Medical Countermeasures and Non-Pharmaceutical Interventions
The timely provision of medical countermeasures (MCM) following a large-scale public health emergency such as pandemic influenza, anthrax attacks, chemical releases, and radiological events can ensure that the health and safety of those impacted are protected. Local health departments have a lead role in providing MCM to their jurisdictions in times of crisis and have developed many strategies to carry out effective public health responses. LHDs can also use non-pharmaceutical interventions to control the spread of disease and help mitigate the negative health effects on their community.
NACCHO works on a variety of projects to help ensure that LHDs are prepared to provide MCM, implement non-pharmaceutical interventions, and respond quickly and efficiently with their community partners in the event of chemical, biological, radiological, nuclear, and explosive (CBRNE) attacks, pandemic outbreaks, and other public health emergencies.
NACCHO works to collect, develop, and disseminate resources that will help LHDs in their MCM planning, implementation, and assessment efforts. This project also works to promote timely and up-to-date information on relevant MCM guidance from the Public Health Emergency Medical Countermeasure Enterprise (PHEMCE) partners, as well as local level best practices for MCM distribution and dispensing. Projects within the MCM and Strategic National Stockpile (SNS) portfolio includes:
MCM Operational Readiness Review (ORR)
NACCHO developed and collected resources that provide insight on best practice strategies to overcome challenges experienced while completing the Centers for Disease Control and Prevention (CDC) MCM ORR. Resources include tools to help with identifying relevant ORR documentation and steps that health departments need to complete as the date of the ORR approaches within their jurisdiction. Resources can be accessed within NACCHO’s Toolbox or within CDC’s MCM SharePoint Site. To find specifc resources within the NACCHO Toolbox to assist with the MCM ORR, download the following fact sheet.
Incorporating Populations with Functional and Access Needs into MCM Planning
In the event of an emergency, populations with functional and access needs may require additional assistance to get the information and resources they need to stay safe and healthy. MCM planners have a moral and legal responsibility to ensure that a “whole community” approach is taken when developing their response plans in order to ensure that everyone has equitable access to life-saving interventions. Taking the appropriate steps to identify the specific needs of your jurisdiction's population and developing strategies to account for those needs are essential.
Meals on Wheels Dispensing Guide
During public health emergencies there are many individuals with access and functional needs who may have difficulty accessing live-saving MCMs at traditional public points of dispensing (PODs). Some local health departments have successfully partnered with home service provider agencies, such as Meals on Wheels, to directly deliver medications to home bound individuals during emergencies. Oakridge Associated Universities (ORAU) and CDC developed the Meals on Wheel Planning Guide to provide standardized considerations and partner practices for public health planning with local Meals on Wheels chapters. NACCHO held a webinar on July 12, 2016 where the guide was described and two local health departments shared promising practices and lessons learned from partnering with Meals on Wheels for their preparedness planning. To access the guide and webinar recording, click here.
For resources to assist with MCM planning for populations with functional and access needs, visit:
- Whole Community Inclusion Project
- Improved Planning for Vulnerable Populations through Use of Closed Points of Dispensing
- Inclusive Just-in-Time Training for Mass Prophylaxis/POD Operations
- Lessons from Local Health Departments on Inclusive MCM Planning
Additional MCM Resources
The MCM toolkit is an online collection of resources on MCM distribution and dispensing, which includes novel approaches to operational-based planning and exercises, presentations, factsheets, protocols, templates, training material, how-to-guides, and other locally developed MCM tools.
NACCHO has developed and compiled a variety of resources highlighting alternative methods of dispensing that are useful for LHDs to consider when developing their overall MCM response strategy. Research has been conducted to better understand how LHDs implement and conduct closed PODs, alternative types of dispensing plans, and fostering partnerships for MCM responses. For additional resources, visit NACCHO’s Toolbox, the SNS resource page (16B), NACCHO’s Publications, as well as the following:
NACCHO is working to better define the LHD role in responding to large-scale chemical incidents. An article published in Domestic Preparedness highlights initial findings related to potential LHD roles and current challenges LHDs face in planning for and assuming those roles. Additional research is currently underway to identify decision points for LHD involvement to ensure full participation in chemical event response.
NACCHO's radiological and nuclear preparedness initiatives aim to improve the capacity and capability of LHDs as they prepare for, respond to, and recover from radiation or nuclear disasters by sharing resources and tools, disseminating promising practices, and providing education and training. NACCHO is working in partnership with a number of organizations on the following projects:
NACCHO Radiological Sheltering Tabletop Exercise Toolkit
In collaboration with CDC, NACCHO has created a new tabletop exercise toolkit that assesses the radiation preparedness considerations needed for the sheltering of evacuees from a community impacted by a radiation emergency and includes information from the CDC's Guide to Operating Public Shelters in a Radiation Emergency. Housed within this toolkit are Homeland Security Exercise and Evaluation program (HSEEP) compliant tabletop exercise document templates that were refined and piloted at five local jurisdictions. This tool is applicable for local health departments at all levels of planning and can be used as a resource to enhance radiation preparedness capabilities and knowledge for health departments and their response partners. To access the documents and resources of this toolkit, click here.
NACCHO Radiation Toolkit
The Radiation Toolkit was created to house the many radiation resources available to public health and emergency management professionals in one place. Resources available in this new toolkit include guidance documents detailing the many aspects of radiation preparedness, links to helpful trainings, operation resources for radiation site planning, and radiation preparedness organization websites. The Radiation Toolkit can be found on the NACCHO Toolbox website by selecting “Radiation Toolkit” in the “Toolkits” drop-down menu.
NACCHO has been working with the Federal Emergency Management Agency (FEMA) to share information to LHDs about using the RadResponder App as a situational awareness tool to monitor radiation levels across their jurisdiction and as a resource to inform response decision making following a radiological event. To learn more about FEMA’s Radiological Emergency Preparedness Program, click here.
Radiation Injury Treatment Network (RITN)
NACCHO is collaborating with the RITN to learn more about local public health radiation preparedness levels around the country and provide information of radiation preparedness resources to local health department planners. RITN is comprised of 57 treatment centers around the country that can provide care to those exposed to radiation. To learn more about RITN, click here.
In July 2016, NACCHO hosted a webinar to provide an overview of the history of the RITN, RITN concepts of operations during radiation incidents, and the preparedness and training resources that RITN offers. To access the webinar, click here.
In order to improve the readiness stance of our nation, RITN, in partnership with NACCHO, was interested in better understanding how jurisdictions are preparing for radiological emergencies. To evaluate awareness, a survey was sent to NACCHO members in jurisdictions within 50 miles of nuclear power plants. To learn more about the survey and the results, the report can be found in the NACCHO Radiation Toolkit.
The National Alliance for Radiation Readiness
NACCHO, in partnership with the Association of State and Territorial Health Officials (ASTHO), the CDC Radiation Studies Branch, and others are working to support the efforts of the National Alliance for Radiation Readiness (NARR). NARR is a coalition of organizations committed to building radiation and nuclear emergency preparedness and response capacity and capabilities. To learn more about NARR and the resources available visit the NARR Website.
Radiation Guidance and Resources
CDC released two key guidance documents for state and local public health planners for population monitoring and establishing shelters following a radiation emergency. These guidance documents focus on the critical planning considerations health departments need to address to ensure they can adequately monitor the population following a radiation event and establish community reception centers (CRCs) and radiation shelters to provide screening, decontamination, and mass care services to people displaced by a large-scale radiation incident. To access additional guidance and resources, click here.
Additional tools and resources can be accessed from the following websites:
NACCHO’s Pandemic Influenza Tabletop Exercise Template was developed and tested by local health offices to help LHDs design and conduct discussion-based tabletop exercises of pandemic influenza response functions. The template is a simple guide to creating a tabletop exercise that can easily be adjusted to meet the needs of exercise planners. The template includes objectives, points of review, local events, and discussion questions for three pandemic response functions and community containment. These functions can be tested independently or together depending on the scope of the exercise.
This template is objective driven rather than scenario-focused; its objectives test specific elements of a local pandemic influenza plan. The suggested scenarios facilitate the testing process. The template may be used in coordination with the Homeland Security Exercise Evaluation Program (HSEEP) toolkit to develop, conduct, and evaluate HSEEP-compliant pandemic influenza exercises.
This free exercise tool includes the following components:
The template provides the fundamental elements of a discussion-based exercise for testing components of a pandemic influenza response plan, but it does not include supporting elements such as facilitation guidelines, controller and evaluator instructions, logistical checklists, and planning timelines. Those and other resources can be found in the HSEEP toolkit. For more information about HSEEP visit HSEEP 101.
NACCHO is working in conjunction with the Association of State and Territorial Health Officials (ASTHO) and CDC to explore alternative models for antiviral distribution and dispensing during a pandemic, or other public health emergency. One such model is Flu on Call®. Flu on Call® is a joint initiative between NACCHO, CDC, ASTHO, United Way 2-1-1, the Council of State and Territorial Epidemiologists (CSTE), and other partners. Flu on Call®is a national network of telephone triage lines for use during a severe pandemic. Under Flu on Call®, clinicians use a medical protocol approved by CDC and the state health department to assess the health status of callers and help callers determine the most appropriate site for their care. Flu on Call® clinicians may provide medical advice and, when appropriate, provide access to antiviral medications. The Flu on Call®capability is designed to reduce surge on medical facilities and increase the public’s access to antivirals during a severe pandemic. For more information see:
NACCHO is also building a suite of pharmacy-based tools that will expand antivirals access during a pandemic. One of these is Flu Med Finder, which is being built in partnership with HealthMap, based out of Boston Children’s Hospital. Flu Med Finder is based on the existing Vaccine Finder, a free web-based map that allows the public to find vaccine services in their zip code. Over 30,000 providers are already enrolled in the system. Flu Med Finder will build off of this database. During a pandemic or other public health emergency, participating pharmacies will report aggregate antivirals inventory data on a daily basis. Providers will be able to use the system to direct patients to antivirals, while public health can use the system to assess community supply of antivirals and direct resources.