2011 Training & UpdatesSNS Training MUST take place
ANNUALLY.
SNS Plans
Be NIMS compliant All Employees must complete IS100, IS200, IS700 within 90
days of employment
Be reviewed and updated ANNUALLY by Administration
Include a Multi-Disciplinary Planning Team This team includes Public Health, Law Enforcement, Health
Care, Schools, Public Service Agencies, Tribal Partners & many others.
Identify the roles and responsibilities of local response partners, ensure that these partners acknowledge their role and responsibilities, and are included in regular training and exercises.
Include State and local policies and procedures to support local mass prophylaxis operations and/or medical supplies management Policies & Procedures can be found in the SNS Plan and/or
the All Hazards Plan
Outline legal issues to support mass prophylaxis operations and/or medical supplies management and distribution Legal Issues are outlined in the SNS Plan
An outbreak is identified
MDCH/CDC determines need for mass medication distribution
SNS Plan activated The EOC is
activated
Estimate made of doses needed for County
SNS arrives at MDCH
MDCH repackages SNS supplies to deliver to Local Health Department Distribution Nodes
Pharmaceuticals Burn Surge
supplies Airway supplies Vaccines Medical supplies Medical equipment
The Local SNS Coordinator (Jenni Zordan) and back-up (Sue Bailey) must be, trained, and the plan must provide their contact information.
SNS functions are integrated within the local Incident Command System (ICS) structure and are NIMS compliant
VBCDHD has a plan to annually test and exercise notification and activation of volunteers below the local level positions identified.
At the local level and dependent upon the placement of the activities in the local Incident Command System organizational structure, the following functions have personnel (primary and back-up) identified with documented contact information.
Tactical Communications/ITS Support Hospital/Alternate Care Facility Leader/Manager Public Information & Communication Inventory Management Coordination Security Coordination Distribution Leader/Manager Dispensing Site Supervisor/Leader Staffing/Volunteer Coordination Safety Coordination
Call-down lists for the personnel identified in the positions above are maintained, current, and updated quarterly.
Local jurisdiction conducts and documents call-down exercises of all personnel identified to test response rates quarterly.
The following slides show the requesting process for local health departments to the State of Michigan
◦ Initial Request Flow Chart◦ Ongoing Request Flow Chart
Received from MISNS 08/2010
What is the trigger point for reporting to local decision makers that the levels of SNS assets are low for consideration to reorder assets from the State?◦ Trigger Points for VBCDHD will be determined on a case-by-case basis. During
H1N1, we requested based on the demand we had for the product.
Describe how inventory levels are determined, monitored and communicated◦ Inventory is overseen by the Director of Nursing and delegated to other staff◦ The process is outlined in the CD manual for nursing staff◦ Currently inventory is managed by paper and online using the MCIR system
Who has the authority to place an order for SNS assets from the local level to the State?◦ SNS Orders will be determined and signed off by the Medical Director and the Health Officer
Only persons delegated by the Medical Director or the Health Officer will have authority to place orders for SNS assets.
How is the order placed?◦ The process for placing orders can be found in the SNS Plan◦ Paper requests forms as well as SharePoint are approved methods
Overall purpose is to provide guidance and resources for communications during an event.
Outlines who is in charge of communications and methods that are to be taken for approval of messages.
Covers how joint communications will be handled in a community wide event (Joint Information Centers – JIC)
Ensure message consistency
Public Information officer (PIO) ◦ Serves as the main point person for
communications going out during an event. ◦ PIO serves as contact point for the media.
Public Information Liaisons◦ Work to gather information from other venues,
such as EOC’s (Emergency Operations Center), distribution nodes, dispensing sites and JIC’s to allow for the current and accurate information to be given to the PIO.
◦ May also be tasked with handling the media at local POD (Points of Dispensing) sites.
Pre-developed messages (scripts) and fact sheets on a variety of topics are available in the PIC plan.◦ Pre-event messages to prepare the public◦ Messages to inform the public of the event◦ Messages to help the public get to the PODs and know
what to bring◦ Messages to help the public navigate through the PODs◦ Messages for after people leave the PODs◦ These should be updated regularly
May include ◦ Dispensing site locations, hours of operation, and
directions◦ Check on your neighbor and carpool to POD sites◦ “Head of Household” information◦ Agent information sheets◦ Instructions to ensure medication compliance◦ Vaccine information sheets◦ Inform public of alternate forms of dispensing
Identify special populations ahead of time (non-English speaking, hearing/visually impaired, home bound, etc)
How will these populations be reached?◦ Through the use of closed POD partners such as: United
Way, Homeless Shelters, Meals on Wheels, Long Term Care Facilities, etc.
◦ Closed captioning to large businesses and employers
Have pre-identified interpreters/interpreting services◦ American Sign Language◦ Foreign Language Interpreting services at VBISD◦ 2-1-1
Have pre-established ways to contact stakeholders for a variety of events◦ These could include hospitals, schools, pharmacies, closed POD
partners, and etc.
Redundant Communication Capabilities◦ E-mail, phone numbers, blast fax, etc◦ Ensure this information is updated often
Non-traditional dissemination methods identified◦ At-risk populations and special populations◦ Methods for disseminating information in a power outage
Work with local media to help disseminate messages during any event.
Prior to and during an emergency, staff notification & communication are priority. The following slides highlight various aspects of the health department tactical communication system.
Staff Lead includes George Kilts/Cary Hindley
4.1 - Review Communications/IT staff call-down list/numbers
Call down lists are reviewed and updated quarterly It is important to keep your personal afterhours information
up to date in the event we need to get a hold of you.
4.2 - Review Comm./IT staff JAG’s and describe the just in time training process◦ Please review Job Action Guides
4.3 – Communication pathways are established and maintained between with land lines, cell phones, 800 mHz radios, internet, etc. with the following agencies
◦ Incident Command◦ Local and State EOC◦ LHD Staff◦ Point of Dispensing Sites◦ Distribution Node◦ OPHP◦ Hospitals◦ Security◦ Transportation
4.4 – Redundant communication systems that are tested quarterly and may be utilized during an event. The following is a list of communications methods used to ensure we have communications that do not fail during an event.
◦ 800 MHz Radio◦ MI-HAN◦ Health Dept. Website◦ Landline, Cell, and Analog (during power failure) Phone◦ Fax◦ E-TEAM◦ City Watch (Reverse 911)◦ TV and Radio (know your Emergency Alert System station)◦ Social Networking (Twitter and Facebook)◦ Amateur Radio◦ 211
Security is an essential component for carrying out a successful SNS emergency response. Individuals involved in these security functions must be trained to protect the following:
•SNS assets•Locations used to support an SNS response (DN, PODs)•Staff, volunteers, and citizens at SNS operations, and•The SNS transportation infrastructure once assets transfer custody from State to local (escort vehicles).
Who Should Be Trained?Staff assigned to the following SNS functional roles should attend local security training events:
• Security Coordinator• DN Manager• POD Supervisor• Inventory Manager• Volunteer Coordinator• Safety Manager• Transportation Manager• Logistics Chief• Local Law Enforcement• Volunteers who may be assigned to assist security, if needed
Security Procedures to Consider for Training Are:
• Transportation of SNS assets• Badging and Credentialing• Communication Procedures• DN/POD Site Security Plans:
- Interior physical security- Exterior physical security- Command and management- Evacuation concerns- Security breach protocol
IMPORTANT: Local law enforcement must review site specific security plans for DN’s/POD’s and have opportunity to ask questions.
The primary site for delivery of SNS assets in a jurisdiction
The location of the local Distribution Node
The Health Department Incident Commander (IC) will notify the County Emergency Manager of activation
The IC must notify the DN facility contact person to request access to the facility, if other than an LHD site
Distribution Node staff will be activated
All DN staff will meet to receive “Just-in-Time” training (prior to receipt of SNS assets)
A Job Action Guideline will be provided for each role, detailing immediate, ongoing, and long-term job duties
Examples of Roles: Distribution Node Manager Warehouse Manager Inventory Manager Picker Staff Quality Control Staff Receiving Staff Shipping Staff Security Staff Safety Staff Communications
Staffing Office equipment Communication equipment Signage Forklifts, pallet jacks, dolly carts Computers, printer, copier Forms
SNS material must be inventoried, packaged, and delivered to the dispensing sites within our jurisdiction
Re-supply requests from dispensing sites/PODS and/or alternate sites are also handled at the DN
Material handling equipment will be supplied by Emergency Management
Anyone required to use material handling equipment will receive training prior to use
Upon receipt of assets, Pick List (invoice) is compared with the items actually received
An inventory database (paper or electronic) must be created for the DN and at each dispensing site
All requests, shipments, and deliveries must be recorded and filed for record keeping purposes
The signatures of individuals both relinquishing and receiving the SNS assets, who they represent and the date and time, establish a chain of custody.
Chain of custody form A DEA registrant may be necessary for the
receipt of controlled substances.
Inventory SNS Ordering Forms and Inventory Pick List establish inventory
MDCH:OPHP Transfer Form for the SNS is signed when assets are transferred to the Health Department
DEA Form -222 is issued by the DEA and is used for the transfer of controlled substances
POD Order Form Local Health Department Chain of Custody
Form
MICHIGAN RSS: Inventory Pick List
Delivery Site Order Number Shipment ID
My Junior High XXXXXXXXX XX
Item Description Doxycycline 100mg oral tablet #20 tab unit of use
Container Number Item Number Cases
27 R03386 66336-449-20 340
Item Description Ciprofloxacin 500mg oral tablet #20 tab unit of use
Container Number Item Number Cases
30 R01030 66336-031-20 60
Date & Time: Page 1 of 1
At the conclusion of the event, all unused unopened medication and durable goods will be returned to the DN from each dispensing site
Returned goods must be inventoried, and the State RSS must be contacted to arrange for the pick-up of returnable items
Any items that are not considered durable goods (plug-in, run on batteries, etc) will remain the custody of the local jurisdiction for proper storage or disposal.
The Distribution Node is a central warehouse for SNS at the local level.
The Inventory Management System organizes, distributes and tracks the SNS assets at the local level.
SNS medication/supplies will be sent to Dispensing Sites/PODS within the community.
Purpose of a mass dispensing campaign
Types of rapid dispensing techniques
Staff notification procedures and reporting
Phases for dispensing medications
Special considerations in mass dispensing planning
Models for increasing throughput at PODs
Dispense medical countermeasures (MCM) in the most efficient and timely manner.
Utilize rapid dispensing techniques
Dispense medications to all County residents within 48 hours
Provide MCM for prophylaxis of asymptomatic individuals
Triage symptomatic individuals and direct them to treatment centers
Dispensing can be limited in scope as well as a community-wide event
These phases are subject to change based on the situation and LHD
Plans. Phase 1: The Health Dept. staff and their household members will
receive the first round of prophylaxis.
Phase 2: The Health Dept. staff will open a designated dispensing site and dispense to First Responders and essential personnel
Phase 3: Pre-identified ancillary facilities will provide prophylaxis to their employees, residents, occupants and household members (i.e., qualifying schools, big businesses, industrial facilities, long-term care facilities, jail, etc.)
Phase 4: Designated dispensing site(s) will open to dispense medications to remaining residents
Health Department staff will be contacted to report to staging area for further instructions
**Contact information should always be up-to-date**
Provide staff briefing & conduct just-in-time training◦ Event information, safety information, job duties,
Incident Command System, etc.
Discuss dispensing phases and modalities◦ Priority groups, dispensing instructions, facility
identification, Emergency Use Authorizations, medication information, & etc.
Number of regimens of medication that can be dispensed to an individual
Handling symptomatic individuals
Handling unaccompanied minors
Handling of non-English speakers/hearing impaired/visually impaired/functionally illiterate (Special populations planning)
Procedures for crowd control, traffic management, security, media
Closed PODs
Drive Through PODs
Mobile PODs
Pre-Deployment to businesses
YELLOW ORANGE RED RESOURCES
Full Care/Individual
Screening
Intermediate Care/Group Screening
Minimum Care/No
Screening
X
Michigan HAN Webpage: Head
of Household Policy & NAPH
Given to Patient X CDC Website
Picked up by Patient
X X CDC Website
State Pharmacy Reqs.
X IND/EUA
FDA Requirements X IND/EUA
Full NAPH Form X NAPH Form
Abbreviated NAPH Form**
X NAPH Form
Full Labeling XState & Federal
Pharmacy Regulations
Dosing Directions Only
X X Weight Charts
Licensed
X If Available If Available
Emergency Management Act 390, Sect.
11
Expanded Professions X If Available Act 390, Sect. 11
Lay Persons X Act 390, Sect. 11Limited Individual
Medical Care & Evaluation
X NAPH Form
En Masse Triage X NAPH Form
Dispensing Staff
Individual Medical Care & Evaluation
DISPENSING TIERS
Drug & Disease Patient Information
Regulation Compliance
NAPH Form Distributed & Reviewed by Staff/Voluntters
Dosing Information
Tablet Crushing & Reconstitution X
Model
Name,Age, Phone, & Home Address (NAPH) Form
Tablet Crushing Information & Weight Charts
X X
Weight Charts, Crushing and
Reconstitution Instructions
The DN serves as a functioning warehouse for receiving and shipping SNS materiel at the local level amidst a public health emergency. From the DN, the assets will further be delivery to local Points of Dispensing (PODs) sites in order to provide these life-saving assets to the public.
The DN distributes Strategic National Stockpile (SNS) medical countermeaures (MCM) to local POD sites.
The State of Michigan delivers SNS assets directly to treatment centers throughout the State.
Providing Security at the DN, POD sites, as well as for the transportation of SNS materiel, is the responsibility of local law enforcement.
The location of the DN should be somewhat centrally located geographically within the jurisdiction and among the identified local POD sites.
The DN is one component of the overall local emergency response
The planning, coordination, and management of the DN is the responsibility of local Public Health.
The health department is responsible for staffing and operating the DN when activated.
The DN is located within the Operations Section of the Incident Command System.
The DN Manager/Leader reports to the Operations Section Chief at the health department
DN Staff report to their perspective branch director or chief, who then reports to the DN Manager.
Unified Incident Command
Liaison Officer
Health and Safety Officer Public Information Officer
Operations SectionLogistics Section Planning Section Finance/Admin
Section
Patient Care Branch
Preventive Svs Branch
Patient Transport Branch
Security Branch
Treatment Care Group
Patient Standards Group
Dispensing/ Vaccination Group
Site Triage Group
Symtomatic Group
Satellite Site/ Worried Well Group
Fixed Site Group
Mobile Group
Criminal Investiga-tion Group
Services Branch
Support Branch
Commun. Unit
Food Beverage Unit
Responder Medical Unit
Distribution Node Unit
Transport Unit
Facilities Mgt Unit
Documenta-tion Unit
SitAnaly/Epi Investigation Unit
Personnel Records Unit
Cost Unit
Resources Procurement Unit
Demobiliza-tion Unit
Resources Status Unit
Volunteer Management Unit
Staging Area
Sample ICS Chart – DN is in Logistics Section
Security Leader
Warehouse Operations
Leader
Shipping/Receiving/
Distribution/ Leader
Inventory Control / Pick
Team
Site Security
SNS Order Staging
Housekeeping / maintenance
Delivery Escort Security
Dispatch
Accounting / record
keeping
Transport Drivers
Distribution Node Manager
PH Liaison / Health and
Safety Officer
Receiving
Local Unified Incident Command makes the decision to activate the DN
The health department is notified of decision to activate the DN
The site, staff, and various suppliers are notified of the DN activation
The DN site is readied to accept SNS materiel Materiel handling and office equipment
obtained - forklift, dolly, copier Communications are setup - radios, fax,
phone, etc. Organization/layout of site – loading,
storage, staging and office areas Cleanliness of site - breakroom, restrooms,
etc. Inventory system set up – electronic or
hard copy Materiel ordering system set up –
ordering, picklist, manifest forms Security (exterior and interior) set up DN staff is briefed/updated on situation,
role and procedures (Just in time training) DN Manager notifies Unified Incident
Command when the DN is ready to accept delivery of SNS materiel from the State
Accepting SNS Delivery at the DN Who is authorized to sign for the
delivery – position/title, Drug Enforcement Agency (DEA) Registrant, authorized backup, etc.
State Transfer form - Chain of Custody form, shipping manifest, etc.
Inventory of Delivery Check manifest, compare to what
was ordered/expected and report discrepancies
Enter received materiel into the inventory system
Storage of Materiel Move materiel to proper location Utilize appropriate rotation system
(FIFO – first in, first out)
Filling a SNS Order from a POD Assume an initial supply is sent to all activated
PODs (apportionment decision by Unified Command), this section applies to subsequent orders
LHD Order filling details here: DN receives SNS order from a POD Use pick list to fill the order Move picked materiel to staging area
in DN and perform quality control Fill out proper shipping forms Verify POD order Inform Dispatch of order readiness
Verify Route(s) for POD deliveries, provide maps, communication equipment, and etc. to drivers
Obtain/arrange security escort for delivery Ensure primary method for communications
with driver is functioning properly DN dispatch informs POD of delivery departure
time and estimated time of arrival (ETA) Upon delivery to POD, informs DN, performs
chain of custody, and provides a return ETA to the DN
Inventory Control position monitors DN supply levels At pre-determined inventory trigger
levels, Inventory Control position notifies DN Manager of need for additional supplies
DN Manager initiates DN Re-supply process SNS order form faxed to local Emergency
Operation Center (EOC) EOC faxes SNS order form to Community
Health Emergency Coordination Center (CHECC)
Confirmation of order is received by local EOC, ETA of SNS delivery provided to DN Manager
SNS materiel is delivered to DN. Same acceptance process as initial delivery
Local Public Health Distribution Node Staff Training Template
Local Public Health Distribution Node Staff Training Template
Public Health Distribution Node requests SNS re-supply from local EOC
POD 1 POD 2 POD 3
Local EOC receives DN SNS request, relays to CHECC
CHECC Receives SNS Order – fills order based upon State inventory and event Characteristics
POD orders exhaust Distribution Node Inventory
Local DN Re-supplied
Local Unified Command will initiate the demobilization process.
DN Manager monitors activity at DN and receives situation reports (sitreps) from the PODs.
Conduct a walk-through and complete a facility checklist to record conditions of the facility after clean-up is complete
Provide maintenance to facility and equipment as necessary
Releases DN staff as incident characteristics dictate
Local Public Health Distribution Node Staff Training Template
Materiel at PODs returned to DN upon completion of activities Security escort of returning materiel
required Process of materiel pickup is similar
to deliveries, but reversed. Paperwork required – chain of custody, intra-county transfer form, etc.
SNS Materiel at DN is re-packaged, readied for transport as per State/Federal instructions. Some SNS materiel may need to be
destroyed and/or disposed of. Prepare CDC durable goods for pick-up by
the State and return to CDC (i.e. anything that plugs in, runs on batteries, etc).
Command and Control – The role of the DN within the ICS structure Communications network between State, PODs, and LEOC Responsibilities of agencies/entities involved in DN operations
Activation/DN Setup – Notification and activation of site and staff Setup of site Equipment acquisition Inventory control/shipping systems functioning
Paperwork trails – POD ordering system DN Re-supply Pick lists Shipment manifests Chain of custody forms.
Security - Interior and exterior security Escort vehicles for deliveries
Review the Job Action Guides for SNS
Sign the Acknowledgement Form available in each office.
If you have questions please contact Jenni Zordan at ext.382