1. THE NATIONAL PHARMACEUTICAL STOCKPILE (NPS) PROGRAM 2001 Centers for Disease Control and Prevention National Center for Environmental Health Division of Emergency and Environmental Health Services

2. Role of the NPS Program Contents of the NPS Capacity of the NPS Transportation Operations/ Logistics Accessing the NPS Obtaining Technical Assistance Program Review

3. Role of the National Pharmaceutical Stockpile (NPS) Program to maintain a national repository of life-saving pharmaceuticals and medical materiel that will be delivered to the site of a chemical or biological terrorism event in order to reduce morbidity and mortality in civilian populations.

4. Whats in the NPS?

5. Pharmaceuticals Antibiotics doxycycline ciprofloxacin gentamicin erythromycin Chemical agent antidotes atropine pralidoxime (2PAM) diazepam

6. Pharmaceuticals Other Medications dopamine epinephrine methylprednisolone albuterol inhaler morphine lorazepam

7. Medical / Surgical Supplies IV Administration Supplies Sterile Water For Injection NaCl flush Syringes/needles/catheters Y site administration sets IV solutions Gloves Tape/ dressings/ gauze/ tourniquets Alcohol pads, betadine swabs, antibiotic ointment

8. Medical/Surgical Supplies Airway Management Supplies ET tubes/ stylettes NG tubes Oropharyngeal airways Laryngoscopes Oxygen masks/ tubing Manual resuscitators (bag-valve-mask) Ventilators and suction units Pediatric and adult sizes where applicable

9. Medical/Surgical Supplies Other Tablet counting machines Power strips Extension cords Duct tape Zip lock baggies

10. Other Pertinent Information Patient information sheets, provider information sheets, data collection sheets

11. How is the NPS Packaged?

12. NPS Components 12-Hour Push Packages: –Ready for deployment to reach designated airfield within 12 hours of Federal activation –Pre-positioned in environmentally controlled and secured facilities –Pre-configured for rapid identification and ease of distribution Vendor Managed Inventory (VMI) Packages: –Will be shipped to arrive within 24 and 36-hour periods –Are comprised of pharmaceuticals and supplies that are delivered from one or more VMI sources –Tailored" to provide specific materiel depending upon suspected or confirmed agent A Two-Tiered Response

13. How Many People Can a 12-hour Push Package Care for?

14. 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 VMI Number of days of medication is scenario driven Note- Therapeutic Tx: treatment of symptomatic persons Prophylaxis: preventive treatment of asymptomatic persons

15. What Does a 12-hour Push Package Look Like?

16. What will a 12-hour Push Package look like when its delivered? Each NPS 12-hour Push Package: Occupies 124 cargo containers Weighs 94,424 pounds Measures 10,329 cubic feet Requires 5,000 square feet ground/floor space for proper staging and management

17. How Do We Get the NPS?

18. Readiness/Response How NPS Assets are Deployed State Requests Federal Assistance 2. Need for Drugs and Medical Supplies Exceeds Local & State Resources 1. In Consultation with the Surgeon General, Secretary HHS, HHS Office of Emergency Preparedness (OEP), FEMA and the FBI Augments Local/State Medical Materiel Resources National Pharmaceutical Stockpile (NPS) 4. Director of CDC Deploys NPS Assets 3.

19. Delivery to Public Reception Initial breakdown Repackaging Resource mgt/ allocation Distribution to Points of Dispensing (POD) Dispensing Identify PODs Set-up PODs Staffing Equipment Security StateLocal Request for Push Package One States View * * Adapted from the State of Colorado

20. Will Someone from the CDC be at the Airfield to Help with the National Pharmaceutical Stockpile?

21. NPS Technical Advisors Advisors include pharmacists, public health experts, and emergency response specialists Hand-off materiel to authorized state representative (in accordance with state plan) Assist in distribution of materiel to the state/local point(s) of dispensing (PODs) Coordinate closely with incident command structure (State and Federal EOCs) Maintain continuous contact with the CDC NPS Program Operations Center Available for a range of technical assistance Readiness/Response

22. Are there any Guidelines for Planning for the NPS?

23. In Draft form: State Planning Guidance for Receiving, Organizing, Repackaging and Distributing the National Pharmaceutical Stockpile Premise: Approved Deployment of the National Pharmaceutical Stockpile –Deployment Algorithm Distributing vs. Dispensing

24. How to Reach Us (non-emergency) Points of Contact: 770-488-7516 Ken Archer Steve Reissman Steve Skowronski Secure List Serv Training Opportunity with NPS (IPA) Next Steps

25. Additional Information

26. State / Local Issue: Distribution of Materiel from Airport Personnel/Equipment to –Unload Cargo Containers –Load trucks Vehicles (public, private, military) Personnel to drive vehicles Methods/Distribution/Bulk Product Breakdown points Security of materiel and personnel Identifying key personnel contacts

27. State/Local Issue: Storage and Handling of Materiel Climate control Security Ease of identification Location of Materiel –Proximity to patient treatment site[s] (selected hospitals) –Proximity to mass prophylaxis dissemination site[s] (not hospitals) –Proximity to airport Controlled Substances

28. State/Local Issue: Treatment Protocols SOPs for treatment of adults, children, immunosuppressed and geriatric populations Patient Information Sheet/Care Instructions Transfer of symptomatic patients from treatment site to definitive care site Mass prophylaxis and/or immunization of at-risk asymptomatic populations Patient tracking/follow-up