1. Cindy Shelton Donna Ruth Kelly parker
Virginia Department of Health
Office Of Emergency Preparedness
Cindy Shelton Donna Ruth Kelly parker

2. The Strategic National Stockpile
Presented by
Cindy Shelton, Assistant Director
Office of Emergency Preparedness
2017 VEMS

3. Purpose
Provide an understanding of the operational characteristics and capabilities of the Strategic National Stockpile (SNS) during a public health event/incident

4. Strategic National Stockpile
A large stockpile of medical countermeasures to protect the American public if there is a public health emergency severe enough to cause local supplies to run out.
Been around since 1999 – called National Pharmaceutical Stockpile – renamed in 2003
CDC’s Strategic National Stockpile is the nation’s largest supply of potentially life-saving pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local supplies to run out. The stockpile ensures the right medicines and supplies are available when and where needed to save lives.

5. SNS Supplied Medical Countermeasures
Biologic/Pharmaceutical
Category A threat agents
Antibiotics (oral and IV)
Nerve agency antidotes
Vaccines
Antivirals
Radiation Countermeasures
Non Pharmaceutical (Medical) Supplies
IV Administration
PPE
Airway Management
Medical Countermeasures defined as products and interventions used to combat the effects of natural disasters, infectious disease outbreaks like pandemic influenza, CBRN events (like anthrax release)

6. CHEMPACK Pre-positioned locally Federal (CDC) asset
Contains nerve agent antidotes and related materials to respond to a nerve agent release
Other SNS assets include Chempack and Federal Medical Stations
CHEMPACK:
Can be rapidly deployed – working on state deployment plan
FEDERAL MEDICAL STATIONS
A non-emergency (not acute) medical center which can be set up during a natural disaster to care for displaced persons with special health needs. These stations can increase local healthcare capabilities in mass casualty events or in response to public health threats. HOWEVER, approval and pre-planning of location and resources must occur before they can be requested.

7. CDC The Process: SNS Assets VA EOC (VDEM) VDH VA RSS Local EOC Local
State Resources Exceeded
VA EOC
(VDEM)
VDH
VA RSS
Discussions with Governor/ Secretary
Local & Regional Resources Exceeded
Local EOC
If there is a potential adverse event/exposure identified, event notification is sent to VDH from health district.
Once agent is known, LEOC/VEOC may be activated to coordinate the response – if local/state resources exhausted, VDH and VDEM will discuss/ advise the governor/secretary. VDH will contact CDC to request SNS assets which will be sent to the RSS. Orders taken and sent to PODs.
Health
Dept
Local
PODs

8. What is RSS? Receive Store Stage Assets are sent to a RSS facility
Receiving – Distribution center is made ready, state assumes custody, unloads product, IMATS activated to receive orders
Storing – Containers moved to enable orders being “picked” and materials placed on pallets/prepared for delivery
Staging – Materials to be delivered are “staged” near bay for delivery

9. RSS Facilities 3 RSS Facilities in Virginia Primary: Sandston
Secondary:
Chesterfield
Fairfax
And now to Donna!

11. Dispensing/Vaccination Sites
Donna Ruth Emergency Health Coordinator VDH - Portsmouth Health District Emergency Preparedness PrograM
This training module can be used to give all site staff a better understanding of how a dispensing or vaccination site operates. We have tried to incorporate experiences from several health districts in preparing this training module. You may wish to personalize this to your own district.

12. Objectives
Define “POD” and identify the purpose and function of a POD.
Describe the difference between a Closed and Open POD
Define a Quick Delivery Center

13. What happens at a POD or QDC?
Mass medication dispensing or vaccination to prevent or treat illness.
Provide alternate/additional source of education to the community.

14. Point Of Dispensing Open POD
Available to general public, regardless of city of residence
Must process many people quickly
Maximizes the use of the facility
Minimizes the use of staff
Capable of being “medical” or “non-medical”
Staffed by LHD and others
Point Of Dispensing Open POD

15. Point Of Dispensing Closed POD
Restricted/limited access
Receives direct shipment of countermeasures from RSS
Signed MOU strongly preferred
Must meet VDH/LHD guidelines
Accountable for countermeasure reporting
Staffed by the supporting entity
Generally only “non-medical” mode

16. Types of Closed PODs Military Bases or Installations Hospitals
Nursing Homes and other LTCF
Jails/Prisons
City Services – Critical infrastructure
Police, Fire, EMS
Large Businesses
Hotels

17. Quick Delivery Centers
Used primarily for initial anthrax dispensing
Considered “non-medical”
May be used in combination with other
dispensing modalities
Speed is of the essence
Minimal staffing to support high volume
May convert to open POD after initial
dispensing

18. Why open a QDC first?

19. Anthrax Exposure: Proportion of Population Saved
7 Days
1 Day
2 Days
3 Days
4 Days
5 Days
6 Days
Immed.
10 Days
84%
78%
71%
62%
54%
45%
36%
28%
95%
91%
85%
69%
59%
49%
39%
97%
94%
89%
83%
75%
65%
43%
98%
96%
92%
87%
80%
60%
99%
76%
66%
100%
81%
72%
86%
77%
82%
DELAY in Initiation
DURATION
of Campaign
This model was developed by Dr. Nathaniel Hupert of Weil Medical College at Cornell. It shows how delays in either detection (initiation of a campaign) or the amount of time it takes to provide antibiotics to a population will translate in lives lost in persons exposed to anthrax.
For example, if the entire population of your city was exposed to anthrax released in the air, if it took 2 days to identify the exposure and 5 days to get antibiotics to the entire population, 8% of those exposed would die. [Note to presenter: use the actual population figures for the city to calculate the potential number of deaths.]

20. Historical Example
Public health has a well-know history of operating mass dispensing and vaccination sites. These are photos from the smallpox vaccination clinics operated in New York City in 1947.
Smallpox vaccinations New York City, (AP Photo/Tony Camerano

21. Materials Supplies are being stockpiled locally.
MMRS – Metropolitan Medical Response System
Local Health Districts
Strategic National Stockpile (SNS)
12 Hour Push Pack
Managed Inventory (MI)

23. emPOWER Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) Kelly Parker Director, Emergency Preparedness Virginia Hospital & healthcare Association
As you all know vulnerable populations or those with access and functional needs continues to be one of the greatest areas of concern during a response of a disaster. Across the country, localities, states, healthcare facilities, emergency management agencies, just to name a few, have attempted many different ways to address vulnerable populations, most widely known are self registries. But as you all are also probably aware, very few people want to register themselves as “vulnerable.” ASPR, the Assistant secretary for preparedness and response through the department of health and human service which houses the Hospital Preparedness Program has been working with CMS for years to develop what they now have as the emPOWER map.
Do you know who lives in your community and what their needs are?
Can we better understand, assess, and mitigate disaster-included healthcare system stress and its impact on access, utilization, and health outcomes for at-risk populations
Can we help a community better understand how many at-risk populations rely upon electricity dependent medical and assistive devices, healthcare services, and their local healthcare system, on a daily, weekly, monthly basis?

24. How can federal health data inform and support preparedness, response, and recovery?
The data they were thinking about is from CMS, the Center for Medicare and Medicaid services and particularly Medicare data – over 55,000,000
What subset of this population is at the greatest risk during a disaster?
Dialysis
Home health
DME

26. emPOWER Initiative
Three initiatives developed between ASPR and the Center for Medicaid and Medicare Services (CMS).
HHS emPOWER Map
HHS emPOWER Initiative’s Emergency Planning Datasets
HHS emPOWER Initiative’s Outreach Response Individual Datasets
ASPR worked with CMS to identify the 2.4 million Medicare beneficiaries who rely on electricity to power medical and assistive devices and to these people can be a life or death matter during a power outage. With the advances in technology concentrators to electric wheelchairs, these individuals are able to live at home independently. However prolonged power outages could force these residents to seek immediate help to a local hospital or shelter because the battery of their life-sustaining equipment is low.
The emPOWER initiative encompasses 3 national capabilities which ASPR developed with CMS to enhance situational awareness and support emergency preparedness, response, and recovery for those whose life depends on this electricity dependent medical equipment.
MAP – integrates de-idetified medicare claims data with real time NOAA weather tracking and a GIS interactive map
EMERGENCY PLANNING DATA SET – currently we can request a monthly de-identified dataset that includes aggravated Medicare beneficiary claims totals for states, counties, zip code down to the different types of durable medical equipment. Ventilators, oxygen concentrators, enteral feeding machines, intravenous pumps, suction pumps, at-home dialysis machines, electric wheelchairs and scooters, and electric beds. As well as beneficiaries who rely on specific healthcare services including dialysis, oxygen tank services, and home health visits.
OUTREACH RESPONSE INDIVIDUAL DATASETS – public health authorities that meet certain privacy protection requirements can submit official requests to CMS via ASPR for the secure disclosure of limited individual data sets. This information will include the addresses of the individuals identified in the data set above.

27. emPOWER Map
Integrates de-identified Medicare data with real-time NOAA weather tracking and GIS interactive mapping to highlight the number of people who use electrically dependent medical equipment in a geographic area.
The HHS emPOWER Map shows the monthly total number of Medicare fee-for-service beneficiaries’ claims for electricity-dependent equipment at the national, state, territory, county, and zip code levels. The tool incorporates these data with real-time severe weather tracking services from the National Oceanic and Atmospheric Administration in a Geographic Information System (GIS).
Open to the public

28. The integrated data accessible through the HHS emPOWER Map can help community organizations, including hospitals, first responders, and electric utility officials, work with health officials to prevent health impacts of prolonged power outages due to storms and other disasters on vulnerable residents.
For example, the HHS emPOWER Map could be used by electric utility companies to determine priority areas for restoring electrical service based on the location of the largest concentrations of electricity-dependent individuals. This could assist hospitals, health care coalitions and Emergency Medical Services in planning better for surges in medical services.
Emergency planners could also use the tool to anticipate whether emergency shelters might experience greater electricity demand due to higher concentrations of electricity-dependent Medicare beneficiaries nearby. Local officials could estimate more accurate assistance needs for transportation and evacuation when local mass transit systems are affected by prolonged power outages after disasters.

29. emPOWER Emergency Planning Datasets
This data set provides more granular de-identified data
Medicare totals by type of DME and healthcare services
Sample Use Cases
Inform power restoration prioritization decision making at all levels
Identify optimal locations, support, and power needs for multiple devices in shelters
Assessing potential transportations needs for evacuating or transport to healthcare providers (e.g. dialysis)
Public Health Authority ESF8-6
Restricted

30. emPOWER Initiative’s Outreach Response Individual Datasets
Purpose is to conduct outreach prior to, during, or after an incident, public health emergency, or disaster that may adversely impact at-risk populations
Public Health authorities that meet HIPAA requirements can submit a request to HHS via their ASPR Regional Administrator/Emergency Coordinator
Declaration
Winter Storm Jonas

31. Virginia Healthcare Alerting and Status System (VHASS) initiative
Integrating emPOWER data into VHASS GIS map

32. Questions? Contacts: Cynthia T. Shelton, MEP
Assistant Director/State SNS Coordinator
Office of Emergency Preparedness
Virginia Department of Health
109 Governor Street, Rm. 1328, Richmond, VA
phone:
Donna M. Ruth
Emergency Coordinator
Portsmouth Health District
1701 High Street, Suite 102
Portsmouth, VA   23704
Office , ext. 8518
Kelly Parker
Director, Emergency Preparedness
Virginia Hospital & Healthcare Association
Office:
Cell: