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:

Extended MCM Response

NACCHO in conjunction with the Association of State and Territorial Health Officials (ASTHO) released a document entitled “Extended Medical Countermeasure Distribution and Dispensing Considerations for an Anthrax Incident” which provides state and local MCM planners with information on a range of relevant long-term MCM distribution and dispensing topics including maintaining essential functions, inventory management, tracking adverse events, and activation timelines. The document also provides example planning assumptions, best practices, and links to many relevant MCM resources. The Extended Medical Countermeasure Distribution and Dispensing Considerations for an Anthrax Incident Document is available for download on the NACCHO Toolbox.

MCM Link Workshop

CDC in coordination with NACCHO and the Office of the Assistant Secretary for Preparedness and Response (HHS ASPR), hosted the MCM Link Workshop at the 2017 Preparedness Summit. The workshop provided relevant federal updates on MCM guidance, the SNS formulary, MCM Operational Readiness Review (ORR) implementation, the On-TRAC technical assistance portal, MCM initiatives, and relevant preparedness trainings. To access the slides and recording from this workshop, please click here.

MCM Operational Readiness Review (ORR)

NACCHO developed and collected resources that provide insight on best practice strategies to overcome challenges experienced while completing the 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 On-TRAC Portal. To find specific resources within the NACCHO Toolbox to assist with the MCM ORR, download the following fact sheet.

Incorporating Populations with Access and Functional 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. For resources to assist with MCM planning for populations with functional and access needs, visit:

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:

Incorporating Data Management into Planning and Exercises

NACCHO, with support from the Radiation Studies Branch at the Centers for Disease Control and Prevention (CDC), works to ensure that local health departments are connected to the most up-to-date and relevant radiation preparedness resources and information. As part of research efforts, NACCHO developed a report entitled Data Management Systems for Radiation Population Monitoring which highlights practices and resources to help state and local health departments develop strategies to manage radiation population monitoring data during radiation emergencies. More recently, NACCHO developed the CDC Community Reception Center (CRC) Exercise Toolkit: Timing and Technology Supplement to allow for inclusion of electronic data management systems and throughput estimation in operations-based CRC exercises. NACCHO also produced the Guide to Incorporating Electronic Resources in Population Monitoring to integrate the CRC eTool and RadResponder Population Monitoring Module into local health department radiation plans and exercises.

Critical Radiation Resources Fact Sheet

NACCHO, in collaboration with the Radiation Workgroup, created the Critical Radiation Resources Fact Sheet. This fact sheet provides links to resources to assist local health departments and emergency managers in planning, responding, and recovering from radiation emergencies. The NACCHO Radiation Workgroup, which is composed of national, state, and local radiation subject matter experts, identified the most relevant radiation preparedness resources to include for each topic in this fact sheet. For more information on NACCHO workgroups and how to join, please visit the Membership Section on NACCHO's website.

Researching Local Health Department Radiation Preparedness

In 2017 NACCHO released a report entitled A Mixed-Methods Approach to Understanding Radiation Preparedness within Local Health Departments that provides information on how local health departments are preparing for radiation events and examines the barriers and facilitators to radiation preparedness planning. In addition, the NACCHO Preparedness Profile Assessment gathers information about preparedness trends and emerging issues including radiation preparedness.

NACCHO Radiological Sheltering Tabletop Exercise Toolkit

In collaboration with CDC, NACCHO has created a tabletop exercise toolkit thatassesses the radiation preparedness considerations needed for the sheltering ofevacuees from a community impacted by a radiation emergency and includes information from the CDC's Guide toOperating Public Shelters in a Radiation Emergency. Housed within thistoolkit are Homeland Security Exercise and Evaluation program (HSEEP) complianttabletop exercise document templates that were refined and piloted at fivelocal jurisdictions. This tool is applicable for local health departments at alllevels of planning and can be used as a resource to enhance radiationpreparedness capabilities and knowledge for health departments and theirresponse partners. To access the documents and resources of this toolkit, click here.

NACCHO Radiation Toolkit

The RadiationToolkit was created to house the many radiation resources available topublic health and emergency management professionals in one place. Resourcesavailable in this new toolkit include guidance documents detailing the many aspects ofradiation 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 beenworking with the Federal Emergency Management Agency (FEMA) to shareinformation to LHDs about using the RadResponder App as asituational awareness tool to monitor radiation levels across theirjurisdiction and as a resource to inform response decision making following aradiological event. In August 2017, the RadResponder App launched new capabilities to be able to display radiation community reception center and population monitoring data. To learn more about FEMA’s Radiological EmergencyPreparedness Program, click here.

Radiation Injury Treatment Network (RITN)

NACCHO is collaborating with the RITN to learn more aboutlocal public health radiation preparedness levels around the country andprovide information of radiation preparedness resources to local healthdepartment planners. RITN is comprised of 57 treatment centers around thecountry that can provide care to those exposed to radiation. To learn moreabout 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 howjurisdictions are preparing for radiological emergencies. To evaluateawareness, NACCHO conducted a series of assessments of local health department radiation preparedness capabilities:

The National Alliance for Radiation Readiness

NACCHO, in partnership with the Association of State andTerritorial Health Officials (ASTHO), the CDC Radiation Studies Branch, andothers are working to support the efforts of the National Alliance forRadiation Readiness (NARR). NARR is a coalition of organizations committed tobuilding radiation and nuclear emergency preparedness and response capacity andcapabilities. 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 andlocal public health planners for populationmonitoring and establishingshelters following a radiation emergency. These guidance documents focus onthe critical planning considerations health departments need to address toensure they can adequately monitor the population following a radiation eventand establish community reception centers (CRCs) and radiation shelters toprovide screening, decontamination, and mass care services to people displacedby a large-scale radiation incident. To access additional guidance andresources, click here.

Additional tools and resources can be accessed from thefollowing 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.

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