Mass Distribution of Medications Overview of Cities Readiness Initiative

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Mass Distribution of Medications Overview of
Cities Readiness Initiative
Terry SappState CRI CoordinatorOffice of
Preparedness Response
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What is CRI?
The Cities Readiness Initiative (CRI) is a pilot
program to aid cities in increasing their
capacity to deliver medicines and medical
supplies during a large-scale public health
emergency such as a bioterrorism attack or
nuclear accident From Centers for Disease
Control and Prevention http//www.bt.cdc.gov/cri/
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Cities Readiness InitiativeCDC Funded Grant

• The funded region must be able to receive and
  distribute Strategic National Stockpile (SNS)
  assets and deliver mass medications (oral
  prophylaxis) to the entire population within 48
  hours of event recognition.

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What is our goal?

• Provide prophylaxis to the entire population
  exposed to aerosolized Anthrax to REDUCE the
  number of people who may become sick, and provide
  information to encourage medication compliance.
• Disaster Medicine Mentality Do the MOST good for
  the MOST people

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Responsibilities

• FEDERAL responsible for sending SNS assets and
  a TARU team
• STATE DHMH is lead, partnered with numerous
  other agencies Secretary of Health advises
  Governor to make request State is responsible
  for receiving SNS and distributing out to local
  level
• LOCAL responsible for delivering assets to the
  people

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FEDs deliver SNS assets
STATE Receives assets distributes out to local
level
Other Dispens. Sites
PODS Points Of Dispensing
Treatment Centers
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CRI Non-Medical Model

• Time is the enemy!
• Once the incident is detected, decision made
  to request SNS, declare public health emergency,
  receive SNS assets and distribute out to locals
• CRI time clock could be as much as 18 hours
  into the event before dispensing begins, leaving
  30 hours to get medication into the population
  for maximum benefit

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Efforts coordinated across region

• Mass dispensing activities taking across a region
  must be consistent. Coordinated effort taking
  place to standardize key CRI Components
• Dispensing algorithm
• Identification requirements
• Household limits
• Residency requirements

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Residency Requirements

• Anyone may pick up medication from any POD, in
  any county (regardless of where they work or
  live)
• Residents will be directed to go to whichever POD
  is closest (home or work)
• Everyone who was exposed is entitled to
  medicationthis includes non-U.S. citizens,
  homeless, incarcerated

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Who can pick up?

• The public will be instructed to send one
  household representative to the POD to pickup
  medications.
• Adult representative preferredleave children
  with responsible adult if possible
• Those with mobility issues, language barriers or
  other special needs encouraged to have a neighbor
  or family member pick up for them.

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Identification Requirements

• No one will be asked to show ID in order to
  receive medications
• Identification WILL be required of POD staff and
  volunteers
• Proof of residency is not requiredhowever large
  medication pickups (eg for an entire apartment
  building) may require additional documentation

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Number of Courses Allowable

• There will be no defined limit on the amount of
  medications that a person may pick up for their
  household .
• However.

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Number of Courses Allowable

• All persons receiving medication must be listed
  on the sheet
• At the discretion of local POD leadership, a
  person requesting an unusually large amount may
  be pulled aside (to avoid slowing the line) and
  asked for more information if abuse/fraud is
  suspected.
• NEVER compromise POD operationswhen in doubt,
  hand it out!

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Unaccompanied Minors

• Minors may pickup the medication for their
  household if the adult is homebound and
• The form is filled out properly by an adult (the
  minor may have to leave the POD to get the
  information filled out properly and return)
• THIS POLICY IS BEING REVIEWED

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CRI the first 48 hours of mass dispensing

• No cost/no fees
• No insurance
• No prescription
• No identification
• No residency requirements
• No limitations
• Benefit of taking prophylaxis for Anthrax
  exposure outweighs risk of side effects

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Algorithm Minimal screening
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Yes
No
No
Smith, Tony
Smith, Barbara
Yes
Yes
No
No
Yes
No
Smith, Tony Jr.
Smith, Mary
No
No
No
Jones, Cynthia
Yes
Yes
No
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3
1
21211
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How Medications Arrive

• Pre-bottled at vendor
• Labeled with
• Medication name
• Amount of tablets per bottle (10-Day course)
• Dosage amount per tablet
• Lot number
• Expiration date
• Instructions on bottle (i.e. Take 1 tablet every
  12 hrs until finished)
• Storage information

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Questions?Terry SappState CRI CoordinatorMD
Dept. of Health Mental Hygiene Office of
Preparedness Responsetsapp_at_dhmh.state.md.us410
-767-4621