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State ESF-8 Operational Planning Unit
Operations Order: Guidelines for dispensing federal and state stockpiles of oseltamivir
to private medical practices, hospitals, and other healthcare facilities.
Date: 05 May 2009 Version 6.0
References:
Mission Order No:
SITUATION
Threat: A previously unidentified (novel) strain of H1N1 influenza has emerged and
presently is circulating in both the United States and other parts of the world. The origin
of the outbreak has been identified as Mexico City with an index case onset date of 13
March 2009.
The state has received a portion of the allocation of oseltamivir and zanamivir for
treatment and post-exposure prophylaxis.
There is no current availability of oseltamivir and zanamivir in retail pharmaceutical
outlets or the retail outlets are experiencing distribution shortages that will be remedied
over a short time period.
The state has moved to community mitigation protocols to reduce the disease burden in
the state.
Validation:
1. A patient meeting the current CDC case definition upon investigation by the CHD 2. High risk contact as defined in the state mitigation strategy. 3. Healthcare worker as defined in guidance.
Current Public Health and Medical Resources:
1) The new variant has shown to be sensitive to oseltamivir and zanamivir.
Assumptions:
1) The novel virus has efficient person to person spread. The current threat level is 2) There is currently a very limited supply of oseltamivir and zanamivir in private EXECUTION
Mission success is defined as providing the appropriate number of therapeutic or
prophylactic antiviral regimens to the public and private healthcare sector through the
County Health Department to fully execute the protocol within no more than 48 hours of
request.

Concept of Operations: The mission will be conducted in four phases.
Phase 1. The Bureau of Pharmacy conducts surveys of the supply chain of the
antivirals from production to distribution to the retail market. Delays in the supply chain
will be assessed and the duration of the shortage calculated.
It is the intent to resume normal dispensing and billing practices of the retail market as
soon as possible; however, patient and contact management are the highest priority.
The state role is to provide emergency overall supplies when indicated, and to provide
courses to those persons lacking other resources to receive the medication.
Bureau of Pharmacy will notify the County Health Department (CHD’s) that the alternate
dispensing chain is in effect through Incident Command.

Phase 2. The medical practice or healthcare facility will request of the County Health
Department in the appropriate jurisdiction the number of courses of oseltamivir to treat
the patient and the high risk contacts associated with that case. It is recommended that
the CHD name two people (one primary, one backup) to handle these requests. It is
further recommended the primary be the CHD’s Strategic National Stockpile (SNS)
planner with the backup designee briefed on the SNS ordering procedures.

Phase 3. Upon validation that the case and contacts meet the mitigation strategy,
CHD’s will provide the patient or the medical practice with the appropriate regimens for
the case from the stockpile allocation provided to them.
Phase 4. Bureau of Pharmacy will resupply the CHD as appropriate.
Coordinating Instructions
The County Health Department, healthcare providers, and facilities will utilize the
protocol for community mitigation to assist in determining the persons meeting the
definition of high risk.

SUPPORT SERVICES
Administration: As provided in the Pan Flu Plan Version 11.2.

Finance: None. Facilities and practices receiving this product cannot bill the patients or
contacts receiving these Federal supplies.
Logistics: As provided for in the Logistics Plan for this event
COMMAND AND COMMUNICATIONS:
.Bureau of Pharmacy will provide Situation awareness on the pharmacy aspects of this
order thorough the Incident Command.
The CHD’s will provide information relative to cases and contacts through the Merlin
module

Source: http://www.floridaarf.org/vendorimages/floridaarf/Antiviral-Guidelines-5-5-09.pdf