Mass Prophylaxis/Immunization Point of Distribution (POD) Sites. Essex Regional Health Commission

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1 Mass Prophylaxis/Immunization Point of Distribution (POD) Sites Essex Regional Health Commission

2 What is Mass Prophylaxis/Vaccination? The preventative treatment of exposed or potentially exposed individuals to a disease agent. This is different from treating patients who are already sick.

3 Point of Distribution Sites (PODs) A Mass Prophylaxis/Immunization campaign is carried out through the activation of Point of Distribution (POD) sites.

4 Point of Distribution Sites (PODs) continued. A POD can be defined as, a site or area where medications or vaccinations can be mass distributed to large numbers of people in the event of a naturally occurring disease outbreak or a bioterrorist event. The number and size of such dispensing sites is determined by the occurring event.

5 POD Site Activation In the event that mass distribution of medication or vaccines to a specified population is deemed necessary by State and Local Officials, supplies will be requested from the Centers for Disease Control (CDC) of the Federal Government. The CDC will deliver supplies to the state and from there they will be made available to the County and subsequently to the affected area. PODs will be activated to distribute medication

6 Activating the SNS & SSS SNS = Strategic National Stockpile SSS = State Strategic Stockpile

7 Activating the SNS & SSS The SNS is maintained at sites around the nation by the CDC. After an emergency is declared, a State s Governor may request assets from the stockpile. CDC will deliver those assets to the Receiving and Storage Site (RSS) designated by the State s plan.

8 Activating the SNS & SSS New Jersey also maintains its own strategic stockpile under the NJ department of Health and Senior Services. Assets of this stockpile (pharmaceuticals) will be available more quickly than the Federal SNS.

9 Activating the SNS & SSS Public health employees at the LINCS agency (ERHC) and NJDHSS routinely monitor reports of Influenza-Like-Illness from schools, hospitals, and long-term care facilities. Additionally, sales of medications for flu-like symptoms from pharmacies are tracked.

10 Activating the SNS & SSS ILI monitoring information is shared among local, county, and state health agencies and hospitals. Dangerous increases in ILI will, most likely, be noted first by Local Health Departments or the County LINCS agency. These ILI increases will be reported to the NJDHSS for action and reported to the affected county and municipal Offices of Emergency Management (OEM).

11 Activating the SNS & SSS When an increase in ILI is discovered that might indicate a terrorist initiated outbreak or a epidemic, NJDHSS will notify State OEM and confer with county, local, and federal agencies to determine the best course of action.

12 Activating the SNS & SSS If it is determined that an outbreak is occurring, the governor will be advised by the State OEM and NJDHSS to declare a state of emergency, release the assets of the SSS, and request federal aid in the form of pharmaceuticals from the CDC and SNS.

13 Activating the SNS & SSS Upon activation, CDC will deliver federal assets to New Jersey s RSS within 12 hours. SSS supplies will be prepared for distribution and will be delivered to county RSS while we are waiting for the SNS.

14 Activating the SNS & SSS SSS and SNS pharmaceuticals will be distributed from the county RSS to Municipal sites according to three plans: First Responder Distribution Plan (emergency workers) Fixed Facility Distribution Plan (hospital employees, large business, school employees) Point Of Distribution Site Plan (general public)

15 Medication Distribution Plans First Responder Plan Calls for prophylactic pharmaceuticals to be distributed to emergency workers (PD, FD, EMT, DPW, OEM) and their families within 24 hours at the EMS site Fixed Facility Plan Calls for Pharmaceuticals to be distributed to major employers, hospitals, emergency relief organizations, etc. for re-distribution to their employees/volunteers and their families at the employers site.

16 Medication Distribution Plans Point Of Distribution (PODs)Plan Calls for pharmaceuticals to be distributed to the general population at a community site (e.g. school).

17 Public Information Campaign A public information campaign regarding a mass prophylaxis clinic would begin immediately after a public health emergency occurs. Provides the public with current information about the incident, steps to take if exposed to the agent, the medical regimen, Provides information regarding appropriate people who should come for the medicine, the clinic locations, hours of clinic operation, and information to bring about their medical history ( e.g. known medication allergies ).

18 Prophylactic Medications The oral medications that are most often used for prophylaxis during a bioterroism include: Doxycycline Ciprofloxacin

19 Possible Flow Plan of a POD

20 JEM Method (Justified Emergency Mass Prophylaxis) Different than the Point of Dispensing (POD) Model previously taught in JCOEM CERT classes Being tested by the NJDHSS Fewer Staff (~27 people vs. 80 people) not including Security Higher Throughput (2000 dose regimens per hour vs 1000 dose regimens) JEM still allows for Head of Household pickup

21 JEM POD Assistance Needed 4 people Reception/Triage 4 people Evaluation/Distribution 2 people 1 SUPERVISOR Evaluation/Distribution 2 people Evaluation/Distribution 2 people Evaluation/Distribution 2 people Evaluation/Distribution 2 people Education Area 2 people EXIT 1 person Assumptions: 72,000 population 20 staff Two 16 hour shifts/day 5 Lines: 400/hour throughput

22 Drive Thru POD Forms (CERT) Registration/Education Station (Police/CERT) Distribution Area Vehicle Lane Vehicle Lane Vehicle Lane Vehicle Lane Traffic Control Medical Consultation (RN)

23 Why use a Drive-through Distribution POD? More accessible for elderly population and those with disabilities No parking allows for better traffic flow High throughput Promotes inter-agency cooperation in providing high quality and effective services

24 Overall Goal of the POD The goal is to have the appropriate pharmaceuticals in the hands of the targeted population within 48 hours.

25 The Screening (Triage)Area Participants sorted into three groups: Ill participants Non eligible participants Eligible participants

26 Registration Area (MRC Role) The participant completes a registration form that will be carried with the participant throughout the whole process. The registration covers person and household members ( i.e. the person may pick up for entire family ).

27 Special Needs Area (MRC Role) Staffed by medical personnel (MD or pharmacist). For anyone with medical conditions or on medications for which the prophylactic medication may be contraindicated. Alternative prophylactic medication is considered. Those who do not speak English or have handicaps would be helped here.

28 Distribution Areas (MRC Role) Ideally would be staffed by health care personnel Preventative medication is administered/distributed Information about the medication and/or how to take the medication is also given.

29 POD Clinic Staffing Staff will be rotated by 8 or 12 hour shifts. Fifty to one hundred fifty volunteers may be needed to staff a POD. The number of participants that can be treated through a properly staffed POD is estimated to be: 1000 participants per hour for oral antibiotic distribution 500 participants per hour for influenza vaccine 250 participants per hour for anthrax or small pox vaccinations

30 Support Services Needed in a POD Clinic Inventory Controller Oversees inventory management and reordering/restocking of clinical and non-clinical supplies. POD monitors Assist traffic flow inside and outside of the POD. POD runner Assists staff at POD workstations. Check-in Register workers and verify clinical credentials.

31 Support Services Needed in a POD Clinic Security staff Ensures security and order in assigned area. Hospitality & Housekeeping Maintain clean workstations & public areas Maintain adequate supplies of food and drink Replenish bathroom supplies. Communication technicians Oversee the technological needs of the POD Assist with set-up of audio-visual and other equipment

32 Potential Difficulties in Applying the Plan It can be expected that approx 1/3 of volunteers will be available when needed. So we must be prepared for the eventuality that there may not be an adequate number of volunteers available in the case of a public health emergency.

33 Strategies for Overcoming Difficulties Make the best use of volunteers who may not be licensed health care professionals for distributing oral medications. Can be done because in an public health emergency, standing orders will be given by the CDC & DHSS. Volunteers will receive just-in-time training.

34 Essex County T3 POD Nutley,NJ

35 Historical Success Mass Smallpox Vaccination New York City, 1947 ~5,000,000 persons vaccinated in a two week period (AP Photo/Tony Camerano)

36 QUESTIONS?

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