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State Agencies -Vs- Private Partnerships: A Cost Benefit Analysis of Tiered SNS Distribution Methods : 

State Agencies -Vs- Private Partnerships: A Cost Benefit Analysis of Tiered SNS Distribution Methods Karla Ann Black, Ph.D. Office of Preparedness and Response SNS Postdoctoral Fellow Carla N. Little, Ph.D. State Strategic National Stockpile Coordinator

2009-10 H1N1 Influenza Pandemic : 

2009-10 H1N1 Influenza Pandemic Received Notification from CDC of distribution 1st 25% of pro rata allocation of Pandemic Influenza Strategic National Stockpile supplies Meeting with Senior Public Health Leadership Meeting with Office of Preparedness and Response Division of Disaster Planning and Readiness staff and the State SNS Team State Strategic National Stockpile Plan was activated

2009-10 H1N1 Influenza SNS Distributions : 

2009-10 H1N1 Influenza SNS Distributions Distribution 1: SNS RSS/RDC mission utilizing state partners Distribution 2: Hospital Preparedness Program hospitals Tamiflu resupply mission Distribution 3: H1N1 Local Health Department (LHD) and Hospital Preparedness Program (HPP) hospitals resupply mission utilizing private warehouse company

DISTRIBUTION #1: April/May 2009 : 

DISTRIBUTION #1: April/May 2009 Initial National Response to looming threat of H1N1 Influenza Pandemic Governor of Illinois, Patrick Quinn, declared public health emergency at the request of Dr. Damon Arnold, Director of Illinois Department of Public Health (IDPH). EOCs fully activated Illinois State Emergency Operations Center (SEOC) Illinois Department of Public Health (PHEOC) Local Health Departments and Hospitals NG Deployed

DISTRIBUTION #1: April/May 2009 Cont’d : 

DISTRIBUTION #1: April/May 2009 Cont’d Full RSS Operations 2/4 RDC Operations Drops- 97 LHDs; 158 Hospitals Deliveries completed within 16 hours

Medical Countermeasures Shipped : 

Medical Countermeasures Shipped Antivirals Relenza Kits- 13,248 cases Tamiflu, 75 mg- 15,980 cases Tamiflu, Oral Suspension- 207 cases Tamiflu, 30 mg- 675 cases Tamiflu, 45 mg- 229 cases Personal Protective Equipment (PPE) Surgical Masks- 853 cases N95 Respirators- 4,017 cases Cost to IDPH/State of Illinois: $162,000

State Agencies Involved in SNS Distribution : 

State Agencies Involved in SNS Distribution Target: LHDs and HPP Hospitals Agencies Involved Illinois Emergency Management Agency (IEMA) Illinois National Guard (ING) Illinois State Police (ISP) Illinois Central Management Agency (CMS) Illinois Department of Agriculture (Ag) Illinois Department of Corrections (DOC) Illinois Department of Human Services (DHS) Illinois Department of Transportation (IDOT) Illinois Department of Public Health (IDPH)

Staff #s Involved in Operations : 

Staff #s Involved in Operations

Distribution Process : 

Distribution Process

DISTRO #1: Lessons Learned : 

DISTRO #1: Lessons Learned There are very enthusiatic and dedicated people working on behalf of the people of Illinois ICS at the RSS and RDCs must be redesigned Develop better just in time training Set up a triage area for staff volunteers as they enter the mission field Safety Officer must be identified and training for RSS and RDC operations MS Groove did not work!

DISTRO #1: Lessons Learned Cont’d : 

DISTRO #1: Lessons Learned Cont’d Better coordination with State partner agencies on drop site locations. More accurate detailed plan for each type of Biothreat event. More accurate staging of IDOT equipment to better fulfill the mission. Need to educate IDPH and State partner agencies on the SNS mission Recruit more volunteers to complete an SNS mission IDPH has to take leadership at the RSS and RDCs

DISTRIBUTION #2: October 2009 : 

DISTRIBUTION #2: October 2009 Tamiflu, Oral suspension Distribution Distributed to Regional Hospital Coordinating Center Hospital Preparedness Program Hospitals Activated Vaccine Warehouse Contracted with United Parcel Service (UPS) Number of drops- 10 RHCC Hospitals Deliveries completed within 5 days of initiation

Medical Countermeasures Shipped : 

Medical Countermeasures Shipped Antivirals only Tamiflu, Oral Suspension- 158 cases Cost to IDPH/State of Illinois: $2,000.00

State Agencies Involved in Distribution : 

State Agencies Involved in Distribution Target: HPP Hospitals Illinois Department of Public Health Illinois Department of Corrections Private Vendor: United Parcel Service

Distribution Process : 

Distribution Process Assets received at IDPH Vaccine Warehouse IDPH and DOC picked and repackaged boxes. Packages shipped via UPS

DISTRO #2: Lessons Learned : 

DISTRO #2: Lessons Learned Very small mission. Overall the process worked well Inventory Management System worked well for tracking small allocations of assets

DISTRIBUTION #3: November 2009 : 

DISTRIBUTION #3: November 2009 H1N1 Medical Countermeasures Resupply Mission Distributed pro rata allocations of antivirals and PPE to LHDs and HPP hospitals Partial activated of PHEOC RSS Operations (IDPH and ING- consultation) Utilized private warehouse vendor for warehouse logistics and transportation operations.

Medical Countermeasures Shipped : 

Medical Countermeasures Shipped Antivirals Relenza Kits- 6,310 cases Tamiflu, 75 mg- 6,867 cases Tamiflu, Oral Suspension- 440 cases Tamiflu, 30 mg- 622 cases Tamiflu, 45 mg- 194 cases Personal Protective Equipment (PPE) Surgical Masks- 766 cases Faces Shields- 278 cases N95 Respirators- 10,142 cases Gloves- 224 cases Gowns- 1,616 cases Cost to IDPH/State of Illinois: $51,000

State Agencies Involved in Distribution Process : 

State Agencies Involved in Distribution Process Target: LHDs and HPP Hospitals Illinois Department of Public Health Illinois National Guard Illinois State Police ILEAS Private Vendor: Federal Warehouse and Logistics

Distribution Process : 

Distribution Process H1N1 Countermeasures received at primary RSS IDPH staff served as quality control and assurance over process Warehouse staff picked and repackaged boxes to be shipped PHEOC Logistics coordinated resource requests for mission Warehouse Logistics shipped packages to all LHDs and hospitals Number of drops- 95 LHD; 154 hospitals

DISTRO #3: Lessons Learned : 

DISTRO #3: Lessons Learned Lessons learned from distro #1 and #2 were implemented for IDPH volunteers Warehouse operations and distribution went very well RITS IMS was a big failure with this type of mission Remember potable water and hand washing stations near work sites Need to implement better communications system- Groove continued to be a problem Great exercise/training of StarCom radios. Constant and consistent communications with all partners is very essential!

CONCLUSIONS : 

CONCLUSIONS State agency personnel very invested in the process Private corporation overall was very accommodating State timeline was not as critical as private industry profit margin Need to develop a better system to communicate between incident/operations sites Consider activation of State SNS Plan when distribution is time critical Including non-governmental entities helps to educate the public on the SNS/CRI mission Consider activation of private partnership distribution for resupply missions, when not as time sensitive. SNS is not limited to a 48 hour anthrax mission. Each mission is different!

ACKNOWLEDGEMENTS : 

ACKNOWLEDGEMENTS Thanks to all the IDPH and State personnel that assisted with the 2009-10 H1N1 SNS MCM Distribution Missions! REGIONAL PUBLIC HEALTH EMERGENCY RESPONSE COORDINATORS Dr. Masood Athar Jonece Tyler Matthew Ringenberg Lynne Reagan Molly Lamb Elizabeth Bussmann Stephen Westbrooks REGIONAL EMERGENCY MEDICAL SYSTEM COORDINATORS Kathie Wagle Brian Kieninger HOSPITAL PREPAREDNESS PROGRAM Gwendolyn Woolridge Dawn Davis IDPH SENIOR LEADERSHIP Dr. Damon T. Arnold, Director Teresa Garate- Assistant Director Winfred Rawls- Deputy Director , Office of Preparedness and Response Andrea Parker- Regional Health Officer, Peoria and Champaign Regions

THANKS! : 

THANKS! Karla A. Black, Ph.D. UIC/ OPR SNS Postdoctoral Fellow Karla.black@illinois.gov 217-557-3913 Carla N. Little, Ph.D. State SNS Preparedness Program Coordinator Carla.little@illinois.gov 312-814-1091 or 217-557-5771

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