun)
• GB (Sarin)
• GD (Soman)
• GF
• VX
• Organophosphates
Agents
•Atropine
•Pralidoxime
•Diazepam
Auto Injectors Multi-dose Vials
Mark-I Nerve Agent Antidote Kit
(NAAK)
Pharmaceuticals
•Atropine
•Pralidoxime
•Diazepam
Two types:
• Emergency Medical Service (EMS) Container:
Mostly auto-injectors
Some multi-dose vials
• Hospital Container:
Mostly multi-dose vials
Some auto-injectors
CHEMPACK Containers
Authorization to open the
CHEMPACK
• The following individuals may order the opening of a
CHEMPACK and the removal of its contents:
– On-scene incident commander
– County/City Emergency Management Coordinator
– Hospital Emergency Department Director
– Local Health District Director
– Local CHEMPACK Coordinator (usually the local Health District
Emergency Planner)
• Inform local CHEMPACK Coordinators as soon as
possible if the CHEMPACK is opened
– This notification requirement should not delay emergency
response actions!
Questions?