countermeasures and emergency management considerations matthew minson, md opsp/aspr/os/usdhhs
TRANSCRIPT
Countermeasures and
Emergency Management Considerations
Matthew Minson, MD
OPSP/ASPR/OS/USDHHS
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Countermeasure Distribution, Dispensing, and Delivery
Current strategies for countermeasure delivery are generally classified by the following:
- Post Exposure Prophylaxis PEP (Given to the public after exposure or presumed exposure during a window of incubation)
- Therapeutic or Corrective (Given once disease has begun, requiring professional administration)
This presentation focuses on the former or mass prophylaxis campaigns
This is best described in the CRI context
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CRI Intelligence
In general the threat consideration is In general the threat consideration is substantialsubstantial
Aerial dispersion of anthrax over a large Aerial dispersion of anthrax over a large geographic area can be accomplished with geographic area can be accomplished with commercially-available equipmentcommercially-available equipment
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7 Days1 Day 2 Days 3 Days 4 Days 5 Days 6 DaysImmed.
10 Days 84% 78% 71% 62% 54% 45% 36% 28%
7 Days 95% 91% 85% 78% 69% 59% 49% 39%
6 Days 97% 94% 89% 83% 75% 65% 54% 43%
5 Days 98% 96% 92% 87% 80% 71% 60% 49%
4 Days 99% 98% 95% 91% 85% 76% 66% 54%
3 Days 100% 99% 97% 94% 89% 81% 72% 60%
2 Days 100% 99% 98% 96 92% 86% 77% 66%
1 Day 100% 100% 99% 97% 94% 89% 82% 72%
DELAY in Initiation
DURATIONof Campaign
AnthraxAnthrax Exposure: Exposure: ProportionProportion ofof PopulationPopulation SavedSaved
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Cities Readiness Initiative
CRI GOAL:» distribute antibiotics to the at-risk population –
up to the entire community» within 48 hours of the decision to do so, (from
time of exposure)» Doxycycline, Ciprofloxacin
CRI Preparedness Indicators:» robust local capability to dispense antibiotics
rapidly over a large geographic area
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Table ICombined 36 cities from 2004 - 2006 CRI
Table II36 planning cities for 2006-2007 CRI
Atlanta, GA Baltimore, MD Boston, MA Chicago, IL Cincinnati, OH Cleveland, OH Columbus, OH Dallas, TX Denver, CO Detroit, MI District of Columbia Houston, TX Indianapolis, IN Kansas City, MO Las Vegas, NV Los Angeles, CA Miami, FL Milwaukee, WI
Minneapolis, MN New York City, NY Orlando, FL Philadelphia, PA Phoenix, AZ Pittsburgh, PA Portland, OR Providence, RI Riverside, CA Sacramento, CA San Antonio, TX San Diego, CA San Francisco, CA San Jose, CA Seattle, WA St. Louis, MO Tampa, FL Virginia Beach, VA
Albany, NY Albuquerque, NM Anchorage, AK Baton Rouge, LA Billings, MT Birmingham, AL Boise, ID Buffalo, NY Burlington, VT Charleston, WV Charlotte, NC Cheyenne, WY Columbia, SC Des Moines, IA Dover, DE Fargo, ND Fresno, CA Hartford, CT
Honolulu, HI Jackson, MS Little Rock, AR Louisville, KY Manchester, NH Memphis, TN Nashville, TN New Haven, CT New Orleans, LA Oklahoma City, OK Omaha, NE Peoria, IL Portland, ME Richmond, VA Salt Lake City, UT Sioux Falls, SD Trenton, NJ Wichita, KS
CRI MSA Tables 2006-2007
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Countermeasure Cascade: Generic
FEDSNSPUSH PACKAGE,MI
STATEReceiving Staging Storing
L. Dist. Center
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Locals
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Cities Readiness Initiative: Goal
An initiative to expedite the timeframe to dispense prophylaxis
– Increase Point of Dispensing (POD) throughput Modified Medical Screening (Non-Medical Model)
– U.S. Postal Service Delivery
– Alternate Dispensing Modalities Drive thru clinics Establish PODS with large employers, universities, etc. Using existing delivery services- Meals on Wheels, Home
Healthcare, etc. Community strike teams
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Medical PODs Medical PODsNon-Medical
PODs
Target Population 1,000,000 1,000,000 1,000,000
PEP duration 2 days 9 days 2 days
Hours of operation 24 hr/day 24 hr/day 24 hr/day
Number of shifts 2 shifts 2 shifts 2 shifts
Patient throughput 500 pts/hr/POD 500 pts/hr/POD 2,000 pts/hr/POD
Number of PODs 42 10 11
Core: Public health 19 19 2
Core: Non-public health 33 33 48
Support staff 13 13 10
Total 65 65 60
Core: Public health 44 44 5
Core: Non-public health 76 76 110
Support staff 30 30 23
Total 150 150 138
Core: Public health 1,821 434 48
Core: Non-public health 3,162 753 1,150
Support staff 1,246 297 240
Total 6,229 1,484 1,438
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Countermeasures: PODS
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Medical PODs vs. Non-Medical PODs
Medical PODsNon-Medical
PODs
Target Population 1,000,000
PEP duration 2 days
Hours of operation 24 hr/day
Number of shifts 2 shifts
Patient throughput 500 pts/hr/POD 2,000 pts/hr/POD
Number of PODs 42 11
Core: Public health 19 2
Core: Non-public health 33 48
Support staff 13 10
Total 65 60
Core: Public health 44 5
Core: Non-public health 76 110
Support staff 30 23
Total 150 138
Core: Public health 1,821 48
Core: Non-public health 3,162 1,150
Support staff 1,246 240
Total 6,229 1,438
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CRI Challenges/Issues
Staffing (Volunteer)
State/Local Leadership
Resistance to Planning (Difficult)
Security Resources
Assessment Process
Population Dynamics (Cooperation)
Untried Scenario (Battle Conditions)
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CRI: Dispensing/Delivery
PODS– POD Standards Project- ASPR, RAND and the DSNS are working
together to establish core standard for POD planning and operations
MedKit:– 8 month study indicated .– 97% efficacy First Responders, Clinic, Corporate– FDA working in parallel to address ‘commercialization’ of MedKits
CRI/Postal:– Postal Option is only “one component of a mass prophylaxis plan, …
meant to buy time for a more thorough Public Health response”– Greater questions facing the Emergency Management community is
how SNS assets will be distributed in a POD structure.
Federal, Corporate, Open and Closed PODs
2008, Institute of Medicine Forum for Public Health and Medical Disasters
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Countermeasures
USPS STRIKE
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Countermeasure Distribution and Dispensing: USPS Delivery
3 Exercises
Operational Development: MSP/MN (pilot)
Collaborative
Dependent on Home stockpiling requirement by the USPS volunteers
Threat Designation (DHS), PHED (HHS), EUA (FDA): Oct, 2008
Future Cities have expressed interest
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USPS and Public Health Emergency Response
During the recent combined ice storm debilitation of some communication resources and the need to inform the public of the potential for contaminated peanut products, the USPS successfully delivered print material to residences thus protecting the population of three Midwestern states.
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Countermeasures
HOME STOCKPILING
MEDKIT
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Countermeasure Distribution, Dispensing, and
Delivery: Personal Stockpiling
MedKit:– 8 month study .– 97% efficacy First Responders, Clinic, Corporate– FDA/BARDA working in parallel to address
‘commercialization’ of MedKits
NBSB rendered opinion: Formalized kit preferable to Discretionary Prescriptions
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CRI MEDKIT
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CRI First Responder Issues
Based on discussions with the USPS Carrier Union Leadership and Service Management certain requirements for participation were determined
PPE (per OSHA/NIOSH)
Physical Security (LE)
In advance provisioning of Antibiotics for Carrier Volunteers and their families
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Countermeasure Distribution, Dispensing, and
Delivery: Personal Stockpiling
Medkit (Home Antibiotic Kits)
USPS (HHS Lead) EUA
HHS Responder (HHS Lead) EUA
DHS Responder (DHS Lead/HHS Support) EUA
Traditional First Responder (as above) EUA
Greater Population (HHS Lead) Commercial Strategy :NDA
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CRI RESPONDERS
Subsequent Discussions with MSP in have indicated that for POD function and USPS strike team preparations that similar considerations should be provided for their local responders
Homeland Security Council undertaking specific countermeasure outreach to FR
HSC/DOL/DHS/HHS consideration of unique environmental challenges in CRI
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Countermeasure Delivery
RECENT DEVELOPMENTS
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PH SUMMIT Countermeasures Strategy
In the Fall of 2007 a Forum to address issues related to a successful countermeasure campaign was conducted
It determined that “dispensing, and delivery” held the greatest impediments to success and workshops were scheduled for Spring and Summer of 2008 to address same.
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PH SUMMIT Countermeasures Strategy
Consensus conclusions rendered included:
Reducing impediments to Public- Private Collaboration
Liability-PREP ACT
Forward positioning of assets- cache, personal stockpiling
USPS amplification
Enhancing communication strategies
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PH SUMMIT Countermeasures Strategy
Since the workshop, a multidisciplinary group has continued to meet and work on these issues
State and Local
HHS-CDC, FDA, ASPR, OGC, DSNS
Industry
Academia
Non-Governmental organizations
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PH SUMMIT Countermeasures Strategy
Actions: DHS Determination, HHS PH Emergency
Declaration, FDA Provision of EUA in October, 2008
MN/MSP/HHS/USPS Operationalizing USPS
PREP ACT Declaration
Discussion of issues with NBSB, on going
Expanded capability at DSNS (first 12 hours)
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PH SUMMIT Countermeasures Strategy
Continued issues
Worker protection
Medkit
POD EUA
Communications Strategies
Increased interest and Federal amplification of USPS option (BARDA Modeling Conclusion)
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Countermeasures
The Future
