Download Van Buren/Cass District Health SNS Plan Draft

Van Buren/Cass
District Health Department
Strategic National Stockpile/
Dispensing Plan
Draft
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SNS Plan Table of Contents
1.
INTRODUCTION ............................................................................................................................................... 7
1.1
1.2
PURPOSE .................................................................................................................................................. 7
PROGRAM DESCRIPTION........................................................................................................................... 8
1.3
1.4
RESPONSIBILITIES ...................................................................................................................................11
JURISDICTION DEMOGRAPHICS ...............................................................................................................14
1.2.1
1.4.1
1.4.2
1.4.3
1.5
1.6
2.
REQUESTING THE SNS ..................................................................................................................................24
2.1
2.2
JUSTIFICATION ........................................................................................................................................24
AUTHORITY AND PROCESS ......................................................................................................................25
2.3
2.4
KEY CONTACTS FOR VAN BUREN/CASS DISTRICT HEALTH DEPARTMENT .............................................26
SNS REQUEST PROCESS ..........................................................................................................................27
2.4.1
2.4.2
2.5
2.6
Communications with Local EOC & State Officials ........................................................................... 28
Communications with Dispensing Sites ............................................................................................... 28
Procedure for requesting additional assets ......................................................................................... 30
CDC Decision Algorithm .................................................................................................................... 30
AFTER THE REQUEST IS MADE .................................................................................................................32
BEFORE THE SNS ARRIVES .........................................................................................................................33
3.1
SNS NOTIFICATION .................................................................................................................................33
3.2
IDENTIFYING OFFICIAL FIRST RESPONDERS AND ESSENTIAL SERVICE PROVIDERS .................................35
3.3
3.4
ACTIVATION OF THE DISPENSING SYSTEM ..............................................................................................37
CREDENTIAL VERIFICATION OF LICENSED PERSONNEL...........................................................................40
3.1.1
3.2.1
3.4.1
3.4.2
3.5
Quick Reference Notifications for the Request of the SNS................................................................... 34
Types of Populations to Receive Mass Prophylaxis ............................................................................ 36
Personnel Badges ................................................................................................................................ 40
MI-Volunteer Registry/Medical Reserve Corp .................................................................................... 42
DISASTER RESPONSE ASSETS ..................................................................................................................42
3.5.1
3.5.2
3.5.3
3.5.4
Pharmaceutical Cache Considerations ............................................................................................... 43
Hospital Pharmaceutical Cache.......................................................................................................... 47
Van Buren/Cass District Health Department Cache ........................................................................... 48
Van Buren County Mass Casualty Incident (MCI) Trailer (For Official Use Only) ........................... 48
3.6
BUYING POWER/SURGE CAPACITY .........................................................................................................52
3.7
REGIONAL CACHES .................................................................................................................................53
3.6.1
3.7.1
3.7.2
State Purchasing Contract .................................................................................................................. 52
Mass Casualty Incident Trailer (MCI) ................................................................................................ 53
MEDDRUN ......................................................................................................................................... 53
3.8
STATE CACHES .......................................................................................................................................63
3.9
NON-SNS FEDERAL CACHES ..................................................................................................................65
3.8.1
3.9.1
3.9.2
CHEMPACK Project........................................................................................................................... 63
Metropolitan Medical Response System (MMRS) ............................................................................... 65
US Postal Service Biohazard Detection System (BDS) ....................................................................... 65
COMMAND AND CONTROL .........................................................................................................................68
4.1
4.2
INCIDENT COMMAND SYSTEM.......................................................................................................68
COMMAND & CONTROL INTERACTION WITH RESPONSE ACTIVITIES.......................................................72
4.3
ROLES AND RESPONSIBILITIES ......................................................................................................73
4.2.1
5.
Activation of the SNS Plan .................................................................................................................. 26
RE-SUPPLY OF SNS ASSETS ....................................................................................................................30
2.5.1
2.5.2
4.
Van Buren County ............................................................................................................................... 14
Cass County ........................................................................................................................................ 14
Pokagon Band of Potawatomi Indians ................................................................................................ 15
ASSUMPTIONS .........................................................................................................................................18
LEGAL ISSUES .........................................................................................................................................20
2.2.1
3.
Division of the Strategic National Stockpile .......................................................................................... 9
Authority.............................................................................................................................................. 72
SNS DISTRIBUTION LOCATIONS/OPERATIONS ....................................................................................76
5.1
SNS SHIPMENT OVERVIEW .....................................................................................................................76
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5.2
6.
DISTRIBUTION NODE FOR VBCDHD ..............................................................................................76
DISPENSING ......................................................................................................................................................81
6.1
6.2
STAFFING CONSIDERATIONS ...................................................................................................................81
DISPENSING OPERATIONS AT DIFFERENT INTENSITY LEVELS .................................................................81
6.2.1
6.2.2
6.2.3
6.2.4
6.2.5
6.3
DISPENSING SITES ...................................................................................................................................86
6.3.1
6.3.2
6.3.3
6.4
6.5
STANDING ORDERS ...............................................................................................................................103
TRACKING MEDICATIONS AND RECIPIENTS ..........................................................................................103
6.14
6.15
PREVENTING DUPLICATE PATIENT PROCESSING ...................................................................................105
PEDIATRIC ISSUES AT THE DISPENSING SITE ..........................................................................................105
6.15.1
6.15.2
MICR All Hazards Module ................................................................................................................ 104
Weight Issues..................................................................................................................................... 105
Oral Suspensions and Chewable Tablets .......................................................................................... 105
TREATMENT CENTERS ...............................................................................................................................106
7.1
7.2
MODULAR EMERGENCY MEDICAL SYSTEM (MEMS) ...........................................................................106
TREATMENT CENTERS...........................................................................................................................106
7.2.1
7.2.2
7.2.3
7.2.4
7.2.5
7.3
7.4
Treatment Center SNS Request Process ............................................................................................ 107
Treatment Center Distribution .......................................................................................................... 107
Treatment Center Receipt of SNS Assets ........................................................................................... 107
Treatment Center Inventory .............................................................................................................. 108
Recovery of Durable Goods .............................................................................................................. 108
NEHC’S ................................................................................................................................................108
LOCAL HEALTH DEPARTMENT COORDINATION ....................................................................................109
INVENTORY MANAGEMENT .....................................................................................................................110
8.1
8.2
8.3
INVENTORY ...........................................................................................................................................110
INVENTORY DOCUMENTATION ..............................................................................................................110
POD INVENTORY STAGING ...................................................................................................................111
8.3.1
8.3.2
8.3.3
8.3.4
8.4
9.
Unaccompanied Minor ........................................................................................................................ 98
Minimum Identification ..................................................................................................................... 102
6.12
6.13
6.13.1
8.
Environmental ..................................................................................................................................... 93
Controlled Substances ......................................................................................................................... 93
PRESCRIPTION LABELING ........................................................................................................................94
PATIENT INFORMATION FORMS ...............................................................................................................97
HEAD OF HOUSEHOLD .............................................................................................................................98
6.11.1
6.11.2
7.
Staffing/Volunteer Management Plan ................................................................................................. 92
MI-Volunteer Registry/Medical Reserve Corp .................................................................................... 92
STORAGE AND HANDLING REQUIREMENTS FOR SNS MATERIEL .........................................93
6.8.1
6.8.2
6.9
6.10
6.11
Tribal Population ................................................................................................................................ 90
Homebound Population....................................................................................................................... 90
INSTITUTIONALIZED POPULATION ...........................................................................................................90
STAFFING RESOURCES ............................................................................................................................91
6.7.1
6.7.2
6.8
Van Buren County ............................................................................................................................... 86
Cass County ........................................................................................................................................ 86
Tribal Health Dispensing Site: ............................................................................................................ 87
ACTIVATION/OPERATIONS OF DISPENSING SITES ....................................................................................89
SPECIAL POPULATIONS ...........................................................................................................................89
6.5.1
6.5.2
6.6
6.7
MDCH Tiered Approach to Dispensing .............................................................................................. 81
Limited-scale event.............................................................................................................................. 84
Worst-case event ................................................................................................................................. 84
Dispensing to Van Buren/Cass County in 48 Hours ............................................................................ 84
Alternative Dispensing Options........................................................................................................... 84
Unloading.......................................................................................................................................... 111
Distribution and Redistribution ......................................................................................................... 111
Chain of Custody ............................................................................................................................... 111
Resupply ............................................................................................................................................ 111
RECOVERY ............................................................................................................................................111
COMMUNICATIONS .....................................................................................................................................112
9.1
RISK COMMUNICATIONS .......................................................................................................................112
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9.2
9.3
9.4
9.5
PUBLIC INFORMATION CENTER .............................................................................................................113
PRODUCTION OF PRINTED MATERIAL.....................................................................................................113
COMMUNICATIONS SUPPORT.................................................................................................................113
OPERATIONAL COMMUNICATIONS ........................................................................................................114
Communications Pathways ............................................................................................................................... 115
10.
SECURITY .......................................................................................................................................................116
10.1
TRANSPORTATION SECURITY ................................................................................................................116
10.2
SECURITY NEEDS ..................................................................................................................................116
10.3
10.4
10.5
10.6
TRAINING AND COMMUNICATIONS .......................................................................................................117
ACCESS CONTROL .................................................................................................................................117
BADGING/CREDENTIALING OF STAFF ....................................................................................................117
RULES OF ENGAGEMENT .......................................................................................................................118
10.1.1
10.2.1
11.
Escort of SNS material ...................................................................................................................... 116
Crowd Control .................................................................................................................................. 117
TRANSPORTATION ......................................................................................................................................123
11.1
11.2
11.3
INTRA-JURISDICTIONAL COORDINATION ...............................................................................................123
COMMUNICATIONS ................................................................................................................................123
TRANSPORTATION ISSUES .....................................................................................................................123
Special Needs/Handicapped.............................................................................................................................. 123
12.
HUMAN SERVICES ........................................................................................................................................125
12.1
12.2
13.
CARE AND FEEDING OF DISASTER WORKERS ........................................................................................125
VAN BUREN COUNTY EMERGENCY OPERATIONS PLAN SUPPORT .........................................................125
SNS PLANNING/TRAINING/EXERCISING ...............................................................................................129
13.1
13.2
13.3
13.4
13.5
SNS PLANNING PROCESS ......................................................................................................................129
SNS PLANNING PARTNERS ...................................................................................................................129
PLAN REVIEW/UPDATES .......................................................................................................................129
PROGRAM EXERCISES ...........................................................................................................................129
TRAINING EFFORTS ...............................................................................................................................130
13.5.1
VBCDHD Training Efforts ................................................................................................................ 130
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Annual Revision Tracking
Year
2005
2006
2007
2008
2009
2010
Updated By:
06/08/2005
02/28/2006
02/27/2007
2/26/2008, 12/08
10/1/2009
3/2010
Date:
Jennifer Zordan, EPC
Jennifer Zordan, EPC
Jennifer Zordan, EPC
Jennifer Zordan, EPC
Jennifer Zordan, EPC
Jennifer Zordan, EPC
2010 Plan Approval
Jeff Elliott
Administrator/Health Officer
Al Svilpe
Director, Office of Domestic Preparedness
Van Buren County
Dave Smith
Director, Emergency Management
Cass County
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1.
INTRODUCTION
1.1 Purpose
The purpose of this plan is to provide a guide to the Van Buren/Cass District Health
Department, and other assisting agencies, in responding to an incident that requires largescale distribution and/or administration of medication or vaccination. Activation of the plan
may or may not require a request for deployment of the Strategic National Stockpile (SNS). A
description of the SNS program and its scope as well as guidance for an SNS component of
mass medication dispensing is an important part of this plan.
If confronted with an intentional or unintentional large scale exposure to a biological agent that
threatens the public health, the priorities of the Health Department will be to assure the
continuation and delivery of essential public health services while providing assistance to meet
emergency needs for the affected population. This plan is the framework and guidelines for
ensuring that an effective system of health and medically related emergency management is in
place to contain adverse outcomes of such a large scale event. Requesting the SNS will
require the coordination of many local, State, and Federal agencies. Those agencies can be
found as partners within this plan.
It is important to note that any plan of this type represents an evolutionary process that must
be periodically reviewed and updated to ensure that its assumptions, resources, priorities, and
strategies are consistent with current knowledge and changing infrastructure. In addition, in
the event of actual large-scale biological threat, the judgments of the public health leadership,
based on epidemiology and extent of population exposure and/or infection, may alter or
override anticipated strategies and plans.
This plan specifies the activities, procedures and responsibilities that must occur or be
assigned to maximize the effectiveness of the coordinated response to a biological, chemical,
technological or natural disaster requiring the Strategic National Stockpile. This plan will detail
what must occur at the local level from the time the material is received from federal authorities
to when it is distributed, including the storage, repackaging and return of unused material.
This plan will be reviewed and revised at least on an annual basis. Actual incidents and/or
exercises may require revisions to the plan.
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1.2 Program Description
The CDC’s Strategic National Stockpile (SNS) is a repository of antibiotics, chemical
antidotes, antitoxins, vaccines, antiviral drugs and other life-saving medical materiel. The SNS
mission is to deliver critical medical assets to the scene of a national emergency.
During a public health emergency, state and local public health systems may be overwhelmed.
The SNS is designed to supplement and re-supply state and local public health agencies in the
event of an emergency within the United States or its territories.
The SNS is organized for flexible response.
If the threat posed by a public health emergency is unknown, the first line of support lies with
the 12-hour Push Packages – so called because they can be delivered anywhere in the United
States and/or its territories within 12 hours of the federal decision to deploy. The 12-hour Push
Packages are 50-ton caches of pharmaceuticals, antidotes and medical supplies designed for
rapid deployment. Each push package is stocked with a broad spectrum of materiel to combat
any number of public health threats.
If the nature of the public health emergency is known, CDC officials can send Managed
Inventory (MI) to combat the threat. MI is maintained at facilities throughout the United States
by either CDC or contract vendors. MI is also used to re-supply deployed 12-hour Push
Packages. MI can be expected to arrive within 24 to 36 hours of a federal deployment
decision.
DSNS is part of a nationwide preparedness program for state and local health care providers,
first responders and governmental partners. To better prepare SNS stakeholders for receipt of
federal medical materiel, DSNS officials provide training on a myriad of topics to include
warehouse design, distribution site layout and preparedness. Additionally, DSNS professionals
offer assistance and advice to state and local governments on how to best maintain medical
materiel stockpiles. Finally, DSNS and CDC staff members provide guidance on ways state
and local governments can better respond to public health emergencies.
During an emergency, a state determines if there is a need for SNS assets and requests
federal assistance. Discussions between state and federal organizations are initiated and a
decision is made at the federal level to deploy assets. DSNS works with federal, state and
local health officials to determine what assets are needed. The material is shipped to the
state’s Receipt, Stage and Store (RSS) site where state and local authorities will distribute
further the countermeasures.
The DSNS program will quickly respond to the medical consequences of terrorist attacks,
natural disasters, and technological accidents by augmenting depleted state and local
resources needed for responding to these incidents. The SNS program continues to provide
medications and material until the region can replenish and sustain such medications and
supplies locally.
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1.2.1 Division of the Strategic National Stockpile
The Strategic National Stockpile (SNS) is a collection of large quantities of medical materiel,
equipment, and pharmaceuticals.
•
12-Hour Push Packages – medical supplies, equipment, and pharmaceuticals prepacked in air cargo containers for immediate shipment. As the name implies, 12-Hour
Push Packages can be deployed anywhere in the United States and its territories within
12 hours after a request is made.
The Strategic National Stockpile (SNS) 12-hour Push Package Product Catalog contains
images and descriptions of the products in a 12-hour Push Package as of November 2008.
A 12-hour Push Package is a 50-ton cache of pharmaceuticals and medical supplies
designed to provide rapid delivery of a broad spectrum of assets for an ill-defined threat.
The 12-hour Push Package can be delivered to a receive, stage, and store (RSS)
warehouse within 12 hours of the federal decision to do so. This formulary, combined with
technical assistance from the project area’s program services consultant, can assist state
and local SNS planners in streamlining the staging and reordering process.
The SNS 12-hour Push Package Product Catalog is updated annually as products are
added or removed. Depending on reordering availability, the products pictured in this
catalog may vary based on brand and packaging. The product description also may indicate
additional sizes that are not pictured in the catalog but are included in the 12-hour Push
Package. The catalog is organized by color codes, which correspond with the colors of the
product list on each cargo container in the 12-hour Push Package. The appendices include
12-hour Push Package items that are used together and items that are not included in the
12-hour Push Package but are sent at the same time. (Source: SNS 12 Hour Push Package
Catalog, November 2009)
The SNS 12 hour Push Pack consists of 50 tons of pharmaceuticals and medical
material that will arrive in 12 hours or less by air or ground transport. The push pack
fills a wide-body aircraft, occupies 130 cargo containers and requires 12,000 square
feet ground/floor space for proper receiving, staging and storing. There are 12 Push
Packages strategically stored across the U.S. Each 12-hour Push Package contains an
assortment of medical products to help in a variety of possible biological, chemical or
nuclear terrorism events. Pre-configured for rapid identification and ease of distribution
 Pre-positioned in environmentally controlled and secured facilities
 Ready for deployment to reach designated area within 12 hours of Federal
activation
•
Managed Inventory – palletized stockpiles of pharmaceuticals, medical supplies and
equipment for use in large-scale emergencies. Normally, this materiel can be sent
within 24 to 36 hours after approval for deployment. The form, packaging, and method
of delivery of managed inventory can vary widely with circumstances.
Some items needed may not be in the push packages but will be shipped as required
as part of the Managed Inventory (MI). The MI may be requested initially, if the threat
and/or agent is known. For example, push packages do not contain vaccines for
anthrax or smallpox, botulism antitoxin, or anthrax hyper-immune plasma but can be
requested as part of MI. The MI can contain specific items and/or medications for a
known threat. More information can be found at www.bt.cdc.gov.
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The Managed Inventory (MI) Packages:




•
•
May be utilized as a Phase I (initial) or Phase II (secondary) response, depending upon the
information available at the time
“Tailored" to provide specific materiel depending upon suspected or confirmed agent
Comprised of pharmaceuticals and supplies that are delivered from one or more MI sources
Everything that is in the 12-hour Push Packages is in MI…only more of it
Vaccines – the repository for various types and quantities of vaccines.
Storage & Rapid Deployment of Vaccines, Anti-virals and Antitoxins
The SNS Program provides security, storage and rapid movement of select
vaccines, anti-virals and antitoxins for release to states in response to a biological,
chemical or nerve threat agent.
Technical Advisory Response Unit (TARU) – a group of individuals from the
DSNS able to provide technical advice to assist state and local responders with
managing SNS assets in response to a large-scale emergency.
The Push Pack is accompanied by a CDC Technical Advisory Response Unit
(TARU) comprised of 6-8 consultants and advisors. These advisors will advise local
authorities on receiving, distributing, dispensing, replenishing and recovering the
SNS. During an event, the SNS Program Technical Advisory Response Unit (TARU)
provides onsite support to state and local authorized personnel on receiving,
distributing, dispensing, replenishing and the recovery of SNS assets.
The TARU:
 Includes public health experts, logisticians and emergency response
specialists
 Manages the transfer of SNS assets to authorized state representatives (in
accordance with state plan) and provides technical assistance
 Coordinates with the local incident command structure
Buying Power/Surge Capacity - The SNS Program’s Acquisition Partner, the Department of
Veterans Affairs (VA) is able to negotiate the rapid purchase (at lower prices than the Federal
Supply Schedule) of medical materiel, because it has already purchased billions of dollars of
pharmaceuticals for the VA medical system.



Based upon market analysis by the VA, the SNS Program selects certain high demand material
items to hold in inventory
The SNS Program has access to manufacturer’s “on-hand” surge capability for non-critical items
The SNS Program uses various methods (like accessing the Universal Data Repository – UDR)
to take a “snap-shot” look at the availability of medical materiel stock across the nation–
specifically for non-critical items which would be needed in mass quantity
CHEMPACK Program - The CHEMPACK Program is a sustainable repository of nerve agent
antidotes, symptomatic treatments and supporting equipment designed to care for individuals
exposed to nerve agents, including but not limited to, pharmaceuticals in the form of autoinjectors, multi-dose vials for injection, and self-monitoring storage containers. CHEMPACK is
discussed in the pharmaceutical inventory section of this plan.
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1.3 Responsibilities
A.
Lead and Support Agencies
The departments, agencies and organizations list may not be all-inclusive.
Additional organizations may be needed based on the incident.
Lead Agencies:
Michigan Department of Community Health
Office of Public Health Preparedness
3423 N. Martin Luther King Jr. Blvd.
PO Box 30195
Lansing, MI 48909
Business Hours:
517-335-8150
After Hours:
517-335-9030
Michigan State Police
Emergency Management Division
4000 Collins Rd.
Lansing, MI 48909
To be contacted through the local EOC.
Support Agencies:
Michigan Department of Military and Veterans Affairs
Michigan Department of Transportation
Michigan Department of Agriculture
Michigan Department of Attorney General
Michigan Department of Corrections
Michigan Department of Environmental Quality
Michigan Department of Information Technology
Michigan Department of Management and Budget
Michigan Department of Natural Resources
Michigan Office for Services to the Aging
Department of Human Services (formerly FIA)
Michigan Pharmacists Association
American Red Cross
Local Public Health Preparedness Coordinators
Local Emergency Managers
Local Law Enforcement Agencies
Local Public Health Agencies and Administrators
Local Hospitals, Clinics and Community Care Centers
Local City Officials/Administrators
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B.
Van Buren/Cass District Health Department (VBCDHD)




C.
Michigan Department of Community Health (MDCH)





D.
Provide assistance to VBCDHD as provided for in the state plan
Credentialing process
Standing orders
Receipt, Storage, and Staging (RSS) site personnel and management.
Transportation of SNS to dispensing sites
Centers for Disease Control (CDC)



E.
Develop local plan for emergency immunization/medication dispensing including
identification of available and needed resources (personnel and supplies),
procedures for securing the SNS, identification of pharmacies that will provide
medication prior to SNS and identification of priority personnel and immediate family
members for receipt of vaccine/medication.
Manage the clinic functions at dispensing sites
Investigation of outbreak
Establish provisions for public notification, and risk communication
Confer with local and state officials to make determination regarding deployment of
the SNS.
Ship the SNS and deploy a Technical Advisory Response Unit (TARU) consisting of
pharmacists, emergency responders, logistics experts to advise local authorities.
Transportation of SNS to RSS site
Van Buren and/or Cass County Emergency Management (EMD)




Activate EOC
Request SNS
Support dispensing site operations by securing resources per the county emergency
operations plan, and providing multi-agency coordination from the EOC
Manage logistics and resources functions at dispensing sites
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F. Law Enforcement
The law enforcement organization is responsible for accomplishing the following tasks per the Van Buren
County Emergency Operations Plan Section G-2. It shall ensure that adequate notification procedures exist,
that personnel are trained, that supplemental procedures exist as necessary, and that resources are available
to carry out these tasks.


Access Control (Barricades, Traffic
Rerouting, Entry to controlled area, Railroad
Access Control, Air Traffic Control)
Security (EOC, Command Post, PIC, Critical
Resources/Facilities, Disaster Site, Shelters,
Staging Area)





G.
Warning and notification
Mortuary Services
Radiological Monitoring
Account for safety of Population
Curfew Restrictions








Clearing house for unidentified
property
Emergency Assistance
Removal of Vehicles
Safety of prisoners
Staging Area
Urban Search and Rescue
Animal Control
Criminal investigation in the case of
a bioterrorist incident
Fire Departments
The fire services organization is responsible for accomplishing the following tasks per the Van Buren County
Emergency Operations Plan Section H-2. It shall ensure that adequate notification procedures exist, that
personnel are trained, that supplemental procedures exist as necessary, and that resources are available to
carry out these tasks.











H.
Warning & Notification(assist Central Dispatch)
Access Control (assist LE)
Traffic Control (assist LE)
Safety Inspections
Emergency Generators/Lighting
Gas Shutoff
Decontamination/Radiological Monitoring
Individual Assistance
Paramedics/EMTs assist in clinic operations if possible
Traffic flow, crowd control and security support
SNS Technical Consultant assigned to Region 5

Provide assistance and facilitation regarding SNS deployment logistics.
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1.4
Jurisdiction Demographics
The Van Buren/Cass District Health Department Jurisdiction consists of Van Buren and
Cass Counties in the southwestern lower corner of Michigan. The counties in Michigan
are split up into eight emergency management regions by the Michigan State Police.
Van Buren and Cass counties both are part of District 5. Other counties within the 5th
District include Allegan, Barry, Berrien, Branch, Calhoun, Kalamazoo, and St. Joseph.
The local health jurisdiction does not have any major airports within its boundaries. There
are several small airports within each county.
1.4.1 Van Buren County
Van Buren County is a rural county and has a total population of 76,263 according to
the 2000 U.S. Census. Van Buren County is host to I-94 a major artery between
Chicago and Detroit. The county also has access to US-31 which is a north-south route
on the west shore of the county. Van Buren County has approximately 13 miles of
waterfront along the Lake Michigan shoreline. Economic characteristics include
industries of Agriculture, Construction, Manufacturing and Government jobs. 43.7% of
the residents travel outside of the county for employment. The median household
income in Van Buren County residents is $39,365 compared to the median household
income of Michigan is $44,667. The county age demographics are as follows: Ages 0-5
(6.8%), 6-18 (21.3%), 18-64 (59.6 %), and over 65 (12.3%). The county is made up of
89.9% Caucasians, 5.9% Black or African American, 0.9% American Indian and 3.3%
others races. Van Buren County has a 7.4% Hispanic or Latino (of any race) population.
Van Buren County has two small community hospitals, South Haven Community
Hospital in South Haven, and Lakeview Community Hospital in Paw Paw.
1.4.2 Cass County
Cass County is a rural county with a population of 51,104. The major road ways
through Cass County are M-60, M-62, and M-51. These roadways are two lane
highways with a modest amount of daily traffic. Cass County borders the state of
Indiana. Economic characteristics include industries of Agriculture, Construction,
Manufacturing, Education and Retail Trade. 58.0% of the residents travel outside of the
county for employment. The median household income in Cass County is $44,264
compared to the median household income of Michigan is $44,667. The county age
demographics are as follows: Ages 0-5 (6.1%), 6-18 (19.4%), 18-64 (60.9 %), and over
65 (13.6%). The county is made up of 91.1% Caucasians, 7.0% Black or African
American, 1.9% American Indian and 1.6% others races. Van Buren County has a 2.4%
Hispanic or Latino (of any race) population. Cass County has one small hospital,
Borgess-Lee Memorial in Dowagiac.
Primary languages for the health jurisdiction are English and Spanish. The health department
is prepared to provide interpretation for those individuals who have no English
communication skills. The Health Department employs bi-lingual persons to assist in this
effort. There are also mutual aid agreements in place to request interpretation services for
Spanish and other languages spoken in our area.
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1.4.3 Pokagon Band of Potawatomi Indians
The tribal population base is located in Dowagiac, Michigan. There are approximately
3,000 tribal members who conduct business in Cass County. The tribe has expressed
interest in supporting their population during times of emergency as well as their
surrounding community. The Health Center is fully equipped with a pharmacy, clinic
rooms, and a captive population. The health center is located in Dowagiac, MI and is a
central locating venue for many tribal members who reside in neighboring counties. The
contact information for the tribe can be located in the CERC plan as well as in the All
Hazards Response Plan.
The relationship between the tribe and the Health Department is enhanced by regular
communications with the health center. The tribe regularly reports communicable
disease and reportable conditions to the health department. Tribal members are
integrated into the communities in which they live, therefore are also considered a
member of the general public. During an emergency the tribe will assist the health
department in communicating with the tribal members as well as any prophylactic care
that may be required. Tribal members are much more willing to follow medical directions
given by a tribal entity than a governmental or public entity. A mutual aid agreement is
in the draft stages with the tribe to provide medications and/or medical care on behalf of
the health department to its members.
An additional mutual aid agreement is in effect between the tribe and the local health
department to distribute mediations, vaccine and other health related information and
materials. It also provides an alternative location to store vaccine for the health
department as they are fully equipped with a generator to power their entire health
facility if needed.
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Regional Structure and Population Breakdowns
Counties
Local Health Department Jurisdiction
Allegan
Barry
Berrien
St. Joseph
Allegan County HD
Barry-Eaton District HD
Berrien County HD
Branch-Hillsdale-St. Joseph Community
Health Agency
Branch-Hillsdale-St. Joseph Community
Health Agency
Calhoun County HD
Kalamazoo County HD
Van Buren-Cass County District HD
Van Buren-Cass County District HD
Total Population
Branch
Calhoun
Kalamazoo
Cass
Van Buren
Population at
2000 Census
108,225
57,661
161,820
62,144
County Percentage
of the Region’s
Population
12.1 %
6.4 %
18.1 %
6.9 %
45,726
5.1 %
138,031
238,544
51,321
76,880
894,626
15.4 %
26.7 %
5.7 %
8.6 %
The following maps depict the population distribution across the counties. There are only a few
areas in the jurisdiction where the population exceeds 1000 persons per square mile. This
indicates that the counties are rural and the population is wide-spread. Additional
demographics of the population can be found in the following table.
Demographic Facts
Van Buren
Cass
Total Population
76,263
51,104
Housing Units
33,975
23,884
55.6
48.5
Persons per square mile
124.8
103.8
Residents under 5 years
5,176
3,102
Residents 5-18 years
18,377
11,267
Residents 65+ years
9,373
6,927
712
337
In group quarters: Non-institutionalized
1,204
407
African Americans
4,523
3,600
414
376
Hispanics
5,634
1,233
American Indian/Alaska Native
1,425
986
Other races
3,110
806
Language other than English spoken at home age 5+
6,304
2,023
361
75
Housing Units per square mile
In group quarters: Institutionalized
Asians
Persons who cannot speak English at all
Source: U.S. Census Bureau 2000
Page 16
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Van Buren County
Cass County
Source: US Census Bureau 2000
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1.5
Assumptions
For planning purposes, the worst-case scenario is being projected. If the situation does not
fully develop, the response can be adjusted. Events that would generate the request of the
SNS would be large-scale, natural or terrorist related infectious disease emergencies.
Determination of scale of the event would be based on epidemiological evidence and
assessment.
The following assumptions are made::
Assumptions: Infectious Disease Emergency
1.
Infectious disease emergencies are inevitable.
2.
In the event of an infectious disease outbreak, local officials, the healthcare
community and the general public will look to the local health department to
coordinate the response.
3.
There will be widespread circulation of conflicting information, misinformation and
rumors. Communication must be coordinated among all relevant agencies to
ensure consistent messages to all entities involved in the response and to the
general public.
4.
The infectious disease emergency must take priority until the emergency is
resolved.
5.
Even during a minor event, such as a case of hepatitis A in a food handler or one
case of measles on a college campus, local health departments will be responsible
for coordinating the distribution and/or administration of vaccine and other relevant
pharmaceuticals in their jurisdiction.
Assumptions: Bioterrorism
1.
Although possible, and likely in a national or global sense, an act of bioterrorism
is unlikely in any given location.
2.
The release of a biological agent will likely go unnoticed until infected persons
present for medical treatment.
3.
Most local public health and health care systems will be overwhelmed by
community requests for information, prophylaxis and treatment when a
bioterrorist threat or event becomes public knowledge.
4.
Public health officials will need to work closely with law enforcement and other
traditional first responders in a bioterrorism event.
5.
Illnesses resulting from a bioterrorist release may be very difficult to differentiate
from a naturally occurring outbreak of disease.
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Assumptions: Influenza Pandemic
1.
An influenza pandemic is currently underway, and may reoccur in the near future.
2.
There may be very little warning. Most experts believe that we will have between
one and six months between the time that a novel influenza strain is identified
and the time that outbreaks begin to occur in the United States. This occurred
with the 2009 H1N1 pandemic.
3.
Outbreaks may occur simultaneously throughout much of the United States,
preventing shifts in human and material resources that normally occur with other
natural localized or regional disasters.
4.
The effect of an influenza pandemic on individual communities will be relatively
prolonged -- weeks to months. The pandemic period for 2009 H1N1 is
approaching 12 months.
5.
The impact of the next pandemic could have a devastating effect on the health
and well being of the American public. It is estimated that in the United States
there will be 50 million outpatient visits, 2 million hospitalizations, and 400,00
deaths as a result of a flu pandemic. VBCDHD estimates that within the health
department jurisdiction there will be:

Up to 44,500 persons will become ill

Up to 34,000 persons will require outpatient care

Up to 650 persons will be hospitalized
 Up to 200 persons will die
Effects of 2009 H1N1 did not approach these extremes, but the next pandemic
strain, may be devastating.
6.
Effective preventive and therapeutic measures -- including vaccines and
antiviral agents -- will likely be in short supply, as well as antibiotics to treat
secondary infections.
7.
Health-care workers and other first responders will likely be at even higher risk
of exposure and illness than the general population, further impeding the care
of victims.
8.
Widespread illness in the community will also increase the likelihood of sudden
and potentially significant shortages of personnel in other sectors who provide
critical community services, including but not limited to, military personnel,
police, firefighters, utility workers, and transportation workers.
The 2009 H1N1 pandemic resulted in an ambitious response from public health. The strain
proved to be mild and did not manifest into a catastrophic event. The above assumptions still
exist for a severe pandemic to occur.
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1.6 Legal Issues
Legal Issues to support SNS Operations
Van Buren/Cass District Health Department
SNS Plan Legal Issues Briefing Paper
The following information has been adopted from the State of Michigan SNS Plan
SNS Legal Issues Briefing Paper and will be utilized as the legal basis for emergency actions
for Van Buren/Cass District Health Department.
The State of Michigan has investigated the following legal issues which support SNS operations:
 Medical practitioners authorized to issue standing orders and protocols for
dispensing sites.
 Personnel authorized to dispense medications during a state of emergency.
 Procurement of private property.
 Liability/workers compensation
 Staff compensation
Medical practitioners authorized to issue standing orders and protocols for dispensing sites
The Public Health Code1 authorizes physicians to issue standing orders and protocols for
dispensing sites. Pursuant to the Code, prescribing is limited to a prescriber. The Code defines
“prescriber” to mean a licensed:







Dentist
Doctor of medicine
Doctor of osteopathic medicine and surgery
Doctor of podiatric medicine and surgery
Optometrist certified under part 174 to administer and prescribe therapeutic
pharmaceutical agents
Veterinarian
Or another licensed health professional acting under the delegation and using,
recording, or otherwise indicating the name of the delegating licensed doctor of
medicine or licensed doctor of osteopathic medicine and surgery.2
There are limits on the authority of each prescriber based on the health profession’s scope of
practice. Physicians (allopathic and osteopathic) are authorized to prescribe, dispense and
administer the full spectrum of prescription drugs, with the exception of controlled substances. In
order to prescribe or dispense a controlled substance, a physician must have a controlled
substances license issued under Article 7 of the Code.3
In addition, licensees may delegate to a licensed or unlicensed individual who is otherwise
qualified by education, training, or experience the performance of selected acts, tasks, or functions
1
Michigan Compiled Laws (MCL) 333.1101 et seq.
MCL 333.17708 (2)
3 MCL 333.7303
2
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where the acts, tasks, or functions fall within the scope of practice of the licensee’s profession and
will be performed under the licensee’s supervision.4
“Supervision”, except as otherwise provided in Article 15 of the Code, means the overseeing of or
participation in the work of another individual by a health professional licensed under Article 15 in
circumstances where at least all of the following conditions exist:

The continuous availability of direct communication in person or by radio,
telephone, or telecommunication between the supervised individual and a licensed
health professional.

The availability of a licensed health professional on a regularly scheduled basis to
review the practice of the supervised individual, to provide consultation to the
supervised individual, to review records, and to further educate the supervised
individual in the performance of the individual’s functions.

The provision by the licensed supervising health professional of predetermined
procedures and drug protocol.5
The delegatory authority of physicians is regulated by administrative rules that are promulgated by
the Board of Medicine6 and the Board of Osteopathic Medicine and Surgery.7 A physician may
delegate to a qualified individual the authority to dispense and administer prescription drugs. In
addition, a physician may delegate the authority to prescribe to another prescriber, with the
exception of controlled substances, which have more limits.
A supervising physician may delegate the prescription of controlled substances listed in schedules
3 to 5 to a physician’s assistant, if the delegating physician establishes a written authorization
containing certain required information and meets other standards that are stipulated in the
administrative rules. 8
Furthermore, a physician may delegate the prescription of controlled substances listed in schedules
3 to 5 to a registered nurse who holds specialty certification as a nurse practitioner or nurse
midwife, if the delegating physician establishes a written authorization containing certain required
information and meets other standards that are stipulated in the rules.9
Medical practitioners authorized to dispense medications during a state of emergency
Medical practitioners are authorized to dispense medications during a state of emergency. Under
the Public Health Code, physicians and pharmacists are authorized to dispense medications, and
these licensed health professions may delegate authority for dispensing medications to qualified
individuals.
Moreover, Article 15 of the Code provides an important exception stipulating that certain
individuals are not required to have a license issued under this article for practice of a health
profession in this state. This exception includes an individual who by education, training, or
4
MCL 333.16215
MCL 333.16109 (2)
6 R 338.2301 et seq.
7 R 338.101 et seq.
8 R 338.2304
9 R 338.2305
5
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experience substantially meets the requirements of this article for licensure while rendering
medical care in a time of disaster or to an ill or injured individual at the scene of an emergency.10
Procurement of private property
The Governor may commandeer or utilize private property necessary to cope with a declared
disaster or emergency. In these circumstances, takings are subject to appropriate compensation, as
authorized by the legislature.11
Liability/workers compensation
 Liability
If the SNS is required in response to a disaster or emergency in the State of Michigan, the
Governor will declare a State of Disaster, State of Emergency, or a Heightened State of Alert
according to the Emergency Management Act.12 When the Governor requests the SNS, the
State of Michigan Strategic National Stockpile Plan is activated and SNS personnel become
disaster relief forces under the Emergency Management Act.13 Therefore, SNS staff would be
immune from tort liability to the extent provided by the Governmental Immunity Act. 14

Worker’s Disability Compensation
Workers’ compensation is an insurance system that provides wage replacement, medical, and
rehabilitation benefits to individuals who are injured while at work. Nearly all employers in
Michigan are covered by workers’ compensation. This includes both public and private
employers.15 In general, personnel who are working in support of the SNS are covered by
workers’ compensation insurance through their respective employers (i.e., the state, county or
municipality).
A volunteer member of disaster relief forces, while on duty, is entitled to the same rights and
immunities as a state employee.16 A volunteer member of disaster relief forces, who is
registered with the Emergency Management Division of the Department of State Police or with
a county or municipal Emergency Management Coordinator, while on duty, is considered a
state or municipal employee for purposes of workers’ compensation benefits.17
Staff compensation
When activated, SNS personnel are part of the State of Michigan’s disaster relief forces. Pursuant
to the Emergency Management Act18, “disaster relief forces” means all agencies of state, county,
and municipal government, private and volunteer personnel, public officers and employees, and all
10
MCL 333.16171 (c)
MCL 30.405 (d)
12 MCL 30.401 et seq.
13 MCL 30.411
14 MCL 691.1407
15 An Overview of Workers’ Compensation in Michigan, Michigan Department of Labor & Economic Growth,
Workers’ Compensation Agency, August 2006, WC-PUB-004.
16 MCL 30.411
17 MCL 418.161
18 MCL 30.401 et seq.
11
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other persons or groups of persons having duties or responsibilities under the Emergency
Management Act or pursuant to a lawful order or directive authorized by the Act.19
Personnel of disaster relief forces while on duty are subject to all of the following provisions:
19
20

If they are an employee of this state, they have the powers, duties, rights, privileges,
and immunities of and receive the compensation incidental to their employment.

If they are employees of a political subdivision of this state, regardless of where
serving, they have the powers, duties, rights, privileges, and immunities and receive
the compensation incidental to their employment.

If they are not employees of this state or a political subdivision of this state, they are
entitled to the same rights and immunities as provided by law for the employees of
this state. All personnel of disaster relief forces shall, while on duty, be subject to the
operational control of the authority in charge of disaster relief activities in the area in
which they are serving, and shall be reimbursed for all actual and necessary travel and
subsistence expenses. 20
MCL 30.402 (f)
MCL 30.411 (1)
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2. REQUESTING THE SNS
2.1 Justification
The Strategic National Stockpile can be requested when an event has overwhelmed, or is
projected to overwhelm, local and state drug and medical supply resources and impede the
ability of local emergency agencies to provide the necessary medical treatment protocols to
the affected population in a timely and sufficient manner.
The request may be justified if there is any:
Table 3-1(v10.02). Requesting Strategic National Stockpile Assets.
Events that can Provide Justification for SNS Asset Deployment
A chemical, biological, radiological, nuclear, or explosive ( CBRNE) event
A medical emergency brought on by a natural disaster
Claim of release by intelligence or law enforcement
An indication from intelligence sources or law enforcement of an increased potential for a terrorist
attack
Clinical, laboratory, or epidemiological indications including:
•
A large number of persons with similar symptoms, disease, syndrome, or deaths
•
An unusual illness in a population – single case of disease from uncommon agent,
and / or a disease with unusual geographic or seasonal distribution, and / or an
endemic disease or unexplained increase in incidence
•
A higher than normal morbidity and mortality from a common disease or syndrome
•
A failure of a common disease to respond to usual therapy
•
Multiple unusual or unexplained disease entities in the same patient
•
Multiple atypical presentations of disease agents
•
Similar genetic type in agents isolated from temporally or spatially distinct sources
•
Unusual, genetically engineered, or an antiquated strain of a disease agent
•
Simultaneous clusters of similar illness in non-contiguous areas
•
Atypical aerosol-, food-, or water-borne transmission of a disease
•
Deaths or illness among animals that precedes or accompanies human death
Unexplained increases in emergency medical service requests
Unexplained increases in antibiotic prescriptions or over-the-counter medication use
Regional and Local Resource Considerations for Deploying SNS Assets
A number of current casualties exceeding the local response capabilities available
The projected needs of the population of the area (including
transients) The hospital surge capacity at the time of the event
The availability of state resources including pharmaceutical distributors, oxygen distributor
availability, nearby hospitals, and transportation services
Local resources (e.g., pharmacy distribution, oxygen availability, and transport capacity)
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2.2 Authority and Process
Only the top elected official of each affected county may request the SNS. It is intended that
the local request for the SNS will be made in consultation with the Van Burn/Cass District
Health Department Health Officer, the local Emergency Management office of the affected
county (counties) and other affected agency officials.
Local resource considerations for asking for SNS deployment include:
 Number of current casualties.
 Projected needs considering the population of the area (including transients), and
consideration of whether the disease is infectious or non-infectious.
 Hospital capacity at the time of the event, including intensive care unit beds and
ventilator needs.
 State resources identified, including pharmacy distributors, oxygen availability, other
nearby hospitals, and in-state alternative care centers.
 Local resources such as pharmacy distribution, oxygen availability, and transport
capacity.
 Existing county plans detailed in this manual for receiving, distributing and dispensing
the stockpile supplies and their ability to be fully activated.
Eligibility for receiving oral drugs will be determined by MDCH and Van Buren/Cass District
Health Department Health Officer and Medical Director(s) working within a unified command
structure based upon reports from EMS, hospitals, Infection Control Practitioners (ICP’s), law
enforcement (LE), and physicians regarding the number of potential casualties.

The Chairman of the Board of Commissioners of the requesting county, will make the
official request for SNS material through the Michigan State Police Regional Emergency
Management Coordinator and the MDCH Director as per the schematic diagram below.

The Emergency Management Coordinator and MDCH Director will initiate a formal
contact with the Governor of Michigan who in turn will request release of the SNS from
the CDC. The request to the CDC and the departments of HHS and HS make the
decision to deploy the SNS. If there is agreement at the federal level, the SNS will be
deployed. These actions are depicted in the following schematic.

The Local Health Department Health Officer in coordination with the Local Emergency
Operations Center (EOC) requests the SNS from the State EOC/Office of Community
Health Emergency Communications Center (CHECC). The CHECC relays the request to
the Governor. The Governor then requests the SNS from CDC officials.
Designated signatories for the SNS from the Van Buren/Cass District Health Department can
be found in the letter to MDCH found here.
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2.2.1 Activation of the SNS Plan
Once the DHHS Secretary decides to deploy SNS assets, follow the response guidelines in
this plan to receive, distribute and dispense SNS assets when they arrive. Key activities
include: Command and Control, Receipt, Store and Staging of assets at the Distribution Node,
inventory control, dispensing, and tactical communications.
2.3 Key Contacts for Van Buren/Cass District Health Department
In the event that the Strategic National Stockpile is requested, the Van Buren/Cass District
health Department would be utilizing the Comprehensive All-Hazards Response Plan found in
the office of the Emergency Preparedness Coordinator at the Hartford facility. This plan
outlines the Public Health Leadership Team and their roles. As part of the requisition process
for the SNS, either the Emergency Management Official or Health Officer must contact the
Chairman of the Board. This contact structure is in place in both counties of our jurisdiction.
Immediate notification contacts might include the following persons:
Health Officer
Jeff Elliott
Office: 269- 621-3143 x337
Fax: 269-621-2725
Home: 269-372-3529
Cell: 269-580-3519
[email protected]
Emergency Preparedness Coordinator
SNS Coordinator
Jennifer Zordan
Home: 269-427-7149
Cell: 269-906-0074
Office: 269-621-3143 x382
Fax: 269-621-2725
[email protected]
Medical Director
Dr. Rick Johansen
Pager: 269-989-0056
[email protected]
Director of Nursing/Alternate SNS
Coordinator
Sue Bailey
Cell: 269-760-7084
Office: 269-621-3143 x319
Home: 269-372-4328
[email protected]
Local SNS Coordinator (Cass County)
Cass County Emergency Management
Dave Smith
Office: (269) 445-4160
Fax: (269)445-4169
[email protected]
Local SNS Coordinator (Cass County)
Van Buren County Domestic Preparedness
Al Svilpe, Director
Office: (269)657.7787
Fax: (269) 657-7786
[email protected]
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2.4 SNS Request Process
Once a public health emergency is recognized as having the possibility of overwhelming local,
regional, and/or state pharmaceutical and medical assets, state health officials should
recommend that the governor request the deployment of SNS assets by calling the CDC’s
Director’s Emergency Operations Center (DEOC) at 770-488-7100.
The decision to deploy will be a collaborative effort between local, state, and federal officials.
The process will begin at the local level when officials identify a potential or actual problem
they believe will threaten the health of their community, such as an unusual number of people
reporting to area hospitals with similar symptoms, or the discovery of significant numbers of
dead animals. Evidence of a credible biological or chemical threat to the region may also be
reason to initiate an SNS request. Efforts to identify the cause of the problem will typically
involve the State Laboratory, as well as laboratory and epidemiological capabilities of the CDC.
Local officials, through established emergency operation plans, will notify the State Emergency
Operations Center (SEOC). The SEOC, in collaboration with the State Health Operations
Center (CHECC), will notify the Governor/designee if the problem appears to be serious
enough to require resources the local community or region may not have. If the Governor
supports that conclusion, she will formally request the SNS directly from the CDC or include
the request as part of a formal request for federal assistance through the national emergency
response system.
The Director of the CDC will quickly evaluate the Governor’s request along with local, state,
and federal officials by evaluating the actual or potential threat, the local/regional resources,
and the planning that has taken place for dealing with the threat. If the Director of the CDC
concurs that local/regional resources will be insufficient, the SNS will be deployed.
SNS Request Flow Local to State
VBCDHD
MDCH/OPHP CHECC
State EOC
(MSP)
Local EOC
Office of the Governor
CDC
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2.4.1
Communications with Local EOC & State Officials
Establish an expedited communications process for rapidly informing local and state officials,
including the governor, of an actual or potential health emergency. It is important to begin
communications among local, state and federal officials as early as possible. Some of the
information you should have available when calling to request SNS assets includes:
 A clear, concise description of the situation
 Any results of specimen testing
 Information on the decisions already made regarding the response to the event
o Target population for prophylaxis, quarantine measures, and facilities to be used
throughout the response process
 Information on the availability of state and/or local response assets
 A description of the SNS assets needed to support a response to the situation.
 Share evidence of terrorism or suspected terrorism
2.4.2 Communications with Dispensing Sites and other partners
The request for re-supply of SNS assets and or other supplies, equipment or personnel will be
done through the EOC. Dispensing sites (DS Manager) will communicate with the Incident
Commander, the Public Health Leadership Team and the EOC. The formal lines of
communication will be determined at the time of the event based on the scale and size. If the
Public Health Leadership Team is not activated, the Dispensing Site Manager will
communicate directly with the Incident Commander and the EOC.
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Partnership matrix
MDCH/OPHP
Local Health
Departments
CHECC
Dispensin
g Sites
Hospitals
Care
Centers
RSS
State EOC
(SEOC)
Local
EOC’s



Security
Transportation
Other Resources
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2.5 Re-supply of SNS Assets
Additional assets are available for an appropriate response, if needed by requesting them
from the DSNS. To fulfill local and regional requirements for additional resources, local and
regional managers need to work with the state to determine methods and procedures for
reordering and exchanging information. Again, all involved parties must be kept informed
of replenishment activities.
2.5.1 Procedure for requesting additional assets
Fax order form to the CHECC as required by in the State of Michigan SNS Plan.
Use the forms found in Attachment 1 and 2 (Original order for and Justification).
The level of federal response will help determine the avenues you will use to request
additional assets. For example, if there is a declared national emergency, the National
Response Plan may be executed. DHS would establish a Joint Operations Center (JOC) with
Emergency Support Function #8 (ESF 8) section responsible for public health and medical
services. Most likely, a state representative would request assistance through ESF 8 at the
JOC. The JOC would task DHHS to provide the additional support to DSNS. In contrast,
under a public health emergency enacted by the DHHS Secretary, a state representative may
request additional support directly from the DHHS Secretary’s Operation Center (SOC) or
from a deployed DHHS response team.
Regardless of the level of federal support or the methods for requesting additional supplies,
the TARU team will be there to assist you. To ensure complete coordination, all involved
parties must be informed of replenishment activities.
2.5.2 CDC Decision Algorithm
The following algorithm (based on CDC SNS guidance) shows the request process, as well as
the CDC process for deciding whether to deploy the SNS.
Based on recommendations from the Michigan Department of Community Health and the
Michigan State Police Emergency Management Division, the Governor or designee will
request the SNS.
The request will be made to the Director of CDC (this request can be made via the CDC
Emergency Hotline at (770) 488-7100.
Note: The local jurisdiction Emergency Management Agency is responsible for the rapid
notification of local and state officials of an event that may require the SNS. Both the state and
local government have developed Emergency Action Guides that detail the notification
procedures used during a major emergency.
Algorithm for Requesting, Deploying, and Receiving the SNS (State to Federal)
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2.6 After the Request is made
Immediately upon conclusion of the request call, DSNS will call the SEOC (MI) to get
information DSNS needs to provide the most appropriate and effective response. These calls
will help to:
 Verify points of contact for DSNS deployment, including the State SNS Coordinator and
RSS manager
 Determine the location and information about the RSS facility and Distribution Node.
 Determine the number of PODs needed
 Assure that you have appropriate security
 Determine the treatment regimen the State ill follow to respond to the situation
 Provide information on State policies and State decisions concerning the use of
investigational new drugs
 Define the population to receive prophylaxis
 Determine the need for additional media announcements, press releases, risk
communications, health alerts, etc.
 Discuss SNS asset transportation plans (from RSS to Distribution Node)
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3. Before the SNS Arrives
3.1 SNS Notification
If the SNS is requested there are specific persons who must be notified that the request
has been made. These individuals are key players in the set up of the dispensing sites or
make significant decisions in the dispensing process. The Public Health Leadership
Team will be involved in making the decision to request the SNS. Once that decision has
been made, the set up procedures and the staff involved need to be notified of the
request. Redundant communication methods are in place to locate and notify essential
personnel in the event that the SNS is requested. Those communication steps include:
1.
2.
3.
4.
MI-HAN: The first step in notification should be a high alert from the Michigan
Health Alert Network (MI-HAN). This alert should be specific to the need for the
request of the SNS and the populations affected. Other information should then
be developed and posted on the portal.
Phones: The second step to the notification process should be phone calls to
direct individuals on their roles in the arrival and set up of the Distribution Node
and Dispensing Sites.
Email: The third step, a final and redundant step, is to send all notification
information including a schedule of events and where to report by email to
essential personnel.
During NORMAL Business Hours: An announcement will be made to all staff.
Email notices will be sent and printed material will be available that outlines the
staffs responsibility to report to the dispensing site(s), shift times and any other
significant information including when/how to receive prophylaxis. During AFTER
Hours, this information will be available at the health department, the dispensing
site and the Emergency Operations Center for distribution.
The following quick reference guide includes those individuals who should receive notification.
Page 33
6/24/2017
3.1.1 Quick Reference Notifications for the Request of the SNS
Home: 269-372-3529
Office: 269-621-3143
Cell:269-580-3519
Home: 269.428.0246
Pager: 269-989-0056
Cell: 269-921-5479
Home: 269-372-4328
Office: 269-621-3143
Cell: 269-760-7084
Health Officer(VBCDHD)
Jeff Elliott
[email protected]
Medical Director (VBCDHD)
Rick Johansen
[email protected]
Nursing Director (VBCDHD)
Sue Bailey
[email protected]
Emergency Preparedness
Coordinator (VBCDHD)
Jennifer Zordan
[email protected]
Home: 269-427-7149
Office: 269-621-3143
Cell: 269-906-0074
Emergency Management Director,
Van Buren County
Al Svilpe
[email protected]
Office: 269-657-7786
Pager: 269-232-4112
Cell: 269-377-4080
Emergency Management Director,
Cass County
David Smith
[email protected]
Phone: 269-445-8768
Cell: (269) 336-1710
Health Officer, Kalamazoo County
Linda Vail Buzas
[email protected]
Office: 269-373-5247
Cell: 269-207-5779
Health Officer, Allegan County
Rashmi Ganesan
[email protected]
Home:269-226-2116
Cell:269-998-1107
Health Officer, St. Joseph County
Steve Todd, RS, MPA
[email protected]
Health Officer Berrien County
Mike Mortimore
[email protected]
Home: 269-429-3123
Office: 269-927-5600
Region 5 Epidemiologist
Kim Kutzko
[email protected]
Office: 269-337-4495
Cell: 517-930-3086
Jeff Mills, Superintendent,
Van Buren ISD
[email protected]
John Ostrowski, Superintendent
Cass ISD
[email protected]
Office: 269-674-8091
Home: 269-673-9600
Cell: 269-208-2493
Dispensing Site Administrator
Van Buren County Site(s)
Dispensing Site Administrator
Cass County Site(s)
Michigan State Police
24/7 Emergency
Duty Officer
MDCH-24/7 Emergency
24/7 Emergency
Office:517-279-9561 ext. 107
Office: (269) 445-6204
Primary Number: 517-241-8000
800-525-5555
Alt Number: 517-241-6843/6862
Non Emergency SEOC Fax:
517-241-6815
Day: 517-335-8150
After Hours: 517-335-9030
Updated: 12/2008, 2/2009, 2/2010
Page 34
6/24/2017
3.2 Identifying Official First Responders and Essential Service Providers
During the early hours of a large-scale public health emergency, the LHD must assure that prophylaxis will be offered to teams
of personnel responsible for “Essential Services” and “First Response”. The goal of this protection is to assure that essential
services will be continued and that the general population will be protected. In general, each agency listed in the table below
should identify a team of workers sufficient in number that two 12-hour shifts per day can be staffed during at least the first 48
hours of the emergency. The staff of the LHD can then work with each agency to determine the best mechanism for delivery of
prophylaxis to these teams plus their family members. Protection of family members assures that workers will be able to report
for work without fear that their families are unprotected. For prophylaxis against bacterial infection, local supplies of antibiotics
will facilitate timely prophylaxis.
*Tribal Staff, Public
Examiners, Mortuary
Veterinarians,
Doctors, Nurses,
Mental Health/Social
Waste/Water
Plants/Utilities,
Organizations (e.g.
Cross), Utilities
Essential personnel
provided by
Management
staff and family
3.2.1
Essential First
Responders
Deployment
Phase for
Prophylaxis
Emergency Mgmt
Law Enforcement
Phase 1
Phase 1
Number of Persons
for Initial
Prophylaxis for Van
Buren/Cass Co.
4/2
139/120
Fire
Phase 1
426/160
EMS
Local Public
Health
Emergency
Department Staff
Phase 1
Phase 1
288/123
75
Phase 1
Hospital planning
Emergency
Department Staff
Phase 1 & 2
Hospital planning
Other Essential
Personnel*
Phase 2
5548/2968
35
Possible
Mechanisms for
Prophylaxis
LHD Fast Track
LHD Fast
Track/MCA
LHD Fast
Track/MCA
MCA
LHD Fast Track
Hospitals should
plan and arrange for
prophylaxis of their
own staff
Hospitals should
plan and arrange for
prophylaxis of their
own staff
LHD at PODs
Works, Medical
Services, Dentists,
Pharmacists,
Animal Control,
Services, RACES,
Treatment
Volunteers, Aid
American Red
based on numbers
Emergency
reflecting agency
members.
3.2.1 Types of Populations to Receive Mass Prophylaxis
Clinic Operations
Front Line Workers
General Public
Homebound
Institutionalized
Special Populations
Who will receive
prophylaxis?
Official first responders
and essential service
providers (see next page
for details)
All affected individuals
who are able to come to
clinic sites
Those confined to homes
such as the elderly
Long term care residents,
educational institutions,
inmates, etc.
Cultural/ language minorities,
illegal aliens, homeless,
persons with disabilities
Where could
prophylaxis be
offered?
Previously designated
Dispensing Sites for First
Responders, Central
location or at work sites
Clinic sites with easy
but controlled access,
sufficient space, climate
control
In home setting, using
Home Health Services
Through usual mechanism
of institution’s health care
Through outreach agencies,
peer educators, mobile
medical teams
When will prophylaxis
be offered?
During first 12 hours of
emergency.
Phase I & II
Beginning at 24 hrs and
continuing until all
affected have been served
Phase III
Beginning at 24 hrs and
continuing until all
affected have been served
Phase III
Beginning at 24 hrs and
continuing until all affected
have been served
Phase III
What is the source of
prophylaxis items?
Local supplies
Begin as soon as clinic
staff have been
immunized or when
supplies arrive but no
later than 24 hrs
Phase III
Local, supplement by
SNS Push Pack,
continue with -managed
inventory (MI) if
needed
Local, supplemented by
SNS Push Pack, continue
with MI if needed
Local, supplemented by
SNS Push Pack, continue
with MI if needed
Local, supplemented by SNS
Push Pack, continue with MI
if needed
How will the clinic be
staffed?
LHD staff, local health
care staff
LHD staff plus medical,
non-medical &
volunteer staff
Mobile Distribution
Teams (MDT) with help
from LHD as needed
Institution health care
facility and teams
Outreach workers, MDT, LHD
staff
How notify
professionals?
Call down of responders
through EOC and Central
Dispatch
Activate clinic medical,
non-medical and
volunteer staffing
Activate MDTs
Institution health care
facility and teams
procedures
Outreach workers, peer
educators, MDTs.
How notify the clients?
Reassuring information
about event & general
information about response
actions
Specific information
about who, what, when
& where for clinics
Specific information by
media and by home health
agencies
Specific information
through normal institution
channels
Specific information by
outreach workers and peer
educators
36
3.3 Activation of the Dispensing System
Phase I Deployment: Intended for immediate prophylaxis of First
Responders (Law Enforcement, Fire & EMS), Public Health, and Emergency
Management staff to safeguard critical public safety, medical and emergency
management infrastructure for management of additional phases. It is
expected that hospitals would use on-site pharmaceuticals for prophylaxis as
needed to cover Hospital Emergency Department staff and other essential
Hospital staff. The intent of Phase I is to rapidly deploy and administer
prophylaxis at existing facilities of each organization to the extent that is
possible, with larger scale operations located centrally at Van Buren
Intermediate School District. Certain areas of Van Buren and/or Cass County
may be prioritized as appropriate depending on threat and incident type
assessment.
Priority will be given to on-duty staff, followed by off-duty staff. Each
organization is responsible to manage deployment to sub-station facilities as
needed. Pharmaceutical resources from hospital and community pharmacies
will be used initially until arrival of SNS resources. Within each organization,
the following priorities should be applied by category of staff:
#1
#2
#3
Field or Front-line Level Personnel
Dispatch/Communications Personnel
Administrative/Management/Facility Personnel
Employees of Facilities to be used as PODs as necessary (only those employees
needed to support POD activities)
 Van Buren Intermediate School District Conference Center
 Van Buren Intermediate School District Technology Center
 Southwestern Michigan College
 Paw Paw High School
 Pokagon Tribal Health Center
 Gobles High School
 Decatur High School
 South Haven Armory
Hospital Emergency Department Staff:
 Lakeview Community Hospital Emergency Department
 South Haven Community Hospital Emergency Department
 Borgess-Lee Memorial Hospital Emergency Department
 Pokagon Tribal Health Center
Health/Human Services:






Van Buren/Cass District Health Department
American Red Cross – Greater Kalamazoo
American Red Cross – Van Buren
CISM
Medical Examiner - Cass
Community Emergency Response Teams




37
Department of Human Services – Cass
Department of Human Services – Van Buren
Mental Health Authority
Medical Examiner – Van Buren
Van Buren County
Cass County
Law Enforcement:














Van Buren County Sheriff’s Dept.
Office of Domestic Preparedness (EM)
Michigan State Police, Post #51, Paw Paw
Michigan State Police, Post #55, South Haven
Bangor Police Dept.
Bloomingdale Police Dept.
Covert Police Dept.
Decatur Police Dept.
Hartford Police Dept
Lawton Police Dept.
Lawrence Police Dept.
Mattawan Police Dept.
Paw Paw Police Dept.
South Haven Police Dept.








Fire Department:













 Dowagiac Fire Dept.
 Cassopolis Fire Dept.
 Pokagon Township Fire Dept.

Bangor Fire Dept.
Bloomingdale Fire Dept.
Columbia Township Fire Dept.
Covert Fire Dept
Gobles-Pine Grove Fire Dept.
Hartford Fire Dept.
Keeler Fire Dept
Lawrence Twp. Fire Dept.
Lawton Fire Dept.
Mattawan Fire Dept.
Paw Paw Fire Dept.
Sister Lakes Fire Dept.
South Have Area Emergency Services
EMS:




Cass County Sheriff’s Dept.
Office of Emergency Management (EM)
Dowagiac Police Department
Cassopolis Police Department
Edwardsburg Police Dept.
Marcellus Police Dept.
Vandalia Police Dept.
Pokagon Tribal Police Dept.
 Cass County Medical Control Authority


Van Buren County Medical Control Authority
VBEMS Ambulance Service
Coloma EMS
South Haven Fire/EMS Service
CONTACT INFORMATION FOR ALL ORGANIZATIONS IS KEPT CONFIDENTIAL AS PART OF THE
EMERGENCY OPERATIONS CENTER CALL DOWN LIST.
38
Phase II Deployment:
Involves vaccination or prophylaxis of First Responder
immediate family, ancillary POD personnel, Government Officials, all medical providers,
and CERT teams. In certain emergencies where disruption of public utilities has
occurred, essential personnel addressing utility concerns will be included in Phase II
deployment.
Full POD mobilization occurs in Phase II. Depending on the infectious agent (extent of
release, transmissibility, timing for effective vaccination or prophylaxis) mobilization of
deployment is defined at three optional levels described as follows:
Alpha: Represents a maximal deployment of resources throughout Van
Buren/and or Cass County for infectious agent cases involving a maximal release
or extreme transmissibility hazard; or less than 7 days to complete effective
vaccination or prophylaxis of the general public. Deployment at this level will be
complex for Command and Control and will likely involve the use of a limited
number of large sites as PODs.
Bravo: Additional but smaller sites Countywide for infectious agent cases with a
lower extent of release or lower transmissibility hazard; and 7 to 14 days timing to
complete effective vaccination or prophylaxis of the general public.
Charlie: Requires deployment of the fewest resources due to limited extent of
release or low transmissibility hazard; and two weeks or more timing to complete
effective vaccination or prophylaxis of the general public. It is likely that this would
involve use of a large number of smaller sites as PODs.
At this phase, POD entry would need to be strictly limited to First Responder immediate family
members, Government Officials, medical care providers and public utility personnel with
appropriate identification. This deployment would also serve as a primary framework for mass
vaccination/prophylaxis of the general public once Phase II deployment is completed. Certain
areas of Van Buren and/or Cass County may be prioritized as needed depending on assessment
of threat and incident type. Notification would be issued through various public media sources.
Phase III Deployment: This phase initiates full-scale general public mass
prophylaxis/vaccination. Additional POD sites beyond those activated in Phase II may
be added expanding into outlying areas. Certain areas of each county may be prioritized
as appropriate depending on threat and incident type assessment. Alpha, Bravo or
Charlie deployment levels would be chosen based upon the infectious agent, extent of
release, transmissibility and time required to effectively complete vaccination or
prophylaxis of the general public.
In addition, these sites could be used in multi-purpose roles depending on the type and
extent of an incident, including shelter sites and Neighborhood Emergency Help Centers
as part of the Modular Emergency Medical System (MEMS).
39
3.4 Credential Verification of Licensed Personnel
The Van Buren/Cass District Health Department will verify the license of volunteers, if
needed through the State of Michigan website at
http://www.cis.state.mi.us/free/default.asp or go to MDCH website and click on
the Health Systems Licensing link on the left side. The LHD will utilize the MDCH/OPHP
and local EOC plans and resources to develop a pre-event list of interested
professionals that would volunteer but are not part of the public health and hospital staff.
This list will come from the Department of Consumer and Industry Services (licensing).
This list of volunteers should be updated every two years by the LHD.
3.4.1 Personnel Badges
Currently the health department has designed Incident badges that are ready to be
printed from the regional badge system (currently owned by Kalamazoo County
Health & Community Services) for distribution to all professional volunteers when an
incident occurs. No one should gain entry to a DS without appropriate ID. The ID
process should be coordinated with the local emergency management as well as
inter-county emergency management communication to enable recognition in other
jurisdictions. The badge system is currently only available to local health department
planning staff regionally due to equipment needs. The local emergency management
offices have plans to utilize the same identification system for all first responders, this
includes public health. Additional funding is needed to purchase a local badge
system. As funds and equipment become available, this process will continue.
Van Buren County Office of Domestic Preparedness also has a FireTrax system that
could be used in the event of a county-wide emergency. The county has already
developed and distributed badges to first responder personnel. Public Health
personnel would likely be given FireTrax badges at the onset of an event. Just in
Time Training for FireTrak can be obtained by contacting the Van Buren county
Emergency Management office or Central Dispatch Director, Jeri Tapper. As part of
the agreement between Emergency Management and Public Health, identification of
personnel is a task that will be coordinated by Central Dispatch. If there is a situation
in which training is required or JITT is required for FireTrax, Central Dispatch will
coordinate this training.
All badges for all personnel responding to a public health event involving medical
material and resources should include the following items:
 Name
 Picture
 Role (or Job)
 Venue
 Access
If needed the Van Buren/Cass District Health Department will develop a local liability
waiver form for volunteers and decide when the form will be signed by individual
volunteer staff for response to the event.
40
41
3.4.2 MI-Volunteer Registry/Medical Reserve Corp
Mi-Volunteer Registry will include a database of volunteers, both licensed and nonlicensed. This database is available to the EPC and MDCH 24/7. Alerts and messages
can be sent to volunteers informing them of an incident.
 A protocol to handle essential personnel not listed in the database
 Pre-determined staging sites to gather personnel and distribute ID badges
(Hartford Office or local EOC)
 A notification system to alert volunteers and direct them to a staging site or
designated clinic site
 A process for collection of ID badges at end of shift
 Tracking/documentation of released and returned badges
The Van Buren/Cass District Health Department may use pharmacists, doctors,
nurses, and other professionals such as interpreters and sign language personnel to
support mass dispensing site operations. The Van Buren and Cass County
Emergency Management Division through its various annexes and partners, Medical
Reserve Corps, (MiVolunteerRegistry), 5th District Medical Response Coalition,
American Red Cross, Van Buren and Cass County United Way, and others, will be
responsible for the recruitment, training, deployment, and retention of not only medical
personnel, but also volunteers needed to support dispensing site operations. To that
end, the Medical Reserve Corps will ensure that program administration, to include
contact information of volunteers, is maintained. The 5th District Medical Response
Coalition is responsible for administration of the Medical Reserve Corps.
Additionally, volunteers in Van Buren or Cass County and throughout Region 5 will be
identified and accessed through the Michigan Volunteer Registry available online at
http://mivolunteerregistry.org. Currently there are more than 260 registered volunteers
in the 5th District. The registry has the capabilities to register, track, credential, and alert
volunteers at any time.
3.5 Disaster Response Assets
The Michigan Emergency Preparedness Pharmaceutical Plan (MEPPP) which is
currently under development at the MDCH/OPHP will reference all pharmaceutical
caches available throughout the state of Michigan. Currently there are several resources
that are known, but may not be in detail. Those include:
 Hospital Pharmaceutical Cache
 Public Health Department Pharmaceutical Cache
 Metropolitan Medical Response System (MMRS)
 Michigan Emergency Drug Delivery and Resource Utilization Network (MEDDRUN)
 Pharmaceutical Wholesaler/Manufacturer
 Michigan State Police Regional Response Team Network (MSP-RRTN) Antidote Kit
Program
 CHEMPACK Program
 State Purchasing Contracts
 Strategic National Stockpile
 Bio-Hazard Detection System (BDS)
42
3.5.1
Pharmaceutical Cache Considerations
CRITERIA OF CHOICE
Antibiotics are considered to be either preferred first line agents or alternate second line
agents. Preferred agents are to be used first unless one of the following conditions
exists:



Allergy or history of prior adverse side effects of the first line agent
Patient is HIV positive or otherwise significantly immune compromised
making the use of the preferred agent dangerous in that patient.
Patient is pregnant and the preferred agent is contraindicated.
BIOLOGICALS
ORAL/SOLID FORMULATIONS
1. PREFERRED
Cipro 500mg 20's Unit of Use Btls.
Doxy 100mg 20's Unit of Use Btls.
Amoxicillin 500mg capsule, 30's Unit of Use btls.
Tetracycline 500mg capsule,
Rifampin 300mg capsule
2. ALTERNATIVE
Erythromycin 500mg
Levofloxacin 500mg
ORAL/LIQUID FORMULATIONS (These formulations can be used for pediatric victims,
elderly victims or any victim with the inability to swallow a solid formulation)
1. PREFERRED
Ciprofloxacin suspension 5gm/100ml
Doxycycline Susp.25mg/ml, 60ml
Amoxicillin 400mg/5ml, 100ml
2. ALTERNATIVE
To be determined by physician.
INTRAVENOUS SOLUTIONS (IV) FOR INJECTION
1. PREFERRED
Ciprofloxacin 400mg in D5W 200ml (Bags)
2. ALTERNATIVE
Doxycycline 100mg IV (Vial)
43
INTRAMUSCULAR INJECTIBLE SOLUTION
1. PREFERRED
Streptomycin IM
2. ALTERNATIVE
Gentamicin Sulfate 40mg/ml (20ml) IM
ANTIVIRALS
1. CHEMOPROPHYLAXIS
Amantadine (Symmetrel)
Rimantadine (Flumadine)
2. TREATMENT
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Pediatric Considerations: Rimantadine is not approved for treatment of children aged <
13 years. For treatment, these persons should receive amantadine (children aged 1-12),
oseltamivir (children aged 1-12), or zanamivir (children aged 7-12).
OPTIONAL FORMULARY ITEMS
To be considered based on demand and the broadening of the targeted population base.
Ancillary supplies and IV diluents solutions are an example of optional items for
consideration.
44
ANTIBIOTIC RATIONALE
Medications for Treatment and Prophylaxis of Infection by Bioterrorism Agents
(some of the same antibiotics can be used for different biological threat agents as
a preferred, alternative, prophylaxis or treatment option. Also, the drugs reflected
in the table below are the most likely to be in short supply during the early phases
of a large scale public health emergency.)
MEDICATION
FORMULATION
PREFERRED or
ALTERNATIVE
INFECTIOUS
ILLNESS
Amoxicillin
Ciprofloxacin
Ciproflaxacin
Doxycycline
Doxycycline
PO
IV
PO
IV
PO
Alternative
Preferred
Preferred
Alternative
Preferred
Erythromycin
Erythromycin
Gentamicin
Levofloxacin
Levofloxacin
Penicillin
Rifampin
Streptomycin
Tetracycline
IV
PO
IM
IV
PO
IV
PO
IM
PO
Alternative
Alternative
Alternative
Alternative
Preferred
Alternative
Preferred
Preferred
Preferred
A(PEP)
A (treat)
A (PEP)
A, P, T (treat)
A,P,T (PEP); B
(treat)
A (treat)
A (PEP)
A, P, T, (treat)
A (treat)
A (PEP)
A (treat)
B (treat)
P, T (treat)
P, T (PEP); Q
(treat)
BIOLOGICAL KEY
A
PEP
P
Treat
T
B
Anthrax
Post Exposure
prophylaxis
Plague
Treatment
Tularemia
Brucellosis
Q
Fever
45
ANTIVIRAL CHEMOPROPHYLAXIS AND TREATMENT
Treatment must begin within 2-days of the onset of symptoms and must be taken for a 5day duration. These drugs can reduce the symptoms of the flu and shorten the time you
are sick by 1 or 2 days. They also can make you less contagious to others. When used
for prevention, these drugs are about 70% to 90% effective for preventing illness in
healthy adults when used for 2-weeks following vaccination.
Agent
Influenza
Virus
Affected
Administration
Amantadine2
Influenza A
Oral
Central nervous system/ 100mg
100mg
Gastrointestinal
twice daily3 twice daily3
Rimantadine4
Influenza A
Oral
Central nervous system/ 100mg
100mg
Gastrointestinal
twice daily3 twice daily3
Zanamivir
Influenza A&B Oral inhalation
Oseltamivir Influenza A&B
Oral
Primary
Side Effects
Respiratory
Gastrointestinal
Treatment Prophylaxis
100mg
twice daily
NA6
75mg
75mg
twice daily3 twice daily3
REFERENCES:
1.
2.
3.
4.
5.
6.
McDade JE, Franz D. Bioterrorism as a public health threat. Emerg Infect Dis. 1998; 4:493-4
Henderson DA. Bioterrorism as a public health treat. Emerg Infect Dis. 1998; 4:488-92
Drugs and vaccines against biological weapons. Med Lett Drugs Ther. 1999; 341;815-26.
Centers for Disease Control and Prevention (Bioterrorism Preparedness and Response) (www.bt.cdc.gov)
Centers for Disease Control and Prevention (publisher of MMWR Morbidity and Mortality Weekly Reports and
Emerging/Infectious Diseases) (www.cdc.gov)
American Society of Health –System Pharmacists Emergency Preparedness – Counter-terrorism Resource Center
(www.ashp.org/public/proad/emergency/em_prep.html)
46
3.5.2 Hospital Pharmaceutical Cache
NOTE: The following information is not for public release/consumption.
The table below provides a current Hospital Supply Snapshot that is updated
annually. The snapshot of supplies below was collected by the 5th District Medical
Response Coalition. The following survey language was used: “The dosage
forms were indicated for purposes of outlining suggested doses for treatment. The
survey seeks to inventory the total doses available in Michigan, so please indicate
the number of dosage equivalents on hand. For example, if you have 100 caps of
Ampicillin 500 mg, 200 caps of Ampicillin 250 mg, and 10 x 150 ml of 250 mg/5 ml
Ampicillin suspension on hand, please indicate the total dosages as: 350 doses
available.
Medication
Reporting Basis
Mark I kits
Atropine 1 mg injection
Atropine bulk (all formulations)
Midazolam injection
Diazepam injection
Lorazepam injection
Cyanide antidote kits
Amyl nitrite
Sodium nitrite 300 mg
Sodium thiosulfate 12.5 g
Potassium iodide 130 mg tabs
Doxycycline caps 100 mg*
Doxycycline injection 100 mg
Tetracycline caps 500 mg*
Ampicillin caps 500 mg
Ampicillin injection
Amoxacillin 500 mg*
Augmentin 500 mg*
Cipro tabs 500 mg*
Cipro injection 400 mg
Cipro XR 1000 mg*
Avelox (moxifloxacin) 400 mg
Avelox (moxifloxacin) injection
Floxin (ofloxacin) 400 mg*
Floxin (ofloxacin) injection
Levaquin (levofloxacin) 500 mg
Levaquin (levofloxacin) injection
Maxaquin (lomefloxacin) 400 mg*
Noroxin (norfloxacin) 400 mg*
Penetrex (enoxacin) 400 mg*
Tequin (gatifloxacin) 400 mg*
Tequin (gatifloxacin) injection
Trovan (trovafloxacin) 200 mg*
Trovan IV (alatrofloxacin) injection
Albuterol MDI 17 g
Total # kits available
Total # doses available
Total # mg when reconstituted
Total # mg available
Total # mg available
Total # mg available
Total # of kits
Total # vaporales available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # mg available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # mg available
Total # doses available
Total # mg available
Total # doses available
Total # mg available
Total # doses available
Total # doses available
Total # doses available
Total # doses available
Total # mg available
Total # doses available
Total # mg available
Total # inhalers available
47
Oaklawn
Quantity
0
75
5000
200
100
200
1
5
0
0
0
150
15
125
200
10000
200
20
100
20
0
0
0
0
0
0
0
0
0
0
100
40
0
0
20
BCHS
Quantity
0
200
0
1760
150
40
1
0
0
2
0
200
50
0
100
10000
100
100
200
10
0
0
0
0
0
400
12000
0
0
0
0
0
0
0
12
Albuterol unit dose 2.5 mg for aerosol
Morphine sulfate injection
Dilaudid injection
Fentanyl injection
Demerol injection
Total # doses available
Total # mg available
Total # mg available
Total # mg available
Total # mg available
100
500
200
200
1000
180
4600
2000
65
50000
Other Devices
Reporting Basis
Number of units available
Number of devices
Oaklawn
Quantity
1
500
Number of devices/units
10
BCHS
Quantity
8
260
20
Portable X-ray units
N95 or above particulate respirators
PAPRS (powered air purifying
respirators)
Ventilators—adult
Ventilators—pediatric
Number of devices
Number of devices
5
5
15
10
3.5.3 Van Buren/Cass District Health Department Cache
The Van Buren/Cass District Health Department currently has enough Tamiflu to
treat the health department essential personnel and their families during an
emergency. The health department also has a stockpile of Doxycycline and
Ciprofloxacin for use during emergencies to treat health department personnel
and their families. The quantity of medications and other medical supplies that are
available for treating essential personnel prior to the arrival of the SNS can be
found on the inventory sheet at the health department. It has also been
determined that hospitals have enough medication (i.e. Doxycycline) on hand to
treat essential personnel during an emergency. There are also numerous local
pharmacies that are collaborating with the health department to identify available
caches during an emergency.
3.5.4 Van Buren County Mass Casualty Incident (MCI) Trailer (For Official Use
Only)
The 5th District Medical Response Coalition (5DMRC) has supplied ed Van Buren
County’s 7’ x 16’ cargo trailer with medical supplies. Van Buren County
Emergency Management and the 5th District MRC will collaborate on issues of
supply, storage, and request. This trailer is currently stored at the Van Buren
County Sheriffs Department and it is in the process of collecting supplies. A list of
contents can be found on the following table. Other equipment found in the trailer
consists of 10 PAPR’s, and 25 Incident Command Identification Vests.
Activation Process
Trailers are under the control of local emergency management director.
Therefore, the trailers would be requested through the local Emergency
Operations Center (if activated) or from the local Emergency Manager (if the EOC
is not activated). Rapid deployment of a trailer may be done through 5 th District
MEDCOM. Currently, MEDCOM is being set up to receive the initial report from
48
the scene EMS officer. Activation procedures will be formalized upon completion
of the trailer and collaboration between Emergency Management and the 5DMRC
49
MCI Trailer Contents (not finalized)
Airway Box
Berman (oral) Airway Kit, Incl Sizes 1-6
Nasal Pharyngeal Airways, 6 per set, with case
Combitube Airway, Adult
Combitube Airway, Small Adult
V-Vac Starter Kit
V-Vac Replacement Cartridge
V-Vac Suction Catheter 4/PK
Lite Blade, Disposable Laryngoscope Set
Ventilation Box
Bag Valve Ventilator, Disposable Adult
Bag Valve Ventilator, Disposable Pediatric
Ventilators, Disposable O2 Powered
IV Box
Sodium Chloride, 0.9% Inj.
IV Start Pak w/PVP, Tegaderm
Intravenous Catheter, 18 ga by 1 1/4"
Intravenous Catheter, 20 ga by 1 1/4"
Gravity IV Admin. Set 10 drop/ml w/one Y site & flashball, 72" long
Disposable Pressure Infuser Bags, Non-Sterile, 1000 ml
Dressings and Bandages Box
Kerlix Burn Dressing, 4-Ply, 17"x26", Sterile
Sterile Absorbant Combine Pads, 8"x10"
Kerlix Lite Gauze Bandage, 4" x 4.1 yds. (96 rolls per case)
4x4 12-Ply Sterile Gauze Pads
3M Hypoallergenic Surgical Tape, Transpore (Plastic): Standard 1"x10
Yds
Emergency Bandage 6" (Military Style)
Triangular Bandage
Ortho / Splint Box
Philly EMT-Choice C-Collar
Lil Patriot C-Collar
"Sam II Splint", 4.25" x 36", GY
Traction Splint, Kendrick
Blanket Box
Blanket, Disposable (50/cs)
50
Quantity
5
1
1
4
2
5
2
1
UOM
12
6
5
6/CS
6/CS
EA
24
40
50
50
50
15
1
1
1
0.2
CS
CS
CS
CS
2
20
60
Boxes
20
5
10
2
100
Assessment Triage
Welch Allyn DuraCHECCk Sphygmomanometer, Child
Welch Allyn DuraCHECCk Sphygmomanometer, Adult
Welch Allyn DuraCHECCk Sphygmomanometer, Large Adult
Stethoscope, Single-Head, Navy
Trauma Shears, Black
Triage Tags (bundles of 25)
EMS Field Notes
PPE - Gloves
Non-Latex Exam Gloves (100/box) Small
Non-Latex Exam Gloves (100/box) Medium
Non-Latex Exam Gloves (100/box) Large
Non-Latex Exam Gloves (100/box) X-Large
PPE - N-95 Respirators
N-95 Respirators (20 per Box)
PPE - Other
Sharps Conmtainer, 1.5Q
Isagel 21 Oz. No-Rinse Hand Gel
Convenience Bag w/guard 12/cs
Protective Goggles
Flashlights
Water - Potable
Water, Drinking (24/cs)
Peds Box
Pediatric Partial High Conc Mask (50/cs)
Bag Valve Ventilator, Disposable Pediatric
MONOJECT I-Type Sternal-Iliac Aspiration Needle (10/cs)
Brasloew Tapes
Hot / Cold Pack Box
Instant Heat, 6x9 (24 per cs)
Cold Pack, Disposable (24/cs)
Disaster Bags
Heavy Duty Disaster Pouch
Free Standing Equipment
Oxygen Manifold, with 8 Ports, Hard Case, 20 O2 Masks
Oxygen Manifold, with 8 Ports (to 15 LPM)
Oxygen Tank, Jumbo D
Oxygen Regulator, Portable, 1 Diss, 1 Barb (0-25 LPM)
Oxygen Tank, MM Aluminum with Valve (3455 L)
Hi Tech Backboard, 18", White
Generator
Lights (500W x2 w/ tripod)
51
1
5
1
10
10
100
100
6 boxes
10 boxes
10 boxes
6 boxes
120
5
4
2
10
10
10
10
6
10
2
48
48
10
1
1
2
2
1
10
1
2
Cases
3.6
Buying Power/Surge Capacity
The SNS Program’s Acquisition Partner, the Department of Veterans Affairs
(VA) is able to negotiate the rapid purchase (at lower prices than the Federal
Supply Schedule) of medical materiel, because it has already purchased billions
of dollars of pharmaceuticals for the VA medical system.



Based upon market analysis by the VA, the SNS Program selects certain
high demand material items to hold in inventory
The SNS Program has access to manufacturer’s “on-hand” surge capability
for non-critical items
The SNS Program uses various methods (like accessing the Universal Data
Repository – UDR) to take a “snap-shot” look at the availability of medical
materiel stock across the nation– specifically for non-critical items which
would be needed in mass quantity
3.6.1 State Purchasing Contract
This is a state asset. Documents describing the cache’s targeted population,
contents, and activation process have been made available to VBCDHD through
MI-DEAL.
52
3.7
Regional Caches
3.7.1 Mass Casualty Incident Trailer (MCI)
Neighboring counties in the 5th District all have MCI Trailer stocked with supplies,
equipment and medications. The contents of the MCI trailer can be found in section
3.4.3 above. These trailers can be activated through mutual aid agreements
between local health departments, or emergency management. The trailers were
stocked with supplies with funds from the HRSA Project with the understanding that
the accepting county would deploy those resources if needed.
3.7.2 MEDDRUN
Michigan Emergency Drug Delivery and Resource Utilization Network
(MEDDRUN)
Agent Specificity: Biological/Chemical
Resource Type: Regional/State
Program Description
The Michigan Department of Community Health Office of Public Health
Preparedness in collaboration with the Michigan State Police Emergency
Management Division, the medical and pharmaceutical communities, rotary air
emergency medical services, regional bio-terrorism preparedness planners, SNS
regional planners, the Michigan Department of Military and Veterans Affairs and
other healthcare partners developed MEDDRUN.
The purpose of MEDDRUN is to bridge the gap between local resources and the
more extensive SNS and other state and federal medical re-supply systems. The
program is designed to rapidly deploy life saving medications and supplies
(MedPacks) to a hospital or an emergency casualty site, ideally within one hour of
request. In order to accomplish this, the MEDDRUN MedPacks have been
geographically placed throughout Michigan in strategic locations that would allow
for rapid deployment.
In order to rapidly deploy these assets, Michigan has worked closely with rotary air
emergency medical services. Over 90% of Michigan’s population is within one hour
of three or more rotary air EMS programs. Complementing the rotary air services
are ground EMS agencies, which serve as back up when air EMS is not available or
not practical due to weather considerations. The ground EMS agencies are also
used to provide primary response in areas not readily covered by air EMS.
While the SNS has been created to address exhaustion of local resources, it is
unlikely that any supplies will arrive at Michigan hospitals for at least 24 hours after
being requested. Furthermore, in a chemical incident, the first two hours is the
critical period and it is unlikely that SNS will have any positive impact in this type of
incident. The resources must be available locally or regionally. In either case,
these resources must be immediately deployable.
53
In addition to pharmaceuticals, it is generally recognized that hospitals also lack
various critical supplies, such as ventilators. Additionally, there is a need for
specialized personal protective equipment (PPE) to allow hospital personnel to
function safely in potentially dangerous conditions.
As part of an overall emergency preparedness system, hospitals should voluntarily
pursue increasing the quantities of certain pharmaceuticals (i.e., antibiotics) that are
used on a regular basis. However, this alone will be insufficient. Additional
resources must be regional and be immediately deployable. MEDDRUN
accomplishes this by placing caches of critical pharmaceuticals, supplies and PPE
(“mini-push-packs”) with Michigan’s’ civilian EMS helicopters. This would be
augmented by identical stockpiles deployed with ground EMS units in the Lansing
area and in the Upper Peninsula.
Why EMS Helicopters: Michigan currently has six civilian EMS helicopters well
distributed throughout the Lower Peninsula. The following reasons support their
use as the means to immediately deploy the mini-push packs to Michigan’s’
hospitals:
 Widespread distribution in the Lower Peninsula (see figure below)
o
Over 90% of the population is within one hour of 5 programs
 24 X 7 immediate availability
o
EMS helicopters are continuously staffed for immediate response
 Familiarity with Michigan’s hospitals
o
EMS helicopters are accustomed to flying into hospitals
 Medical personnel for staffing
o
Programs are staffed by highly qualified medical personnel
 Communications capabilities
o
EMS helicopters’ radios are able to communicate with all
hospitals
 Capacity to handle mini-push packs
o
EMS helicopters can readily handle payloads exceeding 250 lbs.
Mini-Push Pack Contents: The contents of the caches can be determined by
existing bioterrorism planning committees. Available funding will determine specific
contents and their quantities. An example of possible contents is below.
Supplies
N-95s
Gloves
30 cc Syringes
Alcohol wipes
Triage Tags
Equipment
Oxygen Manifolds
Disposable Ventilators
Metered Dose Inhalers
Medications
Albuterol Inhalers
Mark 1 Kits
Atropens 1 mg
Atropens 2 mg
Sodium Nitrite Inhalants
Sodium Nitrite Injectable
Sodium Thiosulfate
Midazolam
Doxycycline
Inventory Control: Each Mini-Push Pack will be kept in a secure location with
medications kept in soft packs with disposable locks. The packs will be inspected
54
regularly. Drug expiration dates will be tracked. For medications commonly used by
hospitals (i.e., antibiotics), it is possible that hospital pharmacies may be able to recirculate the medications into hospital inventories.
Through an innovative regional approach using Michigan’s EMS helicopters
augmented by selected ground response vehicles, the State’s hospitals will have very
timely access to essential medications and support equipment needed to effectively
respond to mass casualties from biological, chemical, or radiological terrorism.
55
Targeted Population
The MEDDRUN MedPacks are intended to be used by any hospital or at any
emergency casualty site, where need exceeds local available resources.
Primary:
On-Scene Emergency Responders; Emergency
Receivers in a Hospital or Health Department Setting
Secondary:
On-scene victims; Those reporting to a hospital
requiring treatment.
Michigan EMS Helicopters with 30 Minute Flight Distance
56
MEDDRUN/CHEMPACK REQUEST FLOW SCHEMATIC
Abbreviations
Biological or
Chemical Event
APOC: Alternate Point of Contact
CSS: CHEMPACK Storage Site
EOC: Emergency Operations Center
EEI: Essential Elements of Information
MA: MEDDRUN Agency
MCA: Medical Control Authority
MCC: Medical Coordination Center
MI-HAN: Michigan Health Alert Network
NA: Nerve Agent
POC: Point of Contact
EMS Identifies Need for
NA Antidote Support or
MEDDRUN/CHEMPACK
Supplies
NA Antidotes or
existing supplies are
depleting
Confers with Incident
Commander or
EMS Provider
Provides EEI to
Central Dispatch or
MC Hospital
Local Emergency
Management informed that
CHEMPACK or MEDDRUN
has been requested
Central Dispatch or
Requesting Agency
EOC Initiates Activation
Local Emergency Response
Agencies / Hospitals / etc.
Notified & Reporting
Submits EEI Report
MEDDRUN/CHEMPACK Communications Agency
Primary: Survival Flight: 877-633-7786
Secondary: Aero Med: 616-391-5330
Notify MCA
regarding
dispatched
transport
vehicle
1.1.1.1.1
First
Second
Contact OPHP POC
Beeper: 517-232-7297
OPHP POC will contact
Requesting Agency to
authenticate request
Deployment Orders to
selected MEDDRUN
Dispatch and / or
CHEMPACK POC / APOC
Selected Agency notifies
transport personnel and
moves desired cache to
designated loading area
MEDDRUN/CHEMPACK
Communications contact
agency to provide
confirmation or recall
deployment
OPHP POC then contacts
Communications Agency to provide
confirmation and determines need for
additional resources
OPHP POC Contacts MSP ELOP
OPHP POC Contacts OPHP Director
If approved, desired cache
is loaded on transport vehicle
OPHP POC Contacts Regional MCC
Agency delivers supplies to
requesting location
OPHP POC coordinates a
MI-HAN Alert consistent with
guidelines
Agency returns to service
57
MEDDRUN/CHEMPACK Deployment Protocol
EMS Determines need for MEDDRUN or CHEMPACK
 Contact Medical Control Hospital or Central Dispatch
 Medical Control Hospital or Central Dispatch will contact MEDDRUN/CHEMPACK
Communications:
Primary Contact Survival Flight 877-633-7786
Secondary Aero Med 616-391-5330
(If communication failure with Survival Flight)
EOC/Hospital/LHD/EMS Determines need for MEDDRUN or CHEMPACK

Contact MEDDRUN/CHEMPACK Communications:
Primary Contact Survival Flight 877-633-7786
Secondary Aero Med 616-391-5330
(If communication failure with Survival Flight)
MEDDRUN/CHEMPACK Communications Agency
1. Obtain information contained on the Essential Elements of Information Form
2. Dispatch the appropriate resource
a. If it is a Nerve agent event and > 300 casualties deployment of up to 3
MEDDRUN MedPacks would be most appropriate.
b. If it is a Nerve agent event and  300 casualties CHEMPACK would be
most appropriate and/or once the MEDDRUN resource has been depleted.
c. MEDDRUN Contents
 Triage Tags
 N-95 Respirators
 Gloves
 Syringes & Alcohol Wipes
 Nerve Agent Antidotes (Mark 1 Kits for about 100 patients)
 Cyanide Antidotes
 Doxycycline
 Respiratory Support
1. Albuterol Inhalers
2. Oxygen Manifolds
3. Disposable Ventilators
d. CHEMPACK
 Nerve Agent Antidotes (Mark 1 Kits for 1000 patients)
 Atropine Sulfate
 Pralidoxime
 Atropen
 Diazepam
 Sterile Water for injection
58
3. Contact OPHP Beeper 517-232-7297 to notify the MDCH and other state
agencies as appropriate.
4. Complete Deployment order and Fax to MEDDRUN Agency or CHEMPACK
Storage Site as appropriate when request has been verified by OPHP POC
5. Remain in contact as appropriate with the deployed agency as necessary
OPHP Point of Contact (POC)






Contact requesting agency to confirm that they did request MEDDRUN or
CHEMPACK and deployment is appropriate
Contact MEDDRUN/CHEMPACK communications agency to confirm the request
or recall the deployment
Contact MSP, ELOP 517-336-6605
Contact OPHP Director
Contact Regional MCC as appropriate to the situation
Send out a Michigan Health Alert Network (MI-HAN) Message based on
guidelines
MEDDRUN Agency



Dispatch transport vehicle containing MedPack
Communicate with transport vehicle and relay information to communications
agency
Deliver MEDDRUN MedPack(s)
CHEMPACK Storage Site
 Pharmacist and security unlock CHEMPACK cage/room
 Contact pre-arranged transportation (Each region’s transportation mechanism
may be different depending on resources available. For instance, some regions
may use law enforcement agencies, or some may use EMS or other secure
transportation. This will be coordinated through the regional bioterrorism
initiatives.)
 Transport CHEMPACK container to pre-designated loading area
 Break the seal
 Load contents into transportation vehicle (pre-designated through regional
initiative) to be delivered to other facility or incident site as directed by
MEDDRUN/CHEMPACK Communications
MSP ELOP
 Contact EMD Duty Officer
 Contact MSP district headquarters and advise of deployment
 Dispatch and response should not be delayed while waiting for confirmation
from OPHP or Deployment Order Fax.
59
Essential Elements of Information (EEI) Report
Essential Elements of Information Report
1. Name, Position, and Contact
Information for the Individual
Requesting Deployment of the
CHEMPACK or MEDDRUN Cache?
Name: ____________________________
2. Name of Physician / Officer in
Charge of Medical Management at the
Scene (if different from “1.” above.)
Name: ____________________________
Position/Title:______________________
Telephone/Other: ___________________
__________________________________
Position/Title: ______________________
Employer: _________________________
Telephone/Other: ___________________
3. Location of Incident
Jurisdiction Name: __________________
Closest Intersection: __________________
(or)
Name of Site:
___________________
4. Estimated Number of Casualties
None
1
2-3
4-5
5. Symptoms of Casualties if NA
suspected
describe:
Pin Pointed Pupils
Dimness of Vision
Slurred Speech
Difficulty in Breathing
6. Local Supplies of Antidotes and
Pharmaceuticals are Exhausted,
multiple lives remain at risk, and
CHEMPACK or MEDDRUN supplies
are needed to save lives?
5-10
10-20
20-40
40-100
Twitching
Seizures
Chest Tightness
Unconsciousness
Yes ________ No ________
60
100-300
300-500
500-1000
1000+
Deployment Order Form
****URGENT***URGENT***URGENT***URGENT****
MEDDRUN/CHEMPACK DEPLOYMENT ORDER
DATE/TIME __________________
From: MEDDRUN/CHEMPACK COMMUNICATIONS AGENCY
POC: Name:
Tele #:
Cell #:
Fax #:
To: CHEMPACK POC Name:
Tele #:
Cell #:
Fax #:
To: MEDDRUN POC Name:
Tele #:
Cell #:
Fax #:
CHEMPACK Deployment Information
Immediately deploy:
EMS CHEMPACK Cache(s) to the following Delivery Point:
POC at scene: _______________ Mobile No. _______________ Radio Freq.
______________
Immediately deploy:
Hospital Cache(s) to the following Delivery Point:
POC at scene:
Mobile No.
Radio Freq.
MEDDRUN Deployment Information
Immediately deploy a MEDDRUN MedPack to the following delivery point:
POC at scene: _______________ Mobile No. _______________ Radio Freq.
______________
Printed Name:
Authentication Signature:
Authentication
* * * U R1.1.1.2
GENT
* * * U R G E N T Signature:
***URGENT***URGENT****
61
MEDDRUN MedPack Contents
Confidential: Not for Public Release
Revised 9/8/04
UOM
Quantity
Use
Mark I Kits
EA
120
Atropen 1mg Auto injector
EA
30
Nerve agent and organophosphate pesticide antidote for children
Midazolam, 10 mg/2 ml (box of 10 vials)
BX
10
Anticonvulsant for nerve agent exposure and general sedative
Amyl Nitrite (12 per pack); 1 per patient
CT
10
Cyanide antidote, inhaled
Sodium Nitrite 300 mg (1 vial per patient)
EA
50
Cyanide antidote, intravenous for 50 patients
Sodium Thiosulfate 12.5 g
EA
50
Cyanide antidote, intravenous for 50 patients
Atropine 1 mg Vial (25 vials per carton)
CT
10
Nerve agent an organophosphate pesticide antidote
Atropen 2 mg Auto Injector
EA
30
Nerve agent and organophosphate pesticide antidote
BTL
10
Antibiotic for prophylaxis of 2500 personnel for 24 hours
Albuterol MDI 17 gm
EA
50
Inhaled bronchodilator for chemical weapons and general use
Pocket Spacer for Use with MDI (50/cs)
CS
1
Improves delivery of Albuterol from inhaler
Syringes, 3 cc w/ 22ga needle (100/box)
BX
2
Syringe for injecting atropine and Midazolam
Syringes, 60 cc 25/box,4 boxes/case (100)
CS
0.25
Alcohol Preps (200/box)
BX
5
General purpose
Triage Tags (500/box)
BX
2
Uniform triage tags for 1000 patients
Ventilator, Disposable (10/case)
CS
2
Disposable pressure ventilator for 20 patients
Oxygen Manifold (8 ports)
EA
3
Provides 8 oxygen ports from single source for 24 patients
Chemical
Nerve agent and organophosphate pesticide antidote
Biological
Doxycycline 100 mg tabs (500/BTL)
Supportive Medications
Clinical Support
Syringe for injecting sodium nitrite and sodium Thiosulfate
Additional PPE
N-95 Respirators 20/Box
BX
25
Non-Latex Exam Gloves (100/box) Small
CS
0.25
General protection
Non-Latex Exam Gloves (100/box) Medium
CS
0.5
General protection
Non-Latex Exam Gloves (100/box) Large
CS
0.5
General protection
Non-Latex Exam Gloves (100/box) X-Large
CS
0.25
General protection
EA
1
Respiratory protection for 500 healthcare workers
Support Equipment
Back Board with Straps
Transport MedPacks
62
3.8 State Caches
3.8.1
CHEMPACK Project
Agent Specificity: Chemical
Resource Type: State
Program Description
The CHEMPACK Project is a sustainable repository of nerve agent antidotes, symptomatic
treatments and supporting equipment designed to care for individuals exposed to nerve
agents. Supplies include, but are not limited to, pharmaceuticals in the form of auto-injectors,
multi-dose vials for injection, and self-monitoring storage containers. The CHEMPACK
Project provides two types of containers:
1. Emergency Medical Service (EMS) Container: designed for use by emergency
responders (material packaged primarily in auto-injector form)
2. Hospital Container - designed for hospital administration (material packaged primarily
in multi-dose vials for adjustable dosing and long term care).
This resource will provide a mechanism for the State of Michigan to effectively respond to
acts of chemical terrorism and other public health emergencies in collaboration with the CDC
and the U.S. Department of Homeland Security.
Targeted Population
CHEMPACK is intended to be used by any hospital or at any emergency casualty site,
where need exceeds local available resources. The primary recipients of the contents may
be on scene emergency responders or emergency receivers in a hospital or health
department setting if necessary then on scene victims, or those reporting to a hospital or
health department requiring treatment.
Primary:
On-Scene Emergency Responders; Emergency Receivers
in a Hospital or Health Department Setting
Secondary: On-scene victims; Those reporting to a hospital requiring
treatment.
Activation Process: Note above Protocol.
Contents
Confidential information for planning purposes only
63
Hospital and EMS CHEMPACK Formularies
Hospital CHEMPACK Container for 1000 Casualties
Qty
Mark 1 auto-injector
Atropine Sulfate 0.4mg/ml 20ml
Pralidoxime 1gm inj 20ml
Atropen 0.5 mg
Atropen 0.1 mg
Diazepam 5mg/ml auto-injector
Diazepam 5mg/ml vial, 10ml
Sterile water for injection 20cc vials
Sensaphone 2050
Satco B DEA Container
480
900
2760
144
144
150
650
2800
1
1
Unit Pack
240
100
276
144
144
150
25
100
1
1
Cases
2
9
10
1
1
1
26
28
1
1
EMS CHEMPACK Container for 1000 Casualties
Qty
Mark 1 auto-injector
Atropine Sulfate 0.4mg/ml 20ml
Pralidoxime 1gm inj 20ml
Atropen 0.5 mg
Atropen 0.1 mg
Diazepam 5mg/ml auto-injector
Diazepam 5mg/ml vial, 10ml
Sterile water for injection 20 cc Vials
Sensaphone 2050
Satco B DEA Container
2640
100
276
288
288
600
100
300
1
1
64
Unit Pack
240
100
276
144
144
150
25
100
1
1
Cases
11
1
1
2
2
4
4
3
1
1
3.9 Non-SNS Federal Caches
3.9.1 Metropolitan Medical Response System (MMRS)
(Excerpted from the MMRS website: https://www.mmrs.fema.gov )
The Metropolitan Medical Response System (MMRS) Program and is funded by the US
Department of Homeland Security (DHS). The primary focus of the MMRS program is to
develop or enhance existing emergency preparedness systems to effectively respond to a
public health crisis; especially a weapons of mass destruction (WMD) event. MMRS
programs maintain local pharmaceutical caches that could provide care for up to 1,000
victims of a chemical, radiological, nuclear, or explosive WMD event. Three Michigan cities
have MMRS programs; Detroit, Grand Rapids, and Warren.
3.9.2
US Postal Service Biohazard Detection System (BDS)
On March 27, 2004, the United States Postal Service began installing automated biohazard
detection systems in postal distribution center facilities (PDCs) across the country. These
systems are specifically designed to detect B. anthracis (anthrax). Identification of
aerosolized B. anthracis spores in an air sample can facilitate prompt on-site
decontamination of workers and subsequent administration of post-exposure prophylaxis to
prevent inhalational anthrax. As part of preparedness efforts, a small, three-day supply of
Doxycycline tablets will be maintained on-site at facilities where the BDS is deployed. BDS
instillations within the State of Michigan include the following nine (9) postal sorting
facilities:
Royal Oak
Grand Rapids
Iron Mountain
Flint
Lansing
Saginaw
Detroit
Kalamazoo
Traverse City
Contact Person: Suzanne Surrell
616.336.5356 (updated 3/2010)
Greater Michigan Division
616.240.3385 (cell)
(Includes Saginaw, Lansing, Grand Rapids, Kalamazoo, Traverse City)
An agreement between all federal agencies was signed to help assist the Department of Health &
Human Services in distributing emergency medications to the general public. Expidit services
provided by Postal Services…to help provide emergency medications to population door to door if
requested by the federal government.
65
Cache Resource Response Timeline (draft*)
Hours
0-1
1-3
Biological Event  Hospital
(Once the event
Caches
has been
 Local Health
identified as a
Department
biological event
Caches
Chemical Event 
(From time of
event)


EMS/First
Responders
(Mark 1 Kits)
Hospital
Caches
MMRS
MEDDRUN




RRTNs
MEDDRUN
CHEMPACK
Hospital
Caches
3-12
12-24
 State Health
 SNS
Department
 VA Caches
Caches
 Pharmaceutical
 State Purchasing
Wholesaler
Agreements
Supplies
Initiated
State Purchasing  SNS
Agreements
 VA Caches
Initiated
 State Purchasing
Agreements
 Pharmaceutical
Wholesaler
Supplies
>24
 BDS
 Private
Partners/
Physicians
Pharmacies
SNS
Radiological
 Hospital Caches  State Health
Event
Department
 Local Health
(From time of
Caches
Department
event)
Caches
* Table presented by Jim Breuker, SNS Coordinator, MDCH/OPHP on 12/3/04, Updated by Jan Davis 7/2008. No
changes to this table as of 2/2010.
66
67
4. Command and Control
4.1 INCIDENT COMMAND SYSTEM
Description of Incident Command System
The Incident Command System (ICS) is an established system to coordinate local or regional
response in an emergency. ICS has clearly defined roles and responsibilities for all participants
regardless of the event. The Van Buren/Cass District Health Department utilizes the Incident
Command System for emergency management purposes. The Incident Command System is
described in detail in the Van Buren/Cass District Health Department’s Emergency Response Plan
and is compliant with the National Incident Management System (NIMS).
The implementation of the local SNS plan will utilize the existing emergency management chain of
command structure within the affected county (counties). Unified command ensures continuity of
ICS structure between jurisdictions.
Role of a County Emergency Operations Center (EOC)
The Emergency Operations Center (EOC) will be activated in the affected county (counties) in the
event that the SNS is requested. It is also acknowledged that an event that triggers requesting the
SNS in any county will probably not be confined to one county’s borders, but will be regional,
state-wide or national in scope. In this case, the existing emergency management system within a
county will continue to be utilized for command and control and be coordinated on a regional basis
through the State of Michigan Emergency Management Division and its Incident Command
System.
ICS Structure if SNS Plan Activated
The management and implementation of the SNS plan will be conducted by the Van Buren/Cass
District Health Department with assistance from the other county agencies within the affected
county (counties) under the direction and coordination of the EOC.
The organizational chart below identifies how ICS will be implemented during the request of the
SNS.
68
PD – DHS-PH
Unified Command
Information Officer
EM/PH
Safety Officer
VB Sheriff
Liaison Officer
Plan/Intel Section
Operations
Section
PH
Deputy VB Sheriff
Traffic & Transportation
Group
Finance/Admin. Section
PH
Security Group
Logistics
Section
POD
PH
Traffic Control Team
Crowd Control Team
Transportation Team
Force Protection
The personnel of the Van Buren/Cass District Health Department, other county agencies and
volunteers will staff the local SNS team. The organization of the local SNS response team will
adhere to the Incident Command System structure reflecting that of the Emergency Management
System.
The Health Officer of the Health Department will assume the role of Incident Commander. The
Liaison Officer from the Van Buren/Cass District Health Department will be appointed to the local
EOC functions of:
1. Answer EOC questions about the SNS.
2. Provide a conduit for information to and from the EOC leadership team to the Incident
Commander and the SNS team.
3. Provide status reports to the EOC concerning stockpile inventories, distribution logistics,
security patterns, restocking orders, and any problems encountered.
All dispensing sites will operate following the Incident Command System (ICS) and will fit into
the existing local emergency command structure. The SNS dispensing team will be involved in
all aspects of the site operation including the receipt of assets at the site, the dispensing of
material and medications and the recovery of unused assets.
Event Command and Control
During an event that utilizes the SNS or the operations of a dispensing site, the Emergency
Management Director will be the Incident Commander. The National Incident Management
System (NIMS) was developed to expand and contract as needed. An incident involving the
Strategic National Stockpile will be considered a Large Scale Event. Many agencies will be
involved in the opening of a dispensing site. The key individuals who will be part of the
command and control function include:
69






Public Health
Emergency Management
Sheriffs Department
Road Commission
RACES (Communications)
POD Site Manager
Table 1: Event Command
Command Agency
Public Health
Van Buren CountyEmergency Mgmt
Van Buren CountySheriff’s Department
Van Buren County
Road Commission
Van Buren County
RACES
Cass County
Emergency Mgmt
Cass CountySheriff;s Department
Cass County
Road Commission
Cass County
RACES
Primary Contact
Jeff Elliott, Health Officer
Secondary Contact
Jennifer Zordan, EPC
Al Svilpe
Tom Lodenslager
Dale Gribler
Undersheriff
John Frank
Grover Hover
Alice Noskey
Scott Garvison
Dave Smith
Patti Kolden
Joe Underwood
Lyndon Parish
Charles Collins
Mel Osment
Bill Casper
Tom Lenz
At this time all contact information for ICS and individuals involved in response is part of the EOC
call down process. At the time of the emergency, key individuals at the EOC will decide who gets
called and when. During that time those individuals will also establish Unified Incident Command
and a Commander. Key player may be named, but this information is very fluid and it is likely that
it will change for each event. Contact information is kept confidential by the EOC personnel.
70
The Van Buren/Cass District Health Department personnel shall take leadership roles for the
dispensing site ICS for a Public Health Emergency is as follows:
Incident Commander:
Health Officer
Dispensing Site Manager:
Nursing Director
Health and Safety Officer:
Medical Director
Public Information Officer:
Health Officer or Medical Director
Operations Section Chief:
Environmental Health Director
Logistics Section Chief:
Administrative Secretary
Communications Chief:
Health Promotions Manager
Finance Section Chief:
Finance Manager
Liaison Officer
Emergency Preparedness Coordinator
A diagram of the Dispensing Site Incident Command System for a Public Health Emergency is
depicted below.
Health Officer
Liaison Officer
(EOC)
Site Manager
Health and Safety Officer
Operations Chief
Logistics Chief
Public Information Officer
Administration/Finance
Communications Chief
Note: The structure of the Incident Command may vary based on the nature of the incident.
During a public health emergency the structure may look very different than an act of
terrorism.
71
4.2 Command & Control Interaction with Response Activities
Local planners will also have to interact with the receiving, storing, and staging (RSS) facility
and/or an EOC. At the local level, a distribution node will be organized to receive material
from the RSS. This is an intermediate warehouse between the RSS facility and the DSs.
Regardless of the procedure and of where you are located (local EOC, DS, or distribution
node), you will have to interact with your source (warehouse, state EOC, etc.) via the same
channels the RSS facility and state/regional EOC and Unified Commander will use (Fig.
4.2.1). Status reports and requests for assistance will go to your higher authority; and
directives, requests for information (RFIs), and information will come to you from the higher
authority. The state of Michigan has identified a Distribution Node for each jurisdiction as
well as Dispensing Sites (DS). Detailed information regarding the Distribution Node and
Dispensing Site for the VBCDHD jurisdiction can be found in sections 5 and 6 of this plan.
Figure 4.2.1: Information flow between the Operations Management Team and the IC/UC/EOC
4.2.1 Authority
The Health Officer in coordination with the Emergency Management Director have
authority to communicate directly with the State of Michigan Operations Center (CHECC)
to implement the decision making process. The CHECC will be in constant communication
with the State EOC and the local EOC. All decisions will be made through the EOC. This
coordinated effort between the local health department, Emergency Management and the
State of Michigan, Department of Community Health (OPHP) will ensure an effective
response.
72
4.3 ROLES AND RESPONSIBILITIES
The responsibilities for each of these functional areas of the SNS dispensing site are detailed in
Appendix F: Dispensing Site – Command Team Job Action Guidelines (JAGs) section of this
manual. The following is a brief description of these roles.

Health Officer: The Health Officer has the overall responsibility for the establishment,
operation and recovery of the SNS dispensing site.

Site Manager: The Site Manager is responsible for the command and control activities of
the dispensing site. This person (s) will manage and control the total operation of the
facility. This Manager ensures the DS functions at the highest level of efficiency possible
with the given staff and supplies.
The Site Manager directly oversees the operations, logistics, communications, and
administration by working closely with the section chiefs and coordinators for all shifts. The
Site Manager (or designee) will communicate and coordinate with the local EOC, LHD
EOC, and MDCH EOC for information and requests. (Refer to Appendix F for JAG and
Appendix K for support staff position JAGs.)

Public Information Officer(s) (PIO): This person will establish and maintain a relationship
with the community's Office of Emergency Management (OEM)/EOC to provide information
and receive information. The DS PIO will coordinate media activities and information
releases with the local EOC and CHECC PIO. Media communications will be the
responsibility of the local or state PIO. Information will be forwarded to the local/state PIOs
for possible distribution to appropriate groups or organizations. The PIO, or designee, will
participate in the Joint Public Information Center (JPIC.) (Refer to Appendix F for JAG and
Appendix K for support staff position JAGs.)

Health and Safety Officer: This person is responsible for ensuring the DS is free from
health and safety hazards before, during and after operations. The Health and Safety
Officer will collaborate with the other section chiefs regarding the resolution of any safety
issue. (Refer to Appendix F for JAG and Appendix K for support staff position JAGs.)

Operations Chief: This person takes responsibility for all clinical areas of the DS. This
section consists of the following functional areas:
 Patient Services: registration, medical screening/triage, emergency care,
transportation of internal patients, patient education and exit monitor.
 Pharmacy Services: dispensing and consultation.
 Special Needs: non-English speaking, deaf, blind, or illiterate patients,
wheelchair/walker/cane patients, and patients requiring mental health services.
 Inventory of supplies, medications, equipment.
The Operations Chief will ensure the staff in the respective services fulfill the requirements
of the standard operating procedures (SOPs) and are within their scope of practice and
training. If staffing adjustments are needed, this Chief will develop a plan or make
73
recommendations for the Site Manager to consider and/or implement. The Operations
Chief must coordinate with the Site Manager to arrange for the transport of any patient from
triage or sick room to a treatment center. (Refer to Appendix B for Operations
Organizational Chart and to Appendix F for JAG and Appendix K for support staff position
JAGs.)

Logistics Chief: This section is responsible for all support needs of the DS. This section
consists of the following functional areas:
o Facility maintenance
o Food Services
o Security
o Equipment Maintenance
o Supplies
o Housekeeping
This section is tasked with procurement of material and therefore, must work closely with
the Operations Chief and the Site Manager.
There are specific refrigeration and security needs for pharmaceuticals that should meet
federal Occupational Safety and Health Administration (OSHA) and Michigan Occupational
Safety and Health Administration (MIOSHA) standards. The nutritional needs of the staff
are essential and this must be coordinated with the local EOC, American Red Cross (ARC),
and other agencies contracted by the local EOC to provide food and beverages.
It is important for the Operations Chief to collaborate with the Site Manager and local EOC
to secure monies or donations necessary to meet staff nutritional needs. (Refer to
Appendix C for Logistics Operational Chart and to Appendix F for JAG and Appendix K for
support staff position JAGs.)

Finance Chief: This section is responsible for ensuring all DS personnel, volunteers,
patient and supply records are correctly kept and maintained throughout the event. This
section consists of the following functional areas:
o Event documentation
o Patient record retention
o Patient data entry
o Coordination of personnel/volunteers (time records, credential verification, staff
schedules)
o Transportation of personnel/volunteers to DS from staging site, if necessary
o Communication with the section chiefs and Site Manager regarding problems,
shortages, needs, etc.
o Documentation, tracking, inventory tools/logs
o Routine reporting to Site Manager, local/state EOC
This Chief will need to work closely with this section's coordinators to insure patient and
personnel statuses are current and accurate. Time, procurement and cost accounting are
the primary functional activities of this section. This section will manage all paperwork
generated at the DS.
The administration section is responsible for patient registration, treatment or its deferral,
disposition of records, and communicating changes in standing orders. Additionally, this
section will direct the management of unassigned personnel/staff, such as spontaneous
volunteers who may report to the DS, and coordinate with the Site Manager to insure
74
impromptu on-site training for new members is provided as necessary. The Administration
section office/workstation should be located in close proximity to the Site Manager.
This Chief must insure internal DS communications conform to the site ICS structure and
must be prepared to handle situations such as:

Post-exposure prophylaxis capacities based on different event scenarios;

Multiple vs. individual regimens;

Adult pick-up for other family members with incomplete identification (ID)
information;

Establishment of triage location at outset;

Collaborating with local and state EOCs to determine volume of patients per hour;

Staffing for continuous operations.
(Refer to Appendix D: Administration/Finance Organization chart; Appendix F for JAG and Appendix K for
support staff position JAGs.)

Communications Chief: Responsible for coordinating the internal and external
communication resources such as radios, walkie-talkies, RACES activities if used, land and
cell phones, computers, printers, and fax machines. Telecommunications and information
technology are crucial because incoming and outgoing information must be efficiently and
consistently maintained.
Important information must be coordinated such as the number of radios, the frequencies
used, and who has what type of equipment. The Communications Chief will perform an
inventory analysis at the end of each shift to account for such material. All offices,
appropriate workstations, and administrative areas must have, at minimum, phone lines.
The Communications Chief will be responsible for verifying the credentials of professional
volunteers using the resources of the local hospitals and the State of Michigan licensing
website.
The Chief will also be responsible for issuing identification badges. Identification badges
will contain a place where a photo ID can be attached to the front of the badge. Since no
one should gain entry to a dispensing site without an identification badge, this process
should be coordinated though the local EOC and through inter county emergency
management communication to enable recognition of badges from other jurisdictions.
The Communications section must have dedicated phone lines and computers to receive
and transmit requests and information. The Chief and section coordinators must provide
technical assistance, as needed, or be able to access such assistance. Additional phone
jacks should be made available. The section should maintain a staff pool to use as
runners if resources are scarce, inadequate, or inoperable.
(Refer to Appendix E: Communications Chief Organizational Chart; Appendix F for JAG and Appendix K for
support staff position JAGs.)
75
5. SNS Distribution Locations/Operations
5.1 SNS Shipment Overview
Van Buren and Cass Counties are part of Region V. If either county requests and is
granted delivery, the SNS will arrive at the Regional Receipt, Staging, & Storage site
outlined in the Regional SNS Plan. This information can be verified by contacting the
Strategic National Stockpile Coordinator at Michigan Department of Community Health.
Contact information for SNS Coordinator:
Jennifer Hankinson
SNS Coordinator
MI Department of Community Health
Office of Public Health Preparedness
201 Townsend Street
Lansing, MI 48913
(517) 335-9657 (Lansing Office)
(517) 335-8150 (OPHP Office)
(517) 930-0671 (Cell)
[email protected]
The RSS operations are the responsibility of the State of Michigan. In the event that
resources become limited and the local jurisdiction needs to augment the RSS operations,
this can be done by informing the EOC. The EOC will arrange for additional staff to help
repackage, transport, secure or other functions determined by the CHECC. This support
can be supplied in the form of personnel or vehicles, or supplies requested from the State.
From the Receipt, Staging and Storage site, the SNS shipment will proceed via ground
transport to identified sites within the respective region for local distribution. Sites can be
either:
1. Distribution Nodes: locations where SNS bulk supplies are delivered to the local public
health jurisdiction. From the node, the supplies will be directed to the dispensing sites.
2. Dispensing sites: locations where the public receives prophylactic medicines. At
dispending sites, the SNS supplies will be distributed first to emergency personnel and
their families, then the general public at risk.
3. Treatment centers: locations in a community where sick receive treatment. These
include hospitals, clinic, and other sites that treat the sick. This may include
Neighborhood Emergency Help Centers outlined by the MEMS Concept.
5.2 DISTRIBUTION NODE FOR VBCDHD
The primary distribution site for Van Buren/Cass District Health Department is the Van Buren
Technology Center Shipping and Receiving Warehouse. The contact information for the
regional distribution site is:
76
Primary Distribution Node Site: Van Buren Intermediate School District, Shipping &
Receiving Bldg
Address (include major cross streets): 633 Blackman, Lawrence, MI 49064 Cross Streets:
I-94 and Red Arrow Highway.
GPS Coordinates: Unavailable at this time
Name of Distribution Node Contact Person: John Hagger
Phone: (269) 674-8091 ext. 392 Cell (269) 208-2482
Site Evaluator:John Hagger & Jennifer Zordan (previous)
Date:11.30.05
Criteria:

Minimum of 10,000 square feet open (Site has 7700 sq feet )
X
Strategically located in relation to Dispensing Sites
X
Perimeter fences or secured area
X
Loading docks
 Number available _2_______________
X
Adequate room in front of loading ramps to maneuver
X
Room temperature and humidity control (59-86 degrees)
X
Sufficient electrical power
X
Emergency electrical power (generator)
 How long will it last? _generator supplied by the EOC for as long as
needed.
 Fuel replacement plan (Yes/No)? YES, Provided by EOC
X
Ease of access to highways that lead to dispensing sites
X
Multiple access points from/to the compound
X
Multiple phones/analog lines
X
Material handling equipment:
 Pallet jacks
 Forklifts (material handling and back-up if loading docks are
unavailable)
 Forklift drivers
 Handcarts/dollies
X
Office equipment – Telephones, Fax machine, tables/chairs, copier
X
No petroleum products or flammables in building
X
Located out of flood plain
X
Bathrooms
X
Break area
X
Ease of movement of vehicles for transporting supplies
X
Ability to lock down
X
Controlling entry/exit of personnel/equipment
X
Protection of personnel and material
X
Space for credentialing or verifying Distribution Node personnel

Onsite refueling (propane) or recharging capability for forklifts
77
DN Command and Control is the responsibility of the DN Manager (--the DN Incident/Site
Commander). DN activities are coordinated with the Logistics Chief, and the Sheriff Department
Official in charge of the DN facility.
DN Operations Organization (these lines represent Command, Communications, and
Coordination)
= Coordination between PH EOC and Sheriff DN Facility Manager
= Coordination between the VBCDHD IT Specialist and the DN
DN Manager
Logistics Chief
Security & Safety
Manager
Sheriff Dept.
Facility Manager
Shipping/Receiving &
Quality Control Manager
Inventory Manager &
Pick Team Manager
Communications & IT
Manager
DN Communications
The DN has all communications capabilities available to VBCDHD, plus Sheriff Department
equipment as backup. This includes: Landlines, Internet access, and fax access
The VBCDHD Incident Command Team will communicate through landline telephone, cellular
telephone, and fax with the DN. Additionally, IC staff will utilize the 800MHz radio system and
HAM radios as back-up communication with POD sites, the DN, and the EOC.
All communications with the DN should occur through the Logistics Chief until otherwise directed.
This includes communications with the State of Michigan. All VBCDHD and County staff will be
provided with redundant contact information and communication methods at the time of SNS
request.
DN Security
DN security requires coordinated effort. The DN Manager holds responsibility over the SNS
materials but shall defer to the Sheriff Dept’s Facility Manager in matters of DN Security, as Sheriff
Deputies are responsible for the facility’s security plan.
The DN Security and Safety Manager and Sheriff personnel will conduct a joint site survey to
determine specific security issues and staffing levels. Note: The site has been previously
reviewed by the County Emergency Management Coordinator, who determined that the facility
and premise can be secured. A site security plan is place.
78
Primary security will be the responsibility of the Van Buren County Sheriff Department in a
collaborative effort through the EOC. Additionally, private security companies may be contracted
through the Emergency Operations Center. The EOC Health Services Representative will work
with the Emergency Management Coordinator and the Law Enforcement EOC Representative to
enhance DN security.
During transport of materiel from the DN to the individual PODs, active security may be required.
Securing transportation escorts will be the joint responsibility of the DN Manager, the PH EOC,
and the Emergency Operations Center’s law enforcement representative.
Staffing
VBCDHD’s Environmental Health Services provides most DN staff. She DN will also be supported
by other VBCDHD Staff Specialists such as the IT Specialist, who provides IT/computer support
and coordination with County IT staff. Volunteers may also provide additional support, but their
identification must be cleared through the Sheriff Department Facility Manager.
Twelve hour shifts are planned for the event’s duration. The DN will be activated throughout the
course of the event, however, staffing levels (except security) may be reduced during overnight
hours or if/when dispensing sites will be less active.
Change of Shift/Transfer of Command will occur twice per day. Shifts leaving duty will thoroughly
brief the incoming staff using the standard ICS forms prepared for them during the previous shift.
The Admin/Finance Chief is responsible for maintaining personnel strength data and collecting
payroll information from VBCDHD personnel.
Material Handling
Following the Push-Package arrival; the pallets have been unloaded into the DN and the pallets
must be broken down according to requested POD site needs. SNS materials must then be
loaded into vehicles for transport to each POD. Materiel may need to be delivered sequentially to
dispensing sites, depending upon each POD’s secure storage capacity.
Temperature Control within the DN meets CDC standards. Material handling equipment (MHE) is
available at the DN site, from the Sheriff Dept. Facility Manager. Additional MHE is requested
through the PH EOC/EOC and will come from various sources listed in the Van Buren and/or
Cass County Resource Guide.
MATERIEL HANDLING GUIDELINES
□ Transfer pallets to the DN using forklifts/pallet jacks, as appropriate.
□ Break down materiel into POD-specific loads.
□ Coordinating with the PHQ, determine distribution schedule and transportation
to each POD at appropriate time/load intervals.
Transportation
County vehicles with logos will be utilized whenever possible, unless directed by the EOC for a
specific reason. Designated transport vehicles will be easily identifiable to security escorts, and
applicable license plate numbers and vehicle identification numbers (VINs) should be provided to
79
the Emergency Operations Center to insure that security details will recognize and allow entry to
non-county vehicles. SNS Shipments will be provided security escorts, if deemed necessary by
EOC staff.
DN Inventory Management
Upon RSS receipt, the SNS State to Local Transfer Form must be completed. The copy of the
original local SNS Order Form with the type and quantity of items (including the SNS-provided
containers which must be returned to the CDC) shipped must be compared to the actual items
received, then filed. All SNS assets received from the RSS must be documented in an Excel
Spreadsheet. All items received must be catalogued with a description of item received, quantity
received, and lot numbers of items.
INVENTORY MANAGEMENT GUIDELINES
□ Maintain Local Transfer form for record keeping purposes.
□ Compare shipping inventory list to items actually received.
□ Document all items received (including durable goods, such as Push
Package containers) in an Excel database. Description, quantity and
lot numbers of all items received must be documented.
□ Create an Excel database for each POD activated. Upon redistributing
the SNS assets into POD-specific groups, document the description,
quantity and lot numbers of POD-specific materials in the appropriate
database.
□ Record all POD site deliveries, requests, and shipments in the
appropriate POD database to maintain real time inventory of assets.
Supplies and Equipment
DN operations require telephone access (land line, mobile), 800 MHz radio, commercial shortrange radios for internal communications, and regular office supplies available through VBCDHD.
All equipment/supplies ordered/used during DN operations must be tracked by the Logistics Chief.
Deactivation Plan
Deactivation shall be done at the direction of the County EOC and the PH EOC and coordinated
with the Sheriff Department Facility Manager.
The DN Manger is responsible for the following tasks:
●All equipment, and supplies to be returned to the SNS will be collected, returned, and or
accounted for.
●All tracking documents shall be completed and submitted to respective agencies.
●All personnel records shall be completed and submitted. i.e. time cards, activity reports, damage
reports
●A deactivation walk through with a representative of the facility shall be done with notation of
damage, loss, or injury to equipment, or facility
●An After-Action Review of site operations, followed by a written After-Action Report including an
Improvement Plan shall be done within acceptable timelines.
80
6. Dispensing
Dispensing sites will be utilized to dispense prophylaxis and other supplies from the Strategic
National Stockpile to first responders and the general public. Treatment centers will be separate
from dispensing sites. Treatment centers will be utilized for treatment and triage of any victims
from an event. Refer to the treatment center section (7.0) for additional information.
The State of Michigan Department of Community Health will arrange transportation of SNS
material from the State RSS site(s) to designated Distribution Nodes and treatment centers within
Van Buren and/or Cass County. From the Distribution Node, Van Buren/Cass District Health
Department will arrange for the transportation of needed material to the dispensing site(s).
According to the Van Buren County Emergency Operations Plan, the transportation section will
arrange for and transport the material to the designated site(s) with assistance from the Road
Commission and Sheriff’s Department, or other county transportation resources. Dispatching and
coordination of the delivery system shall be performed by the EOC staff.
The sites must meet the criteria listed in the Dispensing Site (DS) Checklist.
6.1 Staffing Considerations
The number of personnel needed to operate a POD depends on the number of persons in the
population expected to receive medications, staff availability, POD size, the type of agent, the
magnitude of the event, and whether the agent is infectious or non-infectious.
All POD personnel are key to its success, especially the PH and health care professionals with
specialized skills and training as shown in the following tables. This group includes doctors,
nurses, and pharmacists, and emergency medical services personnel.
6.2 Dispensing Operations at Different Intensity Levels
6.2.1 MDCH Tiered Approach to Dispensing
MICHIGAN DEPARTMENT OF COMMUNICTY HEALTH
OFFICE OF PUBLIC HEALTH PREPAREDNESS
Strategic National Stockpile (SNS)
Tiered Approach for Dispensing (updated 9.15.08)
______________________________________________________________________________
The Tiered Approach for Dispensing is a State-developed model offered for consideration by the
Local Health Departments (LHDs). LHDs should locally discuss the model, pursue consensus
within the jurisdiction, and adapt as necessary to support local dispensing protocols. To
completely address item 10.4 in the CDC SNS Local Technical Assistance Review (TAR)
Tool, authorization protocols and procedures to alter the clinical dispensing model must
be included in the LHD SNS Plan.
81
Overview
The Tiered Approach has been designed to serve as a comprehensive method of instructing staff
and volunteers, and explaining the levels of care that are to be provided during an event at three
distinguished emergency risk levels. The yellow level represents the need and the ability to
provide full care, the orange level allows for the ability to provide intermediate care, and the red
level would allow staff to only provide minimal care to individuals. These variations in standard
levels of care are often due to the time constraints, depending on the severity of the event. In
order to increase client throughput, the items that require a significant amount of time may be
abbreviated or discontinued all together. These tasks conducted by the staff and volunteers may
include: Obtaining signed consent forms, regulating the compliance with FDA labeling
requirements, conducting full patient information retrieval, providing dosing instructions for
medications, and incorporating the use of expanded professionals and/or lay persons to assist in
medication dispensing.
Rationale
In order to ensure that all staff and volunteers clearly understand their roles and responsibilities,
the preplanning tool is necessary in explaining the adjustments expected to occur and the tiers of
care standards to be provided at a particular level of emergency. This tool provides instructions
for those involved in the dispensing process, including medical staff, pharmacists, expanded
professionals, and lay persons.
Objectives


To provide comprehensive instructions for emergency event dispensing planning.
To serve as a fact sheet reference during staff and volunteer trainings, before and during
an event.
Possible Scenarios

Yellow: Yellow-level events may include flu clinics, seasonal clinics, normal public health
operations, voluntary vaccination for an outbreak, and other non-urgent situations. An
example of a level-yellow scenario would include a pre-pandemic influenza vaccination
clinic.

Orange: Orange-level events may include public health incidents requiring mass
distribution of medications in a timely manner. An example of a level-orange scenario
would include a letter containing Anthrax in a building, requiring the containment and
prophylaxis of a defined number of individuals within.

Red: Red-level events include incidents that are epidemiologically geographic, highly
contagious and/or deadly diseases, requiring rapid dispensing of pharmaceuticals. These
types of events would be deemed public health emergencies and may require as little as 48
hours time to prophylaxis the entire Michigan population. An example of a level red
scenario would include an outbreak of smallpox.
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Dispensing Tiers
*IND/EUA: Investigational New Drug and Emergency Use Authorization
** Abbreviated NAPH includes: Name, Phone Contact, Zip Code, Antibiotic Allergy information, Kidney Disease
information, # of pills dispensed, weight, and date of birth.
Resources
 Michigan Health Alert Network: https://michiganhan.org
 CDC Website: www.cdc.gov
 Michigan Emergency Management Act 390
 Tablet Crushing Instructions and Reconstitution
 Child Weight Chart
 Patient and Family Medical History and Consent Form
 Federal and State Drug Labeling Requirements
 Dispensing Multiple Regimens to Head of Household Guidance Procedure
Resources have been posted to the Michigan Health Alert Network (MIHAN) at the following document path:
Document Library : Documents : Local Health Departments : EPC General Information Folder : SNS : SNS Resources
: Tiered Approach for Dispensing Guidance and Resources
Model
Name, Age, Phone, and Home Address (NAPH)
Form
Drug & Disease
Patient Information
Regulation
Compliance
NAPH Form
Distributed and
Reviewed by
Staff/Volunteers
Dosing Information
Given to Patient
Picked up by Patient
State Pharmacy Reqs.
FDA Requirements
Full NAPH Form
YELLOW
ORANGE
RED
Full Care/
Individual
Screening
Intermediate
Care/ Group
Screening
Minimum
Care/ No
Screening
X
X
X
Abbreviated NAPH
Form**
Full Labeling
NAPH Form
X
State & Federal
Pharmacy
Regulations
Weight Charts
X
Tablet Crushing
Information and Weight
Charts
X
X
X
Licensed
X
If Available
If Available
X
If Available
X
Dispensing Staff
Individual Medical
Care and Evaluation
Expanded Professions
Lay Persons
Limited Individual
Medical Care and
Evaluation
X
En Masse Triage
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Weight Charts,
Crushing and
Reconstitution
Instructions
Emergency
Management Act
390, Sect. 11
Act 390, Sect. 11
Act 390, Sect. 11
NAPH Form
X
References
 Amy Stewart, SNS Coordinator, Illinois Department of Public Health
 Mike Robins, SNS Coordinator, Chicago Department of Public Health
Michigan HAN
Webpage: Head
of Household
Policy & NAPH
CDC Website
CDC Website
IND/EUA*
IND/EUA*
NAPH Form
X
X
Dosing Directions only
Tablet Crushing and
Reconstitution
X
X
X
X
RESOURCES
NAPH Form
6.2.2 Limited-scale event
Personnel and Logistic requirements for a limited-scale event are analogous to seasonal fluclinics. These needs are already well-established and documented in VBCDHD Flu Immunization
Plans.
6.2.3 Worst-case event
A worst-case event is an “Incident of National Significance” as defined in the NIMS or National
Response Plan(NRP). A Public Health incident of such magnitude, that by its very nature (e.g.,
smallpox outbreak) it would instantly overwhelm all local and regional resources and become a
Presidentially-declared disaster. In such a case, the NRP will cause mobilization of many other
assets in support of the SNS, in order to operate multiple POD operations.
In the smallpox example for a Van Buren and/or Cass County outbreak, plans are in place to
consolidate Region 5 resources into vaccination teams that would operate using resources from
four regional hospital locations. For further examples of this type of scenario, refer to the All
Hazards Plan, Smallpox Response Plan. Similarly, VBCDHD would assist another county if the
outbreak were there, instead. This, in accordance with the 5 th Region Mutual Aid Agreement.
6.2.4 Dispensing to Van Buren/Cass County in 48 Hours
The situation presented by Pandemic Flu (PFlu) or a similar worldwide biological outbreak, would
be an “Incident of National Significance” but different, in that VBCDHD would be unable to depend
upon neighboring adjacent jurisdictions, Region 5, or the State. In such a scenario, all 45
LHD/DHD would be experiencing the same or equivalent level of emergency response activities
and would not have the resources to lend to other jurisdictions. In addition, it is speculated that
employee illness, care giving to ill family, and fear of contracting the disease would reduce the
workforce by one-third or more, further exacerbating the situation.
The number of persons in this jurisdiction (> 127,000) and a typical throughput (500 per hour) for
an average-size POD indicates the need for five PODs in the Van Buren/Cass jurisdiction to
accomplish dispensing to the entire population in 48 hours. This would require anywhere from 36
to 90 persons per POD (see tables below), yielding a staff requirement totaling from 175 to 450
staff.
The likely solution to this scenario, is that for each of the 5 PODs, two nurses and two helpers
would move to their assigned POD location and dispense, keeping records as best as they are
able. Local media would make the POD location announcements using the Emergency Alert
System (EAS) to alert citizens to listen or view their radios or TVs. Newspapers would back up the
broadcast announcements. Law enforcement assets would be requested to check in with each
location periodically to inquire of their status. It is likely that law enforcement assets would be
severely limited during this scenario, so it is doubtful that security could be guaranteed 24/7. This
leaves open the possibility that dispensing might not take place during the hours of darkness
because the risk to staff might be too great.
6.2.5
Alternative Dispensing Options
Additional options for dispensing would include the ability to scale a clinic down from full-scale
with all stations to limited person to person contact. Some of these options might include the
following:
 Entities with staff physicians (i.e., internal medical staff) may self-dispense
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




Hospitals/Health Care Providers
Long Term Care Facilities
Large corporations
Schools/ Colleges
First Responder Agencies
Other modalities might include:
 Drive thru clinics as an alternative to walk-through clinics
 US Postal Service
Possible ways to scale down a clinic would be to:
 Combine stations to decrease the number of stops (i.e. form/education or
screening/dispensing)
 Hand out only paper for education rather than verbal
 Scale down screening to only include NECESSARY information.
 Post registration forms online (or have a web-based registration process)
The Alternative Dispensing document outlines a few alternative dispensing methods that could be
utilized during an emergency.
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6.3 Dispensing Sites
6.3.1
Van Buren County
Emergency Management Office of Van Buren County should be notified IMMEDIATELY if a
request for the Strategic National Stockpile is needed. The Emergency Manager for Van Buren
County is:
Alternate: (Sheriff Dale Gribler)
Jeri Tapper (Central Dispatch Mgr.)
Van Buren Central Dispatch Center
205 S. Kalamazoo
Paw Paw, MI 49079
Admin # (269) 657-2006
24/7 # (269) 657-3101
Fax: (269) 657-5161
E-Mail: [email protected]
[email protected]
Sgt. Al Svilpe
Van Buren County Office of Domestic
Preparedness
205 S. Kalamazoo Street
Paw Paw, MI 49079
Office: 269-657-7786
Pager: 269-232-4112
Fax: 269 -657-7787
Cell: 269-569-3636
Email: [email protected]
Primary Site and/or First Responder Site:
Van Buren Intermediate School District Conference Center
490 S. Paw Paw Street
Lawrence, MI 49064
Superintendent:
Jeff Mills
674-809
Home: 673-9600
Cell: 269-208-2493
Secondary Site and/or Public Dispensing Site:
Van Buren Intermediate School District Technology Center
250 South Street
Lawrence, MI 49064
Superintendent:
Jeff Mills
674-809
Home: 673-9600
Cell: 269-208-2493
Refer to the Mutual Aid Agreement for this dispensing site.
6.3.2
Cass County
Emergency Management Office of Cass County should be notified IMMEDIATELY if a request for
the Strategic National Stockpile is needed. The Emergency Manager for Cass County is:
Sheriff Joe Underwood
Cass County Sheriffs Department
Office of Emergency Management
130 N. Broadway
Cassopolis, Michigan 49031
Phone: 269-445-1178
Fax: 269-445-1173
24/7: 269-445-1560
E-Mail: [email protected]
Alternate: Lt. Doug Westrick
Cass County Sheriff’s Office
130 N. Broadway
Cassopolis, MI 49031
Admin # (269) 445-2956
24/7 # (269) 445-1560
Fax: (269) 445 2484
E-Mail: [email protected]
86
NOTE: Primary Site: This site can be split into two clinics, one each for first
responders and the general public with separate access points and
traffic flow.
Southwestern Michigan Community College
58900 Cherry Grove Road
Dowagiac, MI 49047
President: David Mathews, 269-782-1000
Emergency Preparedness Contact:
Eileen Crouse
Office: 269-782-1369
Cell: 269-757-2468
Secondary Site:
Southwestern Michigan Community College - Niles Campus
2229 E. US 12
Niles, MI 49120
President: David Mathews, 269-782-1000
Emergency Preparedness Contact:
Eileen Crouse
Office: 269-782-1369
Cell: 269-757-2468
Refer to the Mutual Aid Agreement for this dispensing site.
6.3.3 Tribal Health Dispensing Site:
Pokagon Band of Potawatami Indians, Health Center
57392 M-51 South, Dowagiac, MI 49047
Contact: Health Director – Arthur Culpepper
Office: (269) 782-4141x231
Cell: (269) 240-8330
[email protected]
Alternate: Karen Jako
Office: (269) 782-4141 x341
Cell: (269) 760-1185
87
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6.4 Activation/Operations of Dispensing Sites
The dispensing sites will be activated based on need and severity of the event. It is expected that
the dispensing sites will be operational within 48 hours of request. It has been exercised and
successful implementation of standing up operation with staff in approximately two hour of
deployment of staff. As noted in the above section, there are many steps to receiving the SNS
push pack. During the 48 hours prior to the push pack arriving, it is expected that the Health
Department will utilize local and regional pharmaceutical caches. Supplies and equipment may be
supplied by the 5th District Medical Response.
Supplies needed to activate and operate the dispensing site, with exception of pharmaceuticals,
will be stored at the health department and labeled. Maps of the dispensing site and the clinic flow
can be found in Appendix C.
6.5 Special Populations
Dispensing to special populations is a challenge for local public health. Resources requested from
the Emergency Operations Center will assist the local health department is reaching populations
such as inmates of correctional facilities, homeless, patients in long-term care, hospitalized
patients, home-bound and undocumented aliens. These populations have been identified and
communications have been established and outlined in the CERC Plan. The Department of
Human Services is responsible for tracking most of these populations. A contact list can also be
found for these population/facilities in the CERC Plan.
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6.5.1 Tribal Population
The Pokagon Band of Potawatomi Indians has a population of approximately 4200 members in
the 5th District and neighboring counties, including the State of Indiana. The headquarters for tribal
administration is located in Dowagiac, MI. The tribe will provide communications, health
information, SNS POD responsibilities and coordination with the local health department for
information and treatment/prophylaxis of its members. Contact information can be found in various
sections of this plan including Dispensing, section 6.0. SNS responsibilities have been
coordinated with the local health department.
6.5.2 Homebound Population
The homebound population in Van Buren and Cass counties is a difficult number to note. The
local Emergency Operations Centers in both Van Buren and Cass Counties have an identified
person or persons assigned to special populations who have seats in the EOC. During drill events
directly related to SNS operations and the activation of the EOC, both counties have identified
less than 20 homebound patients who cannot receive care or evacuation by family members. This
list is concurrent with the Area Agency on Aging, Department of Human Services and the medical
community. Due to the fluency of these members, a complete list is almost immediately out of
date.
As homebound individuals are identified, during an even, they will be place on a contact list. It is a
coordinated responsibility of Emergency Management, Law Enforcement, Health & Medical
Services to ensure that homebound individuals are taken care of. This is part of the agreement
between Emergency Management and Public Health.
6.6 Institutionalized Population
The Van Buren/Cass District Health Department will partner with institutions with closed
populations such as nursing homes, adult care center, day care centers, correctional facilities,
hospitals and large corporations to distribute medications to their populations. Information will be
exchanged on a group basis and the institution will be responsible for verifying distribution to
those individuals. Information on adult care centers, hospitals, nursing homes and day care
facilities and their populations is compiled on an annual basis by the Department of Human
Services, this information is shared with the LHD each year. The health department currently has
plans to distribute prophylactic mediations to these institutions based on the situation and the
information dispersed to the medical community.
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6.7 Staffing Resources
Local First Responders: 900
Hospital Personnel: 1300
Mortuary Services: 7
Other: Health Department: 50
The number of personnel needed to operate a DS depends on the size of the DS; the number of
patients expected to be treated over selected days; the type of agent; the magnitude of the event;
and whether the agent is infectious or non-infectious. Identification of staff with proper training is
paramount to DS operations. Staff can be categorized as follows:
Staffing of a dispensing site will be composed of three categories of workers:
1. Health Professionals: includes doctors, nurses and pharmacists.
2. Trained Volunteers*: includes interpreters, nurse assistants, security personnel, clerical,
communications, and administration.
3. Untrained Volunteers*: includes housekeeping, greeters, etc.
* Volunteers will be solicited through coordination between the Van Buren County Office of
Domestic Preparedness, Lakeview Community Hospital and their affiliates, South Haven
Community Hospital and their affiliates, Borgess-Lee Memorial Hospital and their affiliates, and
other volunteer agencies including the American Red Cross. It is assumed that personnel who
generally are employed at the dispensing sites will volunteer to help out during a time of need.
These personnel know the facilities and it surroundings and will play a significant role at the
dispensing sites.
All dispensing site personnel must be issued an identification badge through the Communications
Chief’s section. These badges must be surrendered when a person leaves the site to avoid
misuse of the badges by unauthorized personnel. Badges will be color coded by section.
Each dispensing site shall be staffed in a sufficient manner in order to perform the functions
outlined in the table below.
Function
Triage incoming symptomatic people and redirect
to a treatment center.
Orient the public, answer questions, explain drug
instructions, hand out forms, etc.
Provide security for traffic and crowd control.
Screening based on patient’s medical history.
Weigh children under age of 5.
Distributing drug regimens.
Replenish and reorder supplies and drugs.
91
Needed or Suggested Staff
Health care professional
Trained volunteers
Trained volunteers with law
enforcement supervision
Health Care Professional or
Pharmacy professional
Untrained volunteer
Health Care Professional or Trained
volunteer with Pharmacist/Medical
Doctor supervision
Health care professional with
trained volunteer assistance
Checkout person to ensure completion of NAPH
forms, etc.
Trained volunteer
Dispensing site runners will be rapidly identified by utilizing colored vests, t-shirts, smocks or hats.
Runners will report to the Site Manager and will be available to all dispensing site staff.
The DS will have designated staff parking with appropriate signage to reserve the area. This area
may be roped off for clarity purposes.
Staffing will be determined by the scale of the event. For planning purposes the Van Buren/Cass
District Health Department will use the following schematic:
Outside Traffic:
Security:
Information Distribution:
Triage
Medical Consultants
Screeners
Dispensers/Vaccinators
2
2
2
2
1*
6
4
Total:
18 personnel per clinic per shift (*Medical consult may only be
available by telephone)
Plan for additional 1/3 to cover breaks/illness, etc
Total: 24 additional staff
Non-management staff previously identified would be utilized in any/all functional areas of the
dispensing site. If law enforcement personnel are available, they will be utilized to secure the site
and provide outside traffic direction and perimeter security. Inside the dispensing site will utilize
the stations listed above and can be covered by a variety of personnel described on the previous
page.
6.7.1 Staffing/Volunteer Management Plan
Staffing and Volunteer management has been enhanced to include all SNS functions. The staff
leads will be trained annually and participate in a quarterly call down exercises. This will ensure
that all functions of the SNS plan are covered by qualified personnel. The staff of VBCDHD may
be required to participate in SNS functions outside of their daily duties. Staff will be cross-trained
to enhance our capabilities.
6.7.2 MI-Volunteer Registry/Medical Reserve Corp
Mi-Volunteer Registry will include a database of volunteers, both licensed and non-licensed. This
database is available to the EPC and MDCH 24/7. Alerts and messages can be sent to volunteers
informing them of an incident.
 A protocol to handle essential personnel not listed in the database
 Pre-determined staging sites to gather personnel and distribute ID badges (Hartford Office
or local EOC)
 A notification system to alert volunteers and direct them to a staging site or designated
clinic site
 A process for collection of ID badges at end of shift
 Tracking/documentation of released and returned badges
92
The Van Buren/Cass District Health Department may use pharmacists, doctors, nurses, and
other professionals such as interpreters and sign language personnel to support mass
dispensing site operations. The Van Buren and Cass County Emergency Management Division
through its various annexes and partners, Medical Reserve Corps, (MiVolunteerRegistry), 5th
District Medical Response Coalition, American Red Cross, Van Buren and Cass County United
Way, and others, will be responsible for the recruitment, training, deployment, and retention of
not only medical personnel, but also volunteers needed to support dispensing site operations.
To that end, the Medical Reserve Corps will ensure that program administration, to include
contact information of volunteers, is maintained. The 5 th District Medical Response Coalition is
responsible for administration of the Medical Reserve Corps.
Additionally, volunteers in Van Buren or Cass County and throughout Region 5 will be identified
and accessed through the Michigan Volunteer Registry available online at
http://mivolunteerregistry.org. Currently there are more than 260 registered volunteers in the 5th
District. The registry has the capabilities to register, track, credential, and alert volunteers at any
time.
6.8 STORAGE AND HANDLING REQUIREMENTS FOR SNS MATERIEL
6.8.1 Environmental
SNS materiel must remain at appropriate temperatures during staging, storage, and transportation
to ensure its potency. It is essential to keep most SNS materiel at controlled room temperatures,
between 58ºF and 86ºF. This means storage sites, dispensing sites, treatment centers, and
distribution vehicles must all be able to maintain this temperature range during very hot or very
cold periods. Materiel should not be left outside during these periods. Currently, no items in the
12-hour Push Packages require refrigeration.
6.8.2
Controlled Substances
DEA Registrant: Dr. Frederick Johansen, License on File to sign the FORM 222
Back up DEA Registrants for VBCDHD include: Dr. Andrew Hamilton, Dr. John Ostrowski,
Dr. William Parks, and Dr. LiSandra Soto. (Licenses verified 2/2010)
A 12-hour Push Package currently includes three different controlled substances: morphine,
diazepam, and midazoliam. The Drug Enforcement Administration (DEA) classifies substances by
their potential for abuse. Accordingly, morphine is classified as Schedule C-II, while diazepam
and midazoliam are classified as Schedule C-IV.
The DEA regulates the storage and transfer in accordance with Title 21 of the U.S. Code of
Federal Regulations. The DEA subsequently authorizes individuals (registrants) to handle specific
classes of controlled substances. The registrants must ensure that they maintain a detailed chainof-custody record of all transfers. For C-II substances, that record must include a DEA Form 222
that the person who receives the materiel initiates to request the transfer.
Controlled substances provided by the SNS Program will be sent to hospitals. Hospitals must
have registrants identified that will be able to receive and sign for any controlled substance that
they request and subsequently receive. The DEA recognizes that during an emergency,
availability of the identified DEA registrant may be limited. Also, extreme circumstances may
dictate that controlled substances be delivered to the local health department. If the identified
93
DEA registrant is unavailable to accept receipt at the time of delivery, the DEA will still allow
delivery of the controlled substance to the organization, but the registrant must eventually provide
signed paperwork for each transfer.
The DS must have the ability to maintain appropriately controlled temperature settings (see
Appendix C for DS Checklist) for medications/pharmaceuticals. The U.S. Pharmacopoeia defines
as “the usual and customary working environment of 20° C to 25° C (68-77 F) that allows for brief
deviations between 15° C and 30° C (59-86 F) that are experienced in pharmacies, hospitals,
and warehouses”21. When the DS receives the medications and supplies from the RSS or DN, the
material must be formally accepted and stored immediately by the Supply Coordinator.
The received pharmaceuticals and supplies must be inventoried by the Supply Coordinator and
documented. Any discrepancies (excess/deficiency or wrong medications/supplies) between the
order and delivery require the Site Manager and Administration Chief be notified in order to
contact the RSS for reconciliation.
The delivery invoice is checked, signed off by the Logistics Chief, and then copied by the
appropriate person in logistics. This is then forwarded to the Administration section, RSS, and
local EOC.
Designate delivery points within the DS, with clear signage to avoid unauthorized use by patients
or staff, should be identified. Ensure all signage and directions are provided in the common
foreign language(s) of the area.
Ensure dispensing site has pallet jack and/or forklift to unload supplies if loading dock not
available.
6.9 Prescription Labeling
Prescription labeling may be completed at the RSS site and the completed labels sent with the
material delivered to the dispensing site. If labeling is not complete, the dispensing site will
assume this duty.
Drug Labeling Requirements
Drug label contents must Michigan and Federal legal requirements
Federal Requirements
Section 503(b)(2) of the Food Drug and Cosmetic Act requires the prescription label have the following information:
(1) The name and address of the dispenser (pharmacy);
(2) The serial number of the prescription; (Prescription number)
(3) The date of the prescription or the date of its filling (or refilling) – state law often determines which date
is to be used;
(4) The name of the prescriber;
(5) The name of the patient, if stated in the prescription; and
(6) Directions for use, including precautions, if any, as indicated on the prescription
(7) The quantity dispensed
State Requirements
21
U.S. Pharmacopoeia, Practitioner Reporting. No. 40, Revised 6/94, “Storage Definitions.”
94
Section (333.17745 (7) of the Occupational Regulation Sections of the Michigan Public Health Code requires drugs to be dispensed in a container that bears a
label containing all of the following information:
(1) The address of the patient;
(2) The initials or name of the dispensing pharmacist;
(3) The telephone number of the pharmacy: ( for the purpose of SNS CDC recommends a 24-Hour
telephone number)
(4) The drug name, strength, and manufacturer’s lot or control number;
(5) *The beyond-use date, if any
(6) The name of the manufacturer or distributor.
Michigan law requires an expiration date on the label. The CDC label does not provide a designated area
for the expiration date.
*The expiration date of the prescription drug, or the following statement as required under Michigan
Occupational Regulations section 17756: “Discard this medication 1 year after the date it is
dispensed” unless the medication expires on another date under applicable state or federal law or rules or
regulation or other state or federal standards. Sample Drug label:
Van Buren/Cass District Health Department
57418 CR 681 Hartford, MI 49057
1-800-123-4567
Prescriber: F. Johansen, MD
Patient Name:
Date: mm/dd/yyyy
Patient Address:_________________________________________
Doxycycline hyclate 100 mg tablet
Qty: 14
Directions: Take 1 tablet by mouth twice a day until all of the medicine is gone.
Lot:12458A
Exp:12/2007
Take with or without food. Avoid long times in sunlight while taking this medicine.
Use sunscreen to protect your skin.
Discard this medication 1year from date dispensed.
RX #_______
Place Bar Code Here (if available):
Linking the drug, with the patient, and with drug information
Each SNS drug container has a unique “Rx#” printed in three locations: The large label identifying
the drug in the bottle, plus two small “peel off” labels of which one can be placed on the patient
history form and the other on the patient drug information sheet which describes indications, side
effects, precautions, etc. commonly associated with the drug. Hand write the RX number
appearing on the SNS bottle on the copy of the health history form retained by public health for
post event patient follow up / assessment.
Michigan drug labeling requirements may be met by placing the medication, the health history
form, and the drug information sheet in a zip lock bag and give it to the patient. Be sure to include
instructions for preparing oral liquids from oral solids for patients unable to swallow oral
tablets/capsules.
Labeling equipment will be provided in the SNS shipment. A computer disc with a software
package enabling non-English labeling is also provided in the SNS shipment and has been given
to the State of Michigan. This software utilizes Avery 5395 Name Badge Labels or the equivalent
for printing purposes. (The same CD also includes versions of patient information sheets, dosing
instructions and cautionary language in English and 47 languages.) A copy of this CD will be
available to each dispensing site if necessary.
95
If printing prescription labels becomes necessary at the dispensing site, a computer that will run
the labeling program contained on the CD will be required at the site, as well as a printer and the
Avery labels.
If labels have to be created in a foreign language, the English version of the label will have to be
edited.
 Print two labels (one in English, one in the other language) on Avery 5395 name badge
labels or an equivalent. It will hold all the required information in English.
 The English label is placed on the front of a bag/container and will contain the FDA
required information. Labels in other languages contain instructions for taking the drug and
precautions for using it.
Note: Foreign labels cannot be edited.
Unit dose bottles will only require the prescribing agency, the provider, and a 24-hour telephone
number for questions.
96
6.10 Patient Information Forms
The CDC software supplied on CD-ROM with the prescription drug labeling directions includes
electronic versions of patient history and release of information forms in English and 47 other
languages for each drug and threat. The templates are in Adobe Acrobat and do not require
special fonts. The dispenser's name, the prescriber’s name, and a 24-hour phone number for
questions can be inserted on the forms.
 The CD-ROM contains formats for printing dosing instructions and precautions in multiple
languages that cannot be edited.
 The Van Buren/Cass District Health Department will use these forms rather than assume
responsibility for accurate translation into the appropriate language to meet the multicultural
needs of the community at large.
o
The primary languages of our jurisdiction are Spanish, French, German, Polish,
& Laotian. This represents
o
Van Buren County: English - 95%
French – 0.2%
Polish – 0.3%
Spanish - 7%
German – 0.5%
o
Cass County
English – 96%
Spanish – 2%
French – 0.4%
German – 0.5%
Laotian – 0.3%
With these figures the most prominent language in both counties is English. The second
most prominent language is Spanish. The other languages make up about 1% of the
population combined.
Language Interpretation – HHS (Office of Equal Opportunity and Diversity Programs)
Language Interpretation Contact Sheet. Additional information can be found in the Crisis
and Emergency Risk Communication Plan Appendix D.
The health department has contacts with local printers to produce health history forms, drug and
vaccine fact sheets, and documentation tools for delivery during an emergency (such as a power
outage or when computers/printers are not available.) The contractor will be provided a copy of
the CDC CD-ROM with the forms when necessary. Carbonless (NCR) copy formats of these
forms may be preferred to facilitate tracking.
The patient form needs to contain the name, address, phone/message number and health history
(NAPH) of the patients as well as the lot and prescription number of medications or vaccines,
allergies, birth date, demographics and relevant questions with regard to the specific bio-agent.
This information must be obtained during registration. Barriers to overcome include:
 Language
 Blindness or deafness
 Illiteracy
 Undocumented individuals who are fearful of providing accurate information
97
6.11 Head of Household
In some cases, heads of household will be permitted to pick up medicine for the members of their
household (Refer to Section 10: Supporting Documents, Heads of Household Policy). Permission
to do such will be granted by the Public Health Incident Commander. The person self-identified as
the head of the household will have to provide proof of identity and proof of address. VBCDHD
staff will require the person self-identified as the head of the household to complete a form
(“Heads of Household”). This form collects personal health information about the family members
and documents proof of identity and address.
A family member picking up medications for other family members may not have all the
information needed to accurately prescribe for each member (e.g., a child’s weight). Forms,
therefore, should be short, simple, and bio-agent specific. Parents/Guardians will complete
patient information forms for each family member receiving medications. Dispensing will be
approved by the Medical Director on site. Refer to the Multi-dose regimen policy.
To facilitate clinic flow in a large-scale event, include a page of simple instructions for completing
the patient information form and make it available to people in line. Any actual or probable contraindications to receiving prophylaxis or vaccine for the bio-agent should be referred to an on-site
professional for further assessment and resolution of outcome.
In addition to the patient information form, an appropriate release of information must be signed
for each adult/child who is a recipient of the medications/vaccine so the information can be
entered into a database. The agency will need to aggregate the recipient data either by computer
entry or hand tabulation. Key entry while patients are in line will invariably slow the patient flow
process significantly. On-site key entry, if used, should occur after the client has exited. This
process can be contracted out to a data entry firm if necessary.
Local dispensing sites/clinics will forward data to MDCH/OPHP for aggregate databases in
accordance with established guidelines.
6.11.1 Unaccompanied Minor
It is the policy of the Van Buren/Cass District Health Department to partner with the Department of
Human Services to determine services for children under the age of 16. This will take place within
the dispensing clinic at the special populations’ station and/or mental health.
The State of Michigan distributed a document for guidance regarding dispensing to
unaccompanied minors. This document can be found in the Section 1 folder. In summary,
“Local health departments are responsible for the operation and management of local mass dispensing
sites for the Strategic National Stockpile (SNS). Operations plans for these points of dispensing should
include procedures and protocols for handling unaccompanied minors.
In general, parental consent is required for the medical treatment of an individual who is under 18 years of
age. However, there are exceptions to this general rule. A health care provider may treat a minor without
the consent of the minor’s parent or guardian if there is a true life-or-limb threatening emergency and
reasonable attempts have been made and documented to contact the minor’s parent or legal guardian.
Appropriate medical care for the pediatric patient with an urgent or emergent condition should never be
withheld or delayed because of problems with obtaining consent.”
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CONSENT FOR CARE AND CONFIDENTIAL HEALTH INFORMATION
Michigan Laws Related to Right of a Minor to Obtain Health Care Without Consent or
Knowledge of Parents
Laws regarding consent to medical and surgical
care by minors.
Is parental consent required?
Is parental access to the minor’s
information permitted?
General Rule: A minor is a person 17 years or
younger
Emancipation of Minors Act, MCL 722.1; Age of
Majority Act, MCL 722.52.
Required
Yes
Emancipation/Emancipated Minor
Emancipation of Minors Act, MCL 722.1 –722.6
Not required
No
Abortion
The Parental Rights Restoration Act, MCL
722.901 – 722.909
Required
Yes, unless a judicial waiver.
Birth Control
Provider discretion applies for providers not
funded by Title X
Provider discretion applies for providers
not funded by Title X
There are no specific MI statutes on this issue;
this is a Federal Constitutional “right of privacy.”
Generally, practitioners must be aware that
there is no statutory authority or protection for
their actions.
Title X Agencies: Minors may obtain
information and contraceptives without parental
consent.
There are no specific MI statutes on this
issue; this is a Federal Constitutional “right
of privacy.”
Generally, practitioners must be aware
that there is no statutory authority or
protection for their actions.
Title X Agencies: Parental access to
minor’s information not permitted without
1. An emancipation occurs by court order via a
petition filed by a minor with the family division of
circuit court.
2. An emancipation also occurs by operation of
law under any of the following circumstances:
When a minor is validly married.
When a person reaches the age of 18 years.
During the period when the minor is on active duty
with the armed forces of the United States.
Emancipation/Emancipated Minor
Continued
For the purposes of consenting to routine,
nonsurgical medical care or emergency medical
treatment to a minor, when the minor is in the
custody of a law enforcement agency and the
minor’s parent or guardian cannot be promptly
located.
For the purposes of consenting to his or her own
preventive health care or medical care including
surgery, dental care, or mental health care, except
vasectomies or any procedure related to
reproduction, during the period when the minor is
a prisoner committed to the jurisdiction of the
department of corrections and is housed in a state
correctional facility; or the period when the minor
is a probationer residing in a special alternative
incarceration unit.
There are no specific MI statutes on this issue;
this is a Federal Constitutional “right of privacy.”
Title X Agencies: Family planning agencies
funded under Title X of the Public Health Service
Act, must provide family planning information and
contraceptives without regard to age or marital
status. 42 CFR 59.5.
Written consent of one parent/legal guardian or
a judicial waiver (court order) of parental
consent from probate court.
Minors also must comply with the 24-hour
waiting period prior to obtaining an abortion.
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Laws regarding consent to medical and surgical
care by minors.
Emergency Care
Parent or guardian consent is required.
Mental Health – Inpatient Care
Mental Health Code, MCL 330.1498d
Parents may admit for inpatient care.
Minor may consent to limited inpatient care if 14
years or older.
Is parental consent required?
Is parental access to the minor’s
information permitted?
Title X Agencies: To the extent practical,
funded agencies shall encourage minors to
include their families, however, this is not
mandatory in order to obtain services. 42 USC
§300(a).
the minor’s documented consent, except
as may be necessary to provide services
to the patient or as required by law. 42
CFR 59.11.
Required, other than life-threatening
circumstances, immediate medical attention
needed, and parents cannot be located.
Yes
Required
Yes
A minor of any age may be hospitalized for
mental health reasons if a parent/legal guardian
or agency requests and the minor is found to
be suitable for hospitalization.
A minor of 14 years or older may request and if
found suitable be hospitalized.
Mental Health – Inpatient Care
continued
Suitability, in either case, shall not be based
solely on one or more of the following: epilepsy;
developmental delay; brief periods of
intoxication; juvenile offenses; or sexual,
religious or political activity.
Mental Health – Outpatient Care
Mental Health Code, MCL 330.1707
Not required
Provider discretion applies.
A minor age 14 or older may request and
receive up to 12 outpatient sessions or four
months of outpatient counseling.
Information may be given to parent,
guardian, or person in loco parentis for a
compelling reason based on a substantial
probability of harm to the minor or to
another individual; mental health
professional must notify minor of his/her
intent to inform parent.
Not required
Provider Discretion Applies
The consent of any other person, including the
father of the baby or spouse, parent, guardian,
or person in loco parentis, is not necessary to
authorize health care to a minor or to a child of
a minor.
At the initial visit permission must be requested
of the patient to contact her parents for any
additional medical information that may be
necessary or helpful.
Before providing care the patient must be
informed that notification may take place.
For medical reasons information may be
given to or withheld from spouse, parent,
guardian or person in loco parentis without
consent of the minor and notwithstanding
her express refusal to the providing of the
information.
The minor mother shall consent to care for her
child.
The consent of any other person, including the
father of the baby or spouse, parent, guardian,
foster parent, is not necessary to authorize
health care to a child of a minor.
Minor Mother
Not required
Provider discretion applies.
Minor may consent to limited outpatient care if 14
years of older.
Prenatal and Pregnancy-Related Health Care
Public Health Code, MCL 333.9132
Minor may consent to maintain life and preserve
health of the minor or the minor’s child or fetus.
The provision of health care for a child of the
minor
Public Health Code, MCL 333.9132
Minor may consent to maintain life and preserve
health of the minor or the minor’s child or fetus.
Substance Abuse Services
Public Health Code, MCL 333.6121
For medical reasons information as to the
treatment given or needed, may be given
to or withheld from the spouse, parent,
guardian or person in loco parentis without
consent of the minor and notwithstanding
the express refusal of the minor to the
providing of the information.
Minor may consent
Venereal Disease / HIV
Public Health Code, MCL 333.5127, MCL
Not required
Provider discretion applies as to the
treatment given or needed.
100
Laws regarding consent to medical and surgical
care by minors.
Is parental consent required?
Is parental access to the minor’s
information permitted?
333.5133, and MCL 722.623.
For medical reasons information as to the
treatment given or needed, may be given
to or withheld from the spouse, parent,
guardian or person in loco parentis without
consent of the minor and notwithstanding
the express refusal of the minor to the
providing of the information.
Minor may consent to medical or surgical care for
diagnoses and treatment of a venereal disease or
HIV.
Reportable as reasonable cause to suspect child
abuse if pregnancy or venereal disease found in
child over 1 month but less than 12 years of age.
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Other Michigan Laws Related to Right of a Minor to Obtain Health Care Without or Consent of
Knowledge of Parents
Reporting of Abuse or Neglect
Child Protection Act, MCL 722.622, MCL 722.623
The following individuals are required to report suspected “child abuse or
neglect” to Child Protective Services:
audiologist
certified social worker
dentist
hygienist
law enforcement officer
professional counselor
marriage and family therapist
medical examiner
member of the clergy
nurse
technician
person licensed to provide
emergency medical care
physician
physician's assistant
psychologist
registered dental
regulated child care licensed
provider
school counselor or teacher
school administrator
social worker
social worker
“Child abuse” means harm or threatened harm to a child's health or welfare
that occurs through nonaccidental physical or mental injury, sexual abuse,
sexual exploitation, or maltreatment, by a parent, a legal guardian, or any
other person responsible for the child's health or welfare or by a teacher, a
teacher's aide, or a member of the clergy.
“Child neglect” means harm or threatened harm to a child's health or welfare
by a parent, legal guardian, or any other person responsible for the child's
health or welfare that occurs through either of the following:
(i) Negligent treatment, including the failure to provide adequate food,
clothing, shelter, or medical care.
(ii) Placing a child at an unreasonable risk to the child's health or welfare by
failure of the parent, legal guardian, or other person responsible for the child's
health or welfare to intervene to eliminate that risk when that person is able to
do so and has, or should have, knowledge of the risk.
For reporting purposes, pregnancy of a child less than 12 years of age or the
presence of a venereal disease in a child who is over 1 month of age but less
than 12 years of age is reasonable cause to suspect child abuse and neglect
have occurred.
Medical Records Access Act, MCL 333.26261-MCL 333.26271
Provides for and regulates access to and disclosure of medical records.
Under this act, a minor’s parent, guardian, or person acting in loco
parentis has the right to review and obtain a copy of the minor’s
medical record, unless the minor lawfully obtained health care without
the consent or notification of a parent, guardian, or other person acting
in loco parentis, in which case the minor has the exclusive right to
exercise the rights of a patient under this act with respect to those
medical records relating to that care.
Availability of Laws on the Internet:
Michigan Statutes:
www.legislature.mi.gov
Federal Statutes
http://uscode.house.gov/search/criteria.shtml
Federal Regulations:
http://ecfr.gpoacss.gov
Matrix information compiled by the Michigan Department of Community Health, Office of Legal Affairs (OLA), May 23,
2006
OLA thanks the Henry Ford Health System for providing the original matrix that served as a model for this matrix.
Disclaimer:
This document is for informational purposes only. This document represents OLA’s understanding of various laws, and is not intended
as a legal position from the State of Michigan or the Michigan Department of Community Health. For legal advice, readers should
consult with their own counsel. While every attempt has been made to assure the information presented is accurate as of May 2006,
laws do change, and readers will need to confirm accuracy of various laws cited.
6.11.2
Minimum Identification
It is the policy of the Van Buren/Cass District Health Department to dispense medications to
anyone entering a dispensing site clinic with no minimum identification. During some emergencies
proof of residence may be required. A photo ID and/or proof of residency may be requested by
DS staff, under some circumstances, but no one will be turned away due to lack of proof.
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6.12 Standing Orders
Prophylactic treatments provided at the dispensing site will follow the standing orders for that
disease or type of chemical exposure.
Each dispensing site will have several copies of the standing orders for the specific-bio-agent for
both adult and pediatric regimens.
MDCH Approved Standing Orders can be found in Appendix E. Additional standing orders
documents can be found in the Medical Management Section in the All Hazards Plan.
Additional support documents for specific agents can be found in the Appendices Section of the
All Hazards Plan by referencing the corresponding agent.
Current MDCH Approved Standing Orders include: (SEE All Hazards Plan for list)
 Anthrax
 Botulism
 Plague
 Tularemia
 Smallpox
6.13 Tracking Medications and Recipients
It is very important to document which drugs are dispensed to each individual in the event of
adverse reactions, drug recall, adulteration problems or other concerns.
The tracking of drug lot numbers will be logged on the patients information form as they are given
medications. During a mass prophylaxis clinic is it will be necessary to assign patient numbers to
track individual doses. The lot number of the drugs identifies the origin of the drug and can be
entered into the inventory control database for additional tracking purposes. Additionally, the
dispenser must document the date, time, and location of the dispensing site, then sign and date
the form. The patient information form can be found in appendix H. Adverse reactions will be
logged into the VAERS system.
103
6.13.1 MICR All Hazards Module
MCIR ALL HAZARDS MODULE ACTIVATION
In any public health emergency affecting the community, the MCIR All Hazards module serves a useful role in tracking
persons affected, treated, and/or provided prophylaxis as a result of the emergency. This tracking function allows
local health departments to maintain accurate, real-time patient data, and also serves as a record keeping mechanism
for short and long-term event recovery.
For Pandemic Flu Preparedness, The MDCH Division of Immunization will activate the All Hazards module in MCIR at
WHO Phase 4 and Federal Stage 2, and it will be operational immediately. During this phase All Hazard Scan forms
will be distributed via Email, MCIR.ORG and/or HAN. Regional MCIR staff will begin training Local Public Health and
Hospital employees on how to use the All Hazards module in MCIR.
For Anthrax, Botulism, Plague, Smallpox and Tularemia, the LHD Health Officer, Emergency Planning Coordinator or
designee will notify OPHP of the event. OPHP will notify the Division of Immunizations at MDCH to activate the All
Hazards module in MCIR specific to the event. All Hazards module will become operational immediately and
enhancements to the MCIR application will occur during some events.
Biological Event
Happening in Local
Health Jurisdiction
LHD contacts OPHP
at 517-335-8150 or
after hour’s number
at 517-335-9030 to
notify need for
MCIR start-up.
OPHP Director or Designee contacts Bureau of
Immunizations 517-335-8159 or Division Director
System Activated
LHD can now access All Hazards module. Regional MCIR Coordinators will do
Just In time training as needed. Module will be turned off at the end of the event
with notification from the Community Health Emergency Coordination Center.
At the conclusion of the event, the local health department will notify OPHP that the event has ended. OPHP will
notify the Division of Immunizations at MDCH to turn off the All Hazards Module in MCIR.
Depending on the size of the event, the LHD will determine data entry methods into MCIR. Current options are scan
form or direct data entry into the application. If the scan forms option is selected, scan forms will be completed and
faxed or mailed to the scan center or mailed to:
The Michigan Department of Community Health
Division of Immunization
Att: Scan Center Operations
201 Townsend Street, PO Box 30195
Lansing MI 48909
104
6.14 Preventing Duplicate Patient Processing
The tracking and identification system used at the dispensing site must allow for accurate,
unduplicated patient count and also prevent patients from processing more than once. Hand
stamps may be used as patients exit the clinic to aid this process. Staff at the clinic entry point
should be instructed to check for hand stamps on anyone who enters the clinic to prevent re-entry
of people who have already been served. In some circumstances, it may not be necessary to
enforce this process.
6.15 Pediatric Issues at the dispensing site
Children present special concerns at a dispensing site and these concerns must be adequately
addressed. A qualified pharmacist will be available to each dispensing site to assist with pediatric
issues. Local compounding Pharmacist: Jesse Burley, Rite Aid, Paw Paw, Wilson???.Rite Aid,
Berrien Springs. Additional compounding pharmacists are under investigation for additional
dispensing sites. A database of volunteer pharmacists is available in the CERC Plan.
6.15.1
Weight Issues
A child’s weight is a deciding factor for determining many drug dosages. Each dispensing site
should have a scale to weigh children and a means to accurately record this weight. Scales are
available at each of the Health Department Offices (Cassopolis, Dowagiac, & Hartford) and can be
transported to the mass clinic site. Additional scales can be obtained by contacting local
pediatrician offices.
If medications are being released to the parent or guardian of the child without the child being
present, as accurate a weight as possible should be estimated by the legal guardian. As part of
any public service announcement about the mass clinic operation, guardians of children who
cannot come to the dispensing site should be instructed to weigh their child at home prior to the
guardian coming to the site to pick up medications.
6.15.2
Oral Suspensions and Chewable Tablets
Each 12 hour push package contains limited quantities of Ciprofloxacin and Doxycycline,
Amoxicillin, and Tamiflu in oral suspension for children and others who have trouble swallowing
tablets. The quantities available will provide 4,000 people 5 to 7 days of prophylaxis. Other
alternatives include:
 Utilizing the push package’s 25,000 10-day regimens of amoxicillin chewable tablets for
children between the ages of 2 and 5 years.

Compounding drugs into an oral suspension. Recipes for preparing oral suspensions of
Ciprofloxacin and Doxycycline and Tamiflu can be found in Appendix G.
Additional lots of suspension for Tamiflu have been pushed out to the regional healthcare
response organizations to assist in the pandemic flu response. These lots can be obtained by
contacting the 5th District Medical Response Coalition Medical Director, Dr. Bill Fales.
105
7. Treatment Centers
Treatment centers and Neighborhood Emergency Help Centers will be established as the need
occurs. Treatment centers are those centers already equipped to deal with victims who need
medical treatment during emergencies. At this time, treatment centers are equivalent to
Emergency Departments of the local hospitals. If the emergency overwhelms the emergency
departments at the local hospitals, the regional Modular Emergency Medical System (MEMS) Plan
may be invoked. This involves the opening of smaller treatment centers in the form of Acute Care
Centers (ACC) or Neighborhood Emergency Help Centers (NEHC).
7.1 Modular Emergency Medical System (MEMS)
Within the jurisdiction of the VBCDHD the Modular Emergency Medical System is currently under
development. The regional MEMS group has identified several potential sites for NEHC’s. These
NEHC’s are primarily sub-sets of the hospital system with a few stand alone clinics sites. Sites
that have been identified in each county are listed below. Each site has representation from that
facility and MOU’s will be established to assist in the set up of each facility. The treatment centers
and NEHC’s were identified by community representatives that felt the facility was capable of
handling mass casualty patients in the event of an emergency. Within both rural counties, many
of the facilities identified are owned and operated by the hospital. This ensures continuity of care
to patients and that the MEMS model is uniform across the county.
Treatment centers have been pre-identified by the Michigan Department of Community Health.
Neighborhood Emergency Help Centers have been identified by the planning partners. The
Regional MEMS planning group is in the process of signing mutual aid agreements with several
facilities within Van Buren and Cass Counties.
7.2 Treatment Centers
Van Buren County Locations:
Bronson-Lakeview Hospital
408 Hazen Street, Paw Paw, MI 49079
Emergency Services Coordinator: Kirk Richardson 269-657-1535
South Haven Community Hospital
955 S. Bailey, South Haven, MI 49090
Emergency Services Coordinator: Dr. Owens 269-637-5271
Cass County Locations:
Borgess-Lee Memorial Hospital
420 West High Street, Dowagiac, MI 49047
business profile | phone | map & details
Emergency Services Contact: Marilyn Ballentine, 269-782-8681 x4353
Emergency Department: 269-783-3000
Lakeland Regional Health Systems – Niles Campus
31 N. St. Joseph Ave. (Map)
Niles, 269-683-5510
Emergency Department, 269-687-1412
106
Treatment Centers (Hospitals) are required to follow guidelines for requesting supplies and
equipment from the Strategic National Stockpile. These guidelines have been distributed and
trained on through the 5th District Medical Response Coalition and the 5th District Healthcare
Planning Board. Annual SNS training will take place to support SNS functions. Guidelines for
requesting material from the SNS can be found in the section 3 folder of this plan. The following
are documents that have been distributed and trained at the treatment centers of the 5 th District.
STRATEGIC NATIONAL STOCKPILE (SNS) REQUEST PROCESS (9/09. OPHP)
STRATEGIC NATIONAL STOCKPILE (SNS) PLAN TEMPLATE (9/09, OPHP)
SNS Order Form.XLS (9/09, OPHP)
7.2.1
Treatment Center SNS Request Process
Each Treatment Center is required, pre-event, to designate the process for and the persons
authorized to request SNS materials on behalf of the facility. These designees should be
recorded in each Treatment Center’s emergency response plan.
When all needed local, regional and state countermeasure response assets are exhausted, a
Treatment Center may request assets from the Strategic National Stockpile (SNS) by facilitating a
request through Regional Medical Coordination Center to the local Emergency Operations Center
(EOC) using the correct forms. When the request is sent to the local EOC, the MCC will ensure
the local health department point of contact is included in the communication. The local EOC will
review the request, gather any necessary additional information to support the request, and
forward it to the State Emergency Operations Center (SEOC). The SEOC will coordinate with the
Community Health Emergency Coordination Center (CHECC) to process the orders. This process
is consistent with the State SNS Plan.
7.2.2
Treatment Center Distribution
At this time, the State retains responsibility for SNS distribution directly to Treatment Centers from
the RSS. Treatment Centers, in cooperation with the Local Emergency Operations Center (EOC),
will assume responsibility for placing hospital orders and tracking inventory received at their
location. Additionally, further allocation and delivery of SNS supplies from Treatment Centers to
off-site locations such as Acute/Alternate Care Centers (ACCs) or other locally determined sites
will be the responsibility of the local jurisdiction.
7.2.3 Treatment Center Receipt of SNS Assets
A DEA registrant must be available to sign for controlled substances at the Treatment Centers.
However, there are no licensing requirements for an individual to sign for non-controlled
substances. The Office of Public Health Preparedness (OPHP) recommends that the individual
signing for receipt of the SNS assets should be working under the delegated authority of the
Treatment Center receiving the supplies. The individual receiving assets from the RSS delivery
driver will be required to sign a SNS State to Local Transfer Form (attached).
107
7.2.4 Treatment Center Inventory
Shipments from the RSS to the Treatment Center will contain a copy of the original SNS Item
Order Form (with the type and quantity of items included in the shipment) and a State to Local
Transfer Form.
If a Treatment Center distributes supplies to other locations (such as an ACC), the Treatment
Center must track the delivery location, type, quantity, and lot numbers of the distributed assets.
7.2.5 Recovery of Durable Goods
The Centers for Disease Control and Prevention (CDC) requires that only durable goods be
recovered after an event (i.e. if the material plugs in, runs on batteries, or has wheels). The State
is responsible for recovery of these items and will arrange for pickup at the Treatment Centers. A
good inventory management system is necessary, since Treatment Centers will be responsible for
locating the durable goods provided by CDC
7.3 NEHC’s
Possible NEHC Locations for Van Buren County:
**Bronson-Lakeview Outpatient Center
Heathcare Parkway
Paw Paw, MI 49079
269-657-2550
**Lakeview Medical Center
52375 North Main Street
Mattawan, MI 49071
269-668-5050
business profile | phone | map & details
Lakeview Medical Center-Lawton
310 White Oak Road
Lawton, MI 49065
269-624-2031
phone | map & details
South Haven Family Physicians PC
930 Blue Star Highway
South Haven, MI 49090
269-637-1115
phone | map & details
business profile | phone | map & details
**Intercare Community Health Network Medical
308 Charles Street
Bangor, MI 49013
269-427-7967
**Intercare Community Health Network Southside Family Health
11637 M 140
South Haven, MI 49090
269-637-5284
phone | map & details
phone | map & details
Cooper Medical Clinic
520 Railroad Street
Bangor, MI 49013
269-427-5811
**South Haven Community Hospital
955 South Bailey Avenue, South Haven, MI 49090
http://www.shch.org
more info phone map
phone | map & details
** Denotes that communications and mutual aid agreements are underway.
108
Possible NEHC’s for Cass County:
**Lee Memorial Medical Group
310 North Front Street
Dowagiac, MI 49047
269-782-8696
Edwardsburg Medical Clinic
27082 Main Street
Edwardsburg, MI 49112
269-663-8288
business profile | phone | map & details
Immediate Care Center
1903 South 11th Street
Niles, MI 49120
269-445-3874
business profile | phone | map & details
Lakeview Medical Services
110 East Main Street
Marcellus, MI 49067
269-646-5004
business profile | phone | map & details
business profile | phone | map & details
7.4 Local Health Department Coordination
Each treatment center will have and assigned local health department liaison present. It is the
responsibility of the liaison to ensure that treatment centers are following public health protection
measures. The LHD liaison will be responsible for communicating with the local EOC and the
Public Health Leadership Team.
109
8. Inventory Management
8.1 Inventory
Inventory of pharmaceuticals and supplies received is the Logistics Chief’s responsibility.
Discrepancies (excess/deficiency or wrong medications/supplies) between the order and delivery
require the POD Site Manager/Incident Commander and Administration/Finance Chief to be
notified. The Logistics Chief in turn will contact the RSS and/or DN for reconciliation.
Periodic Inventories of controlled substances will be conducted. Other Push-Package materials
will be inventoried at a frequency set by the POD Manager (or Logistics Chief).
8.2 Inventory Documentation
The delivery invoice is checked, signed off by the Medical Director (due to controlled substances)
or his (qualified—in writing) designee and the POD Site Manager/Incident Commander, with
copies furnished to the Logistics Chief, Administration/Finance Chief, RSS, and EOC.
Upon receipt of the shipment at the DN, from the RSS, the SNS State to Local Transfer Form
must be filed for record keeping purposes. The copy of the original local SNS Order Form with the
type and quantity of items shipped must be compared to the actual items received and filed for
record. All SNS assets received from the RSS must be documented in an Excel Spreadsheet.
This includes durable goods, such as Push Package containers. These will need to be tracked
and returned to the CDC as indicated. All items received must be catalogued with a description of
item received; quantity received, and lot numbers of items.
An Excel Spreadsheet should be created for each individual dispensing site. At the DN, upon
breaking the SNS assets into POD site specific quantities, record the description, quantity, and lot
numbers of materiel designated for each dispensing site. Any changes made to site specific
assets must be recorded on the appropriate spreadsheet(s). As items are delivered to the
dispensing site, record on the spreadsheet and update quantities.
Each POD site will record the description, quantities, and lot numbers of items received from the
DN, as well as requests made to the DN for materiel, and material use within the dispensing site.
A sample database and spreadsheet are available.
Further documentation and control of the Excel spreadsheet, with which control and
documentation are managed, is controlled by the DN/POD Inventory Manager.
110
8.3 POD Inventory Staging
POD delivery points are coordinated between the POD (IC/Site Manager) and the PH EOC
(Logistics Chief). The delivery points will be identified clearly with signage to avoid unauthorized
use.
8.3.1 Unloading
The Logistics Chief will coordinate to ensure (depending upon the POD site(s) selected) that if
needed, each POD will have the necessary material handling equipment (MHE) such as a pallet
jack and/or forklift, to unload supplies if a loading dock is not available. MHE is requested from the
EOC, via the PH EOC.
8.3.2 Distribution and Redistribution
If multiple PODs are used, the DN will sort and rearrange the Push Package’s contents to meet
each POD’s initial and projected needs, as projected by the Planning Chief, based upon input
received from the DN and POD(s).
8.3.3 Chain of Custody
To ensure controlled materials are properly tracked when the SNS materials are redistributed to
one or more PODs, the VBCDHD Chain of Custody Form may be utilized in the absence of CDC
or state forms.
8.3.4 Resupply
The Logistics Chief will monitor Push-Package and internal VBCDHD stock levels as reported by
the POD Manager(s) and the DN Manager.
Resupply of SNS items will be ordered using the forms found in Section 3. forwarded through the
EOC to MDCH. Or, if MDCH requests, directly to CDC.
The regular updates at each staff location (EOC, PH EOC, DN, POD) and the twice-daily shiftchange meetings will inform the Incident Commander and staff at all locations of anticipated
shortages or losses.
The logistics Chief will normally request re-supply of all other categories of materials through the
EOC, with OPHP coordination.
8.4 Recovery
Inventory all:
■ Unused meds/vaccine and supplies
■ Specialized cargo containers
■ Refrigeration systems
■ Unused medications that can be verified for proper temperature maintenance
■ Generators (if borrowed)
■ Computer and communication equipment, as applicable
■ Prepare to return all applicable items to the RSS in labeled boxes/containers
■ Prepare to return all unopened boxes to the RSS or Distribution Node
■ Clean POD facility (if not contracted): remove debris, personal items, medical
supplies/equipment, biowaste
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Remove VBCDHD or County equipment brought to the POD: e.g. tables, chairs, computers,
communication equipment, etc.
Notify the POD owners when the facility is vacated. Provide them with VBCDHD contact
information.
The site manager will be responsible for collecting an inventory of all unused medications/vaccine
and supplies. All materials will be boxed and labeled and returned to the RSS site. These unused
materials will be packaged in the specialized cargo containers supplied by CDC. Cold-chain
management must be maintained for all refrigerated material. All refrigeration systems must be
returned to CDC. Notification to the site Point of Contact once the facility is vacated. The TARU
will also be responsible for assisting in the recovery of unused SNS materiel.
9. Communications
In the event the SNS is deployed, rapid and effective means of communication must exist
between the RSS warehouse, the Local Distribution Node, all dispending sites, treatment centers
and distribution vehicles. A SNS Site communications matrix can be found in Appendix L.
9.1 Risk Communications
During a large-scale public health emergency, it may be necessary to dispense medication quickly
and efficiently to the population of Van Buren and/or Cass County, requiring the activation of the
Strategic National Stockpile. During such an event, the Public Information Team will prepare and
distribute information about the biological agent involved, and will provide instructions for obtaining
medication – both for those who are well and for those who are sick. To ensure consistency,
communication activities for a mass medication event will follow the guidelines and procedures
outlined in the VBCDHD Risk Communication Plan. However, the following information will be
included in communication materials specific to a mass medication event:
Information about the agent and its threat to the public including:
 Whether or not the agent is contagious
 Who should be concerned about exposure
 Who should seek prophylaxis at dispensing sites
 Who should seek treatment at treatment centers
Directions to and information about dispensing site locations including:
 Hours of operation
 Most accessible route to each dispensing site
 Modes of transportation available to dispensing sites
 Information about the dispensing process
 What types of identification are needed
 What type of information is required to pick of medications for other family members:
For Children: weight, age, health information, drug allergies, and current
medications
For Adults: health information, drug allergies, and current medications
Medication information the public will receive at the dispensing site including:
 Reasons for using specific drugs or changing drug regimens
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



Importance of taking all of the medication
Danger of over-medicating
Twenty-four hour contact information for medication questions
Medication is intended for humans and not pets
Samples of these communication pieces are dispensing site video scripts, medication fact sheets,
agent fact sheets. Materials will be supplied as needed by the health department and the
supporting facility (dispensing site) or requests from the EOC. These can be found in the CERC
Plan and in the Public Information annex of this plan. Spanish documents from the CDC are also
available. Additional resources can be found in Local SNS CERC Materials.
The Public Information Officer for the Van Buren/Cass District Health Department is Rick
Johansen, MD. The secondary PIO is Emily Diederich. Contact information for these individuals is
found in the introduction to this plan.
The VBCDHD Risk Communications Plan can be found the office of the Risk Communications
Specialist for Van Buren/Cass District Health Department. This plan includes a list of local media
that will be used for the dissemination of public information in the event of an emergency. Media
Contacts can be found in Appendix C of the CERC Plan. Immediate communications contact
information is updated quarterly and can be found in Appendix L of this plan.
9.2 Public Information Center
A public health liaison will be placed at each dispensing site/node. This representative will report
to the Communications Chief, see Command & Control for more details. The PIC liaison is
responsible for:
 Coordination of information at the dispensing site
 Serve as the Point Of Contact for on-site media
 Handle public information messages
 Handle public information methods
 Handle public information materials
During a large scale event the local public information center may be combined with other
agencies to create a Joint Public Information Center (JPIC). The JPIC or PIC will be in direct
communications with the State PIC. More information on the JPIC can be found in the CERC
plan.
9.3 Production of printed material
Printed material for a dispensing site function will be available on a CD-ROM for each site to
ensure continuity of information. Dispensing site facilities have agreed upon (in a MOU) to
produce forms, patient education and other material as needed for dispensing site activities. Both
pre-designated dispensing sites have mass production/reproduction facilities and equipment on
site.
9.4 Communications Support
Information for dissemination to the public will be delivered through the Joint Information Center
established by the Emergency Operation Center. The Joint Information Center is determined at
the time of the emergency. This facility is designed to allow media outlets to hear one message
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prepared by multiple agencies. The information will be disseminated through press releases,
briefings, and the Emergency Alert System. Public information will NOT be released in any other
capacity.
The SNS Program requires many supplies and materials to launch a successful dispensing site
operation. These supplies and materials may include printed educational material, educational
videos, patient information sheets, patient instructions, signs, labels for medication, etc. Many of
these supplies will be provided by the local health department. Those supplies that are not
provided by the MDCH/OPHP as part of a statewide emergency, the local health department will
notify the Emergency Operations Center of these needs. The EOC has a resource list that
provides s and resources to the EOC in the time of need. Some of the needs may be met by the
host site, such as printing and Technology resources.
9.5 Operational Communications
Establishing Redundant Communication
In the event that some methods of communication are inoperable due to loss of broadcasting
towers, power disruptions, etc., it is vital to have redundant communication mechanisms from, and
between, all parts of the SNS system. The SNS system in this context means the Receipt,
Storage and Staging Site, the RSS warehouse, the vehicles transporting stockpile material, all
dispensing sites and all treatment centers as well as the EOC.
The following will be the hierarchy of establishing communications between the RSS, dispensing
sites and treatment centers, in descending order:
1. Landline telephone service with fax capability.
2. Cellular telephone service.
3. Email/internet capability. Internet service should be of the highest speed available at that
particular site. (E-TEAM, EMSystem, WEB EOC, MI-HAN, etc)
4. Statewide 800 mhz radio system.
5. RACES Amateur radio operations.
6. Two way radio linkage within dispensing sites and treatment centers.
7. Manual runner messaging service.
All distribution vehicles shall be equipped at minimum with two way radios connected to the
Distribution Node warehouse. The Site Manger will be equipped with a radio connected to the
EOC, if needed. The EOC representative will be responsible for establishing communications
between the Distribution node, Dispensing Site, Treatment Centers, Local Health Department,
SEOC, CHECC etc.
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Communications Pathways are as follows:
SEOC/CHECC
Local EOC
Local
Health
Department
EOC
Security
Command
&
Control
Transportation
Resources
Distribution
Node
Treatment
Centers
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10. Security
Law enforcement and trained supervised volunteers will make up the team that will be responsible
for security at all fixed sites within the SNS operations. Security Coordinator has been identified as
the law enforcement representative at the local EOC. Contact information is kept confidential.
10.1 Transportation Security
U.S. Marshals shall supply security for the SNS shipment and the TARU while it is en route to the
Regional Receipt, Staging, & Storage Site. They will also provide security for any unreleased SNS
material. Distribution transportation routes will be patrolled by the Michigan State Police. Limited
law enforcement personnel may be available to escort distribution vehicles delivering
pharmaceuticals beyond normal highway patrolling from the RSS to the Distribution Node and
finally to the Dispensing site.
10.1.1
Escort of SNS material
The local Sheriff’s Department has county wide jurisdiction and can accompany any shipment
from the RSS and/or Distribution Node to Dispensing Sites or Treatment Centers or other sites
that may need SNS material. It is the responsibility of the EOC to maintain secure transportation
for the material of the SNS.
10.2 Security Needs
Local security at the dispensing sites and treatment centers shall be the responsibility of the
Sheriff’s Department of the county affected. Local security will be coordinated through the local
county EOC. Security of medications and materials of the SNS program may be maintained by
the local Sheriff’s Department.
Security for the dispensing sites and treatment centers will be in direct control of the law
enforcement commander (as part of Unified Incident Command). Law enforcement needs will be
address and met by the resources of the EOC.
Coordination of activities with the U.S. Marshals, Michigan State Police, County Sheriff
Departments, and the EOC of the affected county will be the responsibility of the security team
coordinator. This coordination will be conducted through the EOC and the Site Manger.
The RSS warehouse, dispensing sites and treatment centers may need 24 hour security for the
duration of the SNS operations. The number of personnel required will be determined by the size
of each individual operation. 2009 H1N1 response events proved to be a true test for security
needs. It was determined that each venue for dispensing activities is unique and may only require
minimal security needs. It was also found that security personnel was best determined and
planned for in the site specific security plans.
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10.2.1
Crowd Control
The law enforcement representative in the local EOC will be the Security Coordinator for
Dispensing functions. The on-site security personnel will arrange for additional resources for
crowd control if necessary.
10.3 Training and Communications
Assuming law enforcement personnel will be in short supply, trained volunteers with supervision
and adequate two way radio communications should suffice at the dispensing sites and treatment
centers. All commanders will be trained and equipped with the communications methods
established by the EOC. Additional information on communication methods and redundant
communications can be found in the Communications section of this document. All law
enforcement personnel will be equipped with 800 MHz radios that have direct communications
with the state and local entities.
Contact information for security personnel can be found in the Quick Reference Guide in the
Introduction section of this document. The personnel responsible for security would be the
Emergency Manger for the county and Michigan State Police.
10.4 Access Control
The area which needs access controlled to it is determined by the personnel coordinating the
response, including Public Health or Law Enforcement Officials. It is then the law enforcements
responsibility to limit access to the area for security and safety purposes. It will be assisted by the
Public Works organization and/or Fire Services. In addition, Act 390, P.A. 1976, as amended,
gives the Chairperson, Board of Commissioners authority to issue travel restrictions on local
roads. The Michigan Department of Transportation and State Police coordinate the restriction of
travel on state truck lines through formal written agreement.
 Barricades – All routes leading into the area must be blocked. Major routes are
barricaded and may be staffed by law enforcement personnel. Secondary roads are
simply barricaded with appropriate cautionary language.
 Traffic rerouting – The Van Buren and/or Cass County Sheriff’s Office will coordinate with
the Van Buren and/or Cass County Road Commission in rerouting traffic around the
affected area. Appropriate detour signs are put in place.
 Entry to Controlled Area – The Director of the Office of Domestic Preparedness has
developed badges for all emergency workers. These will be distributed to each
organization responsible for coordinating field personnel, including public health. It is the
responsibility of each agency to ensure that each of its employees working in the field in
the affected area has a pass.
10.5
Badging/Credentialing of Staff
Controlled areas of the dispensing site and/or distribution node will be controlled by the Office of
Domestic Preparedness. The Sheriff’s Department currently is using the system of FireTrax or
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other form of acceptable identification. This system would be used to badge all emergency
workers during an event. The credentialing process would be initiated by using the MIVolunteer
Registry, which pre-credentials individuals already in the system. Those individuals NOT
registered with MIVOL Registry would be subject to a holding period of 1-3 hours to determine
proper credentials if necessary. The LHD also has a Mutual Aid Agreement with all of the other
health departments within the 5th District. Several health departments within the 5th District have
purchase quick print identification systems. These systems would be available upon request.
10.6
Rules of Engagement
Below are policy statements from the Michigan Department of Community Health regarding the
rules of engagement for law enforcement during times of emergency and the Strategic National
Stockpile are requested. The following document was released to the local health departments by
Karen Krzanowski in 2006. (This has not been updated as of 2/2010).
Policy issues to support SNS operations are outlined in plan:

Rules of engagement for law enforcement
In the process of completing the State Assessment Tool for the CDC Division of
Strategic National Stockpile (DSNS), Michigan’s SNS Coordinator asked the Division for
clarification regarding what is expected in this part of the plan. She was advised that
the plan should address:

The level of police power that is available to maintain law and order in a
public health emergency.

When law enforcement officers are authorized to arrest, detain, or use force in
carrying out State and local codes related to a public health emergency.

Provide guidance to local health departments to consider a variety of
scenarios in relation to deployment of the SNS and what situations could
require police use of force.22
According to the State of Michigan Plan for Distribution of the Strategic National
Stockpile, the Governor will declare a state of disaster, state of emergency, or a
heightened state of alert before or concomitant with a request for the Strategic National
Stockpile (SNS). Therefore, law enforcement officers will engage as provided for in the
Emergency Management Act.23 A person who willfully disobeys or interferes with the
implementation of a rule, order, or directive issued by the Governor under the
Emergency Management Act is guilty of a misdemeanor.24
Regarding the use of force during a public health emergency involving the SNS, law
enforcement officers will operate according to their legal authority. In general, a warrant
or court order may be in effect before a law enforcement officer makes an arrest,
detains an individual, or uses force. However, law enforcement officers have the legal
22
Email messages between Joseph Merlino, of the DSNS, to Susie Doctor, of MDCH-OPHP, September 1, 2006.
MCL 30.401 et seq.
24 MCL 30.405
23
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authority to make arrests without warrants for all violations of the law committed in their
presence.25 In addition, public health and law enforcement officials (state and local)
may develop additional guidelines to assure the security and safe operation of SNS
facilities and dispensing sites.
In addition to the Emergency Management Act, the Public Health Code26 is expansive in
public health police powers. The Code includes explicit legislative intent that it be
liberally construed to protect the health, safety, and welfare of the people of this state. 27
The structure of the Code provides parallel authority to the state health department and
to Michigan’s 45 local health departments. A range of public health police powers is
authorized to assure that different circumstances can be properly addressed. Parts 22
and 24 of the Code provide basic authority for state and local health officers, including
the power to respond to imminent danger to health by orders, quarantines, or
administration of local laws.
If a health officer (state or local) thinks there is an imminent danger to health or lives,
the health officer has the authority to issue orders that take effect immediately, without
going to court first.28,29 In addition, if a health officer determines that control of an
epidemic is necessary to protect the public health, the health officer, by emergency
order, may prohibit the gathering of people for any purpose and may establish
procedures to be followed during the epidemic to insure continuation of essential public
health services and enforcement of health laws. 30,31 Furthermore, imminent danger
orders and emergency orders to control an epidemic may be directed to law
enforcement officers. The Department of Community Health recognizes that law
enforcement officers need more training about public health orders and their duty to
enforce them; and the department is working with the Michigan State Police,
Emergency Management and Homeland Security Division to assure this training occurs.
There are several enforcement mechanisms available under the Public Health Code.
The Code stipulates that “A person shall not willfully oppose or obstruct a department
representative, health officer, or any other person charged with enforcement of a health
law in the performance of that person’s legal duty to enforce that law.” 32 A person who
violates this law is guilty of a misdemeanor.
In general, a person who violates a rule or order of the Michigan Department of
Community Health (DCH) or of a local health department is guilty of a misdemeanor
25
MCL 28.6 (5)
MCL 333.1101 et seq.
27 MCL 333.1111
28 MCL 333.2251
29 MCL 333.2451
30 MCL 333.2253
31 MCL 333.2453
32 MCL 333.1291
26
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punishable by imprisonment for not more than 6 months, or a fine of not more than
$200.00, or both.33,34
Health officers (state and local) have the authority to use injunctive measures to protect
public health.35,36 In addition, the Public Health Code provides an administrative
mechanism by levying fines of up to $1,000 per day or per violation according to a
schedule created by rule.37,38 This provides an alternative to criminal proceedings in the
courts, and it imposes a continuing monetary burden on violators, making it
uneconomical to continue to violate the law or rules.
33
MCL 333.2261
MCL 333.2441
35 MCL 333.2255
36 MCL 333.2465
37 MCL 333.2262
38 MCL 333.2461
34
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Scenarios
The DSNS posed the following questions and scenarios that State and local health
officers, law enforcement officers, and legal counsel should consider and jointly plan for.
Staff of the MDCH Office of Public Health Preparedness suggests preliminary
responses here to stimulate such planning discussions:
1. Should security apprehend violators of public health statutes during this emergency
public health situation?
Response: Law enforcement officers (LEOs) have the discretion to arrest and
detain violators of public health statutes, rules and orders. They make decisions on
a case-by-case basis according to information received and the belief that a crime
was committed. In general, a person who violates the Public Health Code or the
Emergency Management Act is guilty of a misdemeanor.
2. If a person violates state or local health department directives (i.e., isolation and
quarantine)?
Response: Same as #1.
3. If they cause civil disturbance or public panic by false representations or information
clearly against the good order and community standards?
Response: Same as #1. In addition, the source of false representations or
information must be considered. For example, in individual could be guilty of inciting
a riot. However, if the individual is broadcasting false information, the broadcaster is
not only personally culpable, but could also be subject to broadcasting license
sanctions.
4. If hording or engaging in black market activities involving vital state resources that
are intended for equal distribution to the general public, such as the re-sale of
medicines or medical instruments provided by the State in support of this public
health emergency?
Response: With respect to the SNS, which is a vital state resource, such activities
not only violate the Emergency Management Act, they may also involve violations of
the Penal Code.
5. If failing to appear at PODs or other dispensing sites in accordance with the
Governor’s or State Health Officer’s mandate for citizens to appear and receive
medicine or prophylaxis?
Response: This depends on the situation. For example, in some cases law
enforcement officers might be called-on to apprehend and transport such individuals
for involuntary treatment or prophylaxis. In other cases, law enforcement officers
could be called on to prevent such individuals from entering certain public places,
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such as schools, if they refuse to be vaccinated and, therefore, pose a health threat
to others.
6. If loitering in an around sites deemed sensitive to the State execution of the
functions mandated to be carried out (i.e., RSS site, PODs, JICs)?
Response: Security procedures for PODs and other dispensing sites include
appropriate signage and barricades. If a person crosses such boundaries or fails to
comply with a lawful order, then the person can be arrested or detained as a
disorderly person, or for breaching the peace, trespassing, or violation of local
ordinances against loitering.
7. If disrupting the public health operation causing time sensitive measures to not be
carried out or unduly burdensome?
Response: Same as #6.
8. Cutting lines in the POD, following distribution vehicles on routes or other locations,
interfering with communications of staff (i.e., cell phones, radios, other reporting
mechanisms)?
Response: Same as #6.
9. If they break curfew if announced or in place?
Response: Same as #6.
10. Before a person is detained or arrested, do they get their medicine/prophylaxis?
Response: This depends on the situation and will have to be handled on a case-bycase basis. In most cases, medicine/prophylaxis will be given to the individual as
soon as possible. Protection of the law enforcement officer must be assured.
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11. Transportation
11.1 Intra-jurisdictional Coordination
Coordination of transportation of SNS material will be handled by the EOC staff. Currently there
are mutual aid agreements in place between counties and Emergency Management to provide
services where needed during an emergency. The transportation of SNS material falls under the
direction of the Incident Commander. The Incident Commander coordinates with EOC staff to
arrange for appropriate delivery of SNS material to dispensing sites and/or treatment centers. This
transportation request will include the security of the transport vehicles.
11.2 Communications
Communications between escorts, drivers, security personnel, dispensing sites, EOC, treatment
centers will utilize 800mHz system or other secure system established by Incident Command and
the EOC. In the event that there are not enough 800 mHz radios to occupy each vehicle, other
systems will be used. These may include traditional two-way radios, cell phones, etc.
11.3 Transportation Issues
As the plans are implemented at the EOC to arrange for transportation of SNS material, a tracking
mechanism will be put into place. This tracking mechanism may be as simple as two-way radios
and periodic check points for transportation vehicles, or as complex as web tracking devices
placed on transportation vehicles. Public works will be responsible for setting up road blocks and
diverting traffic with the assistance of law enforcement. This coordination will take place from the
EOC to the Incident Command Post. Other players that may be involved in transportation issues
are M-DOT, local fire, law enforcement, and other security personnel. Vehicle maintenance and
refueling will be the responsibility of the Transportation Official in the EOC. These duties are
typical duties of the transportation official.
The county Emergency Operations Plans outlines many of the factors for transportation including:
“Maintenance of Transportation Routes: Public works agencies will assign personnel to
make a reasonable attempt to maintain transportation routes on Van Buren county roads are clear
of snow, debris, and other obstructions which may impede emergency vehicle access and rapid
traffic movement during an emergency or disaster situation. Stalled, abandoned or vehicles in
need of repair, that are obstructing the flow of traffic will be reported to the appropriate law
enforcement organization for removal.”
“Transportation of Goods: Public works will provide vehicles and personnel to transport
essential goods such as food, medical and other supplies. This will be accomplished as a support
service, if available, at the request of other agencies, such as the Health & Human Services
Department.”
“Traffic Control: The law enforcement organization has primary responsibility for traffic control.
The public works organization may assist by providing and placing barricades and appropriate
signs and light signals to keep traffic moving on designated routs.”
Special Needs/Handicapped: Special needs populations or those individuals who require
handicapped parking will be instructed to park at an off-site facility and be transported to the
dispensing site by special needs transportation vehicles.
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12. Human Services
12.1 Care and Feeding of Disaster Workers
Disaster workers responsible for distribution of SNS material fall under the Emergency
Management Act of 1976 for care, feeding, and mental health services. All disaster workers are
entitled to manageable work hours (no more than 12 hours at a time), regular meals (coordinated
through the EOC), and mental health services (coordinated through the EOC/Human Services
section). Disaster mental health services including Critical Incident Stress Debrief will be provided
by the local coordinating agency for mental health services. The American Red Cross is
responsible for feed and care of disaster workers.
12.2 Van Buren County Emergency Operations Plan Support
The Van Buren county Emergency Operations Plan supports all disaster assistance for
emergency workers. Annex K (Human Services) to the Van Buren County Emergency Operations
Plan pages K2-K3 describe the tasks and execution of the Human Services Department. These
tasks include but are not limited to:

(A) Crisis Counseling (for Public and Emergency Workers)
“If an emergency/disaster occurs of such a magnitude that it is determined victims may need counseling, Van
Buren County Mental Health will provide crisis counseling. If the disaster is severe and many persons may be
in need of this service, the Department of Human Services along with Van Buren County Mental Health will
assign personnel to reception centers to provide crisis counseling.
Van Buren County Mental Health has people trained in providing incident stress debriefing to disaster
workers. This agency will provide counselors to departments who request this service. Coordination of this
service with affected department personnel will be provided through the Van Buren County Department of
Human Services and the department involved. In addition, personal will be at the scene to provide immediate
assistance if necessary.”

(B) Reception Centers
“If evacuation is necessary or if people are made homeless by a disaster, they will register at the reception
center. At this location they will inform officials if they have a need for shelter, or if they plan to stay with
friends and/or relatives. This information will be known to the Missing Persons Information Center (J) and will
be used to account for the safety of the population and inform residents when it is safe to return to the area
after an evacuation. “

(C) Shelters
“The Van Buren County Department of Human Services is responsible for shelter function. Shelter may be
necessary for a short term precautionary evacuation for incidents such as a chemical release, or for longer
term evacuations for disasters which leave people homeless. For short term sheltering needs the Van Buren
County American Red Cross will establish and manage the shelters. Agreements exist between the Red
Cross and the Public Schools and churches (designated as shelters) for the use of these facilities. Food will
be provided by the American Red Cross. Special needs (medical, dietary, animal control, etc) are arranged
through the American Red Cross as part of shelter management. Communications will be provided by
telephone and amateur radio. “

(D) Food
“The ARC with possible assistance from the Salvation Army, will establish areas at the disaster site for
feeding emergency workers and victims of the disaster. These resources are activated by the VBC
Department of Human Services.”
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
(E) Clothing
“The ARC will provide a dispersing order for clothing to meet emergency needs. If more clothing is needed,
other agencies (i.e. Salvation Army, Seventh Day Adventists, Cooperative Ministries, Friends of Decatur
Human Services) will be contacted by the Red Cross. The mechanism for distributing this cash or clothing is
governed by each agency. Longer term clothing needs for disaster victims may be determined at Disaster
Application Centers (DAC) if activated.”

(F) Emergency Needs Programming
“The Van Buren County Department of Human Services provides coordination of the emergency needs
program to be implemented on an individual or widespread basis. Many immediate needs such as food,
clothing, and household items are provided to eligible persons through a variety of programs and agencies.”

(G) Staging Area for Emergency Workers
“The Department of Human Services will establish a staging area for collection of items and personnel
assignments. Food, clothing and other items will be brought to this facility and sorted by workers from the Red
Cross, Salvation Army, and other volunteer agencies. Distribution of these items will be based on information
obtained from the Department of Human Services and if long term from the Disaster Application Center. The
individuals who need these items will be notified that these items are available by the DHS and ARC. Public
information announcements will be made if needed. …”

(H) Transportation (Public, Emergency Workers, and Special Needs Populations)
“The Van Buren County Intermediate School District will coordinate the provision of public transportation.
Persons needing transportation are instructed to call a telephone number to be determined at the time of the
incident. The Human Services Official will coordinate with Public Information Official to assure the public is
aware of the number to call if they need transportation. Also, in accounting for the safety of the population by
a house to house search during an evacuation or after a disaster, law enforcement officials will inquire as to
the sheltering and transportation needs of disaster victims. This information will be made available to the
Human Services Official. School and Van Buren Public Transit buses will be used to provide transportation.
For some disasters which require many emergency workers in a concentrated area, the provision of
transportation to the disaster site may be desirable. It would limit vehicle congestion in the area and more
easily control access. The VBC ISD will choose a location to be used as a meeting point. Emergency workers
will leave their personal vehicles at this location and be bused by school busses to the disaster site. The ISD
will coordinate the provision of transportation. Emergency workers such as hospital or power company
employees may require special transport to their work locations. While the Human Services Official will
coordinate the provisions of such transportation, the resources used will depend on the type of disaster.
Transportation may also be necessary to transport Emergency Operations Center staff and
supplies/equipment from their primary EOC to the alternate EOC.
Each hospital, nursing home or other large institution generally has internal emergency plans, including
evacuations plans. The staff at these institutions will coordinate internal preparatory activities through the
Health Services Official. Institutions requiring the use of ambulances, will notify the Health Services Official
who will coordinate transportation with EMS. … “ The Health Services Official coordinated the evacuation and
relocation of the institutions itself and selects alternate sites.”

(I) Special Needs Groups
“Persons with special needs are provided care through a number of agencies in the community. Van Buren
County Intermediate School District (ISD) works with hearing impaired and can identify and assist these
persons, including warning them of an actual threat or disaster. The Department of Human Services (DHS),
Area Agency on Aging (AAA), and the Health Department work with the elderly and can identify and assist
these persons. The Van Buren County Mental Health and Van Buren ISD work with the mentally impaired and
can identify and assist these persons.
The VB ISD, DHS, and Health Department work with the physically handicapped and can identify these
persons who are known to them. The VB DHS works with the non-English speaking and can identify these
persons. These agencies will perform “outreach” tasks during disasters, contacting their clientele to assure
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they are aware of the situation and their needs are being met. If any of these persons require assistance, the
appropriate agency will work with the Human Services Official to see that the needs are met.”

(J) Missing Persons
“The Red Cross will establish a Missing Persons Information Center at the reception center/shelter. Staff will
be provided by the Red Cross and volunteer agencies. A telephone number for the Missing Persons
Information Center will be given to the Public Information Official who will announce the number to the public
via the news media. Staff will regularly contact agencies such as hospitals and those providing reception and
shelter to obtain available information on the people they are serving.”

(K) Long Term Housing
“The Department of Human Services (DHS) will administer the federal temporary housing program if a
Presidential Disaster is declared. DHS will identify available rental units, or if local housing is unavailable, it
will coordinate with the other local departments in identifying and preparing a site for federally provided mobile
homes. DHS will review eligibility requirements and assign housing.
If federal assistance is unavailable, the department may implement such a program locally if long term
temporary housing is necessary.”

(L) Federal Assistance Programs
“If federal assistance becomes available as a result of a disaster, the Department of Human Services will
administer certain programs. It will review individual and family grant applications for assistance.”

(M) Unemployment Assistance
“The Department of Human Services will coordinate with the Michigan Employment and Security Commission
in providing unemployment benefits to persons who become unemployed if a factory or other employment
center is affected by a disaster, or if persons become unemployed due to some other disaster related
circumstance.”

(N) Volunteer Management
“A volunteer registration center will be established by the American Red Cross. This center will be in an
appropriate location in regards to the situation. Volunteers wishing to assist will be instructed where to call
and the phone number. A hotline number will be made known via the media. The Human Services Official will
coordinate the efforts of all volunteer groups and assign them missions. The official will coordinate with other
members of the EOC staff for possible uses or needs for volunteers. Some volunteer groups directly
associated with an agency, such as the Sheriff’s posse, will remain under that agency’s coordination.”
Associated duties including scheduling of shifts, breaks, meals, lodging and family care are part of the
American Red Cross operations manual.

(O) Emergency Assistance
“If an individual or family requests assistance, such as the delivery of food for medical attention, because they
are isolated due to road washouts, a snowstorm, or other circumstance, the Director of Domestic
Preparedness will coordinate the provision of such assistance. Volunteer agencies under the coordination of
the DHS may be requested to assist. The Sheriff’s office and Local fire departments may also provide some
of these services.”

(P) Disaster Assessment
“All agencies providing human services, report to the Human Services Official in the EOC, figures on number
of people evacuating and registering at reception centers, number of people in shelters, types of special
assistance required, etc. The Human Services Official compiles the data and provides it to the EOC staff.”
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13. SNS Planning/Training/Exercising
13.1
SNS Planning Process
The Strategic National Stockpile Plan planning began with a request from MDCH/OPHP.
This request included a template for developing a local plan. This living document is in
constant revision and is dependent upon many variables. The planning process involves
collaborative meetings with local emergency management, law enforcement, fire, public
works, hospitals, EMS, etc to determine what resources are needed in our jurisdiction to
open a dispensing site. This planning process also includes working with the Administrators
of probable sites to host the dispensing. Mutual Aid agreements will need to be developed
and implemented to make this process complete. As pharmaceutical caches are
established, they will be included in the plan. As other factors change, such as availability of
facilities, contact information, essential personnel, and gross numbers with the VBCDHD
jurisdiction, the plan will reflect those changes.
13.2
SNS Planning Partners
The planning of the Van Buren/Cass District Health Department’s Strategic National
Stockpile Plan consists of many collaborative efforts. The partners involved in this planning
process include:
□
Emergency Management
□
Regional Epidemiologist
□
Local Hospitals
□
Law Enforcement
□
Schools
□
Fire
□
American Red Cross
□
Public Works
□
MDCH/OPHP
□
Region V MEMS Workgroup
□
Region V Bioterrorism Planner
□
Other interested parties
□
Region V Mass Casualty Planner
13.3
Plan Review/Updates
The plan is scheduled for an annual review by the public health leadership team. The plan will
also be updated as identified by exercises or the review process. This is a living document
and will continue to be updated as planning guidance is improved.
13.4
Program Exercises
Tabletop drills and functional exercises involving local county emergency management and
other essential personnel participation will be conducted when possible to improve overall
county readiness. Other exercises will be scheduled in coordination with community
agencies. Annually at least one drill and/or exercise will take place in conjunction with the
county or district-wide exercise program.
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13.5
Training Efforts
Training will occur in individual and group settings. All local efforts will be coordinated by the
Emergency Preparedness Coordinator. Multi-regional efforts will be coordinated by the State
of Michigan. Consistent content to all targeted individuals will be the objective of overall
training efforts. The 5th District is currently implementing a web-based training system for all
health department personnel and volunteers involved in the SNS program. This training
program contains three components: (1) SNS Overview, (2) Medical Management &
Dispensing including job action specifics, and (3) Inventory Management and Control, and (4)
Distribution Node Activities. All health department employees, dispensing site volunteers and
distribution node personnel are required to complete this training. This training module was
used to assist in the April 2009 5th District Mass Dispensing Exercise. Training records can
be found in the training section of CD related to this plan.
13.5.1
VBCDHD Training Efforts
The Van Buren/Cass District Health Department will conduct internal trainings of clinic staff
and related personnel as part of pre-event planning efforts. Training (pre-event or on-site)
must also include use of personal protective equipment (PPE) and relevant infection control
measures, standard operating procedures (SOPs), information on the agent and
prophylactic measures/standing orders, standard reporting procedures, response to outside
requests for information, and patient confidentiality. Standard (Universal) precautions
should be routinely practiced by health care workers/volunteers at the dispensing site.
Hand-washing is paramount. PPE should be disposable and disposed of appropriately.
Local plans will include provisions made for having PPE readily available.
Internal pre-event clinic training will include:
1. Periodic review of the local SNS plan.
2. Review of the clinic schematic for patient flow and work station locations.
3. Roles and functions for each work station. This includes:
a. Scripts for each role
b. Utilizing JAGs for teaching and learning
c. Reviewing Standing Orders
d. Use of forms
4. Communication skills including:
a. Guidelines for handling on-site procedural changes that impact other functional groups
b. Documenting information received via phone
c. Periodic briefing of all staff to clarify misunderstandings, answer questions, and provide
new information/updates
5. Screening Protocols
6. Clinic Supplies and Equipment List
7. Clinic Operations including:
a. Documentation forms: NAPH form, meds/vaccine and recipient tracking
b. Screening tools
c. Patient education materials
d. Referral processes
e. VAERS Reporting
f. Staffing Schedule
g. Organizational structure
h. Signage
i. Taping arrows/lanes/path for clients to follow
j. Numbering stations
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k.
l.
m.
Procedure for victim status monitoring utilizing color-coded system. Provide quick
reference cards to all greeters, registration staff, security, and other relevant personnel.
Procedures detailing client flow, dependent upon prophylaxis regimen
Developing a corps of volunteers to train to function in the majority of dispensing site
functions
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Training of Essential Volunteer Staff
The Van Buren/Cass District Health Department will make efforts to locate and train those
volunteer groups essential to the functions of the dispensing site. Those groups include
doctors, nurses, pharmacists, mental health specialists, security personnel, medical students,
other licensed personnel. The tri-county area (Van Buren, Cass & Berrien counties) utilize
the Volunteer Center of Southwest Michigan for such efforts. This agency has agreed to help
in our efforts to gather volunteers.
MI-Volunteer Registry: The MI Volunteer Registry is a database that functions as a central
location for volunteer information. Individuals interested in volunteering will indicate their
interests and contact information in this secure, electronic environment. Information can then
be queried and appropriate volunteers contacted by authorized personnel via e-mail or text
pager.
The registry intends to help meet the needs of hospitals and emergency responders when
local resources are exhausted. Experience has shown that in an emergency, overwhelming
numbers of healthcare personnel are eager and willing to volunteer their services.
Post Event Training
Post-event training will include the use of on-site manuals equipped with all pre-event training
materials. JAGs will be used to orient each group of personnel to their assigned tasks.
There will be a designated individual on-site at all distribution sites to answer all questions.
Post-event training should occur on-site. Pre-planning will make this process effective and
efficient. Suggested training materials may include: educational videos, job action guidelines,
agent specific information (i.e., fact sheets), samples of accurately completed forms, written
scripts when applicable, and an organizational chart outlining the chain of command and
communication flow. The trainee should be clear about whom to report to regarding
questions. A patient/clinic flow chart should be clearly posted for staff to use as a reference
tool.
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Van Buren/Cass District Health Department
SNS Training Needs Assessment
Please indicate by circling the number that most closely matches your knowledge about the following concepts:
Strongly
Agree
1
Agree
2
Neutral
3
Disagree
4
Strongly
Disagree
5
1
2
3
4
5
1
2
3
4
5
3. I know the procedures that must be followed to request
the SNS from the Federal Government.
1
2
3
4
5
4. I know how long it will take for the SNS to arrive in
Michigan once the request has been approved.
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
9. I know what a Receiving, Storage, and Shipment site
is.
1
2
3
4
5
10. I know what my roles and responsibilities will be when
the SNS comes to my jurisdiction.
1
2
3
4
5
11. I have received Incident Command System (ICS)
training.
1
2
3
4
5
1
2
3
4
5
13. I have received specific POD training relative to my
position.
1
2
3
4
5
14. I know the specific locations designated for PODS in
my jurisdiction.
1
2
3
4
5
15. I know methods of communications that will be used
from a POD to other departments.
1
2
3
4
5
16. I know the concept of triage at a Point of Dispensing
site and why it is important.
1
2
3
4
5
17. I have seen job action sheets that will be used for
positions at a Point of Dispensing site.
1
2
3
4
5
18. I am confident that I will be able to work different
positions at a POD with current knowledge.
1
2
3
4
5
Question:
1. I have received training on the Strategic National
Stockpile (SNS) program and understand it.
2. I know when my jurisdiction may request the SNS.
5. I know what types of items will arrive in the SNS.
6. I know what the Managed Inventory (MI) of the SNS is.
7. I know who the essential personnel are in my
jurisdiction (those who will receive medication first).
8. I know where my agency’s SNS plan is located.
12. I know what a Point of Dispensing (POD) site is.
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