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 CityDir. of Public SafetyYes

2

Northside Park

P & 10th

Central CityDir. of Parks & Rec 

3

Harris High School

O & 29th

Central CityPrincipalYes

4

Bluebird School

I & 2nd

Central CityPrincipalYes

5

Liberty Coliseum

SR10 & I-102

Central CityFacility DirectorYes

6

Super Wal-Mart

FF & 30th

Central CityStore ManagerYes

7

Northside Shopping Mall

U & 5th

Central CityMall ManagerYes

8

Central City Golf Course

C & 18th

Central CityCourse ManagerYes

9

Hoover High School

LL & 22nd

Central CityPrincipal 

10

Paradise Elem. School

V & 18th

Central CityPrincipal 

11

County Fairgrounds

SR 3

Apple ValleyDir. of Public Safety 

12

Simmons Jr. High School

HH & 14th

KingstonPrincipal 

13

Blue Water City Hall

Main St.

Blue WaterCounty EM Dir. 

14

Bayport Seaport Cruise Terminal

175 Bay Blvd.

BayportTerminal ManagerYes

15

Westside Parks & Rec Bldg.

SR 1

FishervilleDir. of Parks & Rec 

16

Fluman-Sloane Stadium

100 Stadium Dr.

Harvest JunctionStadium ManagerYes

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 CharcoalAqueous Solution 50 G / 240 ML BottleActidose20 Bottles
Albuterol Oral Inhalation Solution2.5 MG / 3 ML 0.083%Ventolin Nebules100 Boxes of 25 Doses
AMYL Nitrate Perles (Ampules) for Inhalation0.3 ML 12/box 30 Boxes (360 Each)
Atropine Ophthalmic Solution1% 15 ML Bottle 24 Bottles
Atropine Injection0.4 MG / ML 20 ML Vial 500 Vials
Atropine Injection0.4 MG/ML 1 ML Vial  5000 Vials
Atropine Injection–Pre Filled Syringe10 ML Safety Syringe 0.1 MG/ML 2000 Syringes
BeclomethasoneMulti-dose Inhaler Vanceril30 Inhalers
Ciprofloxacin500 MG 100 Tablets (tab) / BottleCipro10 Bottles (1000 Tabs)
Cyanide Antidote KitKit  50 Kits
Dextrose 5% in waterD5W Injection 250 ML 200 Bags
Dextrose 50%50 ML Vial  12 Vials
Diphenhydramine Injection Unit Dose50 MG / ML 1 ML VialBenadryl200 Vials
Diazepam5 MG / ML Auto Injector Valium4000
Diazepam5 MG / ML 2 ML Ampule / Vial Valium6000 Vials / Ampules
Doxycycline Capsules100 MG 500 Tabs / Bottle 10 Bottles (5000 Tabs)
Epinephrine Injection1:1000 1 MG / ML Ampule 40 Ampules
Epinephrine Injection1:1000 30 ML Vial 20 Vials
Epinephrine Injection Pre- Filled SyringeMG / ML MG / ML 20 Syringes
Gamma Globulin Injection2 ML 50 Vials
Lactated Ringers SolutionInjection 1000 MLLevaquin200 Bags
Mark I Antidote KitsAuto Injector Kit 2000 Kits
Naloxone Injection1 MG / ML 2 ML VialsNarcan10 Vials
Penicillin G Benzathine600,000 Units TubexBicillin 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 MLSSKI100 Bottles
Pralidoxime Injection1 G Vial2-Pam Chloride100 Vials
Silver Sulfadiazine Cream1% 50 GSilvadene Thermazine100
Sodium Bicarbonate Injection44.6 MEQ / 50 ML 50 ML Vial 25 Vials
Sodium Chloride Injection0.9% 100 ML BagNormal Saline Solution192 Bags
Sodium Chloride 0.9% Injection0.9% 500 ML Bag 24 Bags / BoxNormal Saline Solution8 Boxes (192 Bags)
Streptomycin Injection1 G Vial 10 Vials
Tetracaine Ophtalmic Solution0.5% 2 ML 12 / BoxProparacaine3 Boxes (36 Doses)
Water Bacteriostatic for Injection30 ML 400 Vials
Water Sterile for Injection Preservative Free10 ML 800 Vials

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

Table I.9. Managed Inventory (MI) Pharmaceuticals