Veterans Health Administration All-Hazards Emergency Cache Program

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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

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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

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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

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All-Hazards Emergency Cache Program

Veterans Health Administration

Content Categories

• Antibiotics

• Antivirals

• Emergency medications

• Chemical countermeasures

• IV fluids

• Wound care

• Personal protective equipment

Content Capabilities

• Biological

• Chemical

• Explosion and Burn

• Radiological

Facility Caches:

• Full contents at VHA medical

centers

Central Cache:

• Limited contents in central

location

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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)

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All-Hazards Emergency Cache Program

Veterans Health Administration

• Operations managed by VA Emergency Pharmacy Service

• 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

• VHA Office of Public Health

• VHA Emergency Pharmacy Service

• Program Review Committee

• Quarterly review of policies

• Subject matter experts from facilities and VA headquarters

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Perch and Perspective

What happens at a local VA

hospital?

What happens as a Federal

healthcare system?

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VETERANS HEALTH ADMINISTRATION 7

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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

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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

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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