Point of Dispensing POD Staff Orientation

1. Point of Dispensing (POD) Staff Orientation  What You Should Know Welcome and thank you for coming to this talk for Point of Dispensing staff. During this talk I will be referring to point of dispensing clinics as PODS. Welcome and thank you for coming to this talk for Point of Dispensing staff. During this talk I will be referring to point of dispensing clinics as PODS.

3. Overview Points of Dispensing Strategic National Stockpile Incident Command System POD Operations Preparing to Work at a POD Additional Training Resources Information on the Upcoming SNS Exercise

4. What is a POD? A site where medications or vaccines intended to prevent disease may be given quickly to a large number of people in the event of a public health emergency. The preventive therapy may be an antibiotic or a vaccination. The public health emergency could be a naturally occurring or terrorism-related outbreak that might be caused by smallpox, anthrax, plague, botulism, tularemia or influenza. A POD may also be called a mass dispensing clinic. A POD is not medical setting where disease in treated. Sick people should not come to a POD. If they do, they will either be turned away before entering the POD and told to see a doctor or they will be transported to the hospital by ambulance if appropriate. The preventive therapy may be an antibiotic or a vaccination. The public health emergency could be a naturally occurring or terrorism-related outbreak that might be caused by smallpox, anthrax, plague, botulism, tularemia or influenza. A POD may also be called a mass dispensing clinic. A POD is not medical setting where disease in treated. Sick people should not come to a POD. If they do, they will either be turned away before entering the POD and told to see a doctor or they will be transported to the hospital by ambulance if appropriate.

5. Public Health Emergency That May Require a POD Many people have been exposed to an infection that may make them sick AND Disease from that infection may be prevented by antibiotics or a vaccine The infection may be naturally occurring or bioterrorism-related Vaccine or antibiotic preventable diseases that may result in a POD include smallpox, anthrax, plague, botulism, tularemia or influenza. The infection may be naturally occurring or bioterrorism-related Vaccine or antibiotic preventable diseases that may result in a POD include smallpox, anthrax, plague, botulism, tularemia or influenza.

6. All CT Local Health Departments Have Been Asked: To contribute to the: Development of plans to rapidly establish and operate CT PODs Recruitment and training of POD staff. PODs may be set up in schools, town halls or other community facilities. POD staff will include public health and safety professionals and volunteers. A very large number of volunteers will be needed to run a POD PODs may be set up in schools, town halls or other community facilities. POD staff will include public health and safety professionals and volunteers. A very large number of volunteers will be needed to run a POD

7. Connecticut is divided into 40 Mass Dispensing Areas, may of which cover more than one health district/department. Within the MDA one health district/department takes the lead and the others collaborate with the lead. Connecticut is divided into 40 Mass Dispensing Areas, may of which cover more than one health district/department. Within the MDA one health district/department takes the lead and the others collaborate with the lead.

8. Strategic National Stockpile Medical supplies, drugs, and equipment. The strategic national stockpile is a US Centers for Disease Control and Prevention managed source of medical supplies, drugs and equipment that may be used during an activation of a POD. The strategic national stockpile is a US Centers for Disease Control and Prevention managed source of medical supplies, drugs and equipment that may be used during an activation of a POD.

9. Strategic National Stockpile � What Is It? A large 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. 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. 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.

10. Strategic National Stockpile Components 12 Hour Push Package Vendor Managed Inventory 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: Are comprised of pharmaceuticals and supplies that are delivered from one or more VMI sources �Tailored" to provide specific materiel depending upon suspected or confirmed agent Will be shipped to arrive within 24 and 36-hour periods 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: Are comprised of pharmaceuticals and supplies that are delivered from one or more VMI sources �Tailored" to provide specific materiel depending upon suspected or confirmed agent Will be shipped to arrive within 24 and 36-hour periods

11. Incident Command System (ICS) Key to efficient operation and good communication flow

12. What is the ICS ? Standardized Can be applied to a wide variety of emergencies Basic features Common terminology in �plain talk� Modular organization (easy to grow or shrink) Management by objectives Reliance on an Incident Action Plan Chain of Command Unified Command Manageable span of control The need for Common Terminology will be examined below Modular organization will be examined in the next slide An Incident Action Plan specifies objectives and activities to be completed within a specified period of time. A Chain of Command is an orderly line of authority within the ranks of the incident management organization. Unified Command provides guidelines that enable agencies with different legal, geographic and functional responsibilities to coordinate, plan and interact effectively. Span of Control is the number of individuals or resources that supervisor manages. Ideally the number of subordinates does not exceed 5. The need for Common Terminology will be examined below Modular organization will be examined in the next slide An Incident Action Plan specifies objectives and activities to be completed within a specified period of time. A Chain of Command is an orderly line of authority within the ranks of the incident management organization. Unified Command provides guidelines that enable agencies with different legal, geographic and functional responsibilities to coordinate, plan and interact effectively. Span of Control is the number of individuals or resources that supervisor manages. Ideally the number of subordinates does not exceed 5.

13. Each POD in CT will be organized using an incident command system (ICS) . This is a basic depiction of the ICS. Incident Commander: Responsible for all activities and functions. Assesses need for staff. Establishes incident objectives. Directs staff to develop an Incident Action Plan. Information Officer: Advises Incident Commander on information dissemination and media relations. Obtains information from and provides information to planning section, community and the media. Safety Officer: Advises Incident Commander on incident safety. Works with Operations to ensure safety of personnel. Liaison: Assists Incident Commander by serving as point of contact for agency representatives who are helping to support the operation. Provides briefings and answers questions for supporting agencies. Sections: Operations: Conducts tactical operations to meet objectives (in this case getting vaccine or pills into a large number of people in a short period of time). Logistics: Provides support, resources, services to meet operational objectives. Planning: Prepares and documents the Incident Action Plan to accomplish objectives. Evaluates information. Finance/Administration: Provides accounting, procurement, time recording and cost analysis. Each POD in CT will be organized using an incident command system (ICS) . This is a basic depiction of the ICS. Incident Commander: Responsible for all activities and functions. Assesses need for staff. Establishes incident objectives. Directs staff to develop an Incident Action Plan. Information Officer: Advises Incident Commander on information dissemination and media relations. Obtains information from and provides information to planning section, community and the media. Safety Officer: Advises Incident Commander on incident safety. Works with Operations to ensure safety of personnel. Liaison: Assists Incident Commander by serving as point of contact for agency representatives who are helping to support the operation. Provides briefings and answers questions for supporting agencies. Sections: Operations: Conducts tactical operations to meet objectives (in this case getting vaccine or pills into a large number of people in a short period of time). Logistics: Provides support, resources, services to meet operational objectives. Planning: Prepares and documents the Incident Action Plan to accomplish objectives. Evaluates information. Finance/Administration: Provides accounting, procurement, time recording and cost analysis.

14. ICS � Bottom Line Each person at the POD has a specific and limited job Each person within a POD reports to only one designated person Each POD supervisor has a specific and limited number of positions reporting to him or her Refer issues to your supervisor or other personnel as appropriate. A person�s rank in the agency for which he or she usually works does not apply within the incident command structure. Refer issues to your supervisor or other personnel as appropriate. A person�s rank in the agency for which he or she usually works does not apply within the incident command structure.

15. Job Action Sheet: Job Title Job Mission Supervisor Name Immediate Duties On-going Duties Extended Duties When you work at a POD you will be provided with a Job Action Sheet describing your job. This document includes your job title, mission, supervisor and duties to perform. It will describe any equipment that you need to use such as safety or communication equipment. When you work at a POD you will be provided with a Job Action Sheet describing your job. This document includes your job title, mission, supervisor and duties to perform. It will describe any equipment that you need to use such as safety or communication equipment.

16. Internal POD Communication Communication flow should follow the chain of command Your communication role in POD operations will be described in your Job Action Sheet Plain talk � no codes or acronyms Communication equipment Radio, cell phone, whistles, bull horn, walkie talkie Clinic managers will ensure internal clinic communications are tested prior to opening Make sure you know how to use any communication equipment assigned to you Clear communication is critical to the success of a PODClear communication is critical to the success of a POD

17. Why Plain Talk? Many meanings of EMT - Emergency Medical Treatment Emergency Medical Technician Emergency Management Team Eastern Mediterranean Time Effective Methods Team Effects Management Team El Monte, CA (airport code) Electron Microscope Tomography Email Money Transfer

18. The jobs required to run a POD are many and varied. Therefore, everyone has the potential to contribute strength and resources in times of emergency. 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. Therefore, everyone has the potential to contribute strength and resources in times of emergency. 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.

19. Examples of POD Jobs Data entry personnel Form distributors Translators Medical screeners (MD, PA, RN) Pharmacists Security personnel Food preparers Vaccinators Janitorial staff Mental health workers Traffic Control staff ID/Badging staff Runners Telecom / IT support staff EMS transfer personnel There may be more than one job for which you are suited. You can review the Job Action Sheets for more specific information. There may be more than one job for which you are suited. You can review the Job Action Sheets for more specific information.

20. CT Public Health Emergency Response Act (PHERA), 2003 Protects POD staff (employees and volunteers) from liability when acting on behalf of the State or Local Health Department during a declared Public Health Emergency.

21. Operation of this POD Adapt this section as necessaryAdapt this section as necessary

22. This is the ICS structure for POD operations in Connecticut.This is the ICS structure for POD operations in Connecticut.

23. A clinic is arranged to move people through as quickly as possible from entrance to exit. Within a clinic, stations are set up with distinct purposes to help move people through. This figure represents the flow of clients through a POD. It may be used as a model for set up depending upon the space available and the circumstances of the health emergency (BERM model, �Community-based mass prophylaxis: a planning guide for public health preparedness.� Weill Medical College of Cornell University--http://www.ahrq.gov/research/cbmprophyl, figure 3.) Key stations/areas are described below: Entry Screening and Form Distribution � Station where people are 1) directed into the POD, 2) given forms to complete and 3) screened for obvious illness. Triage � Station where people requiring medical and mental health evaluation are identified based on patient completed forms or direct questions. Briefing � Stations were attendees are given information about the drug or vaccine they will receive. Pharmacy areas - Stations where medications or vaccines are administered. Exit � Station where people are directed out of the POD and where forms are collected. May provide additional information on topics such as follow up care or importance of compliance. A clinic is arranged to move people through as quickly as possible from entrance to exit. Within a clinic, stations are set up with distinct purposes to help move people through. This figure represents the flow of clients through a POD. It may be used as a model for set up depending upon the space available and the circumstances of the health emergency (BERM model, �Community-based mass prophylaxis: a planning guide for public health preparedness.� Weill Medical College of Cornell University--http://www.ahrq.gov/research/cbmprophyl, figure 3.) Key stations/areas are described below: Entry Screening and Form Distribution � Station where people are 1) directed into the POD, 2) given forms to complete and 3) screened for obvious illness. Triage � Station where people requiring medical and mental health evaluation are identified based on patient completed forms or direct questions. Briefing � Stations were attendees are given information about the drug or vaccine they will receive. Pharmacy areas - Stations where medications or vaccines are administered. Exit � Station where people are directed out of the POD and where forms are collected. May provide additional information on topics such as follow up care or importance of compliance.

24. Call to Action If mass dispensing is required: State and Local Health Departments will coordinate POD operations You will be: Contacted by telephone, fax or email Asked about your availability to work at the POD Informed about where and when to report and what to bring You may be asked to report to the clinic site or an alternate staging area from which you will report to the sites.You may be asked to report to the clinic site or an alternate staging area from which you will report to the sites.

25. Call to Action Your Local Health Department maintains a list of POD staff. Make sure you inform your Local Health Department about changes in your contact information.

26. Before Your Shift Supervisor will provide Just-In-Time training A briefing on the specific situation and POD functioning Training on your Job Action Sheet Arrangements for food, rest, safety, communication with home Local check in procedures Make sure you know your role in communication and how to operate any equipment assigned to you. Make sure you know your role in communication and how to operate any equipment assigned to you.

27. Signs of Stress and Fatigue in Self and Others Lack of concentration Increasing number of non-critical errors Critical errors Irritability Worry Feeling ill

28. Resources for Clinic Staff During Shift Facilities to support staff Food, rest Mental health support for staff These elements should be determined locally These elements should be determined locally

29. End of Shift At the end of your shift or before you report off duty you will be asked to: Brief your supervisor Turn in all reports and equipment Sign out procedure

30. Dealing with POD Challenges If you need assistance, ask your supervisor General rules for dealing with Special needs populations, e.g. limited mobility, hearing, vision, literacy, non-English speakers Those experiencing extreme distress Conflict

31. Communicating Beyond the POD Only the Public Information Officer should speak with the media Respect the privacy of people working and attending the POD Report any rumors to your supervisor Follow your supervisor�s guidance on communication with friends and family You should not talk with the media about the POD while on duty or after your shift. The Public Information Officer is the only person who should speak with the media. He or she is the expert in communicating with the media. Speaking through the Public Information Officer will result in the dissemination of a unified, fast and accurate message. Report rumors to your supervisor so that a unified response can be developed and presented to the publicYou should not talk with the media about the POD while on duty or after your shift. The Public Information Officer is the only person who should speak with the media. He or she is the expert in communicating with the media. Speaking through the Public Information Officer will result in the dissemination of a unified, fast and accurate message. Report rumors to your supervisor so that a unified response can be developed and presented to the public

32. POD Security Local security arrangements - know before event Staff and volunteers will be briefed on specific security arrangements as part of Just-In-Time training for a drill or event The safety of the clinic staff is of utmost importance The safety of the clinic staff is of utmost importance

33. Personal Safety Safety Officers will be on site to ensure a safe working environment Your Job Action Sheet will describe safety precautions and equipment use Local arrangement for priority prophylaxis of POD workers and family/household

34. Preparing to Work at the POD Events can happen without warning and with very little time to respond, so preplanning is important. Events can happen without warning and with very little time to respond, so preplanning is important.

35. Create a family / household disaster plan that includes a communication plan. You can find templates created by American Red Cross, State of Connecticut and the US Department of Homeland Security at the web addresses provided on the slide. Create a family / household disaster plan that includes a communication plan. You can find templates created by American Red Cross, State of Connecticut and the US Department of Homeland Security at the web addresses provided on the slide.

36. Make Prior Arrangements For Communication between family members Care of elders, children, pets Home security Medication Transportation Any verification of credentials An important part of a disaster plan is a family communication plan to so that family/household members know how to reach each other and have a central meeting point. Make sure the plan is kept up-to-date. You should document medications taken by each member of the household and make sure refills are up-to-date. You should bring a few day�s supply of prescriptions when you come to work at the POD. An important part of a disaster plan is a family communication plan to so that family/household members know how to reach each other and have a central meeting point. Make sure the plan is kept up-to-date. You should document medications taken by each member of the household and make sure refills are up-to-date. You should bring a few day�s supply of prescriptions when you come to work at the POD.

37. Training

38. Additional Training Opportunities DPH online training in key content topic areas: ICS/NIMS Mass dispensing (PODs) operations SNS overview Diseases that could lead to mass dispensing Psychosocial (mental health) Legal Specialized training for licensed professionals � Medical Screeners, Pharmacists Just-In-Time training In addition, Volunteer organization training � American Red Cross, Citizen Emergency Response Teams (or put this in a separate slide) Next page describes online training resources for Connecticut In addition, Volunteer organization training � American Red Cross, Citizen Emergency Response Teams (or put this in a separate slide) Next page describes online training resources for Connecticut

39. TRAINConnecticut Online Access these and other valuable training resources on the internet at http://ct.train.org The manual and flyer show you how to register and start the training TRAINConnecticut is an invaluable public health training resource for our state. [Hand out TRAINCT �volunteer� manual and �how to register� flyer]TRAINConnecticut is an invaluable public health training resource for our state. [Hand out TRAINCT �volunteer� manual and �how to register� flyer]

40. April CT Exercise Information Full scale SNS exercise

41. SNS POD Exercises When April 18th and 19th (mainly the 19th) Where At 7 PODS and 4 hospitals throughout CT Objective To activate a POD and successfully distribute �medication� to residents served by that clinic in response to a simulated biological emergency.

42. What We Know The drill will last approximately 4 hours. It will take place during normal business hours. Bring�.. Don�t bring Food (We will feed you) Drink (We will supply that too) [EDIT: see changes in slide][EDIT: see changes in slide]

43. Remember This is practice. You are not being graded on you performance on the drill. Everyone is learning together. It�s okay to make mistakes. We expect it and we will learn from it. It is okay to have fun!

44. Questions ???????????????????????????????

45. Sources Connecticut Association of Health Directors. Orientation To Connecticut Mass Dispensing Clinics Parts 1 & 2. Centers for Disease Control and Prevention. Strategic National Stockpile website. http://www.bt.cdc.gov/stockpile/ 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 Town of Manchester, Ledge Light Health District, Eastern Highlands Health District 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 AHRQ �Community-based mass prophylaxis: a planning guide for public health preparedness.� http://www.ahrq.gov/research/cbmprophyl (figure 3).

46. Thank You Thank you all for offering to be a POD worker. Federal, State, and Local leaders recognize and appreciate the great service you are performing for your communities, the state, and the nation, and the sacrifices you are making to keep the people safe.