Who You Gonna Call? Responding to a Medical Emergency with the Strategic National Stockpile

Prior to the terrorist attacks of September 11, 2001 and the subsequent anthrax attacks, the Strategic National Stockpile (SNS), known as the National Pharmaceutical Stockpile until March 2003, was an important component of the national medical response to a crisis, but one that had not yet been tested in a real emergency. That changed in the fall of 2001. Since the terrorist attacks against the World Trade Center buildings and the Pentagon, and the later anthrax episodes, the cost of the SNS has grown from a roughly $50 million asset to one worth more than $600 million. The SNS is designed to supplement state and local public health agencies in the event of a biological or chemical terrorism incident anywhere and at any time in the United States or its territories. Federal authorities do not consider the stockpile a first response tool. Rather, its purpose is to bolster the response of a state or city government to a biological or chemical attack or other medical emergency that requires additional resources. The SNS is managed jointly by the Departments of Homeland Security (DHS) and Health and Human Services (HHS). Its use is coordinated through the Centers for Disease Control and Prevention (CDC), one of the major operating components of HHS. The stockpile comprises 12 separate "push packages," each capable of reaching its designated destination within 12 hours of DHS authorization. Each push package includes caches of pharmaceuticals, antidotes, and medical supplies designed to provide a broad spectrum of assets in the early hours of an event. The push packages are positioned in strategically located, secure warehouses and delivered by commercial, express carriers. Additional, specially tailored supplies known as vendor managed inventory (VMI) can follow within 24 to 36 hours of an event. This paper reviews the history and current status of the SNS, provides an overview of its role in incident response, and reports on the testing of SNS deployment in recent terrorism exercises. The paper also explores some of the regulatory and legal issues that surround the use of the SNS and examines the dependence of the U.S. military on SNS supplies during crisis and consequence management support to civilians in the United States.