National Emergency Stockpile System

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National Emergency Stockpile System BC Ministry
of Health Emergency Management Branch EP
Conference Vancouver, October 2005
Christopher Smith, MA, CBCP Manager,
Planning and Programs Emergency Management
Branch BC Ministry of Health
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What is the NESS?

• National Emergency Stockpile System
• Program established in 1950s
• Mission of NESS 
• To have sufficient quantities of supplies in
  support of the provision of Provincial Health and
  Social Services in their efforts to alleviate
  pain and suffering, and to save the lives of
  Canadians and others who are affected by natural
  and human caused disasters
• Public Health Agency of Canada leads NESS program
  through CEPR
• NESS resources held centrally, in Federal Reserve
  and are pre-positioned in P/Ts

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NESS Resources

• Inventory
• 200 Bed Emergency Hospitals
• Advanced Treatment Centres
• Casualty Collection Units
• Mini-Clinics
• Isolation Unit accommodates 300 people
• Bulk Medical and accommodation items
• Pharmaceuticals in Federal Reserve
• Vendor managed pharmaceutical agreements where HC
  owns and maintains specific level of products
  which are rotated through system to maintain best
  possible dating

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Past NESS Deployment

• Between 1981 to 2005 over 115 NESS Deployments
  (48 Since 2000)
• 1985 Mexico City Earthquake
• Operating Theaters and X-Ray Units
• 1998 Provinces of Ontario and Quebec Ice Storms
• Blankets, Generators (3 10KW), First Aid Kits,
  Propane Cylinders, Batteries, Wound Dressing,
  Flashlights, Towels, Litters etc
• 2001 Halifax, Whitehorse, Gander, Moncton, St.
  Johns (US Terrorist Attacks)
• Beds, Litters, Towels, Blankets, Cots
• 2005 SEA Tsunami
• Generators (4 5KW), Water Bladders,
  Amoxicillin, Ciprofloxacin, Doxycycline Tablets
  and Capsules, Tetracycline, Penicillin, Lidocaine
  Hydrochloride, Acetaminophen, Morphine Injection
  and Meperidine Hydrochloride

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Current NESS Deployment
Hurricane Katrina

• 2000 Bandage, Self Adherent Wrap
• 1000 Bandage, Muslin, Triangular
• 3600 Dressing, Surgical, Combination
• 50000 Sponge, Surgical, Gauze, Sterile, 4"
• 20000 Sponge, Surgical, Gauze, Sterile, 2"
• 900 Plaster, Adhesive
• 3000 Bandage, Absorbent
• 20000 Gloves, Examination, Nitrile, Med
• 6000 Gloves, Examination, Nitrile, Large
• 1000 Depressor, Tongue

• 5000 Gown, Isolation, Yellow
• 1800 Cloth, Face
• 1700 Towel, Bath
• 2000 Needle, Angioclath
• 100 Cannula
• 360 Cot, Folding, Aluminum Frame
• 1440 Blanket, Wool and Synthetic Fibre
• 3000 Blanket, Resue, Mylar
• 7000 Blanket, Disposable, Yellow
• 1600 N.V.A Batteries, D Cell

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BC NESS Deployment

• BC NESS Deployment
• 1997 Extreme Weather Sooke, Blankets
• 2003 SARS Vancouver, Thermometer, Clinical
• 2003 Forest Fires Cranbrook portions of EH
  (temporary infirmary)
• 2003 Forest Fires Kelowna, Inquiry Cards
• 2004 AI Lower Mainland Tamiflu

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Location of NESS Resources By Health Authority
HA CCU ATC EH
Fraser 9 2 1
VIHA 26 14 3
VCH 18.5 4 2
IHA 23 7 4
Northern Not including Federal Reserve 18 9 2

• Units are typically stored in BCAS Stations, Fire
  Departments, Public Works Yards, Hospitals,
  Airports, Recreation Centers and Schools

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CCU Purpose Inventory

• Designed to provide first aid treatment for 500
  casualties at the rescue site and to control
  casualty evacuation to the supporting ATC
• 20 Line items packed into 44 cases and consuming
  231 cubic feet of space
• Bandages
• Wound Dressings
• First Aid Haversacks
• Blankets
• Spine boards and Stretchers
• Intended to be
• Deployed and operated by trained EMS/Fire Service
  Personnel
• Managed and administered by Municipalities

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ATC Purpose Inventory

• Designed to provide early life-saving care to the
  seriously injured and to control the equitable
  distribution of the injured among the available
  treatment facilities. The unit has two principal
  functions
• The triage (sorting) of casualties for immediate
  treatment and for transportation to other
  facilities for continuing casualty care
• The provision of emergency medical care to ensure
  the survival of the most seriously injured until
  they reach definitive care facilities. Each unit
  has an initial capability to treat 500
  casualties. The emergency medical care is limited
  to
•  airway maintenance
• control of hemorrhage
• control of shock
• relief of pain
• control of infection

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ATC Purpose Inventory Cont

• Functions dependant on the local situation and
  the assigned tasks
• Treatment of minor injuries
• Sustaining care for the injured awaiting
  evacuation
• Radiological decontamination of casualties
• Reception, sustaining care and patient handling
  at transportation points such as air fields,
  ports, rail-heads and road-heads
• Reception and distribution of casualties in major
  communities
• These units are organized to support the rescue
  and first aid activities of emergency responders
  in major urban areas

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ATC Purpose Inventory Cont

• The Advanced Treatment Centre consists of 143
  line items, packed into 81 cases and one (1)
  cylinder
• Reception Sorting
• Resuscitation
• Minor Treatment
• Major Treatment
• Holding
• Supply
• Evacuation
• Unit consumes 326 cubic feet of space and weighs
  4000lbs

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EH Purpose Inventory

• To support Health system for acute, short term
  sub-acute care
• To support ESS system for reception and housing
• Requires minimum 18,000 square feet for
  deployment (school, arena) with 30,000 square
  feet preferred
• Transport requires 2 X 48 foot trailers or 3 deep
  sea containers
• 673 line items packed into 571 cases and 25
  cylinders
• Consumes 3100 cubic feet and weighs 42,000 lbs

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EH Purpose Inventory

• Functional Packaging and Color Coding
• Admission and Discharge
• Pre-operative Resuscitation
• Operating Rooms
• Recovery
• Eight General Wards
• X-Ray
• Central Supply
• Pharmacy
• Service Utilities

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EH Purpose Inventory

• Workload Operating Requirements
• The hospital contains sufficient expendable
  supplies to last for seven days
• 80 professional, technical and auxiliary
  personnel are required to operate hospital at
  minimum level

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EH Purpose Inventory

• Some of the Equipment
• 10 kilowatt generator
• 3 kilowatt generator
• 1500 gallon portable water tank and electrically
  operated water pump
• 200 folding beds
• Two large portable autoclaves and water boiling
  sterilizer
• 5 X 40lb propane and 20 oxygen cylinders
• Surgical instruments and operating equipment
• 490 wool and synthetic and 100 wool blankets
• Dressing Sutures
• Fracture Appliances
• Field medical equipment

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Public Health Agency of Canada

• Public Health Agency of Canada, Centre for
  Emergency Preparedness Response (CEPR), Office
  of Emergency Response own supplies
• Central Federal Depot located in Ottawa
• 9 Federal Reserves located across Canada
• Chilliwack, BC
• Edmonton, AB
• Winnipeg, MB
• Brampton, ON
• Shawinigan, QUE
• Quebec, QUE
• Montreal, QUE
• Dartmouth, NS
• St. Johns, NFLD
• 60 held in Federal Reserve
• 40 of NESS resources are pre-positioned with
  primary management responsibility assigned to
  provinces and territories (1300 sites)

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NESS Strategic Direction Objectives

• Strategic Direction
• Enhance capacity to respond effectively and
  efficiently to threats caused by natural and
  human caused disasters
• Objectives
• Compile a stockpile of pharmaceuticals, medical
  devices and medical supplies to countermeasure
  terrorist threats, CBRNE
• Upgrade and refurbish NESS to ensure its state of
  readiness for Emergency Response
• Compile a stockpile of pharmaceuticals, vaccines
  and antivirals to respond to epi/pandemic events
• Communication and collaboration with
  provinces/territories on NESS Program
• Undertake strategic review of NESS

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NESS Strategic Review

• Multi-phase process to ensure NESS can meet
  requirement of strategic direction
• Mandate of Strategic Review
• Develop comprehensive risk and threat analysis
• Develop a gap analysis to evaluate the current
  NESS response capability and capacity
• Review the NESS program to evaluate capacity and
  capability to support natural disasters,
  including major disease outbreaks like SARS and
  PI
• Assess the contents of NESS specifically for
  CBRNE capacity
• Evaluate NESS transportation and deployment
  capabilities in conjunction with the NETS review

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BC NESS Management

• BC Ministry of Health directly responsible for
  managing BC NESS Resources under MOA with PHAC.
• One staff position in Ministry of Health
  providing 40-50 NESS support
• NESS resources pre-positioned in over 100
  communities
• Intended to be used as a last resort
• Manage resources on behalf of Public Health
  Agency of Canada including
• Maintaining inventories
• Ensuring appropriate storage and security
• Providing emergency planning advice
• Inspecting supplies
• Facilitating resource acquisition disposal
• Support training requests
• Regional Health Authorities, BCAS and
  local/regional government support many aspects of
  managing NESS

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BC Challenges

• Are NESS resources strategically positioned and
  sufficient to meet all manner of threats?
• Do we have the right resources in the right
  places?
• Do current unit configurations meet existing
  threats?
• Local and regional HRVs used in planning for
  NESS resources.
• How and who decides adequate resource capability?
• Are resources incorporated into local, regional
  and provincial emergency plans?
• Who leads planning?
• How do we move resources?
• Where to deploy?
• Who deploys?
• How do we support and sustain operation?

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BC Challenges

• Activation of NESS resources
• What is the role, if any, for local EOC, PREOC,
  PECC in planning and response?
• How do we challenge stakeholders to consider NESS
  resources as an integral part of their integrated
  disaster preparedness strategy?
• There is an assumption that these resources are
  old and have no value
• How do we do a better job in communicating that
  these resources can be very valuable to a
  communities disaster preparedness?
• There is a need to build capacity through
  training
• Who should be trained?
• How do you access training?

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BC Challenges - Emergency Planning

• Emergency planning
• Plans to support with medical consumables,
  provision for food, water and sanitation services
• How will you support the operation of the unit?
• What is your human resource and staffing plan?
• Pre-positioning and storage location strategies
• Who is the population you are serving?
• What are the risks and consequences of disaster?
• Plans should be effectively integrated with all
  stakeholders
• Municipal Emergency Coordinator, Provincial
  Emergency Program, Emergency Social Services,
  Public Works, Ministry of Health Services, BC
  Ambulance Service and others provincial, private
  and local agencies as required

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Conclusion

• Ultimately, these resources are pre-positioned
  for the benefit of community and regional health
  authority citizens
• They are made available to assist with meeting
  surge capacity requirements or providing
  temporary support where existing facilities are
  damaged and/or inaccessible
• The NESS resource is ideally suited to be
  deployed and operated in non-traditional settings
• Not deployed often but past experience has
  demonstrated the value of the resource