SNS Exercise Planning: Phasing in Best Practices

By Deanna Lamb, Albany County Department of Health Public Health Preparedness Coordinator
The Albany County Department of Health (ACDOH) is responsible for providing mass prophylaxis to approximately 305,000 residents in the event of a large scale public health emergency, such as an aerosolized anthrax attack. To ensure an appropriate and timely response, ACDOH maintains and annually tests its Strategic National Stockpile (SNS)
and Medical Countermeasure (MCM) plans and response operations in Albany County. In the event of a large scale emergency, a county-wide response effort involving multiple departments would be required to ensure
the health and safety of our residents. As part of its continued planning efforts, ACDOH offers annual trainings for county partners to update them on changes to the plans and educate them on their roles and responsibilities in a response. As the standards from the Centers for Disease Control (CDC) continue to expand, local health departments across the country continue to test their plans to identify and address any gaps. ACDOH tested their current SNS Plan in April 2016 with an SNS Functional Exercise. This undertaking was accomplished in several phases: Phase 1 – Planning and Meetings; Phase 2 – Trainings; Phase 3 – Functional Exercise.
PHASE 1 – Planning and Meetings
ACDOH's Public Health Emergency Planning and Response (PHEPR) staff reviewed and updated its current SNS Plan. During that review, it was clear that staffing a County Receiving, Staging and Storing (RSS) site could be a challenge utilizing only ACDOH staff. In a real emergency, time is of the essence and working efficiently is the goal. While it was determined that RSS stations could be combined for more efficient staffing usage, ACDOH still needed to reach out to other county departments for assistance. ACDOH collaborated with the Albany County Sheriff's Office (ACSO) for security, along with the Albany County Departments of Public Works (DPW) and General Services (DGS) for transportation of assets and staffing of roles throughout the exercise. Albany County Department of Information Services (DIS) provided technical support. As some of these partners were new to the SNS process, a brief overview was provided. Once the partners had a better understanding of the SNS process, they were more motivated to participate,
offer input, and coordinate their staff. As a result of these planning meetings, a comprehensive operational flow process was created and trainings were scheduled according to staff assignments.
PHASE 2 – Trainings
Staff assigned to Inventory Control and Quality Assurance roles required training on the Medical Emergency
Response Inventory Management System (MERITS). MERITS is an application found on the New York
State Health Commerce System (HCS) used to maintain and track the flow of inventory from the Medical
Emergency Response Cache (MERC), the SNS or other vendors. Prior to the training, PHEPR staff charged tablets and MiFis, and worked with DIS to address any technical issues. The day of the MERITS training, ACDOH HCS Coordinators assisted staff in getting HCS accounts and assigned them to appropriate MERITS roles. Once logged into MERITS, RSS staff were trained on the MREITS process. PHEPR staff created a stepby-step MERITS Pick Sheet Participant Guide that included comprehensive instructions and screenshots for staff to follow. This tool proved very helpful during the training as any issues with the process were noted and the instructions were revised accordingly. Having staff trained prior to Phase 3 saved a significant amount of time the day of the exercise.
Phase 3 – Functional Exercise
ACDOH initiated the request for SNS assets by placing a phone call to the County Emergency Operations Center (EOC). This request was followed by a confirmation phone call and email from the NYS DOH EOC that SNS assets had been transferred to ACDOH's RSS site within MERITS. On April 25, 2016, DGS and DPW staff arrived at ACDOH to load medical supplies onto pre-identified transportation vehicles, which included a flatbed truck, a box truck and ACDOH's cargo trailer. ACDOH had purchased these supplies to be used in an emergency to equip local medical shelters. Since the supplies had been stored at ACDOH, it was decided to organize them in to 3 medical sheltering kits and transport to the ACSO storage site. The assets were transported to the RSS site for storage overnight. The next day PHEPR and DIS staff arrived at the site to set up tables, tablets, printers, laptops and projectors. DGS and DPW staff moved assets onto the RSS site floor. All other staff arrived and signed-in to receive their job assignment and vest prior to the Just-In-Time Training (JITT). The SNS/RSS/MERITS Overview & JITT was presented by the SNS Coordinator and the RSS Site Manager.
In the event of a real emergency, RSS staff would be divided into teams based on the number of Points of Dispensing sites opened for dispensing operations. For this exercise, staff were divided into 3 teams to sort, pick and load the 3 medical sheltering kits. The exercise timeline ran from 10:00am -2:00pm.
Staff were able to accomplish the following exercise objectives within the 3-hour window allotted:
Through this exercise ACDOH was able to test a new operational flow and identify areas of improvement. Best Practices taken from this exercise included:
 Collaborating with identified county partners allowed ACDOH to integrate other department's expertise and develop a defined interdepartmental response within its SNS plan.
 Providing MERITS training and a Pick Sheet Participant Guide introduced RSS staff to the inventory management system prior to the exercise.
 Providing all drivers with a copy of directions to RSS site and ASCO storage facility, along with the Bill of Lading, aided in the efficient transfer of assets from site to site.
 Placing the directions and BOL into plastic water proof sleeves guaranteed that signed BOLs would be returned to ACDOH without damage.

 Posting signage at all stations and staging areas for quick and easy verification by staff increased the efficiency of RSS operations.