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Appendix

Preparedness Indicators



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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report Appendix Preparedness Indicators

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report This page in the original is blank.

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report Deliverable 2: MMRS Development Plan Plan Elements Inputs Processes Outputs 2.02 Description of how responses to a 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 —Lead agency/official —Meeting minutes —Draft documents and letters —Deliverable signed 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 2.03 Identification of leadership and membership of the developmental team —List of relevant safety and health organizations —Sign-off by appropriate officials —Designated individual 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 New. Description of the planning environment —Plan for soliciting input or gathering data —Evidence of ongoing analysis of community strengths, weaknesses, opportunities, and threats —Identified strengths, barriers/challenges —Priority list for planning efforts —Designated officials/agencies and deadlines for each effort 2.04 Statement of the philosophy of approach —Mission/vision statement   —Ability of representatives from different levels of key institutions to explain mission/vision statement to peer reviewer

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report 2.05 Description of the geographic area —Map of metropolitan area or list of jurisdictions in metropolitan area —Written commitment by participating jurisdictions and state officials —Designated individual and contact information for each jurisdiction —Map or list of participating jurisdictions —See entry for proposed new plan element on identifying the planning environment. 2.06/2.07 Inclusion on steering committee of all relevant organizations, including broad base of emergency response disciplines —Representation by senior officials from public safety, public health, and health care communities —Organizational tables and contact numbers —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 New. Periodic review of membership, gaps in planning, execution of plan, response to CBR terrorism and proxy incidents —Schedule of reviews —Meeting minutes —Restructured coordinating committee as required —File of periodic and after-action evaluations —Reports on quality/system improvements

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report Deliverable 3: Primary MMRS Plan Plan Elements Inputs Processes Outputs 3.02 Indication of existing system(s) being enhanced —Relevant pre-MMRS disaster plans, emergency operations plans, hazmat procedures, state and local laws and regulations —Identification of gaps, shortfalls of existing plans Designation of officials or agencies to address identified gaps and shortfalls —Goals and objectives for enhancing existing plans 3.03 Establishment of interfaces with state plan —State plan —State plan POC —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 demonstrates workable interface between local and state plans 3.04 Coordination with other political, mutual-aid, or other MMRS program jurisdictions —List of other relevant agencies in local jurisdictions, with POCs —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 demonstrates workable interface among local plans 3.05 Identification and plan for accommodating resident federal assets of potential use —List of resident or neighboring federal assets, with POCs —Meeting minutes, e-mail, and other evidence of interaction with local federal facility POCs during the planning process —Sign-off on MMRS plan by local federal facility POCs, with MOUs, —Involvement of federal partners in tabletop or field exercises and other emergency response activities

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report     where appropriate   3.06 Identification of command-and-control measures —Description of current command-and-control measures —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 3.07 Detailed notification and alert procedures —MMRS communication plans (phone, fax numbers, e-mail addresses, radio frequencies and call signs, etc.) —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 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 —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-related hoaxes or incidents or other hazmat or epidemic events 3.09 Provisions for accurate and timely dissemination of information among MMRS —List of current and planned communication systems, including telephone and —Evidence of dissemination to all relevant organizations —Record or schedule of system —Demonstration of effective use of all systems in periods of peak demand through unannounced

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report members 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 where demand or infrastructure damage may make public systems unreliable or unavailable checks or tests tests or use in an actual emergency 3.10 Provisions for centralized communications control —See 3.09 —See 3.09 —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 —Evidence of periodic communication with managers of assets —Availability of anticipated assets on short notice for random check, planned exercise, or actual emergency 3.12 Detailed procedures for the management/ augmentation of medical personnel —Collection of staff augmentation plans —List of sources of additional medical personnel, with POCs —Communitywide list of augmentation personnel, without duplicates —Record or schedule of system checks —Demonstration of effective use of all systems, at multiple sites and for several types of medical personnel, in periods of peak demand, through unannounced

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report       tests or use in an actual emergency (snowstorm, hurricane, etc.) —Documented resolution of any issues related to cross-jurisdictional licensure and liability coverage 3.13 Provisions for management of medical supplies and equipment (see also Deliverable 10) —Communitywide list of routine inventory by location —See Deliverable 10. —Periodic assessment of actual inventory —See Deliverable 10 —See Deliverable 10 3.14 Provisions for emergency management of legal issues and credentialing —POC 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 —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) 3.15 Provisions for emergency management of patient tracking and record-keeping MMRS plan —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

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report 3.16 Provisions for augmentation of epidemiological services and support —List of supporting agencies or institutions, with POCs —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 incidents, or natural disease outbreaks 3.17 Provisions for laboratory support —List of supporting agencies or institutions, with POCs —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-related hoaxes, actual disaster, or CBR event 3.18 Provisions for crowd control —MMRS plan —List of law enforcement/security assets available, with POCs —Evidence of formal or informal agreements with organizations designated to provide emergency security personnel (e.g., National Guard, private security firms) —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 3.19 Provisions for protection of treatment facilities and personnel —Same as 3.18 —Same as 3.18 —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 —Meeting minutes or other evidence of exercise planning —Exercises completed on schedule —Collection of after-action reports

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report   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) —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 recommendations of those reports —Possession by all participating agencies and institutions of collection of after-action reports —Evidence for changes in structure or functioning in response to reported deficiencies 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 —Evidence of interaction with local mental health organization/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 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/coroner —List of local undertakers —List of local religious leaders —Disaster Mortuary —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 —After-action reports from other disasters or crimes that document satisfactory processing of large numbers of human remains —Tabletop exercises testing disposition plans and procedures for fatalities

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report   Operational Response Team (DMORT) POCs plan by undertaking and religious POCs  

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report 7.10 Procedures for augmenting existing morgue facilities and staff —List of hospital morgues, mortuaries, warehouses, other facilities with cold-storage capabilities, and sources of refrigerated trucks, with POCs —Contact information for federal support via specialized DMORT —Contingency contracts or other forward arrangements for obtaining storage capacity —Evidence of NDMS support for MMRS plan and SOPs for activation (joint training, tabletop demonstration of interface with DMORT) —No-notice test of system to determine if surge assets could be made available 7.11 Procedures for decontaminating or isolating human remains when appropriate —SOPs covering decision to decontaminate and the decontamination process —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 7.12 Procedures for identifying environmental risk and determining the need for decontamination or vector intervention —List of local, state, and federal environmental agencies, with POCs —Detection and agent identification equipment capable of verifying safety —Mass medical/infectious waste management plans —See 7.13 —See 7.13 7.13 A process for safe reentry into the affected area in consultation with local, state, and federal environmental agencies —List of local, state, and federal environmental agencies, with POCs —Detection and agent identification equipment capable of verifying safety —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

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report 7.14 Three levels of response: for incidents with up to 100 victims, 100 to 10,000 victims, and more than 10,000 victims. IOM Alternative Identify three capacity levels: normal capacity, capacity with augmentation, and “overwhelmed” level) —Each of the deliverable #7 inputs described above should be evaluated relative to each of these three scenarios —Each of the deliverable #7 processes described above should be evaluated relative to each of these three scenarios —Evaluation of each of the deliverable #7 outputs described above should be evaluated relative to each of these three scenarios

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report Deliverable 8: MMRS Hospital Plan Plan Elements Inputs Processes Outputs 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 phone 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 —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 system —Time from initial contact until hospitals report beds and capabilities available 8.02 Procedures to protect 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 —Capacity of facilities to secure all entrances and exits —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 positive 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

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report       months —Numbers of hours from examination of most recent tuberculosis patient to isolation 8.03 Provisions for the capability of local health care facilities to provide triage and initiate definitive care —Inventory of services/capabilities —Specification by each facility of three levels of capability: normal operations, operations with augmentation, and overwhelmed operations —SOPs on transfer process —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 8.04 Assurance of adequate security to support these activities —MMRS plan —List of law enforcement/security assets available, with POCs —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 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 —Equipment/inventory —Training logs —Demonstration of competency with equipment (e.g., by a respirator fit test) for expert peer reviewer

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report 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 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 population of communities participating in the MMRS program —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-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 time to retrieve requested items in drills or in actual cases 8.07 Ability of medical staff to recognize and treat casualties caused by WMD agents (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 —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 phone, e-mail, Health Alert Network, Internet, mass paging and alert systems, and the like. —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-specific knowledge and skills, if such means for certification become available in the future —Number of hours from 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

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report       exposure to patients with varicella, rubella, or other infectious diseases 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) —Distribution of protocols to all physicians and availability of protocols at all major medical care sites —Training/CME schedule/roster —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-specific knowledge and skills, if such means for certification become available in the future —Compliance with existing protocols New. Procedures for recall of staff —Telephone call list —Public communication plan —List of news media outlets and POCs —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 —Calls to random sample of list show that list is up to date —Percentage of staff returning in 2 hours New. Procedures for delivery of nonmedical supplies (see Deliverable 10) —List of customary and alternative vendors of food, fuel, laundry, and other essential supplies —Contingency contracts with alternative suppliers —Periodic shortages drill —Production of no disruption of services due to shortages during a drill or mass-casualty event —Response times for deliveries —Alternative supplier has necessary quantities or can deliver in 24 hours

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report Deliverable 9: MMRS Training Plan Plan Elements Inputs Processes Outputs 9.01 Training requirements for all personnel responding to the scene of an incident or providing care to victims of a CBR incident —Numbers and locations of police, fire, emergency medical technicians (EMTs), paramedics, vehicle drivers; ED staff-physicians, 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 chemical, biological, and radiological materials addressed —Estimate of logistical support required —Number and content 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, hazmat, or infectious disease outbreak events —Certification or other nationally recognized affirmation of CBR-specific knowledge and skills, if such means for certification become available in the future 9.02 Indication of how training —List of prior training conducted —Revised training  

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report previously received from DOD or DOJ affects initial training requirements, continuing education, and refresher training needs   requirements reflecting previous training   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 chemical, biological, radiological materials addressed —Number and content 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

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report Deliverable 10: MMRS Pharmaceutical/Equipment Plan Plan Elements Inputs Processes Outputs 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 —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 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 population of communities participating in the MMRS program —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 10.03 Timetable for procurement of pharmaceuticals and —Timetable for initial procurement and replenishment based on differences in essential —Establishment of mechanisms for review and update of pharmacopoeia —Availability of all essential antidotes, antibiotics, and immune sera, in appropriate quantities, for

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report equipment pharmaceuticals and equipment and personnel and those actually required in plan —Establishment of mechanisms for monitoring pharmaceutical expiration dates and replacing stock inspection by site visit team or peer reviewer 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) —Periodic assessment of safety of storage and delivery systems —Testing of appropriateness of agents over years (outdating, currency of pharmacopoeia) by a pharmacy and therapeutics committee —Periodic drills, actual events, or questioning by expert peer reviewer test 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 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 —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

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Tools for Evaluating the Metropolitan Medical Response System Program: Phase I Report 10.06 Harmonization of equipment purchases with equipment received from DOD, DOJ, and FEMA —List of essential detection, protective, and decontamination equipment for both field and hospital —List of protective, detection, and decontamination equipment previously received from other federal sources —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 New. Procedures for distributing pharmaceuticals and equipment to local personnel and facilities —List of authorized local recipients —SOPs for release of pharmaceuticals and equipment —Periodic training/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 New. Procedures for requesting, receiving, and distributing pharmaceuticals from the National Pharmaceutical Stockpile (NPS) —SOPs, including phone and e-mail contacts at 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 —Periodic training/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 initial 24 hours of an event