Understanding the Strategic National Stockpile
Human history becomes more and more a race between education and catastrophe. — H.G. Wells, The Outline of History It’s been a strange week in your community. Several schools have closed due to excessive absences, local emergency departments are swamped with victims of a nasty virus, and just this morning several of your medics called in sick. Later in the afternoon, you receive a call from your EMS director, and there’s bad news: All of this seemingly random sickness isn’t random at all: It’s been discovered that bioterrorism has struck your community. You have been assigned to a multi-disciplinary task force that has 12 hours to arrive at a plan to handle the emergency and provide support for incoming resources. Sound scary? You bet. While no one knows exactly how such a scenario would play out, one thing is certain: In any community that is struck by a bioterrorism attack, EMS and other health care providers will likely have less time than needed to mitigate the emergency. However, with some up-front information, some of those time-management issues may be simplified. Before we go into specifics, a couple of definitions are probably in order.
In short, bioterrorism can be summed up as deadly germs and bacteria in the hands of people who want to kill a whole bunch of people. In case of a bioterrorism attack on a US population, local and regional health care providers will be rapidly overwhelmed, and outside resources may be called in to help. In the event of such a circumstance, a state’s health department may decide to request deployment of the Strategic National Stockpile (SNS), which was known as the National Pharmaceutical Stockpile before the current federal restructuring caused it to be renamed. First created under the United States Department of Health and Human Services in 1999, the SNS is currently maintained by the Atlanta-based Centers for Disease Control and Prevention (CDC), and is supported and managed by the Department of Homeland Security. According to the CDC, the Strategic National Stockpile is designed “to maintain a national repository of life-saving material that will be delivered to the site of a bioterrorism event in order to reduce morbidity and mortality in civilian populations.” The Strategic National Stockpile is divided into two distinct entities: the 12-Hour Push Package and the Vendor-Managed Inventory (VMI) Package.
The 12-Hour Push Package is designed to provide a large resource for supplies that may be needed for mass patient care in the event of a terrorism incident. The CDC maintains a total of nine Push Packages stored strategically throughout the United States . Once released by the CDC, the closest Push Package can be in the air within 45 minutes, and on the ground and unloaded in an affected area within 12 hours. Each Push Package is designed to provide a wide array of treatment supplies, including antibiotics, vaccines, airway care, and supportive care supplies. Recently blast, trauma, and burn-care supplies were added to the inventory of each Push Package. According to the CDC, each Push Package can accommodate several thousand patients, depending on what supplies are needed. Some logistical issues inherent with Push Package deployment can present a significant challenge, but can be managed with preplanning. Each Push Package is comprised of more than 50 tons of medical supplies and is packaged into commercial airfreight containers, each of which weighs between 700 and 2,500 pounds. Upon arrival in affected areas, each Push Package requires a minimum of 5,000 square feet (10,000 to 12,000 square feet works better) of lighted, climate-controlled storage space, along with people such as security and maintenance personnel to support that facility. The CDC has the ability to get a Push Package to any location specified by the requesting state; therefore, a community does not need to be near an airport to receive a Push Package. The CDC will get the Push Package to a state-specified location by using regional trucking lines or other transportation resources.
Along with the supplies allocated to each Push Package, the CDC can also deploy teams to provide advice regarding Push Package contents. Comprised of five or six pharmacists and logistics experts, these teams are called Technical Advisory Response Units, or TARUs, and can provide advice and guidance about storage and disbursement of Push Package contents. However, TARU personnel are present in an advisory capacity only. Community resources will be needed to store, move, and distribute Push Package supplies. The second phase of the National Pharmaceutical Stockpile is the Vendor-Managed Inventory, or VMI Package. Unlike Push Packages, a VMI Package can deliver agent-specific supplies such as specific antidotes and antibiotics, and therefore the specific agent must be confirmed before the VMI can be deployed. VMI package components will not begin to arrive in an affected area until 24- and 36-hour time intervals have passed. It’s important to remember that EMS usually does not play a direct role in the deployment of the NPS. The NPS is a federal resource that will be requested as needed by public health officials of an affected state. However, local EMS systems could potentially be called upon to perform a wide range of tasks in support of the event, from transporting patients to a central treatment point to administering medications and/or vaccines under the direction of other health care providers. EMS involvement in a Push Package deployment will depend on local protocol, preplanning, and the resources at hand. Check with your emergency management department to learn about its plan for such an eventuality. While no one likes to think about an infectious disease spreading across an entire community, we as EMS providers need to understand that bioterrorism is a patient care issue just like any other. That fact alone requires us to plan and understand as much as possible in advance of such an event. References
Jeff Robinson, NREMT-P, BA, has worked in EMS since 1979 and is currently a senior team leader at Johnson County Med-Act in Overland Park, Kansas.
|