Colorado’s Planning Guide for Local Mass Prophylaxis or Immunization

A Point of Dispensing (POD) Standard Operating Guide (SOG) for Planning

Version 3.0

December 2006

1

Note: For this manual, we will follow the convention of italicizing in red specific questions to be answered and ideas for the planners will be in red italics. Examples and other explanatory material, while also serving to instruct, will be in black standard type..

I.Introduction

The brief introduction (couple of paragraphs) can be used to give a history of your emergency support function in general or of the demographics of your jurisdiction. This can be any kind of information or background that would not fit anywhere else in the plan and that would give the reader a sense of your operation. It can also be used for a mission or objective statement.

Example: This document is intended to support local public health agencies in writing a plan for the activation and operationalization of a Point of Dispensing (POD) in their county. The document is an annex to the X Health Department’s emergency operations plan and will continue to be revised on an annual basis.

A.Purpose

Why are you writing this plan? Who is meant to read it? The purpose is usually one paragraph, but can be more if needed.

Example: This operating guide will be used during a public health emergency. It was created to assist local public health personnel in initiating requests for SNS supplies and implementing rapid distribution measures to protect the general public by the following:

  • Reducing mortality and morbidity
  • Preserving healthcare services infrastructure
  • Minimizing social disruption during a natural or intended disaster

The critical elements have been identified by the Centers for Disease Control and Prevention (CDC), the State of Colorado, and the Regional Transfer Point Plan as necessary to successfully initiate and operate Points of Dispensing throughout the state of Colorado.

B.Scope

The Scope section of a plan limits and defines both geographical areas (list the counties to which the plan pertaibns) and the work itself.

Example: This Point-of-Dispensing Standard Operating Guide (SOG) applies to situations defined as a natural or intentional emergency/disaster, terrorist attack, or pandemic event requiring mass vaccination or dispensation of pharmaceuticals to the public within X county. This plan provides details about command and control, legal issues, communications, POD operations, logistics, etc.

II.Assumptions

Assumptions are a list of things that you assumed would be happening or in place during the disaster for which you are writing the plan. These types of items may seem obvious but they provide context for your plan.

The assumptions may not be immediately apparent if a disease outbreak is intended or natural. Other disasters, such as tornadoes, floods, and chemical spills may also require that the general population receive SNS resources.

By the time the need to activate the Strategic National Stockpile (SNS) has been determined, the health of the public may already have been impacted and a national emergency may exist.

Local inventories of needed pharmaceuticals and medical supplies will quickly be depleted.

Personnel, volunteers, and strike teams of epidemiologists may need to be activated throughout the state to accommodate operational periods associated with disease outbreaks.

Departmental/County/Regional/State Emergency Operation Centers (EOCs) may be activated.

Multiple disciplines, such as medical, environmental, agricultural, law enforcement, coroners, and emergency management will need to cooperatively address the disaster.

Disasters that require SNS activation will require effective messages to mobilize the press and utilize Emergency Alert/Emergency Broadcasting Systems to notify the public as well as timely press releases, press conferences, and other vital communications.

III.Authority, Responsibility and Legal Issues

This section describes any authorities or legal issues. It should reference all applicable state and local statutes, laws and executive orders such as the Colorado Revised Statutes, Homeland Security Presidential Directives, county insurance for volunteers, etc

Example:

This document quotes and summarizes but does not interpret federal, state or local codes, regulations, statutes or laws. Nothing in this document should be construed as providing legal counsel. Mass clinic planners may wish to consult their legal counsel for any such advice. All applicable codes, statutes, regulations, laws and presidential directives are provided in Attachment X.

A.National Response Plan (NRP)

In Homeland Security Presidential Directive (HSPD)-5, the President directed that the Department of Homeland Security develop a new National Response Plan (NRP). The NRP is based upon the belief that incidents are typically managed at the lowest possible geographic, organizational, and jurisdictional level.

1.ESF 8

The NRP applies a functional approach and groups the capabilities of departments and agencies into Emergency Support Functions (ESFs) to provide the planning, support, resources, program implementation, and emergency services that are most likely to be needed during an incident. ESF 8 refers to Public Health and Medical Services.

2.Target Capabilities List

The purpose of HSPD 5: National Preparedness is to “establish policies to strengthen the preparedness of the United States to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other emergencies”. This directive involves capabilities-based planning. “Strengthen Medical Surge and Mass Prophylaxis Capabilities” has been identified as one of the national priorities and applies to the mass prophylaxis and medical surge capabilities.

B.Colorado Revised Statutes

Per guidelines in the Colorado Revised Statutes, State and local departments have statutory authority to “investigate and control the causes of epidemic and communicable diseases affecting the public health.” C.R.S. 25-1.5-102(1)(a)(State) and 25-1-506(1)(b)(County). See C.R.S. 25-1-650 for similar authority of public health nursing services.

Under the Governor’s Expert Emergency Epidemic Response Committee (GEEERC) statute (C.R.S. §24-32-2104(8)(e), the Governor may issue executive orders directing measures that may include but are not limited to the following:

  1. Procuring and taking supplies of medicines and vaccines;
  2. Ordering physicians and hospitals to cease admissions;
  3. Isolating or quarantining persons or property;
  4. Seizing, destroying or decontaminating property or objects;
  5. Disposing of corpses and infectious waste in a safe manner;
  6. Assessing the safety of food and water supplies;
  7. Providing mental health support;
  8. Providing information to the public.

C.Regional Strategic National Stockpile Plan

Under guidance from CDPHE and CDC, each of the Colorado All-Hazards Emergency Management Regions has developed a Regional Strategic National Stockpile Plan. This plan is the over-arching plan for all of the local POD plans within the region. All regional plans are posted on COHAN.

D.Local/County Plan

Describe the relationship between the POD plan and the local/county plan, such as how they are the same and how they are different.

IV.Concept of Operations

A.National Incident Management System Structure

This plan operates under the National Incident Management System (NIMS). NIMS is designed to aid in the management of resources through the following concepts:

1.Common terminology

2.Integrated communications

3.Modular organization

4.Unified command structure

5.Manageable span of control

6.Consolidated action plans

7.Comprehensive resource management

8.Predesignated incident facilities

B.Regional Transfer Point (RTP)

1.Regional assessment of need, MOU, MOA

Briefly describe how your jurisdiction will determine the need for supplies, pharmaceuticals, equipment and volunteers. Who is contacted, what protocol is followed? Reference MOUs, MOAs, COpharm, etc

Example:

Prior to requesting SNS assets through the CDPHE, the X County/Health Department will coordinate assessment of pharmaceuticals through the COpharm HAN program at CDPHE CMC.

- X is responsible for requesting this assessment.

-Once the COpharm assessment is complete and data is collected, the Health Officer will make the decision to request the pharmaceuticals from the local pharmacy where the needed medicines are currently being housed. (Should the pharmacy not readily relinquish the medicines, the Health Officer will make a request through the CDPHE CMC to the Governor’s Expert Emergency Epidemic Response Committee to enact draft Executive Order 2.0 - Concerning the Procurement and Taking of Certain Medicines and Vaccines Required to Respond to the Current Disaster Emergency.)

- X will be responsible for transport of the pharmaceuticals

- and X will be responsible for securing them during transport.

2.Lateral re-distribution of supplies

Briefly describe your plan for how pharmaceuticals and supplies will be redistributed within your region or to counties in another region. Who is responsible for transport, security, inventory control, chain of custody, etc?

Example:

Once the SNS has been activated and the RTP has distributed SNS materiel to local PODs, the POD may determine that their supply is more than the demand. To move SNS materiel from one POD to another

-the Liaison Officer will be responsible for contacting other POD locations to determine if they are able to utilize the unused position of the supplies. The POD Liaison Officer is also responsible for coordinating this transfer with the departmental EOC.

-If the transfer involves SNS assets, the departmental EOC will make sure to notify the designated CDPHE CMC Liaison.

-The POD Logistics Officer is responsible for organizing transport of the materials whereas

-the Inventory Control Coordinator will be responsible for starting the chain of custody.

The X County/Health Department will coordinate transport from one jurisdiction (county or region) to another through the Liaison Officer at the CDPHE EOC.

3.Requesting SNS assets from the RTP

Briefly describe the process for requesting the needed pharmaceuticals and supplies from the Strategic National Stockpile through the RTP. If an official protocol is available, reference this as an appendix.

C.Point of Dispensing Protocols

1.Clinical protocols

  1. Intake

The process, procedures, stations and personnel involved in getting people into a POD to be assessed. It also includes the completion of any paperwork. The following stations will be involved in this layer:

  1. Traffic management
  2. Initial entry point
  3. Greeting
  4. Registration-- Appendix X contains a sample Name, Address, Phone form. This form is available electronically on COHAN and is available for rapid reproduction locally. These forms are available for household distribution of prophylaxis. The form asks for the weight of household members because the dose of many of the possible drugs is determined by the person’s weight.
  5. Triage

How will health history forms be distributed to patients? How will forms be checked for legibility, accuracy and completeness? How will forms be used to route patients correctly so they receive the correct medication in the right dose?

How will patients be triaged? Please refer to pages 12-6 to 12-8 about segmented PODs vs. non-segmented PODs. Will triage be conducted at a separate location or at the POD site? This could affect the order in which items are discussed in the clinical protocols section.

  1. Screening

The process, procedures, stations and personnel involved in sorting and classifying patients within the POD to optimize resources and maximize survival of patients. The following stations and roles will be involved in this layer.

  1. Screening
  2. First Aid
  3. Medical Transport

How will patients be transported to the POD or to treatment centers? Refer to the above comment about segmented vs. non-segmented PODs.

  1. Mental Health counseling
  1. Dispensing

The process, procedures, stations and personnel involved in preparing and delivering medications to the public.

  1. Exit

The process, procedures, stations and personnel involved in moving the patients out of the POD, as well as providing any necessary follow-up information.

2.Prophylaxing staff and volunteers.

Describe how you will prioritize dispensing medicines to first responders, public health workers, medical workers, etc. prior to dispensing to the general public.

Examples:

The X County/Health Department will follow the Department of Health and Human Services guidelines for prioritizing the use of vaccines and antivirals during a pandemic. See Attachments X and X for the complete list. For non-communicable disease emergencies, X County/Health Department will provide vaccine/medicines to first responders and families in accordance with state and national guidelines provided by CDPHE and the CDC. This priority list can be found in Attachment X. (Make sure this text is kept up to date with the current guidelines.) CDPHE and the GEEERC jointly reserve the right to make an entirely new priority list at the time of the event, if the circumstances seem to warrant that.

3.Standing Orders

The Colorado Department of Public Health and Environment and/or the X County Nursing Service/Health Dept may provide standing orders for vaccine/medication administration, as well as standing orders for responding to medical emergencies, which may occur during a vaccination/medication clinic. See Appendix X for examples of standing orders.

4.Dispensing Oral Meds

Briefly describe how this will occur, what procedures will be followed, who is in charge, where will this take place, etc.

Example:

Pediatric dosing and select geriatric dosing will require some liquid medication preparation. The preparation of these medications will take place under the direction of the Medical Branch Director and must be done by pharmacists or pharmacy assistants. The CDC- recommended preparation procedures should be followed as closely as possible.

5.Language/Translation Services

Identify the main languages that will require translation services. Reference who will provide translation services.

V.Roles and Responsibilities

A.Command and Control

The information in this section addresses the question “who is in charge.” Describe the structure of your group for a response. You can also put information about NIMS and your organization’s ICS strategy. Reference the appendix that contains the sample ICS structure with primary and back-up contact information.

Example:

1.NIMS

This plan operates under the National Incident Management System (NIMS). The Public Health Director or designee(s) will respond to a natural or human-caused emergency/disaster, terrorist attack, or a pandemic disease event requiring POD activation using the NIMS structure.

2.Incident Command: Reference your ICS chart in an appendix

3.Staff Support

In addition to incident command, additional resources should be available for staff support. A system for insuring staff takes regular work breaks will be in place. This break system will also address the provision of workstation coverage during breaks. The support team will consist of non-medical personnel within X County Nursing Service. Additionally, staff support services will include consideration of the following:

a.Risk awareness education, including frank discussions of potential risks and measures for protecting healthcare providers

b.Staff involvement in the quality assurance program

c.Daily clinic updates

d.Opportunities for fearful or anxious healthcare providers to work in other useful roles

4.Mental Health

At the local level, it is anticipated that there will be a need for mental health professionals and/or counselors to staff clinics to support, counsel, and calm patients who may be anxious or frightened. An arrangement has been made with X to address these issues. They have staff on-call 24/7 and will respond with the number of counselors needed to fit the situations.

B.Communications and Notification

1.Tactical Communications

What types of communication systems will you use within your POD? What communication systems will you have at your POD? Two way radios? Runners with message forms? Cell phone? How will you communicate with partners? Who is responsible for maintaining the communication systems and resources for the PODS? Who is responsible for checking and charging batteries, and for testing of communication equipment?

2.Internal Notification Procedures

How will you notify your staff in your agency? What protocols do you have in place for volunteer notification? Who is authorized to send out HAN messages?

You need to have POD lead/back up list and document that info is updated quarterly

3.After Hours Communication Procedures

When your office is closed, how will labs, the state, emergency management or others reach you in an emergency? Through your 911 system? Does your agency have a duty officer? Do you share a pager and rotate call? Describe the procedure here. If there is a written protocol, reference it as an appendix.

C.Public Information

Public health agencies have a responsibility to maintain patient confidentiality just as if it weren’t an emergency. Look in your local jurisdiction to see what agency is responsible for public information. Public messages should be coordinated through a Public Information Officer. If the incident involves other jurisdictions, there may be a Joint Information Center created to coordinate messages to the public and updates to the press. Describe your plan here. Are there subject matter experts identified in your agency?

Example:

In the event of a public health emergency, X County will coordinate with the CDPHE EOC PIO. Point-of-contact information for public information personnel is found in Attachment X. After an emergency has been declared, state and local Joint Information Centers (JICs) will assume primary responsibility for all media relation’s activities. When this occurs, a representative of the local health department may be called upon to serve as JIC liaison. Responsibilities of the JIC Liaison are provided.

1.Coordination with Emergency Management

Public safety messages often are coordinated through the local emergency manager utilizing reverse 911 systems, Emergency Broadcasting Systems, and the Emergency Alert Systems. Messages to the public can be streamlined to alert the public to shelter in place, evacuate, or location of mass clinic operations.