I.6.1. Federal and State Medical Countermeasures and Supplies, Including the Strategic National Stockpile

Available Federal assets are designed to supplement and resupply State and local public health agencies when State and local reserves are at risk of depletion. They include the Strategic National Stockpile (SNS), a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items. Federal medical countermeasures (MCM) and supplies, e.g. SNS, must be requested jointly by public health and emergency management designees as delineated in the State SNS Plan.

SNS comprises:

12-Hour Push Packages: Large caches, in undisclosed locations across the U.S., designed for rapid delivery of a broad spectrum of assets in the early hours of an incident; committed to deploy to a designated local site within 12 hours of the Federal decision to release them.
Managed Inventory (MI): MCM, equipment, and supplies managed by pharmaceutical vendors under contract; deployed as 24–36 hour follow-on to Push Packages as needed, or initially with a well-defined threat.
Federal Medical Stations (FMS): Portable facilities in sets of 250-bed units that can be broken down into 50-bed increments with supplies and equipment to provide non-acute and special needs patient care for 72 hours.
ChemPack: Nationally distributed, forward-placed caches of nerve agent antidotes. Inventory is maintained and monitored by CDC and housed in local sites. (See Section I.6.8.)

DPH maintains a State-level cache of certain antibiotics, antiviral medications, and equipment and supplies at a secure location near Capital City in conjunction with CEMA and OEMS. Elements of the cache may be requested through the State EOC when local assets approach depletion.

I.6.2. Liberty County Medical Countermeasures and Supplies

DPH has provided funding for the counties and cities of Columbia to establish caches of MCM and related supplies and equipment for incidents that require rapid access for the protection and maintenance of the safety and health of community members.

Local caches are maintained by LCPHD, local hospitals, or EMS, and include certain antibiotics, antivirals, medical supplies, and equipment such as personal protective equipment (PPE). Local pharmacies also have supplies of a wide variety of medications. County agencies and healthcare sites access State caches through documentation of need and request through local Emergency Management.

I.6.3. Liberty County Mass Prophylaxis 1

The LCPHD Mass Prophylaxis Plan, located in the Public Health Annex of the Liberty County EOP, describes the procedures for ordering the above Federal assets. In summary:

SNS Push Packages, MI, FMS, and resupply from same must be ordered jointly through the State EOC by the LCPHD Director and Liberty County EM Director upon documentation of risk of depletion of local assets.
Hospital emergency physicians and Liberty County first responders may access ChemPack emergently through the county ChemPack Point of Contact, who is the EMS Director or designee. Out-of-county requests for ChemPack assets will be addressed through existing mutual–aid agreements (Section I.6.8.).

LCPHD will activate, staff, and run a Local Receiving Site (LRS), a facility to receive MCM from the State Receipt, Staging, and Storage Site (RSS) in Capital City. At the LRS, located in Central City, staff will repackage and label the MCM for distribution to Liberty County PODs (Table I.3., [Mass Prophylaxis Points of Dispensing (PODs) in Liberty County] and closed PODs (Section I.6.4).

LCPHD will activate, staff, and run mass prophylaxis PODs at pre-designated sites to deliver MCM to every exposed person in Liberty County within 48 hours without regard to residency status. The Mass Prophylaxis Plan calls for the following PODs, which will be activated depending on the incident:


No.	Name	Address	Locality	Point of Contact	MOU?
1	Farmers’ A&M (Hawkins Stadium)	3640 4th St.	Central City	Dir. of Public Safety	Yes
2	Northside Park	P & 10th	Central City	Dir. of Parks & Rec
3	Harris High School	O & 29th	Central City	Principal	Yes
4	Bluebird School	I & 2nd	Central City	Principal	Yes
5	Liberty Coliseum	SR10 & I-102	Central City	Facility Director	Yes
6	Super Wal-Mart	FF & 30th	Central City	Store Manager	Yes
7	Northside Shopping Mall	U & 5th	Central City	Mall Manager	Yes
8	Central City Golf Course	C & 18th	Central City	Course Manager	Yes
9	Hoover High School	LL & 22nd	Central City	Principal
10	Paradise Elem. School	V & 18th	Central City	Principal
11	County Fairgrounds	SR 3	Apple Valley	Dir. of Public Safety
12	Simmons Jr. High School	HH & 14th	Kingston	Principal
13	Blue Water City Hall	Main St.	Blue Water	County EM Dir.
14	Bayport Seaport Cruise Terminal	175 Bay Blvd.	Bayport	Terminal Manager	Yes
15	Westside Parks & Rec Bldg.	SR 1	Fisherville	Dir. of Parks & Rec
16	Fluman-Sloane Stadium	100 Stadium Dr.	Harvest Junction	Stadium Manager	Yes

Table I.3. Mass Prophylaxis Points of Dispensing (PODs) Sites in Liberty County

I.6.3. Liberty County Mass Prophylaxis 2

Staffing will come from LCPHD, the school systems, Liberty County emergency responders, MRC, and other volunteer organizations, and through Emergency Management assistance. The Roaring River Indian Community will staff and maintain a POD on tribal lands, but enrolled RRIC members and families may obtain prophylaxis at any county POD.

Tables I.4. ,I.5., I.6., I.7. list the supplies and equipment LCPHD has stockpiled for POD operations based on serving 1,800 persons per 12-hour shift (150 persons per hour); additional shifts and larger PODs will be multiples of the amounts shown. Additional stocks of PPE, including N-95 respirators, are available from LCPHD stockpiles.


Item	Quantity
Alcohol Swabs/Wipes	4,000
Band-Aids	2,000
Biohazard Bags 100 10-gallon/100 33-gallon	200
Blankets	5
Cotton Balls	4,000
Cotton Swabs	4,000
Dixie Cups	4,000
First Aid Kit – 50 person, Industrial	2
Gloves - 2,000 S/5,000 M/5,000 L	12,000
Gowns - 20 S/30 M/30 L	80
Hand Sanitizer (12 ounce (oz) bottles)	120
N-95 Respirators	100
Paper Towel – 24 rolls	1 case
Pillows	5
Rain Ponchos	10
Scales – 1 adult/1 child (digital)	2
Sharps Box	12
Surgical Masks	100
Tissue, facial	20

Table I.4. Point of Dispensing Field Kits – Medical Supplies


Item	Quantity
Name Badge Labels (Avery 5395)	2,000
USB	10
Clipboard – 25 standard and 5 box type	30
CDs	10
Duct Tape – various colors	10
Extension Cords	4
File folders/portable file box	12
Flashlights	10
Ink pens/pencils (100 each)	200
Pencil sharpener	1
Post-It notes 3x5	25
Paper clips – giant	5
Paper – legal pads	25
Poster Board	15
Power Strip	4
Push Pins	100
Tape – 5 regular/10 masking	15
Rubber bands	1,000
Scissors	5
Stapler	5
Staples	5
Tool Kit – Emergency	1
Vests (ICS – 60 blue/5 white/5 green/5 orange)	75
Work Gloves	10
Ziploc bags – sandwich/gallon sizes	1,000

Table I.5. Point of Dispensing Field Kits – Administrative Supplies

The following items can be purchased by Central Office for dispensing site purposes but cannot be stored in the field kit containers.


Item
Privacy screens
Specimen Coolers
Wheelchairs

Table I.6. Point of Dispensing Field Kits – Miscellaneous Supplies

The following items are assumed to be available at LCPHD for rapid deployment to the dispensing site and are not included in the field kits.


Item
Line ropes/cones
Table pads/clean paper covers
Cleaning supplies
Hand stamps
Ice/Heat packs
Charts and Markers
Easel pads
Waste baskets/liners
Appropriate Medical Forms
Drug Information Sheets
Two-Way Radios
Cots or Mats
Tickets with numbers preprinted

Table I.7. Point of Dispensing Field Kits – Other Items to Consider

1.6.4. Liberty County Closed PODs

LCPHD also has Memoranda of Understanding (MOUs) with several local private sites for “closed PODs,” i.e., on-site mass prophylaxis for staff, staff families, and/or target populations at non-county locations that are not open to the public. These entities will receive MCM from LCPHD according to their staffing and client populations, and will supply their own health personnel to dispense the MCM at their site. LCPHD’s MOUs are with:

Dupont Chemical
Bayport Refinery
Bayport Seaport
Crisswell Chemical
Columbia State University
Farmers A&M
Huge Mining Company
Garden Run, Hill Top, and Lower Allen Nursing Homes in Central City

I.6.5. Antibiotics

Dupont Chemical
Bayport Refinery
Bayport Seaport
Crisswell Chemical
Columbia State University
Farmers A&M
Huge Mining Company
Garden Run, Hill Top, and Lower Allen Nursing Homes in Central City

I.6.6. Antivirals

CPHD maintains very limited quantities of antiviral medications, and does not maintain supplies of HIV/AIDS antiretroviral medications, which are available through local clinics and other health care providers. Antiviral drugs used for influenza or other viruses causing widespread outbreaks will be obtained through local health care providers and/or State or Federal caches. See Table I.8. State of Columbia Public Health Antiviral Stockpile. Antiviral drugs will be used preferentially for treatment of ill persons unless supplies are adequate for prophylaxis of exposed persons. In the latter case, LCPHD staff will dispense prophylaxis to Liberty County first responders according to the Mass Prophylaxis Plan.


Antiviral Procurement Method	Courses
Purchases through contractual allotments	770,000
State purchases outside the Department of Health and Human Services (DHHS) Contract by Columbia State Health Department (CSHD)	3,291
State purchases under the DHHS contract not under direct CSHD control	33,376
County/Local purchases outside the DHHS contract	1,276
Total Available Courses of Antiviral	807,943

Table I.8. State of Columbia Public Health Antiviral Stockpile

I.6.7. Vaccines

LCPHD maintains a stock of adult and child vaccines including diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, HIB, hepatitis A and B, meningitis, pneumonia, and seasonal influenza. Other vaccines may be available. The Foreign Travel Program maintains a limited stock of typhoid, yellow fever, and rabies vaccines.

I.6.8. ChemPack

ChemPack is a federally-owned SNS component, forward deployed through CDC funding to local communities for rapid deployment in nerve agent attacks. Typically housed at either a hospital or an EMS base, the asset must be secured and stored in a temperature controlled environment. Alarmed electronic security devices notify the SNS staff and the facility housing the materials when the cache is opened. There are 2 ChemPack sites in Columbia, one at the EMS Base in Capital City, and one in Liberty County in a secured area at EMS Headquarters in Central City. Time to deployment of the Liberty County ChemPack under ideal conditions should be less than 1 hour.

Each ChemPack cache comprises 1,000 doses of antidote including:

Mark I auto-injectors
Atropine auto-injectors (0.5 mg and 1.0 mg) and atropine sulfate 0.4 mg/ml, 20 ml vials
Pralidoxime chloride (2-Pam) 1 gm injectable, 20 ml vials
Diazepam (Valium) auto-injectors (5 mg/ml) and 5 mg/ml, 20 ml vials
Sterile water for injection, 20 cc vials

ChemPack does not include antidotes for cyanide, mustard gas, or other chemical agents aside from nerve agents.

I.6.9. Managed Inventory

The local Managed Inventory (MI) emergency pharmaceutical cache is under the control and management of selected local pharmacists who are placed on a rotating emergency call list. Overall medications are in Table I.9. [Managed Inventory (MI) Pharmaceuticals]. This privately managed inventory provides MCM for specific responses. Pharmaceuticals in the MI also have been secured and stored at Central City, Columbia Veterans, Faith, and Levine Hospitals above and beyond their normal inventory (see Appendix H). Through a cooperative agreement, these hospitals can use the pharmaceuticals placed in their charge at their discretion, and rotate the pharmaceuticals so that the inventories always remain within their extended shelf life. In addition, supplies of veterinary medications are located in veterinary offices and clinics in Liberty County. These supplies are available as appropriate through MOUs with local veterinarians (see Appendix R). When MI has been ordered jointly by LCPHD and Liberty County Emergency Management, it can be deployed within 12 hours.


Drug	Description	Brand Name	Amount
Activated Charcoal	Aqueous Solution 50 G / 240 ML Bottle	Actidose	20 Bottles
Albuterol Oral Inhalation Solution	2.5 MG / 3 ML 0.083%	Ventolin Nebules	100 Boxes of 25 Doses
AMYL Nitrate Perles (Ampules) for Inhalation	0.3 ML 12/box		30 Boxes (360 Each)
Atropine Ophthalmic Solution	1% 15 ML Bottle		24 Bottles
Atropine Injection	0.4 MG / ML 20 ML Vial		500 Vials
Atropine Injection	0.4 MG/ML 1 ML Vial		5000 Vials
Atropine Injection–Pre Filled Syringe	10 ML Safety Syringe 0.1 MG/ML		2000 Syringes
Beclomethasone	Multi-dose Inhaler	Vanceril	30 Inhalers
Ciprofloxacin	500 MG 100 Tablets (tab) / Bottle	Cipro	10 Bottles (1000 Tabs)
Cyanide Antidote Kit	Kit		50 Kits
Dextrose 5% in water	D5W Injection 250 ML		200 Bags
Dextrose 50%	50 ML Vial		12 Vials
Diphenhydramine Injection Unit Dose	50 MG / ML 1 ML Vial	Benadryl	200 Vials
Diazepam	5 MG / ML Auto Injector	Valium	4000
Diazepam	5 MG / ML 2 ML Ampule / Vial	Valium	6000 Vials / Ampules
Doxycycline Capsules	100 MG 500 Tabs / Bottle		10 Bottles (5000 Tabs)
Epinephrine Injection	1:1000 1 MG / ML Ampule		40 Ampules
Epinephrine Injection	1:1000 30 ML Vial		20 Vials
Epinephrine Injection Pre- Filled Syringe	MG / ML MG / ML		20 Syringes
Gamma Globulin Injection	2 ML		50 Vials
Lactated Ringers Solution	Injection 1000 ML	Levaquin	200 Bags
Mark I Antidote Kits	Auto Injector Kit		2000 Kits
Naloxone Injection	1 MG / ML 2 ML Vials	Narcan	10 Vials
Penicillin G Benzathine	600,000 Units Tubex	Bicillin LA	50 Tubex
Polymyxin Bacitracin Ointment 0.9 G Pack	144 MEQ / ML 40 MEQ / 20 ML Vial		10 Boxes of 144 (1440 Packets)
Saturated Solution Potassium Iodide (SSKI)	Oral Solution 1 G / 1 ML 30 ML	SSKI	100 Bottles
Pralidoxime Injection	1 G Vial	2-Pam Chloride	100 Vials
Silver Sulfadiazine Cream	1% 50 G	Silvadene Thermazine	100
Sodium Bicarbonate Injection	44.6 MEQ / 50 ML 50 ML Vial		25 Vials
Sodium Chloride Injection	0.9% 100 ML Bag	Normal Saline Solution	192 Bags
Sodium Chloride 0.9% Injection	0.9% 500 ML Bag 24 Bags / Box	Normal Saline Solution	8 Boxes (192 Bags)
Streptomycin Injection	1 G Vial		10 Vials
Tetracaine Ophtalmic Solution	0.5% 2 ML 12 / Box	Proparacaine	3 Boxes (36 Doses)
Water Bacteriostatic for Injection	30 ML		400 Vials
Water Sterile for Injection Preservative Free	10 ML		800 Vials

Note: G = Gram, MG = Milligram, MEQ = Milliequivalent, ML = Milliliter

Table I.9. Managed Inventory (MI) Pharmaceuticals