1. Point of Dispensing (POD) Staff Orientation
What You Should Know
Welcome and thank you for coming to this talk for Point of Dispensing staff. During this talk I will be referring to point of dispensing clinics as PODS.
Insert Local Health Department Logo Here
Supported by CDC Cooperative Agreement No. U90/CCU

2. At the end of this session you should be able to describe:
A POD and when it may be established
The role of the Strategic National Stockpile in a POD
Incident Command System
Basic POD operations: Communication, Job Action Sheet, Legal Protections, Safety/Security, Clinic Flow
Preparations for working in a POD: Family/household planning, further training opportunities

3. Overview Points of Dispensing Strategic National Stockpile
Incident Command System
POD Operations
Preparing to Work at a POD
Additional Training Resources
Information on the Upcoming SNS Exercise

4. What is a POD?
A site where medications or vaccines intended to prevent disease may be given quickly to a large number of people in the event of a public health emergency.
The preventive therapy may be an antibiotic or a vaccination.
A POD may also be called a mass dispensing clinic.
A POD is not medical setting where disease in treated. Sick people should not come to a POD. If they do, they will either be turned away before entering the POD and told to see a doctor or they will be transported to the hospital by ambulance if appropriate.

5. Public Health Emergency That May Require a POD
Many people have been exposed to an infection that may make them sick
AND
Disease from that infection may be prevented by antibiotics or a vaccine
The infection may be naturally occurring or bioterrorism-related
Vaccine or antibiotic preventable diseases that may result in a POD include smallpox, anthrax, plague,tularemia or influenza.

6. All CT Local Health Departments Have Been Asked:
To contribute to the:
Development of plans to rapidly establish and operate CT PODs
Recruitment and training of POD staff.
PODs may be set up in schools, town halls or other community facilities. POD staff will include public health and safety professionals and volunteers. A very large number of staff will be needed to run a POD

7. ± State of Connecticut Mass Dispensing Areas and
Department of Emergency Management and
Homeland Security Planning Regions
MDA Lead Health
Kent
Sharon
Stafford
Killingly
Norfolk
Salisbury
Litchfield
Newtown
Lyme
Lebanon
Guilford
Suffield
Goshen
Tolland
Granby
Woodstock
Haddam
New Milford
Cornwall
Danbury
Pomfret
Ashford
Union
Hebron
Montville
Enfield
Oxford
Ledyard
Groton
Mansfield
Plainfield
Berlin
Salem
Colchester
Avon
Thompson
Greenwich
Wilton
Glastonbury
Madison
Bristol
Coventry
Griswold
Canaan
Stamford
Shelton
East Haddam
Preston
Easton
Hartland
Torrington
Ellington
Hamden
Southbury
Voluntown
Redding
Fairfield
Warren
Windsor
Middletown
Somers
Cheshire
Stonington
Simsbury
Canterbury
Wallingford
Norwich
Woodbury
Sterling
Waterford
Eastford
Ridgefield
Canton
Monroe
Willington
Milford
East Lyme
Brooklyn
Washington
North Stonington
Colebrook
Roxbury
Harwinton
Southington
Winchester
Burlington
Morris
Durham
Meriden
Windham
Barkhamsted
Portland
New Hartford
Bozrah
Wolcott
Waterbury
Norwalk
Hampton
Watertown
Weston
Trumbull
Bethel
Putnam
Old Lyme
Bethany
Chaplin
Sherman
Vernon
Branford
Farmington
Lisbon
Bloomfield
Franklin
Manchester
Orange
Bolton
Westport
Hartford
Chester
Brookfield
East Windsor
South Windsor
Essex
Darien
Bethlehem
Seymour
Prospect
Sprague
Killingworth
East Hampton
Plymouth
Clinton
Columbia
Stratford
Scotland
New Fairfield
Andover
Marlborough
North Branford
New Canaan
Middlebury
North Haven
New Haven
West Hartford
Woodbridge
Bridgeport
Naugatuck
Westbrook
Bridgewater
East Hartford
East Granby
North Canaan
Cromwell
Rocky Hill
Deep River
Newington
Middlefield
Old Saybrook
New Britain
Plainville
East Haven
Thomaston
Wethersfield
West Haven
Derby
Ansonia
Beacon Falls
Windsor Locks
New London
Number Department/ District
Greenwich HD
Stamford HD
Norwalk HD
Westport HD 24
Danbury HD
Bethel HD 34
Newtown HD
New Milford HD 31 41
Torrington Area HD 40
Fairfield HD 9 29 30
Bridgeport HD
Stratford HD 32
Naugatuck Valley HD 33
Pomperaug HD 25 34
Waterbury HD
Chesprocott HD 27 40
Milford HD 28
West Haven HD 26
New Haven HD
Quinnipiack Valley HD 8
Guilford HD
Meriden HD 15 36 38
Wallingford HD 22
Farmington Valley HD 14 16 35
Bristol/ Burlington HD
Southington HD
New Britain HD 23
Central Connecticut HD
WH/ Bloomfield HD
Hartford HD 5 7 20 37
37a
Windsor HD
East Hartford HD
Connecticut is divided into 40 Mass Dispensing Areas, may of which cover more than one health district/department. Within the MDA one health district/department takes the lead and the others collaborate with the lead.
Manchester HD 13
North Central HD 21
Chatham HD 12
Middletown HD 6 19
New London HD 17
37a Ledgelight HD 18 10
Uncas HD 11
DEMHS Regions
Eastern Highlands HD
Northeast HD 4
Legend 1 2 3 1 2 3 4
Miles
November 14th, 2005 3 6 12 18 24 5

8. Strategic National Stockpile
The Strategic National Stockpile is a US Centers for Disease Control and Prevention managed source of medical supplies, drugs and equipment that may be used during an activation of a POD.
Medical supplies, drugs, and equipment.

9. Strategic National Stockpile – What Is It?
A large stockpile of medicine and medical supplies to protect the American public if there is a public health emergency severe enough to cause local supplies to run out.
The medicine in the SNS is FREE for everyone.
The SNS has stockpiled enough medicine to protect people in several large cities or states at the same time.
Federal, state and local community planners are working together to ensure that the SNS medicines will be delivered to the affected area to protect you and your family if there is a terrorist attack or natural disaster.

10. Strategic National Stockpile Components
12 Hour Push Package
Vendor Managed Inventory
The SNS program is comprised of two possible deliveries in response to an event. Components to a Two-Tiered Response:
12-Hour Push Packages:
Ready for deployment to reach designated area within 12 hours of Federal activation
Pre-positioned in environmentally controlled and secured facilities
Pre-configured for rapid identification and ease of distribution
Vendor Managed Inventory:
Are comprised of pharmaceuticals and supplies that are delivered from one or more VMI sources
“Tailored" to provide specific materiel depending upon suspected or confirmed agent
Will be shipped to arrive within 24 and 36-hour periods

11. Incident Command System (ICS)
Key to efficient operation and good communication flow

12. What is the ICS ? Standardized
Can be applied to a wide variety of emergencies
Basic features
Common terminology in ‘plain talk’
Modular organization (easy to grow or shrink)
Management by objectives
Reliance on an Incident Action Plan
Chain of Command
Unified Command
Manageable span of control
The need for Common Terminology will be examined below
Modular organization will be examined in the next slide
An Incident Action Plan specifies objectives and activities to be completed within a specified period of time.
A Chain of Command is an orderly line of authority within the ranks of the incident management organization.
Unified Command provides guidelines that enable agencies with different legal, geographic and functional responsibilities to coordinate, plan and interact effectively.
Span of Control is the number of individuals or resources that supervisor manages. Ideally the number of subordinates does not exceed 5.

13. Command Operational Structure
Each POD in CT will be organized using an incident command system (ICS) . This is a basic depiction of the ICS.
Incident Commander: Responsible for all activities and functions. Assesses need for staff. Establishes incident objectives. Directs staff to develop an Incident Action Plan.
Information Officer: Advises Incident Commander on information dissemination and media relations. Obtains information from and provides information to planning section, community and the media.
Safety Officer: Advises Incident Commander on incident safety. Works with Operations to ensure safety of personnel.
Liaison: Assists Incident Commander by serving as point of contact for agency representatives who are helping to support the operation. Provides briefings and answers questions for supporting agencies.
Sections:
Operations: Conducts tactical operations to meet objectives (in this case getting vaccine or pills into a large number of people in a short period of time).
Logistics: Provides support, resources, services to meet operational objectives.
Planning: Prepares and documents the Incident Action Plan to accomplish objectives. Evaluates information.
Finance/Administration: Provides accounting, procurement, time recording and cost analysis.

14. ICS – Bottom Line
Each person at the POD has a specific and limited job
Each person within a POD reports to only one designated person
Each POD supervisor has a specific and limited number of positions reporting to him or her
Refer issues to your supervisor or other personnel as appropriate.
A person’s rank in the agency for which he or she usually works does not apply within the incident command structure.

15. Job Action Sheet: Job Title Job Mission Supervisor Name
Immediate Duties
On-going Duties
Extended Duties
When you work at a POD you will be provided with a Job Action Sheet describing your job. This document includes your job title, mission, supervisor and duties to perform. It will describe any equipment that you need to use such as safety or communication equipment.

16. Internal POD Communication
Communication flow should follow the chain of command
Your communication role in POD operations will be described in your Job Action Sheet
Plain talk – no codes or acronyms
Communication equipment
Radio, cell phone, whistles, bull horn, walkie talkie
Clinic managers will ensure internal clinic communications are tested prior to opening
Make sure you know how to use any communication equipment assigned to you
Clear communication is critical to the success of a POD

17. Why Plain Talk? Many meanings of EMT - Emergency Medical Treatment
Emergency Medical Technician
Emergency Management Team
Eastern Mediterranean Time
Effective Methods Team
Effects Management Team
El Monte, CA (airport code)
Electron Microscope Tomography
Money Transfer

18. POD Jobs
The jobs required to run a POD are many and varied. Therefore, everyone has the potential to contribute strength and resources in times of emergency. Volunteers can provide essential services both in a medical and non-medical capacity. Professional public health staff will be present to provide the expertise and skills to support clinic functions.

19. Examples of POD Jobs Data entry personnel Form distributors
Translators
Medical screeners (MD, PA, RN)
Pharmacists
Security personnel
Food preparers
Vaccinators
Janitorial staff
Mental health workers
Traffic Control staff
ID/Badging staff
Runners
Telecom / IT support staff
EMS transfer personnel
There may be more than one job for which you are suited. You can review the Job Action Sheets for more specific information.

20. CT Public Health Emergency Response Act (PHERA), 2003
Protects POD staff (employees and volunteers) from liability
when acting on behalf of the State or Local Health Department during a declared Public Health Emergency.

21. Operation of this POD
Adapt this section as necessary

22. Operations Organizational Structure Operations Section Chief
Triage Unit Leader
Floater/Greeter Unit Leader
Security Task Force 1
(Interior)
Forms Distribution Unit Leader
Pharmacy Unit Leader
Security Task Force 2
(Exterior)
Video Orientation Unit Leader (as required)
Vaccine/Prophy Abx Unit Leader
This is the ICS structure for POD operations in Connecticut.
Interior Clinic Traffic Control Unit
Child Care Unit Leader
Exit/Evaluation Unit Leader
EMS/Transfer Unit Leader

23. POD Clinic Flow
A clinic is arranged to move people through as quickly as possible from entrance to exit. Within a clinic, stations are set up with distinct purposes to help move people through. This figure represents the flow of clients through a POD. It may be used as a model for set up depending upon the space available and the circumstances of the health emergency (BERM – Cornel Weill Medical Center)
Key stations/areas are described below:
Entry Screening and Form Distribution – Station where people are 1) directed into the POD, 2) given forms to complete and 3) screened for obvious illness.
Triage – Station where people requiring medical and mental health evaluation are identified based on patient completed forms or direct questions.
Briefing – Stations were attendees are given information about the drug or vaccine they will receive.
Pharmacy areas - Stations where medications or vaccines are administered.
Exit – Station where people are directed out of the POD and where forms are collected. May provide additional information on topics such as follow up care or importance of compliance.

24. Call to Action If mass dispensing is required:
State and Local Health Departments will coordinate POD operations
You will be:
Contacted by telephone, fax or
Asked about your availability to work at the POD
Informed about where and when to report and what to bring
You may be asked to report to the clinic site or an alternate staging area from which you will report to the sites.

25. Call to Action
Your Local Health Department maintains a list of POD staff.
Make sure you inform your Local Health Department about changes in your contact information.

26. Before Your Shift Supervisor will provide Just-In-Time training
A briefing on the specific situation and POD functioning
Training on your Job Action Sheet
Arrangements for food, rest, safety, communication with home
Local check in procedures
Make sure you know your role in communication and how to operate any equipment assigned to you.

27. Signs of Stress and Fatigue in Self and Others
Lack of concentration
Increasing number of non-critical errors
Critical errors
Irritability
Worry
Feeling ill

28. Resources for Clinic Staff During Shift
Facilities to support staff
Food, rest
Mental health support for staff
These elements should be determined locally

29. End of Shift
At the end of your shift or before you report off duty you will be asked to:
Brief your supervisor
Turn in all reports and equipment
Sign out procedure

30. Dealing with POD Challenges
If you need assistance, ask your supervisor
General rules for dealing with
Special needs populations, e.g. limited mobility, hearing, vision, literacy, non-English speakers
Those experiencing extreme distress
Conflict

31. Communicating Beyond the POD
Only the Public Information Officer should speak with the media
Respect the privacy of people working and attending the POD
Report any rumors to your supervisor
Follow your supervisor’s guidance on communication with friends and family
You should not talk with the media about the POD while on duty or after your shift. The Public Information Officer is the only person who should speak with the media. He or she is the expert in communicating with the media. Speaking through the Public Information Officer will result in the dissemination of a unified, fast and accurate message.
Report rumors to your supervisor so that a unified response can be developed and presented to the public

32. POD Security Local security arrangements - know before event
Staff and volunteers will be briefed on specific security arrangements as part of Just-In-Time training for a drill or event
The safety of the clinic staff is of utmost importance

33. Personal Safety
Safety Officers will be on site to ensure a safe working environment
Your Job Action Sheet will describe safety precautions and equipment use
Local arrangement for priority prophylaxis of POD workers and family/household

34. Preparing to Work at the POD
Events can happen without warning and with very little time to respond, so preplanning is important.

35. Create A Family Disaster Plan
Create a family / household disaster plan that includes a communication plan. You can find templates created by American Red Cross, State of Connecticut and the US Department of Homeland Security at the web addresses provided on the slide.

36. Make Prior Arrangements For
Communication between family members
Care of elders, children, pets
Home security
Medication
Transportation
Any verification of credentials
An important part of a disaster plan is a family communication plan to so that family/household members know how to reach each other and have a central meeting point. Make sure the plan is kept up-to-date.
You should document medications taken by each member of the household and make sure refills are up-to-date. You should bring a few day’s supply of prescriptions when you come to work at the POD.

37. Training

38. Additional Training Opportunities
DPH online training in key content topic areas:
ICS/NIMS
Mass dispensing (PODs) operations
SNS overview
Diseases that could lead to mass dispensing
Psychosocial (mental health)
Legal
Specialized training for licensed professionals – Medical Screeners, Pharmacists
Just-In-Time training
In addition, Volunteer organization training – American Red Cross, Citizen Emergency Response Teams (or put this in a separate slide)
Next page describes online training resources for Connecticut

39. TRAINConnecticut Online
Access these and other valuable training resources on the internet at
The manual and flyer show you how to register and start the training
TRAINConnecticut is an invaluable public health training resource for our state.
[Hand out TRAINCT ‘volunteer’ manual and ‘how to register’ flyer]

40. April CT Exercise Information
Full scale SNS exercise

41. SNS POD Exercises When Where Objective
April 18th and 19th (mainly the 19th)
Where
At 7 PODS and 4 hospitals throughout CT
Objective
To activate a POD and successfully distribute “medication” to residents served by that clinic in response to a simulated biological emergency.

42. What We Know The drill will last approximately 4 hours.
It will take place during normal business hours.
Bring…..
Don’t bring
Food (We will feed you)
Drink (We will supply that too)

43. Remember This is practice.
You are not being graded on you performance on the drill.
Everyone is learning together.
It’s okay to make mistakes. We expect it and we will learn from it.
It is okay to have fun!

44. Questions
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45. Sources
Connecticut Association of Health Directors. Orientation To Connecticut Mass Dispensing Clinics Parts 1 & 2.
Centers for Disease Control and Prevention. Strategic National Stockpile website.
FEMA IS Course Material Download: IS-100 Introduction to Incident Command System, I
POD training materials from Town of Manchester, Ledge Light Health District, Eastern Highlands Health District
Virginia Department of Health, Emergency Preparedness and Response Programs. Unit 1 – Dispensing / Vaccination Site Training
University of Minnesota Center for Public Health Preparedness. Mass dispensing sites: a primer for volunteers.

46. Thank You Thank you all for offering to be a POD worker.
Federal, State, and Local leaders recognize and appreciate the great service you are performing for your communities, the state, and the nation, and the sacrifices you are making to keep the people safe.