The proliferation of technical and scientific weapons expertise coupled with increasing numbers of terrorist incidents around the world have raised the specter of potential public health emergencies involving weapons of mass destruction (WMD). Over thirty identified foreign terrorist organizations and other non-state actors have expressed documented interest in acquiring nuclear, biological and chemical weapons. Potential reasons these groups are interested in such weapons may include goals to inflict as much harm as possible, exploit psychological fears, destabilize governments, or achieve political bargaining strength. Any complacency that the United States would be spared attacks within its own borders was brushed away in the wake of the terrorist attacks of September 11th, 2001, and the subsequent anthrax attacks. In the event of a future attack on the civilian population, large quantities of pharmaceuticals and medical supplies may be required with little or no warning. For this reason, the Strategic National Stockpile (SNS), a national repository of antibiotics, antitoxins, life-support medications, IV and airway maintenance supplies and medical/surgical items was created to supplement and re-supply state and local public health agencies during a national emergency. Push packages are positioned strategically to be deployed to designated sites within 12 hours of the federal decision to deploy SNS assets, with follow-up vendor managed inventory (VMI) to be deployed within 24 to 36 hours. However, the relative lack of attention focused on developing pharmaceutical surge capacity for use during the immediate response period before the SNS may become available in areas of need remains a major gap in emergency preparedness at the local and regional level. As governmental agencies, healthcare professionals and public health advocates seek to determine the best ways to mitigate the potential impact of a WMD attack, it is apparent that close coordination of hospitals and public health systems, as well as partnerships with federal, state and local agencies will be vital components of a successful plan. The critical initial period following any acute public health emergency will have most direct impact on potential lives saved. Strengthening the plans for pharmaceutical surge capacity at the local or regional level is imperative. In Maryland, each county local health department has been tasked to develop individual plans to decide the best way to deal with an emergency until the SNS arrives. Many of these responsibilities have been relegated to individual hospitals. Although hospitals have taken a renewed interest in disaster preparedness and are reexamining their disaster plans, competing priorities have left this issue relatively under-examined. Under current conditions, hospitals must be responsible for their own pharmaceutical supplies; supplies which may be inadequate or expired during a public health emergency. Without predetermined arrangements, local suppliers may be overloaded and anticipated channels for obtaining additional pharmaceutical supplies may prove unreliable. Objectives to implement a collaborative pharmaceutical response plan include: As the lead on this project, the Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR) is an office of the Johns Hopkins Institution chartered to oversee disaster planning and response for the Johns Hopkins Enterprise. The Johns Hopkins Enterprise resources are distributed across most of the State of Maryland, including the Washington D.C. area. Recognizing that health system preparedness represents a weak point in the Homeland Security System, CEPAR fulfills a threefold mission: (1) To create, implement and maintain the infrastructure for effective enterprise-wide planning and preparedness for critical events requiring medical and/or public health response. (2) To develop a healthcare system-wide disaster response plan integrated with local, regional, military and other federal assets. (3) To serve as a model for disaster planning and response systems, adaptable to other major metropolitan areas nationally and worldwide. In meeting its stated missions, CEPAR oversees medical preparedness policy development, implements drills and exercises and coordinates activity with local, state, and federal agencies and thus is extremely well suited to coordinate the proposed task at hand. CEPAR will work in close partnership with local, state and federal agencies including the Board of Pharmacy, Maryland Society for Health-System Pharmacists (MSHP), Department of Health and Mental Hygiene (DHMH), Baltimore City Health Department (BCHD), Maryland Institute for Emergency Medical Services Systems (MIEMSS) and Maryland Emergency Management Agency (MEMA). |
