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SNS Planning and Capabilities Update

SNS Planning and Capabilities Update. Greg Burel. Director, Division of Strategic National Stockpile Office of Public Health Preparedness and Response, CDC. 2011 Public Health Preparedness Conference. June 29th, 2011. Agenda. Mission Technical Assistance Executive Order 13527

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SNS Planning and Capabilities Update

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  1. SNS Planning and Capabilities Update Greg Burel Director, Division of Strategic National Stockpile Office of Public Health Preparedness and Response, CDC 2011 Public Health Preparedness Conference June 29th, 2011

  2. Agenda • Mission • Technical Assistance • Executive Order 13527 • PAHPA Reauthorization • Novel Distribution and Dispensing Models • Challenges

  3. Strategic National Stockpile Mission Deliver critical medical assets to the site of a national emergency • Stockpiling the assets and delivering them is important work • That work is wasted if the capabilities and resources don’t exist at the state and local level to utilize the assets • Collaboration is key to making the SNS a continuing resource to the nation

  4. Technical Assistance

  5. DSNS Modeling Support • Distribution • TourSolver • Optimized Distribution Routing software • 396 registered users (as of 4/10/2009) • CERA • Modeled RSS capabilities in 36 cities • Two year contract ended 12/2008 • Dispensing • RealOpt • Optimization tool for designing PODs and treatment clinic planning and operations • Modeling Forum (snsmodeling.org) • Purpose of promoting the exchange of ideas, models and simulations designed to improve emergency response efforts and public health • 74 registered users

  6. Sharing and Improving Practices • Collaboration with partners • Federal Executive Board • ASTHO • NACCHO • Sharing promising practices • SNS ListServs (2) • SNS Extranet • SNS Mass Dispensing Satellite Broadcast Series • 10 broadcasts since 2004 • October 2009: Legal Issues • Continuing Education credits offered • Regional CRI/SNS Workshops • National SNS Training Summit • Fund NACCHO/ASTHO SNS Advisory Groups • Fund NACCHO’s STOCK-Box

  7. Webinar Series • Second Wednesday Webinars • Revolving Topics and Presenters • Archive available on SNS Extranet • Recent Topics: • Integrating SNS, PHEP, and HPP Exercises with HSEEP (May 11, 2011) • DEA Considerations in SNS Planning (April 2011) • Executive Order 13527: Updates on Federal Planning (March 2011) • Closed POD (February 2011)

  8. Division of Strategic National StockpileDeployable Teams • Stockpile Services Advance Group (SSAG) • Experts on Strategic National Stockpile response and state/local capability • Provides short-term technical assistance • Members represent DSNS at Emergency Operations Center, Incident Response Coordination Team, etc. • Receiving, Staging and Storing (RSS) Task Force • Assists with receipt, staging, onward movement and re-supply • Federal Medical Station (FMS) Strike Team • Helps state/local officials set up, re-supply and recover

  9. Composite Measure • Address the need for more accurate preparedness and response indicator • Solution - link the functions and capabilities of dependent governmental sectors in the form of a composite measure • Medical Countermeasure Distribution and Dispensing (MCMDD) composite measure • Developed to serve as a collective indicator of preparedness and operational capability • Measure states, directly funded cities, Cities Readiness Initiative (CRI) planning jurisdictions, U.S. territories and freely associated states • Derived from results of state TARs conducted by DSNS staff, CRI TARs conducted by DSNS and state staffs, drill submissions, a single full-scale exercise, and compliance with programmatic standards

  10. State by State Preparedness Report • Developed by CDC Office of Preparedness and Emergency Response (OPHPR) • Data and Content from DSNS, Division of State and Local Readiness (DSLR), and Division of Select Agents and Toxins (DSAT) • Provide visibility and measurability to Congress and the White House on the value of investments in preparedness • Relatable stories and successes are key to communicating our accomplishments and identifying our needs • Share your story with your SNS Program Services Consultant

  11. Benefits Beyond Terrorism Response • 10 years of SNS planning, training and exercise • Established nationwide capability to receive and dispense SNS MCMs • Benefits beyond this target capability: • Red River Flooding 2009 and 2010 - Fargo, ND • Tactical communications plans, public information messaging, incident management team protocols and procedures, and distribution networks developed through CRI planning efforts used to coordinate successful evacuation, mass care and sheltering of thousands of citizens • 2009 H1N1 Response - Nationwide • State and local health departments around the country utilized their CRI plans to receive, distribute and dispense H1N1 vaccines and antiviral drugs, and many MSAs reported using their plans to set up PODs for vaccination clinics, recruit volunteers, establish closed-POD partnerships and reach vulnerable populations.

  12. Executive Order 13527

  13. Executive Order 13527 • Signed on December 30, 2009 • Charged the federal government with establishing capability for the timely provision of medical countermeasures (MCM) following a biological attack • Three sections identified specific requirements • Section 2: US Postal Service delivery of MCM • Section 3: Federal rapid response • Section 4: Continuity of operations

  14. EO 13527: Section 2 • Postal Model • Collaboration with HHS and USPS since 2004 • Proof of Concept Drills in 2006-2007 • EO 13527 reaffirms support for postal model • Augments traditional PODs, does not replace • Critical requirement for execution: Security Planning

  15. EO 13527: Section 3 • Federal Rapid Response…develop the capacity to anticipate and immediately supplement the capabilities of affected jurisdictions to rapidly distribute MCM following a biological attack • Interagency effort evaluated requirements based on state/local gaps and federal capabilities • Three approaches identified: • Supplemental manpower • Federal closed PODs • Federal open PODs • Ongoing efforts to explore: • Supplemental manpower (including security) • Use of online medical screening to support PODs • Decreasing MCM deployment timelines

  16. EO 13527: Section 4 • Continuity of Operations • Protection of federal workforce to maintain government services • Interagency effort • Great challenges to overcome • Engagement of state and local leaders to leverage resources and integrate plans

  17. PAHPA Reauthorization

  18. PAHPA Reauthorization • Pandemic and All Hazards Preparedness Act • Signed in 2006 • Being addressed by Congress this year • Draft bill currently working in House Energy and Commerce • CDC engaged with HHS, ASTHO, and NACCHO to identify needs • Proposals developed, reviewed and finalized through HHS • Participated in series of briefings to educate staff on Senate HELP Committee on key topics to PAHPA: • SNS • BARDA and Advanced Development of MCM • State and Local Perspectives

  19. Novel Distribution and Dispensing Models

  20. Innovative Approaches to Mass Dispensing:Examples from the States • Boy Scouts – used to deliver medication during an event. • CERT Door-to-Door Delivery • Closed POD (utilities, businesses, faith based organizations, military installations, etc.) • Drive through bank dispensing • Drive through POD's (colleges and Universities) • Grocery Store – used for dispensing

  21. Innovative Approaches to Mass Dispensing:Examples from the States • Home Owner Associations - Fort Lauderdale (Broward County) use Home Owners Associations to facilitate mass dispensing to the public along with traditional POD models. • Large and Small closed PODs • Long Term Care Facility pharmacies – used for dispensing • Mass Transit Stations – dispensing • Mega POD - to facilitate mass dispensing in highly congested areas that is conducive to traffic grid-lock.

  22. Innovative Approaches to Mass Dispensing:Examples from the States • Mobile POD trailers • Private physicians office Closed POD • Retail Pharmacy • School Bus Delivery • Tele-pharmacy dispensing operations • Tiered POD system (with most needed and highest population PODs opened first) • USPS Dispensing

  23. Partnerships Between State and Local Health Departments and Department of Defense • Sample Partnership - North Dakota • Closed POD MOAs in place with Minot AFB and Grand Forks AFB. Agreements first brokered by state health officials, then involved local health departments. Agreements cover active duty military, contractors and family living on base. Air Force medical staff will operate the PODs. • Sample Partnership - Missouri • MOU is in place with Fort Leonard Wood. In addition, four local public health agencies are engaged in planning activities with Whiteman AFB. • AL Center for Emergency Response and Terrorism has initiated quarterly meetings with military and VA partners. Meetings include state and local public health agencies and cover a variety of planning topics, including interoperable comms and closed PODs for dispensing with federal military partners.

  24. Case: Marriott Closed POD Pilot • DSNS conducting pilot project with Marriott hotels to establish closed PODs for hotel properties in local jurisdictions • 16 local public health jurisdictions will be invited to participate, totaling 60 Marriott property locations • Current outreach to eight public health jurisdictions, totaling 37 property locations. Six of the eight jurisdictions agreed to participate, one decision is pending and one declined. • To date, most work has been done in Washington, D.C., and San Diego County, Orange County and Riverside County, CA

  25. Case: Internal Revenue ServiceClosed POD Program • Objective • To assist the states in establishing multiple closed POD sites • To further enable the mass distribution of pill-form medicines during a regional or national emergency • To provide these necessary medicines as a service to IRS employees, IRS contractors, and their family members in an efficient and expeditious manner • To alleviate burden on public PODs • Authority • Homeland Security Presidential Directive-21 (HSPD-21) authorized CDC to partner with other federal agencies and the 50 states to establish open and closed PODs to dispense medicines during a declared national or regional emergency.

  26. IRS Closed POD Overview • Can currently service 321,700 IRS employees, contractors and family members • 104 IRS facilities across the country are planned to be serviced through the closed POD program • 33 facilities actually serve as closed PODs • These 33 facilities also service an additional 71 IRS locations within commuting distance • IRS facilities with 500+ employees are targeted as actual closed POD sites

  27. Developing Volunteer Capabilities • One time funding opportunity announcement • Pilot project between CDC/DSNS, state and local public health agencies • Fund a nationally recognized community volunteer and support organization to develop plans to recruit, train, and maintain volunteers • Support state and local public health agencies during a dispensing campaign • Create an exportable model that can be applied by other organizations and agencies • FOA open April 4th – June 4th, 2011

  28. Challenges

  29. Dispensing Challenges • Liability issues • PREP Act • Non-medical dispensing concerns • EUA Issues • Potential for delay in distribution • Staffing Issues • Volunteer pools • High turnover rate at state and local levels • Mandatory furloughs and work force reductions • Limited and shrinking funds • Logistics of achieving high throughput • Exercise Needs

  30. Fiscal Challenges • Reductions in PHEP funding • Adding requirements at the state and local level • Carrying the message: • State and local preparedness/state and local resources are key to effective response • OPHPR Director Ali Khan’s testimony to House Homeland Security subcommittee on 5/17/2011: “Effectively using the SNS requires a collaborative effort by state, local, tribal, territorial, and federal partners on everything from MCM development to development of diagnostics to detection of an event to distribution and dispensing of MCM.”

  31. Thank you www.cdc.gov/phpr/stockpile/stockpile

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