Point of Dispensing (POD)

Point of Dispensing (POD)
Module 3 Point of Dispensing (POD) Module Instructor The module instructor should have a strong working knowledge of the following: The jurisdictional Point of Dispensing (POD) plan Incident Command System (ICS) Pre-event planning requirements for medical countermeasure dispensing (see CDC Capability 8) The Strategic National Stockpile (SNS) The SNS Technical Assistance Review (TAR) requirements The New Hampshire Public Health Emergency Response framework Knowledge of medication and vaccine dispensing methods Instruction Notes Module 1 reviewed the federal and state roles and responsibilities before and during an SNS response. Module 2 reviewed the state and local roles and responsibilities for planning to dispense medical countermeasures (pills and vaccine) to an identified population. Module 3 will provide information on Points of Distribution (PODs), POD management, and the POD response phases. A POD is an emergency service location where vaccines, antibiotics, and other medicines can be quickly dispensed to a large number of people. Most people have limited experience with receiving emergency services through a POD. A POD is similar to an emergency shelter in that a distinct service is provided by emergency responders to an impacted population. A POD is managed by local officials (fire, police, public health) or through regional collaboration using Incident Command System (ICS) principles. Activity Ask participants to describe their prior experience working in a POD or another type of emergency service location, such as an emergency shelter. Use this question to identify the participants’ knowledge of POD management and to draw parallels between POD management and response phases and other emergency services for which the participants may have more experience. Possible responses include: facility activation, logistics (staff and supplies), site set-up, shift changes, and monitoring resources. Explain to participants that whether it is a POD or an emergency shelter, both are managed using ICS and both have similar response phases over the course of the event. NOTE: If participants do not have prior experience working in a POD or an emergency shelter, describe how this module will provide them with an overview of POD management and response phases. Instruction Resources Module slides POD/ICS reporting structure Job Action Sheets (JASs) Just-In-Time-Training (JITT) example (if applicable) Sample Client Flow Diagram POD station signage Flip chart paper Markers Masking or painter’s tape Sample antibiotic regimens Mary Cook Public Health Emergency Preparedness Coordinator

Point of Dispensing (POD)
Module 3 Learning Objectives Describe SNS resources Describe the purpose of a POD. Describe the POD management structure. Describe POD staff roles. Describe the phases of POD operations. Instruction Notes State the module learning objectives for the participants. By the end of the module you will be able to: Describe SNS resources Describe the purpose of a POD. Describe the POD management structure. Describe POD staff roles. Describe the phases of POD operations. Ask participants if they have any questions about the learning objectives or if there are additional things that they would like to learn about PODs. If participants identify additional information that they wish to know about PODs, write it down on chart paper to ensure that it is covered during the module.

Strategic National Stockpile Purpose
Maintained by CDC/DSNS Pharmaceuticals, supplies & equipment Delivered to site of national emergency Supports public health response operations Bioterrorism Naturally occurring disease Natural disasters Industrial accidents Instruction Notes The Strategic National Stockpile (SNS) is a collection of pharmaceuticals, medical supplies, and equipment that can be deployed to the site of a national emergency. The purpose of the SNS is to support public health emergency response operations when local and state resources are insufficient. SNS resources, or materiel, are managed by the Division of Strategic National Stockpile (DSNS). DSNS is a division of the Office of Public Health Preparedness and Response (OPHPR), which is part of the Centers for Disease Control and Prevention (CDC). Think of the DSNS as the people who manage the materiel (SNS) used to support public health emergency response operations. The mission of the DSNS is to deliver critical medical assets to the site of a large-scale public health event or national emergency.

SNS Countermeasures Pharmaceuticals Supplies & Equipment
Medicines Vaccines Antitoxins Antidotes Radiation countermeasures Supplies & Equipment IV administration Airway management Wound care Burn & blast care Federal Medical Stations (FMS) Instruction Notes SNS materiel is also referred to as the formulary. Formulary describes pharmaceuticals and medical supplies and equipment maintained in the SNS. The materiel or formulary IS the Stockpile. While this training focuses on medical countermeasures dispensing (medicines and vaccines) it is important to note that the SNS has broader capabilities, such as durable medical equipment and the Federal Medical Stations (FMS). The initial formulary was based on the 1999 DHHS Operations Plan for Anti-Bioterrorism Initiative and input from various intelligence agencies and subject matter experts. The formulary is updated as new information becomes available and as the SNS mission is refined. Department of Health and Human Services (DHHS) works with CDC to determine if changes, additions, or deletions are needed to the SNS formulary. The SNS is used to augment local and state supplies of critical medical assets during a response that threatens to exhaust local and state assets. Medical materiel includes pharmaceuticals, vaccines, durable medical equipment, and other medical supplies.

Public Health Threats Bioterrorism (Category A agents)
Anthrax Botulism Smallpox Naturally occurring diseases Natural disasters Industrial accidents Medical materiel from the SNS were deployed to New Hampshire during the H1N1 Pandemic. Instruction Notes SNS resources may be deployed to support operations in response to a number of public health threats. Initial planning for medical countermeasures dispensing capability was based on concerns of bioterrorism or an intentional release of a biological agent. Smallpox and Anthrax are two examples of extreme scenarios where the SNS resources would be vital to public health response capabilities. Pandemic influenza is an example of a naturally occurring disease where deployment of SNS resources may be needed to augment healthcare systems and support medical surge capabilities. SNS resources have been deployed to the site of natural disasters, including the response to Hurricane Katrina. SNS resources have also been deployed to the site of industrial accidents. Example During the response to the H1N1 Influenza Pandemic, the SNS was deployed to each state and U.S. territory to augment local supplies of N95 masks, gloves, surgical gowns, and other Personal Protective Equipment (PPE). New Hampshire Department of Health and Human Services (DHHS) received the SNS resources at its Receive, Store, and Stage (RSS) warehouse. DHHS then developed a plan for the equitable distribution of the SNS resources to statewide hospitals and the New Hampshire Public Health Regions (PHRs) based on available resources. The goal of the RSS is to rapidly and efficiently redistribute the SNS resources to where they are needed and can be put to use. Activity Ask participants to review the list of public health threats and identify which one would require the fastest response. Answer: Anthrax. Anthrax affects exposed people so quickly that responders must be able to provide medical countermeasures within hours of exposure. The HHS target is to provide medications to the affected population within 48 hours of known exposure. This is important to note as the affected population could be small or large. Ask participants to consider what steps would need to be taken to provide pills to everyone in your town or region within a 48-hour period. Possible response include: Coordinated public information Get the appropriate countermeasure Set-up places where people can get the pills Direct people on how to take the pills Which of these public health threat would require the fastest response?

SNS Capabilities SNS Warehouse 12-Hour Push Packages
Threat is ill-defined (Anthrax) Broad spectrum resources needed 130 containers, 50 tons Fits in cargo aircraft 500, day antibiotic regimens Instruction Notes 12-Hour Push Packages are pre-assembled, pre-positioned collections of broad spectrum SNS materiel (antibiotics, antitoxins, medical supplies). A 12-Hour Push Package can be delivered to any state in the continental United States within 12-hours of the decision to deploy. They are deployed in emergency situations where the threat is ill-defined and resource needs may not be clear, such as in an incident of bioterrorism. Each 12-Hour Push Package contains 130 containers, weighs over 50 tons, and would fill a cargo aircraft. At minimum a 12,000 square foot warehouse is needed to receive, store, and stage the containers. The footprint of each container is 43 inches in width by 60.5 inches in diameter. The containers range from inches tall. Along with other critical medical supplies, each push package contains over 500, day antibiotic regimens. Activity (optional) Prior to the arrival of participants, use masking tape to outline the footprint of one container (43” x 60.5”) on the floor of the training room. If space allows outline the footprint of several containers. Use the outline(s) as a visual to create discussion about the challenges associated with receiving, storing, and staging a 12-Hour Push Package. Consider using a tape measure to show the height of the containers (64-80”) or place the container footprint next to a wall so that you could tape an outline of the container’s height as well. NOTE: make sure to only use tape that will not damage the wall (like painter’s tape).

POD Purpose Public health emergency service location
Prevent exposure or treat disease outbreak Managed locally or regionally Occurs over phases of operations A POD is NOT designed to: Provide services found at a healthcare facility Provide extensive treatment or evaluation Instruction Notes A Point of Dispensing (POD) is a public health emergency service location where vaccines, antibiotics, and other medicines can be quickly dispensed to a large number of people. A POD is similar to an emergency shelter in that the physical location (schools, community centers, etc.) is typically familiar to the public and is accessible in terms of functional and transportation needs. (Go over map of where the PODs are located in our region). A POD is similar to an emergency shelter in that it provides a specific service. A POD is used to prevent exposure to an infectious disease or to treat an infectious disease outbreak. An emergency shelter is used to prevent community harm by providing access to temporary housing and feeding. A POD is similar to an emergency shelter in that it uses Incident Command System (ICS) management principles. Both PODs and emergency shelters are managed by local communities or through regional collaboration. A POD is similar to an emergency shelter in that the operations occurs over phases or periods of time where specific response actions occur. Whether a local community is activating a POD or an emergency shelter they will need to activate an appropriate facility, activate staff who are trained to provide the service, and activate the necessary resources. Both PODs and emergency shelters are designed to maintain a safe environment, serve all clients (including those with functional and access needs), expand or contract to the needs of the operation, and provide adequate staffing for the duration of the operation. Neither a POD nor an emergency shelter are designed to provide healthcare services found at a clinic or hospital or extensive medical treatment or evaluation. For this reason it is important to work closely with healthcare system partners during POD and emergency shelter operations.

POD Management Advanced ICS Training Field operations experience Fire/EMS or Public Health background POD Manager Clinical Group Supervisor Non-Clinical Group Supervisor Workforce Support Group Security Officer Liaison Officer Facility Officer Safety Officer Knowledge of community assets Resource coordination experience Security operations planning experience Law enforcement personnel Knowledge of facility Facility manager or custodian Knowledge of health & workplace safety Infection control practitioner Instruction Notes A POD facility and management team is activated by a the Local Emergency Operations Center (LEOC) or by the Public Health Region (PHR) Multi-Agency Coordination Entity (MACE). The POD Management Team reports to the LEOC/MACE and receives its medical direction from New Hampshire Department of Health and Human Services (DHHS). The POD Management Team is responsible for activating, operating, and deactivating the POD operations. The LEOC/MACE provide resource coordination, strategic planning, logistics support, and financial and administrative oversight to the POD management team. POD functions are organized and managed by group supervisors for clinical, non-clinical, and workforce support staff. Licensed clinical staff should be available across all POD functions to ensure accuracy of health information provided to clients. All POD staff should be visually identifiable to both clients and staff. Visual identification is typically in the form of staff vests, name badges (with qualifications), and POD role. Any staff with interpretation or language translation abilities should also be easily identifiable. Example In the above POD management structure the POD Management Team is identifiable by wearing white-colored vests. Individuals wearing red vests are clinicians working within the Clinical Group. Individuals in green vests are non-clinical staff. And individuals wearing yellow are providing staff support and logistics within the POD. Activity Ask participants to describe characteristics of the individuals who might serve in the POD management positions. Use this question to help participants identify staffing requirements and how their individual skills, training, and expertise fit with the POD management roles. Possible responses include: POD Manager: Advanced ICS training; field operations experience; fire/EMS or public health background. Security Officer: Security operations planning experience; law enforcement personnel. Facility Officer: Knowledge of facility; facility manager or custodian. Liaison Officer: Knowledge of community assets; resource coordination experience. Safety Officer: Knowledge of health & workplace safety; infection control practitioner. Different colored vests are used to easily identify POD staff by their assigned role or function.

POD Clinical Group Clinical Group Supervisor Triage Unit Health Education Unit Screening Unit Behavioral Health Unit First Aid Unit Dispensing Unit Separate symptomatic from asymptomatic Orient clients to threat & countermeasure Assess complex medical conditions Provide support, assessment & referral Instruction Notes POD clinical functions are overseen by the Clinical Group Supervisor. Specific POD clinical activities are subdivided into individual units that are managed by Unit Leaders. Unit Leaders oversee the clinical staff who will perform defined tasks that support the overall POD operations. These tasks are outline on Job Action Sheets (JASs) for each position within the POD. The tasks to be performed are organized as they would occur across the phases of POD operations (activation, operation, deactivation). Activity Provide sample JAS to the participants and describe how the JAS is organized. Use this activity to familiarize the participants with the purpose of the JAS. Reinforce that the JAS provide an overview of the roles and responsibilities for each position, the reporting structure, and any qualifications that are required. Draw the participants attention to the tasks that are outlined by the phases of POD operations on the JAS. Briefly describe the purpose of each unit within the Clinical Group. Possible descriptions include: Triage Unit: Separate symptomatic clients from non-symptomatic clients prior to entering the POD. Screening Unit: Assess clients with complex medical conditions prior to dispensing the countermeasure. First Aid Unit: Provide basic first aid to staff and clients and determine if medical transport is necessary. Health Education Unit: Orient clients to the health threat and the recommended countermeasure. Behavioral Health Unit: Provide emotional support, assessment, and referral to behavioral health providers. Dispensing Unit: Dispense or administer medications or vaccines. Provide basic aid & medical transport Dispense medications or administer vaccines POD staff receive a Job Action Sheet (JAS) that describes their assigned role.

POD Non-Clinical Group
Non-Clinical Group Supervisor Greeting Unit Registration Unit Clinic Flow Support Unit Data Entry Unit Discharge Unit Welcomes & orients clients to POD Supports client form completion Monitors & maintains client flow Enters client data (if applicable) Instruction Notes POD non-clinical functions are overseen by the Non-Clinical Group Supervisor. Specific POD non-clinical activities are subdivided into individual units that are managed by Unit Leaders. Unit Leaders oversee the non-clinical staff who will perform defined tasks that support the overall POD operations. These tasks are outline on Job Action Sheets (JASs) for each position within the POD. The tasks to be performed are organized as they would occur across the phases of POD operations (activation, operation, deactivation). Activity Briefly describe the purpose of each unit within the Non-Clinical Group. Possible descriptions include: Greeting Unit: Welcomes clients and orients them to the POD layout; identifies and supports functional needs access. Clinic Flow Support Unit: Supports smooth and continuous client movement throughout the POD, as well as movement of resources between stations. Discharge Unit: Provides clients with any further instructions and directs them to the exit or for post-prophylaxis monitoring (if indicated). Registration Unit: Support client form completion and ensures accuracy and legibility. Data Entry Unit: Enters all clinic/client data into appropriate database (if applicable). Provides clients with further care instructions

POD Workforce Support Group
Workforce Support Group Supervisor Communications Unit Inventory Management Unit Staffing Resources Unit Ensures communications within POD & to external agencies Maintains & distributes supplies to POD stations Supports POD staff & documents shift changes Instruction Notes POD workforce support functions are overseen by the Workforce Support Group Supervisor. Specific POD workforce support activities are subdivided into individual units that are managed by Unit Leaders. Unit Leaders oversee the workforce support staff who will perform defined tasks that support the overall POD operations. These tasks are outline on Job Action Sheets (JASs) for each position within the POD. The tasks to be performed are organized as they would occur across the phases of POD operations (activation, operation, deactivation). Activity Briefly describe the purpose of each unit within the Workforce Support Group. Possible descriptions include: Communications Unit: Ensures smooth and continuous communications within the POD and to external agencies supporting POD operations. Staffing Resources Unit: Provides services and support to POD staff and volunteers, including all staff documentation. Inventory Management Unit: Organizes and distributes supplies and equipment to POD stations.

POD Response Phases Situation Awareness Situation Development
Activate POD Operate POD Deactivate POD Recovery Instruction Notes There are six POD response phases: Situation Awareness Situation Development Activate POD Operate POD Deactivate POD Recovery For each phase, federal and state officials, the LEOC/MACE, and/or the POD management team will have clearly stated objectives that they are trying to meet. To achieve these objectives, staff and volunteers will be assigned specific activities and tasks. Explain to participants that the remainder of the POD module will focus on the activities and tasks that are performed across these phases of POD operations.

Identify threat & population Specify countermeasure & timeline
SITUATION AWARENESS Identify threat & population Specify countermeasure & timeline Assess local inventories Request SNS OBJECTIVES Maintain and activate systems to monitor unusual health activity Determine need for response activation Activate appropriate response plans based on the required capabilities Instruction Notes Federal and state health officials, along with healthcare practitioners, maintain systems for routine monitoring for unusual medical and public health activity. Once a health threat has been identified and characterized (naturally occurring disease outbreak, food-borne outbreak, bioterrorism), an appropriate control or countermeasure will be recommended by federal and/or state health authorities. If a countermeasure is recommended to protect public health local and state inventories will be assessed. If additional countermeasures are needed the Governor can request support from the Strategic National Stockpile (SNS). If countermeasure dispensing exceeds the capacity of the healthcare system POD operations will be mobilized. Example A sudden and unexpected increase in Over-the-Counter (OTC) medicines can be an indicator of unusual health activity in a community. New Hampshire Department of Health and Human Services (DHHS) maintains systems to monitor OTC purchases in NH pharmacies. This system is used to maintain situation awareness. BioSense is a national program designed to improve the nation’s capabilities for real-time biosurveillance. BioSense collects data from Veterans Administration (VA) hospitals and Department of Defense (DOD) healthcare systems across the country. NH DHHS monitors BioSense for unusual health activity in the state and around the country. A countermeasure may not always be appropriate or available. For example, when a pandemic strain of influenza emerges, a vaccine will take time to produce. In situations where a countermeasure is not appropriate or available, health officials will recommend control measures. Activity Ask participants to describe examples of control measures. Use this question to help participant identify other public health strategies to containing or controlling infectious disease outbreaks. Possible responses include: isolation and quarantine, community containment measures (cancelation of events, school closures, social distancing), hand washing and respiratory etiquette, and public information and warning. Explain to participants that the New Hampshire POD training focuses less on control measures and more on countermeasure dispensing, but that both are important strategies. In situations where a countermeasure is not available, a control measure (hand washing, social distancing) may be recommended.

SITUATION AWARENESS Identify threat & population Specify countermeasure & timeline Assess local inventories Request SNS TASKS Identify the agent or cause of the incident Determine the severity of the incident Identify the location of the incident Identify the number of people affected Collect and analyze medical & demographic data Identify functional & access needs Instruction Notes The first activity under Situation Awareness is for federal and state health officials to identify a health threat and the population it impacts. This is achieved by maintaining and monitoring numerous systems to detect unusual health activity or events. When an event is detected several tasks are completed to determine an appropriate countermeasure and dispensing timeline. Describe the following tasks to participants. Emphasize that these tasks are part of Situation Awareness activities and precede POD operations. These tasks are typically performed by federal and state health officials and are coordinated with healthcare providers and local public health. Identify the agent or cause of the incident: Through routine monitoring of various systems, health officials will identify an unusual event and then determine the nature or cause of the event. This may involve laboratory testing. In Module 1 on the SNS, we discussed that some threats may be ill-defined, meaning that identification of the agent may not be readily known, but that a response action is still necessary out of an abundance of caution. For an ill-defined threat the SNS deploys the 12-hour Push Package. Determine the severity of the incident: The severity of an incident may be determined by the size of the incident (number of people, geographic area), the type of threat (Anthrax, pandemic or highly virulent strain of influenza), or the availability of response resources (countermeasures, staff). Identify the location of the incident: It is important to identify if an incident is isolated to a particular community or if it is wide-spread. Identify the number of people affected: Depending on the threat, an entire population may be affected (aerosolized Anthrax used as a bioweapon) or a smaller sub-set of a population may be affected (Hepatitis A in a food handler at a restaurant). Collect and analyze medical & demographic data: Medical and demographic data is used to plan for the types of countermeasures, durable medical equipment, and consumable medical supplies that will be needed to support the response. This information is particularly helpful to ensure that appropriate resources are available for persons with functional, medical, and access needs. Identify functional & access needs: By identifying potential functional, medical, and access needs during the situation awareness phase, we allow additional time to plan for supportive services at a POD. If we know that an event has impacted a population for whom English is a second language, then we have identified the need for translation services and place available resource for that service on alert.

SITUATION AWARENESS Identify threat & population Specify countermeasure & timeline Assess local inventories Request SNS TASKS Identify the countermeasure(s) needed Identify the supplies needed Determine dispensing timeline Identify staff needed to meet dispensing requirements Instruction Notes The second activity under Situation Awareness is for federal and state health officials to recommend a specific countermeasure and a timeline for dispensing that maximizes protection against the threat. This is achieved by reviewing scientific and clinical data on health threat and recommended countermeasures. When a countermeasure is selected several tasks are completed to inform local inventory assessments prior to requesting the SNS. Describe the following tasks to participants. Emphasize that these tasks are part of Situation Awareness activities and precede POD operations. These tasks are typically performed by federal and state health officials and are coordinated with healthcare providers and local public health. Identify the countermeasure(s) needed: Based on the threat and population identification, federal and state health officials will identify the appropriate countermeasures (medications, vaccines, durable medical equipment, and consumable medical supplies) for the response. Remind participants that health officials may also recommend control measures (hand washing, cancelation of events, social distancing). Identify the supplies needed: Certain countermeasure dispensing operations may require specific supplies. For example certain medicine regimens are based on weight, so a dispensing provider might need a scale. In dispensing operations where vaccine is provided needles, syringes, and sharps containers will be needed. In addition to supplies to support dispensing operations it is important to determine what equipment is needed to expand service access to populations with functional, medical, and access needs. Determine dispensing timeline: To maximize protection against the threat, public health officials will establish a timeline for dispensing to the identified population. The timeline is based on scientific evidence for the threat and countermeasure. The timeline also considers countermeasure availability and prioritization of groups for dispensing. The dispensing timeline can impact POD facility selection in terms of how quickly the facility can be made available and the facility’s client capacity. If large numbers of people must receive the countermeasure in a short period of time, larger facilities will be needed. The timeline also impacts the number of staff who are needed to support POD operations. Identify staff needed to meet dispensing requirements: While the number of POD staff is important, ensuring that POD staff are qualified to perform their functions is essential. Federal and state health officials will provide guidance on the qualifications necessary to dispense the specified countermeasure. Under certain situations, federal and state health officials may waive the requirements for dispensing qualifications to expand the number of dispensing staff. In addition, to knowing the types of staff needed, regional and local officials will need to calculate the number of staff needed to reach the population within the dispensing timeline. This is know as the client throughput goal. Example During the response to the H1N1 Influenza Pandemic, it took time to produce the vaccine. The H1N1 vaccine was not available all at once. In fact, public health officials had to establish priorities groups to receive the limited amount of vaccine when it was first released. Determining the dispensing timeline is not always easy and can be influenced by a number of factors. The timeline can also change based on new information or increased availability of resources.

SITUATION AWARENESS Identify threat & population Specify countermeasure & timeline Assess local inventories Request SNS TASKS Assess local countermeasure inventories Request countermeasures from Strategic National Stockpile (SNS) if needed Activate appropriate incident management authorities (SEOC/MACE/LEOC) Instruction Notes The third activity under Situation Awareness is for state and local officials to assess inventories of the recommended countermeasure prior to requesting SNS deployment. This is achieved by assessing all state and local medical countermeasure inventories, including healthcare system inventories. When local inventories have been assessed they can be compared to the needs of the operation to determine if SNS assets are required and should be requested. Describe the following tasks to participants. Emphasize that these tasks are part of Situation Awareness activities and precede POD operations. These tasks are typically performed state health officials and are coordinated with healthcare providers and local public health. Assess local countermeasure inventories: Once the countermeasure is specified state health officials will determine if state and local inventories are sufficient to meet the need or demand for the dispensing operations. The assessment includes healthcare sector inventories and local and state caches (if applicable). In conducting the assessment it is important to consider the potential difference between “need” and “demand” for the dispensing operations. Certain health threats may create public perceptions that lead to a “demand” for countermeasure when a “need” has not been demonstrated (i.e. the individual did not eat at the restaurant where the food handler worked or the individual was not in the area where the Anthrax was released). Request countermeasures from SNS (if needed): If state health officials determine that state and local countermeasure inventories are insufficient to meet the need or demand for dispensing operations, then the Governor (or his/her designee) requests deployment of the SNS. CDC/DSNS the collaborate with state health officials to reach a decision to deploy SNS resources. The need for deployment is met if any of the following justifications are present: Overt release of chemical or biological weapon Claimed release reported to intelligence or law enforcement Indication from intelligence law enforcement of a likely attack Clinical or epidemiological indications Laboratory results Unexplained increase in EMS requests Unexplained increase in antibiotic prescriptions or OTC purchases Activate appropriate incident management authorities: In a large scale event state officials will activate the State Emergency Operations Center (SEOC) to support local and regional response activities. State officials may request activation of the Multi-Agency Coordination Entity (MACE) to support regional coordination of public health resources and information. The Local Emergency Operations Center (LEOC) in the communities that are hosting POD sites may also open to support response activities that are occurring outside of the POD site (traffic management, EMS transport, etc.) Incidents that are narrow in scope may only require LEOC activation. Incidents that are broader is scope will require cross jurisdiction coordination and a MACE should be activated.

SITUATION DEVELOPMENT
Develop Incident Action Plan (IAP) Review Legal & Liability Issues Transition IAP to POD Management SITUATION DEVELOPMENT OBJECTIVES Review POD plan(s) and develop an incident-specific action plan Transition the Incident Action Plan to the POD management team Instruction Notes Following activation of a Local Emergency Operations Center (LEOC) or the Multi-Agency Coordination Entity (MACE), the LEOC/MACE will develop an Incident Action Plan (IAP) for POD operations. An IAP is an operational document that is based on the jurisdictional response plan and factors that are specific to the incident or event. When a MACE is activated, its primary focus is to develop the IAP for POD operations. The LEOCs in each town where a POD will be opened should be activated. During the Situation Development phase, the LEOC is primarily focused on developing an IAP for the community response activities that support POD operations. This includes planning for traffic and security needs during all phases of the operations. If a MACE is not activated the LEOC is responsible for developing both the IAP for POD operations and the IAP for community response activities. The MACE/LEOC coordinate both IAPs to ensure a comprehensive POD/community response to the event. During the IAP development legal authorities and issues of liability should be reviewed. Once the IAP for POD operations is completed and the POD management team is activated, the IAP will be transitioned to the POD management team for implementation.

Develop Incident Action Plan (IAP) Review Legal & Liability Issues Transition IAP to POD Management TASKS Select dispensing modalities & methods Select POD site(s) Determine client flow & throughput rate Develop POD policies & guideline Plan for functional & access needs Mobilize POD resources needed to meet dispensing objectives Instruction Notes The first activity under Situation Development is for the MACE/LEOC to develop an Incident Action Plan (IAP) for POD operations and any community response activities that support POD operations. This is achieved by reviewing existing response plans, considering the specific details of the event, and using a template IAP. When writing an IAP for POD operations several tasks are completed to ensure comprehensive guidance to the POD management team on activation, operation, and deactivation of POD services. Describe the following tasks to participants. Emphasize that these tasks are part of Situation Development activities and precede POD operations. These tasks are typically performed by the MACE/LEOC and are coordinated with state health officials and the SEOC. Explain to participants the state officials will also develop IAPs, especially related to receipt, repackaging, and redistribution of SNS resources. Select dispensing modalities & methods: The IAP should specify if any pre-deployed countermeasures will be dispensed and who will receive them. If push-method dispensing (Closed PODs) will be used the IAP should reference responsibilities for those operations. If pull-method dispensing (Open PODs) will be used the IAP should reference the dispensing method that will be used (head of household, segmented, concurrent) Select POD site(s): POD sites have been designated in each of the 14 New Hampshire Public Health Regions (PHRs). In some cases a POD site may have a defined service area (also known as catchment area). Should a designated POD site not meet the needs of the emergency circumstance, the POD plan and IAP can be used to establish a POD at an alternate location. Facility specification for each POD site have been collected to assist in incident action planning and to inform the POD management team. The selection of a POD site should be based on throughput requirements, staffing needs, and minimizing community disruption. Determine client flow and throughput rate: The IAP should calculate the necessary client flow for the POD site. This is achieved by taking the total number of people at risk and dividing it by the dispensing timeline (this can be expressed in hours or days). For example, in an Anthrax scenario where an entire population of 72,000 have been exposed and the dispensing timeline is 48-hours the throughput rate for one POD would be 2,000/hour (if not using a head of household method). Explanation: 72,000/36=2,000 (36-hours is used to account for the up-to 12-hours to receive SNS resources). Develop POD policies & guidelines: The IAP outlines key policies and guidelines that should be observed during POD operations. Some policies will always be true for any POD operation regardless of the event. For example, clients are never charged for the services that they receive at a POD. Some policies will be determined based on the needs of the incident. Federal and state health officials will often provide guidance on key policies that should be observed. For example, guidelines on dispensing to essential personnel is a policy that should be stated in an IAP and can change based on the details of the event. Plan for functional & access needs: Populations that may require additional assistance when accessing POD services should be identified in the IAP. Examples of populations with functional, medical, and access needs include: non-English speakers, persons of low-literacy (including medical literacy), persons with physical or cognitive disabilities, persons who observe religious and culture practices, elders, and children. Documenting these populations in the IAP allows planners to identify resources that can assist them during POD operations. Mobilize POD resources needed: The IAP estimates the personnel hours required to achieve the POD throughput or service rate. The POD command structure can be customized based on the identified and available human resources. The IAP is used to identify sources of available staff and volunteers from town employees, volunteer groups, and community service agencies. Materiel resources are also identified in the IAP. This is where information from the state and local inventory assessments can be documented. In addition to SNS resources, state, regional, and local resources should be considered for immediate deployment to the POD site(s). Activity Ask participants to consider the following policy statement: No media are allowed in the dispensing area. Use this activity to create discussion about why policies are established during pre-event and incident action planning. Why would it be important to limit media access to the dispensing area? Are there times where this policy could be relaxed to allow media access in the dispensing area? Could the policy be modified to provide some media access? Reinforce that policies established during pre-event planning may be changed during incident action planning. Evaluate the following policy statement: “No media are allowed in the dispensing area.”

Develop Incident Action Plan (IAP) Review Legal & Liability Issues Transition IAP to POD Management SITUATION DEVELOPMENT TASKS Review Public Health Incident Declaration Review Public Health Emergency Declaration Review personnel & volunteer liability Review workers’ compensation Instruction Notes The second activity under Situation Development is for state and local officials to review all legal authorities and liability issues prior to activating and opening POD sites. This is achieved by reviewing existing federal, state, and local statutes related to emergency response declarations and responder and volunteer liability protections. When reviewing legal authorities there are several key provisions that should be considered. Describe the following tasks to participants. Emphasize that these tasks are part of Situation Development activities and precede POD operations. These tasks are typically performed by federal, state, and local authorities as defined by statutes. Review Public Health Incident Declaration: Under New Hampshire statute, the Commissioner of New Hampshire Department of Health and Human Services (DHHS) may declare a Public Health Incident (RSA 508:17-a) to protect public health and safety when response activities require assistance from non-state agencies. A Public Health Incident declaration may be used when the event does not rise to the level of an emergency declaration by the Governor. Review Public Health Emergency Declaration: A Public Health Emergency is a declared event where DHHS has been designated the lead response entity. This includes declarations by the following entities: National Emergency (declared by President) Federal Public Health Emergency (declared by U.S. Dept. of Health & Human Services) State of Emergency (RSA 4:45) (declared by Governor) Public Health Incident (declared by Commission of DHHS) Review personnel & volunteer liability: Describe personnel and volunteer liability protections as detailed in the POD Appendix for your region. Review workers’ compensation: Describe workers’ compensation as detailed in the POD Appendix for your region.

Develop Incident Action Plan (IAP) Review Legal & Liability Issues Transition IAP to POD Management SITUATION DEVELOPMENT TASKS Brief POD management team(s) on incident Brief POD management team(s) on IAP Prepare POD management team(s) for deployment Instruction Notes The final activity under Situation Development is for the MACE/LEOC to transition the IAP to the POD management team for implementation of POD operations. This is achieved by assembling the POD management team and briefing them on the incident, the IAP for POD operations, and specifics about the POD site. Describe the following tasks to participants. Emphasize that these tasks are part of Situation Development activities and precede POD operations. These tasks are typically performed by the MACE/LEOC and coordination with pre-trained POD management teams. Brief POD management team on incident: Once the IAP is completed the POD management team is assembled and briefed on the incident, health threat, target population, and proposed countermeasure to be dispensed at the POD. Brief POD management team on IAP: The POD management team is also briefed on the specifics of the IAP and the designated POD site. This includes information on staffing resources, supplies, key policies and procedures that should be followed. Prepare POD management team for deployment: Once the POD management team has been briefed, they should be prepared for deployment to the POD site to begin activation procedures. Preparation for deployment may include advising them on any additional resources they should bring and how members of their household will be protected.

ACTIVATE POD OBJECTIVES Activate site(s), staff & resources
Set-up site(s) Receive & store SNS Dispense to staff & families Announce POD locations to public ACTIVATE POD OBJECTIVES Implement the IAP for POD operations Mobilize and brief POD staff; assign POD staff roles Mobilize, receive & stage POD resources Secure facility and set-up POD site Dispense to essential personnel & priority groups (if indicated) Prepare site and staff to open the POD Instruction Notes Once the IAP is written and the POD management team briefed, activation of the POD site, staff and volunteers, and resources is initiated. To successfully activate the POD the following objectives should be achieved by the POD management team: Implement the POD IAP: The POD Manager will assign components of the IAP to members of his management team, including the Clinical, Non-Clinical, and Workforce Support Group Supervisors. Mobilize, brief, and assign POD staff: The Workforce Support Group will receive staff and volunteers who have been deployed to the POD and assign them roles based on their qualifications. Mobilize, receive, and stage POD resources: The Workforce Support Group will receive and stage resources that have been deployed to the POD and distribute them to the appropriate stations. Secure the facility and set-up POD: The Security Officer will ensure that the facility and staff are secure while the POD Manager oversee the set-up of the POD site. Dispense to essential personnel: If advised the Clinical Group will dispense to POD staff and other essential personnel prior to opening the POD. Prepared staff prior to opening: Conduct a walk thru of the POD and each station to ensure that staff is ready to receive the public.

ACTIVATE POD TASKS Activate site(s), staff & resources Set-up site(s)
Receive & store SNS Dispense to staff & families Announce POD locations to public ACTIVATE POD TASKS Notify the facility of POD activation Activate POD security plan Develop tactical plan Provide identification to staff & volunteers Assign roles to staff & volunteers Brief & train staff & volunteers Instruction Notes The first activities under Activate POD are for the LEOC/MACE to activate the POD site, staff, and resources and for the POD management team to set up the site. Describe to the participants how site, staff, and resource activation is managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of activating resources to support POD operations. These tasks are typically performed by the LEOC/MACE and POD Management Team. Notify the facility of POD activation: The LEOC/MACE shall notify the owner or facility manager of the designated POD site of the need to activate for POD operations. The LEOC/MACE should confirm with the facility manager that there are no deficiencies with the facility that would make it unfit for use. The facility manager should identify staff to meet the POD Management Team at the site and assist with POD set-up. The POD Manager should conduct a walk-thru with the Facility Manager to assess any issues or damage prior to setting up the POD. Activate POD security plan: The LEOC/MACE will work with local law enforcement to activate security and traffic operations in and around the POD site, including securing SNS resources (if deployed). Develop tactical plan: The LEOC/MACE will work to establish tactical communications with the POD site to ensure communications between the POD and local/regional command posts. Communications within the POD (between stations) will be managed by the Workforce Support Group. Provide identification to staff & volunteers: All POD staff and volunteers should be identified by their name, credentials (if applicable), language(s) spoken other than English, POD position, site location, and site access restrictions (if applicable). Staff identification can be accomplished through pre-issued badges, staff vests, and POD site identification cards. If a staff member does not have a pre-issued badge from a response agency or volunteer organization, but has been pre-credentialed, then a driver’s license or employer-issued identification may be used. The Staffing Resources Unit (under the Workforce Support Group) prepares identification for all POD staff. All POD staff shall present a government issued form of identification to the Staffing Resources Unit when they sign in (Example of a policy). Unaffiliated or spontaneous volunteers who respond to a POD site should be redirected to the MACE/LEOC so that they can be credentialed and redeployed to the POD. Assign roles to staff & volunteers: POD staff and volunteers should be assigned roles based on their level of training, experience and credentials, and comfort with the responsibilities of the position. A staffing schedule should be established and detail shift periods, breaks (at least two 15-minute breaks per 8-hour shift), and meals/snacks. The staffing schedule can be part of a broader staff management plan that includes lodging and family care (if deemed necessary). Brief & train staff & volunteers: POD staff and volunteers should be briefed on the incident, POD set-up instructions, and operational policies, procedures, and guidelines. POD staff and volunteers should receive Just-In-Time-Training (JITT) on POD operations and their specific role, function, and tasks. The Staffing Resources Unit or POD Manager should conduct the JITT. Further, each Unit Leader should train assigned staff on the specific functions of their POD station.

ACTIVATE POD Activate site(s), staff & resources Set-up site(s) Receive & store SNS Dispense to staff & families Announce POD locations to public TASKS Secure SNS resources Distribute resources to the appropriate stations Dispense to staff & families prior to opening (if indicated) Announce POD locations using multiple communication methods Instruction Notes The second activities under Activate POD are for the Workforce Support Group to receive, secure, and store the SNS, the Clinical Group to dispense to staff and families (if indicated), and for the LEOC/MACE to announce POD locations to the public. Describe to the participants how these activities are managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of securing SNS resources and protecting staff prior to opening the POD to the public. These tasks are typically performed by the functional groups within the POD. Secure SNS resources Once received, the Workforce Support Group (specifically the Inventory Management Unit) will work with the Security Officer to secure the SNS resources and implement the appropriate controls to prevent theft of misuse. Distribute resources to stations The Workforces Support Group (specifically the Inventory Management Unit) will distribute SNS and other needed resources to all POD stations. The Unit Leaders are responsible for working with Unit Staff to identify additional resource needs. Requests for additional resources should work through the chain of command to the Inventory Management Unit. Any resources that are not available at the POD site, but needed to fulfill the operational objectives should be communicated up to the POD Manager and out to the LEOC/MACE. Dispense to staff & families If indicated, the Clinical Group (specifically the Dispensing Unit) will dispense to staff and families prior to opening to the POD to the target population. Dispensing to staff and families can be used as a rehearsal for when the POD is opened to the public. This allows staff to identify any issues with client flow or the available resources. If indicated, priority groups may receive prophylaxis prior to opening to the general public. These groups may receive priority dispensing status based on high risk health status or functional needs. Announce POD locations to the public In events where multiple POD sites will be opened, every attempt should be made to open at the same time. Once the POD management team has determine that the staff and site are ready to open, the POD Manager will notify the LEOC/MACE. The LEOC/MACE will notify to SEOC and await final approval to open the POD site(s). The LEOC/MACE will utilize multiple communication methods to announce the POD locations to the public. In certain scenarios, Law Enforcement may be needed to maintain security of SNS resources.

Dispense to target population Monitor operations
Open site(s) Dispense to target population Monitor operations Adjust operations & staffing Report on POD operations OPERATE POD OBJECTIVES Provide safe & efficient services to all clients Monitor & maintain staff morale & wellness Monitor supplies & request resupply (as needed) Execute smooth shift transitions Submit shift reports to the LEOC/MACE Instruction Notes Once the POD site, staff, and resources have been activated and set-up, the POD is opened to the public to receive medical countermeasures. To successfully operate the POD the following objectives should be achieved by the POD management team: Provide safe and efficient services to all clients: While the goal of a POD is for rapid dispensing, it is essential that client and staff safety be preserved. Monitor and maintain staff morale and wellness: Unit Leaders should ensure that staff take regular breaks to eat, drink, and rest. The Behavioral Health Unit should also monitor staff for signs of stress or anxiety. Monitor supplies and request resupply: Unit Leaders should routinely monitor supplies and request resupply from the Inventory Management Unit using the chain of command. Execute smooth shift transitions: Unit Leaders should ensure that the transition of staff between shifts provides for appropriate training and briefing of incoming staff and debriefing of outgoing staff. Submit shift reports to the LEOC/MACE: Unit Leaders should submit shift reports on their unit’s activities. These reports are reported out to the POD Manager and then to the LEOC/MACE.

Open site(s) Dispense to target population Monitor operations Adjust operations & staffing Report on POD operations OPERATE POD TASKS Implement shift schedule & maintain use of ICS Administer countermeasures to POD clients Assess client flow and dispensing model Instruction Notes The first activities under Operate POD are for the POD Manager to open the site to the public and for the POD staff to facilitate medical countermeasure dispensing to the target population. Describe to the participants how these activities are managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of initiating the dispensing process and evaluating its performance. These tasks are typically performed by all POD staff within their respective roles. Implement shift schedule & maintain use of ICS The Workforce Support Group (specifically the Staffing Resources Unit) will implement the staff schedule and coordinate with the LEOC/MACE to obtain additional staffing resources. While each staff person is responsible for observing ICS, the Unit Leaders and Group Supervisors should work closely to maintain use of ICS and correct issues with span of control or chain of command. Administer countermeasure to POD clients While countermeasure administration is the primary function of the Clinical Group (specifically the Dispensing Unit), the client process to reach the dispensing area requires multiple staff interactions and decision points. The Non-Clinical Group and Clinical Group (through their respective units) must collaborate to ensure that the process and services are efficient for all clients. Accurate countermeasure administration is the responsibility of each dispensing provider and should adhere to the Medical Standing Orders for the event and be documented on each client form. Assess client flow and dispensing model The Clinic Flow Support Unit will monitor client flow, identify “bottle-necks,” and communicate them to the POD Manager through the chain of command. The POD Manager will make adjustments to the client flow, station placement, or dispensing model based on these periodic assessments. Unit Leaders should not make significant changes to their areas/stations without higher approval as it may have the unintended consequence of altering the client flow.

Open site(s) Dispense to target population Monitor operations Adjust operations & staffing Report on POD operations OPERATE POD TASKS Monitor staff for fatigue & stress Monitor supplies & request resupply Conduct shift change Submit shift and operations report Instruction Notes The second activities under Activate POD are for Unit Leaders to monitor and adjust operations within their area and for Unit Leaders and the POD Manager to periodically report on POD operations. Describe to the participants how these activities are managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of improving the dispensing process and performance. These tasks are typically performed by all POD staff within their respective roles. Monitor staff for fatigue and stress Unit Leaders should routinely monitor staff for signs of fatigue and stress. Staff showing signs of fatigue or stress should be encouraged to take a break and reminded of the Behavioral Health resources available at the POD. POD staff should take regular breaks and a longer period of time for meals (based on the length of the operational period). The Behavioral Health Unit should periodically deploy staff to circulate throughout the POD to monitor staff for signs of fatigue and stress. Behavioral Health staff should also visit the staff break area to offer support. Monitor supplies and request resupply All staff a responsible for monitoring the supplies within their area or station and requesting resupply through their Unit Leader. Resupply requests are communicated through the chain of command to the Inventory Management Unit for fulfillment. Any resource requests that cannot be fulfilled at the POD site are communicated through the chain of command to the POD Manager and LEOC/MACE. Conduct shift change Unit Leaders are responsible for the efficient change of staff at each shift change. This includes ensuring that incoming staff have been trained to their station functions and have been briefed by the outgoing staff on the prior shift. Additionally, all outgoing staff should be debriefed on their experience and any issues that occurred. The Staffing Resources Unit manages all incoming and outgoing staff and volunteers, including rosters, vests, identification, and on-site injuries. Submit shift and operations report Unit Leaders will submit shift reports that detail area/station activities and any required or requested specific to the unit’s function. Shift reports are reported up the chain of command to the POD Manager and then to the LEOC/MACE.

Dispose of medical waste Demobilize staff & facility
Return supplies Dispose of medical waste Demobilize staff & facility Report adverse events DEACTIVATE POD OBJECTIVES Coordinate closure of POD site(s) with LEOC/MACE Inventory and repack POD supplies Return POD supplies to appropriate authorities Return POD site(s) to original condition and use Instruction Notes Once dispensing operations have been initiative, evaluated, and improved and the target population has received medical countermeasures, the POD is deactivated. To successfully deactivate the POD the following objectives should be achieved by the POD management team: Coordinate closure of POD sites: Just as we coordinate with partner agencies when opening multiple POD sites, the POD management team should communicate to the LEOC/MACE when they think it is time to close the POD. Inventory and repack POD supplies: Accounting for what is left over after a dispensing operations is equally as important as accounting for what was used. Return supplies: Once items have inventoried they should be returned to their sources. Return POD site to facility owner: The POD Manager and Facility Manager should conduct a walk-thru of the facility to determine if any damages occurred that are associated with the dispensing operations.

Return supplies Dispose of medical waste Demobilize staff & facility Report adverse events DEACTIVATE POD TASKS Close POD to public & announce alternate sources for countermeasure Inventory & repackage unused resources Dispose of medical waste following clinical protocols Instruction Notes The first activities under Deactivate POD are for the Unit Leaders to return all supplies from their area to the Inventory Management Unit and for the Facility Officer and Safety Officer to dispose of medical and non-medical waste. Describe to the participants how these activities are managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of demobilizing resources and waste associated with POD operations. These tasks are typically performed by all POD staff within their respective roles. Close POD and announce alternate sources for countermeasures The POD Manager in coordination with the LEOC/MACE and SEOC will determine when to close the POD. The decision to deactivate POD operations will be based on: Dispensing data Demand for POD services Current threat intelligence Facility need for returned social order Once a POD has been deactivated an announcement will be made to the public, including information on alternate sources for receiving medical countermeasures. Inventory & repackage unused resources Unit Leaders will work with Unit Staff to inventory and repackage unused resources within their area. Repackaged resources and inventory information will be returned to the Inventory Management Unit for further repackaging and to aggregate the inventories. The Inventory Management Unit will return all unused resources to their original source. Dispose of medical waste Unit Leaders will work with Unit Staff to collect all medical and non-medical waste within their area and safely store it. All stored medical and non-medical waste will be collect by the Facility Officer and Safety Officer for proper disposal.

Return supplies Dispose of medical waste Demobilize staff & facility Report adverse events DEACTIVATE POD TASKS Debrief staff & collect feedback for improvement planning Provide staff with behavioral health support or aftercare Clean-up POD site & return it to original use Report on any adverse events related to countermeasure dispensing Instruction Notes The second activities under Deactivate POD are for the POD management team to demobilize the staff and facility and for the Safety Officer to report any adverse events associated with the dispensing operation. Describe to the participants how these activities are managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of concluding POD operations and preparing for community recovery efforts and improvement planning. These tasks are typically performed by the POD management team. Debrief staff and collect feedback As staff are demobilized, the Staffing Resources Unit should debrief them on their experience and collect their feedback (positive and negative) to inform improvement planning. Provide behavioral health support or aftercare The Staffing Resources Unit should collaborate with the Behavioral Health Unit to advise POD staff on behavioral health or aftercare resources. This information should be provided as part of the staff debriefing. Additionally, public information about the closing of the POD should provide information on publically available behavioral health resources. Clean-up POD site and return to original use All staff are responsible for assisting to clean-up the POD site so that it can be returned to its original use. The POD Manager and Facility Manager should conduct a walk-thru of the facility to ensure that its condition is satisfactory. Report on any adverse events The Safety Officer will report out to the LEOC/MACE on any adverse event that occurred (to staff or clients) during POD operations. Federal and state health officials will maintain systems to monitor longer term adverse events related to the medical countermeasure.

Maintain dispensing availability Maintain behavioral supports
Develop After Action Report (AAR) Calculate & report expenses RECOVERY OBJECTIVES Complete forms for calculation of expenses & reimbursement Participate in recovery & after action activities Instruction Notes Once the POD is deactivated, the process of community recovery and improvement planning begins. To successfully recovery from a medical countermeasure dispensing event the following objectives should be achieved by the LEOC/MACE/SEOC: Complete expense and reimbursements forms: Calculate expenses (staff, resources, etc.) associated with the response activities. Participate in recovery and after action activities: Collaborate with community sector partners to support relief and recovery services and to inform improvement planning and mitigation strategies by conducting an After Action Review.

Develop After Action Report (AAR) Calculate & report expenses RECOVERY TASKS Coordinate with the public health & healthcare systems to initiate & maintain post-event countermeasure dispensing Coordinate with the behavioral health system to initiate & maintain post-event behavioral health support Instruction Notes The first activities under Recovery are for the public health and healthcare systems to maintain dispensing availability until no longer needed and for the behavioral health system to maintain emotional support within the community. Describe to the participants how these activities are managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of initiating and maintaining post-event dispensing and behavioral health capacities. These tasks are typically performed by the public health, healthcare, and behavioral health systems. Maintain dispensing availability Collaborate with public health and healthcare systems partners, including pharmacies, to provide access to ongoing, post-event countermeasure dispensing. Maintain behavioral supports Collaborate with behavioral health system partner, as well as clergy, to provide access to ongoing, post-event behavioral and emotional support.

Develop After Action Report (AAR) Calculate & report expenses RECOVERY TASKS Conduct an After Action Review & develop an improvement plan Calculate expenses & seek reimbursement (if available) Instruction Notes The second activities under Recovery are for the emergency management officials to conduct an After Action Review of the response to the event and for emergency management and finance officials to calculate and report expenses associated with the response. Describe to the participants how these activities are managed in the Public Health Region. Describe the following tasks to participants. Emphasize that these tasks are part of improving community preparedness and resiliency for future events and receiving reimbursement for expenses. These tasks are typically performed by emergency management and jurisdiction officials. Conduct an After Action Review and develop an improvement plan Collaborate with community sector partners to conduct a review to the response activities. Identify strengths, weaknesses, and areas for improvement. Develop recommended actions for improvement planning and identify parties responsible for their development and implementation. Calculate expenses and seek reimbursement Regardless of whether the event is eligible for reimbursement, always calculate the expenses associated with the response activities. Once calculated, report the costs to jurisdictional authorities and response partners. Submit for reimbursable costs associated with the response to the event.

Additional Information
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Point of Dispensing (POD)

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Point of Dispensing (POD)

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