Facilitated Discussion

Public Health and Pharmacy Responding to an Anthrax Scenario

S C H O O L O F P U B L I C H E A L T H

Objectives

1. Understand capabilities and expectations of public health and pharmacists/pharmacies regarding emergency response 2. Identify challenges and opportunities in present-day community-wide preparedness and in strengthening facility and regional capabilities for medication dispensing 3. Create networks within and between the pharmacy and public health communities

About this Facilitated Discussion

• Hypothetical scenario • Facilitator leads groups of players in discussions about a series of incidents • Identify and discuss plans and actions needed to address each incident

During Discussions

• Assume the scenario is real and view it through your role • Make decisions based on available information • Identify opportunities and barriers • Relax, no right or wrong answer • Focus on learning and problem-solving

Mid-September, Western WA

Suspicion

• Law enforcement on high alert • No specific threat in Washington State

Recognition

• A suspicious person near main ventilation system of convention center • Person detained, law enforcement contacted • Unmarked aerosol can found in trash

Public Health Alerted

• Multiple attacks in Seattle and Pierce counties • Local public health departments are notified • Samples tested – presumptive positive for anthrax Image source: CDC

Mass Dispensing Timeline

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H 1.

2.

3.

4.

5.

Local Health Officers (LHOs) activate medical countermeasures plans Counties proclaim emergencies LHOs request medications Governor proclaims emergency - requests medications from the Centers for Disease Control Regional partners activate response plans Local health jurisdictions activate response plans and prepare to receive medications

Medications as Countermeasures

Collaborative drug therapy agreements for the antibiotics ciprofloxacin, doxycycline, and penicillin are activated.

CDC Recommends Bio-Thrax ® Administered IM at 0,1,6,12 and 18 months. Contains no live or dead bacteria. Made from a non-virulent strain of

Bacillus anthracis

.

Discussion Questions

Pharmacists What are your initial expectations of health departments actions and their communication with you?

All What tools or guidance do you need to prepare for this type of disaster?

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H

CDC Approves Request

Local Public Health asks pharmacies: “Can your stores be utilized as PODs? If so, which ones?” “How soon can your stores be prepared to dispense?” “When should LHJs notify the public that your stores will be dispensing medications?”

Discussion Questions

Pharmacies How would you respond?

• Can your stores be utilized as PODs? If so, which ones?

• How soon can your stores be prepared to dispense?

• When should LHJs notify the public that your stores will be dispensing medications?

Local Public Health How do you see pharmacies fitting in to your regional dispensing strategy?

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H • • • • • • LHJs set up points of distribution (POD) sites, commercial vaccinators notified Pharmacies notify staff Closed POD sites notify employees about operations Hospitals and first responders begin dispense locally cached medications Public health communications staff release messages to the public LHJs communicate with key parties

Discussion Question

What directives, guidance, and tools do LHJs and pharmacies need from local or state officials to support consistent, statewide dispensing operations?

Discussion Question

What material management issues do you foresee arising during this incident? How can we overcome those issues?

Discussion Question

How should communications with the State Board of Pharmacy occur and what information should be conveyed?

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H • POD sites set up and awaiting supplies • Pharmacies identified • Education materials and screening forms distributed • Mass dispensing locations and timing confirmed • Supplies shipped to receiving sites

Discussion Questions

Pharmacies At this point, what are the most important things pharmacists need from local and state public health?

What are your most significant limitations to implementing medical countermeasures dispensing

Discussion Questions

Local Public Health How do you see pharmacies fitting in to your regional dispensing strategy?

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H Public PODs and Closed PODs are ready to receive medications

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H • SNS materials arrive in small quantities • LHJs communicate locations of pharmacies and public PODs • Public medication dispensing begins

Discussion Question

What challenges do you foresee for dispensing sites that receive limited quantities of medications? Would these affect your decision to participate in dispensing at this time?

Discussion Question

What documentation does local public health need pharmacies to utilize during dispensing operations? What data must be collected and communicated to local public health?

48 H 44 H 42 H 38 H 34 H 32 H 30 H 24 H • Mass dispensing underway • Dispensing continues for several days to weeks

Discussion Question

How long can your organization sustain emergency dispensing operations?

Discussion Question

What strategies do you recommend for maintaining availability of antibiotics for all who need them over the next several weeks to months?

0 Hours Remaining

Demobilization Discussion Question

Who should make the decision to return to normal operations and to discontinue receipt of stockpiled supplies, if used? What criteria should be considered?

Demobilization Discussion Question

Who covers the dispensing/administrative fee cost of providing prophylaxis? What documentation might be needed?

Debriefing

1. Moving forward, how can public health and pharmacists/pharmacies jointly strengthen capabilities?

2. What barriers should we address first to improve emergency response?

3. What are our greatest strengths, and what gaps still exist in our planning and our tools? 4. What should be the next steps in community preparedness? 5. List and prioritize 3 short and long-term actions for follow-up.

Summary and Adjourn

• Follow-up actions • Additional resources • After-action report

Thank you

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