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
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.6.6. 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