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5/3/2002

CDC Upgrades Federal Repository of Emergency Medical Supplies

Donna Young

When the Centers for Disease Control and Prevention (CDC) first deployed the National Pharmaceutical Stockpile after the terrorist attacks last fall, most of the medications were in bulk containers of thousands of tablets and capsules—a potential problem when trying to dispense prescription drugs in an emergency situation.

But CDC has upgraded the stockpile to include unit-of-use bottles of antiinfectives, new packaging equipment, and four more 12-hour push packages, raising the total to 12.

Each push package contains 50 tons of antiinfectives, chemical antidotes, antitoxins, life-support medications, i.v. administration and airway maintenance supplies, surgical items, and other medical supplies that can be shipped by ground or air transport within 12 hours of a federal decision to release the supplies (November 15, 2001, AJHP News). About 10 of the 130 cargo containers in each 50-ton push package contain prescription drug products, according to a CDC pharmacist.

CDC is responsible for managing the stockpile and coordinating deployment to disaster locations. Vendors manage some of the stockpile’s pharmaceutical supply.

Susan Gorman, a pharmacist and CDC’s stockpile program associate director for science, said the agency drew from the vendor-managed part of the supply to send antiinfectives to Florida, New Jersey, New York, and the Washington, D.C., area for postexposure treatment after last fall’s anthrax attacks.

Gorman said deployment of a CDC push package is intended as an immediate response to a disaster. But when an agent, such as Bacillus anthracis, has been identified as the cause of the disaster, CDC is more likely to use a threat-specific approach and dispatch only what is needed from the vendor-managed supply rather than send an entire push package, she said.

The stockpile’s formulary of drug products is subject to change when CDC receives new information about potential threats. Gorman said her agency relied on the advice of several experts, including pharmacists, and feedback from emergency workers to determine what CDC needed to do to make the stockpile more user-friendly.

Nearly all of the antiinfectives in the stockpile’s previous inventory, the one used after the September 11 events and last fall’s anthrax attacks, were supplied to emergency workers in bulk form and had to be packaged onsite for patients.

One New Jersey hospital, recruited by CDC in November to help dispense antiinfectives to local postal workers, reported using its own supply of amber prescription bottles and child-resistant lids (December 15, 2002, AJHP News).

But Gorman said that CDC has contracted vendors to package 50% of the stockpile’s antiinfective supply, including doxycycline, ciprofloxacin, and amoxicillin, into 10- or 25-day-supply unit-of-use bottles that are replicas of the larger manufacturer-made containers.

CDC received an increase in the stockpile’s program budget, Gorman added, so the agency could cover the costs of the packaging. She said the budget increase was in the "hundreds of millions" but would not specify further.

Each push package now contains two high-speed industrial repackaging machines that can produce 5000 unit-of-use sealed bags of medications per hour. State and local emergency management workers and health care volunteers do not need to worry about their lack of training on the use of the packaging equipment, Gorman said, because a five-member program staff team, known as the CDC Technical Advisory Response Unit, will assist emergency workers and operate the machines if necessary.

But, she said, not all situations will require use of the packaging equipment. Also, the agency’s vendor-partners might have enough time, she said, to prepare additional unit-of-use bottles and ship them to an emergency disaster location so that the packaging equipment does not need to be used onsite.

"We have lifted the burden of repackaging, for the most part," Gorman said. If small amounts of drug products need to be packaged onsite, each push package contains scoops for tablets and tablet counters with modified foot pedals.

CDC sought people with no pharmacy experience to test the usability of the tablet counters.

"They figured it out in five minutes," Gorman said.

CDC has also updated its stockpile guide with new information that includes dispensing information for the medications, including pediatric formulations.

The Guide for Receiving, Distributing and Dispensing the National Pharmaceutical Stockpile: A Guide for Planners is not available to the general public, Gorman said, but pharmacists may obtain a copy by requesting it from a local emergency management or public health agency.