Regional Pharmaceutical ResourcesColleen Terriff, PharmD, BCPS (AQ-ID), MPH (soon)

Clinical Associate ProfessorWashington State University College of Pharmacy

Deaconess Hospital and Rockwood Health SystemsNovember 21, 2013

History of Involvement• 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

Pharmaceutical Coordinator• CDC CHEMPACK med exchanges• Assist with public health• Stockpiling:

– Decisions: location, medications, ancillary supplies– Distribution– Dosing and preparation information– Inventory– Destruction

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

Bioterrorism PlanningAgent Prophylaxis Treatment PlanAnthrax Antibiotics Antibiotics Local and SNS

Botulinum Observe AntitoxinSupportive care

SNS

Plague Antibiotics Antibiotics Local and SNS

Smallpox Vaccine Invest. DrugsSupportive care

SNS

Tularemia Antibiotics Antibiotics Local and SNS

VHF Invest. Drugs Invest. DrugsSupportive care

SNS

Local BioterrorismPharmaceutical 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

Chemical Terrorism PlanningAgent Treatment Plan

Nerve Agents 2-PAM, atropine, diazepam

Local (CHEMPACK)and SNS

Vesicants Supportive care(BAL for Lewisite)

SNS- BAL

Industrial Chemicals

Supportive care(Cyanide antidotes)

Local and SNS

Riot Agents Supportive care Local and SNS

Local Chemical TerrorismPharmaceutical 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

CHEMPACK Program• 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)

Shelf-Life Extension Program• 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 DistributionEastern Washington

• Hospital:– 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, $$

Antivirals Spring 2009• 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

Antiviral Issues Continued…• 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…

VA Stockpile• Large facilities• Small facilities:

– Spokane• Mass casualty• Color coded• Includes supportive

care meds

• 2008 Directive

HRSA Employee Cache• Ciprofloxacin• Doxycycline• For employees and

families and hospital-based EMS providers

• Maintained by area hospitals

Deaconess Stockpiles1. MMRS- ill patients (i.e. IV meds)

• ED provider can access2. MMRS- POD

– SRHD or Spokane EOM- to be sent to POD3. CHEMPACK plus expired meds4. Antiviral SNS cache5. Employee cache

• Antibiotics and antivirals• HRSA grants

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

Community Pharmacy Inventory• Enroll help of:

– WSU College of Pharmacy Drug Information Center– Spokane Pharmacy Association

• Limited meds• Dispensing to community

MOU’s with Pharmacy

• State-wide initiative community pharmacies:– Chains– Independents

• SRHD with WSU COP:– Mass dispensing– Mass vaccination

Medication Destruction• Partnering with law enforcement (SPD)• Coordinating stockpile destruction with other

incineration needs for LE• Mainly MMRS chemical terrorism meds

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