Michigan's Upper Peninsula (UP) can be fairly isolated and inaccessible during the winter due to heavy snowfall and inclement weather conditions. The main transportation route between the UP and the Lower Peninsula is the Mackinac Bridge, which is often closed for safety reasons during the winter. Another way used to access the UP during an emergency or for search and rescue purposes is via Michigan's Civil Air Patrol (CAP), an auxiliary of the Air Force comprised of civilian volunteers.
- Unsafe transportation. Transporting countermeasures, medications, or other necessary supplies to the UP during a winter public health emergency could be extremely difficult.
- Bridge unavailability. During times of severe winter weather and/or wind, the Mackinac Bridge (the only intrastate mechanism for ground transportation between Michigan's lower and upper peninsulas) is closed.
- Unpredictability of available partners and delivery timeline. Depending on the scale of an emergency, government and commercial partners may be unavailable or unable to assist with delivering supplies to the UP in a timely fashion. When Michigan is not in a State of Emergency, deliveries of antivirals to the UP may take up to two weeks.
The Michigan Department of Community Health (MDCH) developed a process to partner with the CAP to distribute emergency countermeasures to the UP in the event of a public health disaster.
During a health emergency, the Michigan Community Health Emergency Coordination Center (CHECC) is charged with supplying medical countermeasures to local health departments and hospitals, focusing extensively on areas with high need. To ensure rapid delivery during an emergency, MDCH maintains a distribution plan that incorporates government, military, volunteer, and private-sector agencies. To address transportation difficulties and road safety/accessibility, however, MDCH established a partnership with more than 40 in-state CAP squadrons in 2008.
During the height of the 2009-2010 H1N1 outbreak, CAP squadrons assisted MDCH with delivering antivirals to local health departments and medical coordination centers (MCCs) in the UP. Prior to the emergence of H1N1, MDCH and CAP squadrons had exercised CAP's ability to act in this role by testing its abilities to:
- Follow pharmaceutical chain-of-custody procedures across state and local jurisdictions
- Rendezvous with state staff to load and transfer custody of medical countermeasures
- Maintain aircraft cabin temperatures necessary for the transport of medications
- Ensure that redundant technologies were in place for communications occurring in flight and on the ground
- Facilitate cross-training between CAP and CHECC personnel so that roles, responsibilities, and functions were clear
What made this practice possible?
- Grant funding in the form of cooperative agreements from the US Air Force and the US Department of Defense that allowed the CAP to conduct training, exercises, and emergency operations.
- A formal written request process and close relationships ensured quick approval between the time the Michigan Strategic National Stockpile (SNS) coordinator requested CAP assistance and the time that the mission was assigned by the Air Force at the National Operations Center.
- A CAP representative was included in the CHECC, which allowed for greater situational awareness and closer collaboration. Because communication between the two agencies was so efficient, CAP could change flight routes or update the CHECC with current data as quickly as needed.
- Two exercises held the year before H1N1 emerged gave partners an idea of what to expect with the antiviral distribution process. Training provided CAP volunteers, local health department staff, and CHECC staff with a level of comfort and confidence in the effectiveness of this means for transporting assets.
- During H1N1, the CAP distributed 7 shipments of antivirals to the 6 local health departments and 1 MCC in the UP.
- CAP squadrons demonstrated that they are a useful and reliable public health resource for delivering medications and supplies when other forms of transportation are unavailable or unsafe.