Partners in Preparedness

Volume 2 Issue 2

It Used To Be a Secret!

 Michele McMahon RN, BSN, EMHP
Gwinnett, Newton and Rockdale County Health Departments

Imagine a situation where – either by accident or as part of a terroristic attack – a biological agent such as anthrax is released into our community. It could be at a theater, hospital, mall, large church, or concert venue. No matter the reason or intention of the exposure, the fact remains that this would undoubtedly put hundreds or even thousands of people within our community (Gwinnett, Newton or Rockdale counties) at risk.

In order to save lives, people would need medications immediately. These medications, which used to be part of a top secret program, would be made available from the CDC through the local Public Health Departments.

We now want everyone to know about this important program called the Strategic National Stockpile (SNS). It’s a national storehouse of medical supplies and pharmaceuticals stored for use during emergency situations. All the supplies and medications are free but must be requested by the governor only after local supplies are exhausted.  The CDC can send a large shipment from the SNS known as a “push pack” anywhere in the United States within 12 hours. Examples of some of the products contained in the push pack include antibiotics, antidotes, antitoxins, antivirals, gloves, respirators, and vaccines. Given the fact that the CDC is in our backyard, it is likely that our “push pack” may arrive sooner than the 12 hour timeframe.

The Gwinnett, Newton and Rockdale County Health Departments have a plan in place to receive shipments from the SNS and distribute its contents to our community. The goal will be to dispense the needed medications to our tri-county population (approximately 1 million people) within a 48-hour timeframe. It will not be an easy task and will take coordination with many community partners.  Collaboration among public health, public safety, the school systems, the private sector, faith based and volunteer organizations will play a critical role in the effort to distribute quickly and efficiently. This may seem like a daunting task but is achievable.

In this quarter’s newsletter we’ll share some of the “secrets” behind the SNS.  Gerald Gifford, our Strategic National Stockpile Planner’s article will address what the SNS is and the basics of getting the medication dispensed to the community through “Points of Dispensing” (POD). He is the mastermind who details the how, when, where and why of the planning for the Health Department. Chad Conner, Health Department Communications Specialist, walks us through a successful POD implementation exercise in Gwinnett County.  Carol Dellinger, Assistant Director of Pharmacy at Eastside Medical Center, writes about the CHEMPACK program at the local hospitals. Liz Bitler, Health Department Environmental Epidemiologist, will share some valuable information on one of the Biological Agents that could activate the SNS. We hope to never see the day, but in the words of my brother-in-law, “I’m so glad someone is thinking about and planning for that. I just never knew it existed!”

Strategic National Stockpile – 101

 Gerald Gifford
Gwinnett, Newton and Rockdale County Health Departments

Strategic National Stockpile

The Strategic National Stockpile (SNS) is a national repository of lifesaving antibiotics, vaccines, chemical antidotes, antitoxins and other critical medical equipment and supplies.  It is is managed by the Centers for Disease Control and Prevention (CDC). In the event of a public health emergency involving bioterrorism or a natural pandemic, the SNS can supplement and resupply local health authorities that may be overwhelmed by the crisis, with a response time as little as 12hours.

In the event of an emergency, Georgia’s local public health districts will set up medication dispensing sites (also known as Points of Dispensing or PODs) quickly and in numerous locations to get medicines from the SNS to the people within our community. PODs are community based; they will be easy to find and can accommodate large numbers of people. All medications distributed from PODs are free to the public. During an emergency, POD locations will be announced on television, radio and by visiting the Gwinnett, Newton & Rockdale County Health Departments website at www.gnrhealth.com.

Closed PODs

A Closed Point of Dispensing (Closed POD) site is a private business, hospital, university or faith-based organization that conducts dispensing operations for a specific population, such as employees and their families.Closed PODs are not open to the general public. Organizations participating in the Closed POD program have taken the “extra step” to ensure their members are protected during a health crisis by becoming actively involved in preparedness. Employees of businesses participating in the program are able to continue working or return to work more quickly during an emergency. They also have the added peace-of-mind knowing that they and their families are protected. Closed PODs have the added benefit of taking pressure off the public PODs.

To find out more about the Strategic National Stockpile or the Closed POD program, please contact Gerald Gifford, SNS Planner, at gerald.gifford@gnrhealth.com or by calling 678-442-6917.

PODs in Action: H1N1 Flu Shots at Mall of Georgia

 Chad Conner
Gwinnett, Newton and Rockdale County Health Departments

In fall 2009, Gwinnett, Newton and Rockdale County Health Departments used the H1N1 flu pandemic as an opportunity to exercise Points of Dispensing (PODs). Because the H1N1 flu had reached pandemic levels, the Health Department saw a need to reach a wider population, those that might not normally visit Health Department locations. The Mall of Georgia was chosen as the location to hold the event during the two busiest weekends prior to Christmas 2009 since large numbers of people visit daily.

During event times, signs were placed at two primary mall entrances informing visitors that free H1N1 Vaccinations were available. Greeters explained the vaccine options and provided information on how to begin the process. All vaccines were administered without charge; however, if clients had insurance, then the insurance company was billed an administration fee.

Six nursing stations were set up at the event site with two nurses manning each station. When possible, Spanish-speaking nurses were assigned to at least two stations to meet the needs of our Spanish-speaking residents. A station was also provided to accommodate families with wheelchairs or baby strollers.

Using the methods above, staff and volunteers administered 5,900 H1N1 vaccinations in two weekends using approximately 25 staff per shift.  Around 250 people per hour were served as operations were streamlined. In fact, many clients relayed their amazement that the process was so quick and efficient, with wait times never exceeding 15 minutes.

Through this operation, the Health Department confirmed that an effectively administered POD can provide needed medications to a large number of people.

Chempack at Eastside Medical Center

 Carol Delligner
Eastside Medical Center

Eastside Medical Center is proud to partner with the local Health Department’s Emergency Preparedness Team by storing a CHEMPACK container in our facility.  CHEMPACK, part of the CDC’s Strategic National Stockpile, is a nationwide initiative for the placement of nerve agent antidotes in local communities. There are over 1,900 containers strategically distributed across the United States.  The CHEMPACK program, first initiated in 2004, places critical and life-saving antidotes in communities where they will be readily available to emergency medical personnel treating individuals exposed to intentional nerve agent attacks or large-scale organophosphate (pesticide) poisonings.

Eastside Medical Center is a host facility for a CHEMPACK container, which contains enough nerve agent antidote (atropine, pralidoxime, and diazepam) to treat a large number of victims. Our role in partnering with the Health Department’s Emergency Preparedness Team is to provide security and proper storage for the CHEMPACK, ensuring antidotes are safe and effective if needed.  If the CHEMPACK container needs to be deployed to another site, our staff is available 24 hours a day to assist.  Our pharmacists are prepared to act in an emergency situation, not only in handling drug distribution, but also in providing drug information to ensure exposed patients are treated appropriately.

Hopefully, the CHEMPACK container will never need to be opened, but if so, Eastside Medical Center has the assets available on site for a quick response, whether an agricultural accident involving organophosphate pesticides or a terrorist attack involving the nerve agent sarin.  Having the CHEMPACK readily available in the event of an emergency situation benefits our local community and the patient population we serve, as well as our hospital staff and their families.

Biological Agents: Activate the SNS!

 Liz Bitler
Gwinnett, Newton and Rockdale County Health Departments

Bacillus anthracis, or anthrax, is a bacteria known for its role in the bioterror incident of 2001. One week after the September 11 attacks, letters containing anthrax spores began arriving at media outlets and congressional offices. The culprit’s intentional release of the weaponized spores sickened at least 22 individuals, five of whom died.  The incident created panic that continues today.

Anthrax spores occur naturally in the environment, and affect both humans and other animals. Anthrax can be weaponized, increasing the bacteria’s ability to spread and cause increased injury and death.  People (and animals) can become infected in one of three ways, each of which results in a different type of illness.

• Physical contact between the skin and spores can cause cutaneous infection if the spores penetrate a wound or abrasion, resulting in a painless ulcer. This is the most common type of anthrax infection and is generally naturally occurring.
• Ingesting anthrax spores can cause gastrointestinal (GI) infection, resulting in nausea, vomiting, loss of appetite, and fever.
• Breathing in spores can cause inhalational infection, resulting in cold-like symptoms and difficulty breathing.  This is the primary method for weaponized anthrax.

Anthrax causes serious illness, and the death rate is high for the most severe form, inhalational anthrax. However, treatment includes common antibiotics, and early treatment reduces the risk of severe complication.

So how do we identify people who may be infected and provide early treatment? Although some anthrax cases do occur naturally, any cluster of cases in place or time could indicate an intentional release of anthrax. Anthrax cases are extremely rare in the United States, and all reported cases are thoroughly investigated by Public Health and law enforcement. If cases are identified, epidemiologists work to determine common exposures and to identify other individuals that may have been exposed. Anthrax is not spread from person to person, so someone must be directly exposed to the spores to become infected. If an exposure is identified, Public Health, in partnership with CDC, will work to provide preventive treatment to limit the severity and progression of illness. CDC has stockpiles of antibiotics in the SNS that can be utilized for rapid treatment of exposed populations.

Continued communication and education regarding anthrax detection, investigation, and treatment are essential. Public Health works to develop relationships with public and private entities, as well as law enforcement. Should an anthrax event occur, these relationships will be invaluable as our community responds.