Stanly County Standard Operating Guide Strategic National Stockpile

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1 Stanly County Standard Operating Guide Strategic National Stockpile Version 2

2 Section SNS Plan Table of Contents Page Number Changes and Revisions... 1 Glossary of Acronyms... 3 Introduction:... 6 Mission Statement:... 6 Purpose:... 6 Summary:... 6 Formal Request for SNS in Stanly County:... 7 SNS Request and Supply Process... 8 Persons Authorized to Request Initial or Re-supply of SNS Supplies... 9 Resupply Requests Of SNS Materials From The State (RSS) SNS Reorder & Re-supply Process Command and Control: Levels of Activation: Management & Dispensing of SNS Materials: Local Receiving Site (LRS): Maintaining Chain of Custody: Estimation of Pharmaceuticals/Medicine: Point of Dispensing Site(s) (PODS): Recommended Minimum Staffing for Each LRS/POD: Throughput Estimations: Stanly County Health Department Dispensing Site Calculation Worksheet Increasing Client Throughput: Operating Hours: Rapid Dispensing: Rapid Dispensing Strategies: Mode of Dispensing Medications Pulling versus Pushing Hospitals and Alternate Care Facilities Coordination: Security: LRS/POD Staffing and Volunteers: Badging Procedure: Memorandum of Understanding(s) (MOU): Who Can Dispense at a LRS/POD: Staff and Worker Compensation: Medication Pickup at LRS/PODs:... 34

3 Symptomatic Patients: Tracking Inventory: Office Supplies and Other Materials: POD Site Operations: Activation: Mobilization: Medication Preparation: POD Clinic Flow: LRS/POD Material Handling Equipment: Training - Just-In-Time Training - LRS/POD Orientation: Documentation: Hygiene and Infection Control: Demobilization: Priority Prophylaxis: Special Needs Population: Tactical Communications: Stanly County LRS/POD Primary Stanly County LRS/POD Backup Public Information and Crisis Communications: Notification and Coordination: Communicating to Staff and Volunteers: Communicating to the Public: Questions, Concerns, & Adverse Reporting: Additional Modes for Communicating: Methods of Dissemination: Internal and External Communication at the LRS/POD: Communicating with the Media:... 53

4 Changes and Revisions Changes made by: Date: Section (s) Changed: Notes: Becky McKeon 6/9/2009 Updated NC PC Contact List Becky McKeon 6/18/2009 Updated NC PC Contact List Becky McKeon 6/24/2009 Updated NC PC Contact List Becky McKeon 6/26/2009 Contacted SRMC to update contacts Becky McKeon 7/16/2009 Updated PHRST Contact List Becky McKeon 7/16/2009 Updated PHP&R Contact List Becky McKeon 7/21/2009 Updated PHRST Contact List Becky McKeon 8/7/2009 Updated PHP&R Contact List Becky McKeon 8/12/2009 Corrected contact numbers that were invalid/changed Becky McKeon 8/28/2009 Updated NC PC Contact List Becky McKeon 9/3/2009 Updated PHRST Contact List Becky McKeon 9/3/2009 Contacted SRMC to update contacts Becky McKeon 9/22/2009 Updated PHRST Contact List Becky McKeon 10/19/2009 Updated SCHD Contact List Becky McKeon 11/22/2009 Contacted SRMC to update contacts Becky McKeon 1/11/2010 Updated PHRST Contact List Becky McKeon 1/12/2010 Updated PHP&R Contact List Becky McKeon 1/21/2010 Updated SCHD Contact List Becky McKeon 2/10/2010 Updated SCHD Contact List Becky McKeon 2/15/2010 Unaccompanied minors Becky McKeon 2/15/2010 Employee Compensation Becky McKeon 3/16/2010 Updated SCHD Contact List Becky McKeon 3/16/2010 Contacted SRMC to update contacts Becky McKeon 3/16/2010 Updated PHP&R List Becky McKeon 3/16/2010 Updated PHRST List Becky McKeon 3/16/2010 Updated NC PC List Becky McKeon 4/5/2010 Updated SCHD Contact List Updated Animal Control Contact Information - Added Becky McKeon 4/30/2010 pager numbers and cell numbers MOA between SCHD & County of Stanly - Brian Simpson & I worked on wording of MOA Becky McKeon 5/6/2010 Becky McKeon 5/6/2010 LHIT Test Exercise 2010 Becky McKeon 5/20/2010 Medication Request test with Hospital Becky McKeon 7/13/2010 Updated LE information Becky McKeon 7/14/2010 Updates hearing impaired information Becky McKeon 8/12/2010 Updated wording for ARC volunteer data base page 21. Becky McKeon 8/12/2010 Updated wording on JIC page 36 Becky McKeon 8/12/2010 Updated wording in 24/7 phone number page 34 Becky McKeon 8/13/2010 Becky McKeon 8/13/2010 Becky McKeon 8/13/2010 Becky McKeon 8/13/2010 Updated information on Health Department website and Emergency Preparedness page 27 Updated information on getting information out regarding the POD location page 37 Updated information on disseminating messages page 31 Updated information regarding reading level for forms and documents page 31 Updated information on employee transportation to LRS/POD page 26 Becky McKeon 8/13/2010 Becky McKeon 8/13/2010 Updated information on Chain of Custody page 12 Becky McKeon 8/16/2010 CAP for EOC Drill added Becky McKeon 8/19/2010 TAR Call Down CAP Updated Becky McKeon 8/20/2010 Updated Stanly Medical Services Contact Numbers Becky McKeon 8/27/2010 SNS PIC Course Certificates added Becky McKeon 10/7/2010 Site Activation Drill CAP 1

5 Becky McKeon 11/4/2010 Updated PHE Contact List Becky McKeon 11/4/2010 Updated DPH Phone List Becky McKeon 11/6/2010 Updated SRMC Pharmacist info Becky McKeon 11/12/2010 Updated Epi Directory Becky McKeon 12/22/2010 Added link on Health Department website to view Ready.gov preparedness videos Becky McKeon 12/23/2010 Updated IT Equipment for Primary & Backup LRS/POD Becky McKeon 12/28/2010 Updated information on Primary and Backup LRS Checklist Becky McKeon 12/28/2010 Updated contact information for the Primary LRS/POD Update PA System for Primary LRS/POD & Backup LRS/POD Becky McKeon 12/29/2010 Becky McKeon 1/5/2011 Update Board of Health information Becky McKeon 1/14/2011 Updated Board of Health information Becky McKeon 1/18/2011 Updated CRI REGION Veterinary Info Becky McKeon 3/17/2011 Updated SRMC Pharmacist info Becky McKeon 3/22/2011 Changed NCGS wording in Plan Becky McKeon 4/15/2011 Updated rapid dispensing information Becky McKeon 4/28/2011 Updated appearance of document Becky McKeon 6/25/2012 Updated Inventory Tracking Information Becky McKeon 3/9/2012 Update SNS Request and Supply Process Becky McKeon 3/9/2012 Updated SNS Reorder and Resupply Process Becky McKeon 3/9/2012 Update Glossary of Acronyms Updated Methods for Determining Trigger Levels to Request Resupply Becky McKeon 3/10/2012 Becky McKeon 5/15/2012 Updated wording in Plan Becky McKeon 5/16/2012 Updated addresses Becky McKeon 5/24/2012 Checked all staff contact information Becky McKeon 6/25/2012 Updated Inventory Tracking Information Becky McKeon 6/26/2012 Updated all Medical Providers for Stanly County Becky McKeon 7/24/2012 Reviewed mass prophylaxis planning Becky McKeon 8/17/2012 Checked all staff contact information Becky McKeon 9/12/2012 Checked contact information on Core Partners Becky McKeon 10/30/2012 Updated hyperlinks & checked accuracy Becky McKeon 11/8/2012 Checked all staff contact information Becky McKeon 11/8/2012 Updated Health Department Employees in All Contacts Becky McKeon 12/10/2012 Updated County Commissioners Information Becky McKeon 12/10/2012 Updated Dispensing Site Calculations Becky McKeon 1/14/2013 Updated Count Commissioners Becky McKeon 1/14/2013 Updated Stanly County Board of Health Becky McKeon 1/16/2013 Updated Census Numbers Becky McKeon 2/11/2013 Updated web link for Terrorism and Other Public Health Emergencies: A Field Guide for Media. Added Standing Orders information- Medical Director and FNP. Also added 24/7 contact information Becky McKeon 3/27/2013 Becky McKeon 3/27/2013 Updated Rapid Dispensing Strategies Becky McKeon 3/27/2013 Added persons responsible for printing forms/fact sheets Becky McKeon Becky McKeon Becky McKeon Becky McKeon Becky McKeon Becky McKeon Becky McKeon Becky McKeon Becky McKeon Becky McKeon 2

6 Glossary of Acronyms AAR - After Action Reports ACF - Alternate Care Facilities APHA - American Public Health Association ARC - American Red Cross ASTHO - Association of State and Territorial Health Officials AUTODIN - Automatic Digital Network AUTOVON - Automatic Voice Network Bulk - Packages of medications that have not been repackaged into individual doses. BOL - Bill of Lading BT - Bio-terrorism CDC - United States Centers for Disease Control and Prevention CERC - Crisis Emergency Rick Communications CMT - Crisis Management Team DEA - Drug Enforcement Agency DECON - Decontamination DMAT - Disaster Medical Assistance Team DMORT - Disaster Mortuary response Team DHHS - Department of Health and Human Services DOT - Department of Transportation DPH - Department of Public Health DPW - Department of Public Works DSNS - Division of Strategic National Stockpile DSS - Department of Social Services DROC - Disaster Recovery Operations Center EM - Emergency Management EMS - Emergency Medical Services, Emergency Medical Support EMT - Emergency Medical Technician EOC - Emergency Operations Center EOP - Emergency Operations Plan ERT - Emergency Response Team FBI - Federal Bureau of Investigation FCC - Federal Communications Commission FEMA - Federal Emergency Management Association FERC - FEMA Emergency Response Capability FRP - Federal Response Plan GCDC - General Communicable Disease Control HAZMAT - Hazardous Material HD - Health Department HECC - Health Emergency Coordination Center HHS - Department of Health and Human Services HIC - Health Information Center HSEEP - Homeland Security Exercise and Evaluation Program IAP - Incident Action Plan IC - Incident Commander ICC - Interstate Commerce Commission ICP - Incident Command Post ICS - Incident Command System 3

7 IND - Investigational New Drug JCAHO - Joint Committee on Accreditation of Healthcare Organizations JIC - Joint Information Command JICO - Joint Information Command Officer JIS - Joint Information System JTF - Joint Task Force LEMC - Local Emergency Coordinator LHD - Local Health Department LRS - Local Receiving Site LZ - Landing Zone (helicopter) MC - Mobilization Center MD - Medical Doctor MI - Managed Inventory MMRS - Metropolitan Medical Response System MOA - Memorandum of Agreement MOU - Memorandum of Understanding MPD - Metropolitan Police Department NCDA - North Carolina Department of Agriculture NCDHHS - North Carolina Department of Health and Human Services NCDOT - North Carolina Department of Transportation NCDPH - North Carolina Department of Public Health NCEH - National Center for Environmental Health NCEM - North Carolina Emergency Management NCFS - North Carolina Forestry Service NCNG - North Carolina National Guard NCPH - North Carolina Division of Public Health NCSBI - North Carolina State Bureau of Investigation NCSHP - North Carolina State Highway Patrol NCSPARTA - NC State Preparedness and Resource tracking Application (State EOC s Crisis reporting software.) NDMOC - National Disaster Medical Operations Center NDMS - National Disaster Medical System NIIMS - National Interagency Incident Management System OCC - Operations Coordination Center OEMS - Office of Emergency Medical Service OER - Office of Emergency Response PH - Public Health PHCC - Public Health Coordination Center PHP&R - Office of Public Health Preparedness and Response Push Package - This portion of the SNS consists of medical material that can arrive anywhere in the Continental United States within 12 hours; there are 12 Push Packages pre-positioned at strategic locations nationwide Prophylaxis Measures designed to preserve health and prevent the spread of disease PHIO - Public Health Information Officer PIO - Public Information Officer POD - Point of Dispensing RAC - Regional Advisory Committee Receiving - Acceptance of the SNS from the federal government RRT - Regional Response Team 4

8 RSS - Distribution and Repackaging Center, The site where the SNS material is taken to be stored, broken-down, and distributed to dispensing sites, hospitals, and other sites SA - Staging Area SERC - State Emergency Response Commission SERT - State Emergency Response Team SOP - Standard Operating Procedure SORT - Special Operations Response Team Staging - Positioning the SNS at the designated receiving facility in such a way that it can be easily broken down to support shipment to dispensing sites SNS - Strategic National Stockpile, Consists of medical supplies pre-positioned to aid state/local emergency response to acts of chemical or biological terrorism TARU Technical Advisory Response Unit A group of CDC technical advisers who accompany the SNS USPHS - United States Public Health Service 5

9 Introduction: Mission Statement: This operating guide will provide Stanly County with instructions for managing and distributing the Strategic National Stockpile (SNS) at the time of a public health emergency. Purpose: The Stanly County Health Department has developed this operating guide for SNS material management. This operating guide will be used during a public health emergency when local and regional resources have been expended and it is necessary to request the SNS. This document will contain all information necessary for SNS management, including point-of-contact information, directions, flow charts, and point-of-dispensing (POD) clinic management guidance. Summary: The Stanly County Health Department will maintain and update this guide and may provide all involved community partners with a copy; either paper, electronic, or through a secure webpage. SNS Planning Elements are incorporated in the Local All Hazards/Emergency Operations Plan. An electronic copy of this guide will be maintained at the Stanly County Health Department as well as Stanly County Emergency Management EOC. This guide is considered a supplement to the Stanly County All Hazards Plan. In accordance with CDC and NC DPH requirements, this guide will be reviewed at least annually to ensure accurate and updated information. This review is conducted by the health department and partner agencies and any necessary changes made annually, at a minimum. Changes to the plan are made based on many various sources of information, including but not limited to, changes in state or CDC recommendations/requirements, changes in partnering agencies, changes in the county All Hazard Plan, and corrective actions during trainings or exercises. Updates to this plan are recorded on the Record of Review and Updates found at the front of this guide. Stanly County Health Department is considered lead agency in SNS activities, community partners are actively involved. The Stanly County SNS Planning Committee is comprised of members from the Local Emergency Planning Committee (LEPC). Committee members represent various agencies such as health department, emergency services, law enforcement, private business, fire department, hospital, and volunteer groups. A list of the LEPC members and their contact information can be found in Attachment 1: LEPC Folder. Documentation that shows the group meets at least annually to discuss SNS planning is found in Attachment 1. LEPC sign in sheets are also found in Attachment 1. Stanly County Emergency Operations Center (EOC) and Emergency Operations Plan (EOP) will be the operating guidelines for any emergency response, including SNS distribution within Stanly County. A record of signatures representing agencies associated with SNS response is kept on file at Stanly County Health Department with the Preparedness Coordinator. This record represents that partner agencies have read and agree to any part of the SNS Plan that they are responsible for carrying out. In addition, the SNS Plan is a supplement to the local Emergency Operations Plan (EOP). 6

10 Formal Request for SNS in Stanly County: Upon confirmation and identification of the biological or chemical agent or other qualifying event, the Stanly County Health Department (SCHD) will advise the Stanly County Office of Emergency Management, for official request for activation of the SNS and/or Vendor-Managed Inventory (VMI) program if all other resources are expended. If needed, consultation and/or advisement of other county partners such as hospital, local political officials, or law enforcement would be done via telephone, , activation of local EOC, or other appropriate means. The CRI and NCPHP&R would also be consulted. All requests will go through the State. The County will make no direct contact with the Centers for Disease Control and Prevention. If there is a mutual decision to request the SNS for Stanly County, the activation of the SNS/VMI program requires a specific set of actions to ensure plan protocols are followed: a. The primary local agency for activation requests would come from the Stanly County Health Director or his designee (Environmental Health Supervisor or Director of Nursing). b. In the absence of a Stanly County Health Department representative, or if unnecessary delay would occur, the Director of Stanly County Emergency Services will request program activation through the NC Division of Emergency Management. c. In either case, the activation request would be based on medical facts as they are known and originated from the most reliable source available at the time of activation. This process is designed to provide a backup to the local health department. d. The Local EM director or designee will need to provide the following information: 1) Description of situation 2) Status of situation and specimen testing 3) Target population, including estimated numbers of population to be prophylaxed 4) Quarantine measures taken, if any 5) Relevant local SNS plan information a) LRS location b) Number of PODs c) Number of residents d) Number of first responders e) Internal capabilities f) Items needed (SNS is a term meant to refer to the entire cache of medications and supplies maintained by DSNS. Requests should detail exactly the type/quantity of medications and medical supplies needed.) The requesting individual may also be asked to provide additional information such as street address for delivery of packages or delivery method requested (air or ground). The department/agency that requests activation would also activate the following local components: - Request activation of local SNS plan - Ensure all alerts and notifications are implemented - Request activation of Emergency Operations Center (EOC) or command and control location - Advise reception site: Contact Information can be found in Attachment 1 - Ensure all required resources are in place for SNS delivery - Activate dispensing sites with resources and manpower - Assemble and brief team on plan process and program schedule 7

11 SNS Request and Supply Process SNS Request and Supply Process Disaster Occurs Local Medical Supplies Exhausted N O YES Local EM Request Supplies from NCEM NCEM & PHCC Review Request NC RSS ships to Local Receiving Site (LRS) Supplies shipped to NC RSS Supplies NOT Requested YES CDC approves? N O Governor or designee submits request to CDC NO Are supplies available from traditional sources? LRS notifies all PODs of supplies arrival & availability to pickup CDC notifies NC that the request is not approved NCEM & PHCC explore alternate options Traditional sources are used 8

12 Persons Authorized to Request Initial or Re-supply of SNS Supplies Name Agency Contact Information Dennis Joyner, Health Director Patti Lewis, FNP-C Patricia Hancock, RN Director of Nursing Brian Simpson, EM Director Stanly County Health Department Stanly County Health Department Stanly County Health Department Stanly County Emergency Management Office #: Cell #: 704-XXX-XXXX Fax #: Home #: 704-XXX-XXXX Office #: Cell #: 704-XXX-XXXX Fax #: Home #: 704-XXX-XXXX Office #: Cell #: XXX-XXX-XXXX Fax #: Home #: XXX-XXX-XXXX Office #: Cell #: 704-XXX-XXXX Fax #: Home # 704-XXX-XXXX Initial request justification guidelines and procedures for locals to request SNS materiel from the State Criteria that CDC will use to determine if a request for SNS material is justified are: 1. Overt release of a chemical or biological agent, 2. Claim of release by intelligence or law enforcement, 3. Indication from intelligence or law enforcement of a likely attack, 4. Clinical or epidemiological indications, such as: a. large numbers of ill persons with similar disease or syndromes, b. large numbers of unexplained disease, syndromes, or deaths, c. unusual illness in a population, d. higher than normal morbidity and mortality from a common disease or syndrome, e. failure of a common disease to respond to usual therapy, f. single case of disease from an uncommon agent (e.g. smallpox), g. multiple unusual or unexplained disease entities in the same patient, h. disease with unusual geographic or seasonal distribution, i. multiple atypical presentations of disease agents, j. similar genetic type in agents isolated from temporally or spatially distinct sources, k. unusual, genetically engineered, or antiquated strain of the agent, l. endemic disease or unexplained increase in incidence, m. simultaneous clusters of similar illness in non-contiguous areas, n. atypical aerosol, food, water transmission, o. three (3) people presenting the same symptoms near the same time, p. deaths or illness among animals that precedes or accompanies human death, or 9

13 q. illnesses in people not exposed to common vent systems, 5. Laboratory results, 6. Unexplainable increase in emergency medical service requests, and/or 7. Unexplained increase in antibiotic prescriptions or over the counter medication use. When any of these criteria are met and when local and regional resources are expended, Stanly County will follow the SNS resource request chain described below. Requests for material must be coordinated through the LEOC to ensure that all requests from the LEOC to the State Emergency Operations Center (SEOC) are consolidated. LRS/POD or treatment center realizes need for re-supply LRS/POD Site Commander or Treatment Center Coordinator notifies LRS/POD Manager of need via phone, or hand written request or other means of communication LRS/POD Manager issues resupply or notifies Health Director or EM Director of unmet need Process continues as for initial supply request Resupply Requests Of SNS Materials From The State (RSS) The re-supply requests from the Local Receiving Site (LRS) to the RSS should be initiated when the LRS/POD manager (or designee) receives requests from a POD Manager that states additional supplies are needed. This notification will be sent via , direct phone notification, written request, or other appropriate documented means of communication. If sent by written request, a Resource and Medication Request form should be completed for documentation. This form can be found in Attachment 14. If medication and supplies are still available at the LRS/POD, then these medications and supplies will be sent to the location that has requested additional supplies. If the LRS/POD detects a decrease in supplies to be at a level of less than 24 hour supply, the LRS Manager (or designee) will request re-supply from the RSS. An estimate of 24-hour supply will be derived from a periodic review of data that show amount of supplies on hand verses amount of supplies sent to PODS or treatment facilities. The LRS/POD manager (or designee) will then send a request to the Stanly County EM via the Stanly County EOC. Stanly County EM will place the request to the State EOC via WebEOC. The need for additional supplies will be noted by personnel at the LRS/POD facilities. After monitoring the rate of use of supplies received from the LRS/POD, the LRS/POD manager will submit a request for re-supply via , direct phone notification, written request, or other appropriate documented means of communication when the on-hand supply falls below a 24 hour supply. An estimate of 24- hour supply will be derived from a periodic review of data that show amount of supplies on hand vs. amount of supplies dispensed per hour. If stock levels of medications or other equipment/supplies get low, the LRS/POD Site Commander and their command staff will develop a hold strategy. Hold strategies will be predicated on the following considerations: 1. Can substitutes for items in short supply be used? 2. How soon before needed items arrive? 3. Implications of terminating the client process 4. Are other facilities able to pick up the remaining clients (i.e., Closed PODs) 10

14 The hospital and each Closed POD in Stanly County will have one person and a back-up that is designated as authorized to request emergency medical material/sns. This person is required to complete a point of contact authorization/information form. These authorization/information forms can be found in Attachment 13. Contact information for the Closed PODs are updated annually. Upon realization that emergency medical material is required, the contact for the hospital and Closed PODs must contact the Stanly County LRS/POD via telephone at (or another number to be determined at the time of the event) or fax to (or another number to be determined at the time of the event) with the following information: name and quantity of material requested. The request form can be found in Attachment 14. Upon receipt of request, the LRS/POD will confirm receipt and give estimated time of fulfillment of request. Closed PODs will pick up supplies/medications and other items needed to prophylaxis staff/employee/clients/students/etc. Location of pickup will be at the LRS/POD. After the SNS request has been made the SCHD would also be responsible for the following tasks: 1. Prepare to receive SNS by opening LRS 2. Activate LRS/POD 3. Ensure all required resources are in place for SNS delivery 4. Contact all staff utilizing Connect CTY 5. Assemble and brief Command staff on situation 6. Prepare Just-in-time training 7. Contact all agencies/organizations involved with SNS Plan 11

15 SNS Reorder & Re-supply Process POD s & Treatment Centers Reorder if less than 24 hour supply on hand Local Receiving Site (LRS) Are supplies on hand? YES Request is filled by LRS N O Y E S Traditional sources are used Are Supplies Available from Traditional Sources? N O Governor or designee submits request to CDC NCEM & PHCC Review Request CDC Approves? LRS request resupply from Local EM NO NCEM & PHCC explore alternate options YES Supplies shipped to NC RSS LRS notifies all PODs of supplies arrival & availability to pickup NC RSS ships to Local Receiving Site 12

16 Command and Control: Stanly County uses the Incident Command System in accordance with National Incident Management System (NIMS) requirements. Incident Command System (ICS) structures for SNS events are incorporated as part of this SNS Plan including structures for the LRS/PODs, and for an overall event. Structures for the overall event are not limited to the health department but also include the relationship to the county EOC. Each ICS chart includes the positions needed for the response and how the ICS positions fit into overall event structure. Contact information for each ICS position can be found in Attachment 1. Command staff will be allowed full access to the LRS/POD; with other staff allowed limited access. See ICS chart below: UNIFIED COMMAND Joint Information Center Law Enforcement Emergency Management Fire (incl Volunteer) Hospitals EMS Rescue Squads County Management & Local Jurisdiction Representation / Applicable Political Positions DSS Public Health Volunteer Organizations (ex: Red Cross) See Public Health ICS Chart: Attachment 1 13

17 The Command Staff at Stanly County Health Department includes at a minimum: Public Health Incident Commander The Stanly County Health Department Health Director will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Clinic Site Commander/Dispensing Site Leader The Director of Nursing will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Clinic Liaison Officer The Health Educator II will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Public Information Officer The Health Educator II will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Physical Safety Officer/Security Coordination The Stanly County Sheriff s Office Major will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Medical Safety/Safety Coordination A Public Health Nursing Supervisor II will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Logistics Section Chief A Public Health Processing Unit Supervisor V will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Operations Section Chief A Public Health Nursing Supervisor I will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Planning Section Chief A Public Health Environmental Health Supervisor I will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. Finance/Administration Section Chief A Public Health Accounting Technician IV will fill this position. Contact information can be found in Attachment 1. The job action sheet can be found in Attachment 9. The Public Health Incident Command charts are in Attachment 1. The Incident Command chart for the LRS Staff can be found in Attachment 1. Stanly County Health Department will maintain a data base of all staff that is to respond to an SNS event. This data base will contain names and contact information. In addition, the county will also access the statewide ServNC system for medical professionals, if needed through use of Stanly County EM Director s administrative rights. The current of staff will be tested quarterly through an exercise notification drill and the information updated as indicated. Information on quarterly call down drills can be found in Attachment 4. Any information update can be found on the Record of Review and Updates sheet in the front of this document. 14

18 Levels of Activation: Stanly County has four activation levels for response to a public health emergency. The EOC is activated when the level of activation reaches three (3) as described in the chart below: Level 1 Passive Surveillance Day-to-day operations DPH monitors surveillance system statewide Epidemiologist-on-call is notified of reportable diseases or unusual events Level 2 Active Surveillance Active surveillance indicates that an unusual event or outbreak has occurred and further case ascertainment is needed Active Surveillance initiated at the State and/or Local levels Decision makers are able to mobilize internal resources to identify and contain diseases Notifications sent to appropriate health departments and sentinel sites Epidemiological Investigation is conducted by State and Local Health Department staff Law enforcement may be notified if the event has potential law enforcement implications Level 3 Health Response Emergency Public Health Response is necessary Stanly County Emergency Operations Center is activated Limited outside resources needed Decision makers are able to mobilize internal resources to identify, contain, or mitigate the disease Public Information/media notification may begin Level 4 Full-Scale Activation Resources outside of Public Health and Medical agencies are needed State Emergency Operations Center is activated Stanly County EOC is activated Emergency Response Teams are notified and activated if necessary Biological Incident annex and ESF #8 are activated Governor may issue a proclamation declaring a state of disaster emergency Federal resources may be requested (e.g. SNS, NDMS) Joint Information Center is staffed and operational Stanly County EOC is located at 201 South Second Street, Albemarle, NC Directions and maps for the Stanly County EOC are located in Attachment 5. 15

19 Management & Dispensing of SNS Materials: Local Receiving Site (LRS): A local SNS Coordinator/Preparedness Coordinator has been designated to assist with the management of SNS. The name and contact information for the SNS Coordinator and the back-up can be found below and in Attachment 1. These persons are also responsible for SNS related training, exercising, and evaluation. Position Name Office Number Home Number Cell Number SNS Coordinator/PC Becky McKeon N/A 704-XXX-XXXX SNS Coordinator/PC Back-up Patricia Hancock XXX-XXX-XXXX XXX-XXX-XXXX As part of the request for a SNS Push Package deployment, the state will coordinate with the CDC for delivery by ground or air transportation. If the SNS Push Package is delivered by air, materials would be delivered to one of the following airports: Charlotte Douglas International Airport 5501 Josh Birmingham Parkway Charlotte, NC Piedmont Triad International Airport 6415 Bryan Boulevard Greensboro, NC Raleigh-Durham International Airport 2600 West Terminal Boulevard Morrisville, NC SNS supplies are delivered to one of the three designated State Reception, Storage, and Staging (RSS) sites for processing, accounting, and re-packaging for delivery to the local receiving site(s). The State will assume the responsibility of transporting the SNS supplies to a local receiving site in Stanly County. Stanly County Sheriff s Office will provide security once assets arrive in Stanly County. Those who are authorized to sign and receive SNS assets are the Local Health Director, Director of Nursing, or Environmental Health Supervisor I. A DEA Registrant will also be available to sign for controlled substances. This responsibility has been assigned to the nurse practitioner that is contracted by the Stanly County Health Department. Currently the nurse practitioner is Patti Lewis and the back-up DEA Registrant is Stanly County Health Department Medical Director Joseph Hunter, MD. Once the State delivers the SNS to Stanly County LRS/POD, a Transfer of Custody Form will be completed. This form will be completed every time SNS is delivered to a different location (i.e. LRS/POD, Closed POD, hospital). The Distribution Manager, and back up, contact information can be found in Attachment 1. The JAS for the Distribution Manager, and backup, can be found in Attachment 9. 16

20 Materials received at the LRS/POD will not need to be transported since our LRS and POD are the same location. Stanly County Maintenance has trucks available, as well as Stanly County Animal Control, to use for delivery of SNS assets to our backup LRS/POD, if the backup LRS/POD is needed. Staff responsible for this will be the Transportation Unit Manager and Transportation Unit Technician. Job action sheets can be found in Attachment 9. Additional support for transportation and distribution will be coordinated through the EOC or EM. Security for this transportation will be provided or arranged by the Stanly County Sheriff s Office or North Carolina Highway Patrol, if needed. Contact information can be found in Attachment 1. Adequate LRS/POD facilities have been identified to ensure rapid delivery of medical material. The LRS/POD in Stanly County is the Stanly County Agri Civic Center (Primary) and the Stanly County Health Department (Secondary) has designated as the site to which the State will deliver SNS assets. Both the primary and backup have areas that allow for delivery trucks to access areas needed for delivery of items. This is done on a regular basis at each site. Once assets are delivered to the LRS/POD, the LRS/POD team members will be in charge of distribution from the LRS section of the LRS/POD to the POD section of the LRS/POD. Stanly County s LRS and POD are one in the same; being the Stanly County Agri Civic Center, B Newt Road, Albemarle, NC LRS/POD staff positions, with backups, and call down list are reviewed and revised at least quarterly and can be found in Attachment 1. Call down exercises are conducted quarterly to ensure contact information is correct and current. Exercise information can be found in Attachment 4. LRS/POD job action sheets can be found in Attachment 9. LRS/POD Incident Command Structure can be found in Attachment 1. Just-in-time training PowerPoint has been developed for LRS/POD staff. This PowerPoint can be found in Attachment 6. Depending on the situation, actual use of the PowerPoint may or may not be feasible. However, the information within the presentation will be provided to LRS/POD staff. At a minimum, LRS/POD supervisors should review with staff the following: Incident Briefing Facility Basics Safety Review LRS/POD must meet CDC and NC requirements for storage of SNS material. These requirements include the following: 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. Controlled Substances A 12-hour Push Package currently includes 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 17

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