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Regional Pharmaceutical ResourcesColleen Terriff, PharmD, BCPS (AQ-ID), MPH (soon)
Clinical Associate ProfessorWashington State University College of Pharmacy
Deaconess Hospital and Rockwood Health SystemsNovember 21, 2013
History of Involvement• 1999 hoax anthrax letter• Y2K preparation for hospitals• Poster at Midyear and AJHP publication• MMRS Spokane City/County Pharmaceutical
Coordinator (2000- present)• Sept 11, 2001• Participation in variety of exercises:
– Mass vaccination– Mass dispensing– Mass casualty
Pharmaceutical Coordinator• CDC CHEMPACK med exchanges• Assist with public health• Stockpiling:
– Decisions: location, medications, ancillary supplies– Distribution– Dosing and preparation information– Inventory– Destruction
Pharmaceutical Resources• MMRS Stockpiles• CHEMPACKS• SNS Antiviral Cache• VA Cache• HRSA Employee Cache• Hospital Inventory for SRHD• Community Pharmacy Inventory as needed
Bioterrorism PlanningAgent Prophylaxis Treatment Plan
Anthrax Antibiotics Antibiotics Local and SNS
Botulinum Observe AntitoxinSupportive care
SNS
Plague Antibiotics Antibiotics Local and SNS
Smallpox Vaccine Invest. DrugsSupportive care
SNS
Tularemia Antibiotics Antibiotics Local and SNS
VHF Invest. Drugs Invest. DrugsSupportive care
SNS
Local BioterrorismPharmaceutical Plan (MMRS)
• Agents– Levaquin IV/PO, doxycycline IV/PO, gentamicin IV
• Others– dosing syringes, sterile water for injection
• Considerations– pediatrics, pregnancy, elderly,
immunocompromised– first-responders and healthcare professionals– prophylaxis vs. treatment
Chemical Terrorism PlanningAgent Treatment Plan
Nerve Agents 2-PAM, atropine, diazepam
Local (CHEMPACK)and SNS
Vesicants Supportive care(BAL for Lewisite)
SNS- BAL
Industrial Chemicals
Supportive care(Cyanide antidotes)
Local and SNS
Riot Agents Supportive care Local and SNS
Local Chemical TerrorismPharmaceutical Plan (MMRS)
• Nerve agent antidotes:– 2004:
• MARK-1 and diazepam autoinjectors with “sprinklings” of 2-PAM vials, diazepam carpujects
• ALS transport (AMR and Medstar) and non-transport (fire)
– 2009:• Duodotes
• Cyanide antidotes (hydroxocobalamin)– fire chief rigs– Expired: AMR
CHEMPACK Program• Nerve agent antidotes
– antidotes more readily available– improve local response time– treat thousands of patients
(including peds)
• Federally owned cache– decrease cost to local areas: initial
and replacement– Shelf-Life Extension Program (SLEP)
Shelf-Life Extension Program• Previously- military• SNS in conjunction with the FDA may extend
shelf-life of meds (expiration date)• Strict criteria:
– storage and security• Meds from CHEMPACK:
– regardless of dating on vials/packages….– ensured potency!!
• Just implemented for Tamiflu susp.
CHEMPACK DistributionEastern Washington
• Hospital:– Deaconess– Holy Family– Sacred Heart– Valley
• EMS:– AMR (x2)– Valley Hospital– Colville– Pullman
Strategic National Stockpile Program
• CDC/Federal Government assistance• Stockpile (4 components):
– 12 hour push package• antibiotics (IV and PO) and antidotes• fluids, bandages, IV supplies, supportive care meds
– Vendor Managed Inventory- drug or equip.-specific– Vaccine and Antitoxin– CHEMPACK program- pilot: NY, SD, WA
• Additional resources: personnel, $$
Antivirals Spring 2009• CDC released 25% of SNS antivirals• DOH received antivirals and then distributed
to sites identified by local HD• Local:
– Hospitals– Retail/chain with expanded access
• Issues:– storage (physical)– short expiration of suspension– different packaging
Antiviral Issues Continued…• Locals now own stockpile• Who is the “gatekeeper” of access?• Need to use up local supply (in pharmacies)
first, then can utilize SNS• Ancillary supplies…
VA Stockpile• Large facilities• Small facilities:
– Spokane
• Mass casualty• Color coded• Includes supportive
care meds
• 2008 Directive
HRSA Employee Cache• Ciprofloxacin• Doxycycline• For employees and
families and hospital-based EMS providers
• Maintained by area hospitals
Deaconess Stockpiles1. MMRS- ill patients (i.e. IV meds)
• ED provider can access
2. MMRS- POD– SRHD or Spokane EOM- to be sent to POD
3. CHEMPACK plus expired meds4. Antiviral SNS cache5. Employee cache
• Antibiotics and antivirals• HRSA grants
Hospital Pharmacy Inventory• Deaconess and Shriners• Holy Family and Deer Park• Sacred Heart• Valley• VA• Antibiotics, chemical exposure treatment, antivirals• Estimation• SRHD listed resource
Community Pharmacy Inventory• Enroll help of:
– WSU College of Pharmacy Drug Information Center– Spokane Pharmacy Association
• Limited meds• Dispensing to community
MOU’s with Pharmacy
• State-wide initiative community pharmacies:– Chains– Independents
• SRHD with WSU COP:– Mass dispensing– Mass vaccination
Medication Destruction• Partnering with law enforcement (SPD)• Coordinating stockpile destruction with other
incineration needs for LE• Mainly MMRS chemical terrorism meds