Massachusetts Department of Public Health
Office of Preparedness and Emergency Management

STRATEGIC NATIONAL STOCKPILE

PROTOCOL - MATERIAL TRANSFER OF CUSTODY

This document assumes basic knowledge of the Emergency Dispensing Site Management and Operations component of the Template for Infectious Disease Emergency Plan.  Send questions/comments to snssinfo.dph@dph.state.ma.us.

This document also assumes familiarity with the federal Strategic National Stockpile Program.   For additional information on the SNS, please visit http://www.bt.cdc.gov/stockpile.

The state CEMP referenced in this document may be accessed by contacting your community’s EMD.

The Massachusetts Department of Public Health (MDPH) maintains the locations of the receipt, staging and storage (RSS) warehouse facilities on behalf of the U.S. Centers for Disease Control and Prevention (CDC).  The CDC, when administering the Strategic National Stockpile (SNS) Program, will utilize one such facility in Massachusetts in order to dispense medical material in response to a public health emergency or natural disaster.  

After discussions with MDPH, MEMA, FEMA and the Governor of Massachusetts’ (or his/her designee), the CDC will ship a 12- hour “push package” or managed inventory (MI) material from the SNS repositories to Massachusetts.  The CDC will determine the method of transport for these SNS assets (air or land) and the selection of the RSS to which it will deliver the medical material.  Please review the information posted on CDC’s website at http://www.bt.cdc.gov/stockpile should your community not be familiar with the components of the SNS.

The CDC will request a transfer of custody for the material according to federal and state laws and regulations, as well as any applicable emergency provisions put into effect at the time of SNS material delivery to the state warehouse facility.  The initial federal-to-state transfer of custody will be mirrored later on in the state-to-municipality transfer of custody, as outlined in this document.

I.  PRE-EVENT PLANNING

1.  IDENTIFICATION OF EMERGENCY DISPENSING SITES

Communities should have previously identified an emergency dispensing site(s) (EDS) and provided MDPH with the necessary information in order to receive SNS assets. Communities who have yet to register their EDS may do so by submitting to MDPH the Emergency Dispensing Site Identification Form, as posted on the MDPH-OPEM website, as soon as possible to ensure delivery in response to an incident.  Cities and towns may also select “secondary” EDS – the same form would be used and a notation must be made that this site is “secondary”, and the location would be flagged as “secondary” in the MDPH database.  Prior to delivery of SNS assets, the respective municipality would notify us of the use of the secondary EDS should the primary EDS be out of commission for any reason. 

2.  EDS SURVEY

Prior to arrival of SNS assets, communities must also submit the Emergency Dispensing Site (EDS)/Treatment Center (TC) Survey for each EDS within their respective jurisdictions (Appendix A). The site survey contains information critical to delivery by providing a brief description of the delivery conditions for an EDS, such as whether the facility operates a working loading dock or can access a pallet jack.  A statewide incident would require delivery to numerous EDS as well as additional deliveries to treatment centers and hospitals.  The warehouse staff charged with the deliveries must have minimum information on hand (such as the ability to turn a 53-foot truck or whether the EDS has a loading dock) in order to plan to use an appropriate truck (with or without an electronic lifting gate, smaller-sized truck, etc.) for delivery to each EDS.

Any community that has not submitted the form runs the risk of having to off-load assets at a facility other than the designated EDS. In this case, the municipality may have to transport the assets to the EDS and may disrupt local emergency response efforts.  

II.  REQUEST FOR ASSETS DURING AN EMERGENCY 

1.  CONTACT LOCAL EMERGENCY MANAGEMENT DIRECTOR 

Cities and towns will request medical assets as they would request any asset necessary to respond to a disaster situation according to their respective municipal Comprehensive Emergency Management Plans (CEMP).  The local health official would contact the local Emergency Operations Center (EOC) or the local emergency management director for the municipality and make the need known, as identified in the local CEMP and/or EDS plan.  The local EOC would initially look locally to determine if the assets required can be met by the municipality itself.  Depending on the nature of the incident, there may be sufficient supplies already within the immediate local region to meet the request.  

2.  COMMUNICATE REQUEST TO MEMA

If the needs cannot be met locally, the request for medical assets will be forwarded from the local EOC to the Massachusetts Emergency Management Agency (MEMA) office (www.mass.gov/mema). The protocol for activation of the local EOC as well as communication between the local EOC and MEMA’s office should be outlined in the municipality’s CEMP.  

Should MEMA not be able to meet the request, the request for medical assets will be forwarded to the State Emergency Operation Center (SEOC).  The SEOC would follow proper protocol for the notification of MDPH regarding the need for emergency medical material as outlined in the state CEMP.  The SEOC would relay pertinent information and assets to the affected community accordingly should medical material be found in other regions of the state.

Local Board of Health reports the need for medical materiel to the local emergency management director (EMD) or the local emergency operations center (EOC).

Local EOC searches within the municipality’s borders to assess available material, and expands the search to other communities with which it has mutual aid agreements.

The MEMA state emergency operations center (SEOC), relays request to other communities in the region depending on the nature of the incident. MDPH works with MEMA to provide additional assets.

If need for materiel remains unmet, local EOC contacts the MEMA state wide emergency operations center (SEOC) to request additional materiel.

3.  STATE REQUESTS FEDERAL SNS ASSETS

The state makes the determination to request federal SNS assets should the state not have the necessary medical material within its borders to adequately address the incident.  Following notification by the SEOC, MDPH would recommend the request for deployment of the federal SNS to the Governor of the Commonwealth. The Governor would then make a formal request for assistance from the CDC, who would then deliver/deploy SNS assets to Massachusetts.

MDPH, via MEMA’s SEOC, would contact the affected communities as to the approval of SNS status.  At this time, local EOCs would be asked to identify, in a timely manner, which EDS(s) would be receiving the SNS assets.  

In emergency situations, MDPH places staff at the SEOC per the state CEMP to ensure proper communication for public health emergency response efforts.  Throughout the remainder of the document, this will be referred to as MDPH/SEOC.

All communication between the state and municipalities regarding SNS assets must be relayed through the MEMA following state/local CEMP protocol.  

III. COMMUNICATION OF EDS STATUS

1.  IDENTIFY INTENDED EDS

Following the notification of the local EOC as to the impending arrival of SNS assets at the state warehouse, municipalities must convey to MEMA their selection of EDS(s) to activate as well as indicate the “ready” status of their EDSs relative to the receipt of SNS assets at their respective facilities.  

2.  INDICATION OF EDS “READY” STATUS

The “ready” status should be the hour at which the site manager or incident commander believes the EDS will be fully prepared to receive SNS material.  The criteria to determine this “ready” status will vary from town to town as each municipality will follow its own EDS plan regarding the preparation of the EDS facility.  The individual charged with making this decision may determine the status in advance of actual preparation – for example, the notification to MEMA may be placed at 6 AM to indicate a “ready” time of 9 AM. The individual who confirms this “ready” status should be identified in advance according to the local municipal EDS plan and/or CEMP – MDPH will not identify this individual on behalf of any city/town.  Individuals should be identified by position in the municipal CEMP; names and contact information for these positions should be in an appendix to the CEMP to allow for updates.

Upon receipt of EDS “ready” status confirmation, MDPH/SEOC will flag the location on the EDS database maintained by MDPH and add the location to the delivery route for distribution of SNS inventory.  MDPH/SEOC will not confirm a delivery time at this point; that will come later when the trucks making the delivery from MDPH’s warehouse are actually on the road.

3.  LOCAL NOTIFICATION

Once the state receives confirmation from CDC that SNS assets will be delivered, MDPH/SEOC will notify local EOCs and emergency management directors in the affected areas (via MEMA) about the delivery of SNS assets.  The protocol for this notification will follow procedures outlined in the state CEMP.  

IV. ASSET DEPARTURE FROM THE MDPH WAREHOUSE

1.  TRANSPORTATION OF ASSETS

The method of transport from the RSS to municipal emergency dispensing sites (EDS) will be via state and federal highways and local roads using contracted trucking companies and drivers.  Each truck loaded at the facility will depart for its pre-designated EDS(s) with a driver accompanied by a state police escort.   A truck may deliver assets to several communities depending on the amount to be delivered to each respective EDS.  

2.  COMMUNICATION IN TRANSIT

Each vehicle will be equipped with proper communication equipment as well as any information provided by communities to MDPH on the Emergency Dispensing Site Identification Form.  Please refer to the section entitled “Identification of Emergency Dispensing Sites” on page 2 of this document.

3.  PRIOR TO ASSET ARRIVAL AT EDS

It is critical for MDPH to have the site survey information on hand IN ADVANCE of delivery due to the sheer number of potential delivery sites. Collecting this information at the time of an incident for every EDS would not well serve either MDPH or municipalities in medicating the citizens of the Commonwealth.  Please refer to the section entitled “EDS Survey” on page 2 of this document.

The EDS must supply the personnel to off-load the assets. Due to the logistics of deliveries to potentially 500+ locations state-wide, MDPH cannot supply staff to the EDS for this purpose.  The number of personnel required to offload the assets will depend on the amount of material expected at the EDS; this can be tentatively determined from the through-put information submitted on the Emergency Dispensing Site Information Form. The through-put information remains the key factor in MDPH’s determination of the amount of assets delivered to each EDS for the first 24 hours of operation.  

4.  MATERIAL PACKAGE DIMENSIONS

One pallet of antibiotic material such as doxycycline or ciprofloxacin permits the treatment of approximately 10,000 people with a 10-day regimen.  A standard grocery pallet measures 40 x 48; MDPH warehouses will use pallets close to this size as opposed to the 72 x 48 heavy-duty stevedore pallets utilized at seaport shipping docks.  The boxes containing unit-of-use bottles of doxycycline and ciprofloxacin weigh five and seven pounds each, respectively.  The exact configuration of the pallet will depend on the amount of actual material shipped from the warehouse to the EDS.  MDPH anticipates that local personnel will not experience any difficulty in off-loading the material at the EDS.

5.  NOTIFICATION OF ARRIVAL AT EDS

MDPH will contact the site manager at the EDS (using information provided in the aforementioned EDS Identification Form) prior to delivery to provide an update.   MDPH cannot specify a time frame at which it will provide an update on delivery; the contact depends on the efficiency of asset apportionment at the warehouse and the time required to drive that EDS’ delivery route.  (More than one EDS may be serviced by any given vehicle.)  Please know that MDPH intends to give the earliest notification possible as to arrival time at an EDS.

V.  PROCEDURES FOR RECEIPT OF SNS ASSETS AT EDS

1.  ARRIVAL OF ASSETS AT EDS

The driver and the state police escort must be greeted by the site manager (or designee) and a member of the security team.  The site manager (or designee) does not need to be a municipal employee.  The security representative DOES not have to be in uniform (school security, sheriff’s employee, municipal police, contracted security, etc.) at the time of material receipt.  This security representative embodies the counterpart of the Massachusetts State Police member that will accompany each delivery vehicle.  The security representative and/or the site manager (or designee) will be sign the Transfer of Custody document for receipt of material.

MDPH will not require prior knowledge of who is to sign at each site; the only criteria MDPH requires is that a security representative and a site manager (or designee) be on hand to sign off on security for the material.  Please retain the 24/7 contact information for these individuals in the form attached at the end of this protocol document (Appendix B).  This form may be duplicated to address anticipated shift changes at an EDS and may be included as an appendix to local CEMPs. 

2.  DEPOSITING MATERIAL AT EDS FACILITY

MDPH will not specify to municipalities as to how the material is to be “broken down” and stored at the EDS – this will be done at the discretion of the site manager and the personnel at the EDS. The material will arrive in labeled case lots to make consideration of the disbursement more “user friendly.”  

MDPH highly recommends having a pallet jack or hand carts (dollies) on hand for off-loading SNS assets.  Memoranda of Agreement (MOA) may be used to secure the necessary equipment from a private company or other public entity/agency.

3.  CONFIRMATION OF MANIFEST

An inventory of the assets off-loaded will be confirmed by the manifest accompanying said assets. The manifest is not the same as the Medical Material Transfer of Custody Form; rather, this is the inventory document accounting for items actually shipped to the EDS.  The site manager (or designee) will sign the manifest to attest to the delivery.  Sealed case lots will make up the bulk of the delivery.  This should expedite the confirmation of the material delivered matching the material outlined in the manifest.

The driver and the state police escort may confer with DPH personnel at the RSS facility to resolve any discrepancies between the manifest and assets present at the EDS.

4.  TRANSFER OF CUSTODY

The Medical Material Transfer of Custody Form requires the signatures of the EDS manager (sometimes also referred to as the EDS Coordinator or EDS Director) or designee.  SNS assets will not be released without signature.  The form instructs the driver of the truck/and or the state police escort to sign the document to confirm delivery of assets to the EDS.  All fields of the form must be legibly completed.

Upon completion of the transfer of custody form, the driver and state police escort will depart the EDS.  All responsibilities and liabilities regarding the protection and proper distribution of the material now reside with the municipality.  The site manager now possesses the authority to determine the protocol for dispensation of the material to persons within his/her jurisdiction.

VI.  FACTORS TO CONSIDER 

•	Annually update Emergency Dispensing Site Identification Form(s) with MDPH.  This may be done at any time; however, MDPH will also solicit updates annually to ensure up-to-date information in the case of SNS activation.

•	Annually update MDPH with any corrections to the Emergency Dispensing Site (EDS) Survey for each EDS location so that MDPH has the necessary information about the facility in its database.

•	Cities and towns may want to contact local pharmacists to gauge their interest in participating in a local emergency response effort.  Current Massachusetts General Law stipulates that only pharmacists may dispense medication; however, in a state of emergency, the Commissioner of the Massachusetts Department of Public Health would waive this requirement in order to efficiently dispense medication to residents of the Commonwealth.  MEMA as well as MDPH would be advised as to the declaration of a state of emergency, and would take proper action to ensure that necessary regulation waivers are put in place to expedite the mass dispensing process.  Municipalities would greatly benefit from the placement of someone familiar with medication and pharmaceutical terminology at an EDS.

•	Update contact information contained in municipal EDS plan semi-annually, especially after local elections.

•	Register those identified on the Emergency Dispensing Site Identification Form on the Health and Homeland Alert Network (HHAN) for notification of public health emergencies and information pertaining to natural disasters.  Towns and cities will be responsible for determining what EDS staff requires HHAN registration, and will be responsible for registering the necessary parties with the HHAN.  It is in the best interest of cities and towns to make sure the appropriate people are registered to receive emergency notifications from the HHAN.  Please contact your MDPH Regional Coordinator should you wish for additional information on HHAN registration.

APPENDIX A     
(Complete one survey for each EDS)
Massachusetts Department of Public Health
Strategic National Stockpile Program

Date	Name of Municipality(ies) and/or other residential entity (such as university campus) served by EDS
	
Name of person completing this form
	Phone Number(s)	Email address
	
Estimated Population of this Municipality(ies)/community at its highest point: (Take seasonal changes such as student and tourist populations into account.)		
Planned Throughput per hour of this EDS: (e.g. 300 citizens per hour)
Anticipated daily hours of operation: (e.g. 24 hours or 0700-2300)		
Please check one of the following options:
•	A. I am simply updating facility or contact information and not changing the address of an EDS/SNS delivery location.	
•	B. I am registering a new active EDS address/location for SNS delivery.  
•	C. This site replaces another previously registered site.*	
*If box C is checked, below please provide the name and address of the EDS location that this replaces.  This EDS will be listed in our database as inactive and could be used if necessary during an activation.
Name and address of previously registered site:
                                                                                  _________________________________________________________	
Facility Information	
Name of EDS Facility		
Facility Street Address 		
City/Town		Zip Code		
Facility Main Phone Number (rings at facility)
	Facility Secondary Phone Number (rings at facility)	
Is at least one Dispensing Site in this municipality or a neighboring municipality compliant with the American Disabilities Act?	•	YES	•	NO	
If NO loading dock at the site, please write the physical location for an SNS delivery. (i.e. gym entrance)

Is a pallet jack available? 	•	YES
	•	NO	Are hand trucks or carts available?	•	YES
	•	NO	
Primary Site Contact 	
First Name		Last Name
		
Title/Role at site:	
•	Is this person HHAN registered?	
Work Telephone 		Other Phone/Pager 
		
Mobile Telephone 
		Email Address
		
Secondary Site Contact 	
First Name		Last Name
		
Title/Role at site:	
•	Is this person HHAN registered?	
Work Telephone 
		Other Phone/Pager 
		
Mobile Telephone 
		Email Address
		
Please send completed form to snsinfo@dph.state.ma.us or fax (617) 624-5587.

APPENDIX B	SNS MATERIAL TRANSFER OF CUSTODY

The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Emergency Preparedness Emergency Management 
250 Washington Street, Boston, MA 02108-4619

MEDICAL MATERIAL TRANSFER OF CUSTODY

----------------------------------------------------------------------------------------------------------------------
(Receiving Facility’s Name)

The Department of Public Health (DPH) hereby transfers the following medical material into the custody and control of the receiving authority listed below. By signing this form, the receiving authority acknowledges receipt of the medical material listed on the accompanying manifest.

The receiving authority accepts full responsibility for the materials entrusted into its possession and agrees to abide by the terms, conditions, and responsibilities, of all applicable agreements between the Commonwealth of Massachusetts and local authorities, as well as all applicable federal and state laws and regulations.  

Authorized Receiving Authority:	
	
_____________________________________		________________________________
Printed Name/Title						Signature/ Date

_____________________________________	
Printed Agency/Organization					

Please return this signed Transfer of Custody form as soon as you have completed your inventory. 

Any discrepancies in product received should be noted on the Packing List. 
A copy of the Packing List should accompany this form. 
Please scan this form and email it to dph-sns-info@state.ma.us or fax to: (617) 624-5587, 
attn: SNS Program. 

Contact information listed below is to be used for the following emergency dispensing site:

SITE FACILITY NAME