TABLE 1—

Technical Assistance Review Core Functions: United States, 2007 and 2014

TAR Function	Description	Composite Score Weight %a
Developing a plan with SNS elements	A comprehensive, written plan is essential for facilitating the receipt, distribution, and dispensing of SNS assets quickly and efficiently. This plan should be incorporated as part of a state’s comprehensive emergency operations plan.	3
Management of the SNS	The way a state, region, or community manages its response to a public health emergency is considered a program management and command and control function.	10
Requesting SNS	The decision to deploy SNS assets will be a collaborative effort among local, state, and federal officials. It will start at a local level when officials identify a potential or actual situation they believe has the potential to threaten the health of their community. SNS assets are requested from the CDC by the affected state’s governor. Alternatively the state may request assets from HHS.	3
Communications plan (tactical)	The availability of robust and redundant communication systems is critical to coordinating response functions during an emergency. Effective and timely communications between emergency response staffs, operation centers, receiving sites, points of dispensing, and hospitals will be needed to meet and resolve the demands of a mass distribution and dispensing emergency.	3
Public information and communication	During an emergency when MCM assets are to be dispensed to the public, effective and timely public health communications are needed to ensure the public is informed and guided to appropriate locations to receive them.	7
Security	The security of MCM and safety involved in the receipt, distribution, and dispensing operations is essential. The arrival and transport of scarce resources will be newsworthy and may draw attention from persons unwilling to wait for the organized dispensing of prophylactic or treatment medicines.	10
Receipt, stage, and store (state)	The size, location, and characteristics of warehouse facilities used to receive, stage, and store MCM are important factors that will determine the effectiveness of an emergency response. The CDC has established minimum criteria for sites designated to receive, stage, and store federal assets from the SNS. The development of distribution strategies, site-specific plans, and the assignment and training of staff will determine the ability of jurisdictions to meet the demand for the distribution of assets to local populations.	14
Regional or local distribution site (local)	The size, location, and characteristics of warehouse facilities used to receive MCM from the state to distribute them to the identified local population are important factors that will determine the effectiveness of an emergency response. The CDC has established minimum criteria for regional and local sites designated to receive and distribute federal assets received from the state.	14
Inventory management	State and local jurisdictions must possess a robust inventory management system to monitor the receipt of MCM, track their distribution, and record dispensing during a public health emergency. SNS inventory must be properly apportioned and configured in the quantities necessary for the point of dispensing and health care facilities to successfully respond in an emergency.	8
Repackagingb	In the past, a significant amount of planning and preparation was required to repackage bulk oral drugs contained in the SNS before dispensing them to the public. Much of that effort is no longer necessary because the majority of oral medicines in the SNS now come in prepackaged unit of use regimens.	2
Distribution	Distribution is the physical delivery of SNS assets from the RSS facility to dispensing sites, treatment centers, and regional distribution sites. States are responsible for developing distribution networks that account for challenges and barriers unique to their areas.	10
Medical countermeasure dispensing	Dispensing planning is designed to provide initial prophylaxis to 100% of the population within 48 h and should be flexible and scalable so that the infrastructure built for meeting this capability can be used for any incident as part of an all hazards plan.	24, 22b
Hospitals and treatment centers coordination	A large-scale emergency event can happen quickly and overwhelm available resources at hospitals and other acute care providers. This function stresses the need for and measures the degree of coordination among public health, emergency management, and hospitals or alternative care sites to manage and respond to materiel needs at health care facilities.	3
Training, exercise, and evaluation	This function serves to highlight and document the development of emergency response training and exercise and evaluation programs that are compliant with guidelines set forth by HSEEP. Emergency response exercises are intrinsic to the transition of plans to operational response.	10

Note. CDC = Centers for Disease Control and Prevention; HHS = Department of Health and Human Services; HSEEP = Homeland Security Exercise and Evaluation Program; MCM = medical countermeasure; RSS = receipt, stage, and store; SNS =  Strategic National Stockpile; TAR = technical assistance review.

^aTAR weights generated by SNS staff.

^bApplies only to the state TAR; MCM dispensing weight adjusted by 2% to accommodate additional repackaging function.