E
Preparedness Indicators for Metropolitan Medical Response System Program Contract Deliverables



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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program E Preparedness Indicators for Metropolitan Medical Response System Program Contract Deliverables

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Deliverable 2: MMRS Development Plan Plan Elements Inputs 2.02 Description of how responses to a chemical, biological, or radiological (CBR) terrorism incident by public safety, public health, and health services sectors will be coordinated –List of relevant safety and health organizations –Description of proposed mechanisms for coordination of responses –Designation of lead agency or official 2.03 Identification of leadership and membership of the developmental team –List of relevant safety and health organizations 2.New 1 Description of the planning environment –Plan for soliciting input or gathering data 2.04 Statement of the philosophy of approach –Mission or vision statement 2.05 Description of the geographic area –Map of metropolitan area or list of jurisdictions in metropolitan area 2.06 and 2.07 Inclusion on steering committee of all relevant organizations, including broad base of organizations from emergency response disciplines –Representation by senior officials from public safety, public health, and health care communities –Organizational tables and contact numbers 2.New 2 Periodic review of membership, gaps in planning, execution of plan, and response to CBR agent-related terrorism and proxy incidents –Schedule of reviews

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Meeting minutes –Draft documents and letters –Agreement to participate attested to by signature of the deliverable by representatives from each participating organization –Demonstration of effective coordination in an exercise or documentation of effective coordination in an actual incident with or without CBR agents –Sign-off by appropriate officials –Designation of lead individual or official and contact information (point of contact [POC]) for each organization –Memorandum of understanding (MOU) or other formal written agreement where appropriate –Ability of designated officials to talk knowledgeably about their agency’s role in the MMRS plan –Evidence of ongoing analysis of community strengths, weaknesses, opportunities, and threats –Identified strengths, barriers, and challenges –Priority list for planning efforts –List of designated officials and agencies and deadlines for each effort –Ability of representatives from different levels of key institutions to explain mission or vision statement to peer reviewer –Written commitment by participating jurisdictions and state officials –Designation of lead individual or official and contact information for each jurisdiction –Map or list of participating jurisdictions –See entry for proposed new plan element, Description of the planning environment –Evidence of attendance and participation in steering committee meetings by representatives from public safety, public health, and health care communities (e.g., minutes) –Written or oral guidance to drafters of the MMRS plan components –Meeting minutes –Restructured coordinating committee as required –File of periodic and after-action evaluations –Reports on quality and system improvements

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Deliverable 3: Primary MMRS Plan Plan Elements Inputs 3.02 Indication of existing system(s) being enhanced –Relevant pre-MMRS disaster plans, emergency operations plans, hazmat procedures, and state and local laws and regulations 3.03 Establishment of interfaces with state plan –State plan –State plan POC 3.04 Coordination with other political, mutual-aid, or other MMRS program jurisdictions –List of other relevant agencies in local jurisdictions, with POCs 3.05 Identification and plan for accommodating resident federal assets of potential use –List of resident or neighboring federal assets, with POCs 3.06 Identification of command-and-control measures –Description of current command-and-control measures 3.07 Detailed notification and alert procedures –MMRS communication plans (telephone and fax numbers, e-mail addresses, radio frequencies and call signs, etc.) 3.08 Detailed management procedures for public affairs –Designated spokesperson(s) and media plan –List of topics for preplanned media packages –List of news media outlets, including those serving non-English speakers and those with impaired sight or hearing –Protocols for media credentialing

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Identification of gaps and shortfalls of existing plans –Designation of officials or agencies to address identified gaps and shortfalls –Goals and objectives for enhancing existing plans –Meeting minutes, e-mail, and other evidence of interaction with state POC –Sign-off on MMRS plan by state plan POC –Alterations in state plan or functioning reflecting MMRS planning –Evidence from exercises or actual events demonstrating workable interface between local and state plans –Meeting minutes, e-mail, and other evidence of interaction with local POCs –Sign-off on MMRS plan by local POCs –Alterations in plans or functioning of other local jurisdictions reflecting MMRS planning –Evidence from exercises or actual events demonstrating workable interface among local plans –Meeting minutes, e-mail, and other evidence of interaction with POCs of local federal facilities during the planning process –Sign-off on MMRS program plan by POCs of local federal facilities, with MOUs, where appropriate –Evidence of involvement of federal partners in tabletop or field exercises and other emergency response activities –Enhancements or revisions to command-and-control measures for MMRS plan, if needed –Distribution of identified measures to affected agencies –Evidence (documentation or as a result of an actual incident with or without CBR agents) of agreement that all affected agencies have agreed to integration into a command structure that in some instances will make them subordinate to a sister agency –Periodic testing, including during all shifts and under adverse conditions (during holidays, storms, etc.) –Documented success in regular testing or actual use in an emergency –Draft or incomplete set of communiqués for news media on agents, procedures, and public safety –Arrangements for backup communication systems through state emergency management agency or law enforcement channels –Collection of finished communiqués –Documented use of media packages in CBR agent-related hoaxes or incidents or other hazmat or epidemic events

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 3.09 Provisions for accurate and timely dissemination of information among MMRS members –List of current and planned communication systems, including telephone and pager numbers, radio frequencies and call signs, and Internet or intranet addresses of all participating organizations –Standard operating procedures (SOPs) describing when and how to use basic equipment –Equipment and procedures for communication in conditions in which demand or infrastructure damage may make public systems unreliable or unavailable 3.10 Provisions for centralized communications control –See 3.09 3.11 Provisions for control of transportation assets, medical and nonmedical –List of available sources for vehicles and drivers, including those available through mutual-aid agreements, state agencies, and local federal institutions –SOPs for accessing assets 3.12 Detailed procedures for the management and augmentation of medical personnel –Collection of staff augmentation plans –List of sources of additional medical personnel, with POCs 3.13 Provisions for management of medical supplies and equipment (see also Deliverable 10) –Communitywide list of routine inventory by location –See Deliverable 10 3.14 Provisions for emergency management of legal issues and credentialing –POCs for legal affairs –Clear explanation of legal status and liability of medical and other personnel, including volunteers, responding as part of the MMRS program –Copies of or reference to relevant laws and regulations –Procedure for requesting emergency waivers or exceptions

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Evidence of dissemination to all relevant organizations –Record or schedule of system checks or tests –Demonstration of effective use of all systems in periods of peak demand through unannounced tests or use in an actual emergency –See 3.09 –See 3.09 –Evidence of periodic communication with managers of assets –Demonstration of availability of anticipated assets on short notice for random check, planned exercise, or actual emergency –Communitywide list of augmentation personnel, without duplicates –Record or schedule of system checks –Demonstration of effective use of all systems at multiple sites, for several types of medical personnel, and in periods of peak demand through unannounced tests or use in an actual emergency (snowstorm, hurricane, etc.) –Documented resolution of any issues related to cross-jurisdictional licensure and liability coverage –Periodic assessment of actual inventory –See Deliverable 10 –See Deliverable 10 –Confirmation of MMRS plan description of legal issues by legal POCs –Evidence that efforts are under way to eliminate legal obstacles to preparedness –Confirmation by legal authorities that MMRS plans conform to local, state, and federal laws (e.g., the Emergency Medical Treatment and Labor Act)

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 3.15 Provisions for emergency management of patient tracking tracking and record keeping –MMRS plan 3.16 Provisions for augmentation of epidemiological services and support –List of supporting agencies or institutions, with POCs 3.17 Provisions for laboratory support –List of supporting agencies or institutions, with POCs 3.18 Provisions for crowd control –MMRS plan –List of available law enforcement and security assets, with POCs 3.19 Provisions for protection of treatment facilities and personnel –Same as 3.18 3.20 A schedule for exercises –Inclusion on the schedule of an exercise of all required MMRS program functions, separately or together, at least on a yearly basis –Inclusion on the schedule of a full-scale field exercise at least every 2 years 3.21 Assignment of responsibility for after-action reports and addressing report findings –Name(s) of designated individual(s)

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Evidence of implementation of patient tracking plan, software, and training at health care facilities in metropolitan area (e.g., meeting minutes, purchases, training log) –Demonstration of effective patient tracking in an exercise or a multiple-casualty incident of any sort involving large-scale movement of patients within and across health care facilities –Evidence of interaction with and input to planning by POCs –Sign-off or other evidence of agreement with MMRS plan by epidemiological support POCs –Demonstration of epidemiological support (data collection or analysis) in exercises, suspected CBR agent-related incidents, or natural disease outbreaks –Evidence of interaction with and input to planning by POCs –Sign-off or other evidence of agreement with MMRS plan by laboratory support POCs –Demonstration of laboratory support in exercises, CBR agent-related hoaxes, actual disaster, or CBR agent-related event –Evidence of formal or informal agreements with organizations designated to provide emergency security personnel (e.g., National Guard, private security firms) –Demonstration of availability of anticipated assets on short notice for random check, planned exercise, or actual emergency –Time from request to appearance on site if request is for immediate help –After-action reports from events with large attendance such as sporting events, concerts, and political conventions –Same as 3.18 –Same as 3.18 –Meeting minutes or other evidence of exercise planning –Evidence that exercises were completed on schedule –A collection of after-action reports –Meeting minutes or other evidence of after-action report production, including revisions or comments by key agencies –Documented process for evaluation of exercises for development of after-action reports and addressing the recommendations of those reports –Possession by all participating agencies and institutions of the collection of after-action reports –Evidence for changes in structure or functioning in response to reported deficiencies

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 3.22 Designation of mental health care for emergency workers, victims and their families, and others in community needing special assistance –List of local mental health practitioners and sources of extralocal practitioners –SOPs for provision of on-scene and community support 3.23 Provisions for proper examination, care, and disposition of fatalities (see Plan elements 7.09, 7.10, and 7.11) –List of facilities or sites for expanded operations of medical examiner or coroner –List of local undertakers –List of local religious leaders –Disaster Mortuary Operational Response Team (DMORT) POCs Deliverable 4: MMRS Plan for Forward Movement of Patients Using the National Disaster Medical System (NDMS) Plan Elements Inputs 4.01 Detailed procedures for preparation of patients for movement to other areas of the region or nation –A fully developed SOP 4.02 Identification of who makes the decision to implement forward movement of patients –Name(s) of individual(s) at each patient care facility to make decision 4.03 Indication that NDMS would provide transportation and care –Text of plan and NDMS POC –Signed agreements between participating hospitals and NDMS

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Evidence of interaction with local mental health organization or agency –Agreements with private organizations and individual practitioners to provide mental health services for all segments of population –Evidence of practitioner training or experience providing services to disaster victims and/or responders –After-action reports from other kinds of disasters or exercises that document coordination, availability, use, and effectiveness of mental health professionals –Meeting minutes or other evidence of interaction with POCs in funeral business and religious community regarding mass fatalities –MOUs, contracts, or other evidence of support of MMRS plan by undertaking and religious POCs –After-action reports from other disasters or crimes that document satisfactory processing of large numbers of human remains –Evidence of tabletop exercises testing disposition plans and procedures for fatalities Processes Outputs –Distribution of SOPs to emergency medical services (EMSs), local hospitals –Awareness of plan and SOPs by EMSs and hospital officials and when and how to initiate them –Appointment or notification letter, instructions –Sign-off by designated individual(s) –Documentation of contact with NDMS –Identification of their own and federal POCs for facilities with signed NDMS agreements –Evidence of NDMS support for MMRS plan and SOPs for activation (e.g., from joint training, tabletop demonstration of interface)

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program   Processes Outputs –Evidence that SOPs are available at morgue facilities in sufficient quantity to distribute to any expedient sites and personnel required –Hands-on demonstration of decontamination in an exercise or actual incident –See 7.13 –See 7.13 –Record of agreement with the MMRS plan by local, state, and federal environmental agencies –Awareness by the individual or agency charged with judging safety of responsibility and has SOP for decision making –Demonstration of an effective process to expert peer reviewer; in response to questioning; or by performance in an exercise, actual hazmat event, or disease outbreak –Evaluation of each of the Deliverable 7 processes described above relative to each of the three scenarios –Evaluation of each of the Deliverable 7 outputs described above relative to each of the three scenarios

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 8.01 Procedures for notification of hospitals, clinics, health maintenance organizations (HMOs), etc., that an incident has occurred –Comprehensive list of facilities, with POCs and telephone and fax numbers –Designated individual or office to initiate process, staff to carry it out –Communications equipment appropriate for rapid notice, e.g., radio, broadcast fax, or e-mail 8.02 Procedures for protection of hospitals, clinics, and HMOs from contamination from environmental or patient sources (lockdown procedures) –Presence of plan at all local health care facilities –Availability of personal protective equipment required by plan –Capacities of facilities to secure all entrances and exits 8.03 Provisions for the capability of local health care facilities to provide triage and initiate definitive care –Inventory of services and capabilities –Specification by each facility of three levels of capability: normal operations, operations with augmentation, and overwhelmed operations –SOPs on transfer process 8.04 Assurance of adequate security to support provision of emergency and definitive health care during and following a large-scale terrorism event –MMRS plan –List of available law enforcement and security assets, with POCs

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Periodic notification checks conducted at least weekly, including at nights, on weekends, and on holidays –Percentage of facilities contacted in 1 hour during weekly notification checks –Time from initial contact to initiation of hospital disaster plan or incident command priate for system –Time from initial contact until hospitals report beds and capabilities are available –Evidence that personnel at all facilities are provided orientation on plan –Evidence that all facilities have SOPs and provide training to staff on safe care of highly infectious patients (e.g., patients with varicella, tuberculosis, or drug-resistant infections) –Numbers of secondary infections of staff or other patients in prior 6 months –Current conversion rate for positivity for tuberculosis (purified protein derivative) skin tests among staff –Numbers of isolation rooms available, overall and in the ED –Numbers of tuberculosis, rubella, or varicella patients admitted to nonisolation rooms in prior 6 months –Numbers of staff furloughed due to exposure to patients with varicella, rubella, or other infectious diseases in prior 6 months –Numbers of hours from examination of most recent tuberculosis patient to isolation –Evidence that facilities have clear policies and procedures for handling of ED overload and ED diversion –Numbers, types, and durations of diversions in previous 3 months –Numbers and types of patients transferred out of the hospital to other facilities in previous 3 months –Expert assessment of MMRS program-wide hospital exercise or response to mass-casualty event –Evidence of formal or informal agreements with organizations designated to provide emergency security personnel (e.g., National Guard, private security firms) –Evidence that agreements include preexisting plans to allocate security staff when demand exceeds supply –Anticipated assets available on short notice for a random check, planned exercise, or actual emergency –Number of unauthorized entrants during a drill or exercise

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 8.05 Availability of adequate personal protective equipment for hospital and clinic providers (see Deliverable 10) –List of equipment needs –Purchase plan –Training plan for equipment users 8.06 Local availability of adequate pharmaceuticals and equipment (including ventilators) or plans to obtain them in a timely manner (see Deliverable 10) –List of desired pharmaceuticals –Medical treatment protocols for agents specified in the fiscal year (FY) 2000 MMRS program contract (nerve agents; blister agents; choking agents; blood agents; and those responsible for anthrax, botulism, hemorrhagic fever, plague, smallpox, and tularemia) –Data on populations of communities participating in the MMRS program 8.07 Ability of medical staff to recognize and treat casualties caused by agents used as weapons of mass destruction (see 8.08) –Communitywide list of physicians with hospital privileges, with telephone contact information –Medical treatment protocols for agents specified in MMRS program contract (nerve agents; blister agents; choking agents; blood agents; and those responsible for anthrax, botulism, hemorrhagic fever, plague, smallpox, and tularemia) in FY 2000 –Essential antidotes, antibiotics, and immune sera, in appropriate quantities 8.08 Availability of treatment protocols –Medical protocols for at least the agents specified in the MMRS program contract (nerve agents; blister agents; choking agents; blood agents; and those responsible for anthrax, botulism, hemorrhagic fever, plague, smallpox, and tularemia)

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Inventory of available equipment –Training logs –Demonstration of competency with equipment (e.g., by a respirator fit test) for expert peer reviewer –MOUs or other collaborative agreements with other local medical care facilities for emergency loan and distribution of required equipment and pharmaceuticals, including pediatric ventilators –SOPs for requesting CBR agent-specific equipment, supplies, and pharmaceuticals from MMRS program stores –Availability of all essential antidotes, antibiotics, and immune sera, in appropriate quantities, for inspection by site-visit team or peer reviewer –Evidence of effective collaboration in coping with recent national shortages of influenza and tetanus vaccines and gamma globulin and emergency shortages of antibiotics –Response times required to retrieve requested items in drills or in actual cases –Credentialing, where applicable –Continuing medical education (CME) roster or training schedule –Numbers and percentages of staff trained on protocols –Linkage to local, state, federal experts via telephone, e-mail, Health Alert Network, Internet, mass paging and alert systems, etc. –Laboratory quality assurance test results –Demonstration of knowledge in responses to peer reviewer questions, exercise, or actual event –Certification or other nationally recognized affirmation of CBR agent-specific knowledge and skills, if such means for certification become available in the future –Number of hours from time of examination of tuberculosis patients to isolation –Number of isolation rooms available in ED and in total –Number of tuberculosis patients admitted to nonisolation rooms –Number of staff furloughed due to exposure to patients with varicella, rubella, or other infectious diseases –Distribution of protocols to all physicians and availability of protocols at all major medical care sites –Training schedule –Numbers and percentages of staff trained on protocols –Demonstration of knowledge by EDs, intensive care units, and primary care physicians and nurses in responses to peer reviewer questions, exercise, or actual event –Certification or other nationally recognized affirmation of CBR agent-specific knowledge and skills, if such means for certification become available in the future –Compliance with existing protocols

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 8.New 1. Procedures for recall of staff –Telephone call list –Public communication plan –List of news media outlets and POCs 8.New 2. Procedures for delivery of nonmedical supplies (see Deliverable 10) –List of customary and alternative vendors of food, fuel, laundry, and other essential supplies Deliverable 9: MMRS Training Plan 9.01 Training requirements for all personnel responding to the scene of an incident or providing care to victims of a CBR agent-related incident –Numbers and locations of police and fire department personnel, emergency medical technicians, paramedics, vehicle drivers, ED staff (physicians and nurses), hospital administration and infection control officers, chemical and radiation safety officers, local and regional public health authorities, and U.S. Department of Veterans Affairs (VA) hospital staff (if present in the community) –Numbers of qualified, trained instructors –Curricula consistent with prior discipline-specific training or training agreements with appropriate agencies –Hands-on as well as didactic training schedule –List of CBR agents addressed –Estimate of logistical support required 9.02 Indication of how training previously received from the U.S Department of Defense (DOD) or the U.S. Department of Justice (DOJ) affects initial training requirements, continuing education, and refresher training needs –List of prior training conducted

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Periodic tests of accuracy of phone numbers –Periodic tests of recall effectiveness –Test of recall lists to see how many facilities are counting the same people on recall list –Evidence from calls to random sample of list shows that the list is up to date –Percentage of staff returning in 2 hours –Contingency contracts with alternative suppliers –Periodic shortages drill –Evidence of no disruption of services due to shortages during a drill or mass-casualty event –Response times for deliveries –Alternative supplier can deliver necessary supplies in 24 hours –Numbers and contents of courses provided, both lecture and hands-on courses (e.g., disaster drills), with critiques provided to participants –Number of people (and percentage of the target workforce) trained –Number of communitywide exercises including disaster drills and tabletop exercises –Demonstration of knowledge of subject matter to peer reviewer by selected sample of trained personnel from all levels of all participating organizations or through functional drills, communitywide exercises, or responses to actual CBR agent, hazmat, or infectious disease outbreak events –Certification or other nationally recognized affirmation of CBR agent-specific knowledge and skills, if such means for certification become available in the future –Revision of training requirements reflecting previous training  

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 9.03 Description of VA’s role in training medical personnel in NDMS hospitals –Location of and POCs at nearest VA hospital –Agreement with VA hospital to provide training to non-VA employees on space-available basis –Numbers of qualified, trained instructors –Curricula consistent with prior discipline-specific training or training agreements with appropriate agencies –Hands-on as well as didactic training schedule –List of CBR agents addressed Deliverable 10: MMRS Plan for Pharmaceuticals and Equipment Plan Elements Inputs 10.01 List of pharmaceuticals consistent with mission of MMRS program –List of desired pharmaceuticals –MMRS program mission statement –Medical treatment protocols for agents specified in MMRS program contract (nerve agents; blister agents; choking agents; blood agents; and those responsible for anthrax, botulism, hemorrhagic fever, plague, smallpox, and tularemia) in FY 2000 10.02 Quantities of pharmaceuticals sufficient to care for 1,000 victims of a chemical agent and for entire affected population for 24 hours after a biological incident –List of desired pharmaceuticals –Medical treatment protocols for agents specified in MMRS program contract (nerve agents; blister agents; choking agents; blood agents; and those responsible for anthrax, botulism, hemorrhagic fever, plague, smallpox, and tularemia) in FY 2000 –Data on populations of communities participating in the MMRS program 10.03 Timetable for procurement of pharmaceuticals and equipment –Timetable for initial procurement and replenishment based on differences in essential pharmaceuticals, equipment, and personnel and those actually required in plan

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Numbers and contents of courses provided, both lecture and hands-on courses (e.g., disaster drills), with critiques provided to participants –Number of people (and percentage of the target workforce) trained –Demonstration of knowledge of subject matter to peer reviewer by selected sample of trained personnel Processes Outputs –Periodic assessment of appropriateness of agents (outdating, currency of pharmacopoeia, changes in threat) by a pharmacy and therapeutics committee –List that includes all treatments and vaccines specified in MMRS program medical treatment protocols –Algorithm for calculating required quantities of pharmaceuticals –Verification that a project manager can explain the derivation of the algorithm to the satisfaction of an expert peer reviewer –Availability of all essential antidotes, antibiotics, and immune sera, in appropriate quantities, for inspection by site-visit team or peer reviewer –Establishment of mechanisms for review and update of pharmacopoeia –Establishment of mechanisms for monitoring pharmaceutical expiration dates and replacing stock –Availability of all essential antidotes, antibiotics, and immune sera, in appropriate quantities, for inspection by site-visit team or peer reviewer

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Plan Elements Inputs 10.04 Detailed procedures for equipment maintenance and pharmaceutical storage –Pharmacopoeia, with associated storage requirements –Equipment list, with associated maintenance requirements –Property officer(s) –SOPs for equipment maintenance –SOPs for pharmaceutical storage –Identification of secure storage site(s) 10.05 Identification of a property officer responsible for all property received and purchased under MMRS program contract –Name and contact information for designated property officer 10.06 Harmonization of equipment purchases with equipment received from DOD, DOJ, and the Federal Emergency Management Agency –List of essential detection, protective, and decontamination equipment for use both in the field and in hospitals –List of protective, detection, and decontamination equipment previously received from other federal sources 10.New 1 Procedures for distributing pharmaceuticals and equipment to local personnel and facilities –List of authorized local recipients –SOPs for release of pharmaceuticals and equipment 10.New 2 Procedures for requesting, receiving, and distributing pharmaceuticals from the National Pharmaceutical Stockpile (NPS) –SOPs, including phone and e-mail contacts at the Centers for Disease Control and Prevention (CDC) –Source of personnel for breaking down and distributing CDC “push package” to health care facilities –Licenses and approvals as required by federal, state, and local laws governing dispensing of pharmaceuticals

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Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System Program Processes Outputs –Periodic assessment of safety of storage and delivery systems –Periodic testing of appropriateness of drugs supplies (outdated supplies, currency of pharmacopoeia) by a pharmacy and therapeutics committee –Periodic drills, actual events, or questioning by expert peer reviewer demonstrate mechanisms for coordination of activity at multiple sites as well as return and decontamination of equipment and unused supplies –Records of periodic maintenance of equipment –Records of training of logistics personnel on maintenance procedures –Evidence that the mechanism of delivery and storage is secure in natural disasters, mock drills, earthquakes, or hazmat events –Consistency of inventory with records of pharmacy and therapeutics committee meetings –Knowledge of procedures for return of unused supplies and decontamination of equipment by logistics personnel –Evidence that a sample of equipment selected by peer reviewer is in working order –Performance of required maintenance and/or prompt retrieval of maintenance manual by logistics personnel when queried by peer reviewer –Records of purchase and current location of all property –Retrieval of inventory and maintenance records by property officer –Evidence that a sample of property in acceptable condition can be produced for expert peer reviewer at locations specified in property officer records –Purchase plan that reflects equipment and supplies on hand from other sources –Evidence that sum of equipment on hand, on order, or scheduled for purchase is not greater than documented need –Periodic training and testing of distribution plan –Evidence from drill, actual event, or questioning by expert peer reviewer that local distribution of MMRS program pharmaceuticals and equipment will be rapid enough to maintain local supplies for at least the initial 24 hours of an event –Periodic training and testing of distribution plan –Evidence from drill, actual event, or questioning by expert peer reviewer that local distribution of NPS supplies will be rapid enough to maintain local supplies after the initial 24 hours of an event