Current Status

The responsibility of the DHS/CDC is to deliver either push package or VMI assets to an affected site for use after local supplies have been depleted. The onus is on local and state authorities to repackage stocks for individual dosing and to distribute doses at sites within the “hot zone.” To that end, it is critical that local authorities draft SNS deployment plans before a bioterrorist attack, so that lack of local organization does not hamper the rapid distribution of pharmaceuticals. The logistical burden on the local and state responders who receive, dispense, and distribute the SNS is considerable. The time and manpower costs for this activity are significant and include requirements for security and personnel accreditation that will stretch the capacity and capabilities of most local and state authorities. Recent experiences with exercises that involve the SNS (or the notional use of the SNS) have demonstrated the difficulties that are inherent in distributing the SNS materiel over the “last mile” to the target population.

The SNS currently consists of 12 push packages, each identical in content and capable of providing support to a variety of threats. These caches of pharmaceuticals, antidotes, and medical supplies are designed to provide rapid delivery of a broad spectrum of assets in the early hours of an event. They consist of:

• Antibiotics: doxycycline, ciprofloxacin, gentamicin, erythromycin
• Other medications: dopamine, epinephrine, albuterol inhaler, morphine, lorazepam
• Medical/surgical supplies: sterile water for injection, NaCl flush, syringes/needles/catheters, IV solutions, tape/dressings/gauze/tourniquet
• Airway management supplies: oxygen masks/tubing, manual resuscitators (bag-valve-mask), ventilators and suction units
• Other: tablet counting machines, power strips, extension cords, duct tape, plastic zip bags, data collection sheets

The push packages are positioned in environmentally controlled, secured warehouses in secret locations strategically sited around the Nation and ready for immediate delivery by UPS and FedEx to any affected area. The goal is to have the resources onsite within 12 hours of the Federal decision to deploy.

Push packages occupy 124 cargo containers, weigh 94,424 pounds, and require 5,000 square feet of floor space for proper staging and management. A package fills a wide-body aircraft or seven tractor trailers. Follow-on, vendor managed inventory (VMI) supplies can arrive 24 to 36 hours after the event. The SNS is described in great detail—including extensive information on receipt, distribution, and dispensing—in a CDC Guide for Planners. 6

Purchases of pharmaceuticals and medical supplies for the Federal stockpile are made by the Department of Veterans Affairs (VA), according to the General Accounting Office (GAO), which has been issuing reports on the stockpile since 1999. The VA also manages the contracts for storage, rotation, security, and transportation of stocks. Quarterly quality insurance/quality control checks, annual 100 percent inventory, and inspection of environmental conditions, security, and package maintenance are performed to keep packages, including VMI, in top condition.

6. Receiving, Distributing, and Dispensing the National Pharmaceutical Stockpile: A Guide for Planners – Version 9 (Atlanta, GA: Centers for Disease Control, April 2002).