Resources: Distributing the Nation’s Stockpiles of Lifesaving Supplies

Emergency Distribution Concept of Operations (CONOP)

Background:  Beginning in 1999, HHS through the Centers for Disease Control and Prevention (CDC) began developing plans and systems to manage the National Pharmaceutical Stockpile Program.  It is now called the Strategic National Stockpile or SNS. The program was conceived to function using two elements, 12-hour Push Packages and the much larger element, the Vendor Managed Inventory (VMI). The first element, the 12-hour Push Packages were intended to automatically deliver (push) approximately $2 Million in pharmaceuticals to a receiving point near a Bioterrorism event or other disaster. The products were IV solutions, IV and PO Ciprofloxacin (Cipro), limited quantities of other antibiotics and IV and PO Doxycycline (Doxy), along with an assortment of respiratory products, IV catheters and very limited quantities of medical surgical products, mainly for injection site preparation. The Vendor Managed Inventory (VMI) consisted of the identical product mix as the Push Packages, but in very large quantities.  The original concept was to augment the American healthcare distributors’ inventories of pharmaceuticals, IV fluids, limited respiratory products and very limited medical surgical items.

It is likely that healthcare distributors will be out of stock in the first hours of a supply-intensive National disaster, due to extremely lean “just in time” inventory postures. Because of that, VMI was intended to sustain the affected jurisdiction (s) throughout the disaster and until the normal healthcare distribution network (supply chain) recovered and resumed supply operations.

Since its inception, the SNS began to grow and evolve. Over the years, the SNS and its product mix have expanded and the operational complexity has increased. What has not evolved is the distribution concept.  Public Health Officers are required to staff and operate Receiving, Storage and Staging (RSS) facilities to receive, distribute and account for SNS materials. They must develop ever-more sophisticated receipt, distribution, dispensing/immunizing and accounting systems to sustain both Public Health departments and area healthcare organizations from the time healthcare distributors run out of supplies until normal operations resume sometime after the Bioterrorism attack or natural disaster. Medical Logistics is not a core competency of Public Health, and it is unfair and unwise to require Public Health departments to function as regional distributorships during a disaster. My suggested concept of operations will:

  • Save lives
  • Save money
  • Meet the 48 hour  HHS post-exposure prophylaxis requirement
  • Improve stewardship of a National asset
  • Improve operations, inventory tracking and asset visibility (situational awareness at HHS)
  • Reduce in-transit time to the point of dispensing (POD)
  • Facilitate much faster dispensing and vaccination
  • Improve Public Health response
  • Improve citizen acceptance

Initiative:  Use the American Healthcare Industry’s Supply Chain to Distribute SNS Pharmaceuticals, vaccines, medical supplies and equipment.

1. Concept of Operations:  HHS can use established, mature and proven Healthcare Distributor Supply Chains to store, manage (stock rotation and quality control), and rapidly distribute and account for all SNS materials during declared disasters.

  1. During normal operations: HHS maintains oversight of all government owned SNS materiel and develops and shares with distributors a list of participating dispensing centers/immunization centers as well as Public Health and  healthcare entities to be supplied with SNS materials during a disaster. Maximum order quantities and other formulas can be established during this period.
  2. During Disasters: Either HHS or an affected State’s Public Health Officer can release Government owned supplies into the appropriate Healthcare Distributors’ supply chains for distribution to the healthcare or Public Health entities as required. The Distributors know their customers and have primary and alternative transportation companies already established.
  3. Post Disaster Accountability: HHS or an affected State’s Public Health Officer obtains reports from distributors regarding which entities received SNS materials by line item and dollar value.
  4. Distributor-provided SNS usage lists will serve as documentation to request SNS replenishment dollars.
  5. HHS will be able to quickly and easily develop post-disaster activity and accountability reports.

2. Why use existing supply chains and logistics networks?

  1. Healthcare Distributors have the knowledge, competency and experience of moving millions of dollars in medical pharmaceuticals, vaccines, medical supplies and equipment from manufacturers to customers every day.
  2. Defense Logistics Agency (DLA) and the  Department of Veterans Affairs (VA) and the HHS Supply Service Center have already established Prime Vendor relationships with the Nation’s major pharmaceutical and medical surgical distributors-the framework is in place.
  3. Distributor Supply Chains are already established and can do the job in an emergency.
  4. All customers’ addresses are already in the distributors’ system, so the interface for sustainment during disasters will be seamless.
  5. Distributors will be out of their normal operating stock during the disaster-related spike in demand. The workforce can then distribute SNS stock instead of closing shop.
  6. During normal operations, manufacturer supplies flow through this pipeline- the SNS materials can flow through the pipeline just as smoothly.
  7. Distributors have highly developed supplier relationships with:
    1. Pharmacy chains-Walgreen’s, Eckerd, CVS, etc.
    2. Public health clinics
    3. Military and VA hospitals and medical centers
    4. Hospitals and medical centers
    5. Nursing homes
    6. Assisted living communities
    7. Neighborhood health centers & urgent care centers
    8. Prison healthcare centers
  8. Distributors have highly refined  systems to interface with logistics and transportation companies and maintain long-standing relationships with:
    1. UPS
    2. FedEx
    3. Airborne Express
    4. DHL
    5. Emery
    6. Hundreds of other independent short and long-haul freight companies
    7. Thousands of courier services
    8. HHS should leverage this experience to obtain fastest point-to-point service during disasters.

3. Dispensing: 

Since the vast majority of Americans know where they normally get their medicines, use pharmacies for dispensing and physician offices for vaccinations as the 1st tiers of the dispensing and immunization systems.

  1. Pharmacists know their clients
  2. Pharmacies maintain automated records for all patients served in order to discover medication errors, contraindications, allergies etc.
  3. Pharmacies are tied into distributor networks and have alternate distributor arrangements if one is out of stock.
  4. Pharmacists know most of their clients’ family’s medical histories-this enables one family member to pick up courses of treatment for the entire family.
  5. Pharmacies can provide numbers of clients served, number of courses of treatment filled, age mix etc., for post-event epidemiological studies.
  6. Physician offices routinely provide immunizations
  7. Physicians know their patient populations and can best prioritize which patients get immunizations first.

4. Public Health Departments can manage the event from a Public Health and not a distribution prospective.

  1. Public Health “At Risk” populations will receive better and more focused care, when the major portion of the population is being served through pharmacies, physician offices and other Healthcare organizations.
  2. The Public Health Receiving Storage and Staging (RSS) facility will be unburdened by serving Public Health clinics and facilities only.
  3. The RSS staff will have a more manageable mission.
  4. Public Health will have more Post-Disaster time to perform studies on the effects of the disaster, instead of reconciling bottles of medicines received to doses/vaccinations given to the entire population.
  5. Public Health officials can focus on anomalies and exceptions, while managing the entire event.

5. Results:

  1. Provide better SNS management and distribution using very sophisticated inventory management systems. The SNS will:
    1. Remain perpetually fresh with state of the art stock rotation systems.
    2. Maintain its identity in storage as “Government Owned SNS Material.”
    3. Be ready for shipment in minutes-not hours.
    4. Be transported through an operationally tested transportation system of ground and air transporters as well as local couriers.
    5. Arrive at the right place within the shortest timeframe using established, redundant transportation
    6. systems.
    7. Get to exposed Americans and to Healthcare organizations within hours.
  2. This initiative will:
    1. Meet the 48 hr. HHS/DHS requirement for prophylaxis
    2. Provide the safest dispensing system for detecting contraindications, allergies etc.
    3. Provide timely feedback to FDA on adverse reactions and rapid transmittal of FDA Type I, II and III material complaints
    4. Provide better stewardship and accountability.
    5. Provide the fastest emergency movement, distribution, and dispensing of lifesaving pharmaceuticals, equipment, supplies and vaccines anywhere they are needed nationally and internationally.

© JVR Health Readiness, Inc. 2008

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