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During an emergent event, Central Montana Medical Center (CMMC) will support the Strategic National Stockpile (SNS) protocol contained within the Fergus County Emergency Operations Plan (EOP).

Emergent events may include a terrorist attack, natural disaster, biological event, or industrial incident in which pharmaceutical / medical supplies cannot meet the demand of the event. CMMC is designated as the primary drop point location of requested SNS assets for Fergus County, Judith Basin County, and half of the assets for Petroleum County. These assets include pharmaceuticals and/or medical supplies as well as equipment. CMMC will be responsible for staging, tracking, internal distribution and recovery of the acquired SNS assets with assistance from Fergus County emergency services. External distribution will pertain only to the release of assets to the community under the direction of Fergus County Nurse's Office and Central Montana Health District.


A.Collection Data
1.CMMC will annually update the Facility Resource Assessment Tool and submit the information to the Central Montana Health District (CMHD). (See appendix A-1).

B.Requesting SNS Assets
1.Refer to Fergus County Strategic National Stockpile protocol, section III.

2.Additional asset requests will be made through the Fergus County Disaster and Emergency Services Coordinator (DES) and the Emergency Operations Center.

3.CMMC personnel authorized  to contact the Fergus County DES with additional asset requests will be the:

Infection Control Practitioner, or
Emergency Preparedness chair, or
Authorized designee. 

4.If large item assets are needed that are not included within the established SNS program (i.e. refrigeration, etc), requests can be made through the Fergus County DES and / or the Emergency Operations Center (EOC).

5.CMMC Public Information Officer (PIO) will work in conjunction with the Joint Information Center (JIC) and the Emergency Operations Center (EOC) to coordinate release of information to the public. 

C.Receipt of SNS Assets
1.Coordination of asset delivery will be accomplished through the Fergus County Emergency Operations Center.

2.All security measures will be implemented, in association with local Law Enforcement, and security staff in position, prior to asset arrival. 

3.Security measures will be overseen and directed by Law Enforcement, or designee(s), to:

ensure safety of SNS assets until distribution, 
prevent unauthorized entry into the receiving, sorting, and storage areas, and 
provide supportive assistance to  CMMC employees for crowd control.

4.Designated CMMC staff members and one member from the Public Health department must be present at the time of offloading SNS Assets.  

5.CMMC employees authorized to enter the Asset receipt area are the following:

Safety Officer, 
Infection Control Nurse, 
Purchasing Manager,  
Emergency Preparedness Committee chair, or authorized designee(s), 
Designated staff member(s) from CMMC pharmacy, and
Any personnel designated by the CMMC Incident Commander.

6.The CMMC Safety Officer, Infection Control Nurse, Purchasing Manager, and Emergency Preparedness Chair, or authorized designees, are required to be present at the time of asset receipt.  If medications are included in the SNS assets, a Pharmacy staff member is also required to be present.

7.Designated personnel from the community authorized to be in the asset receipt area are:

Fergus County DES Coordinator
Central Montana Health District PHEP Coordinator, Public Health Nurse, and/or designee(s),
Fergus County Sherriff, or designee(s),
City of Lewistown Law Enforcement, or designee(s)

Any personnel designated by the Incident Commander at the EOC.

8.Designated personnel allowed into asset receipt area will be required to follow the color coded exchange system for security identification purposes. The color coded badge will be distributed upon arrival at the receipt location and will be worn on the outside of staff clothing. The color coded badge must be visible to security personnel at all times. (See appendix B).

9.CMMC staff will be required to present their identification badge, and authorized personnel from the community will be required to present photo identification, in order to receive the color coded I.D. badge system. 

10.SNS assets will be received at the maintenance loading dock located at the end of the service drive on the west side of the CMMC campus. Assets will be immediately moved into the garage until transport into the hospital can be under taken. 

11.Photo identification will be required for verification of personnel arriving at CMMC with requested SNS assets.

12.Authorized CMMC personnel will sign the Montana State Chain of Custody form at the time of receipt (See appendix A-3). A DEA form 222 will also need to be signed if controlled substances are being received (See appendix A-4).  A copy of receipt of delivery will be retained and sent to the Purchasing department. Staff authorized to sign for SNS assets are: 

the Purchasing Manager, 
Pharmacy Manager, or
Authorized designee(s)

D.Storing / Sorting of SNS Assets
1.Following signature of receipt, the transport cases will be opened while in the Engineering garage and separated, with the assistance of Public Health, into push packages for pre-determined PUSH sites. 

2.Contents of the PUSH packages will be documented on a Chain of Custody form.

3.PUSH packages will be stored in the Engineering garage until transport is notified and arrives for pick up of SNS assets.

4.Controlled substances will be transported to the CMMC pharmacy for security purposes. Examples of these controlled substances are morphine, diazepam, midazolam or any Schedule II or Schedule IV medications.

5. A member of Law Enforcement, or assigned CMMC staff, will remain inside the Engineering garage with the community assets until all assets are released.

6.A member of Law Enforcement will be located outside the CMMC storage garage at all times until assets are distributed internally and all community assets leave CMMC premises.

7.CMMC SNS assets will NOT be moved to the assigned storage area unless security staff positioned for safe transport.

8.Assets will then be transported to the hospital via the internal stairs that connect the Engineering garage to the hospital Engineering boiler room, located in the basement of the facility. Larger asset items will be transported via the CMMC service elevator. At no time will assets be allowed to be stored in the facility hallways.

9.If any assets are too large for transport via the stairway or elevator, they will be temporarily stored in the Engineering garage until they can be relocated to their proper destination. 

10.Once assets are in the physical hospital building, they will be taken to the Central Supply department for separation of departmental unit packages.

E.Distribution of SNS Assets

1.External distribution:
The Emergency Operations Center(EOC) will be notified when assets are sorted and ready for transfer to distribution and / or PUSH sites. 

Fergus County EOC will arrange for transportation of SNS assets to the Point of Dispensing (POD) and / or PUSH sites.
Photo identification will be required for verification of authorized personnel arriving at CMMC to transport community SNS assets.

Transport personnel must sign for release of assets on the Chain of Custody form and complete all paperwork requirements prior to departure.

Security staff will ensure the security of remaining assets housed in the Engineering garage until all assets have been distributed / transported off CMMC premises.

2.Internal distribution:
CMMC photo identification badge must be worn by all employees involved with the internal distribution of SNS assets. 

Assets will be sorted into department specific groups by two of the following staff positions: Purchasing, Infection Control RN, Safety Officer or Emergency Preparedness personnel, or authorized designees. 

If assets are pharmaceuticals, the Pharmacy Manager, or authorized designee, will oversee the sorting and distribution process.

CMMC Courier personnel will be responsible for transporting asset packages to specified departments.

Following notification, CMMC courier will report to storing area (Central Supply) to acquire assets.

Signatures will be required upon release and receipt of assets using the Intra-facility Chain of Custody Transfer Form (See appendix A).

If security for transport of assets is of concern, additional personnel may be requested. Employees from the Engineering or Environmental Services departments will be available to assist with courier transport.

F.Tracking of SNS Assets

All asset items will be tracked following release to CMMC departments.

An orange I.D. bracelet will be numbered and applied to all SNS equipment (i.e. IV pumps, ventilators).

Intra-facility Chain of Custody Transfer Forms will be utilized at all times to provide adequate tracking and distribution of asset items. (See appendix A).

Receiving staff within each department will complete the Intra-facility Chain of Custody Form upon arrival of asset(s) (See appendix A).  Signatures will be required by both the courier and the recipient staff prior to release of assets to the department.  

Each Department Manager will be responsible for distribution / use/ recovery of asset items within their respective departments. CMMC will NOT charge SNS assets to patients regardless of payer source. 

Distribution and PUSH sites will track the dispensing of pharmaceuticals with the use of State supplied forms.
CMMC is not responsible for disposable assets once removed from CMMC premises.

Surplus assets will be returned to CMMC at the completion of event (see Recovery of SNS Assets).

G.CMMC Internal Dispensing Plan

1.        Notification:
Upon notification of need for mass dispensing of medication / vaccinations to CMMC employees / families / volunteers, the CMMC Liaison Officer will communicate request to Operations Chief.

The ________________will notify the Cardiac Rehab and Fitness Center staff  of preparation for an internal POD. 
The assembly of the internal POD will be established according to the CMMC Flow   Plan for Mass Dispensing (See appendix C).

Facility Call Tree will be activated to notify staff and volunteers off-premises of   Mass dispensing procedure.

2.          Dispensing Procedure:   

1.Each department will be notified of POD implementation and priority position for receipt of Rx / Vaccination. Employees are NOT to report to the internal POD location until instructed to do so. 

2.Department managers, or authorized designee, will be responsible for distributing Information / Consent form(s) to on-site employees at the time of notification (See appendix A). Information / Consent form(s) must be taken with each employee to the internal POD location.

3.CMMC identification badges will be required by all employees for admission to the internal POD.

4.Oral medications for employee family members may be sent 
with each employee at the time of POD visitation, if the employee is 18 years of age or older. Can employees take injections home for family members?

5.Employees will need to remain at work until the completion of assigned shift before taking received medication(s) home to family members?

b. Off- premise employee , volunteer, or employee family:
1.CMMC identification badges will be required for all employees and volunteers to enter the internal POD. A valid driver's license will be required for  identification of employee and volunteer family members. 

2.Employee and Volunteer family members must be 18 years of age or older to receive medication regimen(s) for additional family members. 

3.Information / Consent form(s) will be completed at the form station prior to receipt of medications. Any employee or volunteer picking up medication regimen(s) for family members will need to complete a consent form for each family member. VIS sheets will be given prior to consent signing.  

H.CMMC participation in Lewistown's Mass Dispensing / Point of Distribution (POD) 

1.Role of CMMC
CMMC will support Central Montana Health District (CMHD) and Fergus County Nurse's office in distribution of SNS pharmaceuticals at a Point of Dispensing (POD) location. 
CMMC personnel provided to supplement staffing at a POD, as requested by the CMHD, will be required to continue compliance with all facility policies and will also be covered under Montana State laws governing this type of participation in Mass dispensing of medications – See 
Section III: Legal concerns

The POD Clinic will operate following protocol in Annex F of the Public Health Emergency Operations Plan (EOP) and CMMC employees called to assignment at the POD will be required to follow all CMHD POD policies.  

2.Request procedure for staffing the Lewistown POD
The CMMC Liaison Officer will be notified through the Unified Command of the need for staffing assistance at the Lewistown POD.

The CMMC Incident Commander will be notified of request and will confer with the CMMC Planning Chief regarding staff availability for requested assignment.

CMMC will provide staff to assist with the mass dispensing efforts at the Lewistown POD according to availability of personnel.

CMMC reserves the right to retain the necessary amount of staff needed to ensure adequate delivery of care for the facility needs during such an incident but will allocate staff as able. 

3.Staff assignment
CMMC staff will be notified to report for duty as outlined in the Emergency Operations Plan.

Upon arrival at CMMC Labor Pool, staff will be notified of Lewistown POD assignment.

Once completion of reporting requirements is attained, staff will proceed as directed to designated Lewistown POD and report to the POD personnel coordinator for assignment. 

Transportation to the CMHD POD will be either by staff vehicle or provided by CMMC, depending on staff preference. If facility vehicle is unavailable, staff will need to assume independent transportation. 

The POD Labor Pool Unit Leader will provide assignment and direction to CMMC staff. 

4. Completion of Assignment
Upon completion of Lewistown POD assignment, staff will return to CMMC and report to the Labor Pool.  All required paperwork will be completed prior to duty discharge.

I.Recovery of SNS Assets

1. External:
Any surplus of SNS assets, or SNS equipment, that are required to be returned to the State of Montana, will be returned to CMMC by each individual entity.

Distribution or PUSH sites will be responsible for transportation of surplus SNS assets to CMMC. 

2. Internal:
Surplus SNS asset items will be required to be returned from each CMMC department following incident.

Individual departments within CMMC will be responsible for return of any surplus SNS assets.  Each Department Manager will designate an authorized individual to complete transport process.

Surplus SNS asset items will be returned to the Central Supply department and release signature required by designated transport individual. 

3.SNS asset restoration:
Return of surplus SNS assets to the State of Montana  will be the responsibility of the Purchasing Department Manager, or authorized designee.

Surplus SNS items will be returned as outlined by the State of Montana in their SNS policy.

III.  Legal Concerns:
In order to establish statewide consistency, the following guidance is intended to clarify some of the legal issues that may arise during an emergency. The following is excerpted from the State of Montana SNS plan.

1.Standing Orders.  
The local Medical Officer is authorized to issue standing orders and protocols for dispensing sites. However, if a local order is not in place the State Medical Officer has developed a standing order to prescribe medications for individuals at a Point of Dispensing (POD) site during a mass prophylaxis event. This order will include only those jurisdictions that do not have orders in place. 

2.    Authority to Dispense.  
During an event that the State Medical Officer has determined there is a need to use the Strategic National Stockpile medical assets for prophylaxis purposes, the following authority will go into effect:  

As per MCA 37-2-104 a medical practitioner may furnish a patient any drug during an emergency. Additionally, the furnishing of drugs by a medical practitioner will only be conducted in special incidents requiring the Strategic National Stockpile and is not a usual course of doing business. Therefore, all licensed medical practitioners who have a relationship with dispensing medications are potential candidates to dispense at a POD.

A “medical practitioner” is defined in MCA 37-2-101 and means any person licensed by the state of Montana to engage in the practice of medicine, dentistry, osteopathy, podiatry, optometry, or a nursing specialty and is in the licensed practice to administer or prescribe drugs. 
The Central Montana Health District may determine eligibility to dispense as long as it does not supersede the above guidance. 

As per MCA 10-3-912, a person responding to a request for assistance who is under the operational control of the requesting member is considered to be an employee of the requesting jurisdiction for liability purposes. 

The Central Montana Health District will ensure that lists of volunteers providing service for local health functions are provided to the local EOC. 

4.Worker's Compensation  
As per MCA 10-3-911, a person responding to a request for assistance is entitled to all applicable benefits, including workers compensation, normally available from their home jurisdiction.

Central Montana Health District (CMHD): The Public Health department responsible for Fergus County, Judith Basin County, Musselshell County, Petroleum County, Wheatland County, and  Golden Valley County.

Fergus County Disaster and Emergency Services Coordinator (DES): Employee of Fergus County responsible for coordination of disaster and emergency services. Individual in charge of making request for SNS asset delivery after notification from the Emergency Operations Center (EOC). 

Strategic National Stockpile (SNS):  “A National repository of antibiotics, chemical antidotes, vaccines, antitoxins, antivirals, life-support medications, IV and IV administration sets, airway maintenance supplies, and other medical / surgical items used to augment federal , state and local public health agencies in the event of a terrorist attack or other emergency” – DSNS Brochure  

Drop Point:  Physical location where the SNS assets will be delivered following request by the Fergus County Emergency Operations Center (EOC) / Fergus County DES during an emergent event. 

Central Montana Medical Center will be the Drop Point for Fergus County, Judith Basin County, and half of Petroleum County SNS assets.

Facility Resource Assessment Tool: assessment form completed by CMMC annually to provide information for the CMHD on number of facility employees and their families,  Auxiliary volunteers, and specific types of resource personnel and equipment (See appendix A). 

12-hour push packages:  Caches of pharmaceuticals, antidotes, and medical supplies designed to provide rapid delivery of a broad spectrum of assets for an ill defined threat in the early hours of an event.

PUSH sites: Facilities that have nursing staff to administer medication / vaccinations to their special populations. (i.e. hospital, nursing homes, correctional facilities, assisted living facilities, and group homes. The patients, staff and their families will receive the medication via this method rather than through a POD). 
Point of Dispensing (POD):  County designated location where asymptomatic public receives prophylactic medicines or supplies.

Click Here foe Printable - Appendix A - FORMS