Kitsap County Health District Strategic National Stockpile ... SNS 2005 - Sanitized.pdfKitsap County Health District Strategic National Stockpile Plan 31 August 2005 2. Formally request

Kitsap County Health District

Strategic National Stockpile Plan

Kitsap County Health District 345 6th Street Suite 300 Bremerton, WA 98337

31 August 2005

"All or part of this document is exempt from public disclosurepursuant to RCW 42.56.420 (1) (a). Request for public disclosureof this document, or parts thereof, should be referred immediatelyto the Kitsap County Health District at 356 6th Street, Suite 200,Bremerton, Washington 98337 or by calling 360-337-5235."

Kitsap County Health District Strategic National Stockpile Plan

31 August 2005

KITSAP COUNTY HEALTH DISTRICT

STRATEGIC NATIONAL STOCKPILE (SNS) DISTRIBUTION PLAN

I. PURPOSE

This plan describes the process for requesting, receiving, managing, distributing, and dispensing the contents of the Strategic National Stockpile (SNS). The US Department of Homeland Defense and the US Centers for Disease Control and Prevention (CDC) manage the SNS at the national level; the Washington State Department of Health (DOH) manages the SNS at the Washington State level, and the Kitsap County Health District (KCHD) manages the SNS within Kitsap County. The SNS is a cache of certain pharmaceuticals, vaccines, and medical supplies to assist states in their response to a localized biological or chemical terrorism event. The SNS has two major components: 12-hour Push Package (12hr PP) and Vendor Managed Inventory (VMI). The provisions of this plan apply to both components of the SNS.

II. POLICY

A.

B.

Kitsap County will request deployment of the SNS from the DOH when the Health Officer, or their authorized representative, determines that it is necessary to protect the public health. (See attachment 1, SNS Request Letter)

Within Kitsap County, the following individuals may request the deployment of the SNS:

1. County Commissioners 2. Local Health Officer, or designee 3. Director of Emergency Management, or designee

C. The State of Washington will request deployment of the SNS from CDC as soon as

the Governor or his alternate (in consultation with state and local officials) determines that it is prudent to do so to protect the public health.

D. Within the State of Washington, only the Governor, the Lieutenant Governor, the

Secretary of Health, or the State Health Officer may formally request the deployment of the SNS from the CDC.

E. Nothing in this plan should be construed as independent of or bypassing regular

emergency management procedures. As such, the request for SNS deployment will be made from the KCHD to the Governor of Washington via the Kitsap County Emergency Operations Center (EOC) and the Washington State EOC.

F. DOH will be responsible for the following SNS activities:

1. Assess need for supplemental medications, vaccines, medical supplies, and

equipment.

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2. Formally request the SNS from federal authorities. 3. Receive and breakdown the SNS, repackage into unit doses, and affix labels. 4. Ship SNS elements to the point of delivery (PoD) locations designated by KCHD.

Within Kitsap County, these PoDs will be referred to as Neighborhood Distribution Centers (NDCs).

G. KCHD will be responsible for the following SNS activities:

1. Request the SNS from DOH officials at the Washington State EOC. 2. Setup NDCs as the situation dictates. 3. Dispense medications and/or immunize residents. 4. Be responsible for, and manage SNS assets deployed to Kitsap County.

III. ASSUMPTIONS

A. A request for deployment of the SNS will be accompanied by a declaration of a “State of Emergency” and receipt of a mission/incident number from the Washington State EOC.

B. The SNS will need to support 240,000 people in Kitsap County or potentially 330,000

in Planning Region 2

C. Any event necessitating deployment of the SNS may affect residents from multiple local jurisdictions. In fact, deployment of the SNS may be part of a statewide, national, or international response to a public health threat.

D. From the time DOH receives the SNS, it will take approximately 12-24 hours to

distribute its contents to local health jurisdictions (LHJs).

E. Civil unrest may occur.

F. Additional supplies and logistical resources (beyond that available to KCHD on a day-to-day basis) will be needed. Procurement of these resources will be coordinated through the Kitsap County EOC in accordance with existing emergency logistics procedures.

G. A successful large-scale distribution of the SNS requires the involvement and

participation of a wide-range of community organizations, businesses, and volunteers --- “A Community Response.”

IV. LIMITATIONS

A. Deployment of the SNS is dependent on an accurate and timely identification of the disease or bioterrorist agent that constitutes the public health threat.

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B.

C.

D.

E.

F.

G.

Time is required to deliver the SNS to Kitsap County, set up dispensing or immunization clinics, and staff the clinics with trained personnel.

The number of medical personnel qualified to administer vaccine or dispense pharmaceuticals, and the number of available volunteers to perform support functions, will limit the rate at which residents are treated.

KCHD lacks the staffing needed to operate all of NDCs required to immunize or chemoprophylaxis all Kitsap County residents.

The onset of disease may impact clinic staffing.

Other disease response activities (e.g. epidemiological investigation, isolation and quarantine management) will limit the number of public health staff able to participate in SNS operations.

Maintaining the potency of SNS pharmaceuticals require they be stored at temperatures between 68 and 77 degrees F (with brief deviations between 59 and 86 degrees F). Vaccines must refrigerated and stored at temperatures between 35 and 46 degrees F. That means that during hot or cold weather, SNS operations cannot be conducted outside.

V. DIRECTION AND CONTROL

A. Situations requiring the deployment of the SNS will be managed from the Kitsap County EOC in accordance with existing emergency management procedures. Key players involved in the request for SNS deployment, and subsequent immunization or chemoprophylaxis operations (e.g. elected officials, public health, emergency management, law enforcement, fire, EMS, hospital, public works, and public transit authorities) will be represented at the EOC.

B. SNS operations will be managed using the Incident Command System (ICS) under

the National Incident Management System (NIMS). C. During SNS operations, the Health Officer, or designee, may participate in a unified

command arrangement to provide professional medical advice concerning response activities needed to combat the disease.

D. A liaison officer who will answer questions about the SNS will represent the KCHD

at the Kitsap County EOC. This person will serve as an interface between the EOC and the KCHD Emergency Communications Center that will coordinate KCHD’s overall response and dispensing/immunization clinics.

E. Resource sharing agreements are in development and will be included with each

facility Standard Operating Procedure (SOP).

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VI. CONCEPT OF OPERATIONS

A. KCHD will request deployment of the SNS as circumstances warrant. The decision-making process leading to that request is addressed in the Kitsap County Comprehensive Emergency Management Plan (CEMP) and Tab B (Decision-making Process) to Appendix 1 (Strategic National Stockpile) to Emergency Support Function 8 (ESF 8) (Health and Medical Services) to the Washington State Comprehensive Emergency Management Plan (CEMP).

B. The request for SNS deployment, while originating from KCHD will be directed to

the Governor of Washington via the Kitsap County EOC and the Washington State EOC (Fax: (253) 512-7203). The Washington State EOC will ensure that the Governor and the Washington State DOH receive copies of the request letter. A template for the SNS request letter is at Attachment (1).

C. Once the SNS has been requested, but prior to approval of SNS deployment, the

KCHD will work with Kitsap County Emergency Management to:

1. Provide staffing, logistical support, and transportation for the vaccination/prophylaxis clinics.

2. Coordinate crowd and traffic control. 3. Coordinate transportation for staff and community. 4. Coordinate trash, food, and sanitation needs for vaccination/prophylaxis clinics. 5. Coordinate with other Kitsap County agencies involved in the emergency

response.

D. DOH officials will take possession of the SNS and will distribute its elements further to the PoDs specified by the affected LHJ in its SNS request letter. Potential PoDs in Kitsap County are listed in Tab A, Dispensing and Immunization Clinic Sites.

E. Depending upon the disease being addressed and the overall situation, the local

Health Officer, or designee, may decide to immunize or provide chemoprophylaxis for populations at risk or the entire population of Kitsap County in the event that populations at risk are treated, small to medium sized clinics appropriate to the geographic area will be activated. Should the entire population require treatment, a small number of high-capacity clinics will be activated.

F. KCHD will staff its dispensing and immunization clinics in accordance with Tab B,

Clinic Staffing.

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G. KCHD will procure equipment and supplies listed in Tab D (Equipment and

Supplies) in accordance with existing KCHD and Kitsap County EOC procedures. H. Medical and emergency response personnel may receive their immunization or

chemoprophylaxis before the general public in accordance with a prioritization determined by the local Health Officer, or designee.

I. LHJs will dispense SNS elements to the public in accordance with Tab D (Dispensing

Clinic Operations) and Tab E (Immunization Clinic Operations). Special provisions will have to be made to treat individuals who cannot travel to clinic sites (e.g. jail inmates, nursing home patients, shut-ins, disabled, etc.).

J. State and local authorities will coordinate their activities via emergency management

channels throughout the incident to ensure additional resources are allocated as required.

K. Labeling of Prescriptions:

1. The Reception Storage, and Staging (RSS) facility operated by DOH will label

SNS pharmaceutical prescriptions in accordance with State and Federal regulations. The majority of the information on the labels will be prepared at the manufacturer and will be verified by the RSS at DOH.

2. Staff at the KCHD clinics will need to apply an additional label with the Local Health Officer as the prescriber, the patient’s name on the labels when they dispense the drug, or have the recipient write his or her name on the label.

L. The Name, Address, Phone, Health History (NAPH) form will be used to track

drugs and drug recipients. Forms will be completed by everyone who receives protective medicine, as well as by parents of underage children or authorized representatives of individuals unable to complete the forms.

M. Security at the vaccination/prophylaxis clinics will be provided by local law

enforcement and/or volunteer staff coordinated by the clinic Security Chief. N. Public information initiatives will be coordinated through the Joint Information

Center (JIC), in accordance with existing Kitsap County EOC procedures. O. All medical wastes will be disposed of following the guidelines provided by DOH.

1. All sharps will be disposed of in rigid sharps containers that will be sealed

following use. 2. Appropriate medical waste will be “red-bagged,” and placed in watertight,

puncture resistant containers for transportation. 3. Other wastes will be disposed of in the trash at the clinic site.

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4. Medical waste will either be transported back to KCHD for disposal in

accordance with normal procedures, or a medical waste contractor will be contracted to provide special pick-up at the clinic site.

P. Cessation of Operations. The decision to return to normal operations will be

determined by the Health Officer, or designee, following consultation with local hospitals, health care professionals, and community partners on the status of the event that caused activation of the SNS.

Q. Procedures to be used in monitoring, recovering, and re-deploying the assets of the

SNS are found in the Kitsap County Comprehensive Emergency Management Plan (CEMP) and in Tab F (Monitoring, Recovery and Termination) to Appendix 1 (Strategic National Stockpile) to Emergency Support Function 8 (ESF 8) (Health and Medical Services) to the Washington State Comprehensive Emergency Management Plan (CEMP).

R. State, local, and hospital officials have a responsibility to train staff, as appropriate,

on the concepts and procedures contained in this plan and in relevant state and federal plans, which support this plan.

1. Provisions for orientation, training, and drilling of staff are covered in Tab G

(Orientation, Training, and Drills) to Appendix 1 (Strategic National Stockpile) to Emergency Support Function 8 (ESF 8) (Health and Medical Services) to the Washington State Comprehensive Emergency Management Plan (CEMP).

2. The KCHD, supported by DOH and regional training and educational staff, will develop a training plan and program to ensure KCHD and volunteer clinic staff is aware of the concepts behind the plan and their specific roles and responsibilities.

3. Because of limitations in KCHD staff, volunteers will fill most clinic positions. KCHD will identify primary and alternate staff for the following positions to act as trainers for volunteers: a. Incident Commander b. Operations Chief c. Logistics Chief d. Security Chief

4. Effectiveness of training will be evaluated through periodic exercises and drills.

VII. RESPONSIBILITIES

A. The KCHD is the lead agency in Kitsap County concerning SNS operations. The KCHD is also responsible for a periodic review of this plan, training Dispensing and Immunization Clinic personnel, and exercising the plan.

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B. Other Kitsap County agencies will perform support functions as assigned in

accordance with the Kitsap County CEMP and relevant Emergency Operation Procedures. Specific responsibilities include:

1. Law enforcement will provide security and traffic control at clinic sites. 2. The Departments of Public Works in Kitsap County and the cities of Bainbridge

Island, Poulsbo, Bremerton and Port Orchard will assist with traffic control, and will provide vehicles to transport equipment and supplies as it applies to their respective jurisdictions.

3. Emergency management will direct the Kitsap County EOC and coordinate emergency response activities in accordance with existing procedures.

4. Public transit will transport clinic staff and patients to/from clinic sites. 5. Fire and Emergency Medical Services (EMS) will support clinic operations, as

required. VIII. LISTING OF TABS

A.

B.

C.

D.

E.

Tab A, Neighborhood Distribution Centers/Clinic Sites

Tab B, Clinic Staffing

Tab C, Cities Readiness Initiative

Tab D, Clinic Operations

Tab E, Reserved for Future Development

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Kitsap County Health District Letterhead [INSERT DATE]

From: Kitsap County Health District To: Governor, State of Washington Via: Washington State Emergency Operations Center Dear Governor [INSERT NAME OF CURRENT GOVERNOR], 1. Kitsap County is currently responding to an event of [INSERT DISEASE/BIOTERRORIST AGENT]. The Washington State Emergency Operations Center (EOC) has assigned mission number [INSERT MISSION/INCIDENT NUMBER] to this incident. Request deployment of the Strategic National Stockpile (SNS) to Kitsap County to combat the outbreak. 2. Pharmaceuticals and associated supplies are needed to: [IMMUNIZE/CHEMOPROPHYLAXIS] [INSERT TOTAL NUMBER OF INDIVIDUALS TO BE TREATED]. Please deliver the requested SNS materials to the following locations. Specific items needed include:

a. [INSERT NAME, ADDRESS AND DESIGNATION OF CLINIC] (1) [INSERT SPECIFIC DRUGS NUMBER OF DOSES REQUIRED AND SPECIFIC

SUPPLIES NEEDED] (2) [INSERT SPECIFIC DRUGS NUMBER OF DOSES REQUIRED AND SPECIFIC


SUPPLIES NEEDED]

b. [INSERT NAME, ADDRESS AND DESIGNATION OF CLINIC] (1) [INSERT SPECIFIC DRUGS NUMBER OF DOSES REQUIRED AND SPECIFIC



SUPPLIES NEEDED] 3. This activity is being managed through the Kitsap County Emergency Operations Center, which can be reached at 360-307-5870 (voice) 360-478-9802 (fax). Sincerely, [INSERT SIGNATURE BLOCK FOR ENTITY MAKING THE REQUEST] Copy to: Washington State Department of Health

Attachment 1 SNS Request Letter


31 August 2005



TAB A

NEIGHBORHOOD DISTRIBUTION CENTERS/CLINIC SITES

"Parts of Tab A are exempt from public disclosure pursuant to 42.56.420 (1) (a). Request for public disclosure of this part should be referred immediately to the Kitsap County Health Health District at 356 6th Street, Suite 200, Bremerton, Washington 98337 or by calling 360-337-5285." Kitsap County SNS operational planning is based on the need to support 240,000 people in Kitsap County, or potentially 330,000 people in Planning Region 2. Sufficient SNS points of delivery (PoDs) (referred to within Kitsap County as Neighborhood Distribution Centers (NDCs) are needed to support a wide range of potential chemoprophylaxis or immunization operations that will vary with the disease that is being addressed. In some instances, where the disease outbreak is relatively confined and the possibility for further infection limited, SNS dispensing and immunization operations may be conducted from a small number of PoDs serving specific geographic areas. In other instances, where the outbreak is already widespread, and the threat severe (e.g. smallpox), then a different set of PoDs will be needed to conduct a mass immunization effort. Additionally, there may be situations in which SNS operations will be conducted at medical facilities, such as the Harrison Hospitals, Naval Hospital Bremerton, or the Kitsap County Health District (KCHD) Clinics.


31 August 2005



TAB B

DISPENSING AND IMMUNIZATION CLINIC STAFFING

Kitsap County SNS operational planning is based on the need to support 240,000 people in Kitsap County, or potentially 330,000 people in Planning Region 2. Staffing requirements will vary considerably depending upon the number of SNS points of delivery (PoDs, referred to within Kitsap County as Neighborhood Distribution Centers -- NDCs) that are activated to deal with the disease that is being addressed, the number of dispensing/immunization stations at each NDC, and the timeframe needed to conduct a chemoprophylaxis or immunization operation. In a worst case scenario, such as a mass immunization campaign to combat a smallpox outbreak, a staff of almost 3,700 people would be needed to operate five mass immunization clinics around the county (Bainbridge Island, North Kitsap, Central Kitsap, Bremerton, and South Kitsap), operating in three shifts to maintain around-the-clock operations. A table for calculating the necessary clinic staffing is located in Tab D. The Kitsap County Health District (KCHD) lacks the staffing to conduct an SNS operation, and will require assistance from a wide range of community partners. This assistance will be coordinated through the Kitsap County Emergency Operations Center (EOC) in accordance with existing emergency management procedures. Potential sources for clinic staffing include: Medical personnel from:

a. KCHD b. Naval Hospital Bremerton and subordinate clinics, ships homeported in

Bremerton and Bangor, and the Northwest Dental Command c. Pharmacies d. Harrison Hospital e. Virginia Mason f. The Doctors Clinic g. Group Health h. North Kitsap Family Practice & Urgent Care i. Peninsula Community Health System j. The Veteran’s Administration Outpatient Clinic k. Volunteers, including retired medical professionals l. The American Red Cross m. The Kitsap County Medical Reserve Corps (MRC)

Non-medical personnel from:


31 August 2005

a. KCHD n. Naval activities in the county, including ships homeported in Bremerton and

Bangor, and the Northwest Dental Command o. Harrison Hospital p. Virginia Mason q. The Doctors Clinic r. Group Health s. North Kitsap Family Practice & Urgent Care t. Peninsula Community Health System u. The Veteran’s Administration Outpatient Clinic v. The American Red Cross w. Volunteers mobilized by the United Way x. Volunteers mobilized by the Kitsap County Department of Emergency

Management

Other possible sources of clinic manning (following a presidential emergency declaration):

a. National Disaster Medical Teams (DMAT) b. National Guard Civil Support Team

Tab B-2


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Tab C

Cities Readiness Initiative (CRI) I. Purpose Cities Readiness Initiative (CRI) is an extension of the Strategic National Stockpile (SNS). The CRI will utilize the same facilities designated for the SNS. However, the need for facilities that have a large capacity will be utilized. Therefore the most likely locations will be large schools/churches, in each of the five areas the health district has separated Kitsap County into. These areas are based on population/geographic considerations. For detailed information on physical clinic locations and designations refer to the Kitsap County SNS plan Tab A. II. Policy The CRI plan is not to replace the SNS plan. It is to supplement and streamline operations to increase the likelihood of the number one goal of, “putting pills into people”, Prophylaxing the affected residents of Kitsap County. This plan only identifies the differences between the CRI and SNS so understanding of the SNS plan is crucial to the success of this plan. III. Assumptions

• The greater Seattle area is considered the primary target for this type of attack. • Based on twenty percent (20%) of the working adults in Kitsap County

commuting an hour or more and the average daily Washington State Ferry passenger information. A minimum of forty thousand (40,000) Kitsap County residents (commuters) will need to be prophylaxis against an aerosolized Anthrax attack.

• 48 hours after the attack is the timeframe to prophylax the target population. • If it is determined that the agent is communicable the entire population (240,000)

of Kitsap County will require prophylaxis. • There will be five Points of Distribution (POD) (known as Neighborhood

Distribution Clinics (NDC) in Kitsap County) established prior to the delivery of antibiotics by the Washington State Department of Health’s Receiving Staging and Storage facility.

• Dispensing is limited to 10-day supply of oral antibiotics only. Additional supplies will be dispensed as required.

• Clinics will operate 24 hours a day for the first two days and on an as needed basis following the initial 48 hours.

Tab C - 1


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• Volunteers from the Medical Reserve Corps (MRC), civic and community

organizations will perform the majority of functions in the clinics with just in time training and clinic oversight provided by Kitsap County Health District employees.

• There will be a state of emergency declared on both the state and federal levels. This proclamation covers all medical acts performed in good faith to maximize the preservation of life.

• Communications infrastructure is available to the Neighborhood Distribution Centers (NDC). The use of land line and cellular will be the normal means of communications. If required and available a satellite phone will be delivered to each NDC.

IV. Transportation Transportation will follow a segmented or centralized. All transportation will be coordinated by the Kitsap County Emergency Operations Center (EOC) with Kitsap County transit, Paratransit and the school districts that support the areas in which the clinics are located Kitsap Transit will designate and communicate all the “Park-n-Ride” locations during pre-event planning. V. Clinic Sites High capacity sites have been identifed and will be activated based on need. If they are not available during catastrophic events, several smaller venues have been identified in the same general area and will be chosen opened to replace these locations this decision will be primarily based on facility capacity.

Tab C - 2


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VI. Clinic Staffing Due to the emergent nature of this threat staffing will be greatly reduced. Both Health District and volunteers (i.e. Medical Reserve Corps) will fill the positions. The staff for these clinics follows the National Incident Management System (NIMS) utilizing the Incident Command System (ICS). However, all initially assigned personnel’s (Health District employees) primary responsibility is to support “putting pills into people” all other duties are secondary. After relief workers (MRC and other volunteers) are available to conduct clinic operations those individuals will then assume their ICS/clinic management duties. Incident Commander (IC) /Clinic Manger Responsible for all aspects of clinic operations. Reports to the Emergency Support Function (ESF) 8 (Health and Medical) person(s) at the operations desk in the Kitsap County Emergency Operations Center (EOC). Logistics (Logs) Chief Responsible for ordering any supplies required for operating the clinic. Including the re-supply of pharmaceuticals. All requests for supplies and personnel will be submitted via the logistics desk in the EOC. Reports to the Incident Commander. Operations (Ops) Chief Responsible for the operations of the clinic including the training and assignment volunteers to the various task required to support the Clinic. Qualifications: Health Care Professional, MD, PA, Pharmacist. Conveys all support requirements to the Logistics Chief. Reports to the Incident Commander. Plans Chief Responsible to evaluate the emergency action plan during operations and recommend changes to the Operations Chief and Incident Commander. Reports to the Incident Commander. Security Chief Responsible for maintaining a safe and secure environment in and around the clinic. Qualifications: State, County or local law enforcement official. All requests for Law Enforcement support will be via the EOC. Reports to the Incident Commander.

Tab C - 3


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VII. Secondary Considerations Education Handouts with information about the agent will be available to the public in concert with an aggressive public information campaign. This campaign will be conducted via all media available to the Joint Information Center (JIC) located in the EOC. Patient Information Although crucial to an Epidemiological investigation, the collection of patient information will be a secondary consideration and will not impede the prophylaxis of the population. A voluntary Name, Address, Phone and History (NAPH) forms will be available to all patients. They will be available after they receive their medication and left in the designated area at the exit of the clinic or collected when they return to their park-n-ride destination. Contraindications As this procedure is only in effect during a post exposure event with a 48-hour response time, only those individuals with a known life threatening contraindication will be addressed. All others will be given the antibiotic with the greatest availability.

Tab C - 4


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Appendix 1, Tab C

Pre Identified Neighborhood Clinic Distribution (NDC) Staffing This list of jobs specifically filled by Kitsap County Health District employees will provide the absolute minimum staffing to open a NDC. All personnel listed have been notified and to the maximum extent possible and are located within the area being prophylaxed. All employees and eventually volunteers will have the appropriate identification (Health District or Department of Emergency Management) to ensure authorized access to the clinic.

6:30 a.m. – 7:00 p.m. 6:30 p.m. – 7:00 a.m. IC Public Health Official Public Health Official Logs Ops Public Health/MRC Medical Public Health/MRC Medical Plans Security

Appendix 1,Tab C I-C-1

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31 August 2005 KITSAP COUNTY HEALTH DISTRICT


TAB D

CLINIC OPERATIONS

I. PURPOSE

To define the roles, resources, and materials needed in order to plan a functioning system for mass dispensing of prophylaxis to persons exposed to agents either naturally occurring or as a result of an act of terrorism in the Region.

II. GOALS OF THE DISPENSING OPERATION

To designate dispensing venues that will:

1. Dispense prophylaxis to at least 40 people per hour per dispensing stations. Example: 4 stations, 160 people, 12 hours, 1920 total (Table D-1)

2. Be capable of at least 4 dispensing/vaccination stations per dispensing venue. 3. Safely and successfully dispense antibiotics to at least 3000 people in a 48-hour

time period by operating at least 12 hours per day for two days. 4. Be capable of repeating the dispensing operations on at least three separate

occasions in order to provide the antibiotics required to achieve up to 60 days of treatment for each exposed person.

III. PRE-EVENT

A. PLANNING

1. Dispensing venues are available within hours of the decision to provide mass dispensing. Pre-identification of resources is essential.

2. Assign and orient personnel to incident command and the functions of the leadership positions to assist in planning.

3. Purchase, stage, and store needed equipment and supplies. 4. Establish collaborative drug therapy agreements/standing orders. 5. Devise a communication system to notify area health care providers of any mass

vaccination/prophylaxis activity. 6. Public Health will develop a plan for the utilization of known local stockpiles at

Hospital, Clinics and Pharmacies that can supply antibiotics and enter into an MOU/MOA for how these items may be deployed, transported and used for first responders.

7. Write the situation-specific, exposure information sheet. Use a template that should include the following information:

a. You were exposed to ____ if _____. b. Antibiotics are recommended to you today as a preventive treatment. c. If you get ill, you should see your doctor.


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B.

d. Some people will have side effects from the prophylaxis, call ___ or see your health care provider if you have side effects.

e. If partial treatment is offered, then provide a description of how people can find out how to get the balance of their antibiotic treatment.

8. Develop a plan for creating signage and getting copies made of forms with 24-

hour, 7-day week availability. 9. Make formal pre-arrangements for transportation of people and supplies.

a. Include a plan for transporting exposed persons to dispensing venues. b. Identify teams of people who will unload trucks or other vehicles used to

transport supplies, and cart them into the dispensing venue arrange items according to the dispensing layout.

10. Public Health and the Department of Emergency Management (DEM) will

manage the list, or database, of potential dispensing clinic facilities that describes the features of the facility, MOU/MOAs that provide contact persons for accessing the facility, etc.

11. Within the LHJ jurisdiction, make contact with local law enforcement agencies in order to have law enforcement assess each potential dispensing facility for security vulnerabilities and pre-establish security arrangements.

12. Coordinate with DEM the list of volunteers from the medical community, fire protection services, emergency management agencies, and other sources for possible staff.

13. Public Health will keep all emergency treatment records and consent forms to be secured and stored for at least 2 years, as required by law.

14. Encourage all volunteers to participate in the practice drills. 15. Exercise arrangements to open the dispensing venues. 16. Exercise plans to transport and deploy supplies and equipment. 17. Exercise plans to transport personnel and exposed.

DEPLOYMENT OF RESOURCES

1. Estimate the total number of persons requiring vaccination/prophylaxis. Specify

the numbers of special needs and children who are anticipated to be treated. 2. Utilize the suggested staffing and supply estimate table (Table D – 1), to

determine personnel and supply requirements for each dispensing location. 3. Select the dispensing venues that will best serve the exposed populations. 4. Select and contact personnel to staff the dispensing venues. 5. Public Health personnel will greet, assign, and orient all staff upon arrival. 6. Notify area health care providers of the mass vaccination/prophylaxis effort.

Describe why the effort is necessary, define exposure, and describe what antibiotics are recommended for exposed individuals. Describe how health care providers will be asked to support campaign. Specifically they will need to be ready to handle patient-specific medical issues related to the vaccination/prophylaxis and be able to answer questions about drug therapy, side effects, and contraindications.

Tab D -2


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7. The county Emergency Operations Center (EOC) should contact the Washington

State Emergency Management with requests for supplies or support whenever state or federal resources are required.

8. Begin setup of facility using diagrams provided. 9. Create an exposure information fact sheet and consider the following questions

when creating this fact sheet:

a. Exposure to what? (1) Name the biologic agent. (2) There is no need to give details about the disease, as these should be

included on the disease fact sheet. b. When did the exposure occur?

(1) Dates. (2) Times. (3) Locations.

c. How did the exposure occur? d. What should exposed persons do?

(1) Read the disease information sheet. (2) Watch for symptoms? If ill, then get medical care right away. (3) See a health care provider for advice? (4) Obtain chemoprophylaxis or vaccinations/why?

e. Could an animal get sick if exposed? If so, include information about obtaining veterinary guidance.

f. Can exposed persons infect other persons or pets? If so, what can be done to protect other persons or pets?

g. What are public health and law enforcement doing to investigate and respond to the situation?

h. Where should people call if they have additional questions about the exposure?

IV. IMPLEMENTATION PHASE

A.

B.

The purpose of the implementation phase is to identify, triage, register, and dispense vaccination/prophylaxis to persons who have had an exposure to an infectious disease. The implementation phase is supported by venue-specific administrative functions.

C. STAFF ORIENTATION

1. General for all Clinic Staff

a. Purpose of activity.

b. Identify the leaders and their roles.

c. Incident command function.

d. Overview of dispensing site--entrance, exit, lighting, bathrooms/hand-washing facilities, disposal of hazardous waste, telephone, breaks, etc.

e. Tour of dispensing venue.

Tab D -3


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2. Further orientation after breaking into specific Function Groups.

a. Review function area goals and job descriptions.

b. Describe how this function relates to the other functions.

c. Physically review function area with team and make adjustments as necessary to layout.

d. Assign each staff member to his or her station location.

e. Provide additional function-specific training.

D. ON-SITE COMMAND PERSONNEL ROLE DESCRIPTIONS AND RESPONSIBILITIES

1. Incident Commander is the person who coordinates the details for dispensing operations.

a. In coordination with facility management, determines if adjustments to the mass prophylaxis plan should be made to accommodate the specific venue.

b. Communicates staff and supply needs and activity count to emergency operations staff.

c. Handles media inquiries, if appropriate, or directs media inquiries to the designated Public Information Officer in coordination with Emergency Operations Center (EOC) staff.

d. Coordinates venue-specific Volunteer assignment, Information Technology (IT) personnel (if available).

Desired qualifications: Non-medical with excellent managerial skills and good knowledge of emergency management, logistics support and incident command.

Supervises: Chiefs of logistics, security, and operations.

2. Assistant to Incident Commander designated to aid the Incident Commander.

3. Logistics Chief

a. Coordinates ordering of medications, medical supplies, paper and clerical supplies.

b. Maintains inventory of all supplies and coordinates their distribution.

c. Coordinates sanitation (i.e., biohazard and garbage pick-up, restrooms, hand-washing facilities.)

d. Coordinates food and beverages for the staff through the logistics section of the county EOC.

e. Orients and supervises Supply/Forms Router/Assistant.

Desired qualifications: Non-medical with excellent managerial skills and good knowledge of logistics support, emergency management and incident command.

Reports to: Incident Commander

4. Supply/Forms Router/Assistant

Tab D -4


31 August 2005

(1) Assembles patient forms on clipboards, including:

(a) Registration/Consent Form (which includes demographic information, consent, and medication administration information).

(b) Emergency Treatment Form.

(c) General Frequently Asked Questions (FAQ) about the disease in question or disease specific fact sheet.

(d) Appropriate special patient information sheet(s).

(2) Gives assembled packets to the Greeter/Triage for distribution.

(3) Assures that there is frequent restocking of supplies at all stations.

(4) At a minimum of every hour, collects and counts completed.

(5) Collects clipboards and pens from the Discharge/Administration/Post Education area and returns them to Greeter/Triage station.

5. Security Chief

a. Provides protection of dispensing clinic staff, pharmaceuticals and should be present at all times during the prophylaxis effort.

b. Coordinates crowd control.

c. Coordinates parking and traffic control.

d. Ensures the presence of police or other security personnel.

e. Orients and supervises Security Personnel who:

(1) Secure a limited access perimeter around the clinic site.

(2) Secure the clinic itself (main entrances and exits, front drive and parking areas).

(3) Maintain order in the facility.

(4) To carry out this strategy, security personnel must be prepared to

(a) Detain persons for examination or quarantine

(b) Establish a mechanism to identify and meet appropriate emergency, transit and supply vehicles at the perimeter and direct them to the appropriate entrances.

(c) Direct authorized persons to appropriate entrances.

(d) Provide continuous medication security.

(e) Intercept and detain persons who attempt to gain unauthorized entrance to the facility.

(f) Control and disperse crowds.

(g) Operate available security equipment.

Qualifications: Must be law enforcement or professional security personnel.

Tab D -5


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6. Assistant to Security Chief designated to aid the Security Chief.

7. Operations Chief (Dispensing Clinic Manager):

a. Assures proper set up, implementation, and breakdown of the prophylaxis activity.

b. Identifies staffing and supply needs.

c. Assures the confidentiality of client information.

d. Orients function leaders to the venue and clinic flow.

e. Supervises the following functions: Triage, Registration, and Dispensing Functions.

Qualifications: Clinic management skills. Must be licensed medical professional.


8. Assistant to Operations Chief designated to aid the Operations Chief.

E. OPERATIONS SET-UP (CLINIC FLOW)

1. Prophylaxis venue should be set up so that the progression of pedestrian traffic moves forward through the function activities. (See Figure D - 1)

2. Triage Function:

a. Greeter/Triage: This person greets and performs the initial triage for all potential patients. The location will most likely not be co-located with the clinic. Optimally they will be located at the point of pick up designated by the designated transportation authority (i.e. park and ride). If a segmented transportation plan is not feasible they will be located outside the ENTRY to “dispensing clinic perimeter.”

(1) Greets everyone and performs the initial triage on all persons. The obviously ill will be referred to their Primary Care providers.

(2) Provides a paper work package (NAPH, Who is Exposed, Contact Registration forms, and Education information) to each person/family.

Desired qualifications: This should be a person with basic medical assessment skills, such as an RN, LPN, paramedic or EMT. This person should have a good concept of the overall purpose and functioning of the prophylaxis effort.

Reports to: Operations Chief

b. Clinic Flow Monitor (CFM)/Triage: This person will be at the point that the busses drop off and will direct them to the entrance of the clinic.

(1) While the patients are in the line waiting to be processed, the CFM will be walking up and down the line and monitoring for Special needs issues. These issues include: Onset of illness, Non English speakers, Obvious issues that will disrupt clinic flow (unrest).

Tab D -6


31 August 2005

Desired qualifications: Ideally, the CFM is qualified as counselors with basic mental health assessment skills (e.g., clergy, crisis counselor, and school counselor).

Reports to: Operations Chief.

3. Education Function

a. Education will be addressed via four venues.

(1) Information handed out with the packages during check in.

(2) Signage throughout the clinic.

(3) Mass media will be the primary information containing as a minimum: What is happening, where to go and what to do.

(4) Studies have shown that most people will seek out sources that they trust. They will contact at a minimum, Family friends that are in the medical profession, Clergy and possibly the Internet.

4. Registration Function

a. Registrar checks forms for completeness and accuracy, including signature for consent.

b. Highlights “yes” on any answers (regarding possible contraindications to treatment), Registrar sends client to Medical Counseling Station for review of the contraindications (CI), common reactions and adverse events for the medication.

c. If client checks “no” on all answers (indicating no contraindications to medications), Registrar sends client to Dispensing Station.

Desired qualifications: Supervisory skills and good customer service skills are very important.


5. Special Needs/Questions Function

The purpose of Special Needs is to facilitate smooth traffic flow by providing separate attention to those persons who require special assistance.

(a) Persons who require special assistance include persons who have mobility, sight, or communications issues that require assistance during the Registration process.

(b) It includes persons who are not fluent in English or who have other communication difficulties.

Note: If most common language is other than English, the main clinic may be in that language with English as the secondary track.

Desired qualifications: Function is administrative in nature, requiring good problem-solving and decision-making skills. This person should have a calm,

Tab D -7


31 August 2005

organized manner and be able to communicate clearly, and have a good concept of the overall purpose and functioning of the prophylaxis effort.

Reports to: Operations Chief

Note: Following Registration the Clinic Flow Monitors (CFM) will provide preparatory instructions to patients. Example: Please roll up the sleeve of your shirt. (Flu shots)

6. Dispensing Function

The Purpose Of Dispensing Is As Follows:

a. The strategy is to provide efficient, standardized assessment, counseling, and dispensing services to exposed persons within the limited scope of this effort and under the signature authority of a licensed physician. Persons who have a personal health care provider relationship should be encouraged to use this relationship to handle more complicated questions.

b. Identify persons who are eligible for express or non-routine dispensing and direct them to the appropriate processing point.

c. Select and dispense the appropriate antibiotic and dosage.

Dispensing Flow:

a. Clinic Flow Monitor directs individuals to dispensing station.

b. One dispensing station - one pharmacist (for all stations), two pharmacy dispensing personnel, one line on each side, and one assistant at the end of the table.

c. A separate station may be indicated for special needs, depending on the clinic.

d. The Pharmacist determines which prophylaxis each person receives.

e. Pharmacy dispenser, under the supervision, of the pharmacist distributes and the assistant documents the appropriate information on the individual’s treatment record.

Note: All members of the dispensing team should be fully qualified to allow for movement from one job to another within the prophylaxis function.

7. Medical Counseling/Sick Assessment

a. The purpose of Medical Counseling/Sick Assessment is to provide a medical assessment of persons identified as possibly sick at any of the earlier stations (or at Greeting/Triage, Registration or Dispensing stations) and to evaluate adverse events occurring while the clinic site is operating.

b. Medical Counseling/Sick Assessment Roles and Responsibilities

(1) Medical Care Provider

(a) Provide medical counseling for any significant medical concerns

(b) Assesses illness symptoms of patients referred from Triage or at Education, Registration or Dispensing stations.

Tab D -8


31 August 2005

(i) If the symptoms are compatible with the disease and are

associated with an exposure, arranges transport (via the EOC/ECC) of patient to a hospital for care.

(ii) If the patient assessed is found to be eligible for prophylaxis, then clears patient to proceed with Education, Registration or Dispensing. Provider would sign the release on the Registration/Consent Form (only for those seen by the Medical Care Provider).

(iii) Supervises Sick Assessment Assistant

Desired qualifications: The medical care provider should be a medical doctor, ARNP or PA.


(2) Sick Assessment Assistant

(i) Supports the Medical Care Provider.

(ii) Supports the flow of clients through the sick station.

Desired qualifications: First aid and CPR certification.

Reports to: Medical Care Provider.

8. Discharge/Administration/Post Education

The purpose of Discharge/Administration/Post Education station is to collect forms, remind patients about follow-up care and reinforce the education materials in the packet they received in the beginning. This station also provides dose information back to logistics for inventory management.

Desired qualifications: Non-medical with excellent managerial skills and good knowledge of logistics support.


Tab D -9

EXIT Kitsap County Health District

Vaccination/Dispensing Clinic Site Plan (4 Stations)

Medic

al Co

unse

ling

REGISTRATION

CFM

SPECIAL NEEDS

AS

HOSPCAR

TRIA

GE A

REA

REGI

STRA

TION

VA

CCIN

ATIO

N/DI

SPEN

SING

CFM

Discharge/Forms Collection

Non-

routi

ne

Routi

ne/E

xpre

ss

FORM

S CO

MPLE

TION

SICK SESSMENT

Figure D-1

ITAL/PRIMARY E PROVIDER
ENTER
MEDICAL AID STATION

Tab D

GREETER

EXIT

-10

Table D – 1, Staffing and Supply estimates

Facility Staffing and Supply Estimates for Mass Chemoprophylaxis Assumes: Two shifts with 12 hour activity; dispensing rate of at least 40 people, per dispensing lines, per hour

Number of dispense lines 4 6 8 10 12 14 16 Estimated Demand (# people) 1920 2880 3840 4800 5760 6720 7680

Command Functions Incident Commander 1 1 1 1 1 1 1

Logistics Chief 1 1 1 1 1 1 1 Security Chief 1 1 1 1 1 1 1

Operations Chief 1 1 1 1 1 1 1 Staff

Greeter/Triage 1 1 1 1 1 1 1 Clinic Flow Monitors 4 4 4 4 4 4 4

Registration 1 1 1 1 1 1 1 Special Needs/Questions 1 1 1 1 1 1 1

Medical Counseling/Sick Assessment 2 2 2 2 2 2 2 Dispensing 7 10 13 16 19 22 25

Discharge 1 1 1 1 1 1 1 Supply/Forms Router 1 1 1 1 1 1 1

Assistants (IC, OPS, Security) 3 3 3 3 3 3 3 Supplies

Clipboards 200 300 450 600 750 900 950 Pens 250 300 450 600 750 900 950

Info sheet about exposure 1920 2880 3840 4800 5760 6720 7680 Disease Specific Fact Sheets 1920 2880 3840 4800 5760 6720 7680

Treatment Record and Consent 1920 2880 3840 4800 5760 6720 7680 Tables 10 14 18 22 26 30 34 Chairs 100 140 180 220 260 300 340

Radios (internal communications) 6 6 6 6 6 6 6 Microphones or bullhorns 2 4 6 6 6 6 6

Tab D -11

Supplies Dosage Schedules for Adults/Children 5 6 10 12 14 18 20

Highlighting Pens 4 8 12 16 20 24 28 Indelible Marking Pens 4 8 12 16 20 24 28

Prepackaged Ciprofloxacin Dosage Packs 1920 2880 3840 4800 5760 6720 7680

Ciprofloxacin Suspension Prepackaged Doxycycline Dosage

Packs 192 288 384 480 576 672 768

Doxycycline Suspension Dosing Syringes (for children < 6 years) 192 288 384 480 576 672 768 Prepackaged Amoxicillin Dosage Packs 200 300 400 500 600 700 800

Ciprofloxacin Information Sheets 1920 2880 3840 4800 5780 6720 7680 Amoxicillin Information Sheets 250 500 750 1000 1250 1500 1750

Doxycycline Information Sheets 250 500 750 1000 1250 1500 1750 Signage Pharmacist 4 6 10 12 14 18 20

Signage Call --- for Further Information 2 4 6 8 10 12 14 Signage Exit 2 4 6 8 10 12 14

Signage Questions? 1 2 3 4 5 6 7 Signage "Pharmacist" 5 10 15 20 25 30 35

Table D – 1, Staffing and Supply estimates

Tab D -12

Staff Orientation Checklist Purpose of today’s dispense clinic Purpose of triage Orient exposed to process for obtaining medications and reasons for medications Provide basic info Give time to complete paperwork in preparation for registration and dispense Handout specific position descriptions, please read General purpose of each triage position

Greeter/Triage (by entrance)-first time asks, were you exposed? Perform initial health check; give form packet (each packet on clipboard with treatment record and consent form, drug info, exposure info, direct to transportation or registration area).

Supply forms router-Make sure that greeting/triage area has writing supplies and clipboards assembled, also, help with clinic flow direction. Retrieve clipboards, pens, from dispense discharge/administration/post education as necessary

Sick Assessment – Deal with Sick/Ill. Arrange transport if required. Give site-specific, position duty additions or refinements, if any Set up area so that there is a linear flow through to registration

Monitor traffic flow at beginning of clinic- May have to temporarily reorganize staffing so that there are more staff up front processing the public in the greeting and triage area.

Describe what to do with: • The sick or ill. • Special Needs-communication, mobility, etc. • Disruptive/Dangerous (Let security handle) • Persons who tell you that they were not exposed, but insist on antibiotic treatment • Persons who are recommended antibiotics, but refuse it • Persons who do not have proper consent for treatment

What is proper consent? 18 years or older, spouses, legal guardians or parents for children, legal guardian or parent does not need to be present, another responsible adult can be, but the parent or guardian should have signed); legally married spouses

What is not proper consent? Minor, aunt signing for niece, coworkers signing for each other

Unaccompanied minors No medication dispensed without a responsible adult (present) If emancipated minor, then ok to dispense; have to meet criteria • Persons who have questions beyond your ability First try to find info in handouts Refer to Medical Counseling Need a break? Contact Operations, Logistics, Security Chiefs Tour through venue Walk through to explain how each section works and how it relates to each other section Show where specific functions occur.

Table D – 2, Orientation Checklist

Tab D -13

This Page Intentionally Left Blank


31 August 2005

KITSAP COUNTY HEALTH DISTRICT STRATEGIC NATIONAL STOCKPILE (SNS)

DISTRIBUTION PLAN

TAB E Reserved for future use

Documents

Kitsap County Health District Strategic National Stockpile ... SNS 2005 - Sanitized.pdfKitsap County Health District Strategic National Stockpile Plan 31 August 2005 2. Formally request