Annex 1, Appendix 5

STRATEGIC NATIONAL STOCKPILE COUNTERMEASURE DISTRIBUTION &

DISPENSING

STANDARD OPERATING PROCEDURES (SOP)

SNS SOP Rev Jan 2013 ANNEX 1-Appendix5-1-1

Under 42 USC 300hh-12(c), no federal agency shall disclose under section 552, United

States Code, any information identifying the location at which SNS Program materials

are stored. To the extent permitted by law, the parties agree that neither will disclose

the nature of this effort and the terms of this agreement to any person or entity, except

as may be necessary to fulfill its mission and statutory and regulatory responsibilities.

PRIMARY: Department of Health and Environmental Control (DHEC)

SUPPORT: Office of the Governor, Office of The Adjutant General, SC National Guard

and Emergency Management Division; State Law Enforcement Division;

State Department of Public Safety; Department of Transportation; Office of

the Attorney General; State Budget and Control Board; State Department of

Education; State Commission on Higher Education; Department of Labor,

Licensing and Regulation, Division of Professional and Occupational

Licensing and Division of Fire and Life Safety; Department of Defense;

American Red Cross; SC Baptist Association; SC Hospital Association; SC

Medical Association; SC Nursing Association; SC Pharmacy Association

I. INTRODUCTION

A. The Strategic National Stockpile (SNS) of the Centers for Disease Control and

Prevention (CDC) is a federally owned and managed national repository of

antibiotics, antiviral medication, chemical antidotes, antitoxins, life support

pharmaceuticals and equipment, vaccines, intravenous administration supplies,

airway maintenance supplies, masks, medical/surgical items, pandemic

countermeasures and other medical related supplies established by Congress to

supplement and re-supply state and local supplies of these critical need medical

items in the event of an incident anywhere in the United States involving weapons

of mass destruction,(chemical, biological, radiological or explosive) or a major

natural or technological disaster. This plan provides for the request, receipt,

staging, storage, repackaging, distribution, dispensing, and retrieval and return of

any unused assets of this stockpile, pandemic countermeasures or other medical

countermeasures depending upon the event.

B. Purpose: This SOP implements S.C. Strategic National Stockpile Emergency

Operations Plan Standard Operating Procedure which is incorporated into Annex

1, Appendix 5 “Mass Casualty Plan” of the South Carolina Emergency

Operations Plans (EOP). This SOP provides operational guidance to those who

are assigned to work in ESF-8 at the State Emergency Operations Center, the

DHEC Emergency Operations Center, DHEC Health Region Emergency

Operations Center and in all phases of SNS or other countermeasure distribution

and dispensing operations.

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C. Authorities and References:

1. SC Emergency Operations Plan (SCEOP)

2. SC Emergency Operations Center (SEOC) Plan

3. SC DHEC Emergency Operations Plan

4. SCDHEC, Office of Public Health Preparedness, Emergency Notification

Plan

5. SC Mass Casualty Response Plan, Appendix 5 of the SCEOP

6. Title V, Emergency Preparedness and Response, section 502 of the

“Homeland Security Act of 2002”.

7. SC Emergency Health Powers Act amendment to SC Homeland

Security Act of 2002, rule R. 61-112 Implementation of the Emergency

Health Powers Act

8. Receiving, Distributing, and Dispensing the Strategic National Stockpile, A

Guide for Planners, Version 10.02, August 2006.

9. PB1 (2012-2013) Public Health Emergency Preparedness Cooperative

Agreement

D. Organization: The DHEC Director of Emergency Management, Office of Public

Health Preparedness, assisted by the DHEC Emergency Management

Coordinator and other support staff will serve as the lead of ESF-8 response and

recovery efforts, which includes all state and region Strategic National Stockpile,

or other countermeasure distribution and dispensing activities, and upon

activation will be located at the State Emergency Operations Center (SEOC),

1100 Hatchery Road, West Columbia, SC 29172. All SNS response staff that has

leadership roles is NIMS compliant in accordance with DHEC policy A.1101, the

Homeland Security Presidential Directive (HSPD)-5 and the State of South

Carolina Office of the Governor Executive Order Number 2011-06 signed 27

January 2011. These ESF-8 representatives will coordinate Strategic National

Stockpile efforts through each DHEC Regional Health Director and/or the

Regional Director of Public Health Preparedness or their designee.

In support of ESF-8, the Office of Public Health Preparedness will coordinate

among DHEC deputyships, program areas, named support agencies and

participating private sector resources to support SNS preparedness plans and

response in accordance with this SOP and in conjunction with the South Carolina

Emergency Management Division and the South Carolina Emergency Operations

plan. At the determination of the DHEC Director, the DHEC Emergency

Operations Center (DHEC EOC) may be activated to help coordinate other

department responsibilities associated with a SNS countermeasure deployment to

South Carolina.

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The SEOC ESF-8 representative will coordinate and monitor SNS response and

recovery efforts through the DHEC EOC. This information will be monitored and

executed through WEBEOC at the South Carolina Emergency Operations Center.

These SNS activities will be monitored by the DHEC EOC and further managed

using the DHEC copy of WEBEOC. SNS response information will be provided

to ESF-5 (Information & Planning) by ESF-8 as needed for the standard SEOC

Situation Reports. All public information related to the event will be released in

coordination with the joint information center (JIC) located at the SEOC.

E. Plan Hierarchy: The SNS Emergency Operations Plan is written to be

functional as incorporated as Annex 1, into Appendix 5 “South Carolina Mass

Casualty Emergency Operations Plan” of the South Carolina Emergency

Operations Plan. DHEC Health Regions and the Columbia Metropolitan

Statistical Areas (MSA) Cities Readiness Initiative (CRI) are also required to

have an SNS plans to function as extensions of the State SNS plan and in

coordination with the Regional Mass Casualty plans. Operations in this plan are

to be coordinated by ESF-8 and the ESF-8 SOP.

II. MISSION

The mission of the Strategic National Stockpile is to rapidly and safely provide

antibiotics, antiviral medication, chemical antidotes, antitoxins, life support

pharmaceuticals, vaccines, intravenous administration supplies, airway maintenance

supplies, masks, pandemic countermeasures and medical/surgical items in a rapid and

safe manner to supplement and re-supply any community in South Carolina in the

event that state and local capacities are exceeded or are about to be exceeded due to a

weapon of mass destruction or a major natural or technological disaster. This plan’s

mission is one of response in support of the ESF-8 mission of “health and medical”

and as such serves as the plan for all medical material acquisition and distribution.

III. SITUATION AND ASSUMPTION

A. Situation:

1. A mass casualty event has occurred or is imminent in South Carolina

involving a weapon of mass destruction or a major natural or

technological disaster has occurred.

2. The capacity of South Carolina’s local and state assets to meet the

demand for pharmaceuticals, vaccines, medical supplies, or other

related countermeasures or medical equipment is inadequate or has

been exceeded.

B. Assumptions:

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1. The State Emergency Operations Plan will be activated.

2. The State Emergency Operations Center will be activated at Operating

Condition 1 (OPCON 1) or the appropriate Operating Condition as well as

responding county EOC’s.

3. The South Carolina Emergency Management Division will activate the

Statewide Mutual Aid Agreement and the Emergency Management

Assistance Compact.

4. All infrastructures including communications are intact.

5. The appropriate state and federal declarations have been made by the

Governor of South Carolina, the President of the Unites States and the

Secretary of the Department of Human Services.

6. The arrival of the Strategic National Stockpile 12-Hour Push Package

from the federal stockpile to the state receiving, staging and storage site

(RSS) warehouse will occur within 12 hours and the managed inventory

palletized material will occur within 24 hours once the CDC decision to

deploy has been made per DSNS guidance. Delivery to the Health

Regions will not occur until 12 hours after the first receipt of federal

medical materials.

7. South Carolina has a centralized public health system under the South

Carolina Department of Health and Environmental Control (DHEC). All

county health departments are staffed and managed by DHEC and respond

to emergencies as one agency. Planning and daily management are done

utilizing the 8 DHEC Health Regions as the administrative unit. Each of

these Regions geographically contains four to ten counties and has in

round numbers between 250,000 to 1,000,000 residents.

IV. CONCEPT OF OPERATIONS

A. South Carolina Department of Health and Environmental Control, lead agency

for ESF-8, is responsible for developing, coordinating and maintaining

procedures to support the SNS plan as contained in Appendix 5 “South

Carolina Mass Casualty Emergency Operations Plan” of the SC Emergency

Operations Plan in conjunction with SC Emergency Management Division.

DHEC is responsible for the coordination of all SNS administrative,

management, planning, training, preparedness/mitigation, response, and

recovery activities to include developing, coordinating, and maintaining the

SNS SOP. All ESF-8 supporting agencies will assist DHEC in the planning

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and execution of the above as specified in the SCEOP by Gubernatorial

Executive order 2011-06 signed January 27, 2011.

B. Coordination with all supporting and other appropriate departments/agencies

and organizations will be performed to ensure operational readiness in time of

emergency.

C. DHEC shall provide an Emergency Management Coordinator or Alternate,

designated by the Director, to represent ESF-8 and the SNS at the SEOC,

who, on the behalf of, or in the Director's absence from the SEOC, shall act to

meet the health and medical responsibilities as described in the SCEOP. This

person will be the point of contact and SNS lead for ESF-8 and SNS

Operations at the SEOC. Additional public health personnel to coordinate the

state level response will be housed at the DHEC Emergency Operations

Center located on the second floor of the Sims/Aycock building, 2600 Bull

Street, Columbia, SC 29201.

D. In coordination with the Office of Public Health Preparedness and the SNS

Pharmacist, the DHEC Public Health Regions assess the situation (both pre-

and post-event), and in coordination with local county emergency

management officials and response agencies, develop strategies to respond to

the emergency.

E. Requesting the SNS:

The decision to deploy the SNS will be a collaborative effort between local,

state, and federal officials. After the recognition of a potential or actual

WMD event or a major natural or technological disaster that may or will

exceed local medical capacity, the Region Health Director will contact the

Office of Public Health Preparedness Director of Emergency Management.

The initial recognition of this event may occur at the state level by DHEC and

as such the notifications will be made at that point. A strategic policy group

comprised of the Governor, the SC EMD Director, and the DHEC Director

will be convened to determine if the SNS should be requested. If the Federal

assets are required, the DHEC Director on behalf of the governor will request

the deployment of the SNS in SC in one of two manners.

1) In federally declared disasters it will be necessary to prepare the Action

Request Form (FEMA form 90-136) and process this form through the SC

Emergency Management Division request process for federal assistance

through DHS/FEMA. Upon submission of the request form and approval,

DHS/FEMA will direct HHS to provide the appropriate assistance.

2) In the absence of a federally declared disaster the DHEC Director will

initiate the process in one of 4 ways.

Contact the HHS regional emergency coordinator (REC).

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Reach out to the SNS program services consultant (PSC).

Call the CDC emergency operations center (EOC) at 770-488-7100

Call the HHS secretary’s operations center (SOC) at 202-619-7800

Once a request is received, federal agencies will collaborate with the state

officials to evaluate the nature and magnitude of the public health threat and

to understand how the use of federal medical supplies will address the public

health threat. If a catastrophic incident occurs, credible threats exist or an

attack is imminent, the federal government may direct deployment of SNS

material before a public health emergency declaration; a federal Stafford Act

disaster declaration or receipt of requests for DSNS assets.

The US Marshall’s service no longer routinely deploys with the SSAG. South

Carolina may receive the 12-Hour push package or may receive palletized

material (4 X 4 X 4 pallet) from managed inventory or a combination of the

two. How the SNS material is deployed and signed for will be coordinated as

part of the request for assistance between the state and DSNS. The SNS

Services Advance Group (SSAG) who will determine the type of technical

assistance required in response to the State’s request. “Technical assistance

requirements, including specific objectives and timeframes, will be

coordinated as part of the request for assistance from the project area”. This

request will be made by calling the CDC Director’s Emergency Operations

Center (DEOC) 770-488-7100.

.

F. In response to the event, the Secretary of HHS has properly issued a public

health emergency declaration, justifying the emergency use of certain medical

counter measures to diagnose, treat, provide prophylaxis or prevent the

identified threat. The FDA Commissioner has properly issued an emergency

use authorization for the medical countermeasures shipped to South Carolina,

and DHEC has received and made sufficient copies of the fact sheets required

by the FDA to be distributed or dispensed with the medical countermeasure.

The DHEC Director will request that the Governor declare a “state of

emergency” and a “public health emergency” allowing for the implementation

of the South Carolina Emergency Health Powers Act and its associated

regulations.

G. Prior to the arrival of the Federal assets or in the event that Federal assets are

not yet available, the SNS pharmacist or designee will transfer the State of

South Carolina owned drugs from the pharmaceutical cache located at the

PHP Pharmacy, 8229 Parklane Road, Columbia, SC 29223 to the

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predetermined RSS site for distribution per this plan. If the magnitude of the

event does not warrant utilization of the predetermined RSS site, distribution

operations will be run out of the PHP pharmacy which has been surveyed by

the DSNS program consultant and the US Marshall’s service.

H. Receipt: Once the deployment of SNS assets have been ordered the State

Emergency Operations Center will be activated at OPCON 1 or the

appropriate Operating Condition and the Governor will declare a state of

emergency and a “public health emergency” allowing for the implementation

of the South Carolina Emergency Health Powers Act and its associated

regulations. The responding county EOC’s will also be activated at the

appropriate Operating Condition. A draft South Carolina Emergency Health

Powers declaration has been written by the DHEC Office of General Counsel

and is available in the event it is needed.

DHEC will request the following resources to support this plan through the

State Emergency Operations Center (SEOC): warehouse, warehouse

management and inventory tracking, on-site security, transportation and

security during transport, communication, law enforcement and traffic control.

These resources will be provided by the support agencies as specified in the

SCEOP.

The DHEC Director has predetermined an SNS Receiving, Staging and

Storage (RSS) site for the receipt of all DSNS materials which include

pandemic influenza and other countermeasures. This primary RSS location

has been validated by the DSNS program services consultant and the US

Marshall’s service. The SC SNS Pharmacist or designee will notify the

Receiving, Staging, and Storage site of the deployment of the SNS assets by

the DSNS. Previously when the SNS “12- Hour Push-Package” or “Managed

Inventory” arrived at the SNS RSS site the CDC liaison for the SNS will

immediately transfer custody of the SNS assets to the State of South Carolina

using the “CDC Strategic National Stockpile Program Medical Material

Transfer Form” and the DEA Form 222. As of 10/6/2009 “How SNS materiel

is deployed and signed for will be based on numerous factors and will be

coordinated as part of the request for assistance between the project area and

DSNS”. The SC SNS Pharmacist or designee is designated by the DHEC

Director to officially accept the custody of the SNS assets from the CDC for

the State of South Carolina at the SNS RSS site. In addition to the SNS

Pharmacist the following pharmacists may sign for the SNS, the Director of

Pharmacy DHEC Health Services, the Director of the DHEC Bureau of Drug

Control, the back-up SNS Director or the Assistant Director DHEC Bureau of

Drug Control. The Region Distribution sites will be notified of the arrival of

the SNS assets at the RSS site. South Carolina may accept all or part of the

“12-Hour Push-Package”.

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In the absence of an emergency declaration by the Governor of South Carolina

operations will be managed at the Public Health Preparedness Pharmacy

Warehouse. This facility is licensed by the S.C. Board of Pharmacy and S.C

Drug Control and the federal Drug Enforcement Agency (DEA).

Vaccines shipped to the RSS site or PHP Pharmacy will be stored in the

Division of Immunization walk-in refrigerator (8 feet X 12 feet) at the DHEC

Hayne Building SC Board of Pharmacy, non-dispensing drug outlet permit #

10385, 8231 Parklane Road if the quantity shipped exceeds the capacity of the

PHP Pharmacy refrigerator. All vaccine storage and handling will follow the

DHEC Division of Immunization Vaccine Storage and Handling policy rev.

02/09/12.Once the determination has been made as to where the vaccines need

to be delivered, the vaccines will be transferred to the DHEC Health Region

locations with vaccine refrigerators by ESF-2 or by the DHEC Bureau of

Business Management depending upon the size of the event.

I. Staging: Once custody of the SNS assets have been signed for by the Director

of the Strategic National Stockpile and transferred to the State of South

Carolina at the RSS site or PHP pharmacy, these assets will be off loaded and

staged. The SNS shipping containers will be arranged in a color-coded

schematic by product type and container number:

Red: Oral Antibiotics

Yellow: Intravenous Drugs and Supplies

Blue: Airway Management

Green: Chemical Antidotes and Supplies

White: Medical/Surgical Supplies

Pink: Pediatric Drugs and Supplies

Refrigerated items and control substances will be shipped in specialized

containers to maintain proper storage and legal requirements. Non-

containerized materials will be arranged in an area separate but adjacent to the

containerized materials. Like items will be grouped together.

J. Distribution: While the SNS assets are being staged at the RSS site, the DHEC

Region Director or designee in conjunction with local emergency

management officials will request the supplies that are needed to replenish

exhausted local inventories thru the DHEC Region’s incident command

structure in conjunction with the affected counties’ incident command

structure. The intravenous medicines, IV administration supplies, fluids, life

support medicines, airway equipment, antidotes and symptomatic treatment

material for casualties; and medical or surgical items for treating casualties

from a WMD or a major national natural event will be transported from the

RSS site to the Region Distribution site for transfer to the designated hospitals

or directly to the designated hospitals as specified in the DHEC Health Region

SNS plan. Transportation assets to perform this will be requested through

ESF-2 at the South Carolina Emergency Operations Center (SEOC).

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All Control Drugs will be transferred to the designated treatment center’s

Drug Enforcement Agency (DEA) registrant employing DEA form 222 where

applicable. All Control substances will be packaged separately from other

legend drugs and will be transferred utilizing the “Control Substances in 12-

Hour Push Pack” form revised 9/2011. All Control substances not transferred

to designated treatment center’s DEA registrant will be transferred to the PHP

pharmacy which is a SC Drug Control/DEA as well as SC Board of Pharmacy

permitted location.

Post exposure prophylaxis packages, initial 10 day supply, will be delivered to

the Region Distribution sites. The numbers of regimens needed has been

determined based upon the total population of the Health Region. Additional

supplies of post exposure prophylaxis will be shipped upon request to the

affected Region. Follow on 50 day prophylaxis and/or Anthrax Vaccine

Adsorbed as required by an anthrax exposure will be delivered to the Health

Region once received from the DSNS. The 50 day follow on supplies for the

completion of prophylaxis and/or vaccine will be dispensed/administered by

the Regions to those individuals who were truly exposed as determined by

epidemiological investigation.

The Region Distribution site will distribute these initial regimens to the

identified first responder site, any facility with a confined population with

pharmaceutical services for treatment of residents, staff and staff’s family, the

closed large employer points of dispensing and to the mass public points of

dispensing for distribution to the general public. Hospitals will request any

needed SNS medical material other than initial prophylaxis supplies from the

State RSS site through the ESF-8 liaison at their county Emergency

Operations Center or through the Region unified medical command. These

requests will be forwarded to the RSS site by the ESF-8 leads at the State

Emergency Operations Center.

The Region Distribution sites will meet the same specifications as the RSS

site. A memorandum of agreement currently is in place with the Department

of Labor, Licensing and Regulation, Board of Pharmacy to insure temporary

licensing of drug distribution and dispensing locations. These distribution

sites are located in each DHEC Health Region and can serve as an alternate

RSS site in a more localized event. The DHEC Health Region plan will

provide for necessary support to off load the shipment, manage and track the

inventory, and on-site security at the Region Distribution site. Transport and

transport security, and traffic control of the medical supplies from the Region

Distribution site to the predetermined receiving hospital or to the

predetermined dispensing site will be specified in the Region SNS/CRI plan.

The Region SNS/CRI plan will specify an individual from the predetermined

treatment center/hospital to be available to accept custody of the SNS control

drugs from the DHEC Drug Control Pharmacists. Unless stated otherwise the

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control substances will be delivered to the main pharmacy within the hospital

and received by the Director of Pharmacy or his designee. The DHEC Region

Director (or designee) will be the lead official at the Region Distribution site

and will specify an individual to accept custody of the shipment of the SNS

assets from the RSS site and will assure that the Region Distribution Site is

made ready to receive countermeasures from the RSS site. The SNS

Operations lead or designee will notify the Region Distribution Site of the

deployment of the SNS from the RSS site to the Region Distribution site. The

Region SNS and CRI plans will arrange for transportation and security of post

exposure prophylaxis packages to the local points of dispensing for dispensing

to the entire Region population within the prescribed time frame.

K. Continuation of Supplies: While the initial CDC “12-Hour Push Package”

and/or other pharmaceuticals are being distributed from the RSS site to the

Region Distribution Site, the DHEC Region Director in conjunction with

local/county emergency management officials will continually assess the need

for additional supplies of specific items. If additional medical materiel is

needed, the SC SNS Pharmacist or designee at the RSS site will request these

items from the CDC by calling the CDC 24 Hour Hotline, 770-488-7100 or

the CDC Switchboard, 404-639-3311.

If the event is a declared national disaster and the National Response

Framework has been activated the Department of Homeland Security would

establish a Joint Operations Center (JOC) with an Emergency Support

Function # 8 (ESF-8) for health and medical services. ESF-8 at the SEOC

would request federal support through the tasking desk at the SEOC to ESF-8

at the JOC. A FEMA Action Request Form (ARF) for the additional assets

may be required. The same process will be followed as in the initial request

phase of the response.

The Managed Inventory pharmaceuticals may arrive in bulk or repackaged

regimens and will be shipped directly to the RSS site from their points of

origin. Additional pharmaceuticals and/or medical supplies not available

through the Strategic National Stockpile Managed Inventory program may be

procured through the State of South Carolina emergency procurement

procedures. These procedures may utilize national resources such as RX

Response. In an event when the causative factors have been identified and the

DHEC Region Health Director in conjunction with local/county emergency

management officials and the CDC Director can determine the specific

supplies that are needed, the first shipment received may be from the

Managed Inventory and not from the multi-hazard “12-Hour Push Package.”

The Region Distribution Sites will report continually to the RSS site the

number and type of prophylactic regimens dispensed, the number and types of

SNS assets transferred to the treatment centers and the projected number of

additional assets that will be needed. Requests for additional assets for the

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RDS site from the RSS site will be received at a minimum of daily in

conjunction with the reports. The frequency of these reports will be

determined by the specific incident. The points of dispensing will request

additional post exposure prophylaxis antibiotics from the Region Distribution

Site. The process for this request procedure will be specified in the Region

SNS plan and will mirror the RDS to RSS request process.

Inventory Control at the RSS site and the Region Distribution site will follow

the procedures below.

The DHEC Bureau of Finance will be the lead for inventory control at the

RSS site. The Region/ CRI plan will identify the inventory lead at the Region

Distribution site. The initial packing slips will be given to the inventory

clerks for entry into the manual inventory system. All items received and

distributed will be listed one product per page on DHEC form 1285 SNS

Perpetual Inventory. The following information will be recorded per item:

(1) Item description found on the inventory list provided by DSNS

(2) Lot Number and expiration date

(3) NDC number found on the inventory list provided by DSNS

(4) Unit of measure found on the inventory list provided by DSNS

(5) Unit pack (number per case or box) found on the inventory list provided

by DSNS

All items will be recorded as each and distributed by box or case. There will

be a running decreasing balance (similar to a checkbook) inventory sheet for

every item contained in the shipment. Each entry into the “checkbook” will

list the following:

(1) Which container the item came from or

(2) Where the item is going to

(3) Number received or shipped

Currently the inventory tracking system for the state level response is

transitioning to the secure federal Inventory Management and Tracking

System (IMATS). This system will track all SNS assets which can be

preloaded by the DSNS. The Region Distribution site will continue to use the

paper system or an excel spreadsheet since the RDS in most instances will

handle only oral medications or vaccines.

The initial shipment of SNS materials will be apportioned and shipped to the

affected Region Distribution site, treatment facilities or point of dispensing

based on population if the threat has been identified. DHEC form 1286 or

1287 will be used to record the following information concerning the

shipment:

(1) Region or Point of Dispensing

(2) Treatment center (if applicable)

(3) Date

(4) Time

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(5) Lot Number & Expiration date

(6) NDC Number

(7) Quantity

(8) Requested by (if applicable)

(9) Filled by

(10)Time Filled

(11)Delivered by

(12) Time delivery left

All Control substances will be packaged separately from other legend drugs

and will be transferred utilizing the “Control Substances in 12-Hour Push

Pack” form revised 9/2011. This form will be completed by the individual

who signs for the control substances and will be given directly to the DHEC

Drug Control pharmacist who will make the delivery to the hospital on the

delivery slip.

All drugs control, legend, or other countermeasure will be tracked in the same

manner. The original slip will go to the perpetual inventory clerk and a copy

will be given to the fulfillment area to be filled. Once the order is filled and all

names are recorded two copies of the filled order form will then go with the

shipment as the packing slip and delivery slip. The packing slip will be inside

the order and the delivery slip will be signed and returned to the inventory

clerk at the RSS site or Region Distribution site. This slip may be returned via

the truck driver in hard copy or by fax. The original will return to the

inventory clerk to match the filled order with the requested order. The

contents of the shipment will then be subtracted from the perpetual inventory.

These processed orders will then be set aside awaiting verification of receipt

of the order from the Health Region. The fulfillment area will be manned by

4 teams of 4 people each.

The DHEC forms 1285, 1286, and 1287, 1288 can be found on the DHEC

intranet site and can be accessed as follows:

http://dhecnet --Technologies Tab –RIMS –PDF Forms

“Control Substances in 12-Hour Push Pack” form revised 9/2011 will be

provided at the time it is required by the SNS Pharmacist or designee. Once

the agency EOC is activated and WebEOC is being used to track the incidence

all forms related to the response will be posted in WebEOC.

L. Dispensing Sites: The Region Health Director or his designee in conjunction

with local/ county emergency management agencies will develop the Health

Region Strategic National Stockpile and City of Columbia Metropolitan

Statistical Area (MSA) Cities Readiness Initiative (CRI) plans which identify

adequate public/ private points of dispensing to provide initial ten day

prophylaxis for the entire population within 48 hours of the federal decision to

ship medical countermeasures into South Carolina in response to a disease

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outbreak or other emergency event. First responder dispensing sites separate

from the public points of dispensing will be identified in each Region plan. If

the emergency event is a disease outbreak and laboratory confirmation of the

infecting organism has been made additional prophylaxis up to 60 days may

be required for those exposed to the infecting agent.

The DHEC Region Health Director (or designee) will insure that symptomatic

individuals are directed to treatment facilities, guidelines are followed to

determine whether an individual needs prophylactic drugs, individuals are

counseled on the threat/risk of the drug, potential contraindications in

individuals are identified, guidelines for correct dosage based on age and

weight are provided, proper documentation is maintained identifying

individual that is receiving the drug, lot number, NDC number, expiration

date, and amount of drug received, and that the people who receive a drug

understand how the drug is to be taken and how and who report adverse

reactions to the countermeasure. In the event that the drug is being dispensed

to the public on a Food & Drug Administration Emergency Use Authorization

( EUA), the DHEC Region Health Director will ensure that all terms of the

EUA are followed prior to dispensing including providing adequate

dispensing information as provided by the manufacturer or the DSNS to all

public and private points of dispensing.

Adults may pick up as many medication regimens as needed for children and

homebound adults, with government issued identification, if they can provide

age, weight and a brief medical/ prescription drug history of the person for

whom they are picking up medication. No identification is required for adults,

anyone age 16 or over, picking up medication for themselves only.

Unaccompanied minors, anyone under 16 years of age as defined by section

63-5-340 SC Code of Laws who arrive at a Dispensing Site will be escorted to

the special needs area by the behavioral health team where every effort will be

made to contact the parent or guardian prior to dispensing any

countermeasure. If a parent or guardian cannot be located the child will be

placed with the SC Department of Social Services Child Protective Services

after the proper dosage of medication is dispensed under the authority of SC

Code of laws section 63-5-350. Provisions must be specified in the Region

SNS plan to accommodate citizens with a variety of special needs such as

language, vision and mobility barriers at the dispensing sites. The DHEC

Region Health Director (or designee) will be the lead official at the public

points of dispensing. Large employers, that meet the requirements to serve as

a point of dispensing for their employees and employee’s family will identify

the lead official at the employer’s closed dispensing site and that person will

be listed in the Region SNS or CRI plan.

Facilities with confined populations and established medication dispensing

procedures will provide to the Region distribution site the number of needed

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-14

regimens and will follow their usual and customary medication dispensing

procedures for patients/ residents, staff and staff’s family following CDC and

DHEC guidelines and recommendations. Examples of these affected

institutional populations are hospitals, nursing homes, military installations or

prisons. These medications may be either unit of dispensing containers or bulk

containers. These institutions and how they will receive their medication will

be identified and defined in the DHEC Region or CRI SNS SOP. The DHEC

Region SNS and CRI plans will also identify large employer closed points of

dispensing. These facilities may not have pharmacy permits but will follow

the scope of services as set forth in the DHEC 870(Volunteer Health Care

Provider Agreement). The DHEC Region/CRI plans will identify how traffic

control and security will be provided at the large employer closed point of

dispensing.

Each mass public/closed dispensing site will need to provide for the

following characteristics, while allowing differences to accommodate the

various facilities hosting the dispensing site and the security requirements of

local law enforcement. Adequate signage needs to be in place to ensure a

smooth patient flow.

(1) One way into the parking lot of the facility and one way out

(2) One way into the building and one way out. Be sure that those arriving do

not have access to stop and “visit” with those that are leaving.

(3) An area to screen for those that are currently symptomatic awaiting

transfer to treatment facility

(4) An area to fill out necessary paperwork and receive disease and drug

information via video or printed material.

(5) An area for medical/pharmaceutical counseling if needed.

(6) A drug and patient drug information sheet dispensing area

(7) A special needs area

(8) A holding area for patients creating a disturbance. Depending upon the

nature of the disturbance this room can be used for counseling by social

work or law enforcement.

(9) An area to stamp the hand of the person receiving the medication to

prevent them from immediately returning to the line.

(10) A secure area to store the pharmaceuticals and a delivery access point

and route away from public view.

M. A memorandum of agreement currently is in place with the Department of

Labor, Licensing and Regulation, Board of Pharmacy to insure temporary

licensing of mass public and large employer closed drug dispensing sites and

distribution sites in a Gubernatorial declared emergency. This waiver is for

the duration of the declaration or 30 days whichever is less. After 30 days a

new declaration will be required. The following procedures have been

established to ensure safe drug dispensing and adequate record keeping to

protect the public health, safety and welfare in a mass casualty event that

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SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-15

would require federal or other medical countermeasures being sent to South

Carolina. All necessary forms including the standing orders will be posted to

WEBEOC under file library once most current CDC event driven updates are

available.

1. Protocols/ standing orders to provide current guidelines for the

assessment, prophylaxis and/or treatment and follow-up of

persons who may be exposed to a biological and/or chemical

agent. These protocols can be found in the DHEC standing

orders manual that is available on the DHEC intranet site. To

access these orders go to dhecnet – program areas-health

services manuals & reports- Health services standing orders

manual – BT tab. Copies of these orders will be printed by the

Region Health director or his designee and be available for

review at the points of dispensing. Healthcare workers and

others who participate in the response effort will use these

protocols to insure uniform treatments for all citizens of South

Carolina. These protocols include the CDC treatment and post

exposure prophylaxis guidelines.

2. The Clinical Evaluation Form for Dispensing Mass Post-

Exposure Prophylaxis Therapy ( DHEC 1288) form for

patients exposed to a biologic agent will serve as the (1)

exposure screening form, (2) dispensing record, (3) refill

record, (4) medical chart and (5) acknowledgement of

receiving treatment. To access this form go to dhecnet –

program areas- technologies – RIMS – PDF forms. This form

will be filled out for every person who receives prophylaxis.

This record is to be maintained in the Health Region pharmacy

in lieu of a written prescription document for 3 years after the

last date of service. After 3 years the record is to be transferred

to archives where it will be maintained in accordance with

DHEC policy A.932. The NAPH form will serve as the

prescription form for any refills should they be necessary. A

copy may be maintained in the county Health Department

where services were rendered to insure rapid availability to the

affected individual’s private physician.

Each prepackaged 10-day regimen from the CDC comes

labeled with two perforated labels identifying drug, quantity,

expiration date, NDC number and prescription number. One

label will be attached to the NAPH form for the initial

dispensing and for any refills that may be needed. The

prescription number, quantity of drug, patient name, date and

prescribing physician, (the Deputy Director of Health

Services), will be handwritten on the dispensing label. To

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SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-16

comply with proper prescription labeling each Health Region

must include the name of the Health Region, the complete

address and the phone number on each of the dispensing labels

printed at the Region. Each prescription must be labeled as to

proper dosing instruction and each prescription will be labeled

with the following statement: “Call your doctor for medical

advice about side effects. You may report side effects to Food

& Drug Administration at 1-800-FDA-1088.”

Each patient will be counseled on the proper use of the drug

and any drug- drug and drug- medical condition interactions

using the “Patient Counseling Information for Selected

Antimicrobials Used for Prophylaxis Following Exposure to

Potential Bioterrorist Agents”. A Notification to the Patient’s

Primary Care Physician Form DHEC form 1289 will be given

to the patient to take to his/her physician.

General patient drug information is available to DHEC through

internet based drug information at

www.factsandcomparisons.com. The log-in is located on the

left side of the page. Click on “e answers log-in” and on the left

side of the page is medfacts patient information. Click on that

and scroll through until you find the drug. Each Region with a

pharmacy should have an IP address set up with access to this

site. If not login with SCDOHAEC and SCDOHAEC1. Each

drug information sheet will be labeled with the following

statement: “Call your doctor for medical advice about side

effects. You may report side effects to Food & Drug

Administration at 1-800-FDA-1088.”

Any countermeasures dispensed under an Emergency Use

Authorization will be dispensed with the patient information

prepared by the requesting authority of the EUA.

Each dispensing site will also have available information on

the causative agent if known for distribution to the general

public. This information will be prepared at the time of the

incident initially using the Centers for Disease Control and

Prevention (CDC) agent information sheets available at

www.bt.cdc.gov until the most current information can be

incorporated into the SCDHEC agent information.

Countermeasures that have not completed the Food and Drug

Administration approval process may be dispensed as an

investigational new drug (IND) or on an Emergency Use

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SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-17

Authorization (EUA). The CDC designated lead center,

institute or office will obtain approval from the FDA to use

specific IND protocols for medical countermeasures. The CDC

will provide the forms that patients must read and sign to give

informed consent at the time of the event. CDC will provide

the latest versions of the protocols, authorizations and

instructions for use to be distributed with the countermeasure.

In the event that countermeasures are required that have not

completed the FDA approval process and are not being

dispensed as an IND, DHEC will ensure that a FDA

Emergency Use Authorization has been obtained by the

manufacturer or requesting authority and all appropriate

paperwork will be distributed with the countermeasure to the

DHEC Public Health Region Distribution site for distributing

with the antiviral or other countermeasure to the healthcare

provider or public or closed point of dispensing. These

healthcare providers or public or closed points of dispensing

will be informed of the conditions under which the

countermeasures can be dispensed as are set forth by the FDA

Commissioner at the time that the Emergency Use

Authorization is granted such as:

(1) distribute FDA approved information for healthcare

providers or authorized dispenser

(2) distribute FDA approved information for recipients

(3) monitoring and reporting adverse events

(4) records maintenance

The DHEC Region 3 and City of Columbia Cities Readiness

Initiative (CRI) plans will coordinate planning with the

Charlotte/Mecklenburg county North Carolina CRI to insure

adequate coverage of York County South Carolina and the

Catawba Indian Nation whose population is included under the

Charlotte, NC metropolitan statistical area and is funded as part

of the Charlotte CRI by the Centers for Disease Control and

Prevention. The Office of Tribal government will have its

members receive prophylactic medication through this process

in a declared emergency. The ultimate responsibility for York

County South Carolina falls under the DHEC Region 3 plan.

N. Retrieval

Per the terms of the 2010 memorandum of agreement between the Centers for Disease

Control and Prevention (CDC) and the South Carolina Department of Health and

Environmental Control (DHEC), the CDC retains title to the DSNS and Federal Medical

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-18

Station durable assets. Any durable assets sent to the Region Distribution Sites (RDS)

will be returned to the Receiving Staging and Storage (RSS) site utilizing a transportation

tasking to ESF-1 at the State Emergency Operations Center (SEOC). The RSS site will

arrange for the pick-up of the durable assets from the RDS and returning it to the RSS.

Upon CDC request and at CDC expense the durable assets will be returned to the CDC or

when no longer needed for public health emergency response purposes. Also, per the

terms of the 2010 memorandum of agreement between the CDC and DHEC, at the

conclusion of a public health emergency response, CDC will assess the return of unused

medical materiel to determine if sealed, non-pharmaceutical items stored in accordance

with manufacturer recommendations can be returned to federal custody. CDC will not

otherwise accept return of any unused medical materiel. Other unused medical materiel

including pharmaceutical items will be returned to the RDS. Once all materiel is returned

to the RDS site, these materiels will be returned to the RSS, with any durable assets, for

final disposition.

O. Communication:

The communications function ensures the timely flow of information used in the decision

making process as well as in operational effectiveness. The communications function

involves 3 distinct areas.

1. Public Healthcare Communication

All official public healthcare information related to the incident will be

coordinated through and released in conjunction with the SC Emergency

Management Division and participating agencies through the Joint

Information Center (JIC) located at the State Emergency Operations Center as

described in Annex 15 (ESF-15) of the South Carolina Emergency Operations

Plan and in accordance with the DHEC Public Information Emergency

Operations Plan. DHEC is the lead agency for all ESF-8, health and medical,

response which includes primary responsibility for all messaging which

affects the public’s health.

The types of information released will include information on the event itself,

how to protect yourself and your family and any public health orders such as

quarantine, shelter in place or evacuation orders. Also included will be

messages how to get the medicine, cost of the medicine, medicine for pets,

medication safety. SNS specific messages will include but not limited to

where to pick up your medication, how to pick up your medication, why you

need to pick up the medicine for you and your family, why you need to take

the medicine, what medical information is needed to receive medication, what

is needed for identification, how to take your medication, who should take the

medication, how long to take the medication, what are the expected side

effects of the medication, who to call in the event of unexpected side effects

and what to do if your are currently symptomatic. Templates for these

messages have been written and when needed will be incident specific and

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SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-19

distributed through local public information channels such as television, radio,

newspaper and at the local dispensing sites by the healthcare professionals.

Direct contact with affected individuals will be available through the call-in

SC Public Information Phone System (PIPS), South Carolina 211 or the GIS

based call-out system REACH SC. DHEC, ESF-8, will provide the pre-

scripted messages to the community in a variety of ways to ensure that harder

to reach populations due to economic disadvantage, language or literacy,

medical issues, isolation or age will receive the necessary information. Since

South Carolina has a centralized health agency, all DHEC Health Regions and

the county health departments within those Regions will use the same public

health information provided by DHEC Division of Media Relations.

2. Logistical/ Tactical Communication

Types of information to be included but not limited to are as follows: expected

number of potential individuals needing treatment, number treated with

prophylactic medication and sent home, number transferred to hospitals or

other treatment centers, number still requiring treatment, medications and

supplies transferred to treatment center, additional SNS assets needed by

treatment centers. These numbers will be reported on a regular basis as

determined by the incident by the Region Distribution site lead to the RSS site

and to ESF-8 at the State Emergency Operations Center. The DHEC EOC will

monitor all response and recovery activities through the state and agency

copies of WebEOC. The DHEC EOC will maintain communications with

ESF-8, RSS Site, Region Distribution sites by email, fax, telephone, cell

phone, 800 MHZ radio.

Requests from the county emergency operations center for SNS distributed

medical countermeasures or other health and medical services will be either

called into the SEOC by telephone, transmitted via WebEOC or by radio. The

State Emergency Operations Center (SEOC) Operations Tasking Group

(OTG) will task any such requests for health and medical services to ESF-8.

DHEC representatives in ESF-8 will task either a support agency or the

appropriate DHEC program area. This procedure is consistent with the request

procedure found in the ESF-8 SOP.

Requests from DHEC Health Regions to the DHEC EOC will be tasked by

DHEC EOC personnel to the appropriate program areas within DHEC.

Requests for support from outside the agency for Health Region response will

be requested by the DHEC EOC thru ESF-8 or directly by the Health Region

through the OTG at the SEOC. Completion of all tasks will be reported to the

DHEC representatives in ESF-8 at the SEOC for inclusion in the periodic

situation reports. This procedure is consistent with the request procedures

found in the ESF-8 SOP.

3. Equipment

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SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-20

Cell phones, land lines, fax lines and DHEC internet services will

electronically tether all SNS function and area leads. These communication

services are operational 24 hours/day, 7 days per week and are used daily in

the performance of routine agency functions. The State Emergency Operations

Center, the DHEC Emergency Operations Center, the RSS site, the Region

Distribution Sites, the Region Dispensing Sites will be in communication by

800 MHz 2-way radio, which are linked by a wide area communications

systems that covers the entire state. These radios are currently available

within the agency through the Bureau of Information Services. Additional

communications for RSS and other SNS operations will be requested through

the State Emergency Operations Center ESF-2 (Division of State Information

Technology). Maintenance of the emergency response radios held by the

Division of State Information Technology is the responsibility of the Division

of State Information Technology as described in the ESF-2 annex of the SC

Emergency Operations plan. These include providing additional telephone

lines to the RSS, handheld radios, HAM radios, cellular phones, satellite

phones, computer terminals, internet access, teleconferences and telephone

bridge requirements. DHEC State and Region communication systems that are

not utilized in day to day operations will be tested quarterly to ensure

readiness.

SCDHEC response activities will be tracked through the SCDHEC State and

Region copies of WebEOC. Access and functionality of this system will be

tested and recorded the first month of each calendar quarter.

P. Security and Transport:

The security and transport functions will be coordinated through the State

Emergency Operations Center Operations Group and will be provided by

ESF-1, ESF-8, ESF-13 and ESF-15.

Transportation to the Region Distribution Sites will be tasked through ESF-1.

The SC Department of Transportation (SCDOT) is the primary or lead agency

for ESF-1 and coordinates with support agencies to provide transportation

assets during and post disaster. The state’s emergency responsibility includes

the allocation and prioritization of state transportation assets to include

processing all transportation requests from state agencies and local

governments. Per Annex 1 of the SC Emergency Operations Plan (SCEOP),

the SC Department of Transportation is responsible for all ESF-1

administrative, management, planning, training, preparedness, response,

mitigation and recovery activities to include developing, coordinating and

maintaining the ESF-1 SOP. All ESF-1 supporting agencies as listed in the

SCEOP will assist SCDOT in the planning an execution of the above. ESF-1

is responsible for the execution of all emergency transportation services

necessary to support emergency operations of state agencies including repair

or replacement of disabled vehicles en route. In accordance with Annex 1 of

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SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-21

the SCEOP, ESF-1 will maintain current inventories of government

transportation facilities, supplies and equipment by node and will maintain

current resource directories of all commercial and industrial transportation

assets, facilities, and supplies within the state to include points of contact,

their geographic locations, territories and operating areas. The SC Emergency

Management Division (SCEMD) is responsible for the SC Logistics Plan.

SCEMD in support of the logistics plan maintains transportation services on a

contingency contract and will activate those contracts in support of SNS

logistical activity when required.

Security will be provided for all personnel, material, and equipment involved

in the management and distribution of the SNS countermeasures in

accordance with the South Carolina Law Enforcement Division (SLED) SNS

security plan. The SC Law Enforcement Division is the primary or lead

agency for ESF-13, law enforcement, and provides for the coordination of law

enforcement personnel and equipment in an emergency or disaster for all law

enforcement tasks except for traffic management which is the responsibility of

ESF-16. SLED coordinates with support agencies including the SC

Department of Public Safety (DPS) (ESF-16) to ensure operational readiness

during and post disaster. In accordance with SC Code of Laws Section 23-3-

15 (A) (8), SLED has specific and exclusive jurisdiction and authority for

coordinating the state response in the event of a terrorist threat or actual

incident. Since South Carolina is a ‘home rule” state, the sheriff or chief of

police is responsible for law enforcement activities within his/her jurisdiction.

Per Annex 13 of the SCEOP, when state law enforcement personnel and

equipment are committed, a member of SLED will be assigned to coordinate

state activities with the local law enforcement officer in charge. Also in

accordance with Annex 13 of the SCEOP, no use will be made of private

security agencies or volunteers unless they are sworn and trained special

deputies, state constables or auxiliary policy. Such personnel will be the

responsibility of the public safety agency which appoints and utilizes them.

Security to be provided includes but is not limited to access in and out of the

RSS facility, security within the RSS compound; traffic control within and to

and from the RSS facility. A DHEC driver and vehicle will be available to

transport any CDC/DHS/HHS representative to the State Emergency

Operations Center if needed. The South Carolina Air and/or Army National

Guard have been tasked with providing security for the SNS assets at the RSS

site and will follow the base’s usual and customary use of force guidelines in

maintaining the RSS site integrity. The RSS site will provide security for all

operations within its fence line. This security will be included in the basic

facility security plan that includes but is not limited to controlled access in and

out of the facility, controlled access to the flight line, controlled access to the

RSS warehouse within the facility compound. All entrances to the RSS

warehouse, flight access, and compound fence line are under 24-hour manned

video surveillance.

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-22

All persons working in or with the DHEC SNS program during a disaster

whether natural or a terrorist event will be credentialed as per the attached

description of the credentialing system. All persons without exception will be

required to wear a credential holder around their neck and clearly visible at all

times. The DHEC Region plans will specify credentialing procedures for all

Region dispensing sites and distribution sites. Anyone entering the facility

where the RSS site is housed will have to present a government

issued picture identification to the armed security guard at the guard gate prior

to admission. No one will be admitted unless their name appears on the roster

provided by ESF-8/SCDHEC.

The SC Law Enforcement Division (ESF-13) has been tasked with traffic

control, security and escort in transport to the Region Distribution Sites and

with coordinating security with local law enforcement at the Region

Distribution Site. ESF-2 will notify the RSS site of the size of the truck, a

description of the truck and of the driver’s name. This information will be

given to the guard gate and must be verified against the driver’s identification

prior to admission to the RSS site. The driver will be informed of where the

delivery will be made at the time of loading. The drivers will be escorted

between two law enforcement vehicles. Routing will be determined by law

enforcement. SLED and DPS will utilize their usual and customary use of

force guidelines to insure delivery of the medications to the Region

distribution sites. The South Carolina Law Enforcement Strategic National

Stockpile Standard Operations Plan will support ESF-13’s mission to the SC

Mass Casualty Plan, (Annex 1 – Strategic National Stockpile), of the SC

Emergency Operations Plan (SCEOP). This SOP provides operational

guidance to those who are assigned to work in ESF-13 in all phases of SNS

operations

The Department of Health and Environmental Control Drug Control

Pharmacists are tasked with providing security and transportation of any

controlled substances from the RSS site to the designated DEA registrant

facility usually a hospital pharmacy in each Region.

The Region/CRI SNS plan will provide for security at the Region Distribution

site, security and transport to the points of dispensing and at the mass public

points of dispensing/vaccination. Provision of security at the large employer

closed dispensing/vaccination sites will be identified in the Region/CRI SNS

plans.

If repackaging is necessary prior to distribution from the Receiving, Staging

and Storage (RSS) site, SLED will provide security in transport from the RSS

site to the repackager and back to the RSS site.

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-23

The US Marshall’s service are not considered part of the SNS Services

Advance Group (SSAG) and will not provide routine security for SNS assets

and personnel unless threat analysis of the event indicate federal security is

necessary.

Q. Repackaging

In the event that the prophylactic medication required to treat the biologic

agent is not available in the unit of dispensing packaging, in the 12-Hour push

package or the state receives bulk medication from the DSNS Managed

Inventory the bulk medication will be transported to the Consolidated Mail

Order Pharmacy in Charleston, SC or to the Moncrief Community Hospital

for repackaging into packages of 10-day or other appropriate dosage

regimens.

V. ESF ACTIONS

The emergency operations necessary for the performance of this Attachment I to

Appendix 5 of the SCEOP include but are not limited to the following:

A. Preparedness

1. Develop, coordinate and maintain written plans, which reflect latest

CDC/DSNS requirements, to implement SNS state and regional

response operations in South Carolina.

2. Develop and maintain mutual support relationships with other

governmental entities, professional associations, volunteer

organizations and other private services that may assist during a

WMD, natural or technological disaster.

3. Identify, coordinate and credential personnel necessary to deploy the

SNS assets and other approved countermeasures in support of ESF-8

responsibilities.

4. Identify and establish state and regional locations for receiving,

staging, storing and distributing SNS and other medical materials.

5. Identify and establish adequate regional locations (points of

dispensing/vaccination) to provide initial 10 day prophylaxis to the

entire DHEC Health Region population within 48 hours and to provide

follow up prophylaxis to complete the regimen if needed.

6. Identify and coordinate with other health care providers other sources

of pharmaceuticals and medical equipment/supplies.

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-24

7. Develop and maintain dosing and dispensing guidelines and

procedures for the prophylactic drugs contained in the SNS and for

other medical countermeasures designed for mass distribution or

dispensing.

8. Assure that DHEC Health Regions develop SNS and/or CRI plans for

the management of the medical supplies and medications in the SNS

“12-Hour Push Package”, the SNS Managed Inventory, Pandemic

countermeasures and any additional pharmaceutical and/or medical

supplies.

9. Develop and maintain training and training exercises for related areas

of SNS management.

B. Response

1. Assess the situation and determine if potential or actual WMD event or

a major natural or technological disaster may exceed local medical

supplies.

2. Facilitate the collaboration of state, regional and local officials to

determine whether to request federal assistance.

3. Request the SNS 12-Hour Push package by the DHEC Director with

the consent of the Governor, when it is determined by state and local

officials that Federal assets are required.

4. Participate in the CDC Director’s conference call to the DHEC

Director and other Federal, State and local officials to determine if an

event threatens the public health and exceeds or strains the local

capacity to respond. The CDC Director will then request a copy of the

SC SNS Plan and upon receipt of the SC SNS Plan, the CDC Director

will order the deployment of the SNS.

5. Request deployment of the SNS materiels adequate to respond to the

scope and size of the event.

6. Request the Governor declare a state of emergency and a “public

health emergency” allowing for the implementation of the South

Carolina Emergency Health Powers Act and its associated regulations.

7. Notify the DHEC Regions Health Directors, the Public Health

Preparedness Director and the CRI Coordinator of the deployment of

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-25

the SNS medical assets to the SC RSS site by the CDC and request the

implementation of the Region/CRI SNS plans.

8. Notify SEOC of the deployment of SNS by the CDC to the SC RSS

site.

9. Notify SNS RSS location of expected arrival of the SNS.

10. Notify and coordinate the agencies and organizations involved in the

staging of the SNS.

11. Notify and coordinate the agencies and organizations involved in the

support of the individuals involved in the staging of the SNS.

12. Notify and coordinate the agencies and organizations involved in the

transport of the SNS.

13. Notify Region Distribution sites and/or Region Health or Public

Health Preparedness Directors of the arrival of the SNS at the SC RSS

site. Notify the Region Distribution Sites and/or Region Directors of

the deployment of the SNS to the Region Distribution Site. Request

that the Region points of dispensing are notified of the deployment by

the DHEC Region Health Director.

14. Coordinate with ESF-1 transport of SNS asset from the RSS site to the

Region Distribution sites for distribution to the points of

dispensing/vaccination or designated hospital.

15. Coordinate with DHEC Health Region distribution of SNS medical

assets to designated hospitals.

16. Coordinate with DHEC Health Regions dispensing initial 10 days of

antibiotics or other approved countermeasures to the entire Region

population within the prescribed time frame of 48 hours and follow up

prophylaxis of 50 days if needed.

17 Coordinate with ESF-13 security for SNS assets in transport from the

RSS site to the Region Site, treatment center or repackaging center.

18. Coordinate with ESF-2, Budget and Control Board, the use of

additional 800 MHz radios and the installation of phone and data lines

at the RSS site.

19. Notify the South Carolina Labor, Licensing and Regulation of the

pending arrival of SNS assets in South Carolina and of the

gubernatorial declarations.

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-26

C. Recovery

1. Determine the need for additional medical supplies in conjunction

with the SC DHEC Region Director and the county/local emergency

management officials.

2. Request additional supplies of specific items through the CDC

Managed Inventory of the CDC-SNS program or through the State of

South Carolina emergency procurement procedures.

3. Coordinate with the DHEC Health Regions follow up of

individuals receiving prophylaxis to insure completion of therapy in

individuals actually exposed to the biologic agent.

4. Coordinate retrieval of all unused assets of the SNS program from the

distribution and dispensing sites to the RSS site.

5. Coordinate with CDC the return of unused or reusable Durable Assets

to CDC upon request, at CDC expense unless the CDC has agreed, in

writing, to another disposition of the Durable Assets.

6. Coordinate with CDC at the conclusion of a public health emergency

response, the return of unused medical materiel to determine if sealed,

non-pharmaceutical items stored in accordance with manufacturer

recommendations can be returned to federal custody. CDC will not

otherwise accept return of any unused Medical Materiel.

.

D. Mitigation

1. Support, plan and implement mitigation measures.

2. Support requests and directives resulting from the Governor and/or

CDC concerning mitigation and/or re-development activities.

3. Document matters that may be needed for inclusion in agency or

state/federal briefings, situation reports and action plans.

VI. RESPONSIBILITIES

SNS SOP

SNS SOP Rev Jan 2013 ANNEX 1_Appendix 5-1-27

A. Department of Health and Environmental Control (ESF-8)

1. Develop, coordinate and maintain written plans to implement the

Strategic National Stockpile response operations in South Carolina on

both State and Regional level.

2. Develop and maintain mutual support relationships with other

governmental entities, professional associations, volunteer

organizations and other private services that may assist during a

Weapons Mass Destruction (WMD), natural or technological disaster.

3. Identify, coordinate, train and credential personnel necessary to deploy

the Strategic National Stockpile assets and other approved

countermeasures to meet ESF-8 responsibilities

4. Identify and establish state and regional locations for receiving,

repackaging, staging, storing, distributing SNS and other medical

materiels.

5. Identify and establish adequate regional points of dispensing to

provide initial 10 days of antibiotic prophylaxis to the entire DHEC

Health Region population within 48 hours and follow up prophylaxis

of 50 days if needed to complete the regimen.

6. Identify and coordinate with other health care providers other sources

of pharmaceuticals and medical equipment/supplies.

7. Develop and maintain dosing and dispensing guidelines and

procedures for the prophylactic drugs contained in the Strategic

National Stockpile and for other medical countermeasures designed for

mass dispensing.

8. Assure that Department of Health and Environmental Control Health

Regions develop Strategic National Stockpile and/or Cities Readiness

Initiative plans for the management and distribution of the medical

supplies and medications in the Strategic National Stockpile “12-Hour

Push Package”, Managed Inventory, Pandemic countermeasures and

other pharmaceutical, vaccine or medical materiel.

9. Identify, train, and assign Department of Health and Environmental

Control personnel to implement Strategic National Stockpile plan.

10. Notify all Strategic National Stockpile supporting agencies upon

implementation of the Strategic National Stockpile plan.

11. Develop mutual support relationships with professional associations

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and other private services and volunteer organizations that may assist

during emergencies or disasters.

12. Coordinate and direct the activation and deployment of state agencies,

volunteer health/medical personnel through SCSERV, the emergency

system for advance registration of volunteer health professionals

(ESAR-VHP) and the eight Regional Medical Reserve Corps, supplies,

equipment and provide certain direct resources under the control of the

Department of Health and Environmental Control.

13. Develop and conduct training, drills and exercises to coordinate

emergency medical care in disaster situations requiring Strategic

National Stockpile assets.

14. Assure that the procedure described in section IV.E is in place for

requesting the Strategic National Stockpile “12-Hour Push Package”

and “Managed Inventory” from the Centers for Disease Control and

Prevention.

15. Facilitate the collaboration of state, regional and local officials with

supporting agencies in assessing the situation to determine if a

potential or actual WMD event or a major natural or technological

disaster may exceed state and local medical capacity.

16. Coordinate requesting and consultation phases of the Strategic

National Stockpile with the Centers for Disease Control and

Prevention Division of Strategic National Stockpile among state and

federal response officials.

17. Insure that required information is available for the consultation phase

with the Centers for Disease Control and Prevention. This information

includes but is not limited to the following: current or projected

casualties, projected needs based on population, presence of an

Strategic National Stockpile plan, hospital capacities at the time of the

event including Intensive Care Unit beds and ventilators; other

state/local resources such as pharmacy distributors, oxygen suppliers,

nearby hospital and alternate care sites, other stockpiles of

pharmaceuticals; and a plan to receive, repackage prophylactic oral

antibiotics.

18. Coordinate need for initiating any waiver of rules and regulations

regarding licensing of drug distribution or dispensing outlets.

19. Coordinate the verification of volunteer medical personnel through the

South Carolina ESAR-VHP program.

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20. Insure all state and federal documentation available and in order to

accept and distribute the Strategic National Stockpile assets and that

such documentation complies with state and federal pharmacy and

drug control regulations.

21. Maintain lists of points of contact with all agencies and organizations

involved with the warehouse management, inventory control, on-site

security, transport, transport security, distribution, dispensing, retrieval

and return to Centers for Disease Control and Prevention of Strategic

National Stockpile assets.

22. Provide all inventory control records and distribution records of

Strategic National Stockpile assets as required by Centers for Disease

Control and Prevention.

23. Maintain all expense records associated with deployment of the

Strategic National Stockpile for possible reimbursement.

24. Assess the situation and determine if a potential or actual WMD event

or major natural or technological disaster may/or will exceed local

medical capability.

25. Request Strategic National Stockpile assets by the Department of

Health and Environmental Control Director with the consent of the

Governor, when it is determined by state and local officials that

Federal assets are required.

26. Accept custody of the Strategic National Stockpile assets from the

Centers for Disease Control and Prevention.

27. Participate in the Centers for Disease Control and Prevention Directors

conference call to the Department of Health and Environmental

Control Director and other Federal, State and local officials to

determine if an event threatens the public health and exceeds or strains

the local capacity to respond. If the Secretary of the Department of

Health and Human Services or his designee decides that the event

threatens the public’s health and that the on-site capacity and resources

have or will be strained or exhausted a request will be made for a copy

of the SC Strategic National Stockpile Plan. Upon receipt of the SC

Strategic National Stockpile Plan, the Secretary of the Department of

Health and Human Services or his designee will order the deployment

of the Strategic National Stockpile “12-Hour Push Package” and/or

other medical materiel to the SC Strategic National Stockpile

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Receiving, Staging and Storage (RSS) site as designated by the

Director of the Department of Health and Environmental Control.

.

28. Request the Governor declare a state of emergency and a “public

health emergency” allowing for the implementation of the South

Carolina Emergency Health Powers Act and its associated regulations.

29. Notify the Department of Health and Environmental Control Region

Health Directors, the Public Health Preparedness Directors, the CRI

Coordinator of the deployment of the Strategic National Stockpile

medical assets to the SC Receiving, Staging and Storage site by the

Centers for Disease Control and Prevention and request the

implementation of the Region/CRI Strategic National Stockpile

plan(s).

30. Notify SEOC of the deployment of Strategic National Stockpile assets

by the Centers for Disease Control and Prevention to the South

Carolina Receiving, Staging and Storage site and request notification

of supporting agencies.

31. Notify Receiving, Staging and Storage location of expected arrival of

the Strategic National Stockpile assets.

32. Notify and coordinate the agencies and organizations involved in the

staging of the Strategic National Stockpile assets.

33. Notify and coordinate the agencies and organizations involved in the

support of the individuals involved in the receipt, staging, storage and

on-site security of the Strategic National Stockpile assets.

34. Notify and coordinate the agencies and organizations involved in the

transport and security of the Strategic National Stockpile assets from

the RSS site to the Region distribution sites.

35. Notify Region Distribution sites and/or Region Directors or his

designee of the arrival of the Strategic National Stockpile at the South

Carolina Receiving, Staging and Storage site. Notify the Region

Distribution sites and/or Region Directors or his designee of the

deployment of the Strategic National Stockpile to the Region

Distribution sites. Insure that the Region points of dispensing are

notified of the deployment by the Department of Health and

Environmental Control Region Director.

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36. Coordinate with ESF-1 (Transportation Services) transport of Strategic

National Stockpile assets to the Region Distribution site(s) for

distribution to the local points of dispensing or designated hospitals.

37. Coordinate with Department of Health and Environmental Control

Health Regions distribution of Strategic National Stockpile medical

materials to designated hospitals.

38. Coordinate with Department of Health and Environmental Control

Health Regions and City of Columbia MSA/CRI dispensing initial 10

days of Strategic National Stockpile prophylactic antibiotic regimens

or other approved countermeasures to the entire health Region

population within the prescribed time frame of 48 hours and follow up

prophylaxis of 50 days to complete the regimen if needed.

39. Coordinate with ESF-13 (Law Enforcement) and ESF-16

(Emergency Traffic Management) security for Strategic National

Stockpile assets in transport to the Receiving, Staging and Storage site,

from the Receiving, Staging and Storage site to the Region

Distribution site, designated hospitals, and repackaging facility and

back to Receiving, Staging and Storage site.

40. Provide transport and security of control substances to designated

treatment centers and provide for the transfer of these control

substances to treatment centers that are properly registered to accept

these substances by the federal Drug Enforcement Agency (DEA).

41. Provide transport of bulk pharmaceuticals to repackaging facilities.

42. Determine the need for additional medical supplies in conjunction

with the South Carolina Department of Health and Environmental

Control Region Health Director and the county/local emergency

management officials.

43. Request additional supplies of specific items through the Centers for

Disease Control and Prevention Managed Inventory portion of the

Strategic National Stockpile program and/or through other commercial

sources if available

44. Coordinate with ESF-2, Budget and Control Board, the use of

additional 800 MHz radios, HAM radios, satellite phones, mobile

satellite trailers and the installation of additional telephone and data

lines at the RSS site.

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45. Coordinate with the Department of Health and Environmental Control

Health Regions follow up of individuals receiving prophylaxis to

insure completion of therapy in individuals actually exposed to the

biologic agent.

46. Coordinate retrieval of all unused assets of the Strategic National

Stockpile program from the distribution and dispensing/vaccination

sites to the Receiving, Staging and Storage site.

47. Coordinate with CDC the return of unused or reusable Durable Assets

to CDC upon request, at CDC expense unless the CDC has agreed, in

writing, to another disposition of the Durable Assets.

48. Coordinate with CDC at the conclusion of a public health emergency

response, the return of unused medical materiel to determine if sealed,

non-pharmaceutical items stored in accordance with manufacturer

recommendations can be returned to federal custody. CDC will not

otherwise accept return of any unused Medical Materiel.

49. Maintain and provide all inventory control records and distribution

records as required by the CDC.

50. Maintain all personnel time and other expense records associated with

the deployment of the SNS in the response for possible

reimbursement.

51. Support, plan and implement mitigation measures.

52. Support requests and directives resulting from the Governor and/or

Centers for Disease Control and Prevention concerning mitigation

and/or re-development activities.

53. Document matters that may be needed for inclusion in agency or

state/ federal briefings, situation reports and action plans.

B. Office of the Governor

1. Coordinate with the Department of Health and Environmental Control

Director, South Carolina Emergency Management Director, the

Department of Health and Environmental Control Deputy Director of

Health Services, the Department of Health and Environmental Control

District Health Director and the Department of Health and

Environmental Control Director of Public Health Preparedness

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requesting federal assistance in the form of medical assets from the

Strategic National Stockpile.

2. Authorize the Department of Health and Environmental Control

Director to request Strategic National Stockpile assets.

3. Declare a state of emergency and a “public health emergency”

allowing for the implementation of the South Carolina Emergency

Health Powers Act and its associated regulations.

C. Office of The Adjutant General (ESF-19)

1. SC National Guard

a. Identify, train, and assign South Carolina National Guard

personnel to maintain contact with and prepare to execute

missions in support of Strategic National Stockpile and

Pandemic Influenza Response activities during periods of

activation.

b. Provide on-site security at the Receiving, Staging and Storage

site for Strategic National Stockpile assets and other medical

countermeasures. Site security will follow base usual protocol.

Additional security will be in place at identified RSS building..

c. Provide personnel to perform security at the Receiving, Staging

and Storage site for the Strategic National Stockpile assets and

other medical countermeasures.

d. Provide warehouse facilities to receive, stage, store and

distribute Strategic National Stockpile assets and other medical

countermeasures.

e. Provide personnel to assist with receipt, staging, storage of the

Strategic National Stockpile assets and other medical

countermeasures at the Receiving, Staging and Storage Site.

f. Provide backup transportation for the SNS assets to the Region

Distribution sites.

.

2. SC Emergency Management Division(ESF-5)

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a. In accordance with the SNS Guidance version 11, State

Emergency Management Officials will confer with the

Governor and the Department of Health and Environmental

Control Director to determine the need to request federal

support in the form of the Strategic National Stockpile assets.

b. In accordance with the SNS Guidance version 11 the Governor

or State Emergency Management officials will participate in

the consultation phase of the Strategic National Stockpile with

the Centers for Disease Control and Prevention.

c. Activation of the State Emergency Operations plan and the

State emergency Operation Center (Center) will occur at the

appropriate Operating Condition (OPCON) to ensure adequate

support.

D. Department of Labor, Licensing and Regulation, Division of Professional and

Occupational Licensing

1. Assist with the temporary licensure of drug distribution and

dispensing facilities.

2. Assist with the verification of volunteer medical personnel

through the South Carolina ESAR-VHP program.

3. Review and approve policies and procedures employed at

points of dispensing are consistent with the purpose of Board

of Pharmacy .

E. South Carolina Commission on Higher Education

1. USC School of Pharmacy: Provide pharmacy students to assist

in the repackaging of bulk quantity antibiotics into individual

patient regimens.

2. MUSC School of Pharmacy: Provide pharmacy students to

assist in the repackaging of bulk quantity antibiotics into

individual patient regimens.

F. SC Hospital Association: Identify hospitals to receive SNS supplies when

local capacities are exceeded. Identify hospitals to participate in regional

planning to determine local capacities for response prior to the arrival of the

SNS.

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G. SC Medical Association: Assist with recruitment of physicians for

SNS operations at the points of dispensing. These physicians will assist in

determining appropriate treatment in presenting individuals.

H. SC Pharmacy Association

1. Assist with recruitment of pharmacists for emergency operations by

actively participating in the South Carolina Emergency System for

Advance Registration of Healthcare Professionals.

2. Assist with obtaining pharmaceuticals, medical equipment and

supplies not found in the Division of Strategic National Stockpile

inventory.

3. Disseminate event and/or health information to community providers

through the RX Alert system.

I. SC Nursing Association: Assist with recruitment of nurses from the

community to assist DHEC nurses at the Region Dispensing sites.

J. SC Baptist Convention: Provide 4 meals per day, snacks and personnel to

distribute these meals/snacks for workers staffing the RSS site.

K. SC Department of Education: Provide dispensing sites for prophylactic

drug distribution to the general public in a biologic exposure.

L. American Red Cross: Provide snacks/ liquids at Region points of dispensing.

M. South Carolina Law Enforcement Division: (ESF-13 & 16)

1. Provide security in transport and escort during transport to the Receiving

Staging and Storage site.

2. Provide security in transport and escort during transport to the Region

Distribution site. Coordinate security at the Region Distribution Site with

local law enforcement.

3. Provide security in transport to the repackaging facility and back to the

Receiving Staging and Storage site.

N. South Carolina Department of Transportation: (ESF-1)

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1. Provide transportation and/or coordinate provision of

transportation with local carriers if state assets are not adequate of

the Strategic National Stockpile materials from the Receiving,

Staging and Storage site (RSS) to the Region Distribution sites.

2. Provide transportation and/or coordinate provision of

transportation with local carriers if state assets are not adequate of

the Strategic National Stockpile materials to the designated

treatment centers.

3. Provide transportation and/or coordinate provision of

transportation with local carriers if state assets are not adequate of

Strategic National Stockpile materials to the repackaging facility

and back to the Receiving Staging and Storage site.

4. Provide transportation and/or coordinate provision of

transportation with local carriers if state assets are not adequate of

the return of any unused Strategic National Stockpile assets from

the Region Distribution site to the Receiving, Staging, Storage site

for return to the Centers for Disease Control and Prevention.

O. Budget and Control Board (ESF-2)

1 Provide additional communications devices if needed for

Strategic National Stockpile operations.

2. Provide for additional radios, voice and data lines at the

Receiving Staging and Storage site.

P. South Carolina Society of Health System Pharmacists:

1. Identify Directors of Pharmacy at SC Hospital Association identified

hospitals.

2. Participate in surge capacity planning within their facility to respond to

a mass casualty event.

Q. United States Department of Defense:

Provide repackaging of bulk pharmaceuticals into 10 or 25-day dosage

regimens at Moncrief Community Hospital or the Veterans Administration

Consolidated Mail Order Pharmacy.

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VII. FEDERAL INTERFACE

A. This annex has no counterpart in the National Response Framework.

B. The formation of this plan is required for receipt of the NPS/SNS by the CDC

under Title V, Emergency Preparedness and Response, section 502 of the

“Homeland Security Act of 2002.”

VIII. COUNTY INTERFACE

In conjunction with the DHEC Health Region Director, county emergency

management officials will determine if local medical supplies will be exhausted and if

federal assets in the form of the SNS will be needed to manage the WMD, or major

natural or technological event. The DHEC Region Health Director after consultation

with the county emergency management officials will request the initial SNS “12-

Hour Push Package” and any additional specific SNS assets that are needed to insure

a continual supply of medications and medical supplies to manage casualties until the

event has reached the point that the operation may be scaled down. In conjunction

with the DHEC Health Region, county governments will provide Emergency Medical

Technicians and security at local Dispensing Sites and security at Region Distribution

Sites.

In conjunction with the DHEC Health Regions, county emergency management

officials will report to ESF-8 at the state emergency operations center the number of

people treated, given prophylactic medication and sent home, the number of treated

and transferred to hospitals or other treatment centers and the number of people given

prophylactic medication and sent home. Also to be reported are the projected number

of people still requiring treatment. These numbers will be reported on a regular basis

determined by the particular incident. In conjunction with the DHEC Health Regions

the county will maintain and provide lists of county medical resources.

IX ADMINISTRATION AND LOGISTICS

1. General Reporting Requirements

a. Personnel hours will be recorded as the individuals normal program

and location code and will use the disaster (999) activity code.

2. General Support Requirements

a. Meals at the RSS site will be supplied by the facility caterer.

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b. Shift tours

c. Security/ badging will be accomplished by roster and verification of

identity by DHEC identification badge, response partner support

agency identification badge or other government issued identification.

3. Policies on augmenting response staff

DHEC Administrative Manual Policy A.514 rev. 08/2007

4. Resource Management may include financial record keeping; reporting

procedures; tracking resource needs, sources, use, and cost.