Download Annex 1 - SNS - South Carolina Emergency Management Division

Annex 1, Appendix 5
STRATEGIC NATIONAL STOCKPILE COUNTERMEASURE DISTRIBUTION &
DISPENSING
STANDARD OPERATING PROCEDURES (SOP)
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; State Law Enforcement Division;
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 Baptist Association; SC Hospital Association; SC
Medical Association; SC Nursing Association; SC Pharmacy Association
I.
INTRODUCTION
A. The Strategic National Stockpile (SNS) 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,(chemical, biological, radiological or explosive) or a major
natural or technological disaster. This plan provides 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.
B. Purpose: This SOP implements S.C. Strategic National Stockpile Emergency
Operations Plan Standard Operating Procedure which is incorporated into Annex
1, Appendix 5 “Mass Casualty Plan” of the South Carolina Emergency
Operations Plans (EOP). This SOP provides operational guidance to those who
are assigned to work in ESF-8 at the State Emergency Operations Center, the
DHEC Emergency Operations Center, DHEC Health Region Emergency
Operations Center and in all phases of SNS or other countermeasure distribution
and dispensing operations.
SNS SOP
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ANNEX 1-Appendix5-1-1
SNS SOP
C. Authorities and References:
1.
2.
3.
4.
5.
6.
7.
8.
9.
SC Emergency Operations Plan (SCEOP)
SC Emergency Operations Center (SEOC) Plan
SC DHEC Emergency Operations Plan
SCDHEC, Office of Public Health Preparedness, Emergency Notification
Plan
SC Mass Casualty Response Plan, Appendix 5 of the SCEOP
Title V, Emergency Preparedness and Response, section 502 of the
“Homeland Security Act of 2002”.
SC Emergency Health Powers Act amendment to SC Homeland
Security Act of 2002, rule R. 61-112 Implementation of the Emergency
Health Powers Act
Receiving, Distributing, and Dispensing the Strategic National Stockpile, A
Guide for Planners, Version 10.02, August 2006.
PB1 (2012-2013) Public Health Emergency Preparedness Cooperative
Agreement
D. Organization: The DHEC Director of Emergency Management, Office of Public
Health Preparedness, assisted by the DHEC Emergency Management
Coordinator and other support staff will serve as the lead of ESF-8 response and
recovery efforts, which includes all state and region Strategic National Stockpile,
or other countermeasure distribution and dispensing activities, and upon
activation will be located at the State Emergency Operations Center (SEOC),
1100 Hatchery Road, West Columbia, SC 29172. All SNS response staff that has
leadership roles is 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
January 2011. These ESF-8 representatives will coordinate Strategic National
Stockpile efforts through each DHEC Regional Health Director and/or the
Regional Director of Public Health Preparedness or their designee.
In support of ESF-8, the Office of Public Health Preparedness will coordinate
among DHEC deputyships, program areas, named support agencies and
participating private sector resources to support SNS preparedness plans and
response in accordance with this SOP and in conjunction with the South Carolina
Emergency Management Division and the South Carolina Emergency Operations
plan. At the determination of the DHEC Director, the DHEC Emergency
Operations Center (DHEC EOC) may be activated to help coordinate other
department responsibilities associated with a SNS countermeasure deployment to
South Carolina.
SNS SOP
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ANNEX 1_Appendix 5-1-2
SNS SOP
The SEOC ESF-8 representative will coordinate and monitor SNS response and
recovery efforts through the DHEC EOC. This information will be monitored and
executed through WEBEOC at the South Carolina Emergency Operations Center.
These SNS activities will be monitored by the DHEC EOC and further managed
using the DHEC copy of WEBEOC. SNS response information will be provided
to ESF-5 (Information & Planning) by ESF-8 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 (JIC) located at the SEOC.
E. Plan Hierarchy: The SNS Emergency Operations Plan is written to be
functional as incorporated as Annex 1, into Appendix 5 “South Carolina Mass
Casualty Emergency Operations Plan” of the South Carolina Emergency
Operations Plan. DHEC Health Regions and the Columbia Metropolitan
Statistical Areas (MSA) Cities Readiness Initiative (CRI) are also required to
have an SNS plans to function as extensions of the State SNS plan and in
coordination with the Regional Mass Casualty plans. Operations in this plan are
to be coordinated by ESF-8 and the ESF-8 SOP.
II.
MISSION
The mission of the Strategic National Stockpile 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 South Carolina 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 of “health and medical”
and as such serves as the plan for all medical material acquisition and distribution.
III.
SITUATION AND ASSUMPTION
A.
B.
Situation:
1.
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.
2.
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.
Assumptions:
SNS SOP
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ANNEX 1_Appendix 5-1-3
SNS SOP
1. The State Emergency Operations Plan will be activated.
2. The State Emergency Operations Center will be activated at Operating
Condition 1 (OPCON 1) or the appropriate Operating Condition as well as
responding county EOC’s.
3. The South Carolina Emergency Management Division will activate the
Statewide Mutual Aid Agreement and the Emergency Management
Assistance Compact.
4. All infrastructures including communications are intact.
5. The appropriate state and federal declarations have been made by the
Governor of South Carolina, the President of the Unites States and the
Secretary of the Department of Human Services.
6. The arrival of the Strategic National Stockpile 12-Hour Push Package
from the federal stockpile to the state receiving, staging and storage site
(RSS) 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 DSNS guidance. Delivery to the Health
Regions will not occur until 12 hours after the first receipt of federal
medical materials.
7. South Carolina has a centralized public health system under the South
Carolina Department of Health and Environmental Control (DHEC). All
county health departments are staffed and managed by DHEC and respond
to emergencies as one agency. Planning and daily management are done
utilizing the 8 DHEC Health Regions as the administrative unit. Each of
these Regions geographically contains four to ten counties and has in
round numbers between 250,000 to 1,000,000 residents.
IV.
CONCEPT OF OPERATIONS
A.
Rev Jan 2013
South Carolina Department of Health and Environmental Control, lead agency
for ESF-8, 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 SC Emergency
Operations Plan in conjunction with SC Emergency Management Division.
DHEC is responsible for the coordination of all SNS administrative,
management, planning, training, preparedness/mitigation, response, and
recovery activities to include developing, coordinating, and maintaining the
SNS SOP. All ESF-8 supporting agencies will assist DHEC in the planning
SNS SOP
ANNEX 1_Appendix 5-1-4
SNS SOP
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, to represent ESF-8 and the SNS at the SEOC,
who, on the behalf of, or in the Director's absence from the SEOC, shall act to
meet the health and medical responsibilities as described in the SCEOP. This
person will be the point of contact and SNS lead for ESF-8 and SNS
Operations at the SEOC. Additional public health personnel to coordinate the
state level response will be housed at the DHEC Emergency Operations
Center located on the second floor of the Sims/Aycock building, 2600 Bull
Street, Columbia, SC 29201.
D.
In coordination with the Office of Public Health Preparedness and the SNS
Pharmacist, the DHEC Public Health Regions assess the situation (both preand post-event), and in coordination with local county emergency
management officials and response agencies, develop strategies to respond to
the emergency.
E.
Requesting the SNS:
The decision to deploy the SNS 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 Region Health Director will contact the
Office of Public Health Preparedness Director of Emergency Management.
The initial recognition of this event may occur at the state level by DHEC and
as such the notifications will be made at that point. A strategic policy group
comprised of the Governor, the SC EMD Director, and the DHEC Director
will be convened to determine if the SNS should be requested. If the Federal
assets are required, the DHEC Director on behalf of the governor will request
the deployment of the SNS in SC in one of two manners.
1) In federally declared disasters it will be necessary to prepare the Action
Request Form (FEMA form 90-136) and process this form through the SC
Emergency Management Division request process for federal assistance
through DHS/FEMA. Upon submission of the request form and approval,
DHS/FEMA will direct HHS to provide the appropriate assistance.
2) In the absence of a federally declared disaster the DHEC Director will
initiate the process in one of 4 ways.
 Contact the HHS regional emergency coordinator (REC).
SNS SOP
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ANNEX 1_Appendix 5-1-5
SNS SOP



Reach out to the SNS program services consultant (PSC).
Call the CDC emergency operations center (EOC) at 770-488-7100
Call the HHS secretary’s operations center (SOC) at 202-619-7800
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
material before a public health emergency declaration; a federal Stafford Act
disaster declaration or receipt of requests for DSNS assets.
The US Marshall’s service no longer routinely deploys with the SSAG. South
Carolina may receive the 12-Hour push package or may receive palletized
material (4 X 4 X 4 pallet) from managed inventory or a combination of the
two. How the SNS material is deployed and signed for will be coordinated as
part of the request for assistance between the state and DSNS. The SNS
Services Advance Group (SSAG) who will determine the type of technical
assistance required in response to the State’s request. “Technical assistance
requirements, including specific objectives and timeframes, will be
coordinated as part of the request for assistance from the project area”. This
request will be made by calling the CDC Director’s Emergency Operations
Center (DEOC) 770-488-7100.
.
F.
In response to the event, the Secretary of HHS 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 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 pharmacist or designee will transfer the State of
South Carolina owned drugs from the pharmaceutical cache located at the
PHP Pharmacy, 8229 Parklane Road, Columbia, SC 29223 to the
SNS SOP
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ANNEX 1_Appendix 5-1-6
SNS SOP
predetermined RSS site for distribution per this plan. If the magnitude of the
event does not warrant utilization of the predetermined RSS site, distribution
operations will be run out of the PHP pharmacy which has been surveyed by
the DSNS program consultant and the US Marshall’s service.
H.
Receipt: Once the deployment of SNS assets have been ordered the State
Emergency Operations Center 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. The responding county EOC’s will also be activated at the
appropriate Operating Condition. A draft South Carolina Emergency Health
Powers declaration has been written by the DHEC Office of General Counsel
and is available in the event it is needed.
DHEC will request the following resources to support this plan through the
State Emergency Operations Center (SEOC): warehouse, warehouse
management and inventory tracking, 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 Receiving, Staging and
Storage (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 services consultant and the US
Marshall’s service. The SC SNS Pharmacist or designee will notify the
Receiving, Staging, and Storage site of the deployment of the SNS assets by
the DSNS. Previously when the SNS “12- Hour Push-Package” or “Managed
Inventory” arrived at the SNS RSS site the CDC liaison for the SNS will
immediately transfer custody of the SNS assets to the State of South Carolina
using the “CDC Strategic National Stockpile Program Medical Material
Transfer Form” and the DEA Form 222. As of 10/6/2009 “How SNS materiel
is deployed and signed for will be based on numerous factors and will be
coordinated as part of the request for assistance between the project area and
DSNS”. The SC SNS Pharmacist or designee is designated by the DHEC
Director to officially accept the custody of the SNS assets from the CDC for
the State of South Carolina at the SNS RSS site. In addition to the SNS
Pharmacist the following pharmacists may sign for the SNS, the Director of
Pharmacy DHEC Health Services, the Director of the DHEC Bureau of Drug
Control, the back-up SNS Director or the Assistant Director DHEC Bureau of
Drug Control. The Region Distribution sites will be notified of the arrival of
the SNS assets at the RSS site. South Carolina may accept all or part of the
“12-Hour Push-Package”.
SNS SOP
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ANNEX 1_Appendix 5-1-7
SNS SOP
In the absence of an emergency declaration by the Governor of South Carolina
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).
Vaccines shipped to the RSS site or PHP Pharmacy will be stored in the
Division of Immunization walk-in refrigerator (8 feet X 12 feet) at the DHEC
Hayne Building SC Board of Pharmacy, non-dispensing drug outlet permit #
10385, 8231 Parklane Road if the quantity shipped exceeds the capacity of the
PHP Pharmacy refrigerator. All vaccine storage and handling will follow the
DHEC Division of Immunization Vaccine Storage and Handling policy rev.
02/09/12.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 refrigerators by ESF-2 or by the DHEC Bureau of
Business Management depending upon the size of the event.
I.
Staging: Once custody of the SNS assets have been signed for by the Director
of the Strategic National Stockpile and transferred to the State of South
Carolina at the RSS site or PHP pharmacy, these assets will be off loaded and
staged. The SNS shipping containers will be arranged in a color-coded
schematic 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 assets are being staged at the RSS site, the DHEC
Region Director 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 Region Distribution site for transfer to the designated hospitals
or directly to the designated hospitals as specified in the DHEC Health Region
SNS plan. Transportation assets to perform this will be requested through
ESF-2 at the South Carolina Emergency Operations Center (SEOC).
SNS SOP
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ANNEX 1_Appendix 5-1-8
SNS SOP
All Control Drugs will be transferred to the designated treatment center’s
Drug Enforcement Agency (DEA) registrant employing DEA form 222 where
applicable. All Control substances will be packaged separately from other
legend drugs and will be transferred utilizing the “Control Substances in 12Hour Push Pack” form revised 9/2011. All Control substances not transferred
to designated treatment center’s DEA registrant will be transferred to the PHP
pharmacy which is a SC Drug Control/DEA as well as SC Board of Pharmacy
permitted location.
Post exposure prophylaxis packages, initial 10 day supply, will be delivered to
the Region Distribution sites. 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 on 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 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 Region Distribution site will distribute these initial regimens to the
identified first responder site, 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. Hospitals will request any
needed SNS medical material other than initial prophylaxis supplies from the
State RSS site through the ESF-8 liaison at their county Emergency
Operations Center or through the Region unified medical command. These
requests will be forwarded to the RSS site by the ESF-8 leads at the State
Emergency Operations Center.
The Region Distribution sites will meet the same specifications as the RSS
site. 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 each DHEC Health Region and can serve as an alternate
RSS site in a more localized event. The DHEC Health Region plan will
provide for necessary support to off load the shipment, manage and track the
inventory, and on-site security at the Region Distribution site. Transport and
transport security, and traffic control of the medical supplies from the Region
Distribution site to the predetermined receiving hospital or to the
predetermined dispensing site will be specified in the Region SNS/CRI plan.
The Region SNS/CRI plan will specify an individual from the predetermined
treatment center/hospital to be available to accept custody of the SNS control
drugs from the DHEC Drug Control Pharmacists. Unless stated otherwise the
SNS SOP
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ANNEX 1_Appendix 5-1-9
SNS SOP
control substances will be delivered to the main pharmacy within the hospital
and received by the Director of Pharmacy or his designee. The DHEC Region
Director (or designee) will be the lead official at the Region Distribution site
and will specify an individual to accept custody of the shipment of the SNS
assets from the RSS site and will assure that the Region Distribution Site is
made ready to receive countermeasures from the RSS site. The SNS
Operations lead or designee will notify the Region Distribution Site of the
deployment of the SNS from the RSS site to the Region Distribution site. The
Region SNS and CRI plans will arrange for transportation and security of post
exposure prophylaxis packages to the local points of dispensing for dispensing
to the entire Region population within the prescribed time frame.
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
Region Distribution Site, the DHEC Region Director 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 event is a declared national disaster and the National Response
Framework has been activated the Department of Homeland Security would
establish a Joint Operations Center (JOC) 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 ESF-8
at the JOC. A FEMA Action Request Form (ARF) for the additional assets
may be required. The same process will be followed as in the initial request
phase of the response.
The Managed Inventory pharmaceuticals may arrive in bulk or repackaged
regimens and will be shipped directly to the RSS site from their points of
origin. Additional pharmaceuticals and/or medical supplies not available
through the Strategic National Stockpile Managed Inventory program may be
procured through the State of South Carolina emergency procurement
procedures. These procedures may utilize national resources such as RX
Response. In an event when the causative factors have been identified and the
DHEC Region Health Director in conjunction with local/county emergency
management officials and the CDC Director can determine the specific
supplies that are needed, the first shipment received may be from the
Managed Inventory and not from the multi-hazard “12-Hour Push Package.”
The Region Distribution Sites will report continually to the RSS site the
number and type of prophylactic regimens dispensed, the number and types of
SNS assets transferred to the treatment centers and the projected number of
additional assets that will be needed. Requests for additional assets for the
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ANNEX 1_Appendix 5-1-10
SNS SOP
RDS site from the RSS site will be received at a minimum of daily in
conjunction with the reports. The frequency of these reports will be
determined by the specific incident. The points of dispensing will request
additional post exposure prophylaxis antibiotics from the Region Distribution
Site. The process for this request procedure will be specified in the Region
SNS plan and will mirror the RDS to RSS request process.
Inventory Control at the RSS site and the Region Distribution site will follow
the procedures below.
The DHEC Bureau of Finance will be the lead for inventory control at the
RSS site. The Region/ CRI plan will identify the inventory lead at the Region
Distribution site. The initial packing slips will be given to the inventory
clerks for entry into the manual inventory system. All items received and
distributed will be listed one product per page on DHEC form 1285 SNS
Perpetual Inventory. The following information will be recorded per item:
(1) Item description found on the inventory list provided by DSNS
(2) Lot Number and expiration date
(3) NDC number found on the inventory list provided by DSNS
(4) Unit of measure found on the inventory list provided by DSNS
(5) Unit pack (number per case or box) found on the inventory list provided
by DSNS
All items will be recorded as each and distributed by box or case. There will
be a running decreasing balance (similar to a checkbook) inventory sheet for
every item contained in the shipment. Each entry into the “checkbook” will
list the following:
(1) Which container the item came from or
(2) Where the item is going to
(3) Number received or shipped
Currently the inventory tracking system for the state level response is
transitioning to the secure federal Inventory Management and Tracking
System (IMATS). This system will track all SNS assets which can be
preloaded by the DSNS. The Region Distribution site will continue to use the
paper system or an excel spreadsheet since the RDS in most instances will
handle only oral medications or vaccines.
The initial shipment of SNS materials will be apportioned and shipped to the
affected Region Distribution site, treatment facilities or point of dispensing
based on population if the threat has been identified. DHEC form 1286 or
1287 will be used to record the following information concerning the
shipment:
(1) Region or Point of Dispensing
(2) Treatment center (if applicable)
(3) Date
(4) Time
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ANNEX 1_Appendix 5-1-11
SNS SOP
(5) Lot Number & Expiration date
(6) NDC Number
(7) Quantity
(8) Requested by (if applicable)
(9) Filled by
(10)Time Filled
(11)Delivered by
(12) Time delivery left
All Control substances will be packaged separately from other legend drugs
and will be transferred utilizing the “Control Substances in 12-Hour Push
Pack” form revised 9/2011. This form will be completed by the individual
who signs for the control substances and will be given directly to the DHEC
Drug Control pharmacist who will make the delivery to the hospital on the
delivery slip.
All drugs control, legend, or other countermeasure will be tracked in the same
manner. The original slip will go to the perpetual inventory clerk and a copy
will be given to the fulfillment area to be filled. Once the order is filled and all
names are recorded two copies of the filled order form will then go with the
shipment as the packing slip and delivery slip. The packing slip will be inside
the order and the delivery slip will be signed and returned to the inventory
clerk at the RSS site or Region Distribution site. This slip may be returned via
the truck driver in hard copy or by fax. The original will return to the
inventory clerk to match the filled order with the requested order. The
contents of the shipment will then be subtracted from the perpetual inventory.
These processed orders will then be set aside awaiting verification of receipt
of the order from the Health Region. The fulfillment area will be manned by
4 teams of 4 people each.
The DHEC forms 1285, 1286, and 1287, 1288 can be found on the DHEC
intranet site and can be accessed as follows:
http://dhecnet --Technologies Tab –RIMS –PDF Forms
“Control Substances in 12-Hour Push Pack” form revised 9/2011 will be
provided at the time it is required by the SNS Pharmacist or designee. Once
the agency EOC is activated and WebEOC is being used to track the incidence
all forms related to the response will be posted in WebEOC.
L.
Rev Jan 2013
Dispensing Sites: The Region Health Director or his designee in conjunction
with local/ county emergency management agencies will develop the Health
Region Strategic National Stockpile and City of Columbia Metropolitan
Statistical Area (MSA) Cities Readiness Initiative (CRI) plans which identify
adequate public/ private points of dispensing to provide initial ten day
prophylaxis for the entire population within 48 hours of the federal decision to
ship medical countermeasures into South Carolina in response to a disease
SNS SOP
ANNEX 1_Appendix 5-1-12
SNS SOP
outbreak or other emergency event. First responder dispensing sites separate
from the public points of dispensing will be identified in each Region plan. If
the emergency event is a disease outbreak and laboratory confirmation of the
infecting organism has been made additional prophylaxis up to 60 days may
be required for those exposed to the infecting agent.
The DHEC Region Health Director (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 report adverse
reactions to the countermeasure. In the event that the drug is being dispensed
to the public on a Food & Drug Administration Emergency Use Authorization
( EUA), the DHEC Region Health Director will ensure that all terms of the
EUA are followed prior to dispensing including providing adequate
dispensing information as provided by the manufacturer or the DSNS to all
public and private points of dispensing.
Adults 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 over, 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 SC 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 Region
SNS plan to accommodate citizens with a variety of special needs such as
language, vision and mobility barriers at the dispensing sites. The DHEC
Region Health Director (or designee) will be the lead official at the public
points of dispensing. Large employers, that meet the requirements to serve as
a point of dispensing for their employees and employee’s family will identify
the lead official at the employer’s closed dispensing site and that person will
be listed in the Region SNS or CRI plan.
Facilities with confined populations and established medication dispensing
procedures will provide to the Region distribution site the number of needed
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-13
SNS SOP
regimens and will follow their usual and customary medication dispensing
procedures for patients/ residents, staff and staff’s family following CDC and
DHEC guidelines and recommendations. Examples of these affected
institutional populations 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 will receive their medication will
be identified and defined in the DHEC Region or CRI SNS SOP. The DHEC
Region SNS and CRI plans will also identify 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 870(Volunteer Health Care
Provider Agreement). The DHEC Region/CRI plans will identify how traffic
control and security will be provided at the large employer closed point of
dispensing.
Each mass public/closed dispensing site will need to provide for the
following characteristics, while allowing differences to accommodate the
various facilities hosting the dispensing site and the security requirements of
local law enforcement. Adequate signage needs to be in place to ensure a
smooth patient flow.
(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 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.
Rev Jan 2013
A memorandum of agreement currently is 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 Gubernatorial 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 the public health, safety and welfare in a mass casualty event that
SNS SOP
ANNEX 1_Appendix 5-1-14
SNS SOP
would require federal or other medical countermeasures being sent to South
Carolina. All necessary forms including the standing orders will be posted to
WEBEOC under file library once most current CDC event driven updates are
available.
1.
Protocols/ standing orders to provide current guidelines for the
assessment, prophylaxis and/or treatment and follow-up 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. To
access these orders go to dhecnet – program areas-health
services manuals & reports- Health services standing orders
manual – BT tab. Copies of these orders will be printed by the
Region Health director or his 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 treatments for all citizens of South
Carolina. These protocols include the CDC treatment and post
exposure prophylaxis guidelines.
2.
The Clinical Evaluation Form for Dispensing Mass PostExposure Prophylaxis Therapy ( DHEC 1288) form for
patients exposed to a biologic agent will serve as the (1)
exposure screening form, (2) dispensing record, (3) refill
record, (4) medical chart and (5) acknowledgement of
receiving treatment. To access this form go to dhecnet –
program areas- technologies – RIMS – PDF forms. This form
will be filled out for every person who receives prophylaxis.
This record is to be maintained in the Health Region pharmacy
in lieu of a written prescription document for 3 years after the
last date of service. After 3 years the record is to be transferred
to archives where it will be maintained in accordance with
DHEC policy A.932. The 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.
Each prepackaged 10-day regimen from the CDC comes
labeled with two perforated labels identifying drug, quantity,
expiration 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, (the Deputy Director of Health
Services), will be handwritten on the dispensing label. To
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-15
SNS SOP
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-FDA-1088.”
Each patient will be counseled on the proper use of the drug
and any drug- drug and drug- medical condition 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 his/her physician.
General patient drug information is available to DHEC through
internet
based
drug
information
at
www.factsandcomparisons.com. The log-in is located on the
left side of the page. Click on “e answers log-in” and on the left
side of the page is medfacts patient information. Click on that
and scroll through until you find the drug. Each Region with a
pharmacy should have an IP address set up with access to this
site. If not login with SCDOHAEC and SCDOHAEC1. Each
drug information sheet 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-FDA-1088.”
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 available 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 Centers for Disease Control and
Prevention (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
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-16
SNS SOP
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 forms that patients must read and sign to give
informed consent at the time of the event. 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 appropriate
paperwork will be distributed with the countermeasure to the
DHEC Public Health Region Distribution site 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 are 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
The DHEC Region 3 and City of Columbia Cities Readiness
Initiative (CRI) plans will coordinate planning with the
Charlotte/Mecklenburg county North Carolina CRI to insure
adequate coverage of York County South Carolina and the
Catawba Indian Nation whose population is included under the
Charlotte, NC metropolitan statistical area and is funded as part
of the Charlotte CRI by the Centers for Disease Control and
Prevention. The Office of Tribal government will have its
members receive prophylactic medication through this process
in a declared emergency. The ultimate responsibility for York
County South Carolina falls under the DHEC Region 3 plan.
N.
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
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-17
SNS SOP
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 purposes. Also, per the
terms of the 2010 memorandum of agreement between the CDC and DHEC, at the
conclusion of a public health emergency response, CDC will assess 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. Other unused medical materiel
including pharmaceutical items will be returned to the RDS. Once all materiel is returned
to the RDS site, these materiels will be returned to the RSS, with any durable assets, for
final disposition.
O. Communication:
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 3 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. DHEC is the lead agency for all ESF-8, health and medical,
response which includes primary responsibility for all messaging which
affects the public’s health.
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 medicine, cost of the medicine, medicine for pets,
medication safety. SNS specific messages will include but not limited to
where to pick up your medication, how to pick up your medication, why you
need to pick up the medicine for you and your family, why you need to take
the medicine, what medical information is needed to receive medication, what
is needed for identification, how to take your 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 your are currently symptomatic. Templates for these
messages have been written and when needed will be incident specific and
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-18
SNS SOP
distributed through local public information channels such as television, radio,
newspaper and at the local dispensing sites by the 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. DHEC, ESF-8, will provide the prescripted 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
Types of information to be included 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 assets needed by
treatment centers. These numbers will be reported on a regular basis as
determined by the incident by the Region Distribution site lead to the RSS site
and to ESF-8 at the State Emergency Operations Center. The DHEC EOC will
monitor all response and recovery activities through the state and agency
copies of WebEOC. The DHEC EOC will maintain communications with
ESF-8, RSS Site, Region Distribution sites by email, fax, telephone, cell
phone, 800 MHZ radio.
Requests from the county emergency operations center for SNS distributed
medical countermeasures or other health and medical services will be either
called into the SEOC by telephone, transmitted via WebEOC or by radio. The
State Emergency Operations Center (SEOC) Operations Tasking Group
(OTG) will task any such requests for health and medical services to ESF-8.
DHEC representatives 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 the OTG at the SEOC. Completion of all tasks will be reported to the
DHEC representatives in ESF-8 at the SEOC for inclusion in the periodic
situation reports. This procedure is consistent with the request procedures
found in the ESF-8 SOP.
3.
Equipment
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-19
SNS SOP
Cell phones, land lines, fax lines and DHEC internet services will
electronically tether all SNS 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 Emergency Operations Center, the RSS site, the Region
Distribution Sites, the Region Dispensing Sites will be in communication by
800 MHz 2-way radio, which are linked by a wide area communications
systems that covers the entire state. These radios are currently available
within the agency through the Bureau of Information Services. Additional
communications for RSS and other SNS operations will be requested through
the State Emergency Operations Center ESF-2 (Division of State Information
Technology). Maintenance of the emergency response radios held by the
Division of State Information Technology is the responsibility of the Division
of State Information Technology as described in the ESF-2 annex of the SC
Emergency Operations plan. These include providing additional telephone
lines to the RSS, handheld radios, HAM radios, cellular phones, satellite
phones, computer terminals, internet access, teleconferences and telephone
bridge requirements. DHEC State and Region communication systems that are
not utilized in day to day operations will be tested quarterly to ensure
readiness.
SCDHEC response activities will be tracked through the SCDHEC State and
Region copies of WebEOC. Access and functionality of this system will be
tested and recorded the first month of each calendar quarter.
P.
Security and Transport:
The security and transport functions will be coordinated through the State
Emergency Operations Center Operations Group and will be provided by
ESF-1, ESF-8, ESF-13 and ESF-15.
Transportation to the Region Distribution Sites 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
assets during 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 of the SC Emergency Operations Plan (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 an 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 of
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-20
SNS SOP
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. The SC Emergency
Management Division (SCEMD) is responsible for the SC Logistics Plan.
SCEMD in support of the logistics plan maintains transportation services on a
contingency contract and will activate those contracts in support of SNS
logistical activity when required.
Security will be provided for all personnel, material, and equipment involved
in the management and distribution of the SNS countermeasures in
accordance with the South Carolina Law Enforcement Division (SLED) SNS
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. SLED coordinates with support agencies including the SC
Department of Public Safety (DPS) (ESF-16) to ensure operational readiness
during and post disaster. In accordance with SC Code of Laws Section 23-315 (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 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 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.
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 State Emergency
Operations Center if needed. The South Carolina Air and/or Army National
Guard have been tasked with providing security for the SNS assets at the RSS
site and will follow the base’s usual and customary use of force guidelines in
maintaining the RSS site integrity. The RSS site will provide security for all
operations within its fence line. 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.
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-21
SNS SOP
All persons working in or with the DHEC SNS 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 Region plans will specify credentialing procedures for all
Region dispensing sites and distribution sites. Anyone entering the facility
where the RSS site is housed will have to present a government
issued picture identification to the armed security guard at the guard gate prior
to admission. No one will be admitted unless their name appears on the roster
provided by ESF-8/SCDHEC.
The SC Law Enforcement Division (ESF-13) has been tasked with traffic
control, security and escort in transport to the Region Distribution Sites and
with coordinating security with local law enforcement at the Region
Distribution Site. ESF-2 will notify the RSS site of the size of the truck, a
description of the truck and of 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 insure delivery of the medications to the Region
distribution sites. The South Carolina Law Enforcement Strategic National
Stockpile Standard Operations Plan will support ESF-13’s mission to the SC
Mass Casualty Plan, (Annex 1 – Strategic National Stockpile), of the SC
Emergency Operations Plan (SCEOP). This SOP provides operational
guidance to those who are assigned to work in ESF-13 in all phases of SNS
operations
The Department of Health and Environmental Control Drug Control
Pharmacists are tasked with providing security and transportation of any
controlled substances from the RSS site to the designated DEA registrant
facility usually a hospital pharmacy in each Region.
The Region/CRI SNS plan will provide for security at the Region Distribution
site, security and transport to the points of dispensing and at the mass public
points of dispensing/vaccination. Provision of security at the large employer
closed dispensing/vaccination sites will be identified in the Region/CRI SNS
plans.
If repackaging is necessary prior to distribution from the Receiving, Staging
and Storage (RSS) site, SLED will provide security in transport from the RSS
site to the repackager and back to the RSS site.
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-22
SNS SOP
The US Marshall’s service are not considered part of the SNS Services
Advance Group (SSAG) and will not provide routine security for SNS assets
and personnel unless threat analysis of the event indicate federal security is
necessary.
Q.
V.
Repackaging
In the event that the prophylactic medication required to treat the biologic
agent is not available in the unit of dispensing packaging, in the 12-Hour push
package or the state receives bulk medication from the DSNS Managed
Inventory the bulk medication will be transported to the Consolidated Mail
Order Pharmacy in Charleston, SC or to the Moncrief Community Hospital
for repackaging into packages of 10-day or other appropriate dosage
regimens.
ESF ACTIONS
The emergency operations necessary for the performance of this Attachment I to
Appendix 5 of the SCEOP include but are not limited to the following:
A.
Rev Jan 2013
Preparedness
1.
Develop, coordinate and maintain written plans, which reflect latest
CDC/DSNS requirements, to implement SNS 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 assets and other approved countermeasures in support of ESF-8
responsibilities.
4.
Identify and establish state and regional locations for receiving,
staging, storing and distributing SNS and other medical materials.
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.
Identify and coordinate with other health care providers other sources
of pharmaceuticals and medical equipment/supplies.
SNS SOP
ANNEX 1_Appendix 5-1-23
SNS SOP
B.
Rev Jan 2013
7.
Develop and maintain dosing and dispensing guidelines and
procedures for the prophylactic drugs contained in the SNS and for
other medical countermeasures designed for mass distribution or
dispensing.
8.
Assure that DHEC Health Regions develop SNS and/or CRI plans for
the management of the 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 maintain training and training exercises for related areas
of SNS management.
Response
1.
Assess the situation and determine if 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.
Request the SNS 12-Hour Push package 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 call 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 Plan and upon receipt of the SC SNS Plan, the CDC Director
will order the deployment of the SNS.
5.
Request deployment of the SNS materiels 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” allowing for the implementation of the South
Carolina Emergency Health Powers Act and its associated regulations.
7.
Notify the DHEC Regions Health Directors, the Public Health
Preparedness Director and the CRI Coordinator of the deployment of
SNS SOP
ANNEX 1_Appendix 5-1-24
SNS SOP
the SNS medical assets to the SC RSS site by the CDC and request the
implementation of the Region/CRI SNS plans.
Rev Jan 2013
8.
Notify SEOC of the deployment of SNS by the CDC to the SC RSS
site.
9.
Notify SNS RSS location of expected arrival of the SNS.
10.
Notify and coordinate the agencies and organizations involved in the
staging of the SNS.
11.
Notify and coordinate the agencies and organizations involved in the
support of the individuals involved in the staging of the SNS.
12.
Notify and coordinate the agencies and organizations involved in the
transport of the SNS.
13.
Notify Region Distribution sites and/or Region Health or Public
Health Preparedness Directors of the arrival of the SNS at the SC RSS
site. Notify the Region Distribution Sites and/or Region Directors of
the deployment of the SNS to the Region Distribution Site. Request
that the Region points of dispensing are notified of the deployment by
the DHEC Region Health Director.
14.
Coordinate with ESF-1 transport of SNS asset from the RSS site to the
Region Distribution sites for distribution to the points of
dispensing/vaccination or designated hospital.
15.
Coordinate with DHEC Health Region distribution of SNS medical
assets to designated hospitals.
16.
Coordinate with DHEC Health Regions dispensing initial 10 days of
antibiotics or other approved countermeasures to the entire Region
population within the prescribed time frame of 48 hours and follow up
prophylaxis of 50 days if needed.
17
Coordinate with ESF-13 security for SNS assets in transport from the
RSS site to the Region Site, treatment center or repackaging center.
18.
Coordinate with ESF-2, Budget and Control Board, the use of
additional 800 MHz radios and the 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 assets in South Carolina and of the
gubernatorial declarations.
SNS SOP
ANNEX 1_Appendix 5-1-25
SNS SOP
C.
Recovery
1.
Determine the need for additional medical supplies in conjunction
with the SC DHEC Region Director 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 Health Regions follow up of
individuals receiving prophylaxis to insure completion of therapy in
individuals actually exposed to the biologic agent.
4.
Coordinate retrieval of all unused assets of the SNS program from the
distribution and dispensing sites to the RSS site.
5.
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.
6.
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.
.
D.
VI.
Mitigation
1.
Support, plan and implement mitigation measures.
2.
Support requests and directives resulting 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.
RESPONSIBILITIES
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-26
SNS SOP
A.
Department of Health and Environmental Control (ESF-8)
Rev Jan 2013
1.
Develop, coordinate and maintain written plans to implement the
Strategic National Stockpile response operations in South Carolina on
both State and Regional level.
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 assets and other approved
countermeasures to meet ESF-8 responsibilities
4.
Identify and establish state and regional locations for receiving,
repackaging, staging, storing, distributing SNS and other medical
materiels.
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.
8.
Assure that Department of Health and Environmental Control Health
Regions develop Strategic National Stockpile and/or Cities Readiness
Initiative plans 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 plan.
10.
Notify all Strategic National Stockpile supporting agencies upon
implementation of the Strategic National Stockpile plan.
11.
Develop mutual support relationships with professional associations
SNS SOP
ANNEX 1_Appendix 5-1-27
SNS SOP
and other private services and volunteer organizations that may assist
during emergencies or disasters.
Rev Jan 2013
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 eight 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 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 with
supporting agencies in assessing the situation to 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 with the Centers for Disease Control and
Prevention Division of Strategic National Stockpile among state and
federal response officials.
17.
Insure that required information is available for the consultation phase
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 plan, 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 a plan to receive, repackage prophylactic oral
antibiotics.
18.
Coordinate need for initiating 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.
SNS SOP
ANNEX 1_Appendix 5-1-28
SNS SOP
20.
Insure all state and federal documentation available and in order to
accept and distribute the Strategic National Stockpile 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 assets.
22.
Provide all inventory control records and distribution records of
Strategic National Stockpile assets as required by Centers for Disease
Control and Prevention.
23.
Maintain all expense records associated with deployment of the
Strategic National Stockpile 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.
Request Strategic National Stockpile assets by the Department of
Health and Environmental Control Director with the consent of the
Governor, when it is determined by state and local officials that
Federal assets are required.
26.
Accept custody of the Strategic National Stockpile assets from the
Centers for Disease Control and Prevention.
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 Plan. Upon receipt of the SC
Strategic National Stockpile Plan, 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
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-29
SNS SOP
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” allowing for the implementation of the South
Carolina Emergency Health Powers Act and its associated regulations.
29.
Notify the Department of Health and Environmental Control Region
Health Directors, the Public Health Preparedness Directors, the CRI
Coordinator of the deployment of the Strategic National Stockpile
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
plan(s).
30.
Notify SEOC of the deployment of Strategic National Stockpile 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 assets.
32.
Notify and coordinate the agencies and organizations involved in the
staging of the Strategic National Stockpile assets.
33.
Notify and coordinate 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 assets.
34.
Notify and coordinate the agencies and organizations involved in the
transport and security of the Strategic National Stockpile assets from
the RSS site to the Region distribution sites.
35.
Notify Region Distribution sites and/or Region Directors or his
designee of the arrival of the Strategic National Stockpile at the South
Carolina Receiving, Staging and Storage site. Notify the Region
Distribution sites and/or Region Directors or his designee of the
deployment of the Strategic National Stockpile to the Region
Distribution sites. Insure that the Region points of dispensing are
notified of the deployment by the Department of Health and
Environmental Control Region Director.
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-30
SNS SOP
36.
Coordinate with ESF-1 (Transportation Services) transport of Strategic
National Stockpile assets to the Region 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 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 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 assets in transport to the Receiving, Staging and Storage site,
from the Receiving, Staging and Storage site to the Region
Distribution site, designated hospitals, and repackaging facility and
back to Receiving, Staging and Storage site.
40.
Provide transport 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 transport of bulk pharmaceuticals to repackaging facilities.
42.
Determine the need for additional medical supplies in conjunction
with the South Carolina Department of Health and Environmental
Control Region Health Director and the county/local emergency
management officials.
43.
Request additional supplies of specific items through the Centers for
Disease Control and Prevention Managed Inventory portion of the
Strategic National Stockpile program and/or through other commercial
sources if available
44.
Coordinate with ESF-2, Budget and Control Board, 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.
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-31
SNS SOP
B.
45.
Coordinate with the Department of Health and Environmental Control
Health Regions follow up of individuals receiving prophylaxis to
insure completion of therapy in individuals actually exposed to the
biologic agent.
46.
Coordinate retrieval of all unused assets of the Strategic National
Stockpile 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 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.
Office of the Governor
1.
Rev Jan 2013
Coordinate with the Department of Health and Environmental Control
Director, South Carolina Emergency Management Director, the
Department of Health and Environmental Control Deputy Director of
Health Services, the Department of Health and Environmental Control
District Health Director and the Department of Health and
Environmental Control Director of Public Health Preparedness
SNS SOP
ANNEX 1_Appendix 5-1-32
SNS SOP
requesting federal assistance in the form of medical assets from the
Strategic National Stockpile.
C.
2.
Authorize the Department of Health and Environmental Control
Director to request Strategic National Stockpile assets.
3.
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.
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 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 perform security at the Receiving, Staging
and Storage site for the Strategic National Stockpile 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.
f.
Provide backup transportation for the SNS assets to the Region
Distribution sites.
.
2.
SC Emergency Management Division(ESF-5)
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-33
SNS SOP
D.
a.
In accordance with the SNS Guidance version 11, State
Emergency Management Officials will confer with the
Governor and the Department of Health and Environmental
Control Director to determine the need to request federal
support in the form of the Strategic National Stockpile assets.
b.
In accordance with the SNS Guidance version 11 the Governor
or State Emergency Management officials will participate in
the consultation phase of the Strategic National Stockpile with
the Centers for Disease Control and Prevention.
c.
Activation of the State Emergency Operations plan and the
State emergency Operation Center (Center) will occur 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.
2.
F.
Rev Jan 2013
USC School of Pharmacy: Provide pharmacy students to assist
in the repackaging of bulk quantity antibiotics into individual
patient regimens.
MUSC School of Pharmacy: Provide pharmacy students to
assist in the repackaging of bulk quantity antibiotics into
individual patient regimens.
SC Hospital Association: Identify hospitals to receive SNS 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.
SNS SOP
ANNEX 1_Appendix 5-1-34
SNS SOP
G.
SC Medical Association: Assist with recruitment of physicians for
SNS 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
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 Region Dispensing sites.
J.
SC Baptist Convention: Provide 4 meals per day, snacks and personnel to
distribute these meals/snacks for workers staffing the RSS site.
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 Region points of dispensing.
M.
South Carolina Law Enforcement Division: (ESF-13 & 16)
1. Provide security in transport and escort during transport to the Receiving
Staging and Storage site.
2. Provide security in transport and escort during transport to the Region
Distribution site. Coordinate security at the Region Distribution Site with
local law enforcement.
3. Provide security in transport to the repackaging facility and back to the
Receiving Staging and Storage site.
N.
South Carolina Department of Transportation: (ESF-1)
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-35
SNS SOP
1. Provide transportation and/or coordinate provision of
transportation with local carriers if state assets are not adequate of
the Strategic National Stockpile materials from the Receiving,
Staging and Storage site (RSS) to the Region Distribution sites.
2. Provide transportation and/or coordinate provision of
transportation with local carriers if state assets are not adequate of
the Strategic National Stockpile materials to the designated
treatment centers.
3. Provide transportation and/or coordinate provision of
transportation with local carriers if state assets are not adequate of
Strategic National Stockpile materials to the repackaging facility
and back to the Receiving Staging and Storage site.
4. Provide transportation and/or coordinate provision of
transportation with local carriers if state assets are not adequate of
the return of any unused Strategic National Stockpile assets from
the Region Distribution site to the Receiving, Staging, Storage site
for return to the Centers for Disease Control and Prevention.
O.
P.
Budget and Control Board (ESF-2)
1
Provide additional communications devices if needed for
Strategic National Stockpile operations.
2.
Provide for additional radios, voice and data lines at the
Receiving Staging and Storage site.
South Carolina Society of Health System Pharmacists:
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 or the Veterans Administration
Consolidated Mail Order Pharmacy.
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-36
SNS SOP
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 Health Region Director, county emergency
management officials will determine if local medical supplies will be exhausted and if
federal assets in the form of the SNS will be needed to manage the WMD, or major
natural or technological event. The DHEC Region Health Director after consultation
with the county emergency management officials will request the initial SNS “12Hour Push Package” and any additional specific SNS 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 Health Region, county governments will provide Emergency Medical
Technicians and security at local Dispensing Sites and security at Region Distribution
Sites.
In conjunction with the DHEC Health Regions, county emergency management
officials will report to ESF-8 at the state emergency operations center 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 number
of people still requiring treatment. 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.
IX
ADMINISTRATION AND LOGISTICS
1.
General Reporting Requirements
a.
2.
Personnel hours will be recorded as the individuals normal program
and location code and will use the disaster (999) activity code.
General Support Requirements
a.
Meals at the RSS site will be supplied by the facility caterer.
SNS SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-37
SNS SOP
3.
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 SOP
Rev Jan 2013
ANNEX 1_Appendix 5-1-38