Slides

New Jersey Emergency Pharmaceutical Preparedness

September 28, 2005

New Jersey’s Emergency Preparedness Pharmaceutical System

The Commissioner of Health and Senior Services has directed the development and implementation of a plan that ensures New Jersey’s healthcare system is adequately supplied with pharmaceuticals and medical supplies during any emergency.

Federally supplied materials Strategic National Stockpile CHEMPACK

New Jersey owned supplies Strategic State Stockpile

Hospital caches

Strategic National Stockpile(SNS)

Mission: To deliver pharmaceuticals and medical materiel to the site of a national emergency

Push Package vs. Managed Inventory (MI)

For unknown or multiple threat

7-8 truck loads of medical material

Prepackaged

Delivered in under 12 hours

For the known threat

Pharmaceuticals and medical materials in quantities specifically requested by the state

Delivered within 24 hours

NJ received MI during anthrax events

Oral Antibiotics

IV Supplies

Nerve Agent Antidotes

Airway supplies

Med/Surg Supplies (Clear)

SNS Push Package: 130 Containers

How SNS Assets are DeployedHow SNS Assets are Deployed

CDC Director Deploys

SNS Assets

Augments Local/State

MedicalMateriel

Resources

SNS

Need for Drugs and Medical Supplies Exceeds Local & State Resources

State Requests Federal Assistance

In consultation with the Surgeon General, Secretary of HHS, HHS Office of Emergency Preparedness, FEMS and the FBI

Distribution

PODPOD POD POD

RSSAssets Deployed

in the State

Unit of Use Medications in 12-Hr Push Package

Dispensed as unit of use 10-day Labeled Child-proof bottles Sufficient quantities to

protect 200,000 Designed for the worst case

– an anthrax response

Unit of use medications in 12-Hr Push Package

10-day regimens in Push Package (approx. 15% of containers in 12-hr PP)

88,900 bottles of ciprofloxacin (#20 tab)

88,900 bottles of doxycycline (#20 tab)

24,000 bottles of amoxicillin 250mg chewable (#30 tab) for:

Pregnant women Allergies to ciprofloxacin / doxycycline Children who cannot swallow whole tabs,

but can chew (1,600 bottles of amoxillin 500mg chew tabs (#75 tab)

IND required against anthrax

Additional Unit of Use Drugs – Managed Inventory

For large-scale events SNS has contracts to repackage -

1 million /day!

The toxic effects of nerve agents require immediate pharmaceutical intervention followed by long-term care. This pharmaceutical intervention must be supported in both the pre-hospital and hospital phase. The ability of emergency medical personnel to begin immediate treatment of individuals exposed to nerve agents will directly affect a casualty’s ability to survive the exposure.

CHEMPACK PROJECT

CHEMPACK MISSION

Implement a nationwide project for the “forward” placement of nerve agent antidotes

Provide state and local governments a “sustainable resource” that increases their capability to respond quickly to a nerve agent event

CHEMPACK Assumptions

A deliberate or accidental nerve agent release can occur anywhere

Any major release would probably require large supplies of nerve agent antidotes

The “forward” placement of CHEMPACK assets in various locations (caches) throughout an area will expedite delivery of antidotes to the disaster site

CHEMPACK Containers The CHEMPACK Project provides two types

of containers:

Emergency Medical Services (EMS) ContainerDesigned for emergency responders; material packaged mostly in auto-injectors

Hospital ContainerDesigned for hospital dispensing, with multiuse vials, for precision dosing and long term care.

CHEMPACK Formulary

Mark 1 Kits Atropine Sulfate 0.4 mg/ml 20 ml Diazepam 5 mg/ml auto-injector Pralidoxime 1 gm inj 20 ml Diazepam 5 mg/ml vial, 10 ml vial

Cities Readiness Initiative (CRI)

CRI Goals

Enhance the ability of cities to rapidly dispense life saving drugs to their population

Dispense needed drugs to 100% of each city’s population within a 48-hour timeframe

Assumptions An outside aerosolized release of anthrax.

For the purposes of first year planning “First Responders” are defined as: Public Health Services Office of Emergency Management Law Enforcement Fire Services Emergency Medical Services

Assumptions – cont….

Non-medical personnel will be allowed to distribute medications.

The NJDHSS will receive an adequate supply of oral medications.

Medications will not be available in liquid suspension form.

CRI – NJ Goals What are the goals of the program

Distribute medications to targeted population within 48 hrs.

One goal, for the 1st year of the grant is to develop a medication distribution plan targeted at a narrowly defined group of First Responders and their households members.

STRATEGIC STATE STOCKPILE (SSS)

Report: State Strategic Stockpile Subcommittee

March 22, 2004

Local Medical Inventory Considerations

Threat

Prophylactic medicines and supplies for dealing with those threats

Quantity of medicines and other items needed in local inventory

Location of local inventory convenient to essential personnel when needed

Proceedings of the State MEDPREP Committee

Resources Available in the State

Hospitals MICUs Military V.A. State Cities

Proceedings of the Committee

Possible Scenarios for Chemical, Biological, Radiation, Nuclear and Explosive Events (CBRNE)

High-Risk Locations Storage Distribution Composition Quantity Budgetary Concerns and Restrictions Final Recommendations

Quantity

To determine the quantity of antidotes needed, we estimated the number of potential victims and selected a methodology to determine the severity of an event

To determine numbers of victims we reviewed

A) the Tokyo Subway Attack (> 5500) B) the original Med Prep proposal (100,000) C) the U.S. government estimate (>10,000) D) NJ daily and emergency room visits

FACT: roughly 8,600 daily emergency room visits to NJ Hospitals

Subcommittee arbitrarily doubled this number, plus added a growth factor to come to a total of 20,000 victims for a chemical event.

DETERMINED NEED

State Stockpile for 20,000 victims for the first 48 hours after a chemical event

TASK Develop our own model by utilizing a

successfully determined model

PROBLEM: there are none

The Committee utilized the model developed by the Federal government for their ChemPak Program.

Anticipated injuries in the CHEMPAK model

30% mild 40% moderate 30% severe

AGENTS NEEDED IN A CHEMICAL EVENT

Atropine Pralidoxime Diazepam Sodium Thiosulfate

AGENTS NEEDED IN A BIOLOGICAL EVENT

Ciprofloxacin Doxycycline Clindamycin Gentamicin Amoxicillin

NOTE: All recommendations will allocate 20% of the total for pediatric patients

STORAGE OF STOCKPILE

HOSPITALSChemical -- all hospitals must maintain antidotes for a minimum of 20 patients to a maximum of 200 patients

Biological – all hospitals must have the capability of diagnosing and treating at least 2 patients and plans for cohorting and treating at least 20 patients

STORAGE OF STOCKPILE

REGIONAL STORAGE SITES

Chemical -- LINCS or PODS HOSPITALS or state-determined locale

Biological -- LINCS or PODS HOSPITALS or state-determined locale

FURTHER ACTIONS MedPrep approves actions and methodology of

subcommittee to date

State provides information on budget allocated for stockpile

Trauma/Burns subcommittee provides information on RNE needs

Subcommittee finalizes recommendations based on approved methodology and budgetary information

NJ’s SSS Formulary

Potassium Iodide Received 722,000 doses of potassium iodide (KI) for individuals who live and/or work

within ten miles of a nuclear generating station.

Established dispensing sites in the areas surrounding New Jersey’s four nuclear power plants and distributed over 75,000 doses of KI

Distributed fact sheets, medical counseling, and other information relating to nuclear emergencies

Provided area schools, colleges and daycare centers with KI pills and information regarding KI administration

Antibiotics Antibiotics for the treatment of agents associated with acts of bioterroism are stored in

state and acute care hospital facilities

Chemical Antidotes Acquired and pre-positioned in state

Infection Control Supplies Respiratory masks, thermometers and gloves in support of communicable respiratory

illness response plans

Mass Dispensing – Points of Dispensing (POD)

POD Site Considerations

Determined by: Number of people

exposed/potentially exposed

Who you must treat or prophylax

Site locations The event determines the

number and location of sites

Staffing the POD

Types of Staff Professionals Volunteers Management & Support staff

Staffing the POD

Sources of Staff

Professional Associations Licensing agencies Medical Reserve Corps (MRC)

TOPOFF 3 Lessons Learned – RSS Operations

Federal emphasis has been on Push Package, but TOPOFF emphasized Managed Inventory. NJ not prepared to receive MI in sufficient quantities

Need additional floor space for MI materials

LINCS agencies need additional space/ equipment for receiving MI

TOPOFF 3 Lessons LearnedRSS Operations

Request process for federal assets needs to be streamlined with consistent information/input needed

Must be prepared to both request and deny assets

TOPOFF 3 Lessons LearnedRSS Operations

Not enough antibiotics available in suspension formulation

Need instructions/educational materials for pediatric dosing using tablets

Hippocrates

NJ Medical Reserve Corps

To develop a prepared, trained workforce of volunteers to serve the citizens of NJ in the event of a public health emergency.

www.njmrc.nj.gov

QUESTIONS