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Mass Distribution and Dispensing of Medical Countermeasures
Topic Collection
September 9, 2019

Topic Collection: Mass Distribution and Dispensing of Medical Countermeasures

This Topic Collection provides links to federal, state, local, and tribal programs and resources, lessons learned, plans, tools, and templates, courses, and guidance that can help planners address the need to effectively distribute and administer medical countermeasures (MCMs) to a large number of persons in a short period of time, particularly through mass dispensing efforts led by public health authorities. Various mass dispensing modalities may be employed, with the aim of preventing individuals exposed to a biological, chemical, or radiological agent from becoming ill through their receipt of post-exposure prophylaxis. This “mass prophylaxis” is most often provided to affected individuals through “open”, or public points of dispensing (PODs). “Closed” PODs for response partners and vulnerable populations, and direct delivery of prophylaxis to affected individuals may also be used for mass prophylaxis.

MCMs can include vaccines, antiviral drugs, antitoxins, antibiotics, and materials (e.g., personal protective equipment) that may be used to prevent, mitigate, or treat the adverse health effects of an intentional, accidental, or naturally occurring public health emergency. The majority of our nation’s countermeasures stockpile is housed within the Strategic National Stockpile (SNS) which was managed by the Centers for Disease Control and Prevention before its move to ASPR (Office of the Assistant Secretary for Preparedness and Response) in October 2018. Other federal agencies, including the Department of Defense and the Veteran’s Administration, may also provide countermeasure support after a disaster.

A public health response requiring the distribution and dispensing of MCMs does not occur in isolation, but in the context of a major public health emergency. Few planning and response efforts are as complex as those for MCMs due to: the need to address varied incident types; possibilities of both very tight time constraints and significant volumes of MCMs that need to be moved; risk communication protocols to support public trust and compliance; coincident major epidemiologic and medical surge responses; and the need for coordination across all levels of government and among coalition partners.

Successful MCM planning should begin with an “all-hazards” approach, with more detailed plans developed for specific aspects of distribution and delivery (e.g., warehouse and transportation operations; POD and other dispensing plans) that consider the following:

Related information can be found in the following Topic Collections (listed alphabetically): Bioterrorism and High Consequence Biological Threats; Chemical HazardsEpidemic/Pandemic Influenza; Healthcare-Related Disaster Legal/ Regulatory/ Federal Policy, Hospital Victim Decontamination; Pharmacy; Pre-Hospital Victim Decontamination; Radiological and Nuclear; SARS/MERS; VHF/Ebola; Volunteer Management; and Zika.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

 

Must Reads


Association of State and Territorial Health Officials and the National Association of County and City Health Officials. (2017). Extended Medical Countermeasure Distribution and Dispensing Considerations for Anthrax Incidents.
In the event of a public health emergency involving anthrax, state and local jurisdictions will activate their medical countermeasure (MCM) plans, allowing for an initial 10-day antibiotic distribution. This document can help healthcare authorities plan for the extended post-exposure prophylactic period (in this case, 50-day antibiotic supply, three shot vaccine series, and treatment supplies) and includes promising practices in each domain and links to relevant resources.
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Centers for Disease Control and Prevention. (n.d.). Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide to Preparedness Version 11. (Accessed 4/23/2018.) Homeland Security Digital Library.
This comprehensive document provides an overview of the Strategic National Stockpile (SNS) program, as well as operational and strategic guidance for each operational function required for the distribution and dispensing of medical countermeasures.
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Centers for Disease Control and Prevention. (2016). Strategic National Stockpile: 12-hour Push Package.
These transport-ready containers (strategically located across the country) can supply a community with a broad range of pharmaceuticals and medical supplies in the event of a large-scale public health incident related to an unknown agent, or to help initiate response activities while more targeted countermeasures from the “managed inventory” are being mobilized.
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Centers for Disease Control and Prevention. (2017). Mass Dispensing Overview: An SNS (Strategic National Stockpile) Perspective.
Planners and healthcare providers can learn more about community-level mass dispensing and the logistics related to standing up points of dispensing from this hour-long course, which is provided through CDC TRAIN.
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Centers for Disease Control and Prevention. (2017). Pandemic Influenza Plan: 2017 Update.
This plan includes updates to the seven domains. Domain 3 is “Medical Countermeasures: Diagnostic Devices, Vaccines, Therapeutics, and Respiratory Devices” and includes seven objectives that can “improve effectiveness, timeliness, availability and accessibility to medical countermeasures.”
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This guidance document will assist all Public Health Emergency Preparedness (PHEP) grant recipients and local Cities Readiness Initiative (CRI) planning jurisdictions with conducting the required operational readiness review (ORR). The ORR is a rigorous, evidence-based assessment that primarily focuses on evaluating a jurisdiction’s ability to execute a large response requiring medical countermeasure (MCM) distribution and dispensing.
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Centers for Disease Control and Prevention. (2017). Strategic National Stockpile: Preparing State and Local Responders.
This webpage includes links to various training and exercises related to the Strategic National Stockpile. Resources are listed in the following categories: online courses, webinars, in-person training, on-site training, and exercise support.
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Centers for Disease Control and Prevention. (2018). Strategic National Stockpile.
In the event of a public health emergency so severe that local supplies are taxed, the Strategic National Stockpile (SNS) can be activated to ensure medicine and supplies get to those who need it most. This website includes information on the history of the SNS; sustaining the SNS; partnerships; products included in the 12-hour push packs and managed inventory; training and exercises; and examples of the SNS in action.
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Johnson County Government, Department of Health and Environment. (2017). Dispense Assist.
This online tool may be used to pre-screen individuals that will receive medical countermeasures at Point of Dispensing (PODs) sites to support rapid distribution at the PODs. After answering a few targeted questions, users can print out a completed screening form that indicates the countermeasure they should receive at the POD.
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Melton, M., Puerini, R., and Daoust, E. (2018). Factors that Will Most Significantly Impact the Effectiveness of MCM Distribution (Warehouse and MCM Delivery Operations). Los Angeles County Department of Public Health.
This document consists of a one-page table that summarizes the different factors involved in attaining preparedness for medical countermeasure (MCM) distribution. The authors include considerations for the pre-activation phase; preparing for incoming deliveries; warehouse operations at the Receipt, Store, and Stage (RSS) site; inventory tracking; outgoing deliveries from the RSS site; and readiness of the receiving sites to effectively manage the MCMs when they are delivered.
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National Association of County & City Health Officials. (2018). Medical Countermeasures and Non-Pharmaceutical Interventions.
This webpage includes links to initiatives and helpful information related to medical countermeasures, the Strategic National Stockpile, chemical response, radiation preparedness, pandemic influenza preparedness, and antiviral distribution and dispensing.
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National Association of County and City Health Officials. (2018). Medical Countermeasure Toolkit Resources. (Free registration required.)
NACCHO has published a wide variety of resources that can be replicated by local emergency planners interested in setting up points of dispensing (POD), exercising their medical countermeasure plans, staffing PODs, and the like. With a free account, users can click on the URL, click on “Toolkits,” select “Medical Countermeasure (MCM) Toolkit,” and review the various tools.
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Nelson, C., Chan, E., Chandra, A., et al. (2008). Recommended Infrastructure Standards for Mass Antibiotic Dispensing. The RAND Corporation.
The authors share a set of standards that can be used to develop mass antibiotic dispensing plans and focus on points of dispensing (PODs). The standards address “(1) the number and location of PODs, (2) internal POD operations, (3) POD staffing, and (4) POD security.”
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The authors used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention’s Technical Assistance Review to evaluate and describe outcomes of state and local medical countermeasure preparedness planning. They found that overall preparedness increased during the time period studied, and note that ongoing training, exercising, and incorporation of lessons learned from real events and exercises are all critical to ensuring continued preparedness.
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Rubin, G.J., Chowdhury, A., and Amlôt, R. (2012). How to Communicate with the Public About Chemical, Biological, Radiological, or Nuclear Terrorism: A Systematic Review of the Literature. Biosecurity and Bioterrorism. 10(4):383-95.
The authors reviewed 33 peer-reviewed studies that assessed communication strategies or information needs using hypothetical CBRN scenarios or in actual CBRN incidents to identify in advance what people would want to know, where they would get information from, and how messages should be presented. These strategies are critical for ensuring that affected individuals get to the right place at the right time to receive assessment and interventions.
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San Francisco Department of Public Health. (2018). Emergency Mass Prophylaxis Clinic Planning.
This webpage includes links to information on points of dispensing, planning for infectious disease emergencies, and other resources. Also noted is that San Francisco was named as “model practice for helping organizations dispense antibiotics” and provide a link to the related toolkit.
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Texas Department of Health Services. (2016). Medical Countermeasures Program Manual.
This guidance document created for the state of Texas includes information, flow diagrams, and organizational charts that may be adapted by other jurisdictions. The document covers medical countermeasure distribution and dispensing considerations.
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On June 24, 2019 Congress passed and the President signed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA), Public Law No. 116-22. Amendments include enhancing the authorities of the Secretary, Assistant Secretary for Preparedness and Response, and the Director of the Centers for Disease Control and Prevention to prepare for and respond to public health emergencies.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2012). Behavioral Health Tips for Responders: Maintaining Calm at a POD.
This fact sheet provides recommendations for responders working at points of dispensing (PODs) during an emergency or disaster. It is broken up into three sections: Assumptions; What to do; What to say.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Public Readiness and Emergency Preparedness Act.
The Public Readiness and Emergency Preparedness Act provides liability immunity related to the development process and administration of medical countermeasures against agents that cause public health emergencies. This webpage provides links to current declarations for nerve agents, Zika, Ebola, pandemic influenza, anthrax, acute radiation syndrome, botulinum toxin, and smallpox.
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U.S. Food and Drug Administration. (2018). MCM Legal, Regulatory and Policy Framework.
The FDA works within this framework to ensure that the U.S. legal system effectively supports public health emergency preparedness and response. This webpage includes links to related legislation.
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University of Washington, Northwest Center for Public Health Practice. (2013). Partnering for Medical Countermeasure Distribution in Emergencies.
This toolkit helps public health agencies and pharmacies work together to develop public-private partnerships for community-based medical countermeasure distribution during a public health emergency.
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A working group that included experts in risk and crisis communication and medical countermeasures worked together to list “best practices” in this casebook. These practices stem from real-world lessons learned (from the recent Ebola outbreak, the 2011 Fukushima nuclear accident, the 2009-10 H1N1 influenza pandemic, and the 2001 anthrax letter attacks) and emphasize how solid communication can enhance personal and community resilience.
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* Association of State and Territorial Health Officials. (2012). Modified Scope of Practice Used by States in the 2009 H1N1 Influenza Pandemic.
This fact sheet summarizes how the scope of practice for various practitioners (e.g., pharmacists, emergency medical services responders, physicians, and nurses) was altered in several states to allow for increased numbers of vaccinators.
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* Centers for Disease Control and Prevention. (n.d.). Liability Protection for Public Health Partners. (Accessed 4/23/18.)
This brochure outlines liability protections under the Public Readiness Emergency Preparedness (PREP) Act that may be afforded to private businesses that partner with public health authorities for medical countermeasures dispensing.
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Courtney, B., Sherman, S., and Penn, M. (2013). Federal Legal Preparedness Tools for Facilitating Medical Countermeasure Use During Emergencies. (Abstract only.) Journal of Law, Medicine & Ethics. 41(Suppl 1):22-7.
The authors discuss federal legal tools that are critical to enhancing medical countermeasure legal preparedness for public health emergencies. They focus on the Public Readiness and Emergency Preparedness (PREP) Act and Emergency Use Authorization (EUA) authority to facilitate the emergency use of countermeasures. 
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Hodge, J., Orenstein, D., O'Keefe, S., et al. (2012). Public Readiness and Emergency Preparedness (PREP) Act: Scope of Liability Protections. Robert Wood Johnson Foundation, Network for Public Health Law.
The authors explain that non-governmental entities or persons are covered under liability protections of the federal PREP Act, and that non-federally owned stockpiles of covered countermeasures are also covered by the Act.
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Kels, C.G. (2015). Dispensing Medical Countermeasures: Emergency Use Authorities and Liability Protections. (Abstract only.) Health Security. 13(2): 139-151.
The evolution of authorities and public health liability protection for emergency use of medical countermeasures, associated with the Pandemic and All-Hazards Preparedness Reauthorization Act, is analyzed to advance emergency preparedness and response activities and protection of personnel.
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This Issue Brief addresses many issues private entities should consider when planning to become a closed POD.
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This Executive Order was developed to “(1) mitigate illness and prevent death; (2) sustain critical infrastructure; and (3) complement and supplement State, local, territorial, and tribal government medical countermeasure distribution capacity.” It is comprised of five sections: policy development in the event of a biological attack; United States Postal Service delivery of medical countermeasures; federal response; continuity of operations; and general provisions.
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This Act allows the Secretary of Health and Human Services to issue a declaration providing immunity from state and federal liability to persons and entities involved in the manufacture, testing, distribution, administration, and use of covered pandemic/ epidemic medical countermeasures, and provides a compensation program to certain individuals who receive covered countermeasures.
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On June 24, 2019 Congress passed and the President signed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA), Public Law No. 116-22. Amendments include enhancing the authorities of the Secretary, Assistant Secretary for Preparedness and Response, and the Director of the Centers for Disease Control and Prevention to prepare for and respond to public health emergencies.
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U.S. Department of Health and Human Services. (2015). Anthrax Medical Countermeasures-Amendment.
This amendment includes an updated “description of covered countermeasures and the disease threat; extend[s] the effective time period of the declaration;” and clarifies the terms of the declaration.
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U.S. Department of Health and Human Services, Food and Drug Administration, Office of the Commissioner, Office of the Chief Scientist, and Office of Counterterrorism and Emerging Threats. (2018). Material Threat Medical Countermeasure Priority Review Vouchers Guidance for Industry.
This draft guidance document includes information regarding the implementation of section 3086 of the 21st Century Cures Act (Cures Act) (Public Law 114-255), which added section 565A of the Federal Food, Drug, and Cosmetic Act (FD&C Act) (21 U.S.C. 360bbb-4a). Section 565A requires the Food and Drug Administration “to award a priority review voucher (PRV) to sponsors of certain medical countermeasure (MCM) applications that meet the criteria specified in that section.”
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Legal Authority of the Secretary.
This page describes the legal authority possessed by the Secretary of Health and Human Services with and without a formal declaration of a public health emergency.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). Public Readiness and Emergency Preparedness Act.
The Public Readiness and Emergency Preparedness Act provides liability immunity related to the development process and administration of medical countermeasures against agents that cause public health emergencies. This webpage provides links to current declarations for nerve agents, Zika, Ebola, pandemic influenza, anthrax, acute radiation syndrome, botulinum toxin, and smallpox.
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This order allows public health emergency stakeholders to execute plans for “emergency dispensing of eligible ciprofloxacin products without individual prescriptions in the future if they reasonably believe there is a need to do so because of their constituents’ known, suspected, or likely imminent exposure to B. anthracis.”
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This order allows public health emergency stakeholders to permit emergency dispensing of FDA-approved oral dosage forms of doxycycline products without prescription for the post-exposure treatment of “inhalational anthrax during an emergency involving Bacillus anthracis (B. anthracis), the biological agent that causes anthrax disease.”
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This webpage includes information and links to resources specific to facilitating the development of medical products (including MCMs) and MCM-specific Cures provisions (e.g., Emergency Use Authority and the MCM priority review voucher program).
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U.S. Food and Drug Administration. (2018). Emergency Use Authorization.
This authorization allows the Food and Drug Administration to facilitate the availability and use of medical countermeasures to assist during public health emergencies. Links to information on current authorizations (e.g., anthrax, Ebola, and nerve agent) are provided on this page.
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U.S. Food and Drug Administration. (2018). MCM Legal, Regulatory and Policy Framework.
The FDA works within this framework to ensure that the U.S. legal system effectively supports public health emergency preparedness and response. This webpage includes links to related legislation.
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Considerations for Special Populations


On this podcast, local health department preparedness planners discuss partnerships they have established, the approaches they use to engage these partners, and the benefits of such partnerships as they relate to medical countermeasure planning and response.
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Speakers share challenges associated with vulnerable populations and open points of dispensing (PODs) and strategies for using closed PODs to help protect the health of members of vulnerable populations.
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Disaster Preparedness Advisory Council. (2016). Medical Countermeasures for Children in Public Health Emergencies, Disasters, or Terrorism. Pediatrics. 137(2).
The Council shares that many medical countermeasures (MCM) are more likely to be approved for adult use and may not take the unique needs of children into account. They drafted this policy statement to suggest recommendations that address the gaps for the development and use of MCMs in children during public health emergencies or disasters and discuss available options and regulatory issues.
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Meaney-Delman, D., Zotti, M., Creanga, A., et al. (2014). Special Considerations for Prophylaxis for and Treatment of Anthrax in Pregnant and Postpartum Women. Emerging Infectious Diseases. 20(2).
The authors present information regarding vaccine, antimicrobial drug prophylaxis and treatment, clinical considerations, and other factors healthcare practitioners must take into consideration when treating pregnant and postpartum women after an anthrax exposure.
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This document provides information for public health departments about pursuing Meals on Wheels as an alternate dispensing partner of medical countermeasures.
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On this podcast, local health department preparedness planners discuss best practices for defining and identifying at-risk populations in their jurisdictions, and strategies and planning considerations for inclusive medical countermeasure planning. (Note that Babcock, S., Rowell, E., and Scarborough, N. [2015] is cited in this collection and considered Part 2 of this series.)
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U.S. Food and Drug Administration. (2018). Pediatric Medical Countermeasures.
Pediatric patients may react differently to certain medications, making the development of safe and effective medical countermeasures (MCM) for young patients critical to public health emergency preparedness. This webpage includes links to resources specific to bioterrorism emergencies and radiation emergencies.
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Distribution of MCM: Warehouse and MCM Delivery


* Association of State and Territorial Health Officials and the National Association of County and City Health Officials. (2017). Extended Medical Countermeasure Distribution and Dispensing Considerations for Anthrax Incidents.
In the event of a public health emergency involving anthrax, state and local jurisdictions will activate their medical countermeasure (MCM) plans, allowing for an initial 10-day antibiotic distribution. This document can help healthcare authorities plan for the extended post-exposure prophylactic period (in this case, 50-day antibiotic supply, three shot vaccine series, and treatment supplies) and includes promising practices in each domain and links to relevant resources.
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* Centers for Disease Control and Prevention. (n.d.). Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide to Preparedness Version 11. (Accessed 4/23/2018.) Homeland Security Digital Library.
This comprehensive document provides an overview of the Strategic National Stockpile (SNS) program, as well as operational and strategic guidance for each operational function required for the distribution and dispensing of medical countermeasures.
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This document describes the functions, tasks, performance measures, and resource elements required to achieve Capability 9 (Medical Materiel Management and Distribution) of the Public Health Preparedness Capabilities issued in 2011.
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* Centers for Disease Control and Prevention. (2017). Countermeasure Inventory Tracking (CIT) Dashboard.
The Countermeasure Tracking System (CTS) consists of multiple interoperating components that may be used by federal, state, and local public health agencies to track and manage medical and non-medical inventory and usage during both daily operations and all-hazards events. It includes the Inventory Management Tracking System (IMATs); the Countermeasure and Response Administration (CRA) system; and the Countermeasure Inventory Tracking (CIT) Dashboard.
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* Centers for Disease Control and Prevention. (2017). Receiving 60-Day Anthrax Medical Countermeasures from CDC’s Strategic National Stockpile. (Permission required to access this document from ON-TRAC.)
This guidance can help healthcare planners establish coordinated efforts regarding the receipt, distribution, and dispensing of medical countermeasures during an anthrax response.
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* Melton, M., Puerini, R., and Daoust, E. (2018). Factors that Will Most Significantly Impact the Effectiveness of MCM Distribution (Warehouse and MCM Delivery Operations). Los Angeles County Department of Public Health.
This document consists of a one-page table that summarizes the different factors involved in attaining preparedness for medical countermeasure (MCM) distribution. The authors include considerations for the pre-activation phase; preparing for incoming deliveries; warehouse operations at the Receipt, Store, and Stage (RSS) site; inventory tracking; outgoing deliveries from the RSS site; and readiness of the receiving sites to effectively manage the MCMs when they are delivered.
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* Texas Department of Health Services. (2016). Medical Countermeasures Program Manual.
This guidance document created for the state of Texas includes information, flow diagrams, and organizational charts that may be adapted by other jurisdictions. The document covers medical countermeasure distribution and dispensing considerations.
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Education, Training, and Exercises


While free registration is necessary to view this instructional video, other materials are available on this webpage and include slides for clerks, nurses, pharmacists, and social workers. Users can also access a short video on the role of the social worker at points of dispensing.
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This 25-minute online course provides a basic overview of CHEMPACK. Because the MCM that protects exposed persons from harmful effects of chemical exposure must often be administered within two hours of exposure, the CDC uses the CHEMPACK program to forward place significant caches of these assets within communities, at locations such as hospitals and fire stations.
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Participants will learn more about logistics and maintenance issues associated with CHEMPACK containers in this (Vermont-specific) 20-minute, on-line course. Other topics covered include different CHEMPACK configurations, storage requirements, and mobilization timing.
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CDC TRAIN. (2018). CDC TRAIN. (Free registration required.)
The Centers for Disease Control and Prevention offer numerous on-line courses on medical countermeasures, the Strategic National Stockpile, and points of dispensing. ASPR TRACIE has listed several individual courses under the Education and Training category; users should search by keyword to locate courses specific to their needs.
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Centers for Disease Control and Prevention. (n.d.). Medical Countermeasures: Point of Dispensing (POD), Planning and Response. (Accessed 3/28/2018.)
This in-person course covers the coordination of planning, training and responding to a Medical Countermeasure (MCM) response for a public health incident.
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This course provides state and local agencies with information to manage closed point of dispensing (POD) sites during a public health emergency.
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This webinar, which is provided through CDC TRAIN, will familiarize participants with critical SNS concepts, and help them to better understand the importance of shelf life and its impact on medical countermeasure (MCM) preparedness planning.
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Centers for Disease Control and Prevention. (2016). SNS (Strategic National Stockpile) Overview.
This course, which is provided through CDC TRAIN, provides state and local agencies with basic information regarding the deployment of assets from the SNS into a jurisdiction during a public health emergency and how those assets should be managed.
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Centers for Disease Control and Prevention. (2017). Mass Dispensing Overview: An SNS (Strategic National Stockpile) Perspective.
Planners and healthcare providers can learn more about community-level mass dispensing and the logistics related to standing up points of dispensing from this hour-long course, which is provided through CDC TRAIN.
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Centers for Disease Control and Prevention. (2017). Strategic National Stockpile: Preparing State and Local Responders.
This webpage includes links to various training and exercises related to the Strategic National Stockpile. Resources are listed in the following categories: online courses, webinars, in-person training, on-site training, and exercise support.
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Centers for Disease Control and Prevention. (2018). MCM Coordinator Common Responsibilities and Associated Skills. National Association of County & City Health Officials
The CDC’s Division of State and Local Readiness (DSLR) Training Team identified a set of six common responsibilities and associated skills of Medical Countermeasure (MCM) Coordinators to aid in supporting the training needs of MCM Coordinators across the country. These responsibilities and skills were developed with input from CDC MCM subject matter experts, the National Association of County & City Health Officials (NACCHO), and the Association of State and Territorial Health Officers (ASTHO).
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Chilcott, R.P. and Amlot, R. (Eds.). (2019). Decontamination Guidance for Chemical Incidents. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Biomedical Advanced Research and Development Authority.
The Primary Response Incident Scene Management (PRISM) series is comprised of three volumes that can help ensure that patients exposed to potentially hazardous chemicals receive the most effective treatment possible during the initial stages of an incident (after prompt decontamination). Updated in 2019, PRISM incorporates new scientific evidence on emergency self-decontamination, hair decontamination, the interactions of chemicals with hair, and the effects of a combined decontamination strategy referred to as the “triple protocol.” The clinical research showed that these three steps, taken together, remove 99.9 percent of chemical contamination.
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Los Angeles County Department of Public Health. (2018). MCM Exercise Resource Page.
This webpage includes links to HSEEP-compliant exercise documents that were developed by the Los Angeles County Department of Public Health. This series of exercises concluded with full-scale exercises (FSE) of Medical Countermeasure Distribution and Dispensing (MCMDD) in November 2015. Documents will be added as the department develops another set of HSEEP-compliant exercise documents for the entire series that will lead up to the next FSE of MCMDD in November 2020.
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National Association of County and City Health Officials. (2018). New Medical Countermeasure Coordinator Start Up Guide. (Free registration required.)
This 3-page guide includes information on both a two-year professional development plan for new MCM Coordinators and a number of recommended resources that the members of NACCHO’s MCM Workgroup identified as important to this position.
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Northwest Center for Public Health Practice. (n.d.). Capability 8: Medical Countermeasure Dispensing. (Accessed 3/22/2018.)
This webpage links to several trainings that will assist planners with preparing for medical countermeasure dispensing.
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This online, self-paced training can help healthcare providers and coalitions learn more about and prepare to stand up a closed point of dispensing.
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This course (online and self-paced) was designed to supplement just-in-time training and provides a general overview of points of dispensing (PODs) and the roles that staff and volunteers can play to ensure PODs run smoothly.
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Lessons Learned


* Association of State and Territorial Health Officials. (2012). Modified Scope of Practice Used by States in the 2009 H1N1 Influenza Pandemic.
This fact sheet summarizes how the scope of practice for various practitioners (e.g., pharmacists, emergency medical services responders, physicians, and nurses) was altered in several states to allow for increased numbers of vaccinators.
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On this podcast, local health department preparedness planners discuss partnerships they have established, the approaches they use to engage these partners, and the benefits of such partnerships as they relate to medical countermeasure planning and response.
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Speakers share challenges associated with vulnerable populations and open points of dispensing (PODs) and strategies for using closed PODs to help protect the health of members of vulnerable populations.
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* Center for Infectious Disease Research and Policy. (n.d.). Medical Countermeasure Dispensing. (Accessed 3/23/18.)
This webpage includes lessons learned, planning documents, and sample templates from planners across the country to support preparedness for medical countermeasure dispensing.
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Chalmers, T. (2009). Walk-in or Drive-thru: POD Model Comparisons from the Erie County Hepatitis A Experience. University at Albany Center for Public Health Preparedness.
This webinar includes lessons learned from Erie County, New York’s Hepatitis A outbreak response in 2008, and compares walk-in and drive-thru POD models and experiences.
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Fletcher, M., Puerini, R., Caum, J., and Alles, S.J. (2014). Efficiency and Effectiveness of Using Nonmedical Staff During an Urgent Mass Prophylaxis Response. Biosecurity and Bioterrorism. 12(3): 151-159.
The Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to its internal population. Mean throughput and accuracy rates were compared to a previous public POD exercise staffed by health department personnel and medical volunteers. Overall accuracy, and pediatric dosing accuracy, were found to be significantly lower during the closed POD vs. the public POD.
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This report lists the lessons learned by the U.S. Department of Health and Human Services during the 2009 H1N1 pandemic, including those related to communications and the Strategic National Stockpile. Comments from several federal agencies are included as appendices.
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* Melton, M., Puerini, R., and Daoust, E. (2018). Factors that Will Most Significantly Impact the Effectiveness of MCM Distribution (Warehouse and MCM Delivery Operations). Los Angeles County Department of Public Health.
This document consists of a one-page table that summarizes the different factors involved in attaining preparedness for medical countermeasure (MCM) distribution. The authors include considerations for the pre-activation phase; preparing for incoming deliveries; warehouse operations at the Receipt, Store, and Stage (RSS) site; inventory tracking; outgoing deliveries from the RSS site; and readiness of the receiving sites to effectively manage the MCMs when they are delivered.
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Workshop participants discussed the need for shared terminologies; data needs, sources, and collection methodologies; considerations for conducting rapid clinical research on medical countermeasures (MCM) during a public health emergency; and the federal perspective on MCM. Lessons from a 2012 fungal infection outbreak, anthrax, and H1N1 are shared in sidebars throughout the proceedings.
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National Association of County & City Health Officials. (2014). Using Closed PODs to Protect Critical Infrastructure.
This webpage includes links to an infographic and report on a survey which found 86 percent of surveyed healthcare-related entities have closed POD agreements.
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Puerini, R., Caum, J., Francis, N., and Alles, S. (2015). The 49th Hour: Analysis of a Follow-up Medication and Vaccine Dispensing Field Test. Health Security. 13(1): 54-63.
The authors used a real seasonal influenza vaccination clinic to assess throughput and accuracy, and to evaluate the resources needed to operationalize a Point of Dispensing (POD) model to distribute the additional 50-day course of antibiotics and administer the 3-dose vaccine series required after the initial response to an aerosolized anthrax release is completed.
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The authors used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention’s Technical Assistance Review to evaluate and describe outcomes of state and local medical countermeasure preparedness planning. They found that overall preparedness increased during the time period studied, and note that ongoing training, exercising, and incorporation of lessons learned from real events and exercises are all critical to ensuring continued preparedness.
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Rinchiuso-Hasselmann, A., McKay, R., Williams, C., et al. (2011). Protecting the Public from H1N1 through Points of Dispensing (PODs): Lessons Learned for Future Emergency Response. (Abstract only.) Biosecurity and Bioterrorism. 9(1): 13-21.
The authors discuss lessons learned by the New York Department of Health and Mental Hygiene, which set up and operated 58 points of dispensing (PODs) over 5 weekends during the 2009 H1N1 outbreak.
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Saha, S., Dean, B., Teutsch, S. et al. (2014). Efficiency of Points of Dispensing for Influenza A(H1N1)pdm09 Vaccination, Los Angeles County, California, USA, 2009. Emerging Infectious Diseases. 20(4).
The Los Angeles County Department of Public Health used points of dispensing (PODs) to vaccinate residents during the H1N1 outbreak. This article highlights vaccination rates by demographic, average distance traveled to PODs, and other factors that should be considered by emergency planners.
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On this podcast, local health department preparedness planners discuss best practices for defining and identifying at-risk populations in their jurisdictions, and strategies and planning considerations for inclusive medical countermeasure planning. (Note that Babcock, S., Rowell, E., and Scarborough, N. [2015] is cited in this collection and considered Part 2 of this series.)
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A working group that included experts in risk and crisis communication and medical countermeasures worked together to list “best practices” in this casebook. These practices stem from real-world lessons learned (from the recent Ebola outbreak, the 2011 Fukushima nuclear accident, the 2009-10 H1N1 influenza pandemic, and the 2001 anthrax letter attacks) and emphasize how solid communication can enhance personal and community resilience.
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Wakefield, M. (2015). Local Health Department Engages in Pharmacy Preparedness Exercise. National Association of County & City Health Officials.
The author describes the pilot testing of a program designed to dispense medical countermeasures via a Costco warehouse in Virginia.
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Mass Prophylaxis Planning: General


* Barishansky, R. and Mazurek, A. (2011). MCM Dispensing: The Public Health Point of View.
The authors summarize the various modes of medical countermeasure dispensing under two models: medical and non-medical. They also emphasize how critical partnerships, volunteers, and personal responsibilities are to ensuring a successful response to a public health emergency.
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This document describes the functions, tasks, performance measures, and resource elements required to achieve Capability 8 of the Public Health Preparedness Capabilities issued in 2011.
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This document describes the functions, tasks, performance measures, and resource elements required to achieve Capability 9 (Medical Materiel Management and Distribution) of the Public Health Preparedness Capabilities issued in 2011.
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This webpage provides links to factsheets for healthcare providers and others on the use of doxycycline and ciprofloxacin in the event of a mass casualty incident involving anthrax.
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Centers for Disease Control and Prevention. (2016). Strategic National Stockpile: 12-hour Push Package.
These transport-ready containers (strategically located across the country) can supply a community with a broad range of pharmaceuticals and medical supplies in the event of a large-scale public health incident related to an unknown agent, or to help initiate response activities while more targeted countermeasures from the “managed inventory” are being mobilized.
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* Centers for Disease Control and Prevention. (2017). Community-Wide (Mass) Vaccination.
The goal of community-wide mass vaccination is to inoculate all willing and eligible people in an area. This smallpox-specific webpage defines points of dispensing and provides links to Maxi-Vac Version 1.0 and Maxi-Vac Alternative, a modeling program that can help planners allocate human resources to vaccinate the greatest number of people as quickly as possible.
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* Centers for Disease Control and Prevention. (2017). Medical Countermeasure Readiness.
This webpage includes information on medical countermeasure readiness and the Cities Readiness Initiative (CRI), a federal initiative designed to enhance preparedness in the nation’s largest population centers, where nearly 60% of the population resides, to effectively respond to large-scale public health emergencies needing life-saving medications and medical supplies.
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This guidance document will assist all Public Health Emergency Preparedness (PHEP) grant recipients and local Cities Readiness Initiative (CRI) planning jurisdictions with conducting the required operational readiness review (ORR). The ORR is a rigorous, evidence-based assessment that primarily focuses on evaluating a jurisdiction’s ability to execute a large response requiring medical countermeasure (MCM) distribution and dispensing.
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* Centers for Disease Control and Prevention. (2017). Receiving 60-Day Anthrax Medical Countermeasures from CDC’s Strategic National Stockpile. (Permission required to access this document from ON-TRAC.)
This guidance can help healthcare planners establish coordinated efforts regarding the receipt, distribution, and dispensing of medical countermeasures during an anthrax response.
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Centers for Disease Control and Prevention. (2018). Strategic National Stockpile.
In the event of a public health emergency so severe that local supplies are taxed, the Strategic National Stockpile (SNS) can be activated to ensure medicine and supplies get to those who need it most. This website includes information on the history of the SNS; sustaining the SNS; partnerships; products included in the 12-hour push packs and managed inventory; training and exercises; and examples of the SNS in action.
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Rinchiuso-Hasselmann, A., Starr, D., McKay, R., et al. (2010). Public Compliance with Mass Prophylaxis Guidance. (Abstract only.) Biosecurity and Bioterrorism. 8 (3): 255-263.
This article discusses findings from a series of 8 focus groups conducted by the New York City Department of Health and Mental Hygiene to determine what improvements could be made to public communication and education plans to ensure that the public would adhere to instructions issued during an emergency that required mass antibiotic distribution.
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Rubin, G.J., Chowdhury, A., and Amlôt, R. (2012). How to Communicate with the Public About Chemical, Biological, Radiological, or Nuclear Terrorism: A Systematic Review of the Literature. Biosecurity and Bioterrorism. 10(4):383-95.
The authors reviewed 33 peer-reviewed studies that assessed communication strategies or information needs using hypothetical CBRN scenarios or in actual CBRN incidents to identify in advance what people would want to know, where they would get information from, and how messages should be presented. These strategies are critical for ensuring that affected individuals get to the right place at the right time to receive assessment and interventions.
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SteelFisher, G., Blendon, R., Ross, L.J., et al. (2011). Public Response to an Anthrax Attack: Reactions to Mass Prophylaxis in a Scenario Involving Inhalation Anthrax From an Unidentified Source. Biosecurity and Bioterrorism. 9(3):239-50.
This article discusses findings from a poll conducted to examine the public's response to a mass prophylaxis program conducted under a “worst-case scenario” in which cases of inhalation anthrax are discovered without an identified source and the entire population of a city or town is asked to receive antibiotic prophylaxis within a 48-hour period. Findings provide indicators of public willingness to comply with public health recommendations for obtaining antibiotics from a dispensing site, although they also indicate that public health officials may face several challenges to compliance.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2011). Public Input on Medical Countermeasures-Seattle & King County (Executive Summary).
This report summarizes findings from a conference held with geographically representative residents from the Seattle and King County regions. In general, participants indicated they preferred multiple options regarding medical countermeasure (MCM) development and dispensing; safe and equal access to MCM was of the utmost importance; MCM should be free; clear and timely communication is critical; and most residents will follow directions given regarding collecting MCM.
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Mass Prophylaxis Planning: Points of Dispensing (PODs)


Agocs, M., Fitzgerald, S., Alles, S., et al. (2007). Field Testing a Head-of-Household Method to Dispense Antibiotics. Biosecurity and Bioterrorism. 5(3): 255-267.
Head-of-household points of dispensing (PODs) were tested in a simulation anthrax exercise with the Philadelphia Department of Public Health. The authors note that this method can reach large populations quickly during a public health emergency.
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Alabama Department of Public Health. (2013). Becoming a Closed POD.
While written for the State of Alabama, the guidance in this document can help emergency healthcare planners across the U.S. understand the benefits of developing closed points of dispensing (POD). The document provides an overview of open and closed PODs and lists answers to frequently asked questions.
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* Association of State and Territorial Health Officials and the National Association of County and City Health Officials. (2017). Extended Medical Countermeasure Distribution and Dispensing Considerations for Anthrax Incidents.
In the event of a public health emergency involving anthrax, state and local jurisdictions will activate their medical countermeasure (MCM) plans, allowing for an initial 10-day antibiotic distribution. This document can help healthcare authorities plan for the extended post-exposure prophylactic period (in this case, 50-day antibiotic supply, three shot vaccine series, and treatment supplies) and includes promising practices in each domain and links to relevant resources.
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Baccam, P., Willauer, D., Krometis, J., et al. (2011). Mass Prophylaxis Dispensing Concerns: Traffic and Public Access to PODs. Biosecurity and Bioterrorism. 9(2): 139-151.
The authors examined traffic-related challenges associated with points of dispensing (PODs) and found that planners should consider using physical barriers, traffic control officers, and signage to help guide vehicular and pedestrian traffic. They also found that due to long lines of people waiting to access the PODs, staff would likely be used nearly 90% of the time and encouraged planners to consider burnout in their strategies.
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* Barishansky, R. and Mazurek, A. (2011). MCM Dispensing: The Public Health Point of View.
The authors summarize the various modes of medical countermeasure dispensing under two models: medical and non-medical. They also emphasize how critical partnerships, volunteers, and personal responsibilities are to ensuring a successful response to a public health emergency.
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* Center for Infectious Disease Research and Policy. (n.d.). Medical Countermeasure Dispensing. (Accessed 3/23/18.)
This webpage includes lessons learned, planning documents, and sample templates from planners across the country to support preparedness for medical countermeasure dispensing.
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This document describes the functions, tasks, performance measures, and resource elements required to achieve Capability 8 of the Public Health Preparedness Capabilities issued in 2011.
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Centers for Disease Control and Prevention. (2015). Guidelines for Large-Scale Influenza Vaccination Clinic Planning.
This webpage includes guidance for staffing, location, layout, administration, and vaccine tracking related to large-scale influenza vaccination clinics.
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* Centers for Disease Control and Prevention. (2017). Community-Wide (Mass) Vaccination.
The goal of community-wide mass vaccination is to inoculate all willing and eligible people in an area. This smallpox-specific webpage defines points of dispensing and provides links to Maxi-Vac Version 1.0 and Maxi-Vac Alternative, a modeling program that can help planners allocate human resources to vaccinate the greatest number of people as quickly as possible.
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Gupta, A., Evans, G., and Heragu, S. (2013). Simulation and Optimization Modeling for Drive-Through Mass Vaccination – A Generalized Approach. Simulation Modelling Practice and Theory. 37.
The authors describe the simulation modeling work completed for a mass vaccination drive-through clinic in 2009, where more than 19,000 patients were served (more than two-thirds via 10 drive-through lanes). Using this model can help public health emergency planners determine “the required number of Points of Dispense (POD) lanes, number and length of the lanes for consent hand outs and fill in, staff needed at the consent handout stations and PODs, and average user waiting time in the system.”
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* Johnson County Government, Department of Health and Environment. (2017). Dispense Assist.
This online tool may be used to pre-screen individuals that will receive medical countermeasures at Point of Dispensing (PODs) sites to support rapid distribution at the PODs. After answering a few targeted questions, users can print out a completed screening form that indicates the countermeasure they should receive at the POD.
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* Khan, S. and Richter, A. (2012). Dispensing Mass Prophylaxis — The Search for the Perfect Solution. Homeland Security Affairs. 8, Article 3.
The authors examine Points of Dispensing and alternatives to dispensing oral prophylaxis in the event of a biological attack, from the perspective of a local health department located in a large metropolitan area.
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* Napa County Health and Human Services Agency. (2012). Countermeasure Distribution Plan.
This plan document covers Point of Dispensing (POD) operations, logistics, and staffing. It also reviews POD alternatives. It may be referenced and/or adapted by other jurisdictions and includes tables showing throughput vs. population / time, forms, and layouts.
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National Association of County & City Health Officials. (2008). Clinic Planning Model Generator.
This software can help public health officials quickly develop a model that provides immediate planning assistance specific to disseminating vaccinations and/or dispensing clinic. It can be used either before or during an incident. While slightly dated, this tool may still be useful for those new to the field, new to their role, and/or communities in need of a solid plan.
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Nelson, C., Chan, E., Chandra, A., et al. (2008). Recommended Infrastructure Standards for Mass Antibiotic Dispensing. The RAND Corporation.
The authors share a set of standards that can be used to develop mass antibiotic dispensing plans and focus on points of dispensing (PODs). The standards address “(1) the number and location of PODs, (2) internal POD operations, (3) POD staffing, and (4) POD security.”
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This Point of Dispensing (POD) Field Operations Guide (FOG) was created for the state of Oregon, but may be used as a model for other jurisdictions to develop detailed operational plans for both mass dispensing of prophylactic antibiotics (medical and non-medical models) and mass vaccination of a given population.
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Rebmann, T., Loux, T., Swick, Z., et al. (2015). Are US Jurisdictions Prepared to Dispense Medical Countermeasures Through Open Points of Dispensing? Findings from a National Study. (Abstract only.) Health Security. 13(2): 96-405.
A near-equal number of Cities Readiness Initiative (CRI) and non-CRI sites were surveyed to measure open Points of Dispensing (POD) readiness. The authors found that nearly all open PODS had plans/layouts for each sites. Close to half had plans for an alternative dispensing modality and 42.6% reported adequate staffing. While most respondents had conducted a full scale exercise and a staff notification drill, just 40% had conducted a vaccination clinic exercise.
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San Francisco Department of Public Health. (2018). Emergency Mass Prophylaxis Clinic Planning.
This webpage includes links to information on points of dispensing, planning for infectious disease emergencies, and other resources. Also noted is that San Francisco was named as “model practice for helping organizations dispense antibiotics” and provide a link to the related toolkit.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2012). Behavioral Health Tips for Responders: Maintaining Calm at a POD.
This fact sheet provides recommendations for responders working at points of dispensing (PODs) during an emergency or disaster. It is broken up into three sections: Assumptions; What to do; What to say.
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Mass Prophylaxis Planning: POD Alternatives


* Barishansky, R. and Mazurek, A. (2011). MCM Dispensing: The Public Health Point of View.
The authors summarize the various modes of medical countermeasure dispensing under two models: medical and non-medical. They also emphasize how critical partnerships, volunteers, and personal responsibilities are to ensuring a successful response to a public health emergency.
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Speakers share challenges associated with vulnerable populations and open points of dispensing (PODs) and strategies for using closed PODs to help protect the health of members of vulnerable populations.
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The author evaluates four models for delivering post-exposure prophylaxis (PEP) following an aerosolized anthrax event: local stockpiling; partner storage/rotation agreements; pre-event distribution of PEP to first responders; and the Strategic National Stockpile for the provision of PEP. Evaluation criteria include: timeliness of response; cost; logistics; stakeholder acceptance; and comprehensiveness.
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The author shares information on alternate modes of dispensing (e.g., via door-to-door, pharmacy, civil service, and Kaiser Permanente) and methods for evaluating their effectiveness in Los Angeles County.
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* Khan, S. and Richter, A. (2012). Dispensing Mass Prophylaxis — The Search for the Perfect Solution. Homeland Security Affairs. 8, Article 3.
The authors examine Points of Dispensing and alternatives to dispensing oral prophylaxis in the event of a biological attack, from the perspective of a local health department located in a large metropolitan area.
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National Association of County and City Health Officials.. (2012). Drive-Thru Point of Dispensing Planning Guide.
This guide primarily focuses on planning for Strategic National Stockpile (SNS) responses in urban or suburban areas that have difficulties meeting 100 percent prophylaxis coverage of their population within limited time frames using traditional indoor points of dispensing (PODs).
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This document provides information for public health departments about pursuing Meals on Wheels as an alternate dispensing partner of medical countermeasures.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2011). Postal Model for Medical Countermeasures Delivery and Distribution.
In a public health emergency, the United States Postal Service could deliver self-administrable medical countermeasures to affected communities within one day, allowing healthcare agencies the time to activate their longer-term response and recovery plans. This webpage explains the model and includes links to related resources.
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Plans, Tools, and Templates


Center for Infectious Disease Research and Po. (2018). Guide Provides Resources and Training for Planning Closed Dispensing Sites. City of Minneapolis Department of Health and Family Support.
This resource contains several downloadable documents related to closed PODs, including a training checklist, plan template, field operations guide, and other attachments.
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* Center for Infectious Disease Research and Policy. (n.d.). Medical Countermeasure Dispensing. (Accessed 3/23/18.)
This webpage includes lessons learned, planning documents, and sample templates from planners across the country to support preparedness for medical countermeasure dispensing.
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* Centers for Disease Control and Prevention. (n.d.). Liability Protection for Public Health Partners. (Accessed 4/23/18.)
This brochure outlines liability protections under the Public Readiness Emergency Preparedness (PREP) Act that may be afforded to private businesses that partner with public health authorities for medical countermeasures dispensing.
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* Centers for Disease Control and Prevention. (n.d.). Receiving, Distributing, and Dispensing Strategic National Stockpile Assets: A Guide to Preparedness Version 11. (Accessed 4/23/2018.) Homeland Security Digital Library.
This comprehensive document provides an overview of the Strategic National Stockpile (SNS) program, as well as operational and strategic guidance for each operational function required for the distribution and dispensing of medical countermeasures.
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This document describes the functions, tasks, performance measures, and resource elements required to achieve Capability 8 of the Public Health Preparedness Capabilities issued in 2011.
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This document describes the functions, tasks, performance measures, and resource elements required to achieve Capability 9 (Medical Materiel Management and Distribution) of the Public Health Preparedness Capabilities issued in 2011.
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* Centers for Disease Control and Prevention. (2017). Countermeasure Inventory Tracking (CIT) Dashboard.
The Countermeasure Tracking System (CTS) consists of multiple interoperating components that may be used by federal, state, and local public health agencies to track and manage medical and non-medical inventory and usage during both daily operations and all-hazards events. It includes the Inventory Management Tracking System (IMATs); the Countermeasure and Response Administration (CRA) system; and the Countermeasure Inventory Tracking (CIT) Dashboard.
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Centers for Disease Control and Prevention. (2017). Pandemic Influenza Plan: 2017 Update.
This plan includes updates to the seven domains. Domain 3 is “Medical Countermeasures: Diagnostic Devices, Vaccines, Therapeutics, and Respiratory Devices” and includes seven objectives that can “improve effectiveness, timeliness, availability and accessibility to medical countermeasures.”
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This guide is designed for team leaders who will be delivering Just-in-Time training to personnel involved in mass prophylaxis/POD operations.
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Department of Health Services, County of Los Angeles. (2017). Mobilization of Local Pharmaceutical Caches.
Los Angeles County shares their policy related to the release of local pharmaceutical caches in the event of a major incident.
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* Johnson County Government, Department of Health and Environment. (2017). Dispense Assist.
This online tool may be used to pre-screen individuals that will receive medical countermeasures at Point of Dispensing (PODs) sites to support rapid distribution at the PODs. After answering a few targeted questions, users can print out a completed screening form that indicates the countermeasure they should receive at the POD.
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This plan template may be used by hospitals to develop closed Point of Dispensing (POD) plans to distribute oral antibiotics after an aerosolized anthrax release.
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Mecklenburg County (NC) Public Health Department. (n.d.). Closed Point of Dispensing (POD) Toolkit. (Accessed 11/19/2018.)
This toolkit provides information on how to become a closed POD. It includes materials such as a closed POD dispensing plan template, sample POD checklists, sample Incident Command System structure and job action sheets, and a supply list for closed PODs.
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* Napa County Health and Human Services Agency. (2012). Countermeasure Distribution Plan.
This plan document covers Point of Dispensing (POD) operations, logistics, and staffing. It also reviews POD alternatives. It may be referenced and/or adapted by other jurisdictions and includes tables showing throughput vs. population / time, forms, and layouts.
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* National Association of County & City Health Officials. (2018). Medical Countermeasures and Non-Pharmaceutical Interventions.
This webpage includes links to initiatives and helpful information related to medical countermeasures, the Strategic National Stockpile, chemical response, radiation preparedness, pandemic influenza preparedness, and antiviral distribution and dispensing.
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This webpage includes information on tools and technologies for capturing patient data during vaccination clinics (barcode scanners, digital pens, magnetic card swipers, mobile applications, scanning, and web-based technology), and a link to search examples in the NACCHO Toolbox.
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National Association of County and City Health Officials. (2018). Medical Countermeasure Toolkit Resources. (Free registration required.)
NACCHO has published a wide variety of resources that can be replicated by local emergency planners interested in setting up points of dispensing (POD), exercising their medical countermeasure plans, staffing PODs, and the like. With a free account, users can click on the URL, click on “Toolkits,” select “Medical Countermeasure (MCM) Toolkit,” and review the various tools.
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New Mexico Department of Health. (2016). Point of Dispensing (POD) Operations Guide.
This plan includes operational considerations related to Points of Dispensing, and may be referenced and/or adapted by other jurisdictions in the development of their respective countermeasure dispensing plans.
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This document provides information for public health departments about pursuing Meals on Wheels as an alternate dispensing partner of medical countermeasures.
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Oakland County (MI) Health Division. (n.d.). Emergency Preparedness. Closed POD Planning for Businesses and Organizations. (Accessed 11/19/2018.)
This webpage contains a closed POD toolkit that can be used by healthcare partners. It also provides a Strategic National Stockpile (SNS) closed POD plan template, quick “how-to guide, FAQ sheet, and other attachments. Note: Materials can be found in the dropdown selection at the bottom of the webpage titled, “Closed POD Planning for Businesses and Organizations.”
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Office of the Assistant Secretary for Preparedness and Response. (2019). National Health Security Strategy. U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the plan, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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This Point of Dispensing (POD) Field Operations Guide (FOG) was created for the state of Oregon, but may be used as a model for other jurisdictions to develop detailed operational plans for both mass dispensing of prophylactic antibiotics (medical and non-medical models) and mass vaccination of a given population.
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This is a state-level plan that discusses coordination, and roles and responsibilities among partners, to dispense medical countermeasures in the state of Ohio. It may be adapted for other jurisdictions. This plan is not particularly detailed but does outline better than many the state-level coordination and the number and roles of the many stakeholders.
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* Texas Department of Health Services. (2016). Medical Countermeasures Program Manual.
This guidance document created for the state of Texas includes information, flow diagrams, and organizational charts that may be adapted by other jurisdictions. The document covers medical countermeasure distribution and dispensing considerations.
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University of Washington, Northwest Center for Public Health Practice. (2013). Partnering for Medical Countermeasure Distribution in Emergencies.
This toolkit helps public health agencies and pharmacies work together to develop public-private partnerships for community-based medical countermeasure distribution during a public health emergency.
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Strategic Planning/Research and Development


Biomedical Advanced Research and Development Authority. (2016). Chemical, Biological, Radiological, and Nuclear (CBRN) Threat Programs.
Users can click on various tabs to learn more about BARDA’s work to develop diagnostics, antitoxins, antivirals, vaccines, and treatments for threats such as thermal burns, anthrax, smallpox, botulinum toxin, and Ebola.
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* Centers for Disease Control and Prevention. (2017). Medical Countermeasure Readiness.
This webpage includes information on medical countermeasure readiness and the Cities Readiness Initiative (CRI), a federal initiative designed to enhance preparedness in the nation’s largest population centers, where nearly 60% of the population resides, to effectively respond to large-scale public health emergencies needing life-saving medications and medical supplies.
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This document summarized presentations and discussions that focused on the Strategic National Stockpile and: an overview of the plans to distribute medical countermeasures during a disaster or public health emergency; private industry practices geared towards distributing medical products and supplies (daily and during emergencies); gaps in current planning; opportunities for collaboration; and opportunities for economic sustainability as missions and countermeasures evolve.
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National Association of County & City Health Officials. (2014). Resource Portfolio Project on the CDC Public Health Preparedness Capabilities.
The section on Capabilities 8 and 9 includes links to top- and second-tier resources chosen by the authors as helpful to medical countermeasure planning, training, and exercises.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). 2016 Public Health Emergency Medical Countermeasures Enterprise Stakeholders Workshop Report.
This conference summary provides findings from breakout and plenary sessions. Topics related to medical countermeasures included end-user considerations, federal initiatives and programs, industry partnerships, and emerging infectious diseases and pandemic influenza.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2017). 2017-2018 Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Strategy and Implementation Plan.
This plan is the annual blueprint to protect national health security via the procurement and use of medical countermeasures. Section 1 highlights progress made in medical countermeasures, using the response to Zika and Ebola as examples. Section 2 summarizes updates made since the last plan was published.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Biomedical Advanced Research and Development Authority (BARDA).
This webpage provides links to the work the Biomedical Advanced Research and Development Authority (BARDA) does to develop and field countermeasures under five categories: core services, CBRN programs, pandemic influenza, innovation, and stockpile building. Links to programs and helpful resources are also included.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). MedicalCountermeasures.gov.
This webpage highlights announcements, publications, and events regarding medical countermeasures. Users can register to request TechWatch meetings (on vaccines, diagnostics, therapeutic strategies, and other topics). Links to other federal initiatives, Biomedical Advanced Research and Development Authority (BARDA), and Public Health Emergency Medical Countermeasures Enterprise partners are also provided.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Public Health Emergency Medical Countermeasures Enterprise.
This webpage provides an overview of how PHEMCE coordinates federal preparedness efforts between ASPR and internal and external agency partners. The Enterprise’s focus is to provide medical countermeasures to combat chemical, biological, radiological, nuclear, and emerging infectious disease threats. The page also includes a link to 2017-2018 Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Strategy and Implementation Plan (also referenced in this section).
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U.S. Food and Drug Administration. (2018). Medical Countermeasure Monitoring and Assessment.
This webpage is focused on the need to build and maintain a national capability to monitor and assess medical countermeasures (MCMs) after they are dispensed or administered in response to a chemical, biological, radiological, or nuclear threat or an emerging infectious disease. Links to “FDA Information about Past and Current MCM Monitoring and Assessment Projects” are included.
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U.S. Food and Drug Administration. (2018). Medical Countermeasures Initiative (MCMi).
The FDA coordinates medical countermeasure development under this initiative, and links to various initiatives and resources are provided on this webpage.
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Threat-Specific Countermeasures


Centers for Disease Control and Prevention. (2016). Smallpox: Prevention and Treatment.
This webpage explains how the smallpox vaccine can help prevent infection (prior to or within days of exposure) and lists three antiviral drugs that have been shown effective against smallpox: Tecovirimat, Cidofovir, and Brincidofovir.
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Committee on Prepositioned Medical Countermeasures for the Public. (2011). Current Dispensing Strategies for Medical Countermeasures for Anthrax.
This chapter includes a review of current plans and existing infrastructure for the distribution and dispensing of medical countermeasures necessary in the event of a terrorist attack involving Bacillus anthracis (anthrax). Concerns about the current system and legal and regulatory issues are also presented.
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This document includes guidance for 10 specific agents and has one chapter on “other infectious diseases” and another on agents for which no treatment can be recommended (e.g., ricin and viral encephalitis).
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Houck, M. and Herrmann, J. (2018). Predicting the Impact of Placing Pre-event Pharmaceuticals for Anthrax. The Institute for Systems Research.
The authors discuss the benefits of creating and pre-deploying “MedKits” to households that may be affected by a mass anthrax attack. Cost and logistical may limit the applicability of this strategy.
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IOM (Institute of Medicine). (2012). Prepositioning Antibiotics for Anthrax.
The Institute of Medicine convened a committee to study the role of various prepositioning strategies in the overall medical countermeasures dispensing strategy. The committee found that while prepositioning strategies can save time, it also provides less flexibility (e.g., should an attack take place at a different location or uses a strain of anthrax that is resistant to the pre-positioned treatment).
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Lipsitz, R., Garges, S., Aurigemma, R., et al. (2010). Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010. Emerging Infectious Diseases. 18(12).
Workshop attendees were asked to develop consensus recommendations for post exposure treatment against melioidosis and glanders (caused by Burkholderia pseudomallei and B. mallei infections). Recommended prophylaxes includes trimethoprim/sulfamethoxazole or co-amoxiclav. The authors also emphasized the need for standardized animal models and further research and training.
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U.S. Department of Health and Human Services. Chemical Hazards Emergency Medical Management (CHEMM). (2017). CHEMPACK.
CHEMPACKs contain nerve agent antidotes and are stored in secure locations across the country. More than 90 percent of the U.S. population is within one hour of a CHEMPACK location; most locations are in hospitals or fire stations.
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Doxycycline monohydrate and doxycycline hyclate tablets and capsules (50 mg) and 100 mg of doxycycline are indicated (and stockpiled) for post-exposure prophylaxis or treatment of inhalational anthrax; this guidance document explains how stakeholders can extend the shelf life of these medications.
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U.S. Food and Drug Administration. (2018). Products Approved for Anthrax.
This webpage provides information on and links to resources specific to products approved to treat anthrax and maintained in the Strategic National Stockpile (SNS).
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U.S. Food and Drug Administration. (2018). Products Approved for Other Bioterrorism Emergencies.
This webpage includes links to information and guidance on products approved for use during bioterrorism emergencies, specifically for botulism, Ebola virus disease, plague, smallpox, tularemia, and Zika virus disease.
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U.S. Food and Drug Administration. (2018). Radiation Emergencies.
This webpage provides information on and links to resources specific to products approved to treat the effects of radiation exposure. These products are contained in the Strategic National Stockpile (SNS).
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Agencies and Organizations


Centers for Disease Control and Prevention. Medical Countermeasure Readiness.
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Centers for Disease Control and Prevention. On-TRAC (Online Technical Resource and Assistance Center). Permission needed to join this site. (Permission required to join this site.)
This free resource provides health departments with a secure, user-friendly platform for requesting technical assistance from CDC subject matter experts on public health preparedness. On-TRAC also offers access to new and existing tools and resources that support the public health preparedness capabilities.
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* National Association of County & City Health Officials. Medical Countermeasures and Non-Pharmaceutical Interventions.
This webpage includes links to initiatives and helpful information related to medical countermeasures, the Strategic National Stockpile, chemical response, radiation preparedness, pandemic influenza preparedness, and antiviral distribution and dispensing.
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U.S. Department of Health and Human Services. Chemical Hazards Emergency Medical Management (CHEMM).
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U.S. Department of Health and Human Services. Radiation Emergency Medical Management (REMM).
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. 2017-2018 PHEMCE Strategy and Implementation Plan.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Biomedical Advanced Research and Development Authority (BARDA).
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Medical Countermeasures.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Project BioShield.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. Public Health Emergency Medical Countermeasures Enterprise.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. BARDA. Chemical, Biological, Radiological, and Nuclear (CBRN) Threat Programs.
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U.S. Food and Drug Administration. Emergency Dispensing Orders.
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