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Strategic National Stockpile (SNS)


2013 Training & Updates SNS Training MUST take place ANNUALLY. ... – PowerPoint PPT presentation

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Title: Strategic National Stockpile (SNS)

Strategic National Stockpile(SNS)
  • 2013 Training Updates
  • SNS Training MUST take place ANNUALLY.

Overall PlanningElements
  • SNS Plans

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
  • 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.

  • 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
  • Legal Issues are outlined in the SNS Plan

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

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

What might the Strategic National Stockpile
  • Pharmaceuticals
  • Burn Surge supplies
  • Airway supplies
  • Vaccines
  • Medical supplies
  • Medical equipment

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.

  • 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
  • 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.

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

Received from MISNS 08/2010
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
  • 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

Public Information and Communication
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
  • Covers how joint communications will be handled
    in a community wide event (Joint Information
    Centers JIC)
  • Ensure message consistency

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 EOCs (Emergency Operations Center),
    distribution nodes, dispensing sites and JICs 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.

Messages/Other Materials
  • Pre-developed messages (scripts) and fact sheets
    on a variety of topics are available in the PIC
  • 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
  • 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

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
  • Have pre-identified interpreters/interpreting
  • American Sign Language
  • Foreign Language Interpreting services at VBISD
  • 2-1-1

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
  • Work with local media to help disseminate
    messages during any event.

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

Tactical Communication Lead Staff
  • Staff Lead includes George Kilts/Cary Hindley
  • 4.1 - Review Communications/IT staff call-down
  • Call down lists are reviewed and updated
  • 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 JAGs and describe
    the just in time training process
  • Please review Job Action Guides

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

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)
  • Fax
  • E-TEAM
  • City Watch (Reverse 911)
  • TV and Radio (know your Emergency Alert System
  • Social Networking (Twitter and Facebook)
  • Amateur Radio
  • 211

  • 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,
  • Staff, volunteers, and citizens at SNS
    operations, and
  • The SNS transportation infrastructure once assets
    transfer custody from State to local (escort

  • Who Should Be Trained?
  • Staff assigned to the following SNS functional
    roles should attend local security training
  • 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

  • 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 DNs/PODs and have opportunity to ask

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

Distribution Node Activation
  • The Health Department Incident Commander (IC)
    will notify the County Emergency Manager of
  • 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

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

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

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

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

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

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

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
  • Chain of custody form
  • A DEA registrant may be necessary for the receipt
    of controlled substances.

Inventory Management forms
  • Inventory SNS Ordering Forms and Inventory Pick
    List establish inventory
  • MDCHOPHP Transfer Form for the SNS is signed
    when assets are transferred to the Health
  • 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

Pick List

MICHIGAN RSS Inventory Pick List
Delivery Site Order Number Shipment ID
Item Description Doxycycline 100mg oral tablet 20 tab unit of use
Container Number Item Number Cases
27 R03386 66336-449-20 340
Item Description Ciprofloxacin 500mg oral tablet 20 tab unit of use
Container Number Item Number Cases
30 R01030 66336-031-20 60
Date Time Page 1 of 1
Transfer Form -Chain of Custody
  • 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.

  • 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.

Dispensing Prophylaxis
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
  • Models for increasing throughput at PODs

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
  • Triage symptomatic individuals and direct them to
    treatment centers
  • Dispensing can be limited in scope as well as a
    community-wide event

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
  • 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,
  • Phase 4 Designated dispensing site(s) will open
    to dispense medications to remaining residents

Procedure Prior to Opening a Dispensing Site
  • Health Department staff will be contacted to
    report to staging area for further
    instructionsContact information should always
    be up-to-date
  • Provide staff briefing conduct just-in-time
  • 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.

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

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

Sample Open POD Model
Sample Drive Through Model
Tiered Approach for Dispensing to Increase
Throughput at POD
Local Public Health Distribution Node Staff
Training Template
Purpose/Function of the Distribution Node (DN)
  • The DN serves as a functioning warehouse for
    receiving and shipping SNS materiel at the local
    level amidst a public health emergency. From the
    DN, the assets will further be delivery to local
    Points of Dispensing (PODs) sites in order to
    provide these life-saving assets to the public.

Section 1 (continued)
  • The DN distributes Strategic National Stockpile
    (SNS) medical countermeaures (MCM) to local POD
  • The State of Michigan delivers SNS assets
    directly to treatment centers throughout the
  • Providing Security at the DN, POD sites, as well
    as for the transportation of SNS materiel, is the
    responsibility of local law enforcement.
  • The location of the DN should be somewhat
    centrally located geographically within the
    jurisdiction and among the identified local POD
  • The DN is one component of the overall local
    emergency response

Section II Command and Control
  • The planning, coordination, and management of the
    DN is the responsibility of local Public Health.
  • The health department is responsible for staffing
    and operating the DN when activated.
  • The DN is located within the Operations Section
    of the Incident Command System.
  • The DN Manager/Leader reports to the Operations
    Section Chief at the health department
  • DN Staff report to their perspective branch
    director or chief, who then reports to the DN

Sample ICS Chart DN is in Logistics Section
Sample DN Staffing Org Chart
Section III Activation of the DN
  • Local Unified Incident Command makes the decision
    to activate the DN
  • The health department is notified of decision to
    activate the DN
  • The site, staff, and various suppliers are
    notified of the DN activation

Section III (continued)
  • The DN site is readied to accept SNS materiel
  • Materiel handling and office equipment obtained -
    forklift, dolly, copier
  • Communications are setup - radios, fax, phone,
  • Organization/layout of site loading, storage,
    staging and office areas
  • Cleanliness of site - breakroom, restrooms, etc.
  • Inventory system set up electronic or hard copy
  • Materiel ordering system set up ordering,
    picklist, manifest forms
  • Security (exterior and interior) set up
  • DN staff is briefed/updated on situation, role
    and procedures (Just in time training)
  • DN Manager notifies Unified Incident Command when
    the DN is ready to accept delivery of SNS
    materiel from the State

Section IV Receiving SNS Materiel
  • Accepting SNS Delivery at the DN
  • Who is authorized to sign for the delivery
    position/title, Drug Enforcement Agency (DEA)
    Registrant, authorized backup, etc.
  • State Transfer form - Chain of Custody form,
    shipping manifest, etc.
  • Inventory of Delivery
  • Check manifest, compare to what was
    ordered/expected and report discrepancies
  • Enter received materiel into the inventory system
  • Storage of Materiel
  • Move materiel to proper location
  • Utilize appropriate rotation system (FIFO first
    in, first out)

Section V Processing Requests from Local PODs
  • Filling a SNS Order from a POD
  • Assume an initial supply is sent to all activated
    PODs (apportionment decision by Unified Command),
    this section applies to subsequent orders
  • LHD Order filling details here
  • DN receives SNS order from a POD
  • Use pick list to fill the order
  • Move picked materiel to staging area
  • in DN and perform quality control
  • Fill out proper shipping forms
  • Verify POD order
  • Inform Dispatch of order readiness

Section V Distribution of SNS from DN to PODs
  • Verify Route(s) for POD deliveries, provide maps,
    communication equipment, and etc. to drivers
  • Obtain/arrange security escort for delivery
  • Ensure primary method for communications with
    driver is functioning properly
  • DN dispatch informs POD of delivery departure
    time and estimated time of arrival (ETA)
  • Upon delivery to POD, informs DN, performs chain
    of custody, and provides a return ETA to the DN

Section VI Re-Supply of the DN
  • Inventory Control position monitors DN supply
  • At pre-determined inventory trigger levels,
    Inventory Control position notifies DN Manager of
    need for additional supplies
  • DN Manager initiates DN Re-supply process
  • SNS order form faxed to local Emergency Operation
    Center (EOC)
  • EOC faxes SNS order form to Community Health
    Emergency Coordination Center (CHECC)
  • Confirmation of order is received by local EOC,
    ETA of SNS delivery provided to DN Manager
  • SNS materiel is delivered to DN. Same acceptance
    process as initial delivery

(No Transcript)
Sample LHD Process for Ordering SNS Materiel
CHECC Receives SNS Order fills order based upon
State inventory and event Characteristics
Local EOC receives DN SNS request, relays to CHECC
Public Health Distribution Node requests SNS
re-supply from local EOC
Local DN Re-supplied
POD orders exhaust Distribution Node Inventory
Section VII Deactivation/DemobilizationConsidera
  • Local Unified Command will initiate the
    demobilization process.
  • DN Manager monitors activity at DN and receives
    situation reports (sitreps) from the PODs.
  • Conduct a walk-through and complete a facility
    checklist to record conditions of the facility
    after clean-up is complete
  • Provide maintenance to facility and equipment as
  • Releases DN staff as incident characteristics

Section VII (continued)
  • Materiel at PODs returned to DN upon completion
    of activities
  • Security escort of returning materiel required
  • Process of materiel pickup is similar to
    deliveries, but reversed. Paperwork required
    chain of custody, intra-county transfer form,
  • SNS Materiel at DN is re-packaged, readied for
    transport as per State/Federal instructions.
  • Some SNS materiel may need to be destroyed and/or
    disposed of.
  • Prepare CDC durable goods for pick-up by the
    State and return to CDC (i.e. anything that plugs
    in, runs on batteries, etc).

Section VIII Key Components of DN for Review
  • Command and Control
  • The role of the DN within the ICS structure
  • Communications network between State, PODs, and
  • Responsibilities of agencies/entities involved in
    DN operations
  • Activation/DN Setup
  • Notification and activation of site and staff
  • Setup of site
  • Equipment acquisition
  • Inventory control/shipping systems functioning
  • Paperwork trails
  • POD ordering system
  • DN Re-supply
  • Pick lists
  • Shipment manifests
  • Chain of custody forms.
  • Security -
  • Interior and exterior security
  • Escort vehicles for deliveries

Next Steps
  • Review the
  • Job Action Guides for SNS
  • Sign the Acknowledgement Form available in each
  • If you have questions please contact Jenni Zordan
    at ext.382 or