5/8/ Introduction to DEPR. 2. Types of Disasters. 3. State and National Resources. 4. Pharmacy Partners. 5.

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1 Dianne Malburg, Chief Operations Officer Michigan Pharmacists Association Ferris Spring Seminar May 15, Identify key risk hazards, thereby providing the impetus to plan a coordinated response now. 2. Discuss pharmaceutical countermeasures that are in place and the role pharmacists and pharmacy technicians may play in response. 3. Review the MPA/DEPR All Hazards Toolkit so that pharmacists and pharmacy technicians may evaluate their possible roles as a participant. 1. Introduction to DEPR 2. Types of Disasters 3. State and National Resources 4. Pharmacy Partners 5. Getting Involved 6. Review Questions 1

2 What is your pharmacy practice setting? A. Academia B. Grocery store C. Health system inpatient D. Hospital outpatient E. Independent F. Large chain (> 5 stores) G. Small chain ( 5 stores) H. Other Have you ever been involved in an emergency response? A. Yes B. No 2

Bureau of EMS, Trauma and Preparedness (BETP) A merger of all groups within MDHHS responsible for preparedness and response efforts Division of Emergency Preparedness and Response (DEPR) Division

3 Bureau of EMS, Trauma and Preparedness (BETP) A merger of all groups within MDHHS responsible for preparedness and response efforts Division of Emergency Preparedness and Response (DEPR) Division specifically responsible for all disaster response planning for the State of Michigan H1N1 response Ebola response Flint water situation Maintains contract with MPA for a pharmacist subject matter expert MPA s Emergency Preparedness Coordinator Contract for over 13 years 83 Counties 45 Local Health Departments 12 Federally Recognized Tribes 110 Emergency Management Programs 191 Hospitals 440 LTC facilities 800 Life Support Agencies Monthly Planning Board Local Health Departments Emergency Management Hospital Emergency Manager State Police Behavioral Health Epidemiology Medical Control Authority EMS Hospital Pharmacy Workgroup Alternate Care Site cache Antibiotic cache maintenance Mass dispensing SNS requesting and planning Education 3

4 Mission: Manage volunteer resources Healthcare and non healthcare volunteers Pre credentials healthcare volunteers As of April Pharmacists 22 Pharmacy Technicians List of skills and certifications BCPS Vaccination administration CPR, ACLS, BCLS Certified Multiple languages Chemical Biological Radiological Nuclear Explosive Natural Disasters 4

time and distance from exposure can lessen the effects Shielding can also

5 Nerve agents Organophosphate Pesticides Blister (vesicant) agents Pulmonary (choking) agents Asphyxiant (cyanide) agents Immediate effects Increased time and distance from exposure can lessen the effects Shielding can also lessen the effects Treatment may not be possible because they work so quickly 5

Agent Examples Countermeasure Source Nerve agents Sarin DuoDote autoinjector (atropine + pralidoxime), benzodiazepines MEDDRUN, Chempack Blister agents Mustard gases None (supportive care) Pulmonary

6 Agent Examples Countermeasure Source Nerve agents Sarin DuoDote autoinjector (atropine + pralidoxime), benzodiazepines MEDDRUN, Chempack Blister agents Mustard gases None (supportive care) Pulmonary (choking) agents Chlorine, phosgene None (supportive care) Asphyxiant agents Cyanide Cyanokit (hydroxocobalamin) MEDDRUN, very few in stock Category A Category B Category C Today Today Future Highly infectious Easily transmitted Cause high mortality Complete incapacitation Lower fatality rate than Category A Emerging pathogens DECREASING ORDER OF PRIORITY 6

7 Category A agents: Easily disseminated Highly infectious and easily transmitted Cause high mortality Could cause social disruption Require special action for public health preparedness Anthrax (Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers (filoviruses and arenaviruses) Category B agents: Moderately easy to disseminate Result in moderate morbidity rates and low mortality rates Require significant diagnostic capacity and enhanced disease surveillance 7

8 Brucellosis Epsilon toxin Food safety threats Glanders Melioidosis Psittacosis Q fever Ricin toxin Staphylococcal enterotoxin B Typhus fever Viral encephalitis Water safety threats Category C agents: Readily available Easily produced and disseminated Potential for high morbidity and mortality rates Could have a major health impact Emerging infectious diseases Nipah Virus Hantavirus SARS Rift Valley Fever Crimean Congo Hemorrhagic Fever 8

9 Agent Countermeasure Source Anthrax Antibiotics, vaccine Smallpox Vaccine (3) Plague Antibiotics Hospital?, Regional Cache, SNS SNS (Strategic National Stockpile) Hospital?, Regional Cache, SNS Tularemia Antibiotics Hospital?, Regional Cache, SNS Botulinum Toxin Anti toxin CDC Depot Viral Hemorrhagic Fevers Anti viral therapy with restricted effectiveness; supportive care SPRN (Special pathogen response network) CBRN Protection : Managing the Threat of Chemical, Biological, Radioactive and Nuclear Weapons Agent Countermeasure Agent Countermeasure Brucellosis Antibiotics Q Fever Antibiotic Epsilon toxin Glanders Anti toxin Antibiotics Ricin toxin Staph enterotoxin Supportive care Antibiotics may be effective, supportive care Melioidosis Antibiotics Typhus fever Antibiotic Psittacosis Antibiotics Viral encephalitis Vaccine, supportive care CBRN Protection : Managing the Threat of Chemical, Biological, Radioactive and Nuclear Weapons Agent Nipah virus Hantavirus SARS Rift Valley Fever Crimean Congo Hemorrhagic Fever Countermeasure Anti viral with restricted effectiveness; supportive care None Supportive, high doses of steroids Anti viral with limited effectiveness, supportive care Antibiotics and anti virals with limited effectiveness CBRN Protection : Managing the Threat of Chemical, Biological, Radioactive and Nuclear Weapons 9

10 Nuclear Power Plant incident Accidental exposure Sources Hospitals, Medical equipment Construction sites IED with radioactive contaminant Time, distance, shielding Strategic National Stockpile Prussian Blue Ca DTPA Zn DTPA State of Michigan KI program Mines Rigged bombs Parasitic devices IEDs Suicide bombers 10

11 Security scanners Electronic waves to jam detonation signals Block cell phone frequencies Heat decoys MEDDRUN CHEMPACK SNS 11

12 Michigan Emergency Drug Delivery and Resource Utilization Network Owned by the state Located at sites with rotary air service Can be requested by MSP, EMS, ER, or Public Health Agency 10 caches at this time Federal pre deployed Resource Owned by the CDC Places nerve agent antidotes in the field There are 64 deployed at 36 sites Inspected annually A federal repository of meds and supplies The request process Local Public Health Plan Hospital Plan Final State approval=governors office RSS (Receipt, Stage, Store) Pharmacist 12

report to work! EMS, Police, Fire (e.g., first responders) Plan, exercise, learn, plan, etc.

13 Community Based Public Health is lead agency Schools, malls, civic centers Closed Points Of Dispensing (PODS) Community Pharmacy DEPR/MPA All Hazards Toolkit Hospital Based Employees must report to work! EMS, Police, Fire (e.g., first responders) Plan, exercise, learn, plan, etc. Legal requirements Labeling, dispensing laws Health and History Form Concise, yet complete Dosage forms Records 13

Pandemic Flu Smallpox Anthrax MERS Chikungunya West Nile Dengue MCIR is really important! https://www.

14 Pandemic Flu Smallpox Anthrax MERS Chikungunya West Nile Dengue MCIR is really important! cal_supply_chain.pdf 14

15 A robust pharmaceutical supply chain exists An accessible, robust dispensing system exists Community Pharmacy An educated, trained, and trusted workforce that can discuss medication therapy and disease state management at the patient level exists A system to report and track pharmaceutical dispensing exists Formal Commitment Online Recognition Toolkit Resources FAQ Fact Sheet 15

Incident Command courses through FEMA IS 700 The National Incident Management System, An Introduction IS 100.HCb Introduction to the Incident Command System for Healthcare/Hospitals IS 200.

16 Incident Command courses through FEMA IS 700 The National Incident Management System, An Introduction IS 100.HCb Introduction to the Incident Command System for Healthcare/Hospitals IS 200.HCa Applying ICS to Healthcare Organizations Basic Disaster Life Support (BDLS) Live training program MRC trainings The Pod Game WISER (Wireless Information System for Emergency Responders) Very comprehensive Biological, chemical, nuclear agents Mobile REMM (Radiation Emergency Medical Management) Apple and Android App available Radiation incidents and countermeasures 16

Healthcare Ready www.healthcareready.org Disasters Information Management Research Center https://disasterinfo.

17 Healthcare Ready Disasters Information Management Research Center Johns Hopkins Center for Health Security

18 Emergency Preparedness Live CE Programs Like today s presentation Always have a program at MPA s Annual Convention and Exposition FEMA s Incident Command Courses MI Train Courses ( Online courses some provide pharmacist CE credit Disaster situations are physically and emotionally demanding You need a plan in place before deployment Everyone handles stress differently Responder health is a top priority BEFORE deployment You don t want to become part of the problem Have your personal affairs in order Ability to take time off work Ability to pay bills while away (auto pay is great) Support from family and friends Prearranged care for pets 18

19 Which of the following is not classified as a Category A Bioterrorism Agent by the CDC? A. Plague B. Tularemia C. Ricin D. Anthrax Which of the following is not classified as a Category A Biological Agent by the CDC? A. Plague B. Tularemia C. Ricin D. Anthrax What types of emergency responses might pharmacists and/or pharmacy technicians be involved in? A. Dispensing mass prophylaxis medications B. Administering vaccinations C. Conducting point of care tests D. Collecting data within the community and submitting it to the state E. All of the above 19

20 What types of emergency responses might pharmacists and/or pharmacy technicians be involved in? A. Dispensing mass prophylaxis medications B. Administering vaccinations C. Conducting point of care tests D. Collecting data within the community and submitting it to the state E. All of the above Which of the following is/are Michiganspecific cache resources? A. MEDDRUN B. CHEMPACK C. SNS D. A and B E. All of the above Which of the following is/are Michiganspecific cache resources? A. MEDDRUN B. CHEMPACK C. SNS D. A and B E. All of the above 20

21 What is the first thing you should do as a pharmacist or pharmacy technology to get more involved in emergency preparedness activities? A. Watch a video on MPA s website B. Register as a volunteer at C. Call MDHHS What is the first thing you should do as a pharmacist or pharmacy technology to get more involved in emergency preparedness activities? A. Watch a video on MPA s website B. Register as a volunteer at C. Call MDHHS True or False: You can find a list of Engaged Community Pharmacy Partners who have made commitments to participate in the All Hazard Dispensing Program on the MPA s website. A. True B. False 21

22 True or False: You can find a list of Engaged Community Pharmacy Partners who have made commitments to participate in the All Hazard Dispensing Program on the MPA s website. A. True B. False Dianne Malburg Chief Operations Officer Michigan Pharmacists Association & Pharmacy Services Inc. Dianne@ 22

Public Health Emergencies: Mass Dispensing in the Community

Public Health Emergencies: Mass Dispensing in the Community Chrissy Gamboa - Pinal County Public Health Chris Lyons, RN - Maricopa County Public Health Role of Public Health in an Disease prevention Emergency