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1
RI Department of HealthMedical Countermeasure
Dispensing During Emergencies
in Rhode Island2014-2015
Disclosure Statement
• CONFLICT OF INTEREST
– The planners and presenters have declared no conflict
of interest.
• COMMERCIAL SUPPORT/SPONSORSHIP
– There is no commercial support or sponsorship for this
event.
• CRITERIA FOR SUCCESSFUL
COMPLETION includes attendance at the entire
event and submission of a completed evaluation form.
2
Objectives
Learners will:
1.Describe the Medical Emergency Distribution System (MEDS) in Rhode Island and identify examples of when MEDS has been utilized in Rhode Island
2.Summarize the concept of Points-of-
Dispensing (POD) including the flow and
function of a POD
3.Explain professional roles and responsibilities
required to volunteer as staff in a POD.
What are we preparing for? Emerging Infectious Diseases and Natural Disasters
• Natural Disasters
– Hurricanes
– Tornadoes
– Floods
• Infectious Diseases
– Influenza outbreaks
requiring mass
vaccination
3
What are we preparing for? Biological Agents
• Bioterrorism agents are separated into three
categories - A, B, or C
Category A
• Easily spread person to
person
• High death rates
• Major public health impact
• Social disruption
• Special action for public health
preparedness
Specific Agents:
Anthrax
Botulism
Pneumonic Plague
Small Pox
Tularemia
Viral Hemorrhagic
Fevers
• A national repository of medical countermeasures and supplies– Ciprofloxacin
– Doxycycline
– Amoxicillin
• Types of inventory– 12 Hour push package
– Managed inventory
Federal Mission: Deliver critical medical assets to the site of a national emergency.
Federal Response to Biological ThreatsCDC’s Strategic National Stockpile (SNS)
4
HEALTH’s Mission: Coordinate distribution to PODs and dispensing at local PODs
ALL RI Municipalities’Mission: To get the first pill in the last person in line within 48 hours!
Rhode Island’s ResponseMedical Emergency Distribution System plan (MEDS)
Timeline of MEDS Response
Rhode Island MEDS/POD
Activation Timeline
Declaration of
Public Health
Emergency
Disease outbreak/Release of agent
Hour 0
Aware of threat &
SNS assets
requested
Hour 6
Notify
leaders to
activate
PODs
Hour 12
SNS
arrives;
Deploy to
PODs
Hour 12-48
PODs
open to
dispense
to public
5
Secondary Objectives:
• Keeping anxiety in check / not
adding to anxiety levels
• Keep accurate records
Rhode Island Dispensing MethodObjectives within a POD
Primary Objective:
• Medicate/vaccinate the public
• Educate the public
• Patient history review / drug dispense decision
making
Types of Dispensing
• Open PODs
– Open to the public
– Each municipality opens at least one POD
• Closed PODs
– For a specific list of individuals
– Usually a facility with their own medical professionals on staff
– Examples: hospitals, Adult Correctional Institution
• Alternate Dispensing
– Possibly take countermeasures to homebound populations etc.
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“Open” PODsProphylaxis
Symptomatic
IndividualsTreatment
The Public
Prophylaxis
POD
4 Simple StepsStep 1: Fill out form
Step 2: Have form reviewed
Step 3: Get medication or vaccine
Step 4: Exit (15 minute observation
if vaccine)
POD: Flow
11
7
Standardized, on-scene, all-hazards incident management
approach.
POD Commander
Operations Logistics Planning Finance
Medical Director Site Pharmacist
Safety OfficerPublic Information
Incident Command System (ICS)
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Just-In-Time Training
JITT is tailored to the specific threat and
includes but is not limited to the following
elements:– Infectious agent
– Specific medical countermeasures being
used at POD
– Incident Command at POD
– POD flow and policies ( functions of
stations)
– Communication devices being used (ex.
Radios)
– Job Action Sheets (explanation of
assignments)
– Questions and Answers 17
8
RI-Specific POD Policies
• No IDs will be asked for
• No residency requirements
• Unaccompanied minors OK
• Head of Household (HoH) policy during a
pill response (never vaccine)
• POD workers and their families receive
prophylaxis before POD opening
Liability
National Health Emergency
• PAHPRA Act (2013)
• PREP Act (Pub. L. 109-148)
• Volunteer Protection Act (1997)
• Emergency Use Authorization
• Investigational New Drug
Rhode Island
• RIGL 30-15-15 states:
• Governor's executive order • Expanded scope of practice
24
9
42 Vaccination
Stations69 PODs
2898 Vaccinators
Why We Need You?Minimum # of Staff Needed for One Shift
25 Pill Dispensing
Stations69 PODs
1725 Dispensers
(for a pill response)
1725 Dispensers
or
2898 Vaccinators
~ Per shift ~ in order to
dispense/vaccinate 500
people per hour! 9-
10
Why We Need You?Roles and Responsibilities
Forms Review- Review patient history; make
countermeasure selection; and pass out information
sheets
Dispensing- 2nd review of form- confirm proper
drug/vaccine according to algorithm; refer special
cases to medical director
Inventory Management- Sign for countermeasures;
ensuring proper storage, quarantine, and waste
management; distribute to dispensing areas or
alternate dispensing
Medical Evaluation- Evaluate whether a person can
be seen at POD; troubleshoot special cases; send
patients to doctor or hospital as needed11
10
Case Studies
Station: Forms review station.
Patient: 10 year old with 4 history forms
Forms:
Adult Male = good health, no allergies
Adult Female = pregnant and has multiple
allergies including eggs, and peanuts
2 Children = (ages 10 and 2) no allergies or
medical problems
According to the provided algorithm, what would the appropriate
prescription be for each person?
20 -
22
Case Studies
Station: Dispensing
Problem: You are sitting at the
dispensing station working along side
two non-medical staff. You over hear
one of the staff members telling a
patient only to take the medication if
they feel ill.
What should your response to this be?
11
Case Studies
Station: Observation area
Additional Information: You are staffing the
observation area during a vaccination POD.
You notice a young man approximately 20
years old scratching his arms and legs.
Who should be notified about this situation?
Case Studies
Station: Dispensing
Patient: 19 year old Male
One Form: Allergy to peanuts, no medical
problems
Additional Information: Patient arrives at your
dispensing station, refusing to sit down,
agitated, nervous and demanding more than ten
days worth of medicine because he is “sure he
has been exposed and has the disease”
How would you handle this situation?
12
Get Involved
• Contact your local Emergency
Management Director to volunteer IN
ADVANCE to work a POD
• Take some ICS courses
http://training.fema.gov/IS
• Develop a personal preparedness plan
www.ready.gov
Next Step’s
50 additional day supply plan to re-open PODs.
13
If you would like to volunteer at a POD or have
any questions please contact:
Brittan K. Bates-Manni
Strategic National Stockpile Coordinator
401-222-4905
Brittan.Bates@health.ri.gov
Thank you!
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