Regional Pharmaceutical Resources
Colleen Terriff, PharmD, BCPS (AQ-ID), MPH (soon)
Clinical Associate Professor
Washington State University College of Pharmacy
Deaconess Hospital and Rockwood Health Systems
November 21, 2013

• 1999 hoax anthrax letter
• Y2K preparation for hospitals
• Poster at Midyear and AJHP publication
• MMRS Spokane City/County Pharmaceutical
Coordinator (2000- present)
• Sept 11, 2001
• Participation in variety of exercises:
– Mass vaccination
– Mass dispensing
– Mass casualty

• CDC CHEMPACK med exchanges
• Assist with public health
• Stockpiling:
– Decisions: location, medications, ancillary supplies
– Distribution
– Dosing and preparation information
– Inventory
– Destruction

• MMRS Stockpiles
• CHEMPACKS
• SNS Antiviral Cache
• VA Cache
• HRSA Employee Cache
• Hospital Inventory for SRHD
• Community Pharmacy Inventory as needed

Agent
Anthrax
Prophylaxis
Antibiotics
Treatment
Antibiotics
Plan
Local and SNS
Botulinum
Plague
Smallpox
Tularemia
VHF
Observe
Antibiotics
Vaccine
Antibiotics
Invest. Drugs
Antitoxin
Supportive care
Antibiotics
SNS
Local and SNS
Invest. Drugs
Supportive care
Antibiotics
SNS
Local and SNS
Invest. Drugs
Supportive care
SNS

Local Bioterrorism
Pharmaceutical Plan (MMRS)
• Agents
– Levaquin IV/PO, doxycycline IV/PO, gentamicin IV
• Others
– dosing syringes, sterile water for injection
• Considerations
– pediatrics, pregnancy, elderly, immunocompromised
– first-responders and healthcare professionals
– prophylaxis vs. treatment

Agent
Nerve Agents
Vesicants
Industrial
Chemicals
Riot Agents
Treatment
2-PAM, atropine, diazepam
Supportive care
(BAL for Lewisite)
Supportive care
(Cyanide antidotes)
Supportive care
Plan
Local (CHEMPACK) and SNS
SNS- BAL
Local and SNS
Local and SNS

Local Chemical Terrorism
Pharmaceutical Plan (MMRS)
• Nerve agent antidotes:
– 2004:
• MARK-1 and diazepam autoinjectors with “sprinklings” of 2-
PAM vials, diazepam carpujects
• ALS transport (AMR and Medstar) and non-transport (fire)
– 2009:
• Duodotes
• Cyanide antidotes (hydroxocobalamin)
– fire chief rigs
– Expired: AMR

• Nerve agent antidotes
– antidotes more readily available
– improve local response time
– treat thousands of patients
(including peds)
• Federally owned cache
– decrease cost to local areas: initial and replacement
– Shelf-Life Extension Program (SLEP)

• Previously- military
• SNS in conjunction with the FDA may extend shelf-life of meds (expiration date)
• Strict criteria:
– storage and security
• Meds from CHEMPACK:
– regardless of dating on vials/packages….
– ensured potency!!
• Just implemented for Tamiflu susp.

CHEMPACK Distribution
• Hospital:
Eastern Washington
– Deaconess
– Holy Family
– Sacred Heart
– Valley
• EMS:
– AMR (x2)
– Valley Hospital
– Colville
– Pullman

Strategic National Stockpile Program
• CDC/Federal Government assistance
• Stockpile (4 components):
– 12 hour push package
• antibiotics (IV and PO) and antidotes
• fluids, bandages, IV supplies, supportive care meds
– Vendor Managed Inventory- drug or equip.-specific
– Vaccine and Antitoxin
– CHEMPACK program- pilot: NY, SD, WA
• Additional resources: personnel, $$

• CDC released 25% of SNS antivirals
• DOH received antivirals and then distributed to sites identified by local HD
• Local:
– Hospitals
– Retail/chain with expanded access
• Issues:
– storage (physical)
– short expiration of suspension
– different packaging

• Locals now own stockpile
• Who is the “gatekeeper” of access?
• Need to use up local supply (in pharmacies) first, then can utilize SNS
• Ancillary supplies…

• Large facilities
• Small facilities:
– Spokane
• Mass casualty
• Color coded
• Includes supportive care meds
• 2008 Directive

• Ciprofloxacin
• Doxycycline
• For employees and families and hospitalbased EMS providers
• Maintained by area hospitals

1. MMRS- ill patients (i.e. IV meds)
• ED provider can access
2. MMRS- POD
– SRHD or Spokane EOM- to be sent to POD
3. CHEMPACK plus expired meds
4. Antiviral SNS cache
5. Employee cache
• Antibiotics and antivirals
• HRSA grants

• Deaconess and Shriners
• Holy Family and Deer Park
• Sacred Heart
• Valley
• VA
• Antibiotics, chemical exposure treatment, antivirals
• Estimation
• SRHD listed resource

• Enroll help of:
– WSU College of Pharmacy Drug Information Center
– Spokane Pharmacy Association
• Limited meds
• Dispensing to community

• State-wide initiative community pharmacies:
– Chains
– Independents
• SRHD with WSU COP:
– Mass dispensing
– Mass vaccination

• Partnering with law enforcement (SPD)
• Coordinating stockpile destruction with other incineration needs for LE
• Mainly MMRS chemical terrorism meds

• MMRS defunct
• CHEMPACK program will continue until ?
• Local stockpiles expired
• Keep expired meds until funding changes