10 Ways CDC Gets Ready For Emergencies

Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response
Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

One of the best parts of my job is the opportunity to learn from a wide range of experiences. We have an obligation to not only respond to emergencies today, but to prepare for tomorrow by learning from the past. Our work extends to households affected by disease, communities ravaged by disasters, and U.S. territories battling new and changing threats. In fact, all over the world – we try to get ahead of, and manage, complex responses that touch many lives through ever changing circumstances. In an ideal world the health in every community would be at a level that would make recovery and reliance easier. The reality is that emergencies happen in all kinds of environments and populations.

The Public Health Preparedness and Response National Snapshot is our annual report that gives us an opportunity to showcase the work that we and our state partners do. The report reminds us that no matter how big the emergency, we need to work together to respond to the best of our ability—with the cards we are dealt.

Here are 10 ways CDC’s Office of Public Health Preparedness and Emergency Response worked to keep people safer in 2016 that can inform our work going forward.

1) Four Responses at Once: An Unprecedented Challenge

CDC experts continue to provide 24/7 monitoring, staffing, resources, and coordination in response to natural disasters, terrorist attacks, and infectious disease threats. In early 2016, CDC managed four public health emergencies at the same time through our Emergency Operations Center :

  • Ebola
  • Flint, Michigan, Water Quality
  • Zika Virus
  • Polio Eradication

See us in action:

2) A Complex Threat: Zika Hits the U.S.

CDC scientists and responders were activated in CDC’s Emergency Operations Center, where they combed through research, developed and distributed diagnostic tests, and provided on-the-ground mosquito control and education to protect people at higher risk for the virus, including pregnant women and infants.

3) Right Resources, Right Place, Right Time

CDC’s Strategic National Stockpile is ready to send critical medical supplies quickly to where they are needed most to save lives. The stockpile is the nation’s largest supply of life-saving pharmaceuticals and medical supplies that can be used in a public health emergency if local supplies run out.

Last year, we helped conduct 18 full-scale exercises and provided training for 2,232 federal and state, local, tribal, and territorial emergency responders to ensure that systems for delivering medicines are functioning well before they are needed in an actual emergency. We continue to work with our federal, state, local, and commercial partners to make sure every step of the medical supply chain – from manufacture to delivery – is coordinated.

4) State and Local Readiness

CDC connects with state and local partners to provide support and guidance, helping every community get ready to handle emergencies like floods, hurricanes, wildfires, or disease outbreaks.

This year, we created a new process to evaluate how well state and local jurisdictions can plan and execute a large-scale response requiring the rapid distribution of critical medicines and supplies. Through this program, we conducted assessments of 487 state and local public health departments. The information from these assessments will be used to help improve the ability to get emergency supplies quickly to those who need them most.

5) Cutting-Edge Science to Find and Stop Disease

To protect lifesaving research, CDC experts in biosafety and biosecurity conducted approximately 200 laboratory inspections and thousands of assessments of those who handle dangerous select agents and toxins like anthrax, plague, and ricin to keep these materials safe, secure, and out of the hands of those who might misuse them.

CDC’s Laboratory Response Network (LRN)l also develops and deploys tests to combat our country’s most pressing infectious and non-infectious health issues, from Ebola to Zika virus to opioid overdose. The network connects over 150 labs to respond quickly to high priority public health emergencies.

6) Protecting Our Most Vulnerable

CDC supports efforts all across the country to help those who may not be able to help themselves when a crisis strikes. Some populations, like children, older adults, and others with functional and access needs may need extra help during and after an emergency.

From planning for the 69 million children who may be in school when disaster strikes to the millions of Americans who need to make sure prescriptions are filled, medical equipment is working, and help arrives even if power is out and roads are blocked, it’s up to us to protect our most vulnerable in emergencies.

7) Emergency Leaders: The Future of Incident Response

When every minute counts, we need people who have the knowledge to step in and take immediate action. Learning and using a common framework like the CDC Incident Management System helps responders “speak the same language” during an event and work more seamlessly together.

CDC experts train leaders from around the world—25 countries in 2016—through an innovative, four-month fellowship based at our Atlanta headquarters. Lessons learned from this course were put to work immediately to head off an outbreak of H5N1 influenza in Cameroon.

8) The Power of Preparedness: National Preparedness Month

Throughout September, CDC and more than 3,000 organizations—national, regional, and local governments, as well as private and public organizations— supported emergency preparedness efforts and encouraged Americans to take action.

The theme for National Preparedness Month 2016 was “The Power of Preparedness.” During our 2016 campaign , we recognized the successes of countries and cities who have seen the direct benefits of being prepared, looked at innovative programs to help children and people with disabilities get ready for emergencies, and provided tips for home and family on making emergency kits.

9) Health Security: How is the U.S. Doing?

As part of the Global Health Security Agenda, teams of international experts travel to countries to report on how well public health systems are working to prevent, detect, and respond to outbreaks. In May, a team made a five-day visit to the U.S. to look at how well we’re doing.

In the final report, the assessment team concluded that, “the U.S. has extensive and effective systems to reduce the risks and impacts of major public health emergencies, and actively participates in the global health security system.” They recognized the high level of scientific expertise within CDC and other federal agencies, and the excellent reporting mechanisms managed by the federal government.

10) Helping YOU Make a Difference

Get a flu shot. Wash your hands. Make a kit. Be careful in winter weather. Prepare for your holidays. Be aware of natural disasters or circulating illnesses that may affect you or those you care about. There are many ways to prepare, and in 2016 we provided the latest science and information to empower every one of us to take action.

Every person needs knowledge to prepare their home, family, and community against disease or disaster before an emergency strikes. Whether it’s how to clean mold from a flooded home, how to wash your hands the right way, or how to use your brain in emergencies, our timely tips and advice put the power of preparedness in your hands. From the hidden dangers of hurricanes to the heartbreaking dangers of flu, there are steps we can all take to stay safe every day as we work toward a healthy and protected future.

For more ways we are helping protect America’s health, check out the new National Preparedness Snapshot.

To find out more about the issues and why this work matters, visit our website.

 

Stockpile Expert Helps Responders Prepare for Emergencies

Tom Jackson touring proposed medical materiel storage site in Yaounde, Cameroon in March 2015.
Tom Jackson touring proposed medical material storage site in Yaounde, Cameroon in March 2015.

In the United States, most of us take it for granted that if we need medicine – cough syrup, aspirin, or even most antibiotics – we can just run down to the pharmacy and get it. That’s because our medical supply chain – the series of organizations, companies, and systems that make sure those shelves are stocked – works well. In an emergency, we even have a stockpile of medicines on hand and people with the skills and resources to deliver it anywhere in the United States within 12 hours.

In many parts of the world, it can be hard to even get the basics.

One of the essential goals of the Global Health Security Agenda is to create a structure for sending and receiving medicines and materials (medical countermeasures) and staff between international partners during public health emergencies. As a senior training advisor for the Strategic National Stockpile, my job is to help responders in other countries figure out how to make their supply chains work in any type of public health crisis. The stockpile has hosted medical supply chain workshops in developing countries, including Ethiopia, Uganda and Cameroon.

Every link in the chain is critical

From L to R – Tom Jackson, Joe Vital, and Michael Ayres: DSNS facilitators for medical countermeasures workshop at Ethiopia Public Health Institute in Addis Ababa, Ethiopia, February 2016.
From left to right – Tom Jackson, Joe Vitale, and Michael Ayres: DSNS facilitators for medical countermeasures workshop at Ethiopia Public Health Institute in Addis Ababa, Ethiopia, February 2016.

In a crisis, every link in the chain has to be working properly.

For example, if there’s a disease outbreak, what good is it to send a team to take a sample if you can’t ship that sample to a lab?

Or maybe there’s a nearby lab, but the lab workers don’t have the equipment or training to process the sample. How do you figure out what you’re up against and what supplies to order?

And, finally, if the supply chain can’t get the necessary medicines and supplies to the people who need them, all the other response achievements don’t matter. It all has to be in place, and it all has to work together.

Every emergency – and every place – is different

If every emergency were the same and required the same resources, figuring out how to help people would be easy and no one would ever have to suffer due to a lack of medicine or supplies.

But every place in the world is different, both in the risks people face and the resources they have available. I always tell responders to ask the right questions: What emergencies are most likely to happen? And what can we do to make the supply chain work better?

Let’s say there’s a large-scale public health crisis, and a ship full of medical supplies comes into the harbor. But, there’s not a single dock to unload it. What good are those supplies? However, if there’s even one dock – even if it’s not the best dock – people can unload the ship and deliver help. Improving any part of the supply chain helps.

Any plan is better than none

When I travel to other countries, I tell responders that any plan, even an imperfect plan, is better than no plan at all. In a crisis, we don’t want to be starting from scratch.

What will you do when you’re used to receiving and distributing 20 pallets of medicines and materials and all of a sudden you receive 200…or 2,000? These are the kinds of questions countries should be able to answer before disaster strikes.

Also important is to practice and exercise response plans ahead of time so everyone knows what to do. In the United States, the stockpile partners with state, territorial and local public health to conduct large-scale exercises that simulate a real emergency. This kind of practice is critical to identifying gaps in the plan.

So, in a nutshell, what is it I do? I help countries ask the right questions, plan, and find the resources they need to respond quickly and efficiently. And why do I do what I do? Because I believe this is how we stop outbreaks close to the source and keep epidemics from spreading around the world.

This story illustrates our commitment to implementing the Global Health Security Agenda (GHSA), which aims to improve the world’s ability to prevent, detect, and respond to infectious disease threats. CDC is partnering with 31 countries around the world to reach the goals of the GHSA, including having a national framework for transferring (sending and receiving) medical countermeasures and public health and medical personnel among international partners during public health emergencies.

This Is a Test: Georgia Practices for Bioterrorist Threats

Safety officer delivers briefing

It is November 2015, and Georgia’s emergency personnel are preparing to respond to an outbreak of plague.

Don’t worry, it’s not the real plague. This is only a test. No one is actually sick or in any danger. But what if it were real?

Armed with the knowledge that practice makes perfect, the Georgia Department of Public Health is conducting a statewide exercise to test its systems and practice responding to a large-scale public health emergency. In this case, the state is simulating a bioterrorist attack involving an intentional release of the communicable Category A biological agent Yersinia pestis, commonly known as plague. It is a giant effort involving the entire state: all 18 regional emergency operations centers are activating, and they are working closely with CDC.

It’s all pretend, but for those participating, the exercise is very real. There are real phone calls and real trucks and drivers delivering real pallets of materials with real bottles (of pretend medicine). Each pallet and bottle has a real lot number for tracking. Real people – volunteers – will test their ability to dispense medicine quickly in every corner of the state. It’s a critical part of being ready to save lives in case of a bioterrorist attack.

Making the call

America's emergency medical supplies to protect the public's health
America’s emergency medical supplies to protect the public’s health

The exercise begins with a phone call from the Georgia Department of Public Health to the watch desk located inside CDC’s Emergency Operations Center. In an actual event, this would be the first step to set plans in motion.

“When the state makes that first call to request assistance from the Strategic National Stockpile, they need to be able to tell us who, what, when, where, and how many,” explains Pete Alvarez, an emergency management specialist in CDC’s Strategic National Stockpile who helps states coordinate exercises like this one. “The most vital piece of information we need in the beginning is how many people are potentially affected.”

This exercise uses an imaginary, but realistic, scenario: plague has been released by a person, or group of people, dressed as a gardener spraying “pesticide” at several large outdoor events across the state. The aerosolized plague has been detected and now presents a danger to everyone in the community.

The initial phone call reporting the incident to CDC sets off a cascade of activity. The watch desk officer takes note of the relevant information, particularly the large number of patients said to be presenting with symptoms. Immediately, the officer reaches out to CDC’s experts – both subject matter experts in plague and those who manage CDC’s stockpile, the nation’s largest supply of life-saving medicines and medical supplies for use in a public health emergency severe enough to cause local supplies to run out.

Within 30 to 45 minutes, everyone, including CDC leadership, is on the line to discuss the specific health threat, consider the number of people affected, and make the best possible decisions to control the disease right away.

Getting things moving

Plague has a 2-day incubation period, and people who are exposed must receive antibiotic prophylaxis right away. Therefore, once plague is suspected or identified, state and local responders have to act fast. Due to the magnitude of this incident, authorities agree mass amounts of antibiotics from CDC’s stockpile need to be delivered to the affected area as quickly as possible.

Logistics experts with CDC’s stockpile quickly coordinate with commercial transportation partners who will provide trucks to deliver the medicines and relay anticipated delivery timelines to the state.

Meanwhile, a flurry of preparation takes place. While the trucks are on the way, the team in CDC’s stockpile warehouse pulls the requested products and prepares them for pick up. Georgia officials are getting ready to receive and stage the coming shipments. Emergency responders take their stations. Public health officials begins setting up “PODs” – points of dispensing – in public areas and at places of business. This is where people will come to get the medicine. Volunteers, both from the Medical Reserve Corps and the community, line up to act as “patients.”

Testing the system

Volunteers support POD operations
Volunteers support POD operations.

Many of the PODs are set up in large parking lots, at malls, and other places in the community. Some are set up as drive-thrus. People in cars can bring a pre-filled “head of household” form to the line and pick up antibiotics for their whole family. Cars pull up to three stations, one at a time. First is reception, where volunteers hand in their forms. Next is triage, where they answer questions about their health and the health of others who will be taking the antibiotics (a separate line handles those with health concerns, like those who are pregnant or have allergies). Next, they receive a supply of medication to take home.

At least 50 volunteers move through each POD to test how quickly and efficiently the system works. Every person and every bottle of medicine at every station across the state is tracked carefully and logged. The state and regional emergency operations centers stay nimble and ready to add resources or shift focus at a moment’s notice.

While the exercise is taking place, emergency planners insert what are called “injects” into the process. An “inject” is a surprise issue that comes up during the exercise, and it is meant to simulate the kinds of unexpected twists that can happen during a real response. For instance, a team in the field might send a message back to the state emergency operations center that they have not received the right amounts of each antibiotic or that a patient has presented with an allergic reaction to the medicine. Each “inject” tests how a different part of the system will react when things do not go as planned. In an emergency, you have to be ready for anything.

Help from all corners

To make this exercise as real as possible, Georgia invites other partners to join in the activities. They reach out to all the states in FEMA region 4 to figure out how neighboring states can help each other if an emergency like this actually happens.

They conduct a communication drill with ham radio operators in Tennessee, Alabama, Mississippi, and Florida. Ham operators are especially prepared to step in if regular communication channels are compromised, providing a critical lifeline in emergencies.

“We also practiced air transport with the National Guard,” said Charlisa Bell, planning and exercise manager at the Georgia Department of Public Health. “We put the request in through our state operations center. They brought in a Black Hawk, loaded it, and delivered medication to one of our remote districts.”

Lessons learned

In the end, the drill goes off without a hitch. But it teaches a few good lessons along the way, helping the state firm up its plans for staffing, volunteer training, and building security.

“The exercise was well planned and coordinated,” said Alvarez. “The state wanted to know its gaps – public health planners were not afraid of finding out what they needed to improve. They did really well.”

Collaborative exercises like the one in this story are a critical part of keeping our nation’s health secure. The Public Health Emergency Preparedness (PHEP) cooperative agreement provides funding guidance to Georgia and other state and local health departments to help them develop and test response plans so that, when a real event occurs, the state is better prepared to protect its citizens.

Recognizing the Vital Work of Our Nation’s Public Servants

Greg Burel receiving SAMMIE award.
Photo credit: Aaron Clamage/clamagephoto.com

In April 2015, an Ohio doctor made an urgent call to CDC concerning a possible life-threatening botulism outbreak that posed a risk to as many as 50 people who had attended a church potluck dinner.

Within hours, CDC, the Ohio Department of Health, and a local hospital had determined that botulism antitoxin was needed to treat the food-borne illness. They made an immediate request to the only U.S. source: CDC’s Strategic National Stockpile (SNS).

Greg Burel received the request just after 2 p.m. that day. He quickly issued his approval and set in motion a process that rapidly deployed and delivered botulism antitoxin to Ohio just after midnight to help save the lives of 18 people who had become seriously ill.

For Burel, this was all in a day’s work.

Burel serves as Director of the Division of Strategic National Stockpile at CDC, where he manages the federal government’s $7 billion Strategic National Stockpile of emergency medicines and medical supplies, which are stored in warehouses across the country.

In a public health emergency, the U.S. pharmaceutical supply chain may be unable to immediately provide a medical countermeasure that may be required to prevent, mitigate, or treat adverse health effects resulting from an intentional, accidental, or naturally occurring public health emergency. SNS ensures the right medicines and supplies are available when and where they are needed to save lives.

And The Sammie Goes To…

In recognition of his exceptional leadership and unmatched excellence in the management of CDC’s SNS, Burel was the recipient of one of this year’s prestigious Samuel J. Heyman Service to America Medals―also known as the “Sammie” award―specifically in the Management Excellence category. In his decade-long tenure as Director of SNS, Burel has spearheaded 10 large-scale responses, including national responses to flooding, hurricanes, and influenza pandemics, and more than 30 small-scale deployments for the treatment of individuals with life-threatening infectious diseases including the botulism outbreak and the Ebola crisis.

Burel’s most recent challenge has been dealing with the Zika virus. In the wake of the Zika virus outbreak, SNS is working with diverse partners such as CDC Foundation, commercial pharmacies, and vector control companies to implement public health interventions that wouldn’t have been possible without the expertise and capability of SNS staff to bring it all together. “It’s more than just having the right product on the shelf and an established plan to use it,” Burel said. “We recognize the shifting realities of today’s public health threats and work with partners spanning the public and private spectrum to develop the capacity to respond to any public health emergency.”

Under Burel’s watch, the SNS has steadily expanded its focus so that it is capable of responding to all the global hazards of the 21st century. He says, “I am honored to receive the prestigious Sammie Award, and privileged to work alongside the many esteemed public servants who play an instrumental role in the stockpile’s daily operations.”

With more than 30 years of civil service, Burel has risen through the ranks of the federal government to become a proven leader in medical supply chain logistics, disaster and emergency management, financial management, quality improvement, and organizational design. He began his career at the Internal Revenue Service, and served in leadership roles in the General Services Administration (GSA) and the Federal Emergency Management Agency (FEMA).

The “Oscars” of Government Service

Burel is one of many dedicated and hardworking federal employees across the world. The Sammie Award is an award program that publically highlights excellence in the federal workforce. The awards are also known as the “Oscars” of government service and honor those employees who have made the commitment to make our government and our nation stronger. They are named for the Partnership for Public Service’s late founder, Samuel J. Heyman, who was inspired by President Kennedy’s call to serve in 1963. These awards align with his vision of a dynamic and innovative federal workforce that meets the needs of the American people. The prestigious medals are awarded to a handful of federal employees each year for outstanding service to their country and humanity.

For More Information

The Strategic National Stockpile’s Unique Role in Zika Prevention

Zika Prevention KitsThe first thing that comes to mind when people think about the Strategic National Stockpile (SNS) is probably a big warehouse with lots of medicines and supplies. What many do not know is that even when the SNS does not have the specific medicines or supplies needed to combat a public health threat, SNS experts can play a key role in working with medical supply chain partners to locate and purchase products during an emergency response.

The involvement of the SNS in the Zika virus response is a perfect example of this little-known, but significant, role. Zika is spread to people primarily through the bite of an Aedes aegypti mosquito infected with Zika virus, although Aedes albopictus mosquitoes may also spread the virus. Recent outbreaks of Zika in the Americas, Caribbean, and Pacific Islands have coincided with increased reports of microcephaly and other birth defects as well as Guillain-Barré syndrome. As a result, the Centers for Disease Control and Prevention’s (CDC) response is focused on limiting the spread of Zika virus. Prevention is key for Zika control, because there is no vaccine or medicine for Zika virus. This is where the SNS comes in.

Controlling mosquito populations is key to preventionZika prevention kit

During a public health emergency, CDC can deploy the SNS for medicines and supplies or can use SNS’ contracting abilities to access materials and services that can be used to prevent or treat diseases that threaten U.S. health security. Controlling the mosquito population and addressing other known routes of infection are important to limit the spread of Zika virus in U.S. territories. The SNS is providing immediate vector control services and preventive supplies for pregnant women to protect themselves from mosquito bites. Pregnant women are particularly vulnerable because they can pass Zika virus to their fetuses, which can cause microcephaly and other brain defects.

Before the Zika virus outbreak, the SNS did not stock or purchase medicines or supplies to respond to illnesses spread by mosquitoes, ticks, and other insects. In response to this outbreak, SNS staff are working with CDC procurement experts to award and implement immediate, short-term contracts to deploy materials and services to control the mosquito populations responsible for Zika transmission. These contracts allow CDC to work with territorial public health jurisdictions to treat areas where mosquitoes breed and live, as well as areas where pregnant women live.

Zika Prevention Kits help pregnant women protect themselves

Zika prevention kit bagsThe SNS is creating Zika Prevention Kits for pregnant women in U.S. territories. These kits are being distributed as an effort to help prevent Zika infection in pregnant women and to reduce the number of babies born with birth defects caused by Zika, such as microcephaly and other brain defects. Through donations from the CDC Foundation and its partners and by purchasing products, the SNS has obtained materials for the kits – including insect repellent, larvicides, mosquito netting, condoms to prevent sexual transmission of Zika, and educational materials.  The SNS is rapidly assembling these materials in reusable bags that can be given to pregnant women.

The SNS has sent nearly 7,000 kits to affected areas, and more are planned. Each U.S. territory is identifying the best way to get the kits to pregnant women. In Puerto Rico, local public health officials have partnered with clinics that are part of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) so they can reach expectant mothers. WIC already interacts with this population through its healthcare and nutritional services for low-income women, infants, and children. Local obstetrician offices are also being used to distribute these kits.

In the past, the SNS primarily focused on warehousing products and deploying those products for public health threats related to bioterrorism, pandemics, and natural disasters. With every emergency response, it has become more evident that the SNS can play a much larger role, especially when specialty products, products in high demand, and medical countermeasures are needed to secure the nation’s health. As one of the federal government’s leading groups of medical supply chain and logistics experts, the SNS at CDC has the ability to coordinate with industry partners to rapidly procure and transport medicines and supplies and serve specific populations in a public health emergency.

Medicine Dispensing Exercise Held at Virginia Costco

volunteer packing medicine container in dispensing bag during emergency response exercise

When you think “community,” what comes to mind? Maybe you immediately think of neighbors and friends who live nearby, or perhaps local businesses, churches, civic organizations and others. What about some of your regular stops around your community such as your pharmacy where you fill your prescriptions or buy over-the-counter medicine? Most people have trusted community partners they know well and with whom they interact regularly in everyday life. In fact, some of these same community partners are working with local, state, and federal public health planners to help your communities prepare for emergencies.

Pharmacists standing over table of clipboards.
Pharmacists set up a screening station in a recent exercise to determine which medicine a person should receive to counteract exposure to anthrax.

In June 2015, a Costco warehouse in Potomac Mills, VA, partnered with Prince William Health District (Virginia Department of Health) to show how a private business can step up to help its community in an emergency. In this particular exercise, Costco regional pharmacy staff exercised a local plan to dispense medication – actually empty training bottles – to nearly 200 public volunteers as part of an open, or public, point of dispensing (POD). The scenario was based on a large-scale anthrax attack that would require mass dispensing of antibiotics from the Strategic National Stockpile (SNS). In an emergency where many people were exposed to anthrax, these antibiotics would help prevent people from becoming sick.

Volunteers wait to receive their “pill bottles” in a recent exercise with Costco and Prince William, Va. Health District to test a public dispensing plan in an emergency.
Volunteers wait to receive their “pill bottles” in a recent exercise with Costco and Prince William, Va. Health District to test a public dispensing plan in an emergency.

“Public health and the private sector can share resources and work together as a community to reach one goal,” said Patrick Ashley, emergency preparedness and response coordinator for Prince William Health District. “We have realized that government cannot do everything on its own – and shouldn’t. The success of this exercise comes from having engagement on all sides. Costco came to the table and has been a great partner.”

This public/private dispensing pilot, facilitated by the Centers for Disease Control and Prevention (CDC), demonstrates how large private retailers can partner with state and local public health departments to dispense medications to the public in an emergency. Costco has partnered with public health to operate both closed PODs, which would serve its own employees and their families, and public PODs open to the larger community.

“Costco has a history of serving the community,” said Christopher Loving, Costco regional pharmacy supervisor in Virginia. “This was a great opportunity for us to show our region’s pharmacy managers how this kind of event would work. The POD exercise at Potomac Mills was a huge success.”

At CDC, we know that all response begins locally, and a resilient community is simply one that has made itself ready to use all of its available resources to plan for, respond to, and recover from an adverse event. The real key to creating resilient communities is to strengthen day-to-day activities that help keep the community healthy and thriving.

table with pharmacists packing bags with medicine bottels
Regional Costco pharmacists in Virginia exercise a local dispensing plan to respond to an emergency that would result in wide-spread exposure to aerosolized anthrax.

“The SNS is the nation’s repository of medications and medical devices for responding to public health emergencies, and we focus our efforts on helping build resiliency by ensuring that everyone in a community has access to the life-saving material we can provide,” said Greg Burel, director of CDC’s Division of Strategic National Stockpile. “The National Stockpile’s supplies cannot stop significant health problems after a disaster if communities are not resilient, so we work to facilitate relationships, train people and create strong partnerships between public health and the community. By including private businesses like Costco in these planning efforts, we are able to reach more people who rely on and trust their community partners.”

From the astute healthcare provider who recognizes that a disease is emerging in a community that could pose a public health threat, to the company that wants to make sure its employees and their families are safe, all of us have an important role to play in making our communities resilient. In an emergency, the whole community will be affected. If public health jurisdictions and the private sector can collaborate on planning and partnerships in advance to make that community resilient before something bad ever happens, we are all ultimately safer.

PHPR: Health Security in Action

This post is part of a series designed to profile programs from CDC’s Office of Public Health Preparedness and Response.

The Point of Dispensing program is a program run by CDC’s Office of Public Health Preparedness and Response’s (PHPR) Division of Strategic National Stockpile.

CDC’s CHEMPACK Program—The Stockpile that may protect you from a chemical attack

City life

It’s a terrifying but plausible scenario. You’re in an enclosed crowded place—perhaps a subway or a mall—and a terrorist organization releases lethal quantities of a nerve agent such as sarin into the air. The gas sends your nervous system into overdrive. You begin having convulsions. EMTs rush to the scene while you go into respiratory failure. If they have nerve agent antidotes with them, you may have a greater chance of living. If they don’t, you may be more likely to die. Will you survive?

Thanks to CDC’s Strategic National Stockpile CHEMPACK program, the answer is more likely to be yes.

First responders prepare for CHEMPACK training.
First responders prepare for CHEMPACK training.

CHEMPACKs are deployable containers of nerve agent antidotes that work on a variety of nerve agents and can be used even if the actual agent is unknown. Traditional stockpiling and delivery would take too long because these antidotes need to be administered quickly. CDC’s CHEMPACK team solves this problem by maintaining 1,960 CHEMPACKs strategically placed in more than 1,340 locations in all states, territories, island jurisdictions, and the District of Columbia. Most are located in hospitals or fire stations selected by local authorities to support a rapid hazmat response. More than 90% of the U.S. population is within one hour of a CHEMPACK location, and if hospitals or first responders need them, they can be accessed quickly. The delivery time ranges from within a few minutes to less than 2 hours.

CHEMPACK container
CHEMPACK container

The medications in CHEMPACKs work by treating the symptoms of nerve agent exposure. According to Michael Adams, CHEMPACK fielding and logistics management specialist, “the CHEMPACK formulary consists of three types of drugs: one that treats the excess secretions caused by nerve agents, such as excess saliva, tears, urine, vomiting, and diarrhea; a second one that treats symptoms such as high blood pressure, rapid heart rate, weakness, muscle tremors and paralysis; and a third that treats and can prevent seizures.”

Maintaining CHEMPACKs throughout the nation is challenging, but it is an essential part of the nation’s defenses against terrorism. The CHEMPACK team must coordinate with limited manufacturers to keep the antidote supply chain functioning. CHEMPACK antidotes are regularly tested for potency and are replaced when needed. They must be maintained in ideal locations for quick use by hospitals and first responders. But, having them available is only the first step. Personnel who may use them need to know where they are and must be trained. CDC supports state and local partners as they identify CHEMPACK placement locations and conduct trainings for their responders.

Terrorist nerve agent attacks are not hypothetical. The Aum Shinrikyo group in Japan used sarin gas to attack subway passengers twice: an attack in 1994 killed eight people and a second attack in 1995 killed 12. Experts agree that these attacks were amateurish and a better timed and executed attack could have killed many more people.

CDC’s CHEMPACK team is part of the rarely seen network that protects the people of the United States from unusual threats. You might not have heard much about them, but if you are ever attacked by nerve agents, they may be the reason you survive.