Point of Dispensing Staff Orientation

1. Point of Dispensing Staff Orientation

2. Session Overview POD basics POD management POD roles and responsibilities Preparing to work at a POD The four sessions of today�s discussionThe four sessions of today�s discussion

3. Learning Objectives After completing this module, you will be able to describe: The purpose of a Point of Dispensing (POD) The general structure and operations of public health PODs How you can prepare yourself and your family for your working in a POD

4. POD basics

5. What Is Mass Dispensing? Dispensing a vaccine, antibiotic or other medication quickly to a large group of people. Community members Hospital staff & patients Point of Dispensing (POD) � a location where mass dispensing occurs Describe push pods / pull pods Some mass dispensing planners in the state are considering other models of mass dispensing, such as postal delivery, but this course is focused on PODs. Nevertheless much of the information presented on training mass dispensing staff would be relevant when using other models. Describe push pods / pull pods Some mass dispensing planners in the state are considering other models of mass dispensing, such as postal delivery, but this course is focused on PODs. Nevertheless much of the information presented on training mass dispensing staff would be relevant when using other models.

6. Why would a POD be activated? Usually: To prevent disease in those exposed to an infection but who are not yet sick Possible: To treat an infectious disease The treatment offered would be limited to dispensing a specific medication.

7. What Kinds of Emergencies Might Require a POD? Natural disaster Influenza pandemic Bioterrorism attack Natural disaster - After the flooding caused by Hurricane Katrina along the Gulf Coast, a number of people received emergency vaccines against diseases like Hepatitis A at mass dispensing sites. An act of terrorism - Certain people who worked in places where anthrax- contaminated envelopes were received in fall 2001 were given antibiotic to prevent them from developing anthrax. A naturally occurring epidemic of infectious disease - To protect the public during an influenza pandemic the government may use PODs to dispense vaccines or to treat people who are sick with antiviral medications . Natural disaster - After the flooding caused by Hurricane Katrina along the Gulf Coast, a number of people received emergency vaccines against diseases like Hepatitis A at mass dispensing sites. An act of terrorism - Certain people who worked in places where anthrax- contaminated envelopes were received in fall 2001 were given antibiotic to prevent them from developing anthrax. A naturally occurring epidemic of infectious disease - To protect the public during an influenza pandemic the government may use PODs to dispense vaccines or to treat people who are sick with antiviral medications .

8. What is the Strategic National Stockpile ? A large CDC-managed stockpile of medicine and medical supplies to protect the American public if there is a public health emergency severe enough to cause local supplies to run out. Imagine the number of doses of medication or vaccine that would be need if a whole community were exposed to infection. In [jurisdiction X] that would mean dispensing to [NN,NNN] people. Local supplies would probably not be sufficient. That is why the Strategic National Stockpile was created. The medicine in the SNS is FREE for everyone. The SNS has stockpiled enough medicine to protect people in several large cities at the same time. Federal, state and local community planners are working together to ensure that the SNS medicines will be delivered to the affected area to protect you and your family if there is a terrorist attack or natural disaster. Imagine the number of doses of medication or vaccine that would be need if a whole community were exposed to infection. In [jurisdiction X] that would mean dispensing to [NN,NNN] people. Local supplies would probably not be sufficient. That is why the Strategic National Stockpile was created. The medicine in the SNS is FREE for everyone. The SNS has stockpiled enough medicine to protect people in several large cities at the same time. Federal, state and local community planners are working together to ensure that the SNS medicines will be delivered to the affected area to protect you and your family if there is a terrorist attack or natural disaster.

9. Strategic National Stockpile Components Push Pack/12 Hours Vendor Managed Inventory/ 24-36 hours The SNS program is comprised of two possible deliveries in response to an event. Components to a Two-Tiered Response: 12-Hour Push Packages: Ready for deployment to reach designated area within 12 hours of Federal activation Pre-positioned in environmentally controlled and secured facilities Pre-configured for rapid identification and ease of distribution Vendor Managed Inventory: �Tailored" to provide specific materiel depending upon suspected or confirmed agent Will be shipped to arrive within 24 and 36-hour periods From private pharmaceuticals and vendors The SNS program is comprised of two possible deliveries in response to an event. Components to a Two-Tiered Response: 12-Hour Push Packages: Ready for deployment to reach designated area within 12 hours of Federal activation Pre-positioned in environmentally controlled and secured facilities Pre-configured for rapid identification and ease of distribution Vendor Managed Inventory: �Tailored" to provide specific materiel depending upon suspected or confirmed agent Will be shipped to arrive within 24 and 36-hour periods From private pharmaceuticals and vendors

10. SNS Responsibilities SNS Send medications / vaccines Provide technical assistance State and Local governments Demonstrate need for supplies Receive, stage, store and return supplies Dispense at community PODs Hospitals Receive, store and return supplies Dispense to at hospital PODs

11. For the purpose of preparedness planning and response, the State has been broken down into 5 regions referred to as Department of Emergency Management and Homeland Security regions. Planning for mass dispensing done by health departments, jurisdictions and hospitals occurs on this regional level. For the purpose of dispensing to the community, there are 41 mass dispensing regions made up of one or more health departments For the purpose of preparedness planning and response, the State has been broken down into 5 regions referred to as Department of Emergency Management and Homeland Security regions. Planning for mass dispensing done by health departments, jurisdictions and hospitals occurs on this regional level. For the purpose of dispensing to the community, there are 41 mass dispensing regions made up of one or more health departments

12. Blue Spot Fever Scenario In January a new infectious disease emerged called �blue spot fever.� At first, the disease seemed to be limited to a few isolated cases. However, as more cases were identified, it became clear that the disease was spreading. By May, the disease appeared in several regions of the eastern United States. Scientists with the US Centers for Disease Control and Prevention (CDC) have determined that blue spot fever spreads easily from person-to-person in respiratory droplets created while coughing or sneezing and is potentially fatal. However, certain medications called �antispotics� seem to provide effective protection if given within a few days of contact with an infected person. Throughout this presentation we will be presented a scenario that should help you to gain a practical understanding of how a POD works. It is called the Blue Spot Fever Scenario. [Read aloud so trainees follow the story]Throughout this presentation we will be presented a scenario that should help you to gain a practical understanding of how a POD works. It is called the Blue Spot Fever Scenario. [Read aloud so trainees follow the story]

13. Blue Spot Fever Scenario

14. How Will a POD Be Set Up? The layout of a POD is designed to facilitate accurate and rapid dispensing of a specific medication/vaccine Basic POD floor plan Variation Situation Local circumstances A POD is not designed to represent a general treatment facility The layout of a POD is meant to facilitate rapid dispensing of a specific vaccine or antibiotic During actual events the floor plan of a POD will vary depending on local circumstances and the situation that created the need for a PODA POD is not designed to represent a general treatment facility The layout of a POD is meant to facilitate rapid dispensing of a specific vaccine or antibiotic During actual events the floor plan of a POD will vary depending on local circumstances and the situation that created the need for a POD

15. POD layout - The general layout of a POD - People are only removed out of the POD�s normal flow to if unable to safely take the medicine and to encourage rapid movement through the POD - The general layout of a POD - People are only removed out of the POD�s normal flow to if unable to safely take the medicine and to encourage rapid movement through the POD

16. Where will PODs be located? PODs locations must be : Appropriate size and layout Can be secured Accessible Identify a facility large or area of hospital large enough to handle the population and maintain rapid movement Security is important to protect supplies and control the large number of people as well as secure entry and exit into and out of the building Convenient location to ensure easy access Community POD � parking, public transportation, good road access, wheel chair accessible Hospital � convenient for employees Identify a facility large or area of hospital large enough to handle the population and maintain rapid movement Security is important to protect supplies and control the large number of people as well as secure entry and exit into and out of the building Convenient location to ensure easy access Community POD � parking, public transportation, good road access, wheel chair accessible Hospital � convenient for employees

17. Blue Spot Fever Scenario The POD planners in your Mass Dispensing Area are concerned that the large number of people expected to come to the POD could cause severe traffic congestion. Therefore, they chose to locate the POD at a school that was right off the highway and away from the center of town. They also made sure that local police officers are available to assist with automobile traffic flow in the surrounding area. To ensure the safety and security of POD workers and attendees, they chose a site where security officers can control movement into the clinic. Example of the considerations put into actionExample of the considerations put into action

18. How will a POD be staffed? It takes many people to run a POD Number and mix of skills on depends on situation Source of staff Public health and hospital staff members Other first responders Volunteers Representing many professions, disciplines, agencies, and backgrounds. First responders that will be involved in POD operations include police officers, fire fighters, emergency medical services personnel and health care personnel. PODs will be staffed by a diverse group of people representing all ages, races, occupations, and skills.First responders that will be involved in POD operations include police officers, fire fighters, emergency medical services personnel and health care personnel. PODs will be staffed by a diverse group of people representing all ages, races, occupations, and skills.

19. POD management

20. How will POD operations be managed? Using the Incident Command System which is part of the National Incident Management System (NIMS). In compliance with: with good emergency response practice federal requirements Time and crisis tested It takes getting used to. Started with the Fire ServiceIt takes getting used to. Started with the Fire Service

21. ICS Mass Dispensing POD Org Chart

22. Blue Spot Fever Scenario Successful dispensing of antispotics to the population within a short period of time requires clear command, control and coordination of human resources and materials. Therefore, all PODs, including the ones in your Mass Dispensing area, are being managed using the Incident Command System. �During the Blue Spot Epidemic successful dispensing���During the Blue Spot Epidemic successful dispensing��

23. Blue Spot Fever Scenario At the beginning of the Blue Spot POD operation the scene seems a little chaotic.

24. POD roles and responsibilities Now we shall discuss the roles and responsibilities of POD workers. Now we shall discuss the roles and responsibilities of POD workers.

25. How Will You Know When and Where to Respond? If you are needed, you will be: contacted by a designated person in health department or hospital given specific information about where and when to report On site, you will report to the staff sign-in area where you will be given an assignment

26. How Long Will You Be Working in the POD? Shifts are usually 8-12 hours The POD will be in operation until the mission has been achieved A POD will be in operation until completion of prophylaxis for the MDAA POD will be in operation until completion of prophylaxis for the MDA

27. What Should You Bring ? Bring as little as possible Bring Photo identification � required POD Go Pak Specific equipment, as requested � e.g. stethoscope Food will be provided to you while you work at the POD. There will not be much room to store personal items A Go Pack (prepared in advance) contains�There will not be much room to store personal items A Go Pack (prepared in advance) contains�

28. Blue Spot Fever Scenario At the time of this epidemic, you are called on to work at a POD. Given the large number of people who need prophylaxis you are asked to serve several shifts over a 48 hour period. You commit to serving at the POD. You are told to report to a designated site near the selected POD location at 8:00am. You are told to bring your driver�s license for identification. When you arrive at the designated site you sign-in and receive an ID badge. Once everyone is signed-in a bus takes you, and the other POD workers, to the POD site.

29. How Will You Know What to Do When You Arrive at the POD? Job Action Sheet Just-in-time training You will first be assigned a specific job The job action sheet will describe your responsibilities You will receive just-in-time training before you begin your shiftYou will first be assigned a specific job The job action sheet will describe your responsibilities You will receive just-in-time training before you begin your shift

30. Job Action Sheet Job title Job mission To whom you report Tasks to perform

31. Just-in-time Training The training delivered at the time of an incident Focused on providing the knowledge and skills you need to fill your role - -

32. How Will You be Assigned a Role ? Incident Commander or designee will assign a role based on Your skills Needs of the operation You may be re-assigned as the needs of the operation change Roles are not an assessment of your skills Give examples ( a nurse may work in medical screening or greeting)Roles are not an assessment of your skills Give examples ( a nurse may work in medical screening or greeting)

33. The jobs required to run a POD are many and varied. All roles are important to the success of the POD. Volunteers can provide essential services both in a medical and non-medical capacity. Professional public health staff will be present to provide the expertise and skills to support clinic functions. The jobs required to run a POD are many and varied. All roles are important to the success of the POD. Volunteers can provide essential services both in a medical and non-medical capacity. Professional public health staff will be present to provide the expertise and skills to support clinic functions.

34. Blue Spot Fever Scenario When you and the other POD workers arrive at the POD site you are given just-in-time training as a group. The training includes information on Blue Spot Fever and the set up and organization of the POD including arrangements for security, food and breaks. You are a registered nurse. You have received training on being a smallpox vaccinator. However, at this POD medication, not vaccine, is being dispensed. You are assigned to work as a Triage Officer and given a job action sheet for the role. Your supervisor is the Triage Unit Leader. This is an example of different roles one professional may be able to performThis is an example of different roles one professional may be able to perform

35. After the group training session, you go to the Triage Unit. Your supervisor gives you and the other Triage Officers just-in-time training on your role as described in your job action sheet. You review the form you will be using to perform triage. You don�t understand one of the questions. You ask your supervisor and she explains the question to you. Blue Spot Fever Scenario

36. How Will You be Protected? Vaccination or medication being dispensed before the POD opens Supply and training on appropriate personal protective equipment Safety officer always present Facilities for food & rest - Personal protective equipment includes gowns, gloves, mask, goggles - Personal protective equipment includes gowns, gloves, mask, goggles

37. Dealing with stress Working at a POD may be a stressful Monitor self and others for signs of stress and fatigue POD attendees and co-workers may vent anger. Don�t take it too personally. Mental health workers will be available on site. Report any serious problems to supervisor

38. What are signs of stress and fatigue? Lack of concentration Increased number of non-critical errors Critical errors Irritability Worry Feeling ill In yourself and fellow POD workers signs of stress and fatigue might include the following� In yourself and fellow POD workers signs of stress and fatigue might include the following�

39. Blue Spot Fever Scenario Before the clinic is open you, and the other POD workers, are given antispotics. It appears that the organism that causes Blue Spot Fever can be spread by respiratory droplets from coughs or sneezes. POD workers who interact closely with members of the public have been told to wear masks.

40. Blue Spot Fever Scenario You notice that some of the triage officers are wearing their masks on the top of their heads rather than over their nose and mouth. You suggest that they wear it properly but they continue to wear them on their heads. You tell your unit leader. The Safety Officer is informed about the situation and stops the movement of patients to Triage until the Triage Officers put on their masks. Later on you notice that a fellow Triage Officer is making critical errors and appears to be experiencing extreme anxiety. You tell your Unit Leader who arranges for that Triage Officer to have a break and meet with a Mental/Behavioral Health Specialist.

41. What Are Ethical Guidelines for Working in a POD? Treat members of the public with fairness and respect Courtesy Confidentiality No favoritism or discrimination Don�t spread rumors Honor your commitment to work at a POD until the mission is complete. Your fellow staff members and the public are relying on you.

42. What Do You Do When It's Time to Leave? Your supervisor will tell you when your shift is complete When leaving your supervisor may ask you to: brief him/her turn in a report or equipment Always check out at the staff desk any time you leave a POD

43. What Do You Do When It's Time to Leave? Your supervisor will also tell you when the mission is complete and your service is no longer needed You will be asked to participate in a debriefing called a �hot wash�

44. After 4 days you are told that the POD is shutting down. It has achieved its mission of providing antispotics to the members of your community and therefore saving lives. You participate in a hotwash so that lessons can be learned from the strengths and weaknesses of the operation. You are thanked for your service to your community. Blue Spot Fever Scenario

45. Preparing to work at a POD Prepare now so you are well prepared when you are called to serve at a PODPrepare now so you are well prepared when you are called to serve at a POD

46. How Can I Be Ready to Serve? Have a family preparedness plan Participate in available training & exercises Be prepared to work under the Incident Command System Be sure your employer has your current contact information Prepare a POD go pack You do not want to be distracted by concerns at home Training is important to be prepared in case an emergency situation arises Be familiar with the organization of the POD and hierarchyYou do not want to be distracted by concerns at home Training is important to be prepared in case an emergency situation arises Be familiar with the organization of the POD and hierarchy

47. Communication with household members Care for dependent elders, children and pets Home security Household medication needs Transportation needs

48. Photo identification List of Contact number for your family Medications Personal hygiene items (hand sanitizer, toothbrush, toothpaste If deployed away from home Pillows / blankets Clothing First aid supplies Cell phone charger POD Go Pack List of essentials to have prepared in a waterproof bag before an emergency List of essentials to have prepared in a waterproof bag before an emergency

49. Where Can You Get Additional Training? Consult your POD trainer TRAINConnecticut Online library of courses http://ct.train.org CT training plan for POD workers CT offers training for POD workersCT offers training for POD workers

50. Conclusion A POD is established to dispense a vaccine, antibiotic or other medication quickly to a large group of people usually to prevent disease The clinic flow is intended to maximize movement through the POD PODs are managed using the Incident Command System Imperative of acting quickly and accuratelyImperative of acting quickly and accurately

51. Conclusions Each POD worker will be assigned a specific role which will be described in a Job Action Sheet Safety of POD workers is paramount Plan and train now to be an effective POD worker

52. Acknowledgements Materials derived from course entitled �Working in a POD� developed by the New York Consortium for Emergency Preparedness Continuing Education (NYCEPCE). The CT DPH and Yale CPHP are grateful to those who provided material for the course, especially the NYCEPCE for sharing their course content. The development of this course was supported by CDC Cooperative Agreements No. U90/CCU124251-01 and No. U90/CCU116996

53. Acknowledgements (cont.) Additional material included in the course came from: Connecticut Association of Health Directors. Orientation to Connecticut Mass Dispensing Clinics Parts 1 & 2. Centers for Disease Control and Prevention. Strategic National Stockpile web site. http://www.bt.cdc.gov/stockpile/ FEMA IS Course Material Download: IS-100 Introduction to Incident Command System, I-100. FEMA IS Course Material Download: IS-100 Introduction to Incident Command System, I-100. http://www.training.fema.gov/EMIWeb/IS/is100lst.asp POD training materials from the Connecticut Health Departments/Districts of Manchester, Ledge Light and Eastern Highlands. Virginia Department of Health, Emergency Preparedness and Response Programs. Unit 1 � Dispensing / Vaccination Site Training University of Minnesota Center for Public Health Preparedness. Mass Dispensing Sites: A Primer for Volunteers. http://www.sph.umn.edu/umncphp/massdisp/home.html

54. Questions ?????????