User-Managed Inventory: An Approach to Forward-Deployment of Urgently Needed Medical Countermeasures for Mass-Casualty and Terrorism Incidents

Abstract

<jats:title>ABSTRACT</jats:title><jats:p>The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use (“dual utility”) and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.</jats:p><jats:p>(<jats:italic>Disaster Med Public Health Preparedness</jats:italic>. 2012;6:408-414)</jats:p>

Surge Capacity Logistics

“…Regional stockpiles of critical medical supplies (particularly those used routinely and those that are likely to be required before outside supplies can arrive) at multiple medical facilities can be used to enhance critical care surge preparedness. 9 Critical care surge capabilities rely on support from pharmacy, laboratory, radiology, respiratory therapy, and nutrition services; hence, these should be included in all plans. Critical care experts should discuss with their pharmacy and central supply the quantities that should be readily available and determine arrangements should these supplies become exhausted.…”

Radioprotectors and Radiomitigators for Improving Radiation Therapy: The Small Business Innovation Research (SBIR) Gateway for Accelerating Clinical Translation

“…The current RRP-SBIR effort for advanced development of radiation-effect modulators serves as a model for a pipeline involving basic research (R01), targeted solutions for specific societal needs (MCMs and diagnostics) and reducing risk for small businesses by providing government support that can be targeted to a topic when needed and aiming for dual-utility, thereby enhancing the likelihood of commercial success (47). …”

“…On the other hand, if an agent is in routine use in the radiation oncology clinic, its stockpile and inventory can be far better managed in the event of an emergency. The agent will always be available and there will be familiarity in managing and using such a product (47). Therefore, at the NCI, the RRP and the SBIR Development Center partnered to fill a funding gap to bring in a much desired synergy among academia, government, small businesses and potentially the pharmaceutical industry to facilitate the development of agents for preventing and/or mitigating the adverse effects of radiation therapy in cancer patients through this specific FOA.…”

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE)

“…MCMs that have dual utility for routine clinical care are sought wherever possible to leverage the clinician's familiarity, as well as to reduce costs and increase supply chain availability. 12 In these ways, the CBRNE science approach addresses both the complexity and the need for a depth and breadth of knowledge in pursuing an effective MCM enterprise.…”