Veterans Health Administration All-Hazards Emergency Cache Program
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1 Veterans Health Administration All-Hazards Emergency Cache Program Institute of Medicine Standing Committee for the Centers for Disease Control and Prevention Division of Strategic National Stockpile
2 Veterans Health Administration (VHA) 150 Medical Centers 985 Outpatient Clinics 820 Community-Based 150 Hospital-Based 9 Mobile 6 Independent 300 Vet Centers 70 Mobile Vet Centers 104 Domiciliary Residential Rehabilitation Programs 135 Community Living Centers Source: FY st Quarter Pocket Card 1
3 Overview and Approach All-Hazards Emergency Cache Program Veterans Health Administration Easy Accessibility: Rapid Access to large quantities of commonly used medical supplies and countermeasures Wide Availability: Geographically distributed across national network of hospitals and clinics Complementary: Dovetails with medical supplies and countermeasures held in local VA pharmacies and supply inventories Integrated: Replenished via routine supply chains as necessary Scalable: Able to meet small surge needs for routine care on local level or larger-scale crises on regional/national level Cost-conserving: Not cost-prohibitive 2
4 All-Hazards Emergency Cache Program Veterans Health Administration Content Categories Antibiotics Antivirals Emergency medications Chemical countermeasures IV fluids Wound care Personal protective equipment Facility Caches: Full contents at VHA medical centers Central Cache: Limited contents in central location Content Capabilities Biological Chemical Explosion and Burn Radiological 3
5 All-Hazards Emergency Cache Program Veterans Health Administration Contents are intended for: Veterans VA Staff Members Other victims who present to a local VA medical facility Designed to: Ensure short-term preservation of VA healthcare operations until other local resources are available Support VA facility s involvement in the local community disaster plan, and Bridge supply gap between local pharmacies and other available resources (e.g., SNS) 4
6 All-Hazards Emergency Cache Program Veterans Health Administration Operations managed by VA Emergency Pharmacy Service Provide logistics support Manage Shelf Life Extension Program Manage product acquisition and life-cycle management Oversight and policy Executive Committee VHA Office of Emergency Management VHA Office of Public Health VHA Emergency Pharmacy Service Program Review Committee Quarterly review of policies Subject matter experts from facilities and VA headquarters 5
7 Perch and Perspective What happens at a local VA hospital? What happens as a Federal healthcare system? 6
8 Scalability and Interoperability 7
9 FEMA National Planning Scenario: Aerosolized Anthrax Attach in Chicago Health & Medical Estimates for Chicago Exposures: 328,000 Fatalities: ,000 Injured/Ill: 13,000 Worried Well: > 500,000 Approximately 20,000 Veterans exposed VA Cache Capacity Prophylactic antibiotics for Veterans and VA Staff on campus at the time of the event Additional antibiotics to complete 60-day prophylaxis course after relocation Gaps to Address Further defining roles of VA facilities in local communities Testing ability to dispense countermeasures to large numbers of individuals Refining access to treatment modalities and therapeutics from SNS 8
10 Pharmaceutical Shortages as Cache Triggers Description Generic Name Vendor Name Actions to Handle Shortages Expectated Return SIMVASTATIN TAB 80MG GEN 90 SIMVASTATIN GEN SOURCERX Bulk, other generic Allocation KETOCONAZOLE CRM 2% FOUG KETOCONAZOLE FOUGERA KETOCONAZOLE CRM 2% FOUG KETOCONAZOLE FOUGERA Other generic Other generic Late October Late October METFORM TAB 1000MG MMP 90 METFORMIN HCL MAJOR PHARMACEUTICALS Bulk, other generic Mid October METFORM TAB 1000MG MMP 180 METFORMIN HCL MAJOR PHARMACEUTICALS Other generic, bulk Unknown ZENPEP CAP 20000U 100 LIPASE/PROTEASE/AMYLASE ACTAVIS PHARMA INC Ask McKesson to find some. Mid October 9
11 Future Goals and Directions Practice Dispensing Medical Countermeasures Host demonstrations optimizing VHA dispensing capabilities Advance model to serve Veterans and VA employees as an integrated community Conduct point-of-dispensing exercises in UASI* Tier 1 cities Refine Contents of the VHA Emergency Cache Increase the frequency of cache reviews and modifications Clarify roles during pharmaceutical shortages Integrate PHEMCE** recommendations where appropriate Emphasize scenario-driven and scalable response capabilities Optimize Federal and Local Community Partnerships Enhance integration of each VA medical facility within each local community Work closely with CDC, DoD, PHEMCE** Build community-level understanding of the dual role of VA as a Federally-governed asset and local community healthcare provider *Urban Areas Security Initiative **Public Health Emergency Medical Countermeasures Enterprise 10
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