National Health Emergency Plan

National Reserve Supplies Management and Usage Policies, 3rdedition

Citation: Ministry of Health.2013.National Health Emergency Plan: National Reserve Supplies Management and Usage Policies, 3rd edition.
Wellington: Ministry of Health.

Published in 2013 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand

ISBN 978-0-478-41569-8 (online)
HP 5772

This document is available at

This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made.

Contents

1Purpose of this document

1.1Background

1.2Nationalreservesupplies – purpose

1.3Overallpolicyobjectives

1.4Outlineofresponsibilities–Ministry

1.5Outlineofresponsibilities – DHBs

1.6Supplies–orderofuse

1.7Personsauthorisedtoreleasesuppliesforuse

1.8Releaseprocessoutline(seeappendixforflowchart)

1.9Logistics:deliveryofnationalreservesuppliesfrom bulkstores

1.10NationalreservesuppliesforPHOs,privatesector healthorganisationsandotherresponseagencies

1.11Funding,accounting,andfinancialarrangements

1.12Post-emergencyactions

2National reserve supplies usage policies

2.1Partone–usagepolicies

2.2Parttwo–supplieswithownusageandprioritisation policies

3Process flowchart

National reserve supplies management and usage policies1

1Purpose of this document

Thisdocumentdescribespolicyforthemanagementanduseofnationalreserve supplies,anddetailstheprincipalresponsibilitiesoftheMinistryandDHBsin managingandusingthesesignificantnationalresources.

1.1Background

TheMinistrymanagesand/orcontrolsanumberofnationalreserveemergency supplies.SomeoftheseareheldinDHBstores,andothersinbulkstoresoffDHB sites.

Nationalreservesupplyitems / Stored byDHBs / Stored byMinistry
P2respiratorsandgeneralpurpose masks /  / 
Personalprotectiveequipment
(aprons,gloves,eyeprotection) / 
Clinicalequipment
(syringes,givingsets,IVfluids,etc) / 
Tamiflu
(eachDHBholds200courses) /  / 
Pandemicantibiotics / 
H5N1pre-pandemicvaccine / 
Vaccinationsupplies / 
Bodybags / 
Notavailableatthistime
Pandemicvaccine / N/A / N/A

1.2Nationalreservesupplies – purpose

Nationalreservesupplystockshavebeendevelopedtoensurethatasfarasis possible,DHBsandthewiderhealthsectorhavecontinuedaccesstoessential suppliesduringlargeorprolongedemergenciesthatgenerateunusualdemandson normalhealthservicestocksorsupplychains.

DHB‘businessasusual’suppliesandsupplychaincapacityshouldbemanagedata levelabletoensureallreasonablypredictablelocaleventscanbesupportedwithout requiringadditionalresourcesfromnationalreserves.

1.3Overallpolicyobjectives

Theoverallpolicyobjectivesareto:

  • manage,prioritiseandallocatenationalreservestockstoensurethat(asfar asispossible)criticalsuppliesareavailabletosupportDHBsandthewider healthsectorduringunexpectedorlargescaleemergenciesthatgenerate unusualdemandsonnormalhealthservicestocksorsupplychains;and
  • minimiseadministrativerequirementsonDHBsandtheMinistry,bothatthe timeofanemergencyandafterwards.

1.4Outlineofresponsibilities–Ministry

  • MaintenanceofnationalreservestockpilesinMinistrystores
  • Settingandcommunicatingpoliciesforthemanagement,prioritisation, allocationanduseofnationalreservesupplies
  • Developingclinicalguidelineswhereappropriateandnecessary
  • Releaseofnationalreservesuppliesforusewhennecessaryandappropriate
  • PrioritisationandallocationofnationalreservesuppliesbetweenDHBsand/or regions
  • TransportanddistributionofbulknationalreservesuppliestoDHBs
  • Nationalsuppliesusagemonitoringandforecasting
  • Fundingnationalreservessuppliesusage;and
  • Replenishmentofnationalreservebulksupplies

1.5Outlineofresponsibilities – DHBs

  • MaintenanceandturnoverofnationalreservesuppliesheldinDHBstores
  • InternalDHBsupplyprioritisationandallocationinemergencies
  • SupportofneighbouringorregionalDHBs
  • Localandregionalsuppliesusagereportingandforecasting
  • ApplyingtotheNationalCoordinator(ordesignatedperson)forMinistry releaseofnationalreservesuppliesiforwhenappropriate
  • Allaspectsoftransport,distribution,andsecurityofsupplieswithinDHBdistricts
  • Ensuringobservationofallrelevantclinicalguidelines,usagepoliciesor nationalprioritiesdevelopedbytheMinistry
  • Ensuringappropriateandeconomicaluseofnationalreservesuppliesinall clinicalsettingsintheirdistricts;and
  • AccountingtotheMinistryforallnationalreservesupplyreceiptandusage.

1.6Supplies–orderofuse

Withtheexceptionsnotedinthedocument,nationalreservesupplieswillnotbe releaseduntilsuppliesfromothersourceshavebeendrawndown.Thismeansthat asageneralruleDHBandnationalreservesupplieswillbeusedinthefollowing order:

1.Operationalsupplies

2.Suppliesavailablefromnormalsuppliers,orheldinsupplychains

3.SuppliesabletobesourcedfromregionalDHBswithoutjeopardisingtheir emergencyresponsecapability

4.NationalreservesuppliesheldunderMinistrycontrolinDHBstores

5.NationalreservebulksuppliesheldinMinistrybulkstores

Thisexpectationdoesnotprecludetherapidreleaseofnationalreservesupplies fromanysourcewhenappropriate.

1.7Personsauthorisedtoreleasesuppliesforuse

1.TheNationalCoordinator;or

2.ApersonspecificallydesignatedbytheNationalCoordinatorforthisrole.

1.8Releaseprocessoutline(seeappendixforflowchart)

Ingeneral,ahealthemergencyrequiringthereleaseofnationalreservesupplieswill beknowntotheMinistryandthesectorbeforeanactualreleasebecomes necessary.ThismeansthattheNationalHealthEmergencyPlan(NHEP)willhave beenactivatedtoanappropriatelevelandtheNationalHealthCoordinatingCentre (NHCC)willhavebeensetupintheMinistry.

TheNationalCoordinator(orapersonspecificallydelegatedbytheNational Coordinator)isresponsiblefortheprioritisationandreleaseofnationalreserve supplies.DHBsshouldproactivelydiscusstheirsupplysituationandanypotential requestsforthereleaseofnationalreservesupplieswiththeNationalCoordinatoror otherdelegatedperson.Whereregionalcoordinationisoperating,thediscussion with theMinistryshouldbecoordinatedatregionallevel.

InputsintotheMinistry’sreleaseandallocationdecisionswillincludethenatureand volumeofrequestedsupplies,otherknownorlikelysupplyrequests,thelocal, regionalandnationalemergencystatus,nationaland/orinternationalintelligenceand forecasts,stockusage,andstockavailability.

Requestsforsupplieswillneverbeunreasonablydeclined,butDHBsandregions shouldappreciatetheMinistry’sresponsemusttakeintoaccountanationaloverview ofthewholecountry’sneedsandrequirements,aswellasthoseofindividualDHBsor regions.

1.9Logistics:deliveryofnationalreservesuppliesfrom bulkstores

Suppliesmobilisedfromnationalreservebulkstoreswillbedeliveredtoacentral DHBlocationidentifiedandadvisedbytheDHB.Thedefaultlocationwillbethe DHBmainstoreorpharmacyasmostappropriate.

TheMinistrywillarrangethetransportfromthebulkstores,andpayalltransport chargestothecentralDHBlocation.

OncedeliveredtoaDHB,alltransportandsecurityofsupplieswithinDHBdistricts willbeaDHBresponsibility,andmadeatDHBcost.

1.10NationalreservesuppliesforPHOs,privatesector healthorganisationsandotherresponseagencies

PrimaryHealthOrganisations(PHOs),privatesectorhealthorganisationsandother responseagenciesareresponsibleforprovidingasafeworkingenvironmentfortheiremployees(asareallotheremployers)andshouldmakeallnecessaryprovisionsto ensuretheiremployees’safetyinanyhealthemergency.Somehealthsector-specificadviceandguidancecanbefoundintheNewZealandInfluenzaPandemic ActionPlan(NZIPAP),andintheHazardousSubstancesIncidentHospital Guidelines,2005.

Aprolonged,unusual,orverylargehealthemergencymaycausesupplydifficulties forPHOandprivatesectorhealthorganisations,aswellasDHBs.Intheinterestsof continuedemergencyresponsedeliveryitmaybeappropriateforsupporttobe providedfromnationalreservesupplies.

AnyPHOs,privatesectorhealthorganisationsandotherresponseagencies requestingassistancewithsuppliesmustdosothroughtheirlocalDHB.DHBs shoulddrawdowntheirownsuppliestomeettheserequestsbeforerequesting Ministryreleaseofnationalreservesuppliesforthispurpose.

Thegeneralorderofprioritiesfordistributionofavailablenationalreservesuppliesto organisationssuchasPHOs,privatehealthpracticesand/ornon-healthagenciesin emergenciesis:

1.Healthorganisationsessentialforthecontinueddeliveryofthehealthservice responsetotheemergency,suchasthoseprovidingCommunity-Based AssessmentCentreservicesduringapandemic

2.Healthorganisationsessentialforthecontinueddeliveryofnon-emergency healthserviceresponses,suchas thosecontinuingtoprovideday-to-day‘businessasusual’servicedeliveryduringanemergency;and

3.Non-healthorganisationsessentialtosupportthecontinueddeliveryofcritical servicesduringahealthemergency.

Theprioritisationaboveshouldnotbeinterpretedasaguaranteeofsupply assistancetoanyagenciesororganisations,butratherindicatestheprioritisation hierarchythatwillbeappliedwhilesuppliesremainavailable.

Distributionofanynationalreservesuppliesprovidedforprivatesectorhealth organisationsandnon-healthresponseagencieswillbemadebyandthroughthe relevantDHBs.

1.11Funding,accounting,andfinancialarrangements

DHBswillneedtoaccounttotheMinistryforallnationalreservesuppliesdrawnfromDHBorMinistrystoresusingreporttemplatesdevelopedbytheMinistry.

Definitiveaccounting,financialandfundingarrangementswillbeadvisedatalater date.

TheMinistrywillfundtheuseofnationalreservesaspartofoverallemergency responsefunding.

1.12Post-emergencyactions

Post-emergencyactionswillbedevelopedasappropriatetothespecificsituationand thesuppliesconcerned.

Withoutpre-emptingdecisionstobemadeatthetime,itislikelytheMinistrywillwish torecoveranyunusedsuppliesissuedfromnationalreserves.DHBsmaynot dispose ofanyunusednationalreservesupplieswithoutobtainingpriorMinistry approval.Notethatinsomesituations,suchasapandemic,somenationalreserve suppliescouldbeofusetoothercountriesshouldtheynolongerbeneededinNew Zealand.

TheMinistrywillassesstheneedfor,andarrangeanynecessaryreplenishmentof nationalreservesupplies.

2National reserve supplies usage policies

Thissectionisdividedintotwoparts.Partonedealswiththosesuppliesforwhich thisdocumentprovidestheusagepolicy.Parttwodealswiththosesuppliesfor whichseparatepolicydocumentsexist,orarebeingdeveloped.

2.1Partone–usagepolicies

2.1.1P2respiratorsandgeneralpurposemasks

Nationalreserverespiratorandmaskstockpileswillbemobilisedinhealth emergenciesiforwhennormalsupplychainscannotmeetdemands.TheMinistry willexpectthegeneralorderofuseofsuppliesnotedabovetohavebeenfollowed beforereleasingsuppliesfromDHBorbulkstores.

RequestsforP2respiratorormasksuppliesshouldbeconsistentwithusage guidelinesintherelevantNZIPAPsection,NHEPInfectionPreventionandControl document,orwiththetypeandnatureoftheemergency.

2.1.2Otherpersonalprotectiveequipment(PPE)andclinical equipment

Thesesuppliesconsistofgowns,gloves,IVfluids,givingsets,andassociatedclinicalequipment.Thestockpileswillbemobilisedinhealthemergenciesiforwhen normalsupplychainscannotmeetdemands.

TheMinistrydoesnotholdbulksuppliesoftheseitemsoffDHBsites.Allnational reservesuppliesoftheseitemsareinDHBstores.

2.1.3Pandemicantibiotics

Incaseofaninfluenza(orother)pandemic,nationalreservepandemicantibioticswill bereleasedforuseiforwhenpatientvolumesandresultingantibioticdemandsmakethisappropriateandnecessary.

High-volumeantibioticuseisnotanticipatedotherthanduringthe‘manageit’phase ofaninfluenzapandemic.TheMinistrymayissueclinicalguidelinesforantibiotic use basedonepidemiologyfromoverseasorNewZealandexperience.

TheMinistrydoesnotholdbulksuppliesofantibioticsoffDHBsites.Allnational reservesuppliesoftheseitemsareinDHBstores.

2.1.4Vaccinationsupplies

Nationalreservevaccinationsuppliesconsistofvaccinationsyringeswith incorporatedneedlesandsharpsbins.Theyareintendedtosupportpre-pandemic andpandemicinfluenzavaccinationcampaigns,andwillbemobilisedforthis purposewhennecessary.

AllnationalreservevaccinationsuppliesareheldinMinistrybulkstores.These suppliesarenotheldonDHBsites.

Althoughboughtaspartofthepandemicinfluenzaprogramme,supplieswouldbe mobilisedshouldanothermass(non-influenza)emergencyvaccinationprogramme berequired.

2.1.5Bodybags

Largenumbersofdeathsoverashorttimecouldexceedthecapacityofnormal servicestodisposeofdeadbodieswithinareasonableorculturallyacceptable timeframe,ortosafelystorethemuntildisposalispossible.Thissituationcould resultfromaverylargeearthquakeortsunami,aswellasa pandemic.

Bodybagswillassistinmanagingaverylargemasscasualtyeventbyprovidinga culturallyacceptablealternativetocoffinsforburials,and/orreadilyenablingfrozen storageofthedeaduntilnormaldisposalsystemscanmeetdemands.

TheMinistryholdsNewZealand’sonlylargesupplyofbodybags,inbulkstoresoff DHBsites.Theywillbereleasedforuseasfirstresponsesuppliestosupporthealth serviceandotheragencies’responsesduringorafteraverylargemasscasualty event.

Forinformation,currentpolicyallowsforpartofthestockpiletobemobilisedin supportofoverseasreliefoperationsaftermasscasualtyeventsinthePacificregion.

2.2Parttwo–supplieswithownusageandprioritisation policies

2.2.1Tamiflu

Each DHB holds 440 treatment courses of national reserve Tamiflu. These courses are authorised for immediate use should a suspected or confirmed case of human H5N1 influenza be found. With the exception of some ready-use supplies held in major centres, all other national reserve supplies are held in bulk stores.

DHBs generally do not hold significant additional stocks of Tamiflu beyond the 440course allocation. Accordingly national reserve stocks will be mobilised and made available as first response supplies in case of a pandemic or threatened pandemic.

If there is sufficient warning from overseas developments, the Ministry may distribute Tamiflu as a precautionary measure against future needs. Please see the latest available ‘Sector distribution notes’ version for details.

2.2.2H5N1pre-pandemicvaccine

This vaccine will be released for use by the Director-General when needed, taking into account the situation overseas and in New Zealand, and the advice of the Director of Public Health. Please see the separate H5N1 pre-pandemic vaccine policy for details and operational issues.

2.2.3Pandemicvaccine

Pandemic vaccine will not be available for some time after the recognition of a pandemic. DHBs will be advised of anticipated delivery and release dates.

Mass vaccination programme guidelines containing more details about deliveries, priorities, and logistics will be developed.

National reserve supplies management and usage policies1

3Process flowchart

National reserve supplies management and usage policies1