Appendix F: Evaluation of the National Emergency Stockpile System (NESS) – Studies
Appendix F: Domestic case studies
Department of National Defence (DND)
Information for this section was obtained from interviews, the PHAC survey, documents provided by DND and an extensive web search.
What is the mandate of DND's emergency stockpile?
The Canadian Forces (CF) has the mandate to provide its own health care in accordance with the Constitution Act, 1867, the National Defence Act and Queen's Regulations and Orders, and its exclusion under the Canada Health Act.
The Canadian Forces Health Services (CFHS) is the designated health care provider for Canada's military personnel, delivering health services at military installations across Canada and overseas. It provides health services support to operations and maintains an emergency stockpile to meet military operational requirements. In certain circumstances, civilians may also receive medical care from the CF or have access to specialized drugs in the stockpile.
The CF's Disaster Assistance Relief Team (DART) supports the Government of Canada in providing humanitarian aid and disaster relief. An emergency stockpile is maintained to support its operations.
What is in the stockpile?
Products in the medical stockpile are used to prevent CF personnel from becoming casualties, and diagnosing and treating those that do. They include specialized drugs, such as antivirals and vaccines, and medical supplies, such as gloves and masks. Special attention is given to preparing for a Chemical, Biological, Radiological-Nuclear and Explosives (CBRNE) incident or a pandemic.
Products in the non-medical stockpile include supplies such as cots, blankets and tents. These supplies are intended for deployed military personnel.
How are needs assessed?
The Canada First Defence Strategy is a policy statement that describes the CF's core missions. The Strategy, combined with other policy documents, contingency plans (CONPLANS), and global threat and risk assessments, determines operational requirements.
How is the stockpile system managed?
CFHS maintains most of its medical supplies at the Central Medical Emergency Depot (CMED). Smaller quantities are maintained at "distribution points" or "medical provisioning points." Vendor management is rarely used because many companies do not have the plans and protocols necessary to meet CF requirements for emergency distribution.
CFHS has responsibility for full life-cycle management of the medical stockpile, including logistics. There is a computerized inventory management system in place, including a mechanism for purchasing stock as it is depleted. Standing offers with medical suppliers are frequently used to replace depleted stocks.
CFHS routinely reviews its inventory to ensure it is current and disposes of inventory as required. CFHS replaces expiring drugs and medical supplies because it is not feasible to move them to other markets.
International Response: What is DART?
DART is a multidisciplinary military organization that can be deployed on short notice anywhere in the world in response to situations ranging from natural disasters to complex humanitarian emergencies.
DART is made up of about 200 CF personnel and comprises three components: engineering (water, bridges and light construction); medical treatment; and defence and security:
- Engineer Troop: Engineer Troop includes both field engineers (in the Water Supply Section, Heavy Equipment Section and Field Engineering Section) and construction engineers, to provide limited utilities and vertical construction services.
- Medical Platoon: The members of Medical Platoon operate a medical aid station, a small tented facility offering laboratory, pharmacy, rehydration, preventive medicine and limited obstetrics services. It does not provide surgical or trauma care services. The health care centre can serve 250 to 300 outpatients and 10 inpatients per day, depending on their needs.
- Defence and Security Platoon: Defence and Security Platoon is DART's source of security and general labour services.
How is DART deployed?
There is a small CMED detachment positioned in Trenton to manage and maintain the DART "kit," including drugs and medical supplies.
DART deploys outside Canada only in response to a formal request for its services, either from the affected country or from an international organization such as the United Nations. The Government of Canada bases its decisions to deploy DART on advice from the Department of Foreign Affairs and International Trade, the Canadian Expeditionary Force Command and the Canadian International Development Agency.
DART is equipped to conduct humanitarian and disaster-relief operations for up to 40 days, to bridge the gap until national and international aid agencies arrive to provide long term help. DART can deploy some, or all, of its flexible package of capabilities as the situation demands.
DART has not been deployed domestically and does not have a defined role for domestic emergencies; this may be explored further by Canada Command.
What is DND's current relationship with the Public Health Agency and the NESS?
DND has no role in the management (storage, deployment and utilization) of the NESS.
DND participates in the Public Health Agency-led Pandemic Influenza Advisory Committee and in yearly meetings with the Public Health Agency to discuss threats and risks related to the NESS and the National Antiviral Stockpile. Other ad hoc meetings are held to share knowledge and expertise on specific issues.
DND currently has a Memorandum of Understanding (MOU) with the Public Health Agency for storage of a vaccine system at the NESS, but it has not yet been implemented. DND and the Public Health Agency have undertaken joint purchasing arrangements, as well as stability testing of stockpiled products.
In its role of providing support to the Government of Canada, DND participates with other government departments, including the Public Health Agency, in planning for special events such as the 2010 Winter Olympic Games.
Opportunities for the future
Future opportunities to work with the Public Health Agency and the NESS may include mutual partnership agreements; joint procurement, particularly for expensive products such as vaccines; joint advisory committees; and knowledge sharing.
Canadian Red Cross
The Canadian Red Cross is a member of the International Red Cross and Red Crescent Movement of nationally-incorporated non-profit and humanitarian National Societies. Each operates as an auxiliary service that assists public authorities in the humanitarian field, based on the Geneva Conventions. Consistency of operations and solidarity between National Red Cross and Red Crescent Societies is achieved by adhering to seven fundamental principles: humanity, impartiality, neutrality, independence, voluntary service, unity and universality.[Link to footnote D]
What is the Canadian Red Cross?
The Canadian Red Cross operates under the 1909 Canadian Red Cross Society Act and is active in a number of humanitarian domains in Canada[Link to footnote E] and internationally, such as domestic and international disaster management health/injury prevention (e.g. swimming lessons, first aid training, Health Equipment Loan Program and Homecare Services); a Humanitarian Issues Program (reuniting individuals with their families and a Detention Monitoring Program); a Violence and Abuse Prevention Program; and promotion of International Humanitarian Law.
It is important to note that the Canadian Red Cross wishes to update the 1909 Act to strengthen the foundation of the Canadian Red Cross's activities in a legal sense, e.g. to protect the use of the Red Cross and Red Crescent emblems, and to shape a more holistic relationship with the federal government.[Link to footnote F]
Domestic disaster-management services
The Canadian Red Cross's domestic disaster management services are focused on provision of emergency social services, such as family reunification (evacuee registration, searches and inquiry matching), basic needs (food, shelter, clothing and personal needs) and information management (call-centre operations and service information). In addition to direct services, the Canadian Red Cross also provides donations management and volunteer resource management.
To support service delivery, the organization participates in planning and exercises. This work is governed by Memoranda of Understanding (MOU) with Public Safety Canada, with provinces and territories, and with over 800 municipalities. The MOUs specify areas in which the Canadian Red Cross can assist public authorities in emergency preparedness and response.
The 2006 MOU with Public Safety Canada sets out four objectives:[Link to footnote G]
- identify ways that the Canadian Red Cross can assist an emergency response
- publicly promote emergency preparedness
- participate in training and exercises
- define a common approach to emergency management (including through standards and best practices).
Working as an auxiliary to existing government services and operating under four geographical Zones, Canadian Red Cross volunteers respond to local events, most commonly by providing support for 72 hours to people displaced by house fires. Volunteers assisted 11,042 people in this way in 2009. The Canadian Red Cross has also assisted in larger regional emergencies, such as the ice storm in Ontario and Quebec (1998), the diversion of air traffic to Canada following the "9‑11" terrorist attacks in the United States (2001), British Columbia forest fires (2003) and the aftermath of Hurricane Juan in Atlantic Canada (2003). Most recently, in 2010 the Canadian Red Cross assisted 11,958 people during events such as the Gaspésie, Saskatchewan and New Brunswick floods and extreme weather in Ontario.
In addition, Canadian Red Cross volunteers responded to non-traditional disasters by providing support to people who were isolated by the Severe Respiratory Syndrome (SARS) outbreak in Toronto (2003)[Link to footnote H] and to community vaccination centres during the H1N1 outbreak (2009). In the future, the society could provide similar community-based services for epidemics of communicable diseases.[Link to footnote I]
This domestic response capacity is entirely distinct from the international rapid-response warehousing and deployment capacity that the Canadian Red Cross maintains with the support of the Canadian International Development Agency.
How does the Canadian Red Cross manage inventory?
The Canadian Red Cross has its own regionally managed, volunteer-run inventories of basic emergency social service supplies, consisting mainly of cots that are returned after use and items that are given away, e.g. comfort kits, blankets, water bottles, teddy bears, etc.[Link to footnote J]
Locally and regionally, inventory levels and locations vary according to:
- risk assessments carried out within each geographical Zone
- specific arrangements via MOU, e.g. in the case of Quebec, the Canadian Red Cross manages a stockpile on behalf of the province; in other jurisdictions there is no MOU and limited capacity where provinces may have their own stockpiles
- capacity to purchase inventory and access storage space as a result of donations.
Opportunities for collaboration
There is an opportunity to share ideas with the Canadian Red Cross on procurement arrangements with suppliers and maintaining a flexible response capacity that is appropriate to local or regional needs.
The Canadian Red Cross is also interested in furthering a "whole-of-government" approach to disaster management services, including coordination of stockpiles, through collaborative bodies at Public Safety Canada and the Public Health Agency of Canada, e.g. the Council of Emergency Social Services Directors.
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