STATE OF FLORIDA Department Of Health Strategic National .
STATE OF FLORIDADepartment of HealthStrategic National Stockpile Appendix to the Logistics Support Annexof theEmergency Operations PlanVersion 1.2Last Update: December 2010
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexI.December 2010IntroductionThe 2010 Florida Department of Health (FDOH) Strategic National Stockpile (SNS)Appendix to the Logistics Support Annex documents the procedures needed to optimizeFlorida’s management and distribution of pharmaceuticals, medical supplies and equipmentobtained from the Centers for Disease Control and Prevention’s (CDC) Division of StrategicNational Stockpile (DSNS).The SNS Appendix supports the Florida Department of Health Emergency Operations Plan(EOP)’s Logistics Support Annex and Mass Prophylaxis and Treatment Annex, the FDOHEOP Biological Incident Annex as well as Appendix VIII: Emergency Support Function 8 –Public Health and Medical Services of the Florida Comprehensive Emergency ManagementPlan (CEMP). This Appendix is also compliant with guidance from the Centers for DiseaseControl and Prevention (CDC).In order to maintain state public health and medical readiness and in response to changesprescribed by the CDC, this Appendix is reviewed annually and updated as necessary.Page 2 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexB.December 2010Approval and ImplementationThe Strategic National Stockpile (SNS) Appendix to the Logistics Support Annex tothe Florida Department of Health Emergency Operations Plan (FDOH EOP)provides direction regarding the request, receipt, management and distribution ofpharmaceuticals, medical supplies and equipment from the Centers for DiseaseControl and Prevention’s (CDC) Division of Strategic National Stockpile (DSNS). Itis to be used by personnel deployed for any threat or incident requiring SNSmateriel to assist county health departments that have exceeded their capability orcapacity to respond.The Department activates this Appendix when an emergency threat or incident hasthe potential to overwhelm routine departmental procedures, or when CDC notifiesthe state of incoming SNS shipment(s).The Florida Department of Health, Division of Emergency Medical Operations(DEMO), Bureau of Preparedness and Response (BPR) updates this Appendix asneeded to maintain operational readiness. Email your questions and commentsregarding this document to the Division of Emergency Medical Operations atEOP@doh.state.fl.us .Page 4 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexC.December 2010Table of ContentsIntroduction.2I.A.B.C.II.Signature Page .3Approval and Implementation .4Table of Contents .5Purpose, Scope, Situation and Assumptions .6A.B.C.D.E.Purpose and Intent .6Scope.6Situation Overview .6Planning Assumptions .7Measure of Success .8III.Concept of Operations .8IV.Direction, Control, and Coordination .8A.B.C.FDOH Emergency Management Team (EMT) .8RSS Site .12Points of Dispensing (PODs) .17V.Organization and Assignment of Responsibilities .17VI.Information Collection and Dissemination .17VII.Communications .18A.B.VIII.Intra-Agency .18Inter-Agency .18Administration, Finance and Logistics .18IX.Plan Development and Maintenance .19X.Authorities and References .20XI.Attachments .22Page 5 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexII.December 2010Purpose, Scope, Situation and AssumptionsA.Purpose and IntentThe purpose of the Strategic National Stockpile (SNS) Appendix to the LogisticsSupport Annex is to identify procedures regarding the request, receipt,management, and distribution of medications and medical equipment from theCenters for Disease Control and Prevention’s (CDC) Division of Strategic NationalStockpile (DSNS). Materiel obtained from the SNS is designed to providesupplemental medications for prophylaxis, as well as medical supplies andequipment, for state and public health agencies during an emergency whichthreatens the public’s health and has overwhelmed local response capabilities.FDOH activates this Appendix when SNS resources are needed or directly shippedto Florida by CDC as part of its overall response to the event or incident. TheAppendix is in compliance with the CDC guidelines found in Receiving, Distributingand Dispensing Strategic National Stockpile Assets Guide for Preparedness,Version 10.02 – Draft August 2006, the Logistics Support Annex to the FloridaDepartment of Health Emergency Operations Plan, and the state of Florida CEMP.When activated, this Appendix supports local health and medical activities.B.ScopeThe scope of this Appendix is limited to logistical management of the federalStrategic National Stockpile materiel. It ties closely to FDOH’s EOP base plan,FDOH Logistics Support Annex, FDOH EOP Mass Prophylaxis and TreatmentAnnex, the FDOH EOP Biological Incident Annex, and county SNS/Cities ReadinessInitiative (SNS/CRI) plans at the local level.C.Situation OverviewThe Department activates this Appendix in support of local or regional medicalresponse to an event which overwhelms the local community’s or region’s ability toprovide prophylaxis, or other medical needs which can be supplemented with thedeployment of the Strategic National Stockpile (SNS) push package or with ManagedInventory (MI). Though initially designed for response to a biological terror attack, theSNS may also be deployed for: Tropical Cyclones and Severe Weather - tornadoes with mass casualties ordamaged medical infrastructure Environmental Events - wildfire, lightning, floods, heat waves, earthquake,tsunami Technological Events - nuclear power plants leaks, other hazardous materialspills or leaks Mass Migration Biological Events - zoonotic diseases, disease pandemicPage 6 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexD.December 2010Planning Assumptions1.The SNS Appendix is activated when an event requiring distribution ofpharmaceuticals and/or medical materiel exceeds local and state resources.2.CDC may directly deliver (“push”) SNS assets to Florida, without a request fromthe state, based on a credible intelligence threat or actual activities which makesuch an action prudent prior to a declaration.3.SNS assets can be deployed without a Presidential Disaster Declaration.4.The Florida Department of Health coordinates Florida’s request for the SNS andsubsequent implementation of this Appendix.5.The Strategic National Stockpile materiel is available in two forms: 1) SNS PushPackage: Caches of pharmaceuticals, antidotes and medical supplies designedto provide rapid delivery of a broad spectrum of assets for an ill-defined threatwithin the early hours of a response 1 ; 2) Managed Inventory: Managed Inventory(MI) is available upon request by FDOH. The MI provides a larger number ofpharmaceuticals and medical supplies than the push package. Specificpharmaceuticals and/or medical supplies may be ordered from the MI to meetdemands.6.The federal SNS Push Package arrives in the state within 12 hours of a formalrequest. State Receipt, Stage, and Store (RSS) distribution operations beginwithin four (4) hours after the arrival of the SNS materiel.7.Federal SNS Managed Inventory (MI) is available at the designated RSS facilitywithin 24-36 hours after requested by the state. Product shipment to countiesbegins within 4 hours of receipt.8.An RSS operated by the Florida Department of Health is established to receiveSNS material. The RSS receives, stages, stores, and distributespharmaceuticals, medical supplies and equipment to the affected area.9.An RSS facility accepts mission requests that come from the state personneldesignated to validate and approve requests.10. Each county has developed and validated its Strategic National Stockpile Plan.11. The amount of pharmaceuticals and medical supplies contained within the SNSPush Package may be insufficient to meet local needs, necessitatingapportionment of materiel.12. The population(s) to receive medications is determined by the nature, scope andseverity of the incident.13. Locally identified Points of Dispensing (PODs) are the primary locations for thepublic dispensing of materiel from the SNS cache, and are included in local SNSplans and procedures. County health departments may choose alternatedispensing sites (such as prisons, detention centers, healthcare facilities, largeindustries, first responder prophylaxis sites, residential communities, militaryinstallations, Tribal Nations) as PODs. The PODs may be open to the public orclosed PODs.1www.bt.cdc.gov/stockpilePage 7 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexE.December 2010Measure of SuccessThe successful execution of this Appendix is measured by: Impacted populations receive prophylaxis within 48 hours of an approved SNSrequest for the push package.o Initiate shipments of SNS material to the designated counties within 4 hoursof receiving materiel at the RSS.Accurate accounting of all distributed assets.Recovery of assets (if applicable) and return to normalcy for the affected area(s).III. Concept of OperationsFDOH’s concept of operations for management of the SNS is focused on the followingobjectives:A. Request the SNS Push Package or MI through a collaborative effort among local, stateand federal officials. [Note: CDC may deploy SNS assets, without a Florida request.]B. Receive, stage and store medications and supplies.C. Distribute medications or supplies.D. Recover unused medications or supplies, if appropriate.IV. Direction, Control, and CoordinationA.FDOH Emergency Management Team (EMT)As described in the FDOH EOP base plan, the FDOH EMT is responsible for overalldirection and control of public health and medical resources. This includes policydecisions related to waivers of dispensing laws, materiel allocation andapportionment, and setting response strategies.1.The State Surgeon General (SSG) provides direction, control and coordinationfor the Department of Health as outlined in the FDOH EOP.2.The FDOH EMT coordinates key policy decisions, in compliance with stateand FDOH emergency response structures and procedures. Attachment A8provides a summary of select policy decisions that may be addressed duringactivations of the SNS appendix.3.The FDOH EMT coordinates threat assessments/analyses. Betweenactivations, this function is coordinated by the FDOH Division of EmergencyMedical Operations, in conjunction with the State’s Warning Office. Duringemergency activations, the threat assessment/analysis activities continuethrough the Planning – Situation Unit of the activated command structure.4.The FDOH Emergency Coordination Officer (ECO) notifies State EmergencyManagement of a potential/imminent SNS request. The ECO requests theactivation of the State Emergency Response Team (SERT), if not previouslyactivated.Page 8 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support Annex5.December 2010The FDOH ECO supervises the state SNS program staff, whoa. Develop and disseminate to counties guidelines fordispensing/POD Management. Attachment C5: SNS CountyGuidance contains the current guidance document.b. Coordinate RSS training and exercise activities in accordancewith FDOH, state and federal guidelines.6.The FDOH ECO coordinates SNS resource requests.a. Requests often are triggered by biological threats listed in the BiologicalIncident Annex of the FDOH Emergency Operations Plan. Circumstancesthat exceed local and state capability to provide appropriate mass prophylaxisor other medical countermeasures may also trigger an SNS activation, suchas:1) A verified, positive test result from the BioWatch System.2) A chemical, biological, radiological, nuclear or explosive (CBRNE) threator incident.3) A public health emergency resulting from a natural disaster.4) An intelligence report noting release or potential release of a biological orchemical weapon. This may result in a pre-event deployment of SNSassets.b. Requests are restricted to those individuals whose names are on file with theCDC and updated annually. Positions authorized to request the SNS are:1)2)3)4)5)State GovernorState Surgeon GeneralFDOH Deputy Secretary for HealthFDOH Division of Emergency Medical Operations DirectorFDOH/ESF8 Emergency Coordination Officer (ECO)c. Attachment A1: Requesting SNS Assets provides the information needed atthe time the request is made to CDC, as well as the CDC SNS contactinformation.7.The FDOH ECO coordinates key SNS Appendix activation actions. Many ofthese activities occur simultaneous to requesting SNS resources.a. Directs the Planning Section, in conjunction with technical specialists, todevelop allocation and apportionment plans.b. Coordinates approval of any appropriate Executive Order/Public HealthEmergency. Attachments A4 and A5 provide verbiage examples of either aGovernor’s Executive Order or Public Health Emergency, that may beneeded to optimize SNS operations.c. Initiates RSS set-up.1) At the time the SNS is requested, the ECO, in coordination withappropriate agencies, selects the RSS site(s). This determination takesinto consideration issues such as impacted area, safety, security, traffic.All initial and subsequent SNS assets are received, stored, and staged atthe chosen location. Attachment A2, RSS Sites is confidential. Thecurrent list of approved RSS sites for Florida SNS operations ismaintained by state SNS staff and is available on a need-to-know basis.Page 9 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support Annex2)December 2010Management of SNS materiel is a logistical mission, and is coordinatedby the Logistics Section of the incident management structure. TheLogistics Section Chief activates staff in accordance with Attachment A3:Activation and Notification Checklist. Key activities include activationand deployment of:(a) Designated staff to open the RSS site,(b) An RSS management team and related resources.(1) Attachment A6 contains a RSS Table of Organizationtemplate.(2) Attachment A7 contains the current RSS roster.d. Assures the CDC’s SNS State Assistance Group (SSAG) needs are met.The SSAG are federal SNS staff that coordinate with state and local officialsto assure the SNS assets are efficiently received and distributed upon arrivalat the site.8.The FDOH ECO assures that local requests for SNS materiel receive promptvalidation and response. All requests for medications come first to the CountyEOC, where they are entered into the established requisition system. CountyEOC requests are validated by State staff, utilizing SNS strategy and guidelines.Once these requests have been approved by State ESF-8 Command, a missionto fill the request is generated and entered into the same requisition/trackingsystem and tasked to the RSS facility. After the product has been delivered, thesame system is used to document the mission’s completion. The followingdiagram provides an overview of Florida’s resource request procedure.a. Orders are accepted only from the local CHD through established requisitionsystems. Individuals with delegated authority to request SNS assets areindicated in each county’s SNS Plan.b. The RSS fills orders from a Tribal Nation or a Department of Defense (DOD)facility requesting materiel from the SNS. These requests must be placedthrough the county CHD in which these entities reside.Page 10 of 22
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexOverview of Florida’s Resource Request ProcedurePage 11 of 22December 2010
Florida Department of HealthStrategic National Stockpile Appendix to the Logistics Support AnnexB.December 2010RSS SiteThe RSS site is the location in which the assets received from the CDC are managedprior to distribution to counties.1.Prior to the arrival of the state RSS management team, a designated staffmember located near the RSS site, is deployed to the site to serve as the RSSBranch Director. This staff member initiates RSS set-up in accordance with theprocedures found in Section 1 of the RSS Operations Manual. Attachment B1contains the RSS Operations Manual’s table of contents.2.An RSS Branch Director manages RSS operations in accordance with stateobjectives. The RSS Operations Manual includes a sample RSS Table ofOrganization. The RSS is primarily a logistics function. The incidentmanagement structure provides the following support for the RSS: PublicInformation (if needed), Planning and Finance & Administration Sections.Because of the need for current information from the RSS (e.g. status ofshipments and staff), the RSS Management Team includes a Planning Liaison.Although Finance & Administration activities are primarily coordinated at the statelevel, positions within the RSS roster have been designated that can procureneeded resources in accordance with FDOH and state procedures.3.RSS operations involve:a. Accepting custody of SNS assetsAccepting custody involves the acceptance of SNS assets from thefederal government at the designated RSS site. Section 1 of the RSSOperations Manual documents Florida’s chain of custody procedures,including the management of controlled substances.The RSS operations comply with required procedures of the ControlledSubstances Act of 1970 and the Florida Statutes Chapter 893, DrugAbuse Prevention and Control, in regards to the controlled substancesreceived from the Strategic National Stockpile and distributed to PODs orother health care
FDOH’s concept of operations for management of the SNS is focused on the following objectives: A. Request the SNS Push Package or MI through a collaborative effort among local, state and federal officials. [Note: CDC may deploy SNS assets, without a Florida request.] B. Receive, stage and store medications and supplies.
with the Florida Department of Environmental Protection, Florida Fish and Wildlife Conser vation Commission, and Florida Department of Agriculture and Consumer Services. Members of the Florida Oceans and Coastal Council are as follows: Acknowledgments E X O F F I C I O M E M B E R S Florida Department of Environmental Protection Co chair:
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Florida Statute 381 .0205, Emergency Medical Services (EMS), requires the Department of Health to provide a statewide EMS program pursuant to Chapters 395 (Trauma), and 401 (EMS). The Florida Emergency Medical Services Section is an office designated by the Department of Health (DOH) under the leadership of the Florida Surgeon General.
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