Medical Aspects of Chemical Warfare (2008) - The Black Vault

Domestic PreparednessNational Preparedness Programs and InitiativesIn addition to personnel and resources, there areseveral programs or initiatives that coordinate domesticpreparedness efforts or respond proactively toincidents. Some of these include the National DisasterMedical System (NDMS), the Strategic National Stockpile(SNS), and the Laboratory Response Network.National Disaster Medical SystemThe objective of the NDMS is to coordinate a cooperativeagreement between federal agencies, includingthe DHHS, the DoD, the DHS, and the Departmentof Veterans Affairs, as well as state, local, public, andprivate resources to ensure a coordinated medicalresponse system. The NDMS is activated in responseto emergency events and provides potential assets tomeet medical health services as outlined in ESF 8 inthe NRP. 11,12 FEMA coordinates necessary medical carefor incidents such as natural catastrophes, militarycontingencies, terrorist attacks, or refugee influxes.The response is federalized, with the DHHS actingas the lead federal agency. Medical care personnelinclude disaster medical assistance teams, disastermortuary teams, veterinary medical assistance teams,and WMD medical response teams. 18,21 The MEDCOMNDMS coordinates efforts with the NDMS within ageographical area.Strategic National StockpileThe treatment of mass casualties involved in a biologicalor chemical terrorist attack requires not only acoordinated effort of personnel but may also includelarge quantities of pharmaceuticals and medicalsupplies. Because an attack could occur at any timeor place, life-saving resources require an equallycoordinated response. In most scenarios, state and localgovernments do not have sufficient quantities ofmedical items to provide for a mass-casualty event, soeffective pharmaceuticals must be rapidly deployedfrom a central location. This need led to the creationof a national stockpile.In 1999 Congress directed that the DHHS and theCDC establish a national repository of antibiotics,pharmaceuticals, chemical antidotes, and other medicalsupplies. Identified as the “National PharmaceuticalStockpile,” the mission of this repository is to providethese items during an emergency within 12 hours ofa federal decision to deploy. 33 With the approval andpassage of the Homeland Security Act of 2002, therole of determining the goals and requirements of theNational Pharmaceutical Stockpile shifted to the DHS.In March of 2003 the act’s name was changed to the“Strategic National Stockpile Program,” and oversightand guidance of the pharmaceuticals and the programtransferred returned to the DHHS and the CDC to ensurethat there are enough life-saving pharmaceuticalsand medical supplies available in an emergency.The SNS supplements the initial actions of first respondersfrom state and local public health agencies.“Push packages” of pharmaceuticals and supplies aredeployed within 12 hours of a request. The 12-hourpush packages are composed of broad-spectrum itemsthat can treat or provide symptomatic relief from a varietyof ill-defined or yet-to-be-determined illnesses. Ifrequired, additional supplies or products specific to anincident can be obtained through a vendor-managedinventory. These items can be shipped to the communityor incident site within 24 to 36 hours.Both the DHHS and CDC determine and maintainthe SNS assets. Decisions on which treatments or antidotesto maintain are based on intelligence reports,vulnerability of the population, availability of a commodity,and ease of dissemination. Inventory, continualrotation, and quarterly quality inspections guaranteequality control. A request generates shipping of a preconfiguredpush package via ground or air to state andlocal authorities. A technical advisory response unitcan also be deployed with the SNS assets for advice andassistance. The SNS was used successfully in New YorkCity following the September 11 attacks and again inresponse to the anthrax attacks of 2001.The SNS program staffs, trains, and educates providers,responders, and others in disaster preparedness.In addition, the program continually works withother agencies, including regional coordinators, theDepartment of Veterans Affairs, the DoD, and FEMAto improve and coordinate efforts. Improvements areongoing within the program. These developmentsinclude expanding the capability to respond to newand emerging threats, working with state and localauthorities on preparedness plans, and addressingoperational issues when responding to terrorist threats.The SNS is currently striving to increase city readiness;its goal is to be able to provide oral medicationsto 100% of the population of selected cities within 48hours of an event.Laboratory Response NetworkAnother national resource for both information andcollaboration is the Laboratory Response Network.This network coordinates multiagency laboratoriesinto an integrated communication and response plan.765