Push Partner Registry An Alternative Dispensing Strategy

1. Push Partner RegistryAn Alternative Dispensing Strategy Robbie had a meeting in Salem and will be joining us at the end of the presentation to talk about his experience with the Push Partner Registry. Robbie had a meeting in Salem and will be joining us at the end of the presentation to talk about his experience with the Push Partner Registry.

2. Objectives Understand the county�s response to a mass dispensing effort requiring Push Partner Registry activation based on a 48-hour timeline scenario Understand key concepts of the Push Partner Registry Hear from a key Push Partner (NW Natural) Learn about upcoming opportunities and next steps PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY

3. Important Terms POD = Point of Dispensing A dispensing site to provide preventative antibiotics or vaccination RSS = Receipt, Stage & Storage Center Where you pick up the meds POD: -Federal definition for a POD is a Point of Distribution -Interchangeable term with Points of Dispensing. -Fun Fact: 107 definitions for the acronym POD according to the online Free Dictionary RSS: -Will be determined at the time of the event -The RSS personnel are warehouse staff that manage material for the county on a daily basis and very efficient POD: -Federal definition for a POD is a Point of Distribution -Interchangeable term with Points of Dispensing. -Fun Fact: 107 definitions for the acronym POD according to the online Free Dictionary RSS: -Will be determined at the time of the event -The RSS personnel are warehouse staff that manage material for the county on a daily basis and very efficient

4. Public Health Emergency Preparedness & Cities Readiness Initiative Cities Readiness Initiative: Major cities Potential vulnerability to a biological threat PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY Role of PH in Emergencies: PH emergencies can result from various hazards - natural disasters (e.g., tornado, hurricane); disease outbreaks (e.g., pandemic flu); deliberate acts (e.g., aerosolized release of anthrax). We collaborate with our city, county, regional, and private industry for both planning and response during emergencies. H1N1 is a good example Public Health has been working on pandemic flu preparedness for several years. Prior to H1N1, we worked with partners to create plans around how the community can help to reduce the spread of flu. We worked with non-English speaking communities on the best methods for disseminating information out to the community, and receiving feedback about those communications from the community. We worked on establishing PODs for vaccinating large #�s of the population. We assisted hospitals in the creation of surge plans and exercised with them several times on resource ordering procedures. During H1N1, we put those plans to the test. CRI: A few years ago, it was discovered that major metropolitan areas were having the most trouble creating response plans for large threats. This was due to their geographic size, the number of partners that had to be coordinated with, and flavors of the landscape (urban, suburban, rivers, lakes, etc). The federal government decided to give special focused attention to these cities since they were the most likely to face a biological threat, and the most vulnerable to a major disaster. Role of PH in Emergencies: PH emergencies can result from various hazards - natural disasters (e.g., tornado, hurricane); disease outbreaks (e.g., pandemic flu); deliberate acts (e.g., aerosolized release of anthrax). We collaborate with our city, county, regional, and private industry for both planning and response during emergencies. H1N1 is a good example Public Health has been working on pandemic flu preparedness for several years. Prior to H1N1, we worked with partners to create plans around how the community can help to reduce the spread of flu. We worked with non-English speaking communities on the best methods for disseminating information out to the community, and receiving feedback about those communications from the community. We worked on establishing PODs for vaccinating large #�s of the population. We assisted hospitals in the creation of surge plans and exercised with them several times on resource ordering procedures. During H1N1, we put those plans to the test. CRI: A few years ago, it was discovered that major metropolitan areas were having the most trouble creating response plans for large threats. This was due to their geographic size, the number of partners that had to be coordinated with, and flavors of the landscape (urban, suburban, rivers, lakes, etc). The federal government decided to give special focused attention to these cities since they were the most likely to face a biological threat, and the most vulnerable to a major disaster.

5. The Problem: Planning Scenario Aerosolized release of anthrax Goal 48 hour response time Get Pills in the People! (All 715,000+ !) PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY Bacillus anthracis is a bacterium found in infected animals and animal products, like wool, or from eating undercooked meat from infected animals. There are three types, cutaneous (skin), gastrointestinal, inhalation (pulmonary). Anthrax is still considered a credible threat. It is easily attainable, poses the greatest threat to our health and can be spread across a large area (aerosolized) Aaerosolized Anthrax = requires early preventative antibiotics, and a 60-day course. Success depends on how soon treatment begins. Multnomah County � 715,000 plus residents View SNS video, �Taking Care of Business� This video will provide the initial introduction to Closed PODs . Bacillus anthracis is a bacterium found in infected animals and animal products, like wool, or from eating undercooked meat from infected animals. There are three types, cutaneous (skin), gastrointestinal, inhalation (pulmonary). Anthrax is still considered a credible threat. It is easily attainable, poses the greatest threat to our health and can be spread across a large area (aerosolized) Aaerosolized Anthrax = requires early preventative antibiotics, and a 60-day course. Success depends on how soon treatment begins. Multnomah County � 715,000 plus residents View SNS video, �Taking Care of Business� This video will provide the initial introduction to Closed PODs .

6. July 1993, a liquid suspension of Bacillus anthracis was aerosolized from a rooftop of an 18-story building in KameidoTokyo by the religious group Aum Shinrikyo. The source was from vaccine used in Japan to vaccinate animals against Anthrax. The source was from vaccine used in Japan to vaccinate animals against Anthrax.

7. Public Health�s Response Public PODs: Primary method to dispense medications to the public Common areas located throughout the community (gyms, civic centers, community centers) Managed and operated by the local public health department and partners 18-36 PODs 3600+ staff PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY Public PODs PODs (mass clinics) are the primary method for distributing medication to the masses. Staff? � city, county, CERT, NET, Medical Reserve Corps, schools of nursing, etc You have to be mobile to come to a POD Transportation considerations Need lots of resources: facilities, staff, supplies Long lines Public anxiety During a response, there is also a lot of other activity happening behind the scenes at PH: messages on what the public can do to protect themselves Messages to ease fears is the water contaminated? Surfaces contaminated? etc 18 PODs is the Head of Household model 18 PODs would require around 3600 staff for 24 hour operations. Public PODs PODs (mass clinics) are the primary method for distributing medication to the masses. Staff? � city, county, CERT, NET, Medical Reserve Corps, schools of nursing, etc You have to be mobile to come to a POD Transportation considerations Need lots of resources: facilities, staff, supplies Long lines Public anxiety During a response, there is also a lot of other activity happening behind the scenes at PH: messages on what the public can do to protect themselves Messages to ease fears is the water contaminated? Surfaces contaminated? etc 18 PODs is the Head of Household model 18 PODs would require around 3600 staff for 24 hour operations.

8. Private PODs Private PODs: Specific businesses and organizations that have agreed to work with public health to dispense medication to their staff, family members, and clients (where applicable) Not open to the public Reaches those that cannot or unwilling to come into public POD Safeguards employees so they can get back to work Managed and operated by the business or organization One of the strategies to get pills in the people is to allow organizations and large businesses dispense medication to their staff, families, and clients. Talk about each bulletOne of the strategies to get pills in the people is to allow organizations and large businesses dispense medication to their staff, families, and clients. Talk about each bullet

9. Private PODs Push Partner PODs would only be opened in the rare event that the whole population is at great risk of exposure to a contagious disease or other biological agent and preventative medications need to be taken immediately to prevent severe illness. PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY

10. Choosing to Become a Private POD Benefits our community Helps achieve community dispensing goal more rapidly Decreases the number of people going to open PODs Benefits your organization Protects your employees and their and their families (and clients for some organizations) Helps to ensure your organization�s continuity of operations Exhibits your commitment to our community PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY

11. Multnomah County Health Department Responsibilities Develop guidelines to ensure safe dispensing of medication Assist in development of organization�s Closed POD plan Provide all medication and accompanying information sheets for dispensing Provide training and exercise support Provide tools, templates and ongoing technical assistance PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY

12. Your Responsibilities  Designate liaisons to coordinate with public health officials Licensed medical professional Develop a Private POD plan Determine dispensing location(s) Develop procedures Activation and recall procedures Security planning Receipt of medication Dispensing procedures Provide staff Provide non-medical supplies (tables, chairs, printers, pens, paper, etc) Participate in training and exercise opportunities Operate a Private POD during an emergency (*voluntary*) PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY We like to have a primary and 2 backup coordinators In order to qualify, you need a licensed medical professional who will oversee the dispensing process. They do not have to be on-site (for example, deliveries to homebound individuals) but dispensing staff must work under his/her direction. Does not have to be employed with your company; you can contract with another company, like you might for your occupational health needs. You develop that plan for dispensing. It needs to meet the overall intent of public health to dispense medication but is based on their particular organizational design and structure. We have a template for you to start from. Determine a dispensing location and back-up (in case of construction, for example) - break room, conference room, auditorium, parking lot with pop up tents. Develop dispensing procedures � highlight some of the key procedures. Explain the staffing and the need for a medical professional, ie occupational health nurse, contracted pharmacist, etc. Briefly touch on supplies that will be needed. Train key staff in the procedures. We like to have a primary and 2 backup coordinators In order to qualify, you need a licensed medical professional who will oversee the dispensing process. They do not have to be on-site (for example, deliveries to homebound individuals) but dispensing staff must work under his/her direction. Does not have to be employed with your company; you can contract with another company, like you might for your occupational health needs. You develop that plan for dispensing. It needs to meet the overall intent of public health to dispense medication but is based on their particular organizational design and structure. We have a template for you to start from. Determine a dispensing location and back-up (in case of construction, for example) - break room, conference room, auditorium, parking lot with pop up tents. Develop dispensing procedures � highlight some of the key procedures. Explain the staffing and the need for a medical professional, ie occupational health nurse, contracted pharmacist, etc. Briefly touch on supplies that will be needed. Train key staff in the procedures.

13. Understanding the Process Activation ? Communicate to Staff ? Prepare Materials ? Pick up Meds ? Set-up POD ? Train Staff Explain the steps Activation � phone, email, web site Communicate to staff � call down staff, assemble team, notify staff of when/where to get meds Prepare materials � photocopy materials, gather supplies Pick up meds � RSS Set up POD � tables, chairs, flow, supplies Train Staff � Inclusive Just-in-Time training. Ideally some have already participated in some training.Explain the steps Activation � phone, email, web site Communicate to staff � call down staff, assemble team, notify staff of when/where to get meds Prepare materials � photocopy materials, gather supplies Pick up meds � RSS Set up POD � tables, chairs, flow, supplies Train Staff � Inclusive Just-in-Time training. Ideally some have already participated in some training.

14. POD Set-Up Greeting Screening Dispensing PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY The pictures depicted here are primarily for and organization dispensing to employees. For dispensing to clients at bedside, follow your normal procedure, but be sure to complete the required documentation. For dispensing to clients out in the field, for example, home-bound clients �the meals on wheels� type of approach, drivers will perform all the steps. If you design your POD in a break or conference room it might look more like the picture on the left. The picture on the right is the gymnasium concept that might fit an organization that has a large open area, like a fitness center. Briefly walk through POD stations. The pictures depicted here are primarily for and organization dispensing to employees. For dispensing to clients at bedside, follow your normal procedure, but be sure to complete the required documentation. For dispensing to clients out in the field, for example, home-bound clients �the meals on wheels� type of approach, drivers will perform all the steps. If you design your POD in a break or conference room it might look more like the picture on the left. The picture on the right is the gymnasium concept that might fit an organization that has a large open area, like a fitness center. Briefly walk through POD stations.

15. Take care of POD staff, too! POD staff need to sign in at beginning of shift and sign out at shift end POD staff take their meds prior to clinic opening Debrief at end of POD

16. Step 1: Greeting/Education Welcomes staff to POD Signs in staff (if you choose) Hands out screening forms Gives basic information Directs staff to next station

17. Step 2: Fill Out Form Employee fills out screening form Reviews FAQ�s

18. Step 3: Screening Reviews screening form for co-workers and family members (confidentiality forms are signed prior to opening POD) If contraindications, then direct to Medical Evaluation If no contraindications, then direct to Dispensing

19. Medical Evaluation (part of step 3) Medical professional screens only those who might have contraindications to taking the prescribed medication Follows algorithm and prescribes or refers to physician

20. Step 4: Dispensing Dispensed medication as indicated on the screening form

21. Security Have a plan for security in the event that it is needed Interior � crowd control, protect staff and protect medication Exterior � secures entry, delivery of medication, and traffic control

22. More Details� Ensure all medication is accounted for and inventories are conducted Ensures forms are completed properly Returns screening forms, inventory forms, and unopened medication to public health

23. Medical Medical Issues Use of medical professionals Medical vs. Non-Medical Models Dispensing Protocols during emergencies Head of Household Policies PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY INTENT: Address the concerns related to the use of medical staff at Closed PODs. KEY POINTS: Medical vs. Non- Medical model of dispensing � discuss the use of medical staff given the organization�s access to occupational health and/or other providers and your jurisdiction�s policies. Explain how medical concerns will be addressed at the Closed POD. Elaborate briefly on the use of protocols to support rapid dispensing. Address the head of household policy and the number of bottles per family in your jurisdiction. ADDITIONAL INFORMATION: It is important to assure the audience that there is equity to all people in your community in that the dispensing procedures occurring a the Closed POD are the same as those occurring at the PODS open to the public. INTENT: Address the concerns related to the use of medical staff at Closed PODs. KEY POINTS: Medical vs. Non- Medical model of dispensing � discuss the use of medical staff given the organization�s access to occupational health and/or other providers and your jurisdiction�s policies. Explain how medical concerns will be addressed at the Closed POD. Elaborate briefly on the use of protocols to support rapid dispensing. Address the head of household policy and the number of bottles per family in your jurisdiction. ADDITIONAL INFORMATION: It is important to assure the audience that there is equity to all people in your community in that the dispensing procedures occurring a the Closed POD are the same as those occurring at the PODS open to the public.

24. Liability Issues Oregon Tort Claim Cap HB 3021 www.osbplf.org Federal Public Readiness & Emergency Preparedness Act (PREP Act) www.hhs.gov PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY INTENT: Address the concerns related to legal and liability issues of operating Closed PODs. KEY POINTS: Describe the legal protections afforded based on federal, state and local statutes. Focus on regulations and policies that cover public health preparedness, volunteers and mass dispensing of medical countermeasures during an emergency. Encourage consultation with legal counsel. Agreements � although memorandums of agreement (MOA) and memorandums of understanding (MOU) are not considered legally binding documents, you could stress the need to develop an MOA/MOU to ensure each party was aware of the expectations of operating a Closed POD. Discuss if your health department requires a specific agreement. ADDITIONAL INFORMATION: Prepare to transition to your closing slides.INTENT: Address the concerns related to legal and liability issues of operating Closed PODs. KEY POINTS: Describe the legal protections afforded based on federal, state and local statutes. Focus on regulations and policies that cover public health preparedness, volunteers and mass dispensing of medical countermeasures during an emergency. Encourage consultation with legal counsel. Agreements � although memorandums of agreement (MOA) and memorandums of understanding (MOU) are not considered legally binding documents, you could stress the need to develop an MOA/MOU to ensure each party was aware of the expectations of operating a Closed POD. Discuss if your health department requires a specific agreement. ADDITIONAL INFORMATION: Prepare to transition to your closing slides.

25. Protect what means most to you and your organization� PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY Review objectives: Understand the county�s response to a mass dispensing effort requiring Push Partner Registry activation based on a 48-hour timeline scenario Understand key concepts of the Push Partner Registry Hear from a key Push Partner (NW Natural) Learn about upcoming opportunities and next steps Re emphasize that you understand that the people within their organization are important and you want to partner with this organization to help protect them. Put emphasis on partnership and collaboration and that they won�t be alone in this process. Review objectives: Understand the county�s response to a mass dispensing effort requiring Push Partner Registry activation based on a 48-hour timeline scenario Understand key concepts of the Push Partner Registry Hear from a key Push Partner (NW Natural) Learn about upcoming opportunities and next steps Re emphasize that you understand that the people within their organization are important and you want to partner with this organization to help protect them. Put emphasis on partnership and collaboration and that they won�t be alone in this process.

26. Enroll or schedule a meeting with usUpcoming Exercises:Dec 10, 2010 Build-Your-Plan WorkshopJune 8-10, 2011 Push Partner Exercise PUSH PARTNER REGISTRY AN ALTERNATIVE DISPENSING STRATEGY Dec 10th, 9-12, Multnomah Building, 501 SE Hawthorne, 4th Floor Oak Room June 8-10, Push Partner Exercise details Dec 10th, 9-12, Multnomah Building, 501 SE Hawthorne, 4th Floor Oak Room June 8-10, Push Partner Exercise details

27. Questions?

28. Presenters Cristin Corcoran Cities Readiness Initiative (503) 846-8246 Cristin.corcoran@co.multnomah.or.us Robin Holm Multnomah County Health Department (503) 988-3663 x24426 Robin.m.holm@co.multnomah.or.us Robbie Roberts NW Natural (503) 226-4211 r4r@nwnatural.com

29. For more information http://www.mchealth.org/emergprep/pushpartner.shtml

30. A Key Push Partner! NW Natural Robbie Roberts