mass prophylaxis point of dispensing (pod) field

WASHINGTON STATE

REGION IV PUBLIC HEALTH

MASS PROPHYLAXIS

Point of Dispensing (POD)

Field Operations Guide (FOG)

May 2009

Region IV Mass Prophylaxis POD Field Operation Guide – May 2009 - 2 -

REGION IV’s MASS PROPHYLAXIS POD FOG (5/2009) was adapted from Oregon Public Health Division’s POD FOG (7/2008) developed by the Standardized Point of Dispensing (POD) Workgroup, a team of state and local health department preparedness staff.

This guide may be found electronically at http://www.clark.wa.gov/public-health/preparedness/prepare.html#Dispensing

For additional information please contact: Maria Maribona, Mass Dispensing Coordinator, Region IV Public Health Emergency Preparedness and Response, 360-397-8009 or [email protected]


TABLE OF CONTENTS

Topic Page # Acronyms and Terms………………………………………. 4 Overview …………………………………………………….. 5 Table 1.Total Population, Households, PODs by County 5 POD Operating Procedures…………………………….. … 9 POD Layouts - Internal

Fig. 1 Basic, emphasizing unidirectional flow ….. . 15 Fig. 2 Detailed, emphasizing stations ……………. 16

External - Fig. 3 Model for POD ground layout ……………. 17 Signage and Color-coding …………………………………. 19 Figure 4. Sample Non-medical Anthrax Algorithm....... 20 POD Supervisor JITT Checklist ……………………………. 21 POD Management Structure/Organization Chart ……....... 22 Dispensing POD Staffing Guidelines ……………………… 23 Vaccination POD Staffing Guidelines …………………….. 24 Job Action Sheets ……………………………………………. 25 POD Intake Form

English, medical model ……………………………. 61 Spanish, medical model ………………………….. 62 English, non-medical model ……………………… 63 Spanish, non-medical model ……………………… 64

Provider Referral Letter ……………………………………. 65 Sample Infant and Child Ciproflaxin Dosing Charts …….. 67

for Anthrax and Plague Sample POD Go-Kit Supply Checklist ……………………… 69 Sample Vaccination Station and Emergency Kit Checklists 70 Figure 5. Local to Federal SNS Resource Flow Chart….. 72 Sign-in/Sign-out Sheet ……………………………………... 73

Pharmaceutical Inventory Control Forms and Instructions.. 74 WA DOH SNS POD Pharmaceutical Order Form ………… 80 Material Handling Just-in-Time Training ………………….. 82 Liability Considerations ……………………………………... 85 Resources ……………………………………………………. 89


ACRONYMS and TERMS

Category A Anthrax, Botulism, Hemorrhagic fevers, Plague, Diseases Smallpox, Tularemia CDC Centers for Disease Control and Prevention EOC Emergency Operations Center FOG Field Operations Guide HAN Health Alert Network (referred to as HAN in Oregon and

SECURES in Washington) ICS Incident Command System JAS Job Action Sheet JITT “Just in Time” Training LE Law Enforcement POD Point of Dispensing (aka mass prophylaxis center) PPE Personal Protective Equipment Prophylaxis A medicine, vaccine or device used to prevent disease PHICP Public Health Incident Command Post SNS Strategic National Stockpile SECURES Secure Electronic Communication, Urgent Response, and

Exchange System (Washington State’s Health Alert Network)

Throughput The rate of people moving through a POD over a given

period of time (e.g., number of individuals per hour) WA DOH Washington State Department of Health


OVERVIEW The purpose of this document is to provide a standardized mass prophylaxis point of dispensing (POD) field operating guide (FOG) for Region IV Public Health in southwest Washington State for Clark, Cowlitz, Skamania and Wahkiakum Counties. This POD FOG describes how to set up and manage points of dispensing (PODs) or mass prophylaxis centers that are scalable, adaptable in the field, and meet the Centers for Disease Control and Prevention (CDC) Division of Strategic National Stockpile (SNS) guidance standards. Related information is available in the Region IV Mass Prophylaxis Annex. Medical versus Non-medical Model: The procedures in this guide recognize the need for two different POD models. A medical model involves the screening of individuals for existing medical conditions, current medication use and allergies to specific medications. The assumption is that most public health emergencies will involve a localized event, involving relatively few people, during which there will be sufficient time to employ a medical model. Objectives for a medical model include:

1. Dispense antibiotics to 300 people per hour in one POD. 2. Safely and successfully dispense antibiotics in a 72-hour time period by

operating 24 hours per day for 3 days or longer based on incident objectives. Catastrophic events, however, may affect a large geographic area and involve many hundreds of people. Use of a non-medical model means that individuals will not be screened for existing medical conditions, current medication use or allergies to specific medications. Objectives for a non-medical model include:

1. Dispense antibiotics to 600 people per hour in one POD. 2. Safely and successfully dispense antibiotics in a 48-hour time period by

operating 24 hours per day for 2 days or longer based on incident objectives.

For a catastrophic event, distribution will occur on a household model. The number of households and PODs/mass prophylaxis centers required in Region IV to prophylaxis all persons in the jurisdiction are listed in Table 1 below.

Table 1. Region IV Total Population, Households and PODs by County County Population

( 2008 WA OFM) Avg. Household Size (US Census)

No. of Households

No. of PODS

1. Clark 424,200 2.75 154,255 12* 2. Cowlitz 99,000 2.5 39,600 4 3. Skamania 10,700 2.6 5,115 1 4. Wahkiakum 4,100 2.4 1,708 1 Total 538,000 199,678 18

*This may include drive-through PODs.


During public health emergencies, the local health officer will determine whether a medical or non-medical model is used in the PODs. The criteria for the health officer selection of a non-medical model for rapid dispensing will depend on the number and severity of the morbidity. The health officer will consult with the policy officials and notify them of the decision to use a medical or non-medical model for communication to Incident Command. POD/Mass Prophylaxis Centers Legal and Policy Considerations:

1) There is no limit to the number of regimens that one individual may pick up at a POD. The POD Group Supervisor may impose a limit if an individual’s actions are suspect.

2) A child 12 years of age and older, if unaccompanied by an adult, may pick up medication at a POD. Permitting a child less than 12 years of age to pick up medication will be at the discretion of the POD Supervisor.

3) No identification is required to pick up medication at a POD. 4) If possible, a pharmacist, physician or dentist will be at each POD, to provide

consultation for dispensing of medications. 5) Procurement of private property occurs in accordance with incident authorities

using ICS and EOC procedures. 6) Each county PHICP/EOC is responsible to provide security and crowd control with

local law enforcement officers for the PODs. This may be a combination of law enforcement and private security officers. LE and security officers will follow the Use of Force Policy of their respective employing agency.

7) Liability protection for all incident paid workers and volunteers is covered by the federal PREP Act for instances that require the use of countermeasures to prevent disease (e.g. antibiotic dispensing in an anthrax scenario) and if the federal Secretary of Health and Human Services has issued a PREP Act declaration. Other applicable legal liability coverage authorities are listed in Liability Considerations at the end of this document.

8) Workers and staff compensation: Volunteers who are pre-registered as emergency workers receive workers compensation liability protection under the Emergency Worker laws (WAC 118-04-20). Government and private employees receive workers and staff compensation in accordance with their respective employers’ policies and procedures.

Incident Command System (ICS): ICS is used to plan, manage and operate the incident response. Incident Action Plan (IAP): An IAP authorizes, directs resources and assigns tasks to solve an incident. The response objectives, strategies and tactics are clearly indentified in the IAP. The Operations Section Chief, Deputy or Branch Director, received a copy of the IAP from Incident Command and provides a copy to the POD Group Supervisor during their briefing. Copies of the Division or Group Assignment List (Incident Command – ICS 204), the Communication List (ICS 205), Unit Log (ICS 214) forms and other pertinent information will also be provided to the POD Group Supervisor.


The remainder of this guide contains the following: Basic Procedures This section presents an overview of the procedures for standing up, operating and demobilizing a POD. Internal POD Layout The first internal layout presents the basic station concepts for standing up a POD. This basic layout emphasizes unidirectional flow for dispensing medication or vaccine to the public. The second internal layout provides more detailed information about PODs by emphasizing POD stations. External POD Layout Planning considerations for functions outside of the POD are presented in the external layout. Signage and Color-Coding This section discusses how signs and color-coding can be used to ensure good POD throughput including a model color-coded algorithm for post exposure anthrax. Just in Time Training (JITT) The Job Action Sheets (JAS) will form the basis for Just in Time Training (JITT). Supervisors provide JITT to their direct reports. POD Supervisors will provide JITT to Operations and Logistics Leaders as soon as possible and preferably 3 hours prior to POD opening (please see ‘POD Supervisor JITT Checklist’). Operations and Logistic Leaders provide JITT and JAS to their respective Team Leads who will provide JITT to their direct report staff. JITT will include: response objectives and communication messages for the current shift; knowledge of the reporting structure within each team, e.g., POD organization chart and flow; task training based on Job Action Sheet (JAS); other job aide information such as checklists, standing orders, guidelines, fact sheets, radio use, supply order and re-order procedures, etc.. Additional briefings and JITT occurs by supervisors and team leads at each shift change and as needed. POD Management Structure/Organization Chart This is an Incident Command System (ICS) organization chart that lays out the positions and lines of authority and communication in a POD. This structure can expand or contract according to the needs and capabilities of the jurisdiction. Job Action Sheets These sheets outline the duties of POD staff positions that are listed on the POD management structure/organization chart. Intake Form Mass production of all forms, intake, and medication and disease fact sheets will be the responsibility of each county print shop. Intake forms here describe medical and non-medical model examples for modification in PODs.


The first form, with multiple household members’ information, is given to the public to complete prior to receiving medication when a medical model is in use at a POD. An individual may pick up medication for him/herself and other people, who may or may not live within the same household. It is at the discretion of the POD Supervisor to determine if an individual is requesting an unreasonable number of doses. The second form, containing just three questions, is given to the public to complete when a non-medical model is used at a POD. Provider Referral Letter This letter is to be given to persons who require follow-up with a health care provider because they have a specific medical condition or currently take a drug that may interact with the post-exposure medication. Dosing Charts Limited amounts of pediatric suspension will be available through the SNS so this guide contains three examples of emergency dosing charts for infants and children courtesy of the Oklahoma City-County Health Department (OCCHD) and the Oklahoma University College of Pharmacy. OCCHD has developed emergency pediatric dosing charts for Anthrax, Brucellosis, Influenza, Plague and Tularemia. They are available in English, Spanish and Vietnamese and may be found at http://www.occhd.org/Pediatric%20Dosing%20tables.htm Information on preparation of doxycyline for children and those who cannot swallow: Not everyone may swallow pills. The United State Food and Drug Administration provides information on how to prepare doxycyline for those with swallowing difficulties. Double and single sided pamphlets are available in both English and Spanish entitled, “In an Emergency: How to Prepare Doxycycline for Children and Adults Who Cannot Swallow Pills” at: http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm130996.htm Standing Orders and Emergency Dispensing Sample standing orders for anthrax, tularemia and plague are available at: http://www.oregon.gov/DHS/ph/acd/lhd/stdgordr/stndordr.shtml These dosing charts and standing orders are examples. The Local Health Officer will be responsible for writing the standing orders and approving all medication and vaccination dosing for all incidents as delineated in the IAP. In an emergency situation sufficient licensed health professionals (nurses, nurse practitioners, physician assistants, pharmacists, emergency medical technicians, and physicians) may not be available to dispense medications. In these instances a health educator, other allied health professional, or trained staff may be used to dispense medications. Just-in-time-training with adequate supervision will be provided to all dispensing and POD staff. Optimally, at least one pharmacist, physician or dentist will be available for dispensing consultation at each POD.


Sample POD Go-Kit, Vaccination Station, First Aid and Emergency Kit Checklists Suggested materials and equipment needed to stand-up a POD are presented in these lists. Local POD go-kits will be deployed immediately to commence POD set-up. Each county maintains their own POD go-kits and is responsible for their supply and re-supply. SNS Resource Requests Local resources must be exhausted, or expected to be exhausted, before state and federal resources can be requested. All requests for resources go from the Local PHICP to the County EOC to the State EOC. County and State EOC resource requests use ESF-8 Logistic Unit processes. The State will request deployment of federal assets as soon as the Governor or their designee determines that it is prudent to do so to protect the public’s health. Please refer to Figure 5. (page 74) Local to Federal SNS Resource Request Flow Chart for resource request flow from Local PHICP to PODs. The WA DOH Receiving, Storage, and Staging (RSS) Task Force receives the SNS assets at their Receiving, Staging and Storing warehouse and ships the SNS assets directly to each POD. A WA DOH SNS POD pharmaceutical order form is included in this FOG. Inter-POD resource requests are made using standard logistic ICS procedures and forms. Inventory Tracking Supplies used at the POD sites will be requested through PHICP to the EOC. This includes office and material handling equipment. The ICS request structure to request supplies is: POD Logistics Leader to POD Group Supervisor to Operations Section Branch Director or Section Chief. At the PHICP, the Resource Unit Leader in the Planning Section and the Supply Unit Leader in the Logistics Section are responsible to assure that supplies requested by Operations Section can be secured. The ICS-213-RR form is used to request resources. The PHICP Logistics Supply Unit Leader completes the ICS 259 Resource Order form to track resources ordered and assigned. The Logistics Section develops an excel inventory management spreadsheet or uses a paper inventory management system for each incident. The inventory management system is provided to Operations Section for each POD Supply and Inventory Unit Lead to use to track all inventory within the PODs. Pharmaceutical POD inventory tracking will use the Pharmaceutical Inventory Room Bin Card system to order, re-order pharmaceuticals and track lot numbers. This includes forms for inventory room and dispensing station tracking. Control substances require strict adherence to chain of custody procedures accounting with signed receipt for every vial transferred from station to station and dispensed. All pharmaceuticals will be kept in a secured area. Liability Considerations This section describes liability considerations for public health during emergencies including coverage by federal acts, the powers and duties of the local health officers, coverage for emergency workers and volunteer protection. Resources Links are provided for resources that may be useful in standing up a POD at the end of this document.


POD Operating Procedures The procedures described below outline basic steps for standing up a POD. PODs are intended to be flexible and scalable. That is, PODs can be scaled in size according to the number of individuals expected to present at a POD and the capabilities of a jurisdiction. POD Setup and Personnel: □ The POD Group Supervisor, Logistics and Operations Leaders are to ensure that the

POD facility, personnel, supplies and equipment are available and ready for operations prior to opening the POD to the public. Review the contents of this guide to determine pre-activation needs and procedures.

□ The POD Supervisor and Logistics and Operations Leaders are to brief POD staff and

conduct JITT trainings, as needed, about shift times, signing in and signing out, job duties, supervision, and operational procedures.

o Staff and registered volunteers activated and deployed directly to PODs will arrive one to one and a half hour(s) before the beginning of their shift to receive JITT and report to their stations 15 minutes prior to the beginning of their shift.

o Emergent volunteers will receive JITT at the Volunteer Staging and Training Area and be sent to arrive at the POD 30-45 minutes prior to the beginning of their shift and report to their station 15 minutes prior to the beginning of their shift.

o All personnel will have identification badges and sign in when reporting for duty and sign out at shift changes.

o Credentialing, badging and check-in of staff is the responsibility of the Resource Unit Leader in the Planning Section. A field Check-in Recorder will be sent to PODs from the RESL in the PHICP as needed.

o Shift duration is 12 hours long; POD operations may require 24-hour staffing. o At a minimum, the POD Supervisor and Logistics and Operations Leaders are

to conduct briefings at the beginning and end of each shift. o Personnel are to ensure that their station and/or duties are covered during

breaks. □ Personal Protective Equipment (PPE): In the event that PPE is required, the POD

Supervisor per IMT (Safety Officer and Operations Chief) will assure that the type of PPE required is issued to staff.

o All staff members are expected to wear their PPE. o Personnel that off-load and manage inventory are to wear steel-toed boots and

work gloves. □ Tactical Communications: The following equipment is to be issued by the Logistics

Section Communication Unit Leader: o POD Supervisor - a cell phone and 800 radio (for communicating with the

PHICP) and a hand-held (FRS) radio (for communications with POD Team Leads).

o Logistics and Operations Leaders - hand-held radios. o Traffic Lead and Traffic Controllers - hand-held radios. o Stations - one hand-held radio per station.


Supply Operations: □ Receiving and Storage: POD Supply and Inventory and Traffic Teams are to:

o Receive and unload medication and supplies using the appropriate equipment (e.g., hand trucks);

o Ensure that medication and materials are stored securely; o Ensure that POD stations are stocked with pharmaceuticals and other supplies. o Ensure that federal SNS supplies received from WA DOH are secured and

accounted for in accordance with WA DOH/ SNS forms and procedures.

□ Inventorying pharmaceuticals: o The Medicine/Vaccine Supply Clerk will use the pharmaceutical Inventory

Room Bin Card and the POD Pharmacist will use the Pharmaceutical Inventory Room Record to track pharmaceuticals in the POD.

o Chain of custody for pharmaceuticals is documented by the signature, date and time pharmaceuticals are received and moved from one location to another. Within the POD this occurs on the Pharmaceutical Inventory Bin Card. Pharmacists are responsible for chain of custody for all control substances.

o A separate tracking system provided by PHICP logistics will be used for non-pharmaceutical supplies and will be maintained by the Inventory Clerk.

o Supply Runners will deliver pharmaceuticals to the stations and return with signed as received Supply Order Form.

□ Ordering (and Re-ordering) Pharmaceuticals

o Use the Dispensing Station Pharmaceutical Supply Order Form, found in this FOG, to order supplies for a Dispensing/Vaccination Station from the Pharmaceutical Inventory Room or area.

o To order or reorder SNS supplies from the State, use the order form provided by the Washington SNS staff at the time of delivery or the sample WA DOH SNS order form included in this FOG.

□ Forms Distribution: The appropriate fact sheets on the disease exposure and treatment

will be provided by the Operations Chief in coordination with the Public Information Officer.

Color coding of the forms, e.g., light green for express line, yellow for family/assisted line and pink for medical evaluation will occur if possible. Samples fact sheets are available in printed form, on flash drives in the POD Forms Go-kit and electronically on the web via the WA DOH Preparedness Communication Toolkit http://www.doh.wa.gov/phepr/toolkit/. Mass production of forms and fact sheets is the responsibility of the Logistics Section via arrangements with each county’s print shop and their respective county EOCs.

POD Operations: □ Parking and Entrance to POD: The Traffic Team sets up external signage that clearly

directs the public to POD parking and to the POD entrance. □ Symptomatic individuals ARE NOT to enter the POD. Use running overhead

announcements, traffic and greeter staff and/or signage to refer symptomatic individuals


to medical treatment away from the POD. However, symptomatic individuals may receive prophylaxis for household members in an expedited fashion in an area outside the POD if deemed appropriate by the incident and the POD Supervisor.

□ The Line Team directs the public to complete forms, answer questions and assist with

maintaining an expedited flow throughout the prophylaxis process.

o Tables with chairs, clipboards and pens/pencils are to be available to aid form completion.

o Colored duct tape on the floor for each line to direct the public: Express – Green Assisted – Yellow Medical Evaluation – Red

□ Greeters: Greeters direct the public to the appropriate screening line. Greeters will refer

symptomatic individuals away from the POD.

Each disease will have a different prophylaxis algorithm. The following example is for post exposure to inhalation anthrax. Greeters will ask the public if they are symptomatic by reading the symptoms sign before the public is allowed to enter the POD. If yes to the symptom question, the public is sent to seek medical treatment from their provider and not enter the POD. A Medical Evaluator will be stationed before the POD entrance for Greeters to direct individuals with symptom questions and not hold up the entrance to the POD. This Medical Evaluator may supply prophylaxis for symptomatic member’s household without allowing POD entrance, if warranted.

Greeters will ask additional questions to those entering the POD to distribute the appropriate color coded form, direct forms completion and the public to the appropriate line. This will vary based on the scenario and response objectives. An example algorithm for post exposure prophylaxis to inhalation anthrax follows:

o If the public says yes to: • having children under 9 years of age in the household; • being pregnant or breastfeeding;

Give a yellow form and send to the assisted/family line. o If the public says yes to

• having allergies to antibiotics; • NOT being able to swallow pills;

Give a pink form and send to the medical evaluation line. o If the public has a language or functional limitation needing assistance,

Direct them to the interpreter or assisted/family line as indicated. o If the public appears confused and unable to respond appropriately,

Direct them to the Behavioral Health Station. o If the public does not have a contraindication nor need special assistance,

Give a green form and send to the express line.


� Flow Monitors: Flow Monitors maintain an efficient flow of individuals throughout the POD.

and escort individuals to the “Assisted lines” who need: o language interpretation (this includes non-English speakers, hearing impaired,

visually impaired and functionally illiterate); o assistance due to functional limitations; o pediatric dosing, large families, especially any with young children.

The “Assisted lines” assures appropriate assistance for individuals while not impeding the expedited “Express lines”.

□ Screeners: The Screeners review intake forms for completion, answer exposure questions and instruct individuals to proceed to the assisted or express dispensing lines, or to the Medical Evaluation Station.

□ Interpreters: Interpreters will be available at the screening station to address non-English

speakers, hearing impaired and functionally illiterate individuals. Pictograms, multi-language POD signage as well as fact sheets provided by the PIO in key languages via the POD Group Supervisor will be available for Interpreter and POD staff use. Each local health jurisdiction maintains a contract for language translation services and will be responsible to provide translation services within their jurisdiction for languages not provided via POD interpreter. If the procedure to access the LHJ’s contracted language translation services is not provided, an interpreter resource request will be made and follow standard ICS resource request procedures (Ops to Logs).

□ Medical Evaluators: The Medical Evaluators conduct additional screening for existing

medical conditions and allergies or contraindications to medicines. After screening, the individuals are to be directed to a dispensing station or referred to their health care provider. They also provide back up to the first aid station if needed. This station will not be stood up under a non-medical model.

□ Dispensing/Vaccination Station: Dispensing personnel hand out prophylaxis medication

or administer vaccinations for the individual and additional persons listed on the intake form.

□ First Aid Station: This station provides first aid or emergency medical treatment for the

POD staff or individuals. Staff from the Medical Evaluators Team will be pulled to man this station on an as needed basis.

□ Behavioral Health Station: This station provides psychological support and limited

counseling to the public and POD staff. Security, Greeters, Flow Monitors and Screening staff are to scan the public to identify and refer distressed or agitated individuals to this station.

□ Exit: Signage in the POD should direct the public to the exit. Collection of forms and data

entry occurs at this station.


Demobilization □ The POD Supervisor is to inform POD staff when POD operations will end and

demobilization activities are to begin. □ The POD Supervisor and Logistics and Operations Leaders are to ensure that POD

operations are demobilized appropriately, including breaking down the POD, and reconciling inventory and paperwork/data entry.

o All POD staff is to assist with demobilization activities. o The Vaccination/Dispensing Team will work with the Supply and Inventory

Team to inventory remaining pharmaceutical supplies. □ The POD Supervisor and Logistics and Operations Leaders will dismiss staff, as

appropriate. □ The POD Supervisor, Logistics Leader and Facilities Representative are to conduct a joint

inspection of the facility to assess any damage or maintenance concerns. Damage, missing items, etc. is to be documented in writing. The use of a disposable camera should be considered for photographing damage to the facility and equipment.


Public Entrance

Greeters: Ask questions,

distribute forms, and direct to enter POD

Fill out forms area

Screening Stations

Medication Dispensing

Or

Vaccination Stations

Exit: Data collection

station

Staff Check-in Pod Supervisor

Supply Storage Area Behavioral Health Station

Note: Layout will vary based on facility. Unidirectional flow is essential.

Step 4: Exit Step 3: Get Meds Step 2: Show form Step 1: Fill out formFig. 1 Basic Example of Standardized POD

Public Exit

Staff Entrance

Supply Receiving


Public Entrance

Greeters: Ask questions,

distribute forms, and direct to enter POD

Fill out forms area

Screening, Health Education/

Interpretation

Exit: Data collection

station

Staff Check-in Pod Supervisor

Secured Inventory Control Area Behavioral Health Station

Notes: a) Layout will vary based on facility.b) The number of dispensing/vaccination stations will vary by public demand.

Fig. 2 Detailed Example of Standardized POD

Express Medication or Vaccination Station



Family—Assisted Dispensing/Vaccination

Medical Evaluation

Station

Express Dispensing

Key: = unidirectional patient movement = off-site or other location in facility

Triage: Med.

Evaluator

Staff Entrance

Public Exit

Supply Receiving


PO D

Port-a-Potties

Public Entrance and POD Street S ignage

Sup

ply

Del

iver

y R

oute

Secured delivery site for SNS

m ateria ls

O ff-site

Staff parking

Parking overflow w ith

transportation to POD site

Public entranceSecured staff

entrance

Public exit

O n-site

PO D public parking On-site

Handicapped parking

Public flow

Staff flow

Parking Exit

F ig. 3 M odel for external site e lem ents for fixed PO D grounds layout*

*Roadways, parking, and traffic patterns w ill vary

w ith each site

ON

E W

AY

O NE W AY

Street

Stre

et

Stre

et


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SIGNAGE and POD COLOR-CODES

Signage

Signage for this POD Field Operations Guide was adapted from Washington State’s Medication Center signage website. A link to photo-ready files for each sign can be found in the Resources section of this document.

The size and layout of a POD will influence the number of signs and specific messages needed.

Basic signs to use from this resource are:

o Entrance o No entrance o Prohibited o This is a medical services facility o Symptom signs according to the event: Anthrax, Botulism, Plague, Smallpox,

Tularemia, Hemorrhagic Fever symptoms o Four Simple Steps o Step 1: Fill In Form o Step 2: Show Form o Step 3: Please Wait o Step 4: Turn in Form & Exit o Thank you for your cooperation o First Aid o Exit o No Exit o Arrows

Color-coding Color-coding functions may improve throughput because colors provide the public with a visual path or cues to follow through the POD as long as too many colors are not used.

Line POD Staff Vests Express Green POD Group

Supervisor Green

Assisted Yellow Logistics Yellow Medical Evaluation

Red Operations Red

Vests, caps, nametags, floor tape and tablecloths are items that can be color-coded to distinguish the various functions. The use of small, hand-held flags is helpful to indicate, for example, an available dispenser or for POD staff to call a runner.


Enter

• Allergic to Doxycycline or Tetracycline?

• Under 9 yrs old • Pregnant or

Breastfeeding?

• Allergic to Cipro? • Seizures? • Dialysis/Kidney

Disease? • Blood Thinner

Meds?

Dispensing Station • Doxycyline

Dispensing Station • Cipro for allergic, < 9

years old, pregnant or breast feeding

• Doxy for other household members

Consult Medical Evaluator & Dispensing

NO/ don’t knowGreen Line

NO

YES

YES

Post-Exposure Anthrax DISPENSING ALGORITHM FOR

HEADS OF HOUSEHOLDS

Yellow Line

Red Line

Yellow Line

Exit

Exit

Exit

Figure 4. NON-MEDICAL ANTHRAX POD ALGORITHM

EXAMPLE ONLY EXAMPLE ONLY


POD Supervisor Just-in-Time Training (JITT) Checklist Mass Prophylaxis Centers

The POD Group Supervisor provides JITT to Operations and Logistics Leaders prior to the general all POD staff briefing. Please add other items as pertinent to incident objectives. I. Basic ICS

Review ICS basic principles; chain of command and post POD Org chart Review check-in, required vest and badging process (Planning Section

Resource Unit Check-in Recorder responsibility or may occur at VSTA) Review PPE and safety staff (Field Safety Officer or POD Sup. Responsibility) Review basic communication messages developed by Incident PIO and inform

all working in POD that all media and visiting dignitaries will be referred to Field PIO or POD Supervisor in absence of Field PIO

II. Operations

Describe 3 important elements to operations # 1 – Purpose of the POD (i.e. Incident Objective from IAP, what are we Doing) and POD Goals: 1) keep people moving; 2) provide medication to public. # 2 – Critical elements of operation (i.e. what staff needs to Know). # 3 – Acknowledge and Thank staff/volunteers for important service.

Review and post the POD floor plan. Describe the 4 key steps to POD operations:

Step 1 – Triage, Greeters, Fill out forms; Step 2 – Screening forms, health education (Medical Evaluation if needed); Step 3 – Dispense vaccine or prophylaxis (Express & Assisted lines); Step 4 – Turn in form(s) and Exit

Review Ops situation communication, identify problems and solutions to supervisors ASAP, tracking inventory hourly or as indicated to Supervisors, etc..

Review security issues (law enforcement’s (LE) responsibility).

III. Logistics Process for receiving, storing, tracking prophylaxis/vaccine, restocking supplies

and communications. Protocol for communications within POD and with family Protocol for breaks, food, drinks, changing shifts, traffic control and parking

IV. Job Action Sheet (JAS) and JITT for POD Staff

Review JAS. Operation and Logistic Leaders will provide JITT and distribute JAS to respective POD Team Unit Leads who will provide JITT, distribute JAS and other task specific equipment to their direct reports.

Ensure training is conducted for equipment related to job functions. V. Answer Questions


POD Group Supervisor Security – LE Lead

Inside POD Operations LeaderPOD Logistics Leader

Operations Section Chief/POD Branch Director

Communication Lead

Traffic Lead

Supply & Inventory Lead

Line Lead

Traffic Controllers

Inventory Clerk

Greeters

Flow Monitors

Forms Collector/Data Entry

Screening LeadScreeners

Interpreters

Medicine / Vaccine Supply

Information Technology

Supply Runners

Security Personnel

Facility Point of Contact

Drive-Through (DT) POD Operations Leader

DT - Prophylaxis LeadDT Pharmacist (Dispensing

DT Dispensers

DT Vaccinators

DT Vaccination Assistants

DT - Line LeadDT Greeters

DT Flow Monitors

DT - Screening Lead

DT Screeners

DT InterpretersProphylaxis Lead

Pharmacist (Dispensing Only)

Dispensers

Vaccinators

Vaccination Assistant s

Medical Lead

First Aid

Medical Evaluator

Behavioral Health LeadBehavioral Health Counselors

Fig. 4 POD Management Structure/Organization Chart


DISPENSING MEDICATION CENTER STAFFING GUIDELINES

Position # Req Location Role Exp/Training Group Supervisor 1 Mobile Oversee all POD operations Health Management Security Lead – LE Lead 1 Mobile Oversee security and crowd management from LE LE/Security Security Personnel 8+ Entrance, exits Secure site provided by law enforcement (LE) LE/Security Facility Mngr & Custodial 2+ Mobile Provide facility and custodial support from facility Facility Staff Logistics Leader 1 Mobile Supervise/provide logistical resource needs Inventory skills Communications Lead 1 Comm. Area Ensure operable hardware, redundant communication IT, Communications IT / Com Support 1-2 Comm. Area Operable computers and other hardware IT, Communications Traffic Lead 1 Outside Oversee management of traffic flow, parking area Non-Medical Traffic Controller 6 Parking lot Direct one way traffic flow, parking, crowd control Non-Medical Supply & Inventory Lead 1 Supply area Oversee inventory management system. Inventory Control Inventory Clerk 1 Supply area Maintain inventory management for non-medical Non-Medical Medicine / Vaccine supply 1-2 Supply area Maintain inventory management for medical agents Non-Medical Supply Runner 2-3 Mobile Stock supplies to stations, run errands as needed Non-Medical Operations Leader 1 Mobile Responsible for supervising POD operations Health manager Prophylaxis Lead 1-2 Prophy Area Oversee medication dispensing Health manager Pharmacist (Dispensing) 1 Compounding Compound, dilute, calculate doses, provide expertise Pharm., Phy. , Dentist Dispensers 6-8 Dispensing Area Dispense medication according to protocol Medical; H Educator Medical Lead 1 Med Eval Station Supervise medical support stations Medical First Aid 1-2 First Aid Station Respond to all POD medical emergencies Medical Medical Evaluator 4-5 Triage &Med Eval Screen and assess symptoms and contraindications Medical Behavioral Health Lead 1 BH Station Supervise BH station and Counselors Counselor Behavioral Health 4-5 BH Station Provide brief counseling, crisis intervention, referrals Counselor Screening Lead 1 Screening Area Supervise screeners/ interpreter forms review Health Educator Interpreters 2-3 Screening/Mobile Perform language interpretation services interpreter Screeners 4-6 Screening Area Review forms, provide education; direct to line(s) Health Educators Line Lead 1-2 Mobile Maintain efficient flow of the POD lines Non-Medical Greeter 4-6 POD entrance Greet, direct, distribute form(s), answer questions Non-Medical Flow Monitor 4-6 Stations/Mobile Direct individuals to next station Non-Medical Forms / Data Entry 2-3 POD exit Collect, review forms, and conduct data entry Non-Medical Total Staff per 12 hr shift 65 core to 109 optimal. Staffing guidelines are general estimates, adjust as needed.


VACCINATION MEDICATION CENTER STAFFING GUIDELINES

Position # Req Location Role Exp/Training Group Supervisor 1 Mobile Oversee all POD operations Health Management Security Lead – LE Lead 1 Mobile Oversee security and crowd management from LE LE/Security Security Personnel 8+ Entrance, exits Secure site provided by law enforcement (LE) LE/Security Facility Point of Contact 2+ Mobile Provide facility and custodial support from facility Facility Staff Logistics Leader 1 Mobile Supervise/provide logistical resource needs Inventory skills Communications Lead 1 Comm. Area Ensure operable hardware, redundant communication IT, Communications IT Support 1-2 Comm. Area Operable computers and other hardware IT, Communications Traffic Lead 1 outside Oversee management of traffic flow, parking area Non-Medical Traffic Controller 6 Parking lot Direct one way traffic flow, parking, crowd control Non-Medical Supply & Inventory Lead 1 Supply area Oversee inventory management system. Inventory Control Inventory Clerk 1 Supply area Maintain inventory management for non-medical Non-Medical Medicine / Vaccine supply 1-2 Supply area Maintain inventory management for medical agents Non-Medical Supply Runner 2-3 Mobile Stock supplies to stations, run errands as needed Non-Medical Operations Leader 1 Mobile Responsible for supervising POD operations Health manager Prophylaxis Lead 1-2 Prophy Area Oversee vaccinations Health manager Vaccinators 8-10 Vaccination Area Administer vaccinations Medical Vaccination Assistant 8-10 Vaccination Area Assist vaccinator as assigned Non-Medical Medical Lead 1 Med Eval Station Supervise medical support stations Medical First Aid 1-2 First Aid Station Respond to all POD medical emergencies Medical Medical Evaluator 4-5 Triage &Med Eval Screen and assess symptoms and contraindications Medical Behavioral Health Lead 1 BH Station Supervise BH station and Counselors Counselor Behavioral Health 4-5 BH Station Provide brief counseling, crisis intervention, referrals Counselor Screening Lead 1 Screening Area Supervise screeners/ interpreter forms review Health Educator Interpreters 2-3 Screening/Mobile Perform language interpretation services interpreter Screeners 4-6 Screening Area Review forms, provide education; direct to line(s) Health Educators Line Lead 1-2 Mobile Maintain efficient flow of the POD lines Non-Medical Greeter 4-6 POD entrance Greet, direct, distribute form(s), answer questions Non-Medical Flow Monitor 4-6 Stations/Mobile Direct individuals to next station, escort if needed Non-Medical Forms / Data Entry 2-3 POD exit Collect, review forms, and conduct data entry Non-Medical Total Staff per 12 hr shift 65 core to 109 optimal. Staffing guidelines are general estimates, adjust as needed.


Position: GROUP SUPERVISOR Reports to: Operations Section Chief/Branch Director or Deputy

Supervises: Logistics and Operations Leaders; Indirect: Law Enforcement Security Lead, Facility Point of Contact Role: Manages medication center or point of dispensing (POD). Responsible for implementation of incident action plan (IAP) and division assignments. Oversees POD set-up, operations and demobilization. Acts as POD Safety Officer unless Safety Officer Assistant is present. Serves as onsite media contact unless Field PIO is present. Qualifications: Public health professional, administrator with good management skills, ICS

Check In Attend Operations Section briefing Receive, review and implement Incident Action Plan (IAP) with Division

Assignment List (ICS 204), Communication Plan (ICS 205) and other pertinent information on operational objectives, strategies and tactics, situational awareness, risk communication, safety precautions, protocols/guidelines from Operations Section Chief/POD Branch Director or Deputy

Review Region IV Mass Dispensing Annex and appropriate Appendices Check in: arrive with proper photo ID, put on ID badge, and vest, set up station Review assignments, Job Action Sheets, and incident activities with subordinates

and assign tasks in accordance with IAP Lead Just-in-Time Training (JITT) for Logistics/Operations Leaders, establish

POD ICS reporting structure Ensure subordinates observe required safety precautions Conduct POD walk-through with Facilities POC, Logistics & Operations Leaders

at receipt and return of facility Conduct briefing with POD staff covering:

1. Who reports to whom and chain of command 2. Key risk communication message for the public regarding current situation 3. Not to communicate to media unless directed 4. Safety precautions and process for medical assistance

Ensure: 1. Internal and external security measures are in place 2. Supplies, prophylaxis or vaccine are on-site or in transit 3. Adequate staffing for POD operations 4. Site, operations and staff safety plans are followed

JOB ACTION SHEET


Duties

Oversee proper set up, implementation and breakdown of POD Ensure operations follows the 4 steps:

1. Entrance/greet/triage/forms 2. Review and screen forms/counseling or medical evaluation (if needed) 3. Dispense meds/vaccine 4. Turn-in forms and exit

Receive regular reports from Logistics and Operations Leaders Determine need for assistance on assigned tasks, monitoring all POD operations Request POD resource needs from POD Branch Director/OSC/PHICP Resolve operation issues with Operations Leader, line flow,

dispensing/vaccination, and medical Resolve logistic problems with Logistics Leader:

1. Monitor communications and communication needs; 2. Monitor resources and resources needs with established resource tracking

system; 3. Ensure security of medicine delivery and storage; 4. Ensure adequate food, liquids and breaks for staff.

Submit situation and resource status information, ensuring that PHICP is advised of all changes in status

Report special occurrences, events or accidents Safety – Review POD site and operations safety Media - Triage all media that arrives at POD that is not escorted by PIO or PIO

Assistant Maintain Unit/Activity Log (ICS 214) Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out

Debrief with OSC/Branch Director and incoming POD Supervisor to include work accomplished or to be accomplished, operational difficulties and plans for next operational period

Prepare end of shift report; complete and submit timesheets Ensure POD staff and equipment check-out documentation Check-out/Sign out at the end of your shift


Position: SECURITY/LAW ENFORCEMENT LEAD Reports to: Group Supervisor

Supervises: Security Personnel Role: Provide facility safety support. Monitor the safety of POD location including entrances and exits for POD operations. Provide protection for the POD staff and public including security of medications/vaccines. Qualifications: Security and crowd management experience preferred. Ability to remain standing for lengthy periods of time. Security may be supplied by local law enforcement or professional security personnel.

Check In Check in: arrive with proper photo ID, put on ID badge, and vest, set up station Review Job Action Sheet, become familiar with primary tasks and reporting

structure Receive briefing on situational awareness, risk communication, safety and other

pertinent information as needed from supervisor or other designee Receive just-in-time-training (JITT) from supervisor Provide just-in-time-training (JITT) for direct reports Follow Incident Command System (ICS)

Duties

Participate in securing the site Check and address potential security problems inside and outside the POD Ensure that traffic flow to the POD is being addressed adequately by POD traffic

staff Respond to security issues Watch for and assist with disruptive behaviors Call for back-up, alert 911 if needed Report security status routinely to Group Supervisor Direct media inquiries to Group Supervisor or designated PIO Assistant Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out

Break down station, if indicated Participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets and check-out/sign-out at the end of your shift

JOB ACTION SHEET


Position: SECURITY PERSONNEL Reports to: Security/LE Lead

Role: Provide protection to the POD staff and public Qualifications: Security and crowd management experience preferred. Ability to remain standing for lengthy periods of time. May be supplied by local law enforcement, professional security personnel, etc.

Check In

Check in: arrive with proper photo ID, put on ID badge, and vest, set up station Review Job Action Sheet, become familiar with primary tasks and reporting


pertinent information as needed from supervisor or other designee Receive just-in-time-training (JITT) from supervisor Follow Incident Command System (ICS)

Duties

Participate in securing the site Check and address potential security problems inside and outside the POD Report security status routinely to Security Lead Watch for and assist with disruptive behaviors Call for back-up, alert 911 if needed Direct media inquiries to Group Supervisor or designated PIO Assistant Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out

Break down station, if indicated Participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets Check-out/Sign-out at the end of your shift

JOB ACTION SHEET


Position: FACILITY POINT OF CONTACT / MANAGER Reports to: Group Supervisor working in liaison with Logistics Lead

Role: Provide access to all areas of the facility to support POD operations Qualifications: Facility provided site staff




Duties

Provide subject matter expert information about the site being used for POD operation

Provide information and support to the Logistics Lead and Security Lead/Staff in securing the site prior to start of the POD operations

Facilitate the removal of garbage from all areas inside and outside the POD, with the exception of medical waste which will be removed by the Health Department

Ensures cleanliness of site, to include restrooms, break rooms, workstations, and office areas

Monitor facility areas for spills, etc. that might compromise the safety of staff and the public

Perform minor maintenance as required. Coordinate major facility repair issues. Provide access to facility to appropriate personnel Ensure continual (24 hour) facility use, maintain facility and provide utility support

as needed Work with security staff to ensure safety of facility and grounds

Check Out


JOB ACTION SHEET


Position: LOGISTICS LEADER Reports to: POD Group Supervisor

Supervises: Communication Lead, Traffic Lead, Supply and Inventory Lead Role: Provide logistic needs for all of the Medication Center/POD functions Qualifications: Non-Medical, Inventory control experience, strong organizational skills, basic ICS



pertinent information as needed from supervisor or other designee Receive just-in-time-training (JITT) from supervisor Provide just-in-time-training (JITT) for direct reports Follow Incident Command System (ICS) Obtain, review and check off contents of POD go-kit set and other needed POD

supplies Review Region IV Mass Dispensing Annex and appropriate Appendices Receive IAP (incident action plan) and briefing on situational awareness, risk

communication, safety and other pertinent information as needed from POD Group Supervisor

Ensure availability, transport and security of supplies and prophylactic agents for POD operations including signing for receipt and delivery of the SNS cache

Ensure: 1. Communication equipment works and all assigned staff can use the

equipment 2. Staff is ready to check in for assigned roles (Staff may be sent from a Staging

area or there may be a Planning Section Resource Unit Field Check In Recorder at the POD site. Check In Recorder will be responsible for issuing staff ID badges and vests.)

3. POD supplies have arrived, are inventoried and distributed to the appropriate stations

4. Establishment and maintenance of inventory management system 5. Tracking of all pharmaceuticals and prophylactic agents 6. Proper receipt and re-order of all SNS supplies 7. Parking and traffic management signage and staff are in place

Review POD set up check list with Operations Leader

JOB ACTION SHEET


Report to POD Supervisor that all logistical needs for dispensing or vaccination operations are ready for POD opening one hour before scheduled opening or at beginning of shift

Duties Establish receiving, staging, inventory and distribution of POD supplies and

equipment Arrange for transportation of supplies Ensure proper POD signage and flow in 4 steps:

1. Entrance/greet/forms 2. Screening/counseling or medical evaluation (if needed) 3. Dispense meds/vaccine 4. Turn-in forms and exit

Ensure: 1. Internal and external security measures are in place 2. Supplies, prophylaxis or vaccines are onsite or in transit 3. Adequate staffing for POD operations 4. Establishment and maintenance of inventory management system including

re-supply Ensure that all communication equipment has been set up, tested, and is in

working order Report bottlenecks, suggest necessary changes to POD Group Supervisor Report resource needs to POD Group Supervisor Supervise maintenance of supply inventory Establish and supervise drug/vaccine tracking and inventory system Ensure that waste disposal and medical waste is being handled properly and

regularly by facility Maintain Unit/Activity Log (ICS 214) Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out

Inventory POD go-kit supplies at the end of your shift; request additional supplies if needed for next operational period

Participate in debrief and record comments Report any changes to protocol Ensure POD resource check-out documentation Complete and submit timesheets Check-out/Sign-out at the end of your shift


Position: COMMUNICATIONS LEAD Reports to: Logistics Leader

Role: Ensure that redundant communication devices are available and operable for POD staff Qualifications: Non-medical; communications, information technology skills




Duties

Inventory communications equipment Test communications devices, Identify channels/frequencies Assign communications equipment to POD staff as indicated and maintain log Train staff in communications protocol related for device they are required to use Establish a communication center Staff the communications desk (if applicable) Monitor all communications occurring via radio and other devices Problem-solve communications tool breakdowns Bring unresolved issues to the attention of the Logistics Leader Trouble-shoot problems with Information Technology Technical support Report status, critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: INFORMATION TECHNOLOGY (IT) TECHNICAL SUPPORT Reports to: Communications Lead

Role: Maintain operability of technology used in POD: computers, printers, fax, audio visual and other technology equipment and devices as needed Qualifications: Non-Medical; Information Technology hardware & software skills




Duties

Inventory IT equipment Set up, test and maintain operability of all technical hardware being used at the

POD Ensure internet access, printer, fax and other hardware connections as needed Assign technology equipment to POD staff as indicated and maintain log Train staff on use of technology and provide technology support as needed Ensure data entry station is working properly Problem-solve technology equipment breakdowns Bring unresolved issues to the attention of the Communications Lead Report status, critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: TRAFFIC LEAD Reports to: Logistics Leader

Supervises: Traffic Control Role: Oversee POD outside ingress and egress to include parking area Qualifications: Non-Medical, ability to remain standing for lengthy periods of

time




Duties

Maintain one way traffic flow into and exiting the POD Oversee crowd control measures from the parking lot to the POD Ensure clearly marked separate entrances and exits with clear flow that do not

cross Develop approved messages for public in parking area Set up and maintain external POD signage Ensure that any security concerns are brought to the attention of the Security

Lead Stand by for delivery of medication and other supplies Watch for bottlenecks in traffic flows Direct public to locations Direct media inquiries to Group Supervisor or designated PIO Assistant Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: TRAFFIC CONTROLLER Reports to: Traffic Lead

Role: Provide traffic management outside and in parking area to ensure efficient flow Qualifications: Non-medical. Ability to remain standing for lengthy periods of time. May be supplied by local law enforcement or public works department




Duties

Set up traffic flow patterns for outside of POD Set up and maintain external POD signage Direct traffic and solve parking lot issues Provide crowd control and direction outside the POD Provide appropriate and approved messages to the public in parking area Ensure that any security concerns are brought to the attention of the Law

Enforcement Security Lead/Security Personnel Use radio in accordance with protocol, if indicated Direct media inquiries to Group Supervisor or designated PIO Assistant Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: SUPPLY & INVENTORY LEAD Reports to: Logistics Leader

Supervises: Inventory Clerk, Medicine/Vaccine Supply Clerk; Supply Runners Role: Ensure that all supplies to operate the POD have been received and distributed. Maintain inventory management and control system. Track prophylactic agents/dispensed medicines/vaccines. Make supply re-order requests as necessary. Qualifications: Non-medical – Inventory control - Good administrative and

organizational skills

Check In




Duties

Implement and maintain inventory management system With approval of Logistics Leader, request additional supply/inventory needs for

the POD site from the PHICP and ensure that they are received and entered into the inventory management system

Provide updates to the Logistics Leader with any inventory issues Stand by for delivery of medications and other supplies Ensure that supplies are kept in a locked, secured room Maintain and control all supply inventory Report supply inventory to Logistics Leader Work with runners to stock supplies Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out

Break down station, if indicated and participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets and check-out/sign-out at the end of your shift

JOB ACTION SHEET


Position: INVENTORY CLERK Reports to: Supply & Inventory Lead

Role: Establish and maintain secure inventory and re-supply tracking system for POD supplies or equipment other than medications/vaccinations Qualifications: Non-medical – good organizational skills, ability to lift and move supplies

Check In




Duties

Prepare/ensure secured locked room in POD for storage of supplies Maintain POD inventory management including POD go-kit and other supply lists Receive and store supplies, including prophylactic agents and supplies from the

Strategic National Stockpile (SNS): this includes unloading supplies and recruiting volunteers to assist with this task. Use a shipping dock (if available); otherwise a lot of volunteers may be needed, including a hand truck or pallet jack

Maintain and control all supply inventory Report supply inventory to Supply and Inventory Lead Work with runners to stock supplies Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: SUPPLY RUNNER Reports to: Supply and Inventory Lead

Role: Deliver and maintain adequate supplies for POD stations as needed. Qualifications: Non-medical. Ability to remain standing for lengthy periods of

time and carry supplies




Duties

Assist medicine inventory and supply control Stock supplies for all stations Run errands as needed If indicated, use radio in accordance with protocol Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: MEDICINE/VACCINE SUPPLY CLERK Reports to: Supply & Inventory Lead

Role: Establish and maintain secure inventory and re-supply tracking system for medications or vaccinations Qualifications: Non-medical – good organizational skills, ability to lift supplies

Check In




Duties

Ensure that medications/vaccines are secured in locked room Before Dispensing/Vaccination Operations Begin: Receive, and store

prophylactic agents and supplies including those from the Strategic National Stockpile (SNS): this includes unloading supplies and recruiting volunteers to assist with this task. Use a shipping dock (if available); otherwise a lot of volunteers may be needed, including a hand truck and pallet jack

Maintain accurate inventory management system for prophylactic agents Use the Pharmaceutical Inventory Room Bin Card in POD FOG to track

pharmaceuticals in the POD Track inventory control of all prophylactic agents using inventory management

system (including pharmaceuticals; consult with pharmacist, if available) Ensure that requests to re-supply dispensing or vaccination stations are filled in a

timely manner; Work with Supply Runners to stock supplies Work with “Forms Collector” in Operations (at the POD exit) to monitor how much

medicine/vaccine is being dispensed versus how much is on hand Notify Supply & Inventory Lead when stock is half depleted so additional

meds/vaccines can be reordered; Maintain Universal Precautions Report supply inventory to Supply and Inventory Lead Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information

Check Out Break down station, if indicated; Participate in debrief, if indicated; Complete and submit timesheets; Check-out/Sign-out at the end of your shift Report any changes to protocol

JOB ACTION SHEET


Position: OPERATIONS LEADER – Inside POD Facility or Drive Through Reports to: Group Supervisor

Supervises: Line Lead, Screening Lead, Prophylaxis Lead, Medical Lead Role: Responsible for supervising POD operations. Qualifications: Medical or health manager experience, basic ICS, supervisory skills

Check In Receive IAP (incident action plan) and briefing on situational awareness, risk

communication, safety and other pertinent information as needed from POD Group Supervisor

Review Region IV Mass Dispensing Annex, appropriate Appendices and any procedures, protocols, guidelines or other job aids that may be appropriate



pertinent information as needed from supervisor or other designee Provide just-in-time-training (JITT) for direct reports Receive just-in-time-training (JITT) from supervisor Follow and maintain Incident Command System (ICS) In coordination with Logistics Leader, ensure efficient set-up and POD flow

Duties

Ensure operations follow the 4 steps: 1. Entrance/greet/triage/forms 2. Review and screen forms/counseling or medical evaluation (if needed) 3. Dispense meds/vaccine 4. Turn-in forms and exit

Maintain close communication with POD Group Supervisor and Logistics Leader Coordinate with Logistics Leader for all logistical needs Meet with “direct reports” regularly, identify and resolve issues, receive reports Ensure appropriate implementation of IAP, standing order, applicable guidelines Report bottlenecks and necessary changes to the POD Group Supervisor Determine and request staff resources from POD Group Supervisor Receive and distribute supplies/equipment Ensure adherence by operations staff to drug inventory/vaccine tracking system

established by Logistics Leader Maintain Unit/Activity Log (ICS 214)

JOB ACTION SHEET


Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out Ensure breakdown of POD Participate in debrief Report any changes in practice guidelines and procedures Complete and submit timesheets Check-out/Sign-out at the end of your shift Complete Unit Log IS-214


Position: LINE LEAD - Inside POD Facility or Drive Through Reports to: Operations Leader

Supervises: Greeters, Flow Monitors, Forms Collector/Data Entry [May need 2 Line Leads one to supervise Greeters and another to supervise Flow Monitors and Data Entry] Role: Manage efficient flow of POD “line” Qualifications: Non-Medical, Good communicator, Administrative skills

Check In



pertinent information as needed from supervisor or other designee Receive just-in-time-training (JITT) from supervisor Provide just-in-time-training (JITT) for direct reports Follow Incident Command System (ICS) If needed, assign Greeter and Flow Monitor Team Lead to report to you to

ensure span of control

Duties Maintain communication with greeters (Step 1), flow monitors (Steps 1 & 2), and

forms collection (Step 4) Maintain communication with “traffic control” (crowd and parking control)

positioned outside the POD Problem solve to eliminate/reduce POD line bottlenecks; report changes to

supervisor Provide routine status report and resource requests to supervisor Receive and distribute necessary supplies/equipment Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: GREETER - Inside POD Facility or Drive Through Reports to: Line Lead

Role: Greet, direct and triage the public that enter the POD Qualifications: Non-medical, good communication skills

Check In




Duties

Greet and ask questions to direct public to correct lines/stations as appropriate Have pictograms available, if possible, for communication with non-English

speakers Triage symptomatic individuals away from POD per protocol if appropriate Hand out appropriate forms and ask individuals to fill out forms. Forms should be

color coded if possible e.g. green for express, yellow for assisted lines, pink for medical evaluation station.

Alert appropriate staff (interpreters, flow monitors, etc) if an individual needs assistance (functional limitations, language translation, etc.)

Work closely with Flow Monitors to efficiently maximize POD through-put Alert supply runners when more supplies are needed Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: FLOW MONITOR - Inside POD Facility or Drive Through Reports to: Line Lead

Role: Maintain efficient flow of individuals through the POD line Qualifications: Non-medical, good communication skills




Duties

Direct public to lines/stations Communicate with Greeters and Screeners to efficiently manage the flow of the

lines in the POD Watch for individuals who need assistance (functional limitations, wheel chairs,

hard-of-hearing, non-English speakers, sick, disoriented) and direct/escort to appropriate station

Escort distressed, upset, and anxious individuals to behavioral health counselors Identify and report bottlenecks to Line Lead Monitor and report security issues to Line Lead Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: FORMS COLLECTOR/DATA ENTRY Reports to: Line Lead

Role: Collect POD data Qualifications: Non-medical, good communication skills




Duties

Collect and review forms for completeness and legibility Provide or remind public how to obtain additional information Direct public out of the POD Conduct data entry Maintain count of number of individuals served by time period (e.g., every hour) Report total counts and status routinely to Line Lead Ensure all forms and supplies that are needed are available Alert runner when more supplies are needed Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: SCREENING LEAD - Inside POD Facility or Drive Through Reports to: Operations Leader

Supervises: Screeners, Interpreters Role: Supervise review of completed intake forms and based on POD flow direct public to appropriate line (express, family/assisted, or medical evaluation) Qualifications: Non-medical. Health educator or coordinator with supervisory skills preferred.




Duties

Ensure Screeners and Interpreters are prepared to educate the public about the medication or vaccination and the disease.

Oversee Screeners and be a resource for screeners as they: 1. Review completed intake form 2. Review health education materials 3. Direct public to receive prophylaxis at express or assisted lines, medical

evaluation or behavioral health counseling stations Ensure language translation as appropriate Use pictograms, if available, for communication limitation or in absence of

appropriate language translation. Provide routine reports to supervisor Supervise provision of education materials/FAQ sheets Direct public as needed Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out Break down station, if indicated; Participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets; Check-out/Sign-out at the end of your shift

JOB ACTION SHEET


Position: SCREENER - Inside POD Facility or Drive Through Reports to: Screener Lead

Role: Review and screen forms to direct public to either express, family/assisted lines, or medical evaluation stations Qualifications: Non-medical, health educator, bilingual a plus, good communicator




Duties Review screening algorithm and accompanying forms Assist the public with completing the intake form accurately by:

1. Answering questions 2. Working with interpreters to assist non-English speakers 3. Responding to disruptive clients and referring to Behavioral Health Station 4. Reading intake form for individuals who are unable to read

Review each individual’s form, double-checking for completeness Based on algorithm (e.g., zero ‘yes’ responses to contraindications, etc.), direct

public with completed forms to receive medication/vaccination in appropriate express or family/assisted line or refer to medical evaluation, if indicated

Assist public in understanding materials; Use pictograms as needed to communicate; Maintain Universal Precautions

Refer to Interpreter as needed and if available Answer questions regarding: Why public has been asked to come, what to

expect at the POD, the disease, contraindications for taking the medication/receiving vaccination, how to contact if reaction or further questions

Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information


JOB ACTION SHEET


Position: INTERPRETER - Inside POD Facility or Drive Through Reports to: Screening Lead

Role: Assist non-English speakers by providing interpretation with intake form, disease education, medication or vaccination contraindications, and POD flow Qualifications: Bilingual, language interpreter, ability to read and speak the needed language; good social skills, experience in the health field preferred




Duties

Familiarize yourself with all forms, materials and POD flow procedures Work with Screeners and Dispensers/Vaccinators to identify and assist non-

English speakers Provide language interpretation to non-English speaking individuals Assist with form completion Assist public in understanding materials; use pictograms as needed to

communicate Accompany individuals through POD as necessary Provide routine reports to supervisor Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: PROPHYLAXIS LEAD - Inside POD Facility or Drive Through Reports to: Operations Leader

Supervises: Pharmacists, Dispensers, Vaccinators, Vaccination Assistants Role: Supervise medication dispensing or vaccine administration staff Qualifications: Medical or health care manager, supervisory experience preferred




Duties

Act as prophylaxis technical resource to dispensing/vaccination team Assign staff to appropriate location within the dispensing/vaccination station Monitor flow and recommend staffing adjustments to the POD Operations Leader Ensure that pharmaceuticals/vaccines and supplies are available when needed Ensure that drug or vaccine information sheets are available and provided to

everyone Ensure security, proper storage and inventory of medication/vaccines in

drug/vaccine storage and in dispensing/vaccination stations Ensure dispensing/vaccine protocols are followed:

1. Make sure drugs are properly packaged and instructions are given (e.g., for children)

2. Make sure vaccines are properly administered 3. If individuals are picking up medication for others in their household, ensure

review of each patient record with appropriate instructions for each 4. Review current medical condition/medications taken to determine if any

drug/vaccine interactions can occur. Refer to Medical Evaluation station, if needed

5. Assemble prepackaged medication for all individuals and attach label 6. Ensure that all education needs concerning medical/vaccine concerns are

met

JOB ACTION SHEET


Use the Dispensing Station Pharmaceutical Supply Order Form, found in the POD FOG, to order supplies for a Dispensing/Vaccination Station from the Pharmaceutical Inventory Room or area.

Request and receive other supplies from the Inventory Lead as needed. Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out Break down station, if indicated and participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets Check-out/Sign-out at the end of your shift


Position: PHARMACIST (Dispensing Only) Reports to: Prophylaxis Lead

Role: Support and ensure that dispensing protocol is practiced and maintained. Qualifications: Pharmacist, Physician or Dentist




Duties

Act as a technical resource to dispensing team Use the Pharmaceutical Inventory Room Record in the POD FOG to track and

oversee inventory of pharmaceuticals in the POD Ensure that chain of custody procedures are in place for all control substances;

pharmaceutical lot numbers are tracked and signed for all control substances For infants and children, ensure that drugs are packaged properly and proper

instructions are given Review the current medical condition/medication taken to determine if there are

any contraindications or modification needed in order to take the medications dispensed. Counsel or refer as needed

Ensure that ages and allergies are noted on forms for all medications dispensed Counsel public and answer questions as needed If required, compound, dilute, and/or create drug suspensions Dispense appropriate medication and record medications dispensed Direct individuals to prophylaxis station or exit; Maintain Universal Precautions Report critical issues or necessary changes to supervisor, Prophylaxis Lead Ensure the privacy, confidentiality and security of all protected health information

Check Out

Break down station, if indicated; Participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets; Check-out/Sign-out at the end of your shift

JOB ACTION SHEET


Position: DISPENSER - Inside POD Facility or Drive Through Reports to: Prophylaxis Lead

Role: Ensure Dispensing Protocol is practiced and maintained. Review and complete screening form. Apply needed labels to paperwork or medication. Dispense medication. Maintain drug Inventory at individual station. Qualifications: Medical licensed professional if available, may be non-medical with health education or other appropriate experience for non-medical model

Check In




Duties

Review dispensing protocol and forms Follow these steps to dispense:

1. Ask for and review completed screening form 2. If there are “yes” answers to any medical conditions/contraindications,

determine, per protocol, if any drug interactions can occur. Refer to Medical Evaluation, if needed

3. If individuals are picking up medication for others in their household review each person’s record and give appropriate instructions for each

4. Ensure that all education needs concerning medications are met 5. Standard Dispensing -

a. Pick up medication for first person on the form i. Adult medication: write individual’s name on the pill bottle or label as

appropriate ii. Child medication: write individual’s name and dosing instruction on the

pre-printed label per pediatric dispensing protocol iii. Repeat for each household member on the form

b. Hand medication with information sheet(s) to individual(s) 6. Express Dispensing – Prophylaxis Lead will advise when Express Dispensing

is allowed. a. Do not write individuals’ names on the medication bottles or labels.

JOB ACTION SHEET


b. Hand the individual enough medication bottles for each household member on the form with one medication information sheet in English (unless the individual indicates they would prefer another language). Note number of bottles dispensed to household.

7. Direct individual to forms collection/data entry/exit station. Make sure drugs are properly packaged and instructions are given (e.g., for

children) Ensure security and proper storage of medication in drug storage and dispensing

station Maintain inventory of drugs dispensed Maintain adequate supplies and notify supervisor if additional supplies are

needed Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out

Break down station, if indicated Participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets and check-out/Sign-out at the end of your shift


Position: VACCINATOR - Inside POD Facility or Drive Through Reports to: Prophylaxis Lead

Role: Ensure Vaccination Protocol is practiced and maintained. Review and complete forms. Provide “needle stick” or other form of vaccination depending on the nature of the public health emergency. Ensure proper vaccine handling and inventory at individual stations. Qualifications: Licensed Medical: LPN, RN, MD, Pharmacist, EMT or person qualified under state law or who can be legally delegated to provide an injection under appropriate supervision




Duties

Review vaccination protocol, questionnaire/intake forms and vaccine information statements or comparable public education material

Instruct vaccination assistant on specific assistance required Ensure proper handling of vaccine and use of proper vaccine technique Administer vaccine according to emergency protocol/standing order Sign and record information on appropriate forms or have vaccination assistant

record information Observe client for initial vaccine reactions Report any adverse vaccine reaction to supervisors and complete VAERS form Ensure security and proper storage of vaccines at vaccination station Maintain inventory count of vaccines administered Maintain adequate supplies and notify Prophylaxis Lead if additional supplies are

needed; Maintain Universal Precautions Direct public to forms collection/data entry/exit station as appropriate Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information

Check Out Break down station, if indicated; Participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets and check-out/sign-out at the end of your shift

JOB ACTION SHEET


Position: VACCINATION ASSISTANT - Inside POD Facility or Drive Through Reports to: Prophylaxis Lead

Role: Perform documentation and other duties as assigned to expedite the vaccination process. Qualifications: Non-Medical or Medical – Health clinic experience preferred

Check In




Duties

Determine specific information recording needs and proper method of documentation from Vaccinator

Assist Vaccinator as needed by: 1. Assuring individual has proper forms 2. Reviewing individual’s paperwork 3. Preparing needle and vaccine as needed 4. Documenting the vaccine administered and the site on the forms 5. Assisting with bandaging 6. Ensuring maintenance of proper vaccine temperature, a clean and stocked

work area Assist with recording as specified by Vaccinator Document all actions and decisions in an Activity Log Direct client to forms collection/data entry/exit station Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions


JOB ACTION SHEET


Position: MEDICAL LEAD Reports to: Operations Leader

Supervises: Medical Evaluator, First Aid, Behavioral Health Counselors Role: Supervise and oversee triage of Medical Evaluator and First Aid stations. Provide medical consultation to POD Leads as needed. Qualifications: Medical – doctor, nurse, nurse practitioner, physician assistant



pertinent information as needed from supervisor or other designee Receive just-in-time-training (JITT) from supervisor Provide just-in-time-training (JITT) for direct reports Follow Incident Command System (ICS) Coordinate placement and supply requirements of Medical Evaluation, First Aid

and Behavioral Health Counseling Stations with Operation and Logistics Leaders Assist team in set up of stations

Duties

Review protocols, treatment guidelines and other information Oversee and supervise medical assessments and evaluations performed by

Medical Evaluators, and First Aid. Provide medical support/clinical guidance to POD Leads during a medical

emergency, to those providing first aid, and to resolve any medical or psychiatric POD issues

Advise team and Operations Leader on need and use of PPE (personal protective equipment)

Ensure stations have necessary medical assessment resources as needed (staff, supplies and equipment)

Identify and report to the Operations Leader any tactical resources needed Prepare regular reports for Operations Leader Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out Break down station, if indicated; Participate in debrief, if indicated Complete and submit timesheets; Check-out/Sign-out at the end of your shift

JOB ACTION SHEET


Position: FIRST AID

Reports to: Medical Lead Role: Respond to medical emergencies that may arise in the POD. Determine and provide within the context of patient care guidelines and physician oversight the most appropriate treatment for patients in the field, including appropriate mode of patient transport and destination. Qualifications: Medical – doctor, nurse, nurse practitioner, physician assistant, EMT, paramedic




Duties

Medically evaluate and determine appropriate care and treatment for persons if a medical emergency should arise

Provide immediate care to injured and/or sick POD staff members or public Conduct medical evaluation and complete appropriate form If the individual screens positive for the suspect agent, complete referral form

and direct to the nearest medical treatment facility Communicate with patient and/or family regarding medical condition Request transport by EMS if necessary and available If appropriate, coordinate the transport to emergency vehicle for delivery to

appropriate medical facility Give a copy of the appropriate forms to the client or EMS for the receiving facility. If individual screens negative, return them from where they were referred Ensure that appropriate documentation is maintained on all public and staff

illness or injuries; Maintain Universal Precautions Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information


JOB ACTION SHEET


Position: MEDICAL EVALUATOR Reports to: Medical Lead

Role: Provide medical assessment and evaluation of individuals with vaccination or medication contraindications and or symptoms – Medical evaluation occurs at triage station prior to POD entrance for symptomatic individuals and at medical screening station for those with prophylaxis contraindications Qualifications: Medical – doctor, nurse, nurse practitioner, physician assistant

Check In




Duties

Screen symptomatic individuals to determine if they may enter POD or must be referred for care

Screen intake forms and review contraindications Provide in-depth medical screening, and answer individual questions Refer individuals back to dispensing or vaccination stations if appropriate Determine and provide, within the context of care guidelines, the most

appropriate treatment avenue Communicate with individuals and/or family regarding medical condition If appropriate, refer patient to emergency vehicle/EMT or direct to nearest

hospital or treatment center Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information Maintain Universal Precautions

Check Out


JOB ACTION SHEET


Position: BEHAVIORAL HEALTH LEAD Reports to: Operations Leader

Role: Direct establishment of appropriate behavioral health services for the POD staff and the public. Supervise Behavioral Health Counselors. Behavioral health provides services to normal populations during times of elevated stress as well as triaging mental health needs. Qualifications: Behavioral health professional, counselor, or clergy – Supervisory skills



pertinent information as needed from supervisor or other designee Receive just-in-time-training (JITT) from supervisor Provide just-in-time-training (JITT) for direct reports Follow Incident Command System (ICS) Coordinate placement and supply requirements of Behavioral Health Station Assist team in set up of behavioral health station

Duties

Ensure appropriate behavioral health services needed at POD: 1. Triaging and referring individuals needing mental health assessment 2. Addressing welfare and safety of vulnerable populations at PODs, if needed 3. Providing POD staff brief stress management and counseling services 4. Providing comfort care for the public with brief supportive intervention or

psychological “first aid” to anxious citizens and victims Review Behavioral Health Annex for Mass Prophylaxis for Portland Metropolitan

area 08/2007 PsySTART Triage Form, other pertinent plans, or screening tools, if available; Maintain Universal Precautions

Oversee and supervise Behavioral Health Counselors Monitor environment and alert security of any potential violent situations Report resource needs, critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health information


JOB ACTION SHEET


Position: BEHAVIORAL HEALTH COUNSELORS Reports to: Behavioral Health Lead

Role: To assist the public and responder staff at a POD with behavioral health support and crisis counseling Qualifications: Behavioral health professional, counselor, or clergy




Duties

Provide Behavioral Health Support to ease fears and anxieties of the public and staff

Review Behavioral Health Annex for Mass Prophylaxis for Portland Metropolitan area 08/2007 PsySTART Triage Form, other pertinent plans, or screening tools, if available

Triage and refer individuals for mental health assessment, if needed Provide comfort care for the public with brief supportive intervention or

psychological “first aid” to anxious citizens and victims Provide referral information and education to individuals as needed Address welfare and safety of vulnerable populations at PODs by assisting with

barriers (e.g., language, hearing impaired, physical or mental functional limitations) as needed

Provide or refer POD staff for brief stress management/ brief counseling services, as needed (this may be offered at the Volunteer Staging and Training Area); Maintain Universal Precautions

Monitor environment and alert security of any potential violent situations Report critical issues or necessary changes to supervisor Ensure the privacy, confidentiality and security of all protected health informatio

Check Out

Break down station, if indicated; Participate in debrief, if indicated Report any changes to protocol Complete and submit timesheets ;Check-out/Sign-out at the end of your shift

JOB ACTION SHEET


INSTRUCTIONS: Please FILL OUT all of this form to receive medicine for you and up to 5 other people. Please PRINT Your Name:

Address: City:

Phone Number: Other Phone Number:

Is the person ALLERGIC to any of these medicines?

Name (First and Last)

Age

Wei

ght

Doxycycline Vibramycin

Tetracycline Sumycin

Minocycline Minocin

Ciprofloxacin Cipro

Levofloxacin Levaquin

Ofloxacin Floxin

Is the person PREGNANT or BREASTFEEDING?

Is the person on KIDNEY DIALYSIS or have KIDNEY DISEASE?

Is the person TAKING any of these medicines? Coumadin Theophylline Glyburide Probencid

1. Yourself:

Yes No

Yes No

Yes No

Yes No

Yes No

2.

Yes No

Yes No

Yes No

Yes No

Yes No

3.

Yes No

Yes No

Yes No

Yes No

Yes No

4.

Yes No

Yes No

Yes No

Yes No

Yes No

5.

Yes No

Yes No

Yes No

Yes No

Yes No

6.

Yes No

Yes No

Yes No

Yes No

Yes No

Staff Use Only: Screener, please indicate medicine to be given. Dispenser, please adhere medication label for each person. Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8 Circle D C A D C A D C A D C A D C A D C A D C A D C A

Affix label here

D = Doxycycline; C = Ciprofloxacin; A = Amoxicillin

Initial Here: Screener:______

Dispenser:______


INSTRUCIONES: Por favor complete esta forma para recibir medicina para usted y otras 5 personas. Por favor IMPRIMA Nombre:

Dirección: Ciudad:

Número de teléfono: Otro teléfono:

Tiene ALERGIAS a algunos de estas medicinas?

Primer nombre y apellido

Edad

(men

os d

e 10

año

s)

Peso

(men

os d

e 99

libr

as)

Doxycycline Vibramycin

Tetracycline Sumycin

Minocycline Minocin

Ciprofloxacin Cipro

Levofloxacin Levaquin

Ofloxacin Floxin

Esta EMBARAZADA o DANDO PECHO?

Esta recibiendo DIÁLISIS DEL RIÑON o tiene ENFERMEDAD DEL RIÑON?

Esta TOMANDO algunas de estas medicinas? Coumadin Theophylline Glyburide Probencid

1. Usted:

Sí No

Sí No

Sí No

Sí No

Sí No

2.

Sí No

Sí No

Sí No

Sí No

Sí No

3.

Sí No

Sí No

Sí No

Sí No

Sí No

4.

Sí No

Sí No

Sí No

Sí No

Sí No

5.

Sí No

Sí No

Sí No

Sí No

Sí No

6.

Sí No

Sí No

Sí No

Sí No

Sí No

Staff Use Only: Screener, please indicate medicine to be given. Dispenser, please adhere medication label for each person. Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Patient 7 Patient 8 Circle D C A D C A D C A D C A D C A D C A D C A D C A

Affix label here

D = Doxycycline; C = Ciprofloxacin; A = Amoxicillin

Initial Here: Screener:______

Dispenser:______


Sample non-medical intake form - English

Intake Form 1) How many people are in your household? _______________ 2) Is anyone in your household allergic to antibiotics? (circle one)

Yes No Don’t Know 3) Is there anyone in your household that CANNOT swallow

pills? (circle one)

Yes No Don’t Know

Intake Form 1) How many people are in your household? _______________ 2) Is anyone in your household allergic to antibiotics? (circle one)

Yes No Don’t Know 3) Is there anyone in your household that CANNOT swallow

pills? (circle one)

Yes No Don’t Know


Sample non-medical intake form - Spanish

Cuestionario ¿Cuántas personas hay en su casa? ___________________ ¿Tiene alguien en su casa que tiene alergia a los antibióticos? (Haga un círculo alrededor de una respuesta abajo)

SÍ NO NO SÉ ¿Hay alguien en su casa que no tiene el capaz de tomar pastillas? (Haga un círculo alrededor de una respuesta abajo)

SÍ NO NO SÉ

Cuestionario ¿Cuántas personas hay en su casa? ___________________ ¿Tiene alguien en su casa que tiene alergia a los antibióticos? (Haga un círculo alrededor de una respuesta abajo)

SÍ NO NO SÉ ¿Hay alguien en su casa que no tiene el capaz de tomar pastillas? (Haga un círculo alrededor de una respuesta abajo)

SÍ NO NO SÉ


----------------------------------------------------------------------------------------------------------------- This letter is a sample; add logo, contact information and other items as appropriate. It is to be given to persons who require follow-up with a health care provider because they have a specific medical condition or currently take a drug that may interact with the post-exposure medication.

----------------------------------------------------------------------------------------------------------------- Date ________________ Dear Provider, Your patient may have been exposed to . S/he has been given a post exposure prophylactic dose of:

Ciprofloxacin Doxycycline Neither – Due to allergy

Your patient indicates that s/he is taking or has:

Coumadin Theophylline Glyburide Probencid Kidney Disease

We have advised him/her to make the following alterations to their current medications, as indicated by the National Pharmacy Response Team:

Decrease Theophylline dose by 50% Stop Probencid temporarily Seek physician for advice and monitoring

Because of your patient’s medical condition or potential drug interactions between his/her medicine and the post exposure medication, your patient is being referred to you for appropriate monitoring. Region IV Public Health Contact telephone number and e-mail


This page left blank intentionally.


This card explains how to prepare emergency dosages of

Ciprofloxacin for infants and children exposed to anthrax

Once you have been notified by your federal, state, or local authorities that you

have been exposed to anthrax, it may be necessary to prepare emergency doses of ciprofloxacin for infants and children using ciprofloxacin tablets.

You will need: One (1) 500 milligram (mg) ciprofloxacin tablet Metal teaspoon Measuring spoons [1 teaspoon (tsp); and ½ teaspoon (tsp)]

(NOTE measuring spoons are preferred, however if not available, use the metal spoon to grind, measure and give the medicine) 1 small bowl One of these foods

- chocolate syrup - maple syrup - caramel syrup - ketchup

Directions: 1. Put one (1) 500-mg ciprofloxacin tablet into a small bowl. Crush the tablet

with the back of the metal spoon until no large pieces are seen. 2. Add six (6) level teaspoons (tsp) of a food to the crushed ciprofloxacin. Stir

them together until the drug looks evenly mixed with the food.

How Much of the Ciprofloxacin Mixture to Give a Child The number of teaspoons of the ciprofloxacin mixture to give a child depends on the child’s weight. If child’s weight is unknown, weigh child before giving the first dose. The chart tells you how much to give a child for one dose. You should give child two doses each day (one in the morning and one in the evening) for 60 days.

If the child weighs Give the child

4 - 6.5 pounds (lbs.)

One half (1/2) teaspoon (tsp) (2.5mL) of the ciprofloxacin mixture

7 - 12.5 (lbs.) One (1) teaspoon (5mL) of the ciprofloxacin mixture

13 - 18 (lbs.) One and one half (1 ½) teaspoons (7.5mL) of the ciprofloxacin mixture

19 - 24 (lbs.) Two (2) teaspoons (10mL) of the ciprofloxacin mixture

25 - 30 (lbs.) Two and one half (2 ½) teaspoons (12.5mL) of the ciprofloxacin mixture

31 - 37 (lbs.) Three (3) teaspoons (15mL) of the ciprofloxacin mixture

38 - 43 (lbs.) Three and one half (3 ½) teaspoons (17.5mL) of the ciprofloxacin mixture

44 - 49 (lbs.) Four (4) teaspoons (20mL) of the ciprofloxacin mixture

50 - 55 (lbs.) Four and one half (4 ½) teaspoons (22.5mL) of the ciprofloxacin mixture

56 - 61 (lbs.) Five (5) teaspoons (25mL) of the ciprofloxacin mixture

62 - 67 (lbs.) Five and one half (5 ½) teaspoons (27.5mL) of the ciprofloxacin mixture

68 - 73 (lbs.) Six (6) teaspoons (30mL) of the ciprofloxacin mixture (or 1 tablet)

Children heavier than 73 pounds who are exposed to anthrax should take one (1) 500-mg tablet of ciprofloxacin two times a day

(at the same time each day if possible) for 60 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give 6

teaspoons twice a day How already prepared Ciprofloxacin mixture should be stored Prepare the Ciprofloxacin mixture daily; store mixture in covered container

and refrigerate. Mixture will keep for at least 24 hours refrigerated. Throw away any unused portions.


This card explains how to prepare emergency dosages of

Ciprofloxacin for infants and children exposed to plague

Once you have been notified by your federal, state, or local authorities that you

have been exposed to plague, it may be necessary to prepare emergency doses of ciprofloxacin for infants and children using ciprofloxacin tablets.

You will need: One (1) 500 milligram (mg) ciprofloxacin tablet Metal teaspoon Measuring spoons [1 teaspoon (tsp); and ½ teaspoon (tsp)]

(NOTE measuring spoons are preferred, however if not available, use the metal spoon to grind, measure and give the medicine) 1 small bowl One of these foods

- chocolate syrup - maple syrup - caramel syrup - ketchup

Directions: 3. Put one (1) 500-mg ciprofloxacin tablet into a small bowl. Crush the tablet

with the back of the metal spoon until no large pieces are seen. 4. Add six (6) level teaspoons (tsp) of a food to the crushed ciprofloxacin. Stir

them together until the drug looks evenly mixed with the food.

How Much of the Ciprofloxacin Mixture to Give a Child The number of teaspoons of the ciprofloxacin mixture to give a child depends on the child’s weight. If child’s weight is unknown, weigh child before giving the first dose. The chart tells you how much to give a child for one dose. You should give child two doses each day (one in the morning and one in the evening) for 7 days.

If the child weighs Give the child

4 – 5 pounds (lbs.)

One half (1/2) teaspoon (tsp) (2.5mL) of the ciprofloxacin mixture

5.5 -10 (lbs.) One (1) teaspoon (5mL) of the ciprofloxacin mixture

11 – 15 (lbs.) One and one half (1 ½) teaspoons (7.5mL) of the ciprofloxacin mixture

16 - 20 (lbs.) Two (2) teaspoons (10mL) of the ciprofloxacin mixture

21 – 25 (lbs.) Two and one half (2 ½) teaspoons (12.5mL) of the ciprofloxacin mixture

26 -30 (lbs.) Three (3) teaspoons (15mL) of the ciprofloxacin mixture

31 – 35 (lbs.) Three and one half (3 ½) teaspoons (17.5mL) of the ciprofloxacin mixture

36 – 40 (lbs.) Four (4) teaspoons (20mL) of the ciprofloxacin mixture

41 – 45 (lbs.) Four and one half (4 ½) teaspoons (22.5mL) of the ciprofloxacin mixture

46 – 50 (lbs.) Five (5) teaspoons (25mL) of the ciprofloxacin mixture

51 – 55 (lbs.) Five and one half (5 ½) teaspoons (27.5mL) of the ciprofloxacin mixture

56 -60 (lbs.) Six (6) teaspoons (30mL) of the ciprofloxacin mixture (or 1 tablet)

Children heavier than 60 pounds who are exposed to plague should take one (1) 500-mg tablet of ciprofloxacin two times a day

(at the same time each day if possible) for 7 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give 6

teaspoons twice a day How already prepared Ciprofloxacin mixture should be stored Prepare the Ciprofloxacin mixture daily; store mixture in covered container

and refrigerate. Mixture will keep for at least 24 hours refrigerated. Throw away any unused portions.


POD/ Medication Center Go- Kit Supply Checklist

POD Go-kits are available in each of the four counties in Region IV to provide initial POD startup.

Review this checklist and augment to the go-kits as needed based on the scenario.

ITEM Qty. ITEM Qty. General Intake forms* 1 to photocopy Paper tablets (8-1/2” x 11”) 12 pads Educational videos/DVD 1-2 (smallpox) Pens, red 1 - 12/box SNS/Mass Prophylaxis Plan 1 Pens, black 10 - 12/box Flash drive with sample forms

toolkit, plans, POD FOG 1

Forms collection box 1 Drug reference guides (TBD) Markers 1 box Technical Highlighters 1 box Computer (or access to) 1 Stapler and staple puller 2 each FAX machine (or access to) 1 Staples 1 box Printer (or access to) 1 Scissors 2 Photocopier (or access to) 1 Calculators 2 Internet access 1 Scotch tape and dispenser 2 each Cell Phone 1/POD Sup Masking, clear and duct tape 2 rolls each Walkie-talkies – FRS radios 24/POD Clipboards with pens 48 800 radios 1/POD Sup Rubber bands (assorted) 1 box Flashlight (for power failures) 10-20 Paper clips, small & large 2 boxes each Flashlight batteries 10-20 sets

Nitrile gloves , S, M, L 2 boxes of 100 each size

Battery-operated weather radio 1

Face masks 2 boxes of 50 Batteries for radio 48/AA-24 D Facial tisse Disposable camera 1 Garbage bags, bio red 48 Television & VCR/DVD player

optional 1-2

Colored floor 1” roll tape: red, yellow, green, and black

2 each color Power strips/ surge protectors 4

Post-it notes 3x3 12 Extension cords 4 Ziploc bags, gallon and quart 6-8 each size Phone extension cord – 25+ feet 2 Vests 50-70 Scale, small step-on 1 Envelopes - interoffice 10 Sign Go-Kit – in Portfolio Case

plus 2 separate easel stands

Medication Center signs 1 set Bull Horn 1 Pads of Flip Chart Paper 2 - 4 Whistle on lanyard 6 Sharpie Markers 2 sets 4/color Screening, Education clear packing tape & dispenser 2 Disease agent fact sheets* 1 to

photocopy Hand-held flags, red (optional) 12

Medication fact sheet* 1 to photocopy

* Provide in multiple languages


Vaccination Station Go Kit Checklist

Vaccination Station Go Kit

Stored in Archive or Record storage boxes for easy transport – 1 per station Item Quantity Small sharps Containers (1 for waste other for temperature cooler for vaccine)

2

alcohol pads 1 box gauze pads (2 x2) 1 pkg band aids boxes 1 box plastic backed drape sheets 6 - 12 syringes with needles 25g 5/8" 3 ml 30 in Ziploc bag 23 g 1" 3ml syringe needles 100 in Ziploc bag 25 g 5/8" 3ml syringe needles 50 in Ziploc bag red biohazards bags 6 facial tissue 1 box hand sanitize 1 box brown paper lunch sized bag 6 ice cold instant packs 2 pens 4 small pad paper 1


First Aid and Emergency Medical Kit Checklists

Checklist adapted from: L. May et al. A model “Go-Kit” for use at Strategic National Stockpile Points of Dispensing. Journal of Public Health Management and Practice, 2007, 13(1), 23-30.

First Aid Kit Checklist

Region IV has 16 Medic Bags, one per POD for Clark and Cowlitz Counties. Use this list to compile additional first aid kits. Item Quantity 1-in. adhesive bandage compresses 16 Antiseptic swabs 20 Ammonia inhalers 10 4-in. adhesive bandage compresses 8 40-in.triangular bandage compresses 40 6 containers of silva sulfadiazine 1/8 oz. Noninflatable arm splint 1 Noninflatable leg splint 1 4-in. roller bandages 4 1-in. rolls of adhesive tape 2 Bandage scissors 1

Emergency Medical Kit

Region IV has 4 mass casualty trauma bags located in Clark County. Item Quantity Sphygmomanometer 1 Stethoscope 1 Oropharyngeal airways 3 10 cm3 syringes 4 50 percent dextrose 50 mL Normal saline or lactated ringers (two 1-L bags) 2-250mL

bags Intravenous catheters-assorted 18 and 20 gauge 5 of each

gauge 25-gauge butterfly catheters 10 Epinephrine (1:1000) (4 ampules) or epi-pen (4 adult) and 2 epi-pen junior

Diphenhydramine hydrochloride (25; 1pkg) and 2 injectable single-dose ampules

Liquid benadryl for children (12.5mg in 5ml) 1 bottle Sublingual nitroglycerin tablets 10 AED (automatic external defibrillator) – if feasible/available 1


Figure 5. Local to Federal SNS Resource Request Flow Chart

Local supplies not sufficient to respond to Public Health Threat – Local PHICP requests resources from EOC

Local resource request received by County EOC ESF-8 Logistics Unit

County Commissioners Declare Emergency

County EOC receives and submits request to WA State EOC ESF-8 Logistics Unit Washington State Governor Declares Emergency

SNS assets along with SNS technical staff (TARU) deployed to WA State DOH receiving, staging and storing (RSS) site

WA EOC ESF -8 Logistics Unit in Coordination with WA DOH RSS Task Force processes resource requests and ships/delivers orders and re-orders to each POD

Resource demobilized or expended

No

State EOC receives and submits request to Federal Joint Field Office for SNS Assets Approved by Governor, Secretary of State or State Health Officer

President Declares Emergency

Note: Resources must be exhausted or expected to be exhausted locally and at the state level before federal assets are requested.

Additional resources required ?Yes


Staff /Volunteer Sign-In/Sign-Out Sheet

[Sample Form – Task Responsibility of Field Check-In Recorder from Planning Section]

DATE: _____________________ POD Site: _______________________

Print Name Signature Assignment Station Time In Time Out


POD Inventory Tracking

PHARMACEUTICAL INVENTORY ROOM BIN CARD

ITEM:

NDC/Product Number: Minimum Stock (Units of Use)

Lot Number: Maximum Stock (Units of Use)

Date Time Quantity Received (Units of Use)

Quantity Issued

Station Number

Balance (Total Balance in Stock)

Physical Count Signature

11/22/06 13:00 800 vials Ed Jones

11/22/06 14:00 10 Vials Station 2 790 Ed Jones

Adapted from: PHSKC Medication Center Inventory Management Plan, Seattle & King County, NW Center for PH Preparedness, Jan. 2006



PHARMACEUTICAL INVENTORY ROOM RECORD

Start Date: End Date: Site Name: Event: Street Address: Pharmacist/Facilities Lead:

Date Time Item Description

Quantity Requested

Quantity Received Signature Remarks

11/22/06 13:00 Adult Flu Vaccine

200 vials Ed Jones Request to stock POD

11/22/06 14:00 Adult Flu Vaccine 200 vials Ed Jones Received 200 vials.




DISPENSING STATION PHARMACEUTICAL SUPPLY ORDER FORM

DATE: STATION: STATION STAFF: (NAME) FACILITIES LEAD OR RUNNER: (NAME)

Time Item

Description Quantity

Requested Quantity

Dispensed Order Filled By:

14:00

Adult Seasonal Flu Vaccine

10 vials

10 vials

Ed Jones



INSTRUCTIONS Pharmaceutical Inventory Room “Bin Card”

The “BinCard” is like a register in a checkbook. The goal is to keep the balance current at all times. • A bin card tracks information about one type of pharmaceutical supply that is exactly the

same. • A bin card may track pharmaceutical supplies that are:

o Stored in more than one box o Arrive from different sources (Strategic National Stockpile or local caches) o Arrive at the POD at different times o Examples include:

• Vaccine, antibiotics or another drug with the same lot number • Injection needles of the same type • Gloves of the same type

PHARMACEUTICAL INVENTORY ROOM/AREA STAFF: 1. Upon delivery of pharmaceutical supplies to the POD:

• Create one Bin Card for each like pharmaceutical supply • Complete the following information on each Bin Card:

o Item o NDC/Product Number o Lot Number o Maximum Stock levels o Minimum Stock levels o Date o Time o Quantity Received in units of use o Total amount in stock in the balance o Signature (sign off after each transaction)

2. Upon receipt of a Pharmaceutical Supply Order Form from a POD station: • “Pick the Order” (find the pharmaceutical supplies requested) • Update the Bin Card at the time you remove the pharmaceutical supplies with the

following information: Date Quantity Issued Time Update the Balance Station Number Signature

3. At the end of the shift:

• Count the cases and remainders of items in the stock room in each stack. • Complete the following information on the Bin Card:

o Date o Time o Physical Count

• Check to be sure the Balance and the Physical Count amounts are equal. Adapted from: PHSKC Medication Center Inventory Management Plan, Seattle & King County, NW Center for PH Preparedness, Jan. 2006


INSTRUCTIONS Pharmaceutical Inventory Room Record

The Pharmaceutical Inventory Room Record serves as a record/diary of the requests and deliveries of pharmaceutical supplies in and out of the POD. FACILITIES LEAD/PHARMACIST Upon delivery of pharmaceutical supplies to the POD, complete the following information on the Pharmaceutical Inventory Room Record form:

• Start Date • End Date • Site Name • Street Address • Event • Facilities Lead (name)

Upon submitting a request to the county EOC for pharmaceutical supplies, complete the following information:

• Date • Time • Item Description • Quantity Requested

Upon arrival of the pharmaceutical supplies complete the following information: • Quantity Received • Signature • Remarks

o discrepancies or variances between the request or the expected delivery and the actual delivery

o anything else that may be noteworthy



INSTRUCTIONS Dispensing Station Pharmaceutical Supply Order Form

Follow the instructions and complete the Pharmaceutical Supply Order Form to order more supplies for a POD station from the pharmaceutical inventory room.

DISPENSING/VACCINATION STATION

1. Complete the following portions of the Pharmaceutical Supply Order Form: • Date • Station Number • Station Staff (name) • Time • Item Description • Quantity Requested

2. Give completed Dispensing Station Pharmaceutical Supply Order Form to the Facilities Lead or a Runner.

FACILITIES LEAD OR RUNNER

1. Enter your name on the Pharmaceutical Supply Order Form. 2. Deliver Pharmaceutical Supply Order Form to Pharmaceutical Inventory Supply Room. 3. Deliver requested supplies and return the Pharmaceutical Supply Order form to the appropriate Station once the order

has been filled.

PHARMACIST 1. Complete the following portions of the Pharmaceutical Supply Order Form:

• Quantity Dispensed • Order Filled By (name)

2. Give the requested pharmaceutical supplies and order form to the Facilities Lead or Runner to deliver to the appropriate

Station.



WASHINGTON STATE Strategic National Stockpile Point of Dispensing Order Form

Facility name: Point of Contact: Phone #: Facility address: Alternate POC: Phone #:

City: ZIP: Facility Code: WA Ordered by:

Item (Description/NDC) Population to Serve

UOM & Quantity Required

RSS Use ONLY (to be completed by

DOH RSS personnel)

/

/

/

/

/

/

/

/

/ CS=case BT=bottle PG=package BX=box EA=each VI=vial KT=kit


WASHINGTON STATE

Strategic National Stockpile Point of Dispensing Order Form

Strategic National Stockpile Program 8 March 2004 POD Pharmaceuticals Description UOM Unit Pack Amoxicillin 400mg/5cc, oral suspension CS 72 72/CS Amoxicillin 500mg oral capsule unit of use #30 cap bottle CS 40 40/CS Amoxicillin 500mg oral capsule unit of use #30 cap bottle CS 480 480/CS Amoxicillin 500mg oral capsule unit of use #30 cap bottle CS 80 80/CS Ciprofloxacin 250mg/5ml oral suspension, powder, 100ml bottle CS 24 24/CS Ciprofloxacin 500mg oral tablet #20 tab unit of use bottle CS 100 100/CS Doxycycline suspended (Vibramycin) 50mg/5ml syrup 473ml CS 6 6/CS Doxycycline 100mg oral tablet #20 tab unit of use CS 100 100/CS

UOM abbreviations: CS=case BT=bottle PG=package BX=box EA=each VI=vial BX=box KT=kit


POD MATERIAL HANDLING EQUIPMENT Just-In-Time Training

PROPER LIFTING OF BOXES/CARTONS:

(Image source: www.hughston.com)

POD staff should not lift boxes unless authorized to do so through their normal job duties.

Ask for help or use a hand truck (see below) if a box is too large, heavy or awkward for one person to pick up.

To avoid injury when lifting and lowering a box: Bend your knees, with one foot slightly ahead of the other Squat down Grasp the box with your hands Keeping your back straight, rise to a standing position Reverse these steps to lower a box to the floor.

HAND TRUCKS

(Image source: www.ise.ncsu.edu) Description: A hand truck is a manually powered, two-wheeled piece of equipment that is appropriate for horizontally transporting light loads (e.g., a few cartons) over short distances when the loads are too heavy or too awkward for a person to carry. Components: The hand truck has a load-carrying surface (lip), two fixed wheels, a backrest or frame, a brace attached to the frame, and one or two handles.


Operating a Hand Truck:

Create a small gap between the floor and container by pushing the container forward.

Push the lip of the hand truck into the gap until the container’s edge rests against the frame of the hand truck.

Holding on to the handle(s), place one foot on the hand truck’s brace, press down on the brace, and tilt the loaded hand truck into the balanced position that allows the truck to be moved.

The weight load should be on the two wheels of the truck, the lip of the truck, and the user’s arms.

Move the hand truck by pushing or pulling on its handle(s). To unload the hand truck, stop walking and carefully lower the lip of the truck to the

floor using the handles and brace for control. Remove the lip from under the containers.

(Source: Mulcahy, D. Materials Handling Handbook, Publisher: McGraw-Hill)

MANUAL PALLET JACKS Description: A manually powered tool used to lift and move pallets. A pallet is a flat transport structure that supports materials that are being lifted by a pallet jack or forklift. Pallets are commonly made of wood but can also be made of metal and plastic. Components: A hydraulic pump with a handle, one or two wheels underneath the pump, and single wheels attached inside at the end of two forks. As the jack is raised vertically, the front wheels are separated vertically from the forks, which forces the load to rise. The load is lifted high enough to clear the floor for movement of the load across the floor Operating a Pallet Jack: (Source: http://www.ehow.com/how_2088130_operate-manual-pallet-jack.html) The little handle inside the main unit controls the lift of the jack. Place this handle in the down position to lift the jack. While it is in this position pump the handle up and down to raise the jack. Once you have the height you want, move the handle to the center position to keep it from adjusting while you move. Squeeze the handle upward to lower the jack when you have reached your final destination. Step2

With the jack in its lowest position, slide it under the pallet you need to move. You have to use a little force as you may have to cross a few pieces of timber to get all the way under the pallet. Make sure that the forward wheels are not on the last slat of the pallet.


Step3 Raise the pallet by placing the control handle in the down position and pumping the main handle 10 to 15 times. You don't need to raise the pallet too high, just enough to keep it from dragging. Step4 Pull the pallet to where it needs to go. It is best to pull versus push as you need to make sure you have proper clearance on the sides and to make sure the floor is clear of debris. Step5

Once you get to where the pallet needs to be placed, use the control arm to maneuver it into place. The arm can move 180 degrees and makes putting a large pallet into a tight spot very easy. It is best to push the pallet into place rather than pull it. You don't want to get stuck against a wall or other pallet.

Step6

Squeeze the control handle to lower the pallet. Pull the jack out and start all over.


Liability Considerations Public Readiness and Emergency Preparedness (PREP) Act The PREP Act authorizes the Secretary of the Department of Health and Human Services (“Secretary”) to issue a declaration (“PREP Act declaration”) that provides immunity from tort liability (except for willful misconduct) for claims of loss caused, arising out of, relating to, or resulting from administration or use of countermeasures to diseases, threats and conditions determined by the Secretary to constitute a present, or credible risk of a future public health emergency to entities and individuals involved in the development, manufacture, testing, distribution, administration, and use of such countermeasures. A PREP Act declaration is specifically for the purpose of providing immunity from tort liability, and is different from, and not dependent on, other emergency declarations. http://www.hhs.gov/disasters/discussion/planners/prepact/index.html Emergency Use Authorization (EUA) The Project BioShield Act of 2004 (Public Law 108-276) established the Emergency Use Authorization (EUA) program. During certain, well defined emergency conditions, the EUA authorizes the FDA to approve emergency use of drugs, devices, and medical products, that were not previously approved, cleared or licensed by the FDA or the off-label use of approved products. More information on the FDA’s policies for authorizing the use of an unapproved medical product or an unapproved use of an approved medical product during a declared emergency can be found in the draft FDA guidance document available at http://www.fda.gov/oc/bioterrorism/emergency_use.html. Powers and duties of local board of health RCW 70.05.060. Each local board of health shall have supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction and shall: (1) Enforce through the local health officer or the administrative officer appointed under RCW 70.05.040, if any, the public health statutes of the state and rules promulgated by the state board of health and the secretary of health; … Local health officer -- Powers and duties RCW 70.05.070. The local health officer, acting under the direction of the local board of health or under direction of the administrative officer appointed under RCW 70.05.040 or 70.05.035, if any, shall: (1) Enforce the public health statutes of the state, rules of the state board of health and the secretary of health, and all local health rules, regulations and ordinances within his or her jurisdiction including imposition of penalties authorized under RCW 70.119A.030 and 70.118.130, the confidentiality provisions in RCW 70.24.105 and rules adopted to implement those provisions, and filing of actions authorized by RCW 43.70.190; (2) Take such action as is necessary to maintain health and sanitation supervision over the territory within his or her jurisdiction; (3) Control and prevent the spread of any dangerous, contagious or infectious diseases that may occur within his or her jurisdiction; (4) Inform the public as to the causes, nature, and prevention of disease and disability and


the preservation, promotion and improvement of health within his or her jurisdiction;… (9) Take such measures as he or she deems necessary in order to promote the public health, to participate in the establishment of health educational or training activities, and to authorize the attendance of employees of the local health department or individuals engaged in community health programs related to or part of the programs of the local health department. Role of the Local Health Officer Compared to Emergency Management On the local level of government, the heads of political subdivisions1 are the heads of the executive branch, and the local department of emergency management (DEM) manages the corresponding emergency response. Public health departments, and their local health officers, do not declare emergencies in the legal sense. Rather, the heads of the executive branch of government issue emergency proclamations. Thus, depending on the scale of an event, the President of the United States can declare an emergency. RCW 43.06.010 (12) authorizes Washington’s governor to declare an emergency, and the declaration can relate to all of the state or just part of it. RCW 38.52.020(b) authorizes the governor and executive heads of political subdivisions of the state to exercise emergency powers. The role of the health department, and local health officer, is to contribute expertise and make recommendations to the governor and appropriate local officials, pertaining to health and disease related threats, but not to declare an emergency.

WAC 118-04-200 - Personal Responsibilities of Emergency Workers (1) Emergency workers shall be responsible to certify to the authorized officials registering them and using their services that they are aware of and will comply with all applicable responsibilities and requirements set forth in these rules. (a) Emergency workers have the responsibility to notify the on-scene authorized official if they have been using any medical prescription or other drug that has the potential to render them impaired, unfit, or unable to carry out their emergency assignment. (b) Participation by emergency workers in any mission, training event, or other authorized activity while under the influence of or while using narcotics or any illegal controlled substance is prohibited. (c) Participation by emergency workers in any mission, training event, or other authorized activity while under the influence of alcohol is prohibited. (d) Emergency workers participating in any mission, training event, or other authorized activity shall possess a valid operator's license if they are assigned to operate vehicles, vessels, or aircraft during the mission unless specifically directed otherwise by an authorized official in accordance with RCW 38.52.180. All emergency workers driving vehicles to or from a mission must possess a valid driver's license and required insurance. (e) Use of private vehicles, vessels, boats, or aircraft by emergency workers in any mission, training event, or other authorized activity without liability insurance required by chapter 46.29 RCW is prohibited unless specifically directed otherwise by an authorized official in accordance with RCW 38.52.180. (f) Emergency workers shall adhere to all applicable traffic regulations during any mission, training event, or other authorized activity. This provision does not apply to 1 “Political subdivision” means any county, city or town. RCW 38.52.010(3).


individuals who have completed the emergency vehicle operator course or the emergency vehicle accident prevention course and who are duly authorized under state law to use special driving skills and equipment and who do so at the direction of an authorized official. (2) Emergency workers have the responsibility to comply with all other requirements as determined by the authorized official using their services. (3) When reporting to the scene, emergency workers have the responsibility to inform the on-scene authorized official whether they are mentally and physically fit for their assigned duties. Emergency workers reporting as not fit for currently assigned duties may request a less demanding assignment that is appropriate to their current capabilities. (4) Emergency workers have the responsibility to check in with the appropriate on-scene official and to complete all required recordkeeping and reporting. Emergency Workers as Compared to Covered Volunteer Emergency Workers An “emergency worker” is any person who is registered with a local emergency management organization or the state military department and holds an identification card issued by the local emergency management director or state military department for the purpose of engaging in authorized emergency management activities, or is an employee of the state of Washington, or any political subdivision thereof who is called upon to perform emergency management activities.2 A “covered volunteer emergency worker” is an emergency worker as defined in RCW 38.52.010 who (i) is not receiving or expecting compensation as an emergency worker from the state or local government, or (ii) is not a state or local government employee unless on leave without pay status.3 The State of Washington has assumed considerable liability for damage to property or injury or death to persons that might occur during an emergency or disaster. Generally, emergency workers, including state and local employees unless on leave without pay, are indemnified by the State; covered volunteer emergency workers are immune from liability.4 Covered volunteer emergency workers are granted immunity by subsection (3), which provides: (3) No act or omission by a covered volunteer emergency worker while engaged in a covered activity shall impose any liability for civil damages resulting from such an act or omission upon:

(a) The covered volunteer emergency worker; (b) The supervisor or supervisors of the covered volunteer emergency worker; (c) Any facility or their officers or employees; (d) The employer of the covered volunteer emergency worker;

2 RCW 38.52.010(4). 3 RCW 38.52.180(5)(a). 4 RCW 38.52.180 (2) and (3).


(e) The owner of the property or vehicle where the act or omission may have occurred during the covered activity;

(f) Any local organization that registered the covered volunteer emergency worker; and

(g) The state or any state or local government entity. The immunity applies only when the covered volunteer emergency worker is engaged in a covered activity and acted within the scope of his or her duties and under the direction of a local emergency management organization or law enforcement.5 Covered activities are defined by the act.6 Acts or omissions that constitute gross negligence or willful or wanton misconduct are not immune from liability.7 The Volunteer Protection Act (“VPA”---codified at 42 U.S.C. § 14501 et. seq.) Provides qualified immunity from liability for volunteers and, subject to exceptions, preempts inconsistent state laws on the subject, except for those that provide protections that are stronger than those contained in the VPA. The VPA defines a volunteer as “an individual performing services for a nonprofit organization or a governmental entity which does not receive compensation" (other than reasonable reimbursement or allowance for expenses actually incurred); or any other thing of value in lieu of compensation, in excess of $500 per year....” 42 U.S.C. § 14506(6).

Under the VPA, a volunteer of a nonprofit organization or governmental entity is immune from liability for harm caused by an act or omission of the volunteer on behalf of the organization or entity if: (1) the act or omission was within the scope of the volunteer’s responsibilities in the organization or entity; (2) if required, the volunteer was properly licensed, certified, or authorized by the appropriate state authorities for the activities or practice giving rise to the claim; (3) the harm was not caused by “willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed by the volunteer,” and (4) the harm was not caused by the volunteer’s operation of a motor vehicle, vessel, aircraft, or other vehicle for which the state requires the operator to possess a license or maintain insurance. 42 U.S.C. § 14503(a).

5 RCW 38.52.180(4). 6 RCW 38.52.180(5)(b). 7 RCW 38.52.180(4)(c).


RESOURCES

Clark County Public Health Preparedness Program

http://www.clark.wa.gov/public-health/preparedness/prepare.html#Dispensing CDC Emergency Preparedness and Response

http://www.bt.cdc.gov/ Model Standing Orders for Anthrax, Plague, Tularemia

http://www.oregon.gov/DHS/ph/acd/lhd/stdgordr/stndordr.shtml

Model Standing Orders for Vaccines – Oregon State Public Health http://www.oregon.gov/DHS/ph/imm/provider/stdgordr.shtml Oregon Public Health Division

http://oregon.gov/DHS/ph/ Oregon Health Network (HAN) (password required)

https://www.oregonhan.org/ (PHICP Document Library)

U.S. Census Bureau “FactFinder” http://factfinder.census.gov/

U.S. FDA Drug Preparedness and Response to Bioterrorism http://www.fda.gov/cder/drugprepare/default.htm http://www.fda.gov/cder/drug/infopage/penG_doxy/doxycyclinePeds.htm Washington State DOH Medication Center Signage http://www.doh.wa.gov/phepr/signs/ Washington State DOH Preparedness Communication Toolkit

http://www.doh.wa.gov/phepr/toolkit/

Public Exit Secured delivery site for SNS and other materials

EMS Staging Area Delivery Route Command Station Staff Entrance

Public Entrance

Greeter with forms Key: = unidirectional patient flow = off-site or in another

Notes: a) Layout will

vary based on available facility.

b) The number of

Triage: Med. Evaluator Express Medication or Vaccination Station

Express Dispensing Express Medication

or Vaccination Station

First Aid Station

Screening, Health Education/ Interpretation

Express Medication

or Vaccination Station

Staff Break Area

Fill Out forms Area

Family – Assisted Dispensing / Vaccinatio

Medical Evaluator Station

Public Exit

Supply Receipt Secured Inventory Control Room/Area

Behavioral Health Station

Data Collection Station Fig. 2 Detailed Examp

Screenin

Medication Dispensi

Fill Out Forms Area

Exit: Data Collection Station

Public Entranc

e

Public Exit

Command Station Staff Entrance Supply Receipt Note: Layout will vary based on facility. Unidirectional flow is

BehavioralHealth Station

Supply Storage

Area

Staff check-in Fig. 1 Basic Example of

Medical Screener 2 Notes: The goal for throughput is ~350

Medical Screener 1 Dispensing Supply Runner

HAM radio operators Vaccinator Assistants Triage Staff Information Technology (IT) staff

Interpreter(s)

Dispensers/ Vaccinators Medical Screening/ Triage Physician

Traffic Controller(s)

Facility Representative

Pharmacist (minimum 1) Health Educators Runners Supply Runner

Vaccination/Dispensing Crew Leader (1)

Behavioral Health Crew Leader (1)

Medical Screening/ Triage Crew Leader (1)

Security Personnel

Greeters Flow Monitors POD Flow Team Leader (1)

Education/Forms Team Leader (1)

Facilities Team Leader (1)

Security/Traffic Control Team Leader

Clinical Task Force Team Leader

POD Supervi

sor* (1)

ersonnel Coordinator (1)

Staff check-in Greeters: ask questions, distribute forms &

Step 4: Exit Step 2: Show form

Step 3: Get Meds

Step 3: Get Meds Step 2: Show form Step 1: Fill out form

Step Public Information Coordinator (1)

mass prophylaxis point of dispensing (pod) field

Documents