EMERGENCY PREPAREDNESS

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EMERGENCY PREPAREDNESS

• WHAT YOU NEED TO KNOW

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LEARNING OBJECTIVES

• A look at the history of Bioterrorism
• Why anthrax is our 1 PH threat
• An overview of Strategic National Stockpile (SNS)
• Understanding the Points of Dispensing (PODs)
• Why volunteers are important to SNS

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BIOTERRORISM

• Bioterrorism is the intentional or threatened use
  of viruses, bacteria, fungi or toxins from living
  organisms to produce death or disease in humans,
  animals or plants.
• Source Centers for Disease Control and
  Prevention

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BIOLOGICAL AGENTS

• Anthrax
• Botulism
• Plague
• Smallpox
• Tularemia
• Viral Hemorrhagic Fevers - Ebola, Lassa, and
  Marburg

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History of Bioterrorism
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20th Century Bioterrorism

• 1914 -1918 - Germany used anthrax to infect
  livestock and animal feed to infect Allies
• 1933-1945 - Unit 731 Japanese Army facility
  experimented on prisoners and civilians (anthrax,
  botulism, cholera, meningococcal infection and
  plague)

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20th Century Bioterrorism

• 1940s - Nazis infected some prisoners with
  bacteria, viruses, and parasites and treated them
  with investigational vaccines and drugs
• 1942-1943 Operation Vegetarian, Britain
  developed strategic amounts of anthrax and
  produced anthrax-infected cattle feed cakes that
  were to be dropped over Germany to retaliate

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20th CENTURY BIOTERRORISM(continued)

• 1942-1969 The US Army began a bioweapons
  research program.
• 1979 An outbreak of anthrax in a small city in
  the Soviet Union killed nearly 70 people.
• 1993-1995 After ten attempts a cult, Aum
  Shinrikyo, successfully released sarin gas (a
  chemical agent) in a Tokyo subway, killing 12
  commuters and injuring more than 5,000 citizens

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Anthrax
PUBLIC HEALTH ENEMY 1
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Anthrax

• Anthrax is an acute infectious disease caused by
  the spore-forming bacterium Bacillus Anthracis.
  This disease occurs most frequently in sheep,
  goats, and cattle. Humans can become infected
  through skin contact, ingestion and inhalation.

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Anthrax

• In humans the anthrax infection can occur in
  three forms depending on the route of exposure
• Inhalation (associated with Bioterrorism) -
  Fatality rate approximately 75
• Cutaneous - Fatality rates of 20 without
  antibiotics, less than 1 with antibiotics
• Gastrointestinal Fatality rate 25-60

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What does an anthrax attack look like?

• No explosions or plumes of smoke
• Sick people arrive at hospitals
• Delayed recognition and diagnosis
• Population panic

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Early Anthrax incidents

• Largest experience with inhalation anthrax
  occurred in Sverdlovsk, Russia in 1979 at a
  military biology facility
• Accidental release of aerosolized anthrax spores
• 79 cases were reported, 68 were fatal
• Probability of over 100
• One case developed 46 days after exposure

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The line in the sand was crossed October 2001
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Anthrax outbreak 2001

• 22 cases
• 11 Inhalation- 5 deaths
• 11 Cutaneous (7 confirmed and 4 suspected)

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Inhalation Anthrax

• Infection begins after spores are inhaled and
  deposited in the lungs
• Incubation period-7-10 days
• Non-specific flu-like symptoms, fever, cough,
  malaise, and nausea
• Lethal stage - high fever, respiratory distress,
  and shock
• Early treatment with antibiotics can dramatically
  reduce mortality

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Cutaneous Anthrax
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Post-Exposure Treatment

• All persons who may have been directly exposed to
  the initial release
• Family, friends, healthcare providers who were
  not exposed to the release do not require
  prophylaxis
• Oral antibiotic therapy is provided for 60 days

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Strategic National Stockpile (SNS)Program
Overview
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Strategic National Stockpile (SNS) Program
Overview

• from U.S. Centers for Disease Control
  Prevention
• The SNS is a national repository of
  antibiotics, life-support medications, IV
  administration, airway maintenance supplies, and
  medical/surgical items. The SNS is designed to
  supplement and re-supply state and local public
  health agencies in the event of a national
  emergency anywhere and at anytime within the U.S.
  or its territories.

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Cities Readiness Initiative (CRI)

• A federally funded program to prepare major U.S.
  cities and metropolitan areas to dispense needed
  drugs and medical supplies within 48 hours of the
  decision to do so.

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Strategic National Stockpile (SNS) Program
Overview

• 12-Hour Push Packages
• Located in 12 secure sites across the United
  States
• Ready for deployment to reach designated area
  within
• 12 hours of the Federal decision to deploy
• Managed Inventory (MI)
• Tailored" to provide specific materiel depending
  upon suspected or confirmed agent
• Comprised of pharmaceuticals and supplies that
  are owned and managed by the SNS program, but
  stored by commercial vendors

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Strategic National Stockpile (SNS) Program
Overview

• SNS 12-Hour Push Package Contents
• Pharmaceuticals
• IV Supplies
• Airway Management Supplies
• Wound Care Supplies
• Adult Pediatric Airway Supplies
• Respirators

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Strategic National Stockpile (SNS) Program
Overview

• Each 12-hour Push Package contains enough
  ciprofloxacin and doxycycline start anthrax
  prophylaxis for 300,000 people for ten days.
• Limited amount of Amoxicillin suspension for
  pediatric dosing.
• Small amount of controlled substances

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Aircraft Configuration
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Truck Delivery
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Anti-Viral Assets
Based on FDA approved treatment regimen
On hand quantities in constant flux
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Other Pan Flu Assets
On hand quantities in constant flux
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Pending Procurements

• Other PPE (besides masks/respirators)
• Gloves
• Gowns
• Face shields
• IV antibiotics
• Additional ventilators
• Syringes/Needles to support pre-pandemic and
  pandemic vaccine distribution.

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How SNS Assets are Deployed
3.
Director of CDC Deploys SNS Assets
Augments Local/State Medical Materiel Resources
Discussion with key officials (i.e.
HHS, FBI, FEMA, NSC, Office of Homeland Security,
State, etc)
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Receipt, Store Stage (RSS)

• What is it?
• Where is it?
• Who manages it?

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Receipt, Store Stage (RSS)
Privately owned
Several loading docks
Exceeds recommended sq. ft.
Personnel Equipment
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Strategic National Stockpile (SNS) Program
Overview

• QUESTIONS??

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POINTS OF DISPENSING
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PURPOSE OF A POD

• A site that will provide prophylaxis or
  vaccinations to all citizens within the State of
  Georgia
• To save lives and prevent illness in an orderly
  and efficient process.

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Dispensing in Georgia

• Based on the 2006 U.S. Census the population of
  Georgia is estimated at 9,544,750
• Approximately 5,000,000 live in the Atlanta
  Metropolitan Statistical Area (MSA)

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Dispensing in Georgia

• 18 health districts in Georgia
• 11 Districts involved in the Cities Readiness
  Initiative (CRI) which encompasses the 28 county
  MSA
• Each responsible for dispensing to their local
  counties

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Essential Partnerships
Local
State
Federal
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Dispensing in Georgia

• Districts have developed plans to use
• Facility-based dispensing sites
• Drive-thru clinics
• Closed dispensing sites
• Jails, prisons, nursing homes, assisted living
  facilities, and local businesses.

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Mass Medication Dispensing Greatest Volunteer
Need
There is a critical need for large numbers of
volunteers who could help meet staffing needs
for any number of mass medication dispensing
sites in an affected area. We need people who can
assist with Medical Services Non-medical
Services Site Support Services Other Specialized
Services Stress Management
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Volunteer Roles

• Medical Services
• Nurses
• Medical screening, assessment, triage
• Doctors
• Medical evaluations
• Pharmacists
• Repackaging, compounding, special needs
• Other
• Dispensing site managers
• Mental health counselors (staff public)
• Triage assistants

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Volunteer Roles

• Non-Medical Services
• Site flow assistants
• Interpreters (spoken sign language)
• Health Screening assistants
• Forms completion, review, collection
• Clerks
• Restocking supplies, data entry
• Runners
• Errands, supplies checks, copying
• Multi-purpose, float staff
• Answer phones, transmit messages

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Volunteer Roles

• Site Support Services
• Greeters
• Welcome the public,
• distribute forms, share information
• Traffic flow, parking direction
• Unload distribution trucks
• Facilities maintenance

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Volunteer Roles

• Specialized Support Services
• Volunteer support
• Provide food, other support
• Transport volunteers in surge
• Special populations support
• Deliver medications to
• home-bound individuals
• Help notify those without media access where to
  get medicine
• Assist those with access needs related to
  physical disability, literacy, hearing or vision
  impairment, etc.

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Can you help?

• In a public health emergency, we may need
  THOUSANDS of volunteers in order to reach people
  quickly to help save lives and reduce suffering.

• We recognize that service to community follows
  safety for volunteers and their families,
  therefore, they will be provided medications.
• Volunteers are provided orientation, training,
  exercises and other resources to support your
  vital service.

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TAKE AN ACTIVE ROLE!!

• Get the word out about SERVGA and the need for
  volunteers to sign up.
• www.servga.gov
• THANK YOU,
• YOU MAY HAVE SAVED SOMEONES LIFE!

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QUESTIONS???
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PUBLIC HEALTH CONTACTS

• Leticia A. Mathis, SNS Program Coordinator
• 404-463-1420
• lxmathis_at_dhr.state.ga.us
• Rachel Vasconez, MBA, MPH Interim
  Health Community Preparedness Director
• 404-463-8430
• rdvasconez_at_dhr.state.ga.us