1/ @man_integrated the following is a conversation w/an MD friend of mine regarding SNS, VMI, ICS & NIMS.

This might be a bit long. So Once More with Feeling let's educate the masses!

2/ There are 2 parts of the SNS. The first is the medicine part which includes NS, LR atropine, vasopressors and other “emergent” lifesaving meds. Along with ABX & vaccines like smallpox. The second part is the Vendor Managed Inventory.

3/ VMI is the equipment piece such as ventilators, respiratory equipment, beds, PPE, and other supplies geared to help hospitals surge when their capabilities & capacity is overwhelmed.

4/ VMI is kept in warehouses and can’t be touched until the Stafford Act is exercised under an emergency declaration as part of ESf 8. Once that happens Governor’s may request support.

5/ The problem currently is that not all of the VMI was replaced after H1N1. Was that an oversight or failure of HHS & CDC to prioritize the VMI b/c the stockpile wasn’t touched? Did the Vendors rotate the stock out for use & not replace it b/c it hadn’t really been used?

6/ Were contracts not renewed after 2009-2010? Not sure we’ll ever find out. We’re supposed to have enough VMI to handle a surge across the entire country. Same for the SNS as well.

7/ MD asked me the following question: “How much better off would we be if we hadn’t used up stocks in H1N1 or if it had been replaced?”

8/ My response: I think it’s a multifactorial problem. 1st the SNS & VMI were initially designed to respond to a biological/chemical attack given the incident uptick in the late 90s by offshoot groups.

9/ The SNS & VMI were established for a different type of response in a single concentrated area. I’m not sure the planners/modelers at HHS/CDC thought something like this could/would happen. Even with the most recent exercise run by JH we really didn’t think this would happen

10/ IMO the impact of H1N1 was complacency b/c the EVENT wasn’t as disastrous as it was predicted to be. As a result, both Feds & State didn’t really consider it necessary to restock.

11/ HHS/CDC/DHHS Leadership probably gave the Obama Administration recommendations to replenish on a staggered supply chain allowing for utilization of assets on other priorities for the administration.

12/ You see this all the time across DOD, DOS, and other agencies. They essentially rob Peter to pay Paul at a given point in time hoping the bill never comes due. Unfortunately, that bill came due and we don’t have the ability to pay it.

13/ What’s unfortunate is that the hotwash after this is over will recommend a bunch of changes that most likely won’t be implemented b/c something bigger will come up that will need to be addressed & the $$$ set aside to address the gaps will be diverted to the new threat.

14/ I’ve seen this too often working supply chain/logistics across DOD, HHS, & DOS. And it really applies across all agencies/cabinet positions when it comes to budgeting and execution of $$$.

15/ We also have a problem that very few people in government (federal, state, & local) do not understand National Incident Management System (NIMS) and the Incident Command System (ICS); nor how how response is executed to an event.

16/ Part of that is due to irregular use of ICS and NIMS b/c we only use it during disasters or planned events like the Olympics.

17/ The only agency who regularly executes ICS effectively & efficiently is the National Interagency Fire Center (NIFC). This is b/c it’s their system. Only Local Fire/Police/EMS understand it and how to employ it b/c they utilize it when they respond to events at the local level

18/ This isn’t something that is easily conveyed to the average citizen or member of Congress. They expect a DOD type response when that’s not how it works.

19/ All responses are managed and executed at the Local level by Fire/EMS/Police & other emergency responders depending on the event. When those resources capabilities & capacities are overwhelmed, they ask the State for assistance.

20/ The state sends personnel & resources. Part of those resources should include activation of the National Guard. If/when those State assets capabilities & capacities become overwhelmed the Governor of the State can request Federal aid.

21/ What most people don’t understand about this response framework is that for the Stafford act to be leveraged National Guard must be activated before the Feds can respond. Which was one of the reasons the Feds didn’t respond as quickly.

22/ The Feds have to wait for all the boxes to be check. This is to ensure the Federal gov’t doesn’t overextend its power and allow State to maintain their power/responsibility.

23/ Once those boxes have been checked & the Stafford act is executed then federal funds can start flowing to States. It’s the responsibility of the Sates to use said funds to execute their response and flow funds/resources to localities.

24/ The States not the Federal Gov’t is responsible for using the Stafford funds to secure necessary equipment and materiel. Currently there seems to be an issue with how the VMI is being distributed.

25/ The materiels are being managed by a “clearing house” that’s pitting States against States. This is not how this was set up & it appears that the company/companies that have the contracts for distribution of VMI is taking advantage of the situation to make a profit.

26/ When I set up the VMI we had a list of vendors & manufactures who reserved material from their normal stocks that couldn’t be distributed until the Stafford Act was executed.

27/ These vendors also were required to rotate said stock to ensure the longest expiration date remained in the VMI. I would hope that CDC continued this practice, but they could have cut corners. I don’t know.

28/ My experience running logistics response for HHS Office of Emergency Preparedness during 9/11 was they were ill prepared to execute ESF 8. They’re not as effective or efficient as DOD in logistics operations during a disaster. So, I’m not surprised with the HHS/CDC response

29/ There are very few loggies within HHS/CDC organizations. Most are doctors, nurses, scientists, researchers & epidemiologists. The majority of these don’t understand how logistics works. So, management of something large like the SNS and VMI would be challenging.

30/ The pharmacists w/in CDC are probably best suited to manage the SNS & VMI b/c of their awareness of expiration dates, lot # & drug recalls. Regardless, it’s a huge lift for someone who isn’t a logistics professional by trade. Can it be done? Yes. But things will be missed.

31/ There is so much to unpack here. The majority don't understand what it takes to manage & move stuff. Nor do the understand how to do it during a disaster. Yet they expect everything INSTANTLY in the days of Amazon Prime delivery. Folks this isn't normal ops.

Obligatory dog photo. Trooper is disappointed in the lack of tennis balls being thrown.