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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.

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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

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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)

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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

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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

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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

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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

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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-

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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

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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 -

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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?

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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?

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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.

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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!