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Annex 1, Appendix 5
STRATEGIC NATIONAL STOCKPILE/MEDICAL COUNTERMEASURES
EOP
Under 42 USC 300hh-12(c), no federal agency shall disclose under section 552, United
States Code, any information identifying the location at which SNS Program materials
are stored. To the extent permitted by law, the parties agree that neither will disclose
the nature of this effort and the terms of this agreement to any person or entity, except
as may be necessary to fulfill its mission and statutory and regulatory responsibilities.
PRIMARY:
Department of Health and Environmental Control (DHEC)
SUPPORT:
Office of the Governor, Office of The Adjutant General, SC National Guard
and Emergency Management Division; South Carolina Law Enforcement
Division (SLED); State Department of Public Safety; Department of
Transportation; Office of the Attorney General; State Budget and Control
Board; State Department of Education; State Commission on Higher
Education; Department of Labor, Licensing and Regulation, Division of
Professional and Occupational Licensing and Division of Fire and Life Safety;
Department of Defense; American Red Cross; SC Hospital Association; SC
Medical Association; SC Nursing Association; SC Pharmacy Association
I.
INTRODUCTION
A. The Strategic National Stockpile (SNS)/ Medical Countermeasures (MCM) of the
Centers for Disease Control and Prevention (CDC) is a federally owned and
managed national repository of antibiotics, antiviral medication, chemical
antidotes, antitoxins, life support pharmaceuticals and equipment, vaccines,
intravenous administration supplies, airway maintenance supplies, masks,
medical/surgical items, pandemic countermeasures and other medical related
supplies established by Congress to supplement and re-supply state and local
supplies of these critical need medical items in the event of an incident anywhere
in the United States involving Weapons of Mass Destruction (WMD) (Chemical,
Biological, Radiological, Nuclear and high-yield Explosives) or a major natural or
technological disaster.
B. Authorities and References:
1. SC Emergency Operations Plan
2. State Emergency Operations Center SOP
3. SC DHEC Emergency Operations Plan
4. SCDHEC Office of Public Health Preparedness (OPHP) Emergency
Notification Plan
5. Appendix 5 (SC Mass Casualty Response Plan) to the SCEOP
1
SNS/MCM
6. Title V, Emergency Preparedness and Response, section 502 of the
“Homeland Security Act of 2002”.
7. SC Emergency Health Powers Act amendment to SC Homeland Security
Act of 2002, rule R. 61-112 Implementation of the Emergency Health
Powers Act
8. Receiving, Distributing, and Dispensing the Strategic National Stockpile,
A Guide for Planners, Version 11.
9. PB2 (2013-2014) Public Health Emergency Preparedness Cooperative
Agreement
C.
Organization: The DHEC OPHP, assisted by the DHEC Emergency
Management Coordinator and other support staff will serve as the lead of
ESF-8 (Health and Medical Services) response and recovery efforts, which
includes all state and regional SNS, or other countermeasure distribution and
dispensing activities, and upon activation will be located at the DHEC EOC.
All SNS response staff that have leadership roles are NIMS compliant in
accordance with DHEC
policy A.1101, the Homeland Security
Presidential Directive (HSPD)-5 and the State of South Carolina Office of the
Governor Executive Order Number 2011-06 signed 27 Jan 2011.
South Carolina has a centralized public health system under the South
Carolina DHEC. All County health departments are staffed and managed by
DHEC and respond to emergencies as one agency. Planning and daily
management is done utilizing the 4 DHEC Public Health Regions. Each
of
the Regions covers 11 to 12 counties and has approximately 1,000,000
residents per region.
In support of ESF-8( Health and Medical Services), the OPHP will coordinate
among DHEC directorates, program areas, named support agencies and
participating private sector resources to support SNS/MCM Preparedness
EOPs and response in accordance with this EOP and in conjunction with
South Carolina Emergency Management
Division (SCEMD) and the
South Carolina Emergency Operations Plan (SCEOP). At the determination
of the DHEC Director, the DHEC EOC may be activated to help coordinate
other department responsibilities associated with an SNS/MCM
deployment to South Carolina.
The ESF-8 (Health and Medical Services) representative will coordinate and
monitor SNS response and recovery efforts through the DHEC EOC.
This information will be monitored and executed through Web EOC at the
SNS/MCM EOP
Annex 1, Appendix 5-1-2
July 2014
SNS/MCM
DHEC EOC. SNS/MCM response information will be provided to SEOC
Operations by ESF-8 (Health and Medical Services) as needed for the
standard SEOC Situation Reports. All public information related to the
event will be released in coordination with the Joint Information Center
located at the SEOC.
D.
Plan Hierarchy: The SNS/MCM Emergency Operations Plan is written to be
incorporated as Annex 1 to Appendix 5 (South Carolina Mass Casualty
Emergency Operations Plan) of the SCEOP. DHEC Health Regions and the
Columbia Metropolitan Statistical Areas (MSA) Cities Readiness Initiative
(CRI) are also required to have an SNS plan to function as an extension of the
State SNS/MCM EOP and in coordination with the Regional Mass Casualty
plans. Operations in this plan are to be coordinated by ESF-8
(Health
and Medical Services) in accordance with Annex 8 (Health and
Medical
Services) of the SCEOP and the ESF-8 SOP.
II.
MISSION
DHEC, as the lead public & environmental health agency for the State of South
Carolina, conducts medical operations in response to natural or man-made
disasters or events, or acts of terrorism requiring the requisition, utilization and
management of the Strategic National Stockpile (SNS) and other medical
countermeasures in order to ensure the health and well-being of the citizens and
persons within the boundaries of the State. The mission of the SNS/MCM is to
rapidly and safely provide antibiotics, antiviral medication, chemical antidotes,
antitoxins, life support pharmaceuticals, vaccines, intravenous administration
supplies, airway maintenance supplies, masks, pandemic countermeasures and
medical/surgical items in a rapid and safe manner to supplement and re-supply
any community in the event that state and local capacities are exceeded or are
about to be exceeded due to a weapon of mass destruction or a major natural or
technological disaster. This plan’s mission is one of response in support of the
ESF-8 mission.
III.
PURPOSE
A. Provide for the request, receipt, staging, storage, repackaging, distribution,
dispensing, and retrieval and return of any unused assets of this stockpile,
pandemic countermeasures or other medical countermeasures depending upon the
event. This plan serves as the plan for all medical materiel acquisition,
distribution and dispensing.
SNS/MCM EOP
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Annex 1, Appendix 5-1-3
SNS/MCM
B. Implement the S.C. Strategic National Stockpile Emergency/MCM Operations
Plan Standard Operating Procedure which is incorporated into Annex 1, Appendix
5 (Mass Casualty Plan) of the South Carolina Emergency Operations Plans
(SCEOP).
C. Provide SNS/MCM operational guidance to ESF-8 (Health and Medical Services)
at the State Emergency Operations Center (SEOC), the DHEC Emergency
Operations Center (DHEC EOC), and the DHEC Regional Coordination Centers
and in all phases of SNS or other countermeasure distribution and dispensing
operations.
IV
V.
ASSUMPTIONS
A.
The SCEOP will be activated.
B.
The SEOC will activate at Operating Condition (OPCON) 1 or the appropriate
OPCON as well as responding county EOCs.
C.
SCEMD will activate the Statewide Mutual Aid Agreement and Emergency
Management Assistance Compact.
D.
All infrastructures including communications are intact.
E.
The appropriate state and federal declarations have been made by the
Governor of South Carolina, the President of the United States and the
Secretary of the Department of Health and Human Services (DHHS).
F.
The arrival of the SNS 12-Hour Push Package from the federal stockpile to
the State Receiving, Staging and Storage (RSS) site warehouse will occur
within 12 hours and the managed inventory palletized material will occur
within 24 hours once the CDC decision to deploy has been made per Division
of National Strategic Stockpile (DSNS) guidance. Delivery to the Health
Regions may not occur until 12 hours after first receipt of federal medical
materials.
G.
Emergency declarations will include provisions for SLED to assure security in the
transport of all materiel and authorization or paramedics to aide in dispensing.
SITUATION
SNS/MCM EOP
Annex 1, Appendix 5-1-4
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SNS/MCM
VI.
A.
A mass casualty event has occurred or is imminent in South Carolina
involving a weapon of mass destruction or a major natural or technological
disaster has occurred.
B.
The capacity of South Carolina’s local and state assets to meet the demand for
pharmaceuticals, vaccines, medical supplies, or other related countermeasures
or medical equipment is inadequate or has been exceeded.
CONCEPT OF OPERATIONS
A. South Carolina DHEC, the lead agency for ESF-8 (Health and Medical Services), is
responsible for developing, coordinating and maintaining procedures to support the
SNS plan as contained in Appendix 5 (South Carolina Mass Casualty Emergency
Operations Plan) of the SCEOP in conjunction with SCEMD. DHEC is responsible
for coordination of all SNS/MCM administrative, management, planning, training,
preparedness/mitigation, response, and recovery activities to include developing,
coordinating, and maintaining the State SNS/MCM EOP. ESF-8 (Health and Medical
Services) supporting agencies will assist DHEC in the planning and execution of the
above as specified in the SCEOP by Gubernatorial Executive order 2011-06 signed
January 27, 2011.
B. Coordination with all supporting and other appropriate departments/agencies and
organizations will be performed to ensure operational readiness in time of emergency.
C. DHEC shall provide an Emergency Management Coordinator or Alternate,
designated by the Director of OPHP, to represent ESF-8 and the SNS/MCM at the
DHEC EOC, who, shall act to meet the health and medical responsibilities as
described in the SCEOP. This person will be the point of contact and SNS/MCM lead
for ESF-8 and SNS/MCM Operations at the SEOC. Additional public health
personnel to coordinate the state level response will be housed at the DHEC EOC
D. In coordination with the OPHP and the SNS/MCM Pharmacist, the DHEC Regional
Public Health Directors assess the situation (both pre- and post-event), and in
coordination with local county emergency management officials and response
agencies, develop strategies to respond to the emergency.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-5
SNS/MCM
E.
Requesting the SNS/MCM:
The decision to deploy the SNS/MCM will be a collaborative effort between local,
state, and federal officials. After the recognition of a potential or actual WMD event
or a major natural or technological disaster that may or will exceed local medical
capacity, the Regional Public Health Preparedness Directors, who will notify the
Director of OPHP of the event. If initial recognition of this event occurs at the state
level by DHEC, notifications will be made from that level. A strategic policy group
comprised of the Governor, SCEMD Director, and DHEC Director will convene to
determine if the SNS/MCM should be requested. If Federal assets are required, the
DHEC Director on behalf of the Governor will request deployment of the SNS/MCM
in SC in one of two manners.
1. In federally declared disasters it will be necessary to prepare the Resource
Request Form (RRF) (FEMA form 010-0-7) (Attachment I) and process this
form through SCEMD request process for federal assistance through DHS/FEMA.
Upon submission of the request form and approval, DHS/FEMA will direct
DHHS to provide the appropriate assistance.
2. In the absence of a federally declared disaster, the DHEC Director will contact the
Health and Human Services (HHS) Regional Emergency Coordinator (REC) to
initiate the request. The CDC Emergency Operations Centers (EOC) at 770488-7100 will be also informed of the request as well as the
SNS Program
Services Consultant (PSC).
Once a request is received, federal agencies will collaborate with the state officials
to evaluate the nature and magnitude of the public health threat and to understand
how the use of federal medical supplies will address the public health threat. If a
catastrophic incident occurs, credible threats exist or an attack is imminent, the
federal government may direct deployment of SNS/MCM material before a public
health emergency declaration; a federal Stafford Act disaster declaration or receipt
of requests for DSNS assets.
F.
In response to the event, the Secretary of DHHS has properly issued a public health
emergency declaration, justifying the emergency use of certain medical counter
measures to diagnose, treat, provide prophylaxis or prevent the identified threat. The
FDA Commissioner has properly issued an emergency use authorization for the
medical countermeasures shipped to South Carolina, and DHEC has received and
made sufficient copies of the fact sheets required by the FDA to be distributed or
dispensed with the medical countermeasure. The DHEC Director will request that the
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Annex 1, Appendix 5-1-6
July 2014
SNS/MCM
Governor declare a “State of Emergency” and a “Public Health Emergency” allowing
for the implementation of the South Carolina Emergency Health Powers Act and its
associated regulations.
G.
Prior to the arrival of the Federal assets or in the event that Federal assets are not yet
available, the SNS/MCM pharmacist or designee will transfer the State of South
Carolina owned drugs from the pharmaceutical cache located at the PHP Pharmacy to
the predetermined RSS site for distribution. If the magnitude of the event does
not
warrant utilization of the predetermined RSS site, distribution
operations may be
conducted from the PHP pharmacy.
H.
Once deployment of SNS/MCM assets has been ordered, the SEOC will be
activated at OPCON 1 or the appropriate Operating Condition and the Governor will
declare a state of emergency and a “public health emergency” allowing for the
implementation of the South Carolina Emergency Health Powers Act and its
associated regulations.
DHEC will request the following resources to support this plan through the SEOC:
warehouse, warehouse management and inventory tracking (IMATS), on site
security, transportation and security during transport, communication, law
enforcement and traffic control. These resources will be provided by the support
agencies as specified in the SCEOP.
The DHEC Director has predetermined an SNS/MCM RSS site for the receipt of all
DSNS materials, which include pandemic influenza and other countermeasures. This
primary RSS location has been validated by the DSNS program service consultant
and the US Marshall’s service. The SC SNS/MCM Pharmacist or designee will
notify the RSS site of the deployment of the SNS/MCM assets by the DSNS.
When the SNS “12-Hour Push-Package” (Attachment 2) or “Managed
Inventory”(Attachment 3) arrives at the SNS RSS site, the CDC liaison for the
SNS/MCM will immediately transfer custody of the SNS/MCM assets to the State of
South Carolina using the “CDC Strategic National Stockpile Program Medical
Material Transfer Form” and the DEA Form 222(Attachment 4). The SC SNS/MCM
Pharmacist or designee is designated by the DHEC Director to officially accept the
custody of the SNS/MCM Assets from the CDC for the State of South Carolina at the
SNS RSS site. In addition to the SNS/MCM Pharmacist, the following may sign for
the SNS: the Director of Pharmacy, DHEC Health Services Director, the Director of
the DHEC Bureau of Drug Control, the back-up SNS/MCM Director or the Assistant
Director DHEC Bureau of Drug Control. The Regional Distribution Sites (RDS) will
be notified of the arrival of the SNS/MCM assets at the RSS site. South Carolina
may accept all or part of the“12-HourPush Package”.
In the absence of an emergency declaration by the Governor, operations will be
managed at the Public Health Preparedness Pharmacy Warehouse. This facility
is licensed by the S.C. Board of Pharmacy and S.C Drug Control and the
federal Drug Enforcement Agency (DEA).
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-7
SNS/MCM
Vaccines will immediately be transferred to the DHEC Division of Immunization
and control substances will be distributed to the, treatment centers/hospitals during an
event, escorted by Drug Control Pharmacists to the respective treatment
centers/hospitals. All vaccine storage and handling will follow the DHEC Division of
Immunization Vaccine Storage and Handling policy (see Attachment 4). Once the
determination has been made as to where the vaccines need to be delivered, the
vaccines will be transferred to the DHEC Health Region locations with vaccine
refrigerator by ESF-1 or by the DHEC Bureau of Business Management, depending
upon the size of the event.
I.






Staging: Once custody of the SNS/MCM assets has been transferred to the
State of South Carolina at the RSS site or PHP pharmacy, these assets will be
downloaded and staged. The SNS/MCM shipping containers will be arranged
in a color-coded scheme by product type and container number:
Red- Oral Antibiotics
Yellow – Intravenous Drugs and Supplies
Blue – Airway Management
Green – Chemical Antidotes and Supplies
White – Medical/Surgical Supplies
Pink – Pediatric Drugs and Supplies
Refrigerated items and control substances will be shipped in specialized
containers to maintain proper storage and legal requirements. Noncontainerized materials will be arranged in an area separate but adjacent to the
containerized materials. Like items will be grouped together.
J.
Distribution:
While the SNS/MCM assets are being staged at the RSS site, the DHEC
Regional Coordination Center (RCC) Manager or designee in conjunction
with local emergency management officials will request the supplies that are
needed to replenish exhausted local inventories thru the DHEC Region’s
incident command structure in conjunction with the affected counties’
incident command structure. The intravenous medicines, IV administration
supplies, fluids, life support medicines, airway equipment, antidotes and
symptomatic treatment material for casualties and medical or surgical items
for treating casualties from a WMD or a major national natural event will be
transported from the RSS site to the Regional Distribution Sites (RDS) for
transfer to the designated Points of Dispensing(PODs). RSS will ship directly
to hospitals as specified in the DHEC State SNS EOP. ESF-8 (Health and
Medical Services) will coordinate for transportation of assets to be performed
through ESF-1 (Transportation) at the SEOC.
SNS/MCM EOP
Annex 1, Appendix 5-1-8
July 2014
SNS/MCM
All Control Drugs will be transferred to the designated treatment center’s
Drug Enforcement Agency (DEA) registrant employing DEA form 222 where
applicable.
Post exposure prophylaxis packages, initial 10 day supply, will be delivered to
the RDS. The numbers of regimens needed has been determined based upon
the total population of the Health Region. Additional supplies of post
exposure prophylaxis will be shipped upon request to the affected Region.
Follow up 50 day prophylaxis and/or Anthrax Vaccine Adsorbed as required
by an anthrax exposure will be delivered to the Health Region once received
from the DSNS. The 50 day follow up on supplies for the completion of
prophylaxis and/or vaccine will be dispensed/administered by the Regions to
those individuals who were truly exposed as determined by epidemiological
investigation.
The RDS will distribute these initial regimens to the identified first responders
sites (pre-identified), any facility with a confined population with
pharmaceutical services for treatment of residents, staff and staff’s family, the
closed large employer points of dispensing and to the mass public points of
dispensing for distribution to the general public. Critical infrastructure staff
located within the Central DHEC Office Staff will receive post exposure
prophylaxis in the same manner as the closed large employer points of
dispensing. Public health staff responding at the state level will receive
prophylaxis through employee health or at their duty location. Family
members of critical infrastructure staff and first responders will be given their
post exposure prophylaxis at the same time as the responder provided the
responder can provide a brief medical history as occurs at the public points of
dispensing (Attachment 5). Hospitals will request any needed SNS medical
material/MCM, other than initial prophylaxis supplies, through the Regional
Coordination Centers or through the Region unified medical command. These
requests will be forwarded to the RSS site by ESF-8 (Health and Medical
Services) at the SEOC.
The RDS will meet the same specifications per Guidance given in Receipt,
Staging and Storing, version 11. A memorandum of agreement currently is in
place with the Department of Labor, Licensing, and Regulation, Board of
Pharmacy, to insure temporary licensing of drug distribution and dispensing
locations. These distribution sites are located in all 4 of the DHEC Health
Regions and can serve as an alternate RSS site in a more localized event. The
Regional SNS/MCM SOP will provide for necessary support to off load the
shipment, manage and track the inventory, and on-site security at the Regional
Distribution sites. Transportation, transport security, and traffic control of the
medical supplies from the RDS to the predetermined receiving hospital or to
the predetermined dispensing site will be specified in the Regional plans
(including SNS/CRI jurisdictions).
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-9
SNS/MCM
The State RSS will specify an individual from the predetermined treatment
center/hospital to be available to accept custody of the SNS/MCM control
drugs from DHEC Drug Control Pharmacists. Unless stated otherwise, the
control substances will be delivered to the main pharmacy within the hospital
and received by the Director of Pharmacy or their designee.
K.
Continuation of Supplies
While the initial CDC “12-Hour Push Package” and/or other pharmaceuticals
are being distributed from the RSS site to the RDS, the DHEC Regional
Public Health Preparedness (PHP) Directors in conjunction with local/county
emergency management officials will continually assess the need for
additional supplies of specific items. If additional medical materiel is needed,
the SC SNS Pharmacist or designee at the RSS site will request these items
from the CDC by calling the CDC 24 Hour Hotline, 770-488-7100 or the
CDC Switchboard, 404-639-3311. If the PODS or the RDS are in need of
more supplies, the request goes to the RCC, who will send that request up the
chain so that the RSS can respond by shipping out more supplies.
If the event is a declared national disaster and the National Response
Framework has been activated, FEMA would establish a Joint Field Office
(JFO) with an Emergency Support Function 8 (ESF-8) for Health and Medical
Services. ESF-8 at the SEOC would request federal support through the
tasking desk at the SEOC to the federal ESF-8 at the JFO. A FEMA Resource
Request Form (RFF form 010-0-7) for the additional assets may be required.
The same process will be followed as in the initial request phase of the
response.
L.
Dispensing/Vaccination Sites
The Regional Public Health Director or their designee, in conjunction with
local/county emergency management agencies, will develop the Health
Region Strategic National Stockpile and Cities Readiness Initiative (CRI)
plans; the Midlands Health Region will also develop the City of Columbia
Metropolitan Statistical Area (MSA) plan. All plans will identify an adequate
number of public/ closed Points of Dispensing(PODs) to provide an initial ten
day prophylaxis for the entire population within 48 hours of the federal
decision to ship medical countermeasures to South Carolina in response to a
disease outbreak or other emergency event.
First responder dispensing sites, separate from the public points of dispensing,
will be identified in each Regional SOPs. If the emergency event is a disease
outbreak and laboratory confirmation of the infecting organism has been made
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Annex 1, Appendix 5-1-10
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SNS/MCM
additional prophylaxis up to 60 days may be required for those exposed to the
infecting agent.
The DHEC Regional Public Health Directors (or designee) will insure that
symptomatic individuals are directed to treatment facilities, guidelines are
followed to determine whether an individual needs prophylactic drugs,
individuals are counseled on the threat/risk of the drug, potential
contraindications in individuals are identified, guidelines for correct dosage
based on age and weight are provided, proper documentation is maintained
identifying individual that is receiving the drug, lot number, NDC number,
expiration date, and amount of drug received, and that the people who receive
a drug understand how the drug is to be taken and how and who reports
adverse reactions to the countermeasure agent. In the event that the drug is
being dispensed to the public on a Food & Drug Administration Emergency
Use Authorization (EUA), the DHEC Regional Public Health Director will
ensure that all terms of the EUA are followed prior to dispensing information
provided by the manufacturer of the DSNS to all public and private points of
dispensing.
Head of Household (see HOH Dispensing, Section N) may pick up as many
medication regimens as needed for children and homebound adults, with
government issued identification, if they can provide age, weight, and a brief
medical/prescription drug history of the person for whom they are picking up
medication. No identification is required for adults, anyone age 16 or older,
picking up medication for themselves only.
Unaccompanied minors, anyone under 16 years of age as defined by section
63-5-340 SC Code Of Laws, who arrive at a Dispensing site will be escorted
to the special needs area by the behavioral health team, where every effort will
be made to contact the parent or guardian prior to dispensing any
countermeasure. If a parent or guardian cannot be located, the child will be
placed with the South Carolina Department of Social Services Child
Protective Services, after the proper dosage of medication is dispensed under
the authority of SC Code of Laws section 63-5-350. Provisions must be
specified in the Regional SOP to accommodate citizens with a variety of
special needs such as language, vision and mobility barriers at the dispensing
sites. Large employers, that meet the requirements to serve as a point of
dispensing for their employees, employee’s family and vendors, contract
workers or other identified participants in their plan will provide the lead
official name and contact information to the Regional Coordination Center.
The DHEC POD Manager (or designee) will be the lead official at the Public
Points of Dispensing.
Facilities with confined populations and established medication dispensing
procedures will provide to the Regional Coordination Center (RCC), the
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Annex 1, Appendix 5-1-11
SNS/MCM
number of needed regimens and will follow their usual and customary
medication dispensing procedures for patients/residents, staff and staff’s
family following CDC and DHEC guideline and recommendations. Examples
of these affected institutions are hospitals, nursing homes, military
installations or prisons. These medications may be either unit of dispensing
containers or bulk containers. These institutions and how they receive their
medications will be identified and defined in the DHEC Regional SOP. The
DHEC Regional SOP will also identify planning for large employer closed
points of dispensing. These facilities may not have pharmacy permits, but
will follow the scope of services as set forth in the DHEC Closed POD
agreement. The DHEC Regional SOP will identify how traffic control and
security will be provided at the large employer closed point of dispensing.
Each public/closed dispensing site will need to develop an efficient flow
diagram in their POD Plan. Adequate signage will need to be in place to
ensure a smooth patient flow. While allowing differences to accommodate the
various facilities hosting the dispensing site and the security requirements of
local law enforcement, each POD site should have:
(1) One way into the parking lot of the facility and one way out
(2) One way into the building and one way out. Be sure that those arriving do
not have access to stop and “visit” with those that are leaving.
(3) An area to screen for those that are currently symptomatic and/ or awaiting
transfer to treatment facility
(4) An area to fill out necessary paperwork and receive disease and drug
information via video or printed material.
(5) An area for medical/pharmaceutical counseling if needed.
(6) A drug and patient drug information sheet dispensing area
(7) A special needs area
(8) A holding area for patients creating a disturbance. Depending upon the
nature of the disturbance, this room can be used for counseling by social
work or law enforcement.
(9) An area to stamp the hand of the person receiving the medication to
prevent them from immediately returning to the line.
(10) A secure area to store the pharmaceuticals and a delivery access point
and route away from public view.
M.
A Memorandum of Agreement (MOA) is currently in place with the
Department of Labor, Licensing, and Regulation, Board of Pharmacy to insure
temporary licensing of mass public and large employer closed drug dispensing
sites and distribution sites in a Governor’s declared emergency. This
waiver is for the duration of the declaration or 30 days, whichever is less.
After 30 days a new declaration will be required.
The following procedures have been established to ensure safe drug
dispensing and adequate record keeping to protect public health, safety
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and welfare in a mass casualty event that would require federal or other
medical countermeasures being sent to South Carolina. All necessary forms,
including the standing orders, will be posted on WebEOC under the file
library once most current CDC event driven updates are available.
1) Protocols/Standing Orders are available to provide current
guidelines for the assessment and prophylaxis along with followup of persons who may be exposed to a biological and/or chemical
agent. These protocols can be found in the DHEC Standing Orders
Manual that is available on the DHEC Intranet site. (Attachment
5). To access these orders, go to dhecnet – program area – health
services manuals and reports – Health Services Standing Orders
Manual – BT tab. Copies of these orders will be printed by the
Regional PHP Director or their designee and be available for
review at the Points of Dispensing. Healthcare workers and others
who participate in the response effort will use these protocols to
insure uniform treatment for all citizens of South Carolina. These
protocols include the CDC treatment and post exposure
prophylaxis guidelines.
2) The Clinical Evaluation Form (NAPH form) for dispensing mass
post- exposure prophylaxis therapy for patients exposed to a
biologic agent will serve as the (1) exposure screening form (2)
dispensing record (3) refill record (4) medical chart (5)
acknowledgement of receiving treatment. To access this form, go
to dhecnet-program areas-technologies- RIMS-PDF forms. This
form , or the Head of Household (HOH) NAPH form, will be filled
out for every person who receives prophylaxis. This record is to be
maintained in the Health Regional pharmacy in lieu of a written
prescription document for 3 years after the last date of service.
After the 3 years, the record is to be transferred to archives where
it will be maintained in accordance with DHEC policy A.932. The
Clinical Evaluation NAPH form will serve as the prescription form
for any refills, should they be necessary. A copy may be
maintained in the County Health Department where services were
rendered to insure rapid availability to the affected individual’s
private physician, upon request.
Each prepackaged 10-day regimen from the CDC comes labeled
with two perforated labels identifying drug, quantity, expiration
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date, NDC number and prescription number. One label will be
attached to the NAPH form for the initial dispensing and for any
refills that may be needed. The prescription number, quantity of
drug, patient name, date and prescribing physician, will be
handwritten on the dispensing label. To comply with proper
prescription labeling, each Health Region must include the name of
the Health Region, the complete address and the phone number on
each of the dispensing labels printed at the Region. Each
prescription must be labeled as to proper dosing instruction and
each prescription will be labeled with the following statement:
“Call your doctor for medical advice about side effects. You may
report side effects to Food & Drug Administration at 1-800-FDA1088”.
Each patient will be counseled on the proper use of the drug and
any drug-drug and drug-medical conditions interactions using the
“Patient Counseling Information for Selected Antimicrobials Used
for Prophylaxis Following Exposure to Potential Bioterrorist
Agents”. A notification to the patient’s primary care physician
Form DHEC form 1289 will be given to the patient to take to
their physician.
Any countermeasures dispensed under an Emergency Use
Authorization will be dispensed with the patient information
prepared by the requesting authority of the EUA.
Each dispensing site will also have information on the
causative agent, if known, for distribution to the general public.
This information will be prepared at the time of the incident
initially using the CDC agent information sheets available at
www.bt.cdc.gov until the most current information can be
incorporated into the SCDHEC agent information.
Countermeasures that have not completed the Food and Drug
Administration approval process may be dispensed as an
investigational new drug (IND) or on an Emergency Use
Authorization (EUA). The CDC designated lead center, institute,
or office, will obtain approval from the FDA to use specific IND
protocols for medical countermeasures. The CDC will provide the
latest versions of the protocols, authorizations and instructions for
use to be distributed with the countermeasure. In the event that
countermeasures are required that have not completed the FDA
approval process, and are not being dispensed as an IND, DHEC
will ensure that a FDA Emergency Use Authorization has been
obtained by the manufacturer or requesting authority and all
SNS/MCM EOP
Annex 1, Appendix 5-1-14
July 2014
SNS/MCM
appropriate paperwork will be distributed with the counter measure
to the DHEC Public Health RDS for distributing with the antiviral
or other countermeasure to the healthcare provider or public or
closed point of dispensing. These healthcare providers or public or
closed points of dispensing will be informed of the conditions
under which the countermeasures can be dispensed as set forth by
the FDA Commissioner at the time that the Emergency Use
Authorization is granted such as:
(1) Distribute FDA approved information for healthcare providers or
authorized dispenser
(2) Distribute FDA approved information for recipients
(3) Monitoring and reporting adverse events
(4) Records maintenance
N.
Head of Household Plan
SUBJECT: Head of Household Dispensing
Policy Statement:
During a large scale public health emergency (i.e.:
bioterrorism, Pandemic Influenza, etc.) in order to expedite the distribution
of prophylaxis to the affected population, a designated representative from a
household may obtain medications for as many people in their household,
related or not without them being present at the mass dispensing site.
Standards:
1. The Head of Household dispensing model will be implemented at every mass
dispensing site under DHEC’s oversight.
2. A representative from a household is defined as someone 16 years of age or
older who is presenting on behalf of a designated group of persons for the
purpose of prophylaxis.
a. The representative presenting is called the “Head of the Household”
for the purposes of prophylaxis and dispensing.
3. Standing orders will be written to allow for Head of Household dispensing,
as well as for individual patient dispensing.
Procedures:
1. Upon arrival to the mass dispensing site, the Head of Household must
provide the following:
a. Government issued identification (ID) that includes address
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-15
SNS/MCM
i. If they do not have government issued ID, the address will be
verified as completely as possible. They will not be turned
away from the dispensing site.
b. A working phone number;
c. List of the family members needing prophylaxis including the
following for each:
i. Full name
ii. Date of Birth
iii. Medication allergies
iv. Medical conditions
v. Current medications
vi. Current weight for family members under the age of 12
2. The Head of Household will complete the required paperwork for each
family member.
3. Upon review of the information for each family member, appropriate
medication will be dispensed per the standing medical orders. The
identifying numbers will be the prescription number and lot number
assigned to the bottle given to each person. It is located on the SNS label.
4. Instructions will be provided to the Head of Household regarding use of the
medication and any needed follow-up.
O.
Retrieval
Per the terms of the 2010 memorandum of agreement between the Centers for
Disease Control and Prevention (CDC) and the South Carolina Department of
Health and Environmental Control (DHEC), the CDC retains title to the
DSNS and Federal Medical Station durable assets. Any durable assets sent to
the Region Distribution Sites (RDS) will be returned to the Receiving Staging
and Storage (RSS) site utilizing a transportation tasking to ESF-1 at the State
Emergency Operations Center (SEOC). The RSS site will arrange for the
pick-up of the durable assets from the RDS and returning it to the RSS. Upon
CDC request and at CDC expense, the durable assets will be returned to the
CDC or when no longer needed for public health emergency response, CDC
will assess the return of unused medical materiel to determine if sealed, nonpharmaceutical items stored in accordance with manufacturer
recommendations can be returned to federal custody. CDC will not otherwise
accept return of any unused medical materiel. Other unused medical materiel,
including pharmaceutical items, will be returned to the RDS. Once all
materiel is returned to the RDS sites, these materiels will be returned to the
RSS, with any durable assets, for final disposition.
P.
Communication
SNS/MCM EOP
Annex 1, Appendix 5-1-16
July 2014
SNS/MCM
The communications function ensures the timely flow of information used in
the decision making process as well as in operational effectiveness. The
communications function involves three distinct areas.
1.
Public Healthcare Communication
All official public healthcare information related to the incident will be
coordinated through and released in conjunction with the SC Emergency
Management Division and participating agencies through the Joint
Information Center (JIC) located at the State Emergency Operations Center as
described in Annex 15 (ESF-15) of the South Carolina Emergency Operations
Plan and in accordance with the DHEC Public Information Emergency
Operations Plan.
The types of information released will include information on the event itself,
how to protect yourself and your family and any public health orders such as
quarantine, shelter in place or evacuation orders. Also included will be
messages how to get the medication and medication safety. SNS/MCM
specific messages will include, but will not be limited to, where to pick up
medication, what medical information is needed to receive the medication,
what is needed for identification, how to take medication, who should take the
medication, how long to take the medication, what are the expected side
effects of the medication, who to call in the event of unexpected side effects
and what to do if one is currently symptomatic. Templates for these messages
have been written and when needed will be incident specific and distributed
through local public information channels such as television, radio,
newspaper, and at the local dispensing sites by healthcare professionals.
Direct contact with affected individuals will be available through the call-in
SC
Public
Information
Phone
System
(PIPS),
South Carolina 211 or the GIS based call-out system, REACH SC (HAN)
housed on the DHEC server. DHEC, ESF-8, will provide the pre-scripted
messages to the community in a variety of ways to ensure that harder to reach
populations, due to economic disadvantage, language, or literacy, medical
issues, isolation or age will receive the necessary information. Since South
Carolina has a centralized health agency, all DHEC Health Regions and the
county health departments within those regions will use the same public
health information provided by DHEC Division of Media Relations.
2.
Logistical/Tactical Communication
Logistical/Tactical Communication include, but not limited to, are as follows:
expected number of potential individuals needing treatment, number treated
with prophylactic medication and sent home, number transferred to hospitals
or other treatment centers, number still requiring treatment, medications and
supplies transferred to treatment center, additional SNS/MCM assets needed
by treatment centers. These numbers will be reported on a regular basis as
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-17
SNS/MCM
determined by the incident, by the RCC to the RSS site and to ESF-8 at the
SEOC. The DHEC EOC will monitor all response and recovery activities
through the state and agency copies of Web EOC. The DHEC EOC will
maintain communications with ESF-8, RSS site, RDS sites by email, fax,
telephone, cell phone, 800MHZ radio.
Requests from the county emergency operations center for SNS/MCM or
other health and medical services will be either called into the SEOC by
telephone, transmitted via Web EOC or by radio. The SEOC Operations will
task any such requests for health and medical services to ESF-8. DHEC
representative in ESF-8 will task either a support agency or the appropriate
DHEC program area. This procedure is consistent with the request procedure
found in the ESF-8 SOP.
Requests from DHEC Health Regions to the DHEC EOC will be tasked by
DHEC EOC personnel to the appropriate program areas within DHEC.
Requests for support from outside the agency for Health Region response will
be requested by the DHEC EOC thru ESF-8 or directly by the Health Region
through SEOC Operations Section. Completion of all tasks will be reported to
the DHEC representatives in ESF-8 at the SCEOC for inclusion in the
periodic situation reports. This procedure is consistent with the request
procedures found in the ESF-8 SOP.
3.
Equipment
Cell phones, land lines, fax lines and DHEC internet services will
electronically tether all SNS/MCM function and area leads.
These
communication services are operational 24 hours/day, 7 days per week and are
used daily in the performance of routine agency functions. The State
Emergency Operations Center, the DHEC EOC, the RSS site, and the RDS
will be in communication by 800 MHZ 2-way radio, which are linked by a
wide area communications system that covers the entire state.
.
Q.
Security and Transportation
The security and transportation functions will be coordinated through the
SEOC and will be provided by ESF-1, ESF-8, ESF-13 and ESF-15 and ESF16.
Transportation to the RDS will be tasked through ESF-1. The SC Department
of Transportation (SCDOT) is the primary or lead agency for ESF-1 and
coordinates with support agencies to provide transportation of assets during
SNS/MCM EOP
Annex 1, Appendix 5-1-18
July 2014
SNS/MCM
and post disaster. The state’s emergency responsibility includes the allocation
and prioritization of state transportation assets to include processing all
transportation requests from state agencies and local governments. Per Annex
1 (Transportation) of the SCEOP, the SC Department of Transportation is
responsible for all ESF-1 administrative, management, planning, training,
preparedness, response, mitigation and recovery activities to include
developing, coordinating and maintaining the ESF-1 SOP. All ESF-1
supporting agencies, as listed in the SCEOP, will assist SCDOT in the
planning and execution of the above. ESF-1 is responsible for the execution
of all emergency transportation services necessary to support emergency
operations of state agencies, including repair or replacement of disabled
vehicles en route. In accordance with Annex 1 (Transportation) of the
SCEOP, ESF-1 will maintain current inventories of government transportation
facilities, supplies, and equipment by node and will maintain current resource
directories of all commercial and industrial transportation assets, facilities,
and supplies within the State to include points of contact, their geographic
locations, territories and operating areas.
SCEMD is responsible for the SC Logistics Plan. SCEMD maintains
transportation services on a contingency contract and will activate those
contracts in support of SNS/MCM logistical activity when required.
Security will be provided for all personnel, material, and equipment involved
in the management and distribution of the SNS/Medical countermeasures in
accordance with the South Carolina Law Enforcement Division (SLED)
SNS/MCM security plan. The SC Law Enforcement Division is the primary or
lead agency for ESF-13 (law enforcement) and provides for the coordination
of law enforcement personnel and equipment in an emergency or disaster for
all law enforcement tasks except for traffic management which is the
responsibility of ESF-16. ESF-13 coordinates with support agencies including
the SC Department of Public Safety (DPS) to ensure operational readiness
during and post disaster.
In accordance with SC Code of Laws Section 23-3-15 (A) (8), SLED has
specific and exclusive jurisdiction and authority for coordinating the state
response in the event of a terrorist threat or actual incident. Since South
Carolina is a “Home Rule” state, the sheriff or chief of police is responsible
for law enforcement activities within his/her jurisdiction. Per Annex 13 (Law
Enforcement) of the SCEOP, when state law enforcement personnel and
equipment are committed, a member of SLED will be assigned to coordinate
state activities with the local law enforcement officer in charge. Also in
accordance with Annex 13 (Law Enforcement) of the SCEOP, no use will be
made of private security agencies or volunteers unless they are sworn and
trained special deputies, state constables, or auxiliary policy. Such personnel
will be the responsibility of the public safety agency which appoints and
utilizes them.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-19
SNS/MCM
Security to be provided includes but is not limited to access in and out of the
RSS facility, security within the RSS compound; traffic control within and to
and from the RSS facility. A DHEC driver and vehicle will be available to
transport any CDC/DHS/HHS representative to the SEOC if needed. The
South Carolina Air and/or Army National Guard have been tasked with
providing security for the SNS/MCM assets at the RSS site and will follow
the base’s usual and customary use of force guidelines in maintaining the RSS
site integrity. This security will be included in the basic facility security plan
that includes but is not limited to controlled access in and out of the facility,
controlled access to the flight line, controlled access to the RSS warehouse
within the facility compound. All entrances to the RSS warehouse, flight
access, and compound fence line are under 24-hour manned video
surveillance.
All persons working in or with the DHEC SNS/MCM program during a
disaster whether natural or a terrorist event, will be credentialed as per the
attached description of the credentialing system. All persons without
exception, will be required to wear a credential holder around their neck and
clearly visible at all times. The DHEC Regional SOPs will specify
credentialing procedures for all Regional Dispensing sites and Distribution
sites. Anyone entering the facility where the RSS site is housed will have to
present a government-issued photo identification to the armed security guard
at the gate prior to admission. No one will be admitted unless their name
appears on the roster provided by ESF-8/SCDHEC.
ESF-13 (Law Enforcement) will coordinate with its internal agencies and with
ESF-16 (Emergency Traffic Management) for traffic control, security and
escort in transport to the RDSs and with coordinating security with local law
enforcement at the RDSs. ESF-1 (Transportation) will notify the RSS site of
the size of the truck, a description of the truck and the driver’s name. This
information will be given to the guard gate and must be verified against the
driver’s identification prior to admission to the RSS site. The driver will be
informed of where the delivery will be made at the time of loading. The
drivers will be escorted between two law enforcement vehicles. Routing will
be determined by law enforcement. SLED and DPS will utilize their usual
and customary use of force guidelines to ensure delivery of the medications to
the Regional Distribution sites.
The South Carolina Law Enforcement SNS/MCM Operations Plan will
support ESF-13’s mission to the SC Mass Casualty Plan (Annex 1 –
SNS/MCM) of the SCEOP. This SOP provides operational guidance to those
who are assigned to work in ESF-13 in all phases of SNS/MCM operations.
The DHEC Drug Control Pharmacists are tasked with providing security and
transportation of any controlled substances from the RSS site to the
SNS/MCM EOP
Annex 1, Appendix 5-1-20
July 2014
SNS/MCM
designated DEA registrant facility, usually a hospital pharmacy in each
region.
The Regional MCM SOP will provide for security at the Regional
Distribution site and transport to the points of dispensing and at the mass
public points of dispensing/vaccination. Security for the large employer
closed dispensing/vaccination sites will be identified in the Regional/CRI
SNS/MCM SOP.
If repackaging is necessary prior to distribution from the RSS site, SLED will
provide security in transport from the RSS site to the repackager and back to
the RSS Site.
The US Marshall’s service is not considered part of the SNS/MCM SSAG
(Surveillance Science Advisory Group) and will not provide routine security
for SNS/MCM assets and personnel unless threat analysis of the event
indicates federal security is necessary.
R.
Repackaging
In the event that the prophylactic medication required to treat the biologic
agent is not available in the unit of use packaging in the 12-Hour push
package or the state receives bulk medication from the Managed Inventory
(MI), the bulk medication will be repackaged into unit of use containers by an
off-site re-packager prior to distribution from the RSS site. At this time
Moncrief Hospital is our re-packaging facility.
V.
ESF ACTIONS
The emergency operations necessary for the performance of this Annex I to
Appendix 5 of the SCEOP include, but are not limited to the following:
A.
Preparedness
1.
Develop, coordinate and maintain written plans to implement
SNS/MCM state and regional response operations in South Carolina.
2.
Develop and maintain mutual support relationships with other
governmental
entities,
professional
associations,
volunteer
organizations and other private services that may assist during a
WMD, natural or technological disaster.
3.
Identify, coordinate and credential personnel necessary to deploy the
SNS/MCM assets and in support of ESF-8 responsibilities.
4.
Identify and establish state and regional locations for receiving,
staging, storing and distributing SNS/MCM.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-21
SNS/MCM
B.
5.
Identify and establish adequate regional locations (points of
dispensing/vaccination) to provide initial 10 day prophylaxis to the
entire DHEC Health Region population within 48 hours and to provide
follow up prophylaxis to complete the regimen if needed.
6.
With other health care providers, identify and coordinate other sources
of pharmaceuticals and medical equipment/supplies.
7.
Develop and maintain dosing and dispensing guidelines and
procedures for the prophylactic drugs contained in the SNS/MCM
designed for mass distribution or dispensing.
8.
Assure that DHEC Health Regions develop SOPs for the management
of medical supplies and medications in the SNS “12-Hour Push
Package”, the SNS Managed Inventory, Pandemic countermeasures
and any additional pharmaceutical and/or medical supplies.
9.
Develop and implement training and training exercises for related
areas of SNS/MCM management.
Response
1.
Assess the situation and determine if a potential or actual WMD event
or a major natural or technological disaster may exceed local medical
supplies.
2.
Facilitate the collaboration of state, regional and local officials to
determine whether to request federal assistance.
3.
Coordinate request for the SNS 12-Hour Push package, Managed
Inventory, Pandemic countermeasures and other pharmaceutical,
vaccine or medical materiel by the DHEC Director with the consent of
the Governor, when it is determined by state and local officials that
Federal assets are required.
4.
Participate in the CDC Director’s conference calls to the DHEC
Director and other Federal, State and local officials to determine if an
event threatens the public health and exceeds or strains the local
capacity to respond. The CDC Director will then request a copy of the
SC SNS EOP and upon receipt will order the deployment of the
SNS/MCM.
SNS/MCM EOP
Annex 1, Appendix 5-1-22
July 2014
SNS/MCM
5.
Request deployment of a SNS/MCM package, Managed Inventory,
Pandemic countermeasures and other pharmaceutical, vaccine or
medical materiel adequate to respond to the scope and size of the
event.
6.
Request the Governor declare a state of emergency and a “public
health emergency” to allow the implementation of the South Carolina
Emergency Health Powers Act and its associated regulations.
7.
Notify the DHEC Regional PHP Directors and the Regional MCM
Coordinators, the PHP Director and the CRI Coordinator of the
deployment of the SNS/MCM medical assets to the SC RSS site by the
CDC and request implementation of Regional SOPs.
8.
Notify SEOC of the deployment of SNS/MCM by the CDC to the SC
RSS site.
9.
Notify SNS location of expected arrival of the SNS/MCM.
10.
Notify and coordinate the agencies and organizations involved in the
staging of the SNS/MCM.
11.
Notify and coordinate with the agencies and organizations involved in
the support of the individuals involved in the staging of the
SNS/MCM.
12.
Notify and coordinate with the agencies and organizations involved in
the transport of the SNS/MCM.
13.
Notify RDS and/or Regional PHP Directors of the arrival of the
SNS/MCM at the SC RSS site. Notify the RDS and SNS/MCM
Coordinators in the Regions (including CRI) of the deployment of the
SNS to the RDS. Request that the Regional Points of Dispensing are
notified of the deployment by the regional DHEC SNS/MCM
Coordinators.
14.
Coordinate with ESF-1 to transport SNS/MCM assets from the RSS
site to the Regional Distribution sites for distribution to the Points of
Dispensing/vaccination.
15.
Coordinate with DHEC RCC distribution of SNS/MCM medical assets
to designated hospitals.
16.
Coordinate with DHEC RCC dispensing initial 10 days of antibiotics
or other approved countermeasures to the entire Region population
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-23
SNS/MCM
within the prescribed time frame of 48 hours and follow up
prophylaxis of 50 days if needed.
17
Coordinate with ESF-13 to secure SNS/MCM assets in transport
from the RSS site to the Region Site, treatment center or repackaging
center.
18.
Coordinate with ESF-2, Communication, for use of additional 800
MHZ radios and installation of phone and data lines at the RSS site.
19.
Notify the South Carolina Labor, Licensing and Regulation of the
pending arrival of SNS/MCM assets in South Carolina and of the
gubernatorial declarations.
20.
Coordinate all official public health information related to the event
with participating agencies through the Joint Information Center at the
South Carolina Emergency Operations Center.
C. Recovery
1.
Determine the need for additional medical supplies in conjunction with
the SC DHEC RCC and the county/local emergency management
officials.
2.
Request additional supplies of specific items through the CDC
Managed Inventory of the CDC-SNS program or through the State of
South Carolina emergency procurement procedures.
3.
Coordinate with the DHEC Regions to ensure follow-up with
individuals actually exposed to the biological agent and provide
remainder of their medical countermeasure prophylaxis.
4.
Coordinate retrieval of all unused assets of the SNS/MCM program
from the distribution and dispensing sites to the RSS site.
5.
Coordinate with CDC to return unused or reusable Durable Assets to
CDC upon request at CDC expense unless the CDC has agreed, in
writing, to another disposition of the Durable Assets.
6.
Coordinate with CDC at the conclusion of a public health emergency
response to return of unused medical materiel to determine if sealed,
non-pharmaceutical items stored in accordance with manufacturer
recommendations can be returned to federal custody. CDC will not
otherwise accept return of any unused Medical Materiel.
SNS/MCM EOP
Annex 1, Appendix 5-1-24
July 2014
SNS/MCM
D.
Mitigation
1.
Support, plan and implement mitigation measures.
2.
Support requests and directives from the Governor and/or
CDC concerning mitigation and/or re-development activities.
3.
Document matters that may be needed for inclusion in agency or
state/federal briefings, situation reports and action plans.
VI.
RESPONSIBILITIES
A.
Department of Health and Environmental Control (ESF-8)
1.
Develop, coordinate and maintain written plans to implement the
Strategic National Stockpile/MCM response operations in South
Carolina on both State and Regional levels.
2.
Develop and maintain mutual support relationships with other
governmental
entities,
professional
associations,
volunteer
organizations and other private services that may assist during a
Weapons Mass Destruction (WMD), natural or technological disaster.
3.
Identify, coordinate, train and credential personnel necessary to deploy
the Strategic National Stockpile/MCM assets to meet ESF-8
responsibilities.
4.
Identify and establish state and regional locations for receiving,
repackaging, staging, storing, distributing SNS/MCM and other
medical materiel.
5.
Identify and establish adequate regional Points of Dispensing to
provide initial 10 days of antibiotic prophylaxis to the entire DHEC
Health Region population within 48 hours and follow up prophylaxis
of 50 days if needed to complete the regimen.
6.
Identify and coordinate with other health care providers other sources
of pharmaceuticals and medical equipment/supplies.
7.
Develop and maintain dosing and dispensing guidelines and
procedures for the prophylactic drugs contained in the Strategic
National Stockpile and for other medical countermeasures designed for
mass dispensing.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-25
SNS/MCM
8.
Assure that Department of Health and Environmental Control Health
Regions develop Strategic National Stockpile and/or Cities Readiness
Initiative SOPs for the management and distribution of the medical
supplies and medications in the Strategic National Stockpile “12-Hour
Push Package”, Managed Inventory, Pandemic countermeasures and
other pharmaceutical, vaccine or medical materiel.
9.
Identify, train, and assign Department of Health and Environmental
Control personnel to implement Strategic National Stockpile/MCM
EOP.
10.
Notify all Strategic National Stockpile/MCM supporting agencies
upon implementation of the Strategic National Stockpile/MCM EOP.
11.
Develop mutual support relationships with professional associations
and other private services and volunteer organizations that may assist
during emergencies or disasters.
12.
Coordinate and direct the activation and deployment of state agencies,
volunteer health/medical personnel through SCSERV, the emergency
system for advance registration of volunteer health professionals
(ESAR-VHP) and the four Regional Medical Reserve Corps, supplies,
equipment and provide certain direct resources under the control of the
Department of Health and Environmental Control.
13.
Develop and conduct training, drills and exercises to coordinate
emergency medical care in disaster situations requiring Strategic
National Stockpile/MCM assets.
14.
Assure that the procedure described in section IV.E is in place for
requesting the Strategic National Stockpile “12-Hour Push Package”
and “Managed Inventory” from the Centers for Disease Control and
Prevention.
15.
Facilitate the collaboration of state, regional and local officials from
supporting agencies to assess the situation and determine if a potential
or actual WMD event or a major natural or technological disaster may
exceed state and local medical capacity.
16.
Coordinate requesting and consultation phases of the Strategic
National Stockpile/MCM with the Centers for Disease Control and
Prevention Division of Strategic National Stockpile/MCM among state
and federal response officials.
17.
Ensure that required information is available for the consultation phase
SNS/MCM EOP
Annex 1, Appendix 5-1-26
July 2014
SNS/MCM
with the Centers for Disease Control and Prevention. This information
includes but is not limited to the following: current or projected
casualties, projected needs based on population, presence of an
Strategic National Stockpile/MCM EOP, hospital capacities at the time
of the event including Intensive Care Unit beds and ventilators; other
state/local resources such as pharmacy distributors, oxygen suppliers,
nearby hospital and alternate care sites, other stockpiles of
pharmaceuticals and an EOP to receive, repackage prophylactic oral
antibiotics.
18.
Determine need to initiate any waiver of rules and regulations
regarding licensing of drug distribution or dispensing outlets.
19.
Coordinate the verification of volunteer medical personnel through the
South Carolina ESAR-VHP program.
20.
Ensure all state and federal documentation is available in order to
accept and distribute the Strategic National Stockpile/MCM assets and
that such documentation complies with state and federal pharmacy and
drug control regulations.
21.
Maintain lists of points of contact with all agencies and organizations
involved with the warehouse management, inventory control, on-site
security, transport, transport security, distribution, dispensing, retrieval
and return to Centers for Disease Control and Prevention of Strategic
National Stockpile/MCM assets.
22.
Provide all inventory control records and distribution records of
Strategic National Stockpile/MCM assets as required by Centers for
Disease Control and Prevention.
23.
Maintain all expense records associated with deployment of the
Strategic National Stockpile/MCM for possible reimbursement.
24.
Assess the situation and determine if a potential or actual WMD event
or major natural or technological disaster may/or will exceed local
medical capability.
25.
With the consent of the Governor and it has been determined by state,
local officials, the Department of Health and Environmental Control
Director will request Strategic National Stockpile/Assets.
26.
Accept custody of the Strategic National Stockpile/MCM assets from
the Centers for Disease Control and Prevention.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-27
SNS/MCM
27.
Participate in the Centers for Disease Control and Prevention Directors
conference call to the Department of Health and Environmental
Control Director and other Federal, State and local officials to
determine if an event threatens the public health and exceeds or strains
the local capacity to respond. If the Secretary of the Department of
Health and Human Services or his designee decides that the event
threatens the public’s health and that the on-site capacity and resources
have or will be strained or exhausted, a request will be made for a
copy of the SC Strategic National Stockpile/MCM EOP. Upon receipt
of the SC Strategic National Stockpile/MCM EOP, the Secretary of the
Department of Health and Human Services or his designee will order
the deployment of the Strategic National Stockpile “12-Hour Push
Package” and/or other medical materiel to the SC Strategic National
Stockpile Receiving, Staging and Storage (RSS) site as designated by
the Director of the Department of Health and Environmental Control.
.
28.
Request the Governor declare a state of emergency and a “public
health emergency” to allow the implementation of the South Carolina
Emergency Health Powers Act and its associated regulations.
29.
Notify the Regional PHP Directors, the Regional SNS/MCM
Coordinators and the CRI Coordinator(s) of deployment of the
Strategic National Stockpile/MCM medical assets to the SC Receiving,
Staging and Storage site by the Centers for Disease Control and
Prevention and request the implementation of the Region/CRI
Strategic National Stockpile SOP(s).
30.
Notify SEOC of deployment of Strategic National Stockpile/MCM
assets by the Centers for Disease Control and Prevention to the South
Carolina Receiving, Staging and Storage site and request notification
of supporting agencies.
31.
Notify Receiving, Staging and Storage location of expected arrival of
the Strategic National Stockpile/MCM assets.
32.
Notify and coordinate with the agencies and organizations involved in
the staging of the Strategic National Stockpile/MCM assets.
33.
Notify and coordinate with the agencies and organizations involved in
the support of the individuals involved in the receipt, staging, storage
and on-site security of the Strategic National Stockpile/MCM assets.
34.
Notify and coordinate with the agencies and organizations involved in
the transportation and security of the Strategic National
SNS/MCM EOP
Annex 1, Appendix 5-1-28
July 2014
SNS/MCM
Stockpile/MCM assets from the RSS site to the Regional distribution
sites.
35.
Notify Public Health Preparedness Directors or his designee of the
arrival of the Strategic National Stockpile/MCM at the South Carolina
Receiving, Staging and Storage site. Notify the PHP Director or his
designee of the deployment of the Strategic National Stockpile/MCM
to the Regional Distribution sites. Ensure that the Regional points of
dispensing are notified of the deployment by the DHEC Regional PHP
Director.
36.
Coordinate with ESF-1 (Transportation Services) transportation of
Strategic National Stockpile/MCM assets to the Regional Distribution
site(s) for distribution to the local points of dispensing or designated
hospitals.
37.
Coordinate with Department of Health and Environmental Control
Health Regions distribution of Strategic National Stockpile/MCM
medical materials to designated hospitals.
38.
Coordinate with Department of Health and Environmental Control
Health Regions and City of Columbia MSA/CRI dispensing initial 10
days of Strategic National Stockpile/MCM prophylactic antibiotic
regimens or other approved countermeasures to the entire health
Region population within the prescribed time frame of 48 hours and
follow up prophylaxis of 50 days to complete the regimen if needed.
39.
Coordinate with ESF-13 (Law Enforcement) and ESF-16
(Emergency Traffic Management) security for Strategic National
Stockpile/MCM assets in transport to the Receiving, Staging and
Storage site, from the Receiving, Staging and Storage site to the
Regional Distribution sites, designated hospitals, and repackaging
facility and back to Receiving, Staging and Storage site.
40.
Provide transportation and security of control substances to designated
treatment centers and provide for the transfer of these control
substances to treatment centers that are properly registered to accept
these substances by the federal Drug Enforcement Agency (DEA).
41.
Provide transportation of bulk pharmaceuticals to repackaging
facilities.
42.
Determine the need for additional medical supplies in conjunction
with the SCDHEC Regional PHP Director and the county/local
emergency management officials.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-29
SNS/MCM
43.
Request additional supplies of specific items through the Centers for
Disease Control and Prevention Managed Inventory portion of the
Strategic National Stockpile/MCM program and/or through other
commercial sources if available
44.
Coordinate with ESF-2, Communication, the use of additional 800
MHZ radios, HAM radios, satellite phones, mobile satellite trailers and
the installation of additional telephone and data lines at the RSS site.
45.
Coordinate with the DHEC Regions to ensure follow-up with
individuals actually exposed to the biological agent and provide
remainder of their medical countermeasure prophylaxis.
46.
Coordinate retrieval of all unused assets of the Strategic National
Stockpile/MCM
program
from
the
distribution
and
dispensing/vaccination sites to the Receiving, Staging and Storage site.
47.
Coordinate with CDC the return of unused or reusable Durable Assets
to CDC upon request, at CDC expense unless the CDC has agreed, in
writing, to another disposition of the Durable Assets.
48.
Coordinate with CDC at the conclusion of a public health emergency
response, the return of unused medical materiel to determine if sealed,
non-pharmaceutical items stored in accordance with manufacturer
recommendations can be returned to federal custody. CDC will not
otherwise accept return of any unused Medical Materiel.
49.
Maintain and provide all inventory control records and distribution
records as required by the CDC.
50.
Maintain all personnel time and other expense records associated with
the deployment of the SNS/MCM in the response for possible
reimbursement.
51.
Support, plan and implement mitigation measures.
52.
Support requests and directives resulting from the Governor and/or
Centers for Disease Control and Prevention concerning mitigation
and/or re-development activities.
53.
Document matters that may be needed for inclusion in agency or
state/ federal briefings, situation reports and action plans.
SNS/MCM EOP
Annex 1, Appendix 5-1-30
July 2014
SNS/MCM
B.
C.
Office of the Governor
1.
Coordinate with the Department of Health and Environmental Control
Director, South Carolina Emergency Management Director, the
Department of Health and Environmental Control Director of Health
Services, the Department of Health and Environmental Control
Regional Public Health Preparedness Directors and the Department of
Health and Environmental Control Director of Public Health
Preparedness to request federal assistance in the form of medical assets
from the Strategic National Stockpile/MCM.
2.
Authorize the DHEC Director to request Strategic National
Stockpile/MCM assets.
3.
Declare a state of emergency and a “public health emergency” to allow
for the implementation of the South Carolina Emergency Health
Powers Act and its associated regulations.
Office of The Adjutant General (ESF-19)
1.
SC National Guard
a.
Identify, train, and assign South Carolina National Guard
personnel to maintain contact with and prepare to execute
missions in support of Strategic National Stockpile/MCM and
Pandemic Influenza Response activities during periods of
activation.
b.
Provide on-site security at the Receiving, Staging and Storage
site for Strategic National Stockpile assets and other medical
countermeasures. Site security will follow base usual protocol.
Additional security will be in place at identified RSS building.
c.
Provide personnel to assist in the unloading/loading at the
Receiving, Staging and Storage site for the Strategic National
Stockpile/MCM assets and other medical countermeasures.
d.
Provide warehouse facilities to receive, stage, store and
distribute Strategic National Stockpile assets and other medical
countermeasures.
e.
Provide personnel to assist with receipt, staging, storage of the
Strategic National Stockpile assets and other medical
countermeasures at the Receiving, Staging and Storage Site.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-31
SNS/MCM
f.
Provide backup transportation for the SNS/MCM assets to the
Regional Distribution sites.
.
2.
D.
SC Emergency Management Division(ESF-5)
a.
In accordance with the CDC SNS/MCM Guidance version 11,
State Emergency Management Officials will confer with the
Governor and the DHEC Director to determine the need to
request federal support in the form of the Strategic National
Stockpile/MCM assets.
b.
In accordance with the SNS/MCM Guidance version 11 the
Governor or State Emergency Management officials will
participate in the consultation phase of the Strategic National
Stockpile/MCM with the Centers for Disease Control and
Prevention.
c.
The State Emergency Operations Plan and the State Emergency
Operation Center (SEOC) at the appropriate Operating
Condition (OPCON) to ensure adequate support.
Department of Labor, Licensing and Regulation, Division of Professional and
Occupational Licensing
1.
Assist with the temporary licensure of drug distribution and
dispensing facilities.
2.
Assist with the verification of volunteer medical personnel
through the South Carolina ESAR-VHP program.
3.
E.
Review and approve policies and procedures employed at
points of dispensing are consistent with the purpose of Board
of Pharmacy.
South Carolina Commission on Higher Education
1.
USC School of Pharmacy: Provide pharmacy students to assist
in the repackaging of bulk quantity antibiotics into individual
patient regimens.
SNS/MCM EOP
Annex 1, Appendix 5-1-32
July 2014
SNS/MCM
2.
MUSC School of Pharmacy: Provide pharmacy students to
assist in the repackaging of bulk quantity antibiotics into
individual patient regimens.
F.
SC Hospital Association: Identify hospitals to receive SNS/MCM supplies
when local capacities are exceeded. Identify hospitals to participate in
regional planning to determine local capacities for response prior to the arrival
of the SNS/MCM.
G.
SC Medical Association: Assist with recruitment of physicians for
SNS/MCM operations at the Points of Dispensing. These physicians will
assist in determining appropriate treatment in presenting individuals.
H.
SC Pharmacy Association
1.
Assist with recruitment of pharmacists for emergency operations by
actively participating in the South Carolina Emergency System for
Advance Registration of Healthcare Professionals.
2.
Assist with obtaining pharmaceuticals, medical equipment and
supplies not found in the Division of Strategic National
Stockpile/MCM inventory.
3.
Disseminate event and/or health information to community providers
through the RX Alert system.
I.
SC Nursing Association: Assist with recruitment of nurses from the
community to assist DHEC nurses at the Points of Dispensing (PODS)
J.
Two Meals a day will be served to the RSS participants and McEntire Air
National Guard personnel assisting in the shipping and receiving of the RSS
Assets. This will be accomplished by calling the SEOC and requesting food.
K.
SC Department of Education: Provide dispensing sites for prophylactic
drug distribution to the general public in a biologic exposure.
L.
American Red Cross: Provide snacks/ liquids at Regional points of
dispensing.
M.
South Carolina Law Enforcement Division: (ESF-13)
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-33
SNS/MCM
1. Provide security escort during transportation from the Georgia/South
Carolina border to the Receiving Staging and Storage site.
2. Provide security escort during transportation from the RSS to the RDS.
Coordinate security at the RDS with local law enforcement.
3. Provide security escort during transportation to the repackaging facility
and back to the Receiving Staging and Storage site.
N.
South Carolina Department of Transportation: (ESF-1)
1. Provide transportation and/or coordinate provision of
transportation with local carriers of the Strategic National
Stockpile/MCM materials from the Receiving, Staging and
Storage site (RSS) to the RDS if state assets are not adequate .
2. Provide transportation and/or coordinate provision of
transportation with local carriers of the Strategic National
Stockpile/MCM materials to the designated treatment centers if
state assets are not adequate .
3. Provide transportation and/or coordinate provision of
transportation with local carriers of Strategic National
Stockpile/MCM materials to the repackaging facility and back to
the Receiving Staging and Storage site if state assets are not
adequate .
4. Provide transportation and/or coordinate provision of
transportation with local carriers of the return of any unused
Strategic National Stockpile/MCM assets from the RDS to the
Receiving, Staging, Storage (RSS) site for return to the Centers
for Disease Control and Prevention if state assets are not adequate.
.
O.
P.
Budget and Control Board (ESF-2)
1
Provide additional communications devices if needed for
Strategic National Stockpile/MCM operations.
2.
Provide for additional radios, voice and data lines at the
Receiving Staging and Storage site.
South Carolina Society of Health System Pharmacists:
SNS/MCM EOP
Annex 1, Appendix 5-1-34
July 2014
SNS/MCM
1. Identify Directors of Pharmacy at SC Hospital Association identified
hospitals.
2. Participate in surge capacity planning within their facility to respond to
a mass casualty event.
Q.
United States Department of Defense:
Provide repackaging of bulk pharmaceuticals into 10 or 25-day dosage
regimens at Moncrief Community Hospital.
VII.
VIII.
FEDERAL INTERFACE
A.
This annex has no counterpart in the National Response Framework.
B.
The formation of this plan is required for receipt of the NPS/SNS by the CDC
under Title V, Emergency Preparedness and Response, section 502 of the
“Homeland Security Act of 2002.”
COUNTY INTERFACE
In conjunction with the DHEC PHP Director(s), county emergency management
officials will determine if local medical supplies will be exhausted and if federal
assets in the form of the SNS/MCM will be needed to manage the WMD, or
major natural or technological event. The DHEC PHP Director(s) after consultation
with the county emergency management officials will request the initial SNS “12Hour Push Package” and any additional specific SNS/MCM assets that are
needed to insure a continual supply of medications and medical supplies to manage
casualties until the event has reached the point that the operation may be scaled
down. In conjunction with the DHEC Public Health Preparedness Director(s), county
governments will provide Emergency Medical Technicians and security at local
Dispensing Sites and security at Regional Distribution Sites.
In conjunction with the DHEC Health Regions, county emergency management
officials will report, to ESF-8 at the SEOC, the number of people treated, given
prophylactic medication and sent home, the number of treated and transferred to
hospitals or other treatment centers and the number of people given prophylactic
medication and sent home. Also to be reported are the projected numbers of people
still requiring prophylaxis. These numbers will be reported on a regular basis
determined by the particular incident. In conjunction with the DHEC Health Regions
the county will maintain and provide lists of county medical resources.
SNS/MCM EOP
July 2014
Annex 1, Appendix 5-1-35
SNS/MCM
IX
ADMINISTRATION AND LOGISTICS
1.
General Reporting Requirements
Personnel hours will be recorded as the individual’s normal program
and location code and will use the disaster (999) activity code.
2.
3.
General Support Requirements
a.
Two Meals a day will be provided to the RSS Staff and McEntire
personnel assisting in the shipping and receiving of the MCM Assets.
A request will be made thru the SCEOC.
b.
Shift tours
c.
Security/ badging will be accomplished by roster and verification of
identity by DHEC identification badge, response partner support
agency identification badge or other government issued identification.
Policies on augmenting response staff
DHEC Administrative Manual Policy A.514 rev. 08/2007
4.
Resource Management may include financial record keeping; reporting
procedures; tracking resource needs, sources, use, and cost.
SNS/MCM EOP
Annex 1, Appendix 5-1-36
July 2014