The Strategic National Stockpile (and What It Can Do For You)

You may have heard of the Strategic National Stockpile, or SNS, and wondered what it is and why it's important to you and your EMS agency. Read on for an overview of this important resource--one you might need sooner than you think.

What Is the SNS?

The SNS is a national repository of medicine and medical supplies to protect the American public if there is a public health emergency (terrorist attack, flu outbreak, earthquake, etc.) severe enough to exhaust local supplies. The mission of the SNS, which is managed by the CDC, is to supplement the medical resources possessed by state and local public health agencies by providing additional resources in times of crisis. Included in the SNS are antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration equipment, airway maintenance supplies, and medical/surgical items. Its formulary is based on the medical vulnerability of the United States population; there is no cost to state and local jurisdictions receiving the supplies. In addition, the SNS is committed to delivering the supplies within 12 hours of the decision to provide them. They are warehoused in strategic locations around the U.S. to ensure rapid delivery anywhere.

SNS deployment occurs when state and federal authorities agree there is a need. In times of crisis--for example, a terrorist attack or influenza pandemic--a state governor's office would make a deployment request to the CDC and Department of Health and Human Services. After both of those bodies review the request and confirm the need, "push packages"--the term used for prepackaged collections of pharmaceuticals, antidotes and general medical supplies--are sent. As the push packages are shipped out (usually via cargo aircraft or trucks), Technical Advisory Response Units (TARUs) also are being deployed to the disaster scene to work with state and local officials in dealing with the crisis. After the supplies arrive they become the responsibility of local authorities. TARU personnel usually remain on the scene to help, but actual distribution is handled by state and local health entities.

Shipment of SNS assets can also be authorized when there is evidence of the release of a biological or chemical agent that could be harmful to the public. The push packages consist primarily of a variety of general-needs materials, but the SNS program also has a number of more specialized VMI (vendor-managed inventory) supplies available. The VMI packages are tailored to meet more particular needs or provide special materials that have been specifically requested, and their delivery usually follows the push packages by 12 to 24 hours or so. However, if the cause of the emergency is identified and defined early enough, the VMI materials also can be immediately shipped as part of the SNS's first-response actions.

History

The SNS originated as the National Pharmaceutical Stockpile (NPS) in 1999, when Congress ordered HHS and the CDC to establish a cache of medical materials to resupply states and local communities in future times of emergency. Later, the Department of Homeland Security (DHS) became responsible for the stockpile, and in March 2003 the NPS officially became the SNS. Still later, after passage of the 2004 Project BioShield Act, the program again returned to CDC management.

The most common concern about the SNS is skepticism about the ability of state and local public health agencies to rapidly disseminate its contents in an emergency. To that end, since 2001, the CDC has been working with state, local and tribal public health entities on distribution plans. Today, all 50 states have developed a wide variety of plans to meet their individual needs. These plans must include the process for assuring a substantial complement of personnel, detail the numerous logistical tasks in patient screening and dispensing, and specify the required presence of public safety officials, as well as other critical elements.

To that end, when, in April 2009, the acting HHS secretary determined a nationwide public health emergency existed involving swine influenza A (now known as 2009 H1N1 influenza), this formal declaration led to the release of a quarter of the SNS' antiviral drug inventory (Tamiflu and Relenza), personal protective equipment and respiratory protection devices to various states.

Conclusion

Don't make the mistake of thinking the SNS program has any downtime. Even when there is no current crisis, the program offers training to federal officials, governors' offices and a broad spectrum of state and local officials. The CDC is also always at work assuring that SNS asset-distribution plans are in place and based on reality.

Raphael M. Barishansky, MPH, is chief of public health emergency preparedness for the Prince George's County (MD) Health Department. A frequent contributor to and editorial advisory board member of EMS World Magazine, he can be reached at rbarishansky@gmail.com.