Ensuring Point of Dispensing Operations are Inclusive of Access & Functional Needs

1. Ensuring Point of Dispensing Operations are Inclusive of Access & Functional Needs Karie Hawk John Duffy Aimee Voth Siebert

2. Disclosure Statement - CE/CME • There is no conflict of interest for anyone involved in planning or presenting this learning activity. • To receive CME/CE hours for qualified sessions:  attend the session or participate in the skills lab and complete a CE (Continuing Education) verification form. • *Forms are in your packet. Questions about CME/CE? Stop by the registration desk for assistance.

3. Topics to Cover • Poll Everywhere instructions • How PODs came to be and their importance today • Exercises to enhance Community Inclusion • Alaskan exercises past-future • Training • Resources

4. Responding with Poll Everywhere Grab your smart device, and decide whether you want to respond by text or on the web… Pollev.com/kariehawk280 22333 kariehawk280 <your response> Web voting Textvoting

6. Public Health Emergency Preparedness (PHEP) and the Strategic National Stockpile (SNS) Program The timely provision of medical countermeasures (MCM) following a large-scale public health emergency such as pandemic influenza, anthrax attacks, chemical releases, and radiological events can ensure that the health and safety of those impacted are protected. Health officials have a lead role in planning for providing MCM to their jurisdictionsin times of crisis and have developed strategies to carry out effective public health responses.

7. News Headlines and Reports over the Years

8. News Headlines and Reports over the Years (CNN) -- A letter found by police in the mailroom of the New York Post newspaper has tested positive for anthrax and has the same postmark as anthrax-laced letters sent to Sen. Tom Daschle and NBC News anchor Tom Brokaw, an FBI official said Saturday. (Oct 21, 2001)

9. News Headlines and Reports over the Years The Washington Health Department is investigating additional cases of possible anthrax infection, including one person connected to the Brentwood mail facility who has been hospitalized. People began stockpiling Cipro, an antibiotic that is typically recommended for the treatment of anthrax. Talk swirled about the possibility of a large-scale anthrax attack. What if it was scattered over a city? Blown into the ventilation system of a skyscraper? “Never forget,” read the bumper stickers and T-shirts after September 11, 2001. But there was another terrorist attack against the United States that began later that month, the anthrax attacks that spread through the U.S. Mail.

10. News Headlines and Reports over the Years

11. News Headlines and Reports over the Years

12. The Federal SNS Program Inside-the-secret-US Stockpile-meant-to-save-us-all-in-a-bioterror-attack

13. Enter and the Evolution of the PHEP Program

14. Public Health Preparedness Capabilities

15. Supporting State and Local Preparedness

16. Snapshot of Public Health Preparedness Advancements

17. Roles in a Large Scale Response RSS Site Storage & Transport PODs &Treatment Centers Federal State Local

18. Why we are discussing POD Operations Inclusive of Access & Functional Needs “You have spent years planning and exercising and training because you need to know what to do if 100,000 doses of Cipro showed up in your state,” “How would you get it out? Who would dispense it? Can you get it to your entire population? These parts are as critical as maintaining the medicines in pristine condition and the ability to rapidly distribute them.” Attributed to Dr. Ali Khan, who used to oversee the CDC Office of Public Health Preparedness and Response program and now is dean at the University of Nebraska Medical Center’s College of Public Health.

20. Enhancing Exercises through Community Inclusion: Strategies from PHED Ex, Colorado’s 2017 Full Scale Exercise

21. Colorado’s 2017 Public Health Emergency Dispensing Exercise (PHED Ex) • CDPHE Video • El Paso Video: https://www.facebook.com/ElPasoCountyCO/videos/1612314722193266/

22. PHED Ex Objectives • Information Sharing: Demonstrate the ability to effectively collect, synthesize, and share information with local and state partners throughout the duration of the incident. • Emergency Operations Coordination: Demonstrate the ability to activate an operations center, develop a coordinated response strategy, and manage and sustain response to a public health incident. • Medical Countermeasures Dispensing/Medical Material Management and Distribution: Demonstrate the ability to support and participate in Colorado’s medical supply chain procedures.

23. People Hazard Effective, Responsive, Inclusive Planning Infrastructure

24. C M I S T • TRUST • Economics • Isolation • geographic • social • cultural • Capacity • Housing • Racism OMMUNICATION EDICAL/HEALTH Hazard-based? Daily conditions? NDEPENDENCE AFETY, SUPPORT, SERVICES RANSPORTATION

26. Inclusion Evaluators • Area Agencies on Aging, Senior Centers • Local Housing Authority • Long Term Care Facility • Home care services • Community members • Public Health programs • Independent Living Centers • Community Mental Health Centers • Multicultural organizations • Community Center Boards • Early Learning • Inclusion Evaluators[x][x][x] • Trained on POD environments, CMIST, Inclusion Evaluation Forms • 22 evaluations from 16 open POD sites

29. CMIST Themes and Lessons • M: Behavioral health and paramedics on site. How to ensure people understood instructions for taking medicine. • “Just handing folks a sheet of paper with directions and a bottle of meds isn’t enough.” • C: Inclusive communication is the hardest to practice consistently and comprehensively. Low tech solutions can fill small, temporary gaps. • “Personnel well trained, but when there were many people, one interpreter is not enough”

30. CMIST Themes and Lessons • I: Minimal representation. People given support tailored to their requests and needs. • “When triage saw a pin on participant saying “face me to speak” she made sure to.” • S: Volunteer to community member staff ratio adequate. • “Runners on board to assist if needed and to help with flow. Forms filled out for many community members.” • T: Generally good flow through POD stations. Entrance, exit, and signage is where inclusive difficulties arose.

32. Other Inclusion Lessons • For inclusion evaluators, more CMIST guidance was sometimes needed • Hard to test effectiveness with low flow, lack of attendance or representation. • Presumptions about separate PODs for AFN • The importance of inclusion in pre-POD public information • Community willingness to help and novel resources! • Learning along the way…

33. Local Planning Activities • Grant activity for inviting non-traditional community observers • Developing mobile/closed POD plans with trusted groups & places In the year preceding this statewide full-scale exercise, the Colorado Community Inclusion workgroup brainstormed strategies and developed resources to promote inclusion activities. State Planning Activities Colorado Community Inclusion Workgroup • GIS Resources – Community Inclusion Maps • Suggested Participant List • Community Inclusion Injects • Plain language “Save the Date”

35. Operational Inclusion Strategies • Community Inclusion Strategies • Just-in-Time Community Inclusion Discussion • Budget for functional services & support, • On-site or telephonic interpretation (including ASL), literacy and health educators • Resources for kids who accompany single-parent heads of household • Alternative information formats (picture-based, large print, non-English) • Plan for people with personal mobility difficulty onsite • Alternative flow or places to sit for people who cannot stay standing. • Space and accommodations for people with personal equipment (walkers, wheelchairs, oxygen tanks, other durable medical equipment and service animals) • Collaborate with delivery systems that function for the community everyday (i.e. Meals on Wheels) • Plan POD locations close to communities with limited transportation access or mobility difficulty

36. Outside the Box: Community Inclusion POD

37. Community Inclusion Exercise Resources https://www.colorado.gov/pacific/cdphe/community-inclusion-exercise-resources

38. Open/Closed Point of Dispensing Exercises Fairbanks North Star Borough Frontier POD for Pills to Polar Bears Wasilla POD

39. Other examples of FAN inclusions in AK Crisis Canines helping at the registration desk at the Family Assistance Center during Alaska Shield 2016

40. Exercises and Testing Communication http://www.atlaak.org/ Assistive Technology of Alaska “Rock and a Hard Place 2015” “Arctic Chinook 2016” State of Alaska Translation Services Speech-to-Speech (STS) relay service 1-866-355-6198 in Alaska

41. Trafficability Considerations

42. Future Exercises Raging Contagion 10-13 April 2019 Functional Phase, Day 1-2 • Pneumonic Plague symptoms are spreading among communities throughout the state. • Lab confirmed pneumonic plague • State declares emergency • Requests Fed support • Tasks AKNG/AST support • CDC ships Rx Inventory to Ted Stevens • ANTHC RSS activated • Local Jurisdictions alerted for POD set-up • Local staff call down • Site activation • POD site set-up • FBI/Epi conduct joint investigation. • Samples sent to State Lab • DHSS EOC Activated Full Scale Phase, Day 3(4) • Local PODS staffed/ready • Volunteers assembled • Closed POD partners ready • Meds shipped w/ escort • PODS receive meds • POD Ops conducted • Volunteer patients get meds • Locals send report to EOC • Recover unused meds • Demob PODS, RSS & EOC • ENDEX • Hotwash • AKNG Mobilized w/ AST • Warehouse secured • US Marshal escorts shipment • ANTHC receives and begins distribution processing

43. Training Opportunities • Points of Dispensing Essentials in person training team • TEEX (Texas A&M Extension Service) • Mass Antibiotic Dispensing Training (MGT-319) • https://teex.org/Pages/class-calendar.aspx • POD Essentials online training • https://www.train.org/main/course/1079139/live_event Charles Pelton Training, Exercise and Outreach Charles.pelton@Alaska.gov (O) 907-334-2242 (C) 719-238-3245

44. Resources within the State of Alaska for FAN • Get Ready! Toolkit: http://dhss.alaska.gov/dph/wcfh/Documents/disability/GetReadyWebaccessible.pdf • Downloadable or in paper copy SLI: Sign Language interpreters RNR Interpreting Registry of Interpreters for the Deaf www.RID.org • Disaster Preparedness: For Families of Children and Youth with Special Health Care Needs Toolkit: http://dhss.alaska.gov/dph/wcfh/Documents/disability/CYSHCNBookletWebAccessible.pdf • Downloadable or in paper copy Hidden Disabilities: https://www.youtube.com/watch?v=HmJX3c43szg(Communication Tips for First Responders) • Alaska Health and Disability Emergency Preparedness website: http://dhss.alaska.gov/dph/wcfh/Pages/disability/EmergencyPreparedness.aspx • Emergency Preparedness (EP) for All video: https://vimeo.com/89664822 • Tip Sheets for First Responders: http://dhss.alaska.gov/dph/wcfh/Documents/disability/Resources/FirstResponderTipsSheet.pdf

45. Contact Info: