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October 07, 2009
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Pandemic flu planning: How to set up point of dispensing sites

Editor's note: In the event of a pandemic flu, the need for mass immunizations will be vital to containing the spread of the disease and also decreasing the impact to the nation's critical infrastructure. To operate a successful Point of Dispensing (POD), key leaders from all disciplines — fire/EMS, health, law enforcement and emergency management — will need to work together. This article by Jim Sideras will cover goals, planning considerations, site selection, and security for creating a successful POD.

By Jim Sideras 

Little is written about PODs as their use has been infrequent. However, the military uses the POD concept very efficiently in immunizing deploying soldiers throughout National Guard units. I have had to opportunity to set up a number of these PODs and learned first-hand what works and what can be a setback. This article will offer ideas garnered from real evaluations and research to assist in making your POD operate effectively and efficiently.

The term "Point of Dispensing" refers to a mass dispensing site where immunizations would take place to prevent disease spread or for prophylactic treatment in the event of a terrorism incident. There is a significant difference between dispensing immunizations in a POD as opposed to clinic settings. PODs require a quick setup time and the ability to treat large numbers of people seeking immunizations. Also, PODs will require several agencies working together across organizational boundaries and disciplines.

Goals
The first goal in a mass immunization plan is to decrease the pool of individuals who might become ill. This necessitates the need to quickly implement a POD and have it running in a short period of time to immunize patients.

The second goal is providing the public with useable and timely health information concerning what they can do to prevent getting and spreading the disease. The key is providing both information and medication. A dispensing program is not considered successful if it lacks an effective media-public relations risk communications campaign.

Planning Considerations
Planning considerations need to take place well ahead of implementing a POD and several key decisions need to be resolved prior to the emergency. One of the most important is a policy that covers the dispensing of the vaccine that is consistent throughout your system. Every POD within your system needs to be operating under the same guidelines.

This will ensure the public and media view the dispensing system as fair and equitable to all those seeking treatment. If there is a difference in operations between PODs, this information will quickly be discovered and rapidly passed throughout your system. This can cause people to inundate one POD over the others, and there will be a perception of inequity or ineptness within the system.

Basic planning considerations will need to include:

  • Consistent hours of operation. Will PODs be operating on a 24-hour schedule or "traditional" clinic hours?

    * How will this information be conveyed to the public?
    * How will scheduling rotations be accomplished as well as food and breaks? Remember, the pool of available providers may be limited as a result of illness. 

  •  Prior to shutting down POD operations for any reason, where is the point or time when those seeking treatment will be turned away? 

    * What will those being turned away be told?

  • Consistent guidelines for treatment, including if treatment varies by ages. 

    * For example, if those receiving treatment must be over 65, what about a person who turns 65 next week?

    * How will a person's age be verified prior to treatment? How will this information be conveyed to the public as to what information to bring?

  • What level of provider can disperse or inject patients? This will vary by state, but are laws in place to waive this regulation in the event of a national emergency? 
  • Will there be one medical director overseeing each POD or overseeing the system?
  • Can residents of other states or countries be treated in your POD? As an epidemic will cross state and national borders, it can be assumed that your system may be treating a region as opposed to just your community.

    * Is there an accurate population count for the community and region in the event of national epidemic requiring PODs? This will be important for accurate numbers for coverage. 

  • Medical take-home information.
  • A 24-hour contact number for information that is well publicized in the media.

    * This should include a Web site with constant updates and FAQ capabilities.

  • If people arrive who do not meet the criteria for receiving treatment but are demanding care, how will they be handled?

    * It may be as easy as a consistent statement such as, “We understand your concern and this is scary. However, you do not meet the exposure criteria set up by the Medical Director, and you will not be getting any medication or immunizations today. We want you to take this information package, which lists a 24-hour phone number so you can receive more information.”

Security
Depending on the public perception and the availability of treatment, planning for security is another significant concern. In the event of a pandemic flu, law enforcement officers will be a valuable but limited resource. They may not be able to fill all the roles that are required for security at the POD. Arrangements should be made in advance to utilize the National Guard, private security companies, or non-law enforcement personnel to help fulfill these roles.

Every POD must have a security plan to handle different roles at the POD. This needs to be part of the planning process and can be critical to the operational safety of the POD. Some of these roles and considerations include:

  • Asset Protection. Medications and supplies may become a highly desirable commodity in an actual pandemic and may need to be protected from theft. 
  •  In addition to asset protection, security may be needed during resupply operations and at stockpile facilities.
  • Staff and volunteer identification.
  • POD staff protection.
  • Help with traffic, parking, and general safety issues when potentially thousands of people are in one location.
  • Maintaining civil order inside the POD.

Site Selection
The selection for PODs should be sites that are familiar to much of your population, and that are easily accessible. Places such as schools, malls, voting locations, or other commercial buildings are good examples. Be sure to consider accessibility issues when scouting for potential POD sites in order to provide coverage for people with impaired mobility.

Careful consideration should be taken when planning for the size of the building and protection from elements. The first consideration for the POD is the size of the building. POD sites must be large enough to keep several hundred, or possibly even thousands, of people in one area and out of inclement weather. Protecting people waiting in line from heat, cold, rain and snow is very important as many of those who show up may already be ill. Some large-scale exercises have used PODs as large as 60,000 square feet, and that size may be needed for larger communities. Agreements should be made in advance with building management for the use — or potential use — of their building for a POD.

Each POD site should have the following characteristics:

  • Electricity
  • Heat and air conditioning units to control room temperature
  • Adequate toilet facilities (one for every 40 people)
  • A receiving area for supplies that is out of public view
  • The appropriate number and types of material handling equipment
  • Space for parking at or near the POD
  •  Water
  • Maintenance staff who know the building and how to control heating, air conditioning, lights, and plumbing
  • Chairs and tables already on site.

Transportation Issues
It will be important to determine how people will get to the PODs. This will vary greatly as to the number of PODs set up as well as the uniqueness to the sites selected. Consideration will need to be taken for the various types of transportation people will use to get to the POD sites. For example, automobiles are used most often in rural and suburban settings, which will necessitate parking and traffic-related concerns for PODs in those types of locations. However, in urban settings, trains, buses, subways, and taxis are used with much greater frequency. Considerations of PODs in these areas may include providing directions or guides from train, bus, and subway stops to the POD.

Each POD should also have a plan for dealing with abandoned vehicles. In the event people arrive too ill and require transportation to a hospital, their vehicle will be abandoned. If this occurs with any frequency, the parking facilities could be quickly overwhelmed especially since ill patients may park directly in front of the building because they are unable to walk any distance. These abandoned vehicles, even a few, will quickly disrupt traffic patterns and flow.

It cannot be overemphasized that prior planning is critical for the success of implementing PODs for mass immunizations. The planning and distribution of the plan is vital — in the event of a national epidemic, the people who know the plan best may be ill. That is why the plan needs to be simple and cover key elements to ensure success.

This article dealt with goals, planning considerations, site selection, and security for creating a successful POD. The next article in this series will discuss site setup, layout, staffing, and public information deployment. If you have any questions so far, please e-mail me at jim.sideras@ems1.com.

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