Hospitals and other healthcare facilities order, receive, and administer medications to patients on a daily basis. However, not as routine is the issue of how to acquire and administer drugs to staff and their families during a biological incident. To address this potential response issue, a well thought-out plan is required. Healthcare facilities in Washington, D.C., have recently partnered with the District of Columbia Health Department to address this important response need.
Fortunately, the U.S. Centers for Disease Control and Prevention (CDC), working in coordination with local and state health departments, has already been encouraging local jurisdictions to develop comprehensive medical countermeasure programs for their own communities. A critical component of such programs is Points of Distribution (PODs), of which there are two types: (a) Open PODs (OPODs); and (b) Closed PODs (CPODs).
Most OPODs are operated by health departments to provide medications to the general public during a biological incident. During and after such incidents many OPODs would be operated simultaneously to facilitate the distribution of medications as quickly as possible to adults and children in the community. Citizens coming to the OPOD can obtain oral antibiotic/antiviral medications for themselves and their family members – vaccinations/immunizations, however, require that each individual comes in person to receive the injection. Public messaging directs citizens to an open nearby OPOD. The availability of the OPOD streamlines the distribution of medications while at the same time minimizing the need for citizens having to go to a hospital in person to receive the medications.
CPODs are typically operated by businesses to distribute medications to their own staff and a designated number of direct family members. The purpose of using CPODs is to ensure that, to preserve their health, staff could receive needed medications in a timely manner and, therefore, would not have to go to a hospital or OPOD to receive the medications.
An important question frequently asked is: “Where do hospitals and skilled nursing home staff and their families receive their own medications?” Over the past two years, the District of Columbia Department of Health (DOH) has effectively fostered the development of PODs within D.C. Those efforts have been very successful both in creating and exercising the two types of PODs. More recently, an intense effort has been initiated to encourage D.C. healthcare facilities to become CPODs.
Public-Private Partnership Planning To assist healthcare facilities in developing a CPOD, a four-step process has been described in a Closed POD Dispensing Planning Guide. The Planning Guide, created and distributed by the DCDOH, outlines – in a comprehensive but easy-to-read format – all of what a healthcare facility needs both to understand and to do in establishing a CPOD.
The first step involves executing a memorandum of agreement (MOA) with the local DOH – information on the MOA document is included in the Planning Guide materials. The MOA, which outlines the responsibilities of both parties involved, includes a stipulation that, in return for completing the outlined steps, the healthcare facility will, in an emergency, be provided the number of medications requested to cover its own staff and designated family members.
Managing the Process The second step involves the facility devising a Closed POD Site Plan by using a planning template included in the Planning Guide. The same plan addresses a number of closely related topics, including outlining the incident command structure both to provide leadership to the CPOD operation and to integrate that operation into the healthcare facility’s overall incident command system. The principal positions assigned to provide the leadership needed are those of the Closed POD Coordinator and the leaders of three principal units: Forms and Queuing Unit; Dispensing Unit; and Logistics Unit. Job Action Sheets are written for each command position and provide suggested actions and outline reporting relationships. The Site Plan also spells out the throughput design – which encompasses, among other important duties and responsibilities: Greeting and Form Distribution; Form Screening; Medication Dispensing; and Special Assistance.
The number of lines established to maximize client throughput at any given healthcare facility is usually dependent on both the number of staff members available and the space needed to allow a redundant line design;eally, of course, the greater the staff size, the greater the number of process lines that can be formed. Facility planning must also address such ancillary management issues as staff rotation, resupply, documentation, communications, and security.
To help familiarize the healthcare facility planners responsible for managing that facility’s CPOD, the D.C. DOH has created and made available a series of training sessions described as “Step 3” in the overall process. These sessions help participants both to understand and to use the guidance materials available and to discuss the lessons learned from other facilities that have previously completed the CPOD process – specifically including the conduct of an exercise. After the healthcare facility has completed its CPOD plan, the plan is submitted, along with the signed MOA, to the DOH for its review and comments.
Training and Exercising The final step of the CPOD process requires that the specific facility involved provides training to the healthcare staff designated to operate the CPOD. That training includes reviewing the plan, the incident command system (ICS) – and the individual roles and responsibilities assigned by the ICS – as well as the throughput system design and various documentation requirements.
Following the in-house training required, each healthcare facility conducts a full-scale operational exercise. During that exercise, the plan is implemented from the beginning and encompasses such important actions and responsibilities as: (a) the alert and notification process; (b) the system “set up” process; (c) medication receipts from DOH; and (d) the distribution of medications to the volunteer staff members arriving to receive them.
Following the exercise, all of the parties involved participate in an after-action discussion that not only leads to a comprehensive report being written but also lists various changes that should be made to the plan.eally, such exercises would be conducted annually to ensure adequate staff familiarization and implementation capabilities.
To briefly summarize, the potential for a community to encounter a biological incident requiring the distribution of medical countermeasures is a major planning concern for health departments across the country. No less important is for hospitals and other healthcare facilities to be ready to open a CPOD to provide medications to their staff and family members, thus optimizing staff responsibilities and capabilities by: (a) focusing on doing their own jobs during the crisis; (b) building confidence that their individual family needs also have been met; and (c) reducing the number of persons waiting in line at an OPOD.
________________________ Craig DeAtley is Director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital; he also is the Emergency Manager for the National Rehabilitation Hospital and co-executive director of the Center for HICS Education and Training. He previously served as an Associate Professor of Emergency Medicine, for 28 years, at George Washington University, and now also works as an Emergency Department Physician Assistant for Best Practices, a large physician group that staffs emergency departments in Northern Virginia, and has been both a volunteer paramedic with the Fairfax County Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. He also has served, since 1991, as the Assistant Medical Director for the Fairfax County Police Department.