Veterans Health Administration All-Hazards
Emergency Cache Program
Institute of Medicine
Standing Committee for the Centers for Disease Control and Prevention Division of Strategic National Stockpile
VETERANS HEALTH ADMINISTRATION
Veterans Health Administration (VHA)
•
135
Community Living Centers
•
300
Vet Centers
•
150
Medical Centers
•
985
Outpatient Clinics
820
Community-Based
150
Hospital-Based
9
Mobile
6
Independent
•
104
Domiciliary Residential
Rehabilitation Programs
1•
70
Mobile Vet Centers
VETERANS HEALTH ADMINISTRATION
Overview and Approach
All-Hazards Emergency Cache Program
Veterans Health Administration
•
Easy Accessibility: Rapid Access to large quantities of commonly
used medical supplies and countermeasures
•
Wide Availability: Geographically distributed across national
network of hospitals and clinics
•
Complementary: Dovetails with medical supplies and
countermeasures held in local VA pharmacies and supply
inventories
•
Integrated: Replenished via routine supply chains as necessary
•
Scalable: Able to meet small surge needs for routine care on
local level or larger-scale crises on regional/national level
•
Cost-conserving: Not cost-prohibitive
VETERANS HEALTH ADMINISTRATION
All-Hazards Emergency Cache Program
Veterans Health Administration
Content Categories
•
Antibiotics
•
Antivirals
•
Emergency medications
•
Chemical countermeasures
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IV fluids
•
Wound care
•
Personal protective equipment
Content Capabilities
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Biological
•
Chemical
•
Explosion and Burn
•
Radiological
Facility Caches:
•
Full contents at VHA medical
centers
Central Cache:
•
Limited contents in central
location
VETERANS HEALTH ADMINISTRATION
All-Hazards Emergency Cache Program
Veterans Health Administration
•
Contents are intended for:
•
Veterans
•
VA Staff Members
•
Other victims who present to a local VA medical facility
•
Designed to:
•
Ensure short-term preservation of VA healthcare operations until
other local resources are available
•
Support VA facility’s involvement in the local community disaster plan,
and
•
Bridge supply gap between local pharmacies and other available
resources (
e.g
., SNS)
VETERANS HEALTH ADMINISTRATION
All-Hazards Emergency Cache Program
Veterans Health Administration
•
Operations managed by VA Emergency Pharmacy Service
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Provide logistics support
•
Manage Shelf Life Extension Program
•
Manage product acquisition and life-cycle management
•
Oversight and policy
•
Executive Committee
•
VHA Office of Emergency Management
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VHA Office of Public Health
•
VHA Emergency Pharmacy Service
•
Program Review Committee
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Quarterly review of policies
•
Subject matter experts from facilities and VA headquarters
VETERANS HEALTH ADMINISTRATION
Perch and Perspective
What happens at a local VA
hospital?
What happens as a Federal
healthcare system?
VETERANS HEALTH ADMINISTRATION 7
VETERANS HEALTH ADMINISTRATION
FEMA National Planning Scenario:
Aerosolized Anthrax Attach in Chicago
8
Health & Medical Estimates for Chicago
• Exposures: 328,000 • Fatalities: 6000 -13,000 • Injured/Ill: 13,000
• Worried Well: > 500,000
• Approximately 20,000 Veterans exposed
VA Cache Capacity
• Prophylactic antibiotics for Veterans and VA Staff on campus at the time of the event • Additional antibiotics to complete 60-day prophylaxis course after relocation
Gaps to Address
• Further defining roles of VA facilities in local communities
• Testing ability to dispense countermeasures to large numbers of individuals • Refining access to treatment modalities and therapeutics from SNS
VETERANS HEALTH ADMINISTRATION
Pharmaceutical Shortages as Cache Triggers
Description Generic Name Vendor Name Actions to Handle Shortages Expectated Return
SIMVASTATIN TAB 80MG GEN 90 SIMVASTATIN GEN SOURCERX Bulk, other generic Allocation KETOCONAZOLE CRM 2% FOUG 15GM@ KETOCONAZOLE SANDOZ @(FORMERLY
FOUGERA Other generic Late October
KETOCONAZOLE CRM 2% FOUG 15GM@ KETOCONAZOLE SANDOZ @(FORMERLY
FOUGERA Other generic Late October
METFORM TAB 1000MG MMP 90 METFORMIN HCL MAJOR PHARMACEUTICALS Bulk, other generic Mid October
METFORM TAB 1000MG MMP 180 METFORMIN HCL MAJOR PHARMACEUTICALS Other generic, bulk Unknown
ZENPEP CAP 20000U 100 LIPASE/PROTEASE/AMYLASE ACTAVIS PHARMA INC Ask McKesson to find some. Mid October
VETERANS HEALTH ADMINISTRATION
Future Goals and Directions
Practice Dispensing Medical Countermeasures
• Host demonstrations optimizing VHA dispensing capabilities
• Advance model to serve Veterans and VA employees as an integrated community • Conduct point-of-dispensing exercises in UASI* Tier 1 cities
Refine Contents of the VHA Emergency Cache
• Increase the frequency of cache reviews and modifications • Clarify roles during pharmaceutical shortages
• Integrate PHEMCE** recommendations where appropriate • Emphasize scenario-driven and scalable response capabilities
Optimize Federal and Local Community Partnerships
• Enhance integration of each VA medical facility within each local community • Work closely with CDC, DoD, PHEMCE**
• Build community-level understanding of the dual role of VA as a Federally-governed asset and
local community healthcare provider
*Urban Areas Security Initiative
**Public Health Emergency Medical Countermeasures Enterprise