Bioterror.004b.doc

Appendix III
Procedure: Weapons of Mass Destruction: Code Black
Dispensing of Antibiotic Prophylaxis for SAH Associates – see form Appendix III
1.
A Code Black notification is in effect; a biologic event has been identified. Pharmacy associates have been notified by the Command Center that antibiotic prophylaxis of associates is required. Doxycycline is the drug of choice for antibiotic prophylaxis; other alternative antibiotics are ciprofloxacin and amoxicillin (See Pharmacy Department Emergency Response Plan Appendix IA, and Appendix III) Designated pharmacy associates will locate and obtain the oral antibiotics from the Code Black rolling shelves (also the small plastic zip lock bags, approximately 2 inches X 4 inches). A designated pharmacy technician or pharmacist will prepare the labels for the antibiotics. Packages of preprinted labels are located on the rolling shelves with the antibiotics, OR will be prepared on the Pharmacy Sidetrack Computer Program. These labels will require the lot number/manufacturer/expiration date code entered prior to dispensing. Pharmacy associates will prepare individual packets of 72 hours of the above-specified antibiotics in plastic zip lock bags. Estimated numbers: doxycyline 3000, ciprofloxacin 1500, amoxicillin 500. Pharmacy associates will assist with the dispensing and distribution of the antibiotics in a location designated by the Command Center. Each SAH associate that desires antibiotic prophylaxis will complete a screening questionnaire and be directed to the medication distribution station. Pharmacy associates or Employee Health associates will review the screening questionnaire and dispense the appropriate medication. 10. The associate will show their badge and sign for receipt of the medication on the antibiotic dispensing Emergency Response Pharmacy Plan – Bioterrorism Antimicrobial Doses Distribution/Dispensing
Emergency Response Pharmacy Plan – Bioterrorism Antimicrobial Doses Distribution/Dispensing
Emergency Response Pharmacy Plan – Bioterrorism Antimicrobial Doses Distribution/Dispensing
Emergency Response Pharmacy Plan – Bioterrorism Antimicrobial Doses Distribution/Dispensing
Emergency Response Pharmacy Plan – Bioterrorism Nuclear, Biologic, Chemical Terrorism Readiness Plan – Code Black
References: Biologic Terrorism
•
Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon: Medical and public health management. JAMA 2001; 285:1059-70 Borio L, Inglesby T, Peters CJ, et al. Hemorrhagic fever viruses as biologic weapons. JAMA 2002; 287:2391-2405 CDC: Smallpox vaccine adverse events among civilians – United States, February 18-24, 2003. MMWR 2003; 52:156-7 CDC: Smallpox vaccination and adverse reactions, Guidance for clinicians. MMWR 2003; 52:1-29 CDC: Follow-up of deaths among United States postal service workers potentially exposed to Bacillus anthracis, District of Columbia 2001. MMWR 2003; 52:937-8 CDC: Use of anthrax vaccine in response to terrorism: Supplemental recommendation of the advisory committee on immunization practices. MMWR 2002; 51:1024 CDC: Update: Investigation of bioterrorism related anthrax adverse events from antimicrobial prophylaxis. MMWR 2001; 50:973-6 CDC: Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR 2001; 50(no.42) CDC: Biological and chemical terrorism: strategic plan for preparedness and response. MMWR 2000; 49(no. RR-4) CDC: Update: investigation of anthrax associated with intentional exposure and interim public health guidelines, October 2001. MMWR 2001; 50:889-93; MMWR 2001; 50:909-19 CDC: Recognition of illness associated with the intentional release of a biologic agent. October 2001. MMWR 2001; 50:893-7 Charatan F. US plans drugs stockpile to counter bioterrorism threat. BMJ 2000; 320:1225 Franz DR, Jahrling RB, Friedlander AM, et al. Clinical recognition and management of patients exposed to biological warfare agents. JAMA 1997; 278:399-411 Gage KL, Dennis DT, Orloski KA, et al. Cases of cat-associated human plague in the western US, 1977-1998. Clin Inf Dis 2000; 30:893-900 Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in Yersinia pestis mediated by a transferable plasmid. N Engl J Med 1997; 337:677-80 Henderson DA, Inglesby TV, Barlett JG, et al. Smallpox as a biological weapon: Medical and public health management. JAMA 1999; 281:2127-37 Inglesby TV, Henderson DA, Barlett JG, et al. Anthrax as a biological weapon: medical and public health management. JAMA 1999; 281:1735-45 Inglesby TV, Dennis DT, Henderson DA, et al. Plague as a biological weapon: medical and public health management. JAMA 2000; 283:2281-90 Inglesby TV, O’Toole T, Henderson DA, et al. Anthrax as a biological weapon 2002. JAMA 2002; 287:2236-52 Johns Hopkins University, Center for Civilian Biodefense Studies: fact sheets Migden D. Bubonic plague in a child presenting with fever and altered mental status. Ann Emerg Med 1990; 19:207-9 Ratsitorahina M, Chanteau S, Rahalison L, et al. Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar. Lancet 2000; 355:111-13 Terriff CM, Tee AM. Citywide pharmaceutical preparation for bioterrorism. Am J Health-Syst Pharm 2001; 58:233-7 Wetter DC, Daniell WE, Treser CD. Hospital preparedness for victims of chemical or biological terrorism. Am J Public Health 2001; 91:710-16 References: Chemical Terrorism
•
Potassium iodide as a thyroid-blocking agent in radiation emergencies. U.S. HHS, FDA, CDER. December 2001, Rockville, MD Medical Response to Chemical Warfare and Terrorism, Medical Management of Chemical Casualties Handbook. USAMRICD, 3rd Edition, 1998, Aberdeen Proving Ground, MD Metropolitan Strike Team Medical Treatment Protocols (For Clinical Settings) Medical Aspects of Chemical and Biological Warfare. Editors Sidell FR, Tukafuji ET, Franz DR. Borden Institute, Walter Reed Army Medical Center, 1997, Washington, D.C Organization for the Prohibition of Chemical Weapons (OPCW). FAO Briefing Book on Chemical Weapons. 1992, Stockholm, Sweden Gorman S. Preparing for the unthinkable, chemical terrorism. CDC. Supplemental Education Resources and Abstracts, 2004 ASHP Midyear Clinical Meeting. Harrison S, Blair P. The CHEMPACK project: A strategic national stockpile initiative. Virginia Department of Health, Emergency Preparedness and Response Programs. 05/16/04

Source: http://mshp.org/document/AppIIDispensingProphyBioTerror.004.pdf