In the event that refrigeration storage conditions are compromised, measures ensuring a swift response can prevent the loss of thousands of dollars in wasted medications. The CDC’s Vaccine Storage & Handling Toolkit is a comprehensive document that provides detailed guidance on best practices for storing and handling vaccines. (See: http://www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf.)The toolkit also includes a downloadable Emergency Resources Contact List, which makes it easy to centralize all necessary contact information. It is imperative to create a written Emergency Vaccine Retrieval and Storage Plan that details the response steps in the event of an emergency, such as a unit malfunction, a power failure, or a natural disaster. The written plan should be reviewed with all relevant staff (including security and custodial staff), stored in an easily accessible location near the refrigeration units, and updated annually.

Designate a Vaccine Coordinator
Assign a vaccine coordinator (and one or two back-up coordinators) to oversee all vaccine issues, from policy and procedure (P&P) development to emergency management. In this role, the coordinator is responsible for a variety of tasks, from tracking weather conditions that could impact vaccine storage to ensuring sufficient fuel is on hand to continuously run back-up generators. As such, this person must be detail oriented and have a clear understanding of the cost and value of vaccine stock. Proximity of the coordinator’s home to the facility may be a consideration. 

Create a Moving Plan
Each unit that stores vaccines must have a moving plan ascribed to it for both refrigerated and frozen vaccines. Thus, it only makes sense to apply a moving plan to every refrigeration unit containing medications in your facility. Keep on hand sufficiently qualified, insulated containers; packing materials (eg, bubble wrap); and coolant packs to transport the maximum amount of inventory stored in each unit. Likewise, include the source for these materials and attendant contact information in the written plan. Provide calibrated temperature monitoring devices to accompany each container during the move, as documented temperature maintenance throughout the entire transport process is imperative. Consider purchasing portable refrigerators and freezers to ensure cold chain maintenance throughout transport, depending on the level of the emergency. 
In the event of a wide-scale emergency that requires packing and transporting medications to a separate location, additional staff may be required. The vaccine coordinator should pre-designate appropriate staff members and include their contact information in the Emergency Resources Contacts List. A transport P&P should be written identifying the vehicles and drivers that will be used. It is important to note that medications should never be transported in a car trunk, given the extreme temperature fluctuations therein. 

The secondary location also should be established in advance. Consider other hospitals, LTC facilities, commercial pharmacies, Red Cross, or fire departments that have a back-up generator. Map primary and alternate routes to the location and plan for 24-hour access. 

Short-term Power Outage
Should a refrigerator temporarily malfunction or experience a short-term power loss (<2 hours), if the room temperature is not extreme, and there are water bottles in the refrigerator and coolant packs in the freezer, the temperature will probably be maintained as long as the door remains closed. Tape off the unit, provide signage, and notify staff members not to open the unit. Once power is restored, check the temperature readings to determine if the unit went out of range. At this point, the value of a monitoring device that provides temperature readings without needing to open the unit door becomes immediately apparent.