Antibiotics Dispensing in the Event of a Citywide Emergency How Businesses Can Help

ANTIBIOTIC DISPENSING IN THE EVENT OF A CITYWIDE EMERGENCY

PUSH P A R TNER P R OGRAM

SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH PUBLIC HEALTH EMERGENCY PREPAREDNESS & RESPONSE October 13, 2016

 1995- Oklahoma City Bombing prompts Department of Health and Human Services need for medical readiness  1999- Strategic National Stockpile (SNS) created  2001- September 11 & October Anthrax Attack  2004- Cities Readiness Initiative

Anthrax Powder

 Develop strategies, in the event of a  Doxycyc large scale infectious disease emergency, line (Doxy) to dispense antibiotics to all residents and visitors of San Francisco within 48 hours

 If taken after exposure, antibiotics prevent disease: post-exposure prophylaxis (PEP)  Basis for SFDPH’s Mass Prophylaxis Plan  2 primary types of Antibiotics:  Ciprofloxacin (Cipro) Ciprofloxacin Sources of Antibiotics

 Emergency Responder cache : agreement with pharmaceutical company, cache for emergency responders and health care workers  Strategic National Stockpile (SNS ): federally maintained cached. Initial portion “push package” to arrive within 12 hours of request Overall Response Strategies

1. Maintain critical infrastructure in San Francisco, including the willingness of our emergency responders and health care professionals to come to work: Prophylax these employees from the ER cache 2. Prophylax the general public Antibiotics will come from the SNS Initial Response

 Incident Occurs (Anthrax Attack) 

 Local and State Government convene 

 Governor issues an emergency declaration 

 Strategic National Stockpile assets are requested from the federal government Deployment of Strategic National Stockpile Assets Local Level Point of Dispensing (POD)

Antibiotic Dispensing: 3-Tiered Approach

1st Tier: First Responders – to receive prophylaxis from the Emergency Responder cache, prior to arrival of SNS. Intent: to staff emergency response & continue critical operations

2nd Tier: Open PODs – to dispense medication to general public

3rd Tier: Closed PODs – Push Partners, to dispense medication to designated populations. Staffed by the agency/company Identified and assessed sites throughout SF to serve as open POD sites for general public 18 Primary, >20 Back-up open POD sites Primarily Schools and Recreation Centers Staffed by City and County of SF Disaster Service Workers Aim for high throughput (# people dispensed medications/hour/POD) while maintaining accuracy in screening & dispensing  Agencies who serve homebound and other vulnerable groups  Large organizations who can dispense to their own employees (and family members) to reduce burden on open PODs  Emergency Responder Agencies  Option to dispense to employees, employee family members and if applicable, clients.  Improve continuity of operations – Allows employees to more rapidly return to critical operations. Motivates staff come to work due to receipt of life-saving medication  Increase staff morale, will appreciate agency’s interest in preserving their health, protecting their family  Contribute to the overall response effort in San Francisco by reducing surge at open PODs

 SFDPH provides dispensing tools, other resources: Screening forms, Basic Dispensing Layouts, Job Action Sheets, Drug Information Sheets, Sample POD Org Chart Screening Instructions: how to give the correct Push Partner Program Does Not Require Medical Staff

 Dispensing protocols were created to allow for non- clinicians to perform dispensing

 Push Partner operations would only be activated in large-scale public health emergency

 In declared emergencies, the local health officer has broad powers to “take measures as may be necessary to prevent the spread of disease or occurrence of additional cases and protect the public’s health”(California Health and Safety Code Section 120175). POD OPERATIONS  Intake ScreeningDispensingExit

 Intake: Traffic and Flow Management, Triage, Entry, Greeting, Forms distribution  Screening: Determining antibiotic based on algorithm; if needed, medical review  Dispensing: Individuals receive medication, Drug Information Sheets  Exit: Ensure individuals have medications and educational materials, collection screening forms o Multi-Person Pick Up policy o Option to pick up medication for family members o Just-In-Time Training for closed PODs o Electronic Screening o Answer questions on BADM (BayAreaDisasterMeds) website, identifies the antibiotic appropriate for you o Bring printed screening form to POD, eliminates need for staff to screen  proceed to “Rapid Dispensing” pick up medication  Consider which SF based federal agencies to be involved in closed POD planning (staff numbers/agency)

 Initiate development of closed POD dispensing plan Amy Ovadia, Medical Countermeasures Coordinator San Francisco Department of Public Health, Public Health Emergency Preparedness & Response 30 Van Ness Ave. Suite 2300 San Francisco, CA. 94102 Phone: (415) 558-5917 Fax: (415) 558-5991 amy .o v adia@sfdph. org