Community Preparedness and Mass Dispensing Capabilities - This practice address the need to develop the capability to acquire and distribute prophylactic medication and/or vaccinations in large quantities during a public health emergency through community based outreach and preparedness methods. The goal of this practice is to increase community participation in the Orange County POD planning program through a series of trainings and workshops.
One objective for this practice is to ensure 100 percent (34 of 34 cities within Orange County) of the key city representatives within Orange County have been exposed to the POD planning program through the POD seminar by May 31, 2010 in order to address the need to develop the capacity to provide mass prophylaxis capabilities. The second objective is to work with a minimum of 15 cities to develop city specific POD site maps and plans through the POD Workshop by Nov. 30, 2010 in order to establish community based mass prophylaxis locations. The final objective is to train a minimum of 600 volunteer and first responders identified in POD supervisory roles via the FOG workshop in order to increase their understanding of the POD Field Operations Guide (FOG), the national incident management system, the incident command system and their application during POD operations by November 30, 2010 in order to enhance community preparedness levels.
This practice intends to build on previous Orange County POD outreach campaigns by utilizing a community based education and outreach model to target those cities that have been difficult to reach or bring to the table. Therefore, the practice intends to identify the current need and provide possible incentives to those cities who have yet to begin this planning process. Therefore, the overarching goal is to reach and engage 100% of the target population in the POD planning process to ensure Orange County has identified, planned and trained the response staff necessary to reach the population of Orange County in the event a mass prophylaxis campaign was required. POD plans are tested each year through a seasonal influenza POD exercise.
Since March 2007, the outcome of this practice has seen 10 cities complete the POD planning and training process as well as volunteer to participate in an annual POD exercise that is designed to test and evaluate site plans by providing seasonal influenza vaccinations to the public. These exercises have provided over 10,000 free seasonal influenza vaccinations to the public since the inception of the exercise in 2007. This process of plan validation has also allowed for 5 of these cities at 3 previously established locations to established H1N1 vaccination clinics that provided over 9,500 H1N1 vaccinations to the community over the course of two days.
In the event of a large scale health emergency, such as an aerosolized anthrax attack or infectious disease outbreak (e.g. meningitis, influenza, etc.), it is the role and responsibility of the local health department to ensure there is a mechanism in place to provide medical countermeasures (i.e. antimicrobials, vaccinations, etc.) to the public quickly. One program that centers on this type of scenario is the Center for Disease Control and Prevention's (CDC) Cities Readiness Initiative (CRI). The CRI program is focused on developing and demonstrating the capability to acquire & distribute resources of the Strategic National Stockpile (SNS) to the population of Orange County within a 48-hour timeframe. The main mode of distribution at the community level is accomplished through the Point of Dispensing (POD) site.
The Health Disaster Management (HDM) Division within the Orange County Health Care Agency is responsible for the POD preparedness, planning, and training and response activities related to Bioterrorism and Public Health Emergency response, which includes POD planning, within Orange County. With a resident population of over 3.2 million people, HDM must develop over 75 POD sites to ensure the goals of the CRI program are met, thus the issue at hand is to not only identify these sites, but with the numbers of sites needed, to establish a program that can build community resiliency that will allow community partners involved in this effort to take ownership of the response and not have to rely solely on the local health department to oversee the response effort. In order to accomplish this goal, HDM must work with many governmental and community based groups in order to build and maintain a level of responsibility that allows the community partners involved in this effort a stake in the POD site they have established. Although the core practice is designed to ensure that the local health department can provide medical countermeasures to its entire population within a 48-hour period, this practice has expanded beyond the public health field in that the POD concept can be utilized to respond to any type of event where large quantities of materials (e.g. food, water, medications, etc.) need to be distributed to the public. In order to develop an organized and streamlined approach to POD planning, HDM went through a strategic planning process.
The first step in this process was to conduct a county-wide needs assessment based on federal grant deliverables for the local health department and tie that into a program that city and county constituents could utilized and take part in when they were not mandated to do so. This needs assessment showed that the county with a population of 3.2 million people was divided into 34 cities, all of which were identified as needing at least one POD site to mitigate any effects of a health emergency, such as an infectious disease outbreak. The result was a need to identify, plan, and train to over 75 POD sites plans within Orange County. Once this needs assessment was completed and city specific POD site numbers were identified, a strategy was put into place that identified yearly goals and objectives from the first year of development to a five year plus sustainment period. The result was a strategy for the POD outreach program that contained a program mission, vision, goals and objectives that would allow the county to reach its overarching goal of completing plans for all 75 plus POD sites in the county. In order to ensure that the program met these goals and objectives, the need to identify the core stakeholder groups to target in this process was critical. To focus this outreach effort, specific groups who would have a hand in agreeing to participate in the planning process were targeted. These included: city emergency planners/managers, local/city law enforcement, city fire personnel, schools and universities; local businesses, public works, emergency me
Agency Community RolesThe main role of the Health Disaster Management Division is provide each site and site planning team with the tools needed to develop and plan their POD site while demonstrating the need for that POD site planning team to take ownership in the POD planning process. This is done by establishing a planning timeline prior to initiating the planning process and discussing the core deliverables that will guide the planning process. This allows each POD site planning team to identify the key individuals who will be part of the planning team as well as those who will be trained to fill key site supervisory/management roles. At the end of the process, each site is self sufficient knowing that if they were requested to activate their site, that they have the level of confidence to do so without a large area of support from the local health department.
The role of the stakeholders involved in this process is critical to the success of the planning process. With the LHD serving as the guiding entity in the planning process, the role of the stakeholders are to serve as planning coordinators for their city/site. Thus, the stakeholders determine the site location, provide meeting and training locations for the planning process, work collaboratively off line to develop the site plan and identify staff and provide the necessary support to ensure exercise operations can be maintained. This allows the Health Disaster Management Division to serve as subject matter experts guiding this planning and response process while identifying any additional training needs (i.e. ICS, NIMS, etc.) that certain groups may require to allow them to mesh into the response process.
Costs and ExpendituresThis program begin in FY 2006–07 with an estimated start up and implementation cost of $51,000, which does not include personnel time or the costs associated with the influenza vaccine. This cost includes the systems required to build a cache materials and supplies that would allow for program sustainably and maintenance. Sustainability costs for year two (FY 2007–08) of the training program was estimated at $29,000.
Since FY 2007–08, the estimated costs to support and sustain the program is estimated at $13,000 per year in equipment and material cost to deliver the trainings with an additional $8,000 in equipment costs per completed POD site plan that provides each site with a set of POD specific signage, a set of Incident Command System (ICS) vests, and a secure storage case to house these items. At this time, each city that participates in the POD planning, training and exercise process is contributing in-kind costs through the provision of providing personnel to assist in the process. Those costs are estimated to be between $15,000.00 to $45,000.00 per year depending on the organization participating. Funding for this program come from two funding sources: Center for Disease Control and Prevention's (CDC) Healthcare Preparedness Cooperative Grant Agreement. Urban Area Security Initiative (UASI) Grant - FY 2007, 2008 and 2009. Additional funding to provide city based personnel planning cost reimbursement is expected for FY 2008–2010.
ImplementationThe Point of Dispensing planning program is broken down into 4 trainings, which include: 1. POD Seminar - An Introduction to the role and responsibility of HCA and HDM, the SNS and CRI programs and an overview of the purpose and basic concepts surrounding the POD. 2. POD Workshop - Designed as an informal training followed by a workshop breakout session to develop a detailed POD site map based on a specific site. Participants will be provided a POD planning packet that will be utilized during the POD plan development process and incorporated into the FOG . 3. Field Operations Guide (FOG) Workshop - Designed as an informational training providing an overview of the POD and introducing each section of the FOG, the use of each section and how the FOG is used during POD operations. 4. Interactive POD Training - A hands-on training for selected POD exercise participants designed to acquaint all players to the physical requirements needed to operate a POD. Portions of the POD seminar, POD Management Tabletop and Final Planning Conference presentation will be incorporated and discussed. 5. POD Exercise - Full scale exercise dispensing free seasonal influenza vaccinations to the general public (1 day event) in order to test the site specific POD plan.
The overall planning process can vary based on each city/site's need to complete the planning process. During the exercise planning cycle, the process from POD seminar to exercise completion is six months with a training occurring every two months throughout the six month process. The POD Seminar is a two-hour training at a location designated by Orange County Health Care Agency and targets all stakeholder groups. The POD Workshop is a two-hour training at a location designated by stakeholder group (usually at the designated POD site) The Field Operations Guide (FOG) Workshop is a two-hour training at a location designated by stakeholder group. An Interactive POD Training is delivered to just those cities/site exercising and is a two-hour training at the POD site location (exercising site only). Finally, the POD Exercise is a full day event at the POD site(s).
To increase awareness and understanding of the SNS/CRI programs and the importance of developing POD site plans within each city of Orange County.By November 2010, HDM will conduct a POD seminar and/or overview presentation that will target 100 percent of the key city representatives within Orange County. This will be measured through POD seminar attendance and city emergency management representation at the seminar.Data collected will be name, agency and position title for each participant. Data will be collected by the Health Care Agency. Data will be collected by utilizing an online registration system and event sign in sheets. The data is collect the moment the participant registers to attend the event. Their name, title, organization and address is collected at the time of registration. This data is collected annual with each annual POD seminar. Health Disaster Management's Mass Dispensing and Vaccination team collects the data and provides feedback related to city desire to participate in the POD planning process. Targeted stakeholder participation is needed to ensure all cities are represented. Invitation only events have been conducted and personal phone calls made to invitee individuals to attend.Beginning in October 2009 to January 2010, 8 additional cities have participated in this planning process and have identified an additional 40 POD sites within Orange County, bring the total number of cities and sites involved in this process to 11 and 48, respectively.
By November 2010, 35 additional cities and all 78 POD sites will have participated in the POD planning process to include the: POD Workshop, FOG Workshop and POD online position training. This will be measured by the number of cities participating in the POD workshop and POD site planning process. The end result is a completed POD site Incident Action Plan that entails a site map, staffing assignments, equipment lists and site security, medical, communication, staffing and demobilization plans. Data collected includes training sign in sheets, completed plan documents and evaluation forms completed after each training. Health Disaster Management's mass dispensing/vaccination team Completed site plans are provided electronically via email with sign in sheets collected after each scheduled event. Data is collect after each training is delivered. This includes sign in sheets, site maps, equipment lists, staffing rosters and completed site plans. As certain stakeholder groups are suggested to attend a particular training, if those groups are not in attendance, then plans may be modified later on in the planning process, causing confusion amongst the other groups. 40 additional POD plans are currently in process with an additional 38 expected by the end of 2010 with POD plans completed based on city demographics (i.e. 1 POD site plan developed for every 38,400 people living within the city).
By October 2010, four cities will have enrolled and participated in the annual POD mass vaccination exerciseFour POD sites will exercise their planning team and volunteer groups on the last Friday in October. This exercise assumes the exercise requirement set forth by the Homeland Security Exercise Evaluation Program (HSEEP) with a formal after action report generated based on exercise evaluation components. Data from this exercise will be collected from exercise evaluation guides designed to evaluate exercise objectives. This is correlated into an After Action Report with corrective actions and improvements identified. The data is collected annually after the conclusion of the exercise. As certain stakeholder groups are suggested to attend a particular training, if those groups are not in attendance, then plans may be modified later on in the planning process, causing confusion amongst the other groups. All cities are now required to have representative from the groups they are instructed to have present before planning activities can proceed. An informal meeti
Commitment is ensured by making the POD exercise an annual event. Thus, cities who want to plan a POD site have the option to then test the site within their community. The success of this program has afforded the Health Disaster Management team to successfully vaccinate over 10,000 people throughout the 3 years of exercising as well as the opportunity to reach back to five previous partners in November 2009 to establish H1N1 clinics to provide over 9,500 H1N1 vaccines to the public. In 2010, HDM will partner will a new set of four cities in order to test four site plans as well as plan all 78 POD sites throughout the county.
With 34 cities in Orange County, this program is something that will continue for years to come. And with funding for the program at a minimum ($13,000/year to implement) and having received commitment from the Health Care Agency Immunization Program for annual vaccine allotment to support this event, sustainment is an issue that has been addressed and mitigated. Alternate funding sources, such as the UASI grant, has allowed for the purchasing of equipment that will be provided to each POD site that completes a detailed POD plan. H1N1 funding, along with HDM's participation in a Regional Catastrophic Planning Grant Program (RCPGP) will provide each city $5,000.00 in personnel reimbursement to plan their required number of POD sites. Thus, by the end of 2010, all 78 POD sites are expected to have been planned, trained to, and equipped to respond to any health emergency.