2011 Training & Updates SNS Training MUST take place ANNUALLY.

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

or [email protected]