2011 Training & Updates
SNS Training MUST take place
ANNUALLY.
SNS Plans

Be NIMS compliant
 All Employees must complete IS100, IS200, IS700 within 90
days of employment

Be reviewed and updated ANNUALLY by Administration

Include a Multi-Disciplinary Planning Team
 This team includes Public Health, Law Enforcement, Health
Care, Schools, Public Service Agencies, Tribal Partners & many
others.

Identify the roles and responsibilities of local response
partners, ensure that these partners acknowledge their
role and responsibilities, and are included in regular
training and exercises.

Include State and local policies and procedures to
support local mass prophylaxis operations and/or
medical supplies management
 Policies & Procedures can be found in the SNS Plan and/or
the All Hazards Plan

Outline legal issues to support mass prophylaxis
operations and/or medical supplies management
and distribution
 Legal Issues are outlined in the SNS Plan




An outbreak is
identified
MDCH/CDC
determines need
for mass
medication
distribution
SNS Plan activated
The EOC is
activated



Estimate made of
doses needed for
County
SNS arrives at
MDCH
MDCH repackages
SNS supplies to
deliver to Local
Health Department
Distribution Nodes






Pharmaceuticals
Burn Surge supplies
Airway supplies
Vaccines
Medical supplies
Medical equipment



The Local SNS Coordinator (Jenni Zordan) and
back-up (Sue Bailey) must be, trained, and the plan
must provide their contact information.
SNS functions are integrated within the local
Incident Command System (ICS) structure and are
NIMS compliant
VBCDHD has a plan to annually test and exercise
notification and activation of volunteers below the
local level positions identified.

At the local level and dependent upon the placement of the
activities in the local Incident Command System
organizational structure, the following functions have
personnel (primary and back-up) identified with documented
contact information.









Tactical Communications/ITS Support
Hospital/Alternate Care Facility Leader/Manager
Public Information & Communication
Inventory Management Coordination
Security Coordination
Distribution Leader/Manager
Dispensing Site Supervisor/Leader
Staffing/Volunteer Coordination
Safety Coordination

Call-down lists for the personnel identified in the positions above
are maintained, current, and updated quarterly.

Local jurisdiction conducts and documents call-down exercises of all
personnel identified to test response rates quarterly.

The following slides show the requesting
process for local health departments to the
State of Michigan
◦ Initial Request Flow Chart
◦ Ongoing Request Flow Chart
Received from MISNS 08/2010

What is the trigger point for reporting to local decision makers that the levels
of SNS assets are low for consideration to reorder assets from the State?
◦ Trigger Points for VBCDHD will be determined on a case-by-case basis. During H1N1,
we requested based on the demand we had for the product.

Describe how inventory levels are determined, monitored and communicated

Who has the authority to place an order for SNS assets from the local level to
the State?
◦ Inventory is overseen by the Director of Nursing and delegated to other staff
◦ The process is outlined in the CD manual for nursing staff
◦ Currently inventory is managed by paper and online using the MCIR system
◦
SNS Orders will be determined and signed off by the Medical Director and the Health Officer


Only persons delegated by the Medical Director or the Health Officer will have authority to place orders for SNS
assets.
How is the order placed?
◦ The process for placing orders can be found in the SNS Plan
◦ Paper requests forms as well as SharePoint are approved methods




Overall purpose is to provide guidance and
resources for communications during an event.
Outlines who is in charge of communications and
methods that are to be taken for approval of
messages.
Covers how joint communications will be handled
in a community wide event (Joint Information
Centers – JIC)
Ensure message consistency

Public Information officer (PIO)

Public Information Liaisons
◦ Serves as the main point person for
communications going out during an event.
◦ PIO serves as contact point for the media.
◦ Work to gather information from other venues,
such as EOC’s (Emergency Operations Center),
distribution nodes, dispensing sites and JIC’s to
allow for the current and accurate information to
be given to the PIO.
◦ May also be tasked with handling the media at
local POD (Points of Dispensing) sites.

Pre-developed messages (scripts) and fact sheets
on a variety of topics are available in the PIC plan.
◦ Pre-event messages to prepare the public
◦ Messages to inform the public of the event
◦ Messages to help the public get to the PODs and know what
to bring
◦ Messages to help the public navigate through the PODs
◦ Messages for after people leave the PODs
◦ These should be updated regularly

May include
◦
◦
◦
◦
◦
◦
◦
Dispensing site locations, hours of operation, and directions
Check on your neighbor and carpool to POD sites
“Head of Household” information
Agent information sheets
Instructions to ensure medication compliance
Vaccine information sheets
Inform public of alternate forms of dispensing

Identify special populations ahead of time (nonEnglish speaking, hearing/visually impaired, home
bound, etc)

How will these populations be reached?

Have pre-identified interpreters/interpreting
services
◦ Through the use of closed POD partners such as: United
Way, Homeless Shelters, Meals on Wheels, Long Term Care
Facilities, etc.
◦ Closed captioning to large businesses and employers
◦ American Sign Language
◦ Foreign Language Interpreting services at VBISD
◦ 2-1-1

Have pre-established ways to contact stakeholders for a
variety of events
◦ These could include hospitals, schools, pharmacies, closed POD
partners, and etc.

Redundant Communication Capabilities

Non-traditional dissemination methods identified

Work with local media to help disseminate messages during
any event.
◦ E-mail, phone numbers, blast fax, etc
◦ Ensure this information is updated often
◦ At-risk populations and special populations
◦ Methods for disseminating information in a power outage
Prior
to and during an emergency, staff notification &
communication are priority.
The following slides highlight various aspects of the
health department tactical communication system.


Staff Lead includes George Kilts/Cary Hindley
4.1 - Review Communications/IT staff call-down
list/numbers
 Call down lists are reviewed and updated quarterly
 It is important to keep your personal afterhours information up
to date in the event we need to get a hold of you.

4.2 - Review Comm./IT staff JAG’s and describe the
just in time training process
◦ Please review Job Action Guides

4.3 – Communication pathways are established and
maintained between with land lines, cell phones, 800
mHz radios, internet, etc. with the following agencies
◦
◦
◦
◦
◦
◦
◦
◦
◦
Incident Command
Local and State EOC
LHD Staff
Point of Dispensing Sites
Distribution Node
OPHP
Hospitals
Security
Transportation

4.4 – Redundant communication systems that are tested quarterly
and may be utilized during an event. The following is a list of
communications methods used to ensure we have
communications that do not fail during an event.
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
800 MHz Radio
MI-HAN
Health Dept. Website
Landline, Cell, and Analog (during power failure) Phone
Fax
E-TEAM
City Watch (Reverse 911)
TV and Radio (know your Emergency Alert System station)
Social Networking (Twitter and Facebook)
Amateur Radio
211
Security is an essential component for carrying out a successful SNS
emergency response. Individuals involved in these security
functions must be trained to protect the following:
•SNS assets
•Locations used to support an SNS response (DN, PODs)
•Staff, volunteers, and citizens at SNS operations, and
•The SNS transportation infrastructure once assets transfer
custody from State to local (escort vehicles).
Who Should Be Trained?
Staff assigned to the following SNS functional roles should attend local
security training events:
•
•
•
•
•
•
•
•
•
•
Security Coordinator
DN Manager
POD Supervisor
Inventory Manager
Volunteer Coordinator
Safety Manager
Transportation Manager
Logistics Chief
Local Law Enforcement
Volunteers who may be assigned to assist security, if needed
Security Procedures to Consider for Training Are:
•
•
•
•
Transportation of SNS assets
Badging and Credentialing
Communication Procedures
DN/POD Site Security Plans:
-
Interior physical security
Exterior physical security
Command and management
Evacuation concerns
Security breach protocol
IMPORTANT: Local law enforcement must review site specific security plans
for DN’s/POD’s and have opportunity to ask questions.


The primary site for
delivery of SNS
assets in a
jurisdiction
The location of the
local Distribution
Node



The Health Department
Incident Commander
(IC) will notify the
County Emergency
Manager of activation
The IC must notify the
DN facility contact
person to request
access to the facility, if
other than an LHD site
Distribution Node staff
will be activated


All DN staff will meet
to receive “Just-inTime” training (prior to
receipt of SNS assets)
A Job Action Guideline
will be provided for
each role, detailing
immediate, ongoing,
and long-term job
duties
Examples of Roles:
 Distribution Node Manager
 Warehouse Manager
 Inventory Manager
 Picker Staff
 Quality Control Staff
 Receiving Staff
 Shipping Staff
 Security Staff
 Safety Staff
 Communications







Staffing
Office equipment
Communication equipment
Signage
Forklifts, pallet jacks, dolly carts
Computers, printer, copier
Forms


SNS material must be
inventoried, packaged,
and delivered to the
dispensing sites within
our jurisdiction
Re-supply requests
from dispensing
sites/PODS and/or
alternate sites are also
handled at the DN


Material handling
equipment will be
supplied by
Emergency
Management
Anyone required to
use material
handling equipment
will receive training
prior to use



Upon receipt of assets, Pick List (invoice) is
compared with the items actually received
An inventory database (paper or electronic)
must be created for the DN and at each
dispensing site
All requests, shipments, and deliveries must
be recorded and filed for record keeping
purposes



The signatures of individuals both
relinquishing and receiving the SNS assets,
who they represent and the date and time,
establish a chain of custody.
Chain of custody form
A DEA registrant may be necessary for the
receipt of controlled substances.





Inventory SNS Ordering Forms and Inventory
Pick List establish inventory
MDCH:OPHP Transfer Form for the SNS is
signed when assets are transferred to the
Health Department
DEA Form -222 is issued by the DEA and is
used for the transfer of controlled
substances
POD Order Form
Local Health Department Chain of Custody
Form
MICHIGAN RSS: Inventory Pick List
Delivery Site
Order Number
Shipment ID
My Junior High
XXXXXXXXX
XX
Item Description
Doxycycline 100mg oral tablet #20 tab unit of use
Container
Number
Item Number
Cases
27
R03386
66336-449-20
340
Item Description
Ciprofloxacin 500mg oral tablet #20 tab unit of use
Container
Number
Item Number
Cases
30
R01030
66336-031-20
60
Date & Time:
Page
1
of
1



At the conclusion of the event, all unused
unopened medication and durable goods will be
returned to the DN from each dispensing site
Returned goods must be inventoried, and the State
RSS must be contacted to arrange for the pick-up
of returnable items
Any items that are not considered durable goods
(plug-in, run on batteries, etc) will remain the
custody of the local jurisdiction for proper storage
or disposal.



The Distribution Node is a central
warehouse for SNS at the local level.
The Inventory Management System
organizes, distributes and tracks the SNS
assets at the local level.
SNS medication/supplies will be sent to
Dispensing Sites/PODS within the
community.

Purpose of a mass dispensing campaign

Types of rapid dispensing techniques

Staff notification procedures and reporting

Phases for dispensing medications

Special considerations in mass dispensing planning

Models for increasing throughput at PODs

Dispense medical countermeasures (MCM) in the most efficient
and timely manner.

Utilize rapid dispensing techniques

Dispense medications to all County residents within 48 hours

Provide MCM for prophylaxis of asymptomatic individuals


Triage symptomatic individuals and direct them to treatment
centers
Dispensing can be limited in scope as well as a community-wide
event
These phases are subject to change based on the situation and LHD
Plans.
Phase 1: The Health Dept. staff and their household members will
receive the first round of prophylaxis.
Phase 2: The Health Dept. staff will open a designated dispensing site
and dispense to First Responders and essential personnel
Phase 3: Pre-identified ancillary facilities will provide prophylaxis to
their employees, residents, occupants and household members (i.e.,
qualifying schools, big businesses, industrial facilities, long-term
care facilities, jail, etc.)
Phase 4: Designated dispensing site(s) will open to dispense
medications to remaining residents

Health Department staff will be contacted
to report to staging area for further instructions
**Contact information should always be up-to-date**


Provide staff briefing & conduct just-in-time training
◦ Event information, safety information, job duties,
Incident Command System, etc.
Discuss dispensing phases and modalities
◦ Priority groups, dispensing instructions, facility
identification, Emergency Use Authorizations,
medication information, & etc.

Number of regimens of medication that can be dispensed
to an individual

Handling symptomatic individuals

Handling unaccompanied minors


Handling of non-English speakers/hearing
impaired/visually impaired/functionally illiterate (Special
populations planning)
Procedures for crowd control, traffic management,
security, media

Closed PODs

Drive Through PODs

Mobile PODs

Pre-Deployment to businesses
DISPENSING TIERS
YELLOW
Full
Intermediate
Care/Individual Care/Group
Screening
Screening
Model
Regulation Compliance
NAPH Form Distributed & Reviewed by Staff/Voluntters
Dosing Information
Tablet Crushing & Reconstitution
Dispensing Staff
RESOURCES
Minimum
Care/No
Screening
X
Given to Patient
Picked up by
StatePatient
Pharmacy
X
CDC Website
Reqs.
FDA Requirements
X
IND/EUA
Full NAPH Form
Abbreviated NAPH
Form**
X
NAPH Form
Full Labeling
X
Dosing Directions
Only
Tablet Crushing
Information &
Weight Charts
X
X
NAPH Form
X
State & Federal
Pharmacy
Regulations
X
X
X
X
X
X
If Available
If Available
Licensed
Lay Persons
Limited Individual
Medical Care &
Evaluation
En Masse Triage
CDC Website
IND/EUA
X
X
Expanded Professions
Individual Medical Care & Evaluation
RED
Michigan HAN
Webpage: Head
of Household
Policy & NAPH
Name,Age, Phone, & Home Address (NAPH) Form
Drug & Disease Patient Information
ORANGE
Weight Charts,
Crushing and
Reconstitution
Instructions
Emergency
Management
Act 390, Sect.
11
If Available Act 390, Sect. 11
X
X
Weight Charts
Act 390, Sect. 11
NAPH Form
X
NAPH Form
The DN serves as a functioning warehouse for receiving and
shipping SNS materiel at the local level amidst a public
health emergency. From the DN, the assets will further be
delivery to local Points of Dispensing (PODs) sites in order to
provide these life-saving assets to the public.
The DN distributes Strategic National Stockpile (SNS)
medical countermeaures (MCM) to local POD sites.
 The State of Michigan delivers SNS assets directly to
treatment centers throughout the State.
 Providing Security at the DN, POD sites, as well as for
the transportation of SNS materiel, is the
responsibility of local law enforcement.
 The location of the DN should be somewhat centrally
located geographically within the jurisdiction and
among the identified local POD sites.
 The DN is one component of the overall local
emergency response

The planning, coordination, and management of
the DN is the responsibility of local Public Health.
 The health department is responsible for staffing
and operating the DN when activated.
 The DN is located within the Operations Section of
the Incident Command System.
 The DN Manager/Leader reports to the Operations
Section Chief at the health department
 DN Staff report to their perspective branch director
or chief, who then reports to the DN Manager.

Sample ICS Chart – DN
is in Logistics Section
Unified Incident Command
Health and Safety Officer
Public Information Officer
Liaison Officer
Operations Section
Logistics Section
Planning Section
Staging
Area
Patient Care
Branch
Preventive
Svs Branch
Patient
Transport
Branch
Security
Branch
Services
Branch
Support
Branch
SitAnaly/Epi
Investigatio
n Unit
Personnel
Records
Unit
Distribution
Node Unit
Documenta
-tion Unit
Resources
Procuremen
t Unit
Treatmen
t Care
Group
Dispensi
ng/
Vaccinati
on Group
Symtomatic
Group
Fixed Site
Group
Commun.
Unit
Patient
Standard
s Group
Site
Triage
Group
Satellite
Site/
Worried
Well Group
Mobile
Group
Responde
r Medical
Unit
Transport
Unit
Resources
Status Unit
Food
Beverage
Unit
Facilities
Mgt Unit
Demobiliza
-tion Unit
Criminal
Investiga
-tion
Group
Finance/Admin
Section
Cost Unit
Volunteer
Manageme
nt Unit
Distribution Node
Manager
PH Liaison / Health
and Safety Officer
Warehouse
Operations Leader
Inventory
Control / Pick
Team
SNS Order
Staging
Security Leader
Site
Security
Delivery
Escort
Security
Shipping/Receiving/
Distribution/
Leader
Receiving
Dispatch
Transport
Drivers
Housekeeping
/ maintenance
Accounting /
record
keeping
 Local
Unified Incident Command makes the
decision to activate the DN
 The health department is notified of
decision to activate the DN
 The site, staff, and various suppliers are
notified of the DN activation


The DN site is readied to accept SNS materiel
 Materiel handling and office equipment
obtained - forklift, dolly, copier
 Communications are setup - radios, fax,
phone, etc.
 Organization/layout of site – loading,
storage, staging and office areas
 Cleanliness of site - breakroom, restrooms,
etc.
 Inventory system set up – electronic or hard
copy
 Materiel ordering system set up – ordering,
picklist, manifest forms
 Security (exterior and interior) set up
 DN staff is briefed/updated on situation,
role and procedures (Just in time training)
DN Manager notifies Unified Incident
Command when the DN is ready to accept
delivery of SNS materiel from the State

Accepting SNS Delivery at the DN



Inventory of Delivery



Who is authorized to sign for the
delivery – position/title, Drug
Enforcement Agency (DEA) Registrant,
authorized backup, etc.
State Transfer form - Chain of
Custody form, shipping manifest, etc.
Check manifest, compare to what was
ordered/expected and report
discrepancies
Enter received materiel into the
inventory system
Storage of Materiel


Move materiel to proper location
Utilize appropriate rotation system
(FIFO – first in, first out)
Filling a SNS Order from a POD
 Assume
an initial supply is sent to all activated
PODs (apportionment decision by Unified
Command), this section applies to subsequent
orders
 LHD Order filling details here:






DN receives SNS order from a POD
Use pick list to fill the order
Move picked materiel to staging area
in DN and perform quality control
Fill out proper shipping forms
Verify POD order
Inform Dispatch of order readiness
 Verify
Route(s) for POD deliveries, provide maps,
communication equipment, and etc. to drivers
 Obtain/arrange security escort for delivery
 Ensure primary method for communications with
driver is functioning properly
 DN dispatch informs POD of delivery departure
time and estimated time of arrival (ETA)
 Upon delivery to POD, informs DN, performs
chain of custody, and provides a return ETA to
the DN

Inventory Control position monitors DN
supply levels


DN Manager initiates DN Re-supply
process




At pre-determined inventory trigger levels,
Inventory Control position notifies DN
Manager of need for additional supplies
SNS order form faxed to local Emergency
Operation Center (EOC)
EOC faxes SNS order form to Community
Health Emergency Coordination Center
(CHECC)
Confirmation of order is received by local
EOC, ETA of SNS delivery provided to DN
Manager
SNS materiel is delivered to DN. Same
acceptance process as initial delivery
Local Public Health Distribution
Node Staff Training Template
CHECC Receives SNS Order – fills order based
upon State inventory and event Characteristics
Local EOC receives DN SNS
request, relays to CHECC
Local DN Re-supplied
POD 1
Public Health Distribution
Node requests SNS resupply from local EOC
POD 2
POD 3
POD orders exhaust Distribution Node Inventory
Local Public Health Distribution
Node Staff Training Template
 Local
Unified Command will initiate the
demobilization process.
 DN Manager monitors activity at DN and
receives situation reports (sitreps) from the
PODs.
 Conduct a walk-through and complete a
facility checklist to record conditions of the
facility after clean-up is complete
 Provide maintenance to facility and
equipment as necessary
 Releases DN staff as incident characteristics
dictate
Local Public Health Distribution
Node Staff Training Template


Materiel at PODs returned to DN upon
completion of activities
 Security escort of returning materiel
required
 Process of materiel pickup is similar to
deliveries, but reversed. Paperwork
required – chain of custody, intracounty transfer form, etc.
SNS Materiel at DN is re-packaged,
readied for transport as per State/Federal
instructions.


Some SNS materiel may need to be
destroyed and/or disposed of.
Prepare CDC durable goods for pick-up by
the State and return to CDC (i.e. anything
that plugs in, runs on batteries, etc).

Command and Control –




Activation/DN Setup –





Notification and activation of site and staff
Setup of site
Equipment acquisition
Inventory control/shipping systems functioning
Paperwork trails –






The role of the DN within the ICS structure
Communications network between State, PODs, and LEOC
Responsibilities of agencies/entities involved in DN operations
POD ordering system
DN Re-supply
Pick lists
Shipment manifests
Chain of custody forms.
Security 

Interior and exterior security
Escort vehicles for deliveries
 Review
the Job Action Guides for
SNS
 Sign the Acknowledgement Form
available in each office.
If you have questions please
contact Jenni Zordan at ext.382 or
jzordan@vbcassdhd.org