Download POD/Mass Clinic Template for Standard Operating Guidelines

COLORADO’S PLANNING GUIDE FOR
LOCAL MASS PROPHYLAXIS OR
IMMUNIZATION
A Point of Dispensing (POD) Standard
Operating Guide (SOG) for Planning
Version 3.0
December 2006
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Note: For this manual, we will follow the convention of italicizing in red specific questions to
be answered and ideas for the planners will be in red italics. Examples and other
explanatory material, while also serving to instruct, will be in black standard type..
I.
Introduction
The brief introduction (couple of paragraphs) can be used to give a history of your
emergency support function in general or of the demographics of your jurisdiction. This
can be any kind of information or background that would not fit anywhere else in the
plan and that would give the reader a sense of your operation. It can also be used for a
mission or objective statement.
Example: This document is intended to support local public health agencies in writing a
plan for the activation and operationalization of a Point of Dispensing (POD) in their
county. The document is an annex to the X Health Department’s emergency
operations plan and will continue to be revised on an annual basis.
A. Purpose
Why are you writing this plan? Who is meant to read it? The purpose is usually
one paragraph, but can be more if needed.
Example: This operating guide will be used during a public health emergency. It
was created to assist local public health personnel in initiating requests for SNS
supplies and implementing rapid distribution measures to protect the general public
by the following:
 Reducing mortality and morbidity
 Preserving healthcare services infrastructure
 Minimizing social disruption during a natural or intended disaster
The critical elements have been identified by the Centers for Disease Control and
Prevention (CDC), the State of Colorado, and the Regional Transfer Point Plan as
necessary to successfully initiate and operate Points of Dispensing throughout the
state of Colorado.
B. Scope
The Scope section of a plan limits and defines both geographical areas (list the
counties to which the plan pertaibns) and the work itself.
Example: This Point-of-Dispensing Standard Operating Guide (SOG) applies to
situations defined as a natural or intentional emergency/disaster, terrorist attack, or
pandemic event requiring mass vaccination or dispensation of pharmaceuticals to
the public within X county. This plan provides details about command and control,
legal issues, communications, POD operations, logistics, etc.
II.
Assumptions
Assumptions are a list of things that you assumed would be happening or in place
during the disaster for which you are writing the plan. These types of items may seem
obvious but they provide context for your plan.
The assumptions may not be immediately apparent if a disease outbreak is intended or
natural. Other disasters, such as tornadoes, floods, and chemical spills may also
require that the general population receive SNS resources.
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By the time the need to activate the Strategic National Stockpile (SNS) has been
determined, the health of the public may already have been impacted and a national
emergency may exist.
Local inventories of needed pharmaceuticals and medical supplies will quickly be
depleted.
Personnel, volunteers, and strike teams of epidemiologists may need to be activated
throughout the state to accommodate operational periods associated with disease
outbreaks.
Departmental/County/Regional/State Emergency Operation Centers (EOCs) may be
activated.
Multiple disciplines, such as medical, environmental, agricultural, law enforcement,
coroners, and emergency management will need to cooperatively address the disaster.
Disasters that require SNS activation will require effective messages to mobilize the
press and utilize Emergency Alert/Emergency Broadcasting Systems to notify the
public as well as timely press releases, press conferences, and other vital
communications.
III. Authority, Responsibility and Legal Issues
This section describes any authorities or legal issues. It should reference all applicable
state and local statutes, laws and executive orders such as the Colorado Revised
Statutes, Homeland Security Presidential Directives, county insurance for volunteers,
etc
Example:
This document quotes and summarizes but does not interpret federal, state or local
codes, regulations, statutes or laws. Nothing in this document should be construed as
providing legal counsel. Mass clinic planners may wish to consult their legal counsel for
any such advice. All applicable codes, statutes, regulations, laws and presidential
directives are provided in Attachment X.
A. National Response Plan (NRP)
In Homeland Security Presidential Directive (HSPD)-5, the President directed that
the Department of Homeland Security develop a new National Response Plan
(NRP). The NRP is based upon the belief that incidents are typically managed at
the lowest possible geographic, organizational, and jurisdictional level.
1. ESF 8
The NRP applies a functional approach and groups the capabilities of
departments and agencies into Emergency Support Functions (ESFs) to
provide the planning, support, resources, program implementation, and
emergency services that are most likely to be needed during an incident.
ESF 8 refers to Public Health and Medical Services.
2. Target Capabilities List
The purpose of HSPD 5: National Preparedness is to “establish policies
to strengthen the preparedness of the United States to prevent and
respond to threatened or actual domestic terrorist attacks, major
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disasters, and other emergencies”. This directive involves capabilitiesbased planning. “Strengthen Medical Surge and Mass Prophylaxis
Capabilities” has been identified as one of the national priorities and
applies to the mass prophylaxis and medical surge capabilities.
B. Colorado Revised Statutes
Per guidelines in the Colorado Revised Statutes, State and local departments have
statutory authority to “investigate and control the causes of epidemic and
communicable diseases affecting the public health.” C.R.S. 25-1.5102(1)(a)(State) and 25-1-506(1)(b)(County). See C.R.S. 25-1-650 for similar
authority of public health nursing services.
Under the Governor’s Expert Emergency Epidemic Response Committee
(GEEERC) statute (C.R.S. § 24-32-2104(8)(e), the Governor may issue executive
orders directing measures that may include but are not limited to the following:
1.
Procuring and taking supplies of medicines and vaccines;
2.
Ordering physicians and hospitals to cease admissions;
3.
Isolating or quarantining persons or property;
4.
Seizing, destroying or decontaminating property or objects;
5.
Disposing of corpses and infectious waste in a safe manner;
6.
Assessing the safety of food and water supplies;
7.
Providing mental health support;
8.
Providing information to the public.
C. Regional Strategic National Stockpile Plan
Under guidance from CDPHE and CDC, each of the Colorado All-Hazards
Emergency Management Regions has developed a Regional Strategic National
Stockpile Plan. This plan is the over-arching plan for all of the local POD plans
within the region. All regional plans are posted on COHAN.
D. Local/County Plan
Describe the relationship between the POD plan and the local/county plan, such
as how they are the same and how they are different.
IV. Concept of Operations
A. National Incident Management System Structure
This plan operates under the National Incident Management System (NIMS).
NIMS is designed to aid in the management of resources through the following
concepts:
1. Common terminology
2. Integrated communications
3. Modular organization
4. Unified command structure
5. Manageable span of control
6. Consolidated action plans
7. Comprehensive resource management
8. Predesignated incident facilities
B. Regional Transfer Point (RTP)
1. Regional assessment of need, MOU, MOA
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Briefly describe how your jurisdiction will determine the need for supplies,
pharmaceuticals, equipment and volunteers. Who is contacted, what
protocol is followed? Reference MOUs, MOAs, COpharm, etc
Example:
Prior to requesting SNS assets through the CDPHE, the X County/Health
Department will coordinate assessment of pharmaceuticals through the
COpharm HAN program at CDPHE CMC.
- X is responsible for requesting this assessment.
- Once the COpharm assessment is complete and data is collected, the
Health Officer will make the decision to request the pharmaceuticals
from the local pharmacy where the needed medicines are currently
being housed. (Should the pharmacy not readily relinquish the
medicines, the Health Officer will make a request through the CDPHE
CMC to the Governor’s Expert Emergency Epidemic Response
Committee to enact draft Executive Order 2.0 - Concerning the
Procurement and Taking of Certain Medicines and Vaccines Required
to Respond to the Current Disaster Emergency.)
- X will be responsible for transport of the pharmaceuticals
- and X will be responsible for securing them during transport.
2. Lateral re-distribution of supplies
Briefly describe your plan for how pharmaceuticals and supplies will
be redistributed within your region or to counties in another region.
Who is responsible for transport, security, inventory control, chain of
custody, etc?
Example:
Once the SNS has been activated and the RTP has distributed SNS
materiel to local PODs, the POD may determine that their supply is
more than the demand. To move SNS materiel from one POD to
another
- the Liaison Officer will be responsible for contacting other POD
locations to determine if they are able to utilize the unused position
of the supplies. The POD Liaison Officer is also responsible for
coordinating this transfer with the departmental EOC.
- If the transfer involves SNS assets, the departmental EOC will make
sure to notify the designated CDPHE CMC Liaison.
- The POD Logistics Officer is responsible for organizing transport of
the materials whereas
- the Inventory Control Coordinator will be responsible for starting the
chain of custody.
The X County/Health Department will coordinate transport from one
jurisdiction (county or region) to another through the Liaison Officer at
the CDPHE EOC.
3. Requesting SNS assets from the RTP
Briefly describe the process for requesting the needed pharmaceuticals
and supplies from the Strategic National Stockpile through the RTP. If an
official protocol is available, reference this as an appendix.
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C. Point of Dispensing Protocols
1. Clinical protocols
a. Intake
The process, procedures, stations and personnel involved in
getting people into a POD to be assessed. It also includes the
completion of any paperwork. The following stations will be
involved in this layer:
i. Traffic management
ii. Initial entry point
iii. Greeting
iv. Registration-- Appendix X contains a sample Name,
Address, Phone form. This form is available electronically
on COHAN and is available for rapid reproduction locally.
These forms are available for household distribution of
prophylaxis. The form asks for the weight of household
members because the dose of many of the possible drugs
is determined by the person’s weight.
v. Triage
How will health history forms be distributed to patients?
How will forms be checked for legibility, accuracy and
completeness? How will forms be used to route patients
correctly so they receive the correct medication in the
right dose?
How will patients be triaged? Please refer to pages 12-6
to 12-8 about segmented PODs vs. non-segmented
PODs. Will triage be conducted at a separate location or
at the POD site? This could affect the order in which
items are discussed in the clinical protocols section.
b. Screening
The process, procedures, stations and personnel involved in
sorting and classifying patients within the POD to optimize
resources and maximize survival of patients. The following
stations and roles will be involved in this layer.
i. Screening
ii. First Aid
iii. Medical Transport
How will patients be transported to the POD or to
treatment centers? Refer to the above comment about
segmented vs. non-segmented PODs.
iv. Mental Health counseling
c. Dispensing
The process, procedures, stations and personnel involved in
preparing and delivering medications to the public.
d. Exit
The process, procedures, stations and personnel involved in
moving the patients out of the POD, as well as providing any
necessary follow-up information.
2. Prophylaxing staff and volunteers.
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Describe how you will prioritize dispensing medicines to first
responders, public health workers, medical workers, etc. prior to
dispensing to the general public.
Examples:
The X County/Health Department will follow the Department of Health
and Human Services guidelines for prioritizing the use of vaccines
and antivirals during a pandemic. See Attachments X and X for the
complete list. For non-communicable disease emergencies, X
County/Health Department will provide vaccine/medicines to first
responders and families in accordance with state and national
guidelines provided by CDPHE and the CDC. This priority list can be
found in Attachment X. (Make sure this text is kept up to date with the
current guidelines.) CDPHE and the GEEERC jointly reserve the
right to make an entirely new priority list at the time of the event,
if the circumstances seem to warrant that.
3. Standing Orders
The Colorado Department of Public Health and Environment and/or
the X County Nursing Service/Health Dept may provide standing
orders for vaccine/medication administration, as well as standing
orders for responding to medical emergencies, which may occur
during a vaccination/medication clinic. See Appendix X for examples
of standing orders.
4. Dispensing Oral Meds
Briefly describe how this will occur, what procedures will be followed,
who is in charge, where will this take place, etc.
Example:
Pediatric dosing and select geriatric dosing will require some liquid
medication preparation. The preparation of these medications will take
place under the direction of the Medical Branch Director and must be
done by pharmacists or pharmacy assistants. The CDCrecommended preparation procedures should be followed as closely
as possible.
5. Language/Translation Services
Identify the main languages that will require translation services.
Reference who will provide translation services.
V.
Roles and Responsibilities
A. Command and Control
The information in this section addresses the question “who is in charge.” Describe
the structure of your group for a response. You can also put information about
NIMS and your organization’s ICS strategy. Reference the appendix that contains
the sample ICS structure with primary and back-up contact information.
Example:
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1. NIMS
This plan operates under the National Incident Management System
(NIMS). The Public Health Director or designee(s) will respond to a
natural or human-caused emergency/disaster, terrorist attack, or a
pandemic disease event requiring POD activation using the NIMS
structure.
2. Incident Command: Reference your ICS chart in an appendix
3. Staff Support
In addition to incident command, additional resources should be available
for staff support. A system for insuring staff takes regular work breaks will
be in place. This break system will also address the provision of
workstation coverage during breaks. The support team will consist of
non-medical personnel within X County Nursing Service. Additionally,
staff support services will include consideration of the following:
a. Risk awareness education, including frank discussions of potential
risks and measures for protecting healthcare providers
b. Staff involvement in the quality assurance program
c. Daily clinic updates
d. Opportunities for fearful or anxious healthcare providers to work in
other useful roles
4. Mental Health
At the local level, it is anticipated that there will be a need for mental
health professionals and/or counselors to staff clinics to support,
counsel, and calm patients who may be anxious or frightened. An
arrangement has been made with X to address these issues. They
have staff on-call 24/7 and will respond with the number of counselors
needed to fit the situations.
B. Communications and Notification
1. Tactical Communications
What types of communication systems will you use within your POD?
What communication systems will you have at your POD? Two way
radios? Runners with message forms? Cell phone? How will you
communicate with partners? Who is responsible for maintaining the
communication systems and resources for the PODS? Who is
responsible for checking and charging batteries, and for testing of
communication equipment?
2. Internal Notification Procedures
How will you notify your staff in your agency? What protocols do you
have in place for volunteer notification? Who is authorized to send out
HAN messages?
You need to have POD lead/back up list and document that info is
updated quarterly
3. After Hours Communication Procedures
When your office is closed, how will labs, the state, emergency
management or others reach you in an emergency? Through your 911
system? Does your agency have a duty officer? Do you share a pager
and rotate call? Describe the procedure here. If there is a written
protocol, reference it as an appendix.
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C. Public Information
Public health agencies have a responsibility to maintain patient confidentiality just
as if it weren’t an emergency. Look in your local jurisdiction to see what agency is
responsible for public information. Public messages should be coordinated through
a Public Information Officer. If the incident involves other jurisdictions, there may
be a Joint Information Center created to coordinate messages to the public and
updates to the press. Describe your plan here. Are there subject matter experts
identified in your agency?
Example:
In the event of a public health emergency, X County will coordinate with the
CDPHE EOC PIO. Point-of-contact information for public information personnel is
found in Attachment X. After an emergency has been declared, state and local
Joint Information Centers (JICs) will assume primary responsibility for all media
relation’s activities. When this occurs, a representative of the local health
department may be called upon to serve as JIC liaison. Responsibilities of the JIC
Liaison are provided.
1. Coordination with Emergency Management
Public safety messages often are coordinated through the local
emergency manager utilizing reverse 911 systems, Emergency
Broadcasting Systems, and the Emergency Alert Systems. Messages to
the public can be streamlined to alert the public to shelter in place,
evacuate, or location of mass clinic operations.
Public health messages pertaining to POD locations have been created
and provided to the county emergency manager. These messages will
be provided to the public via reverse 911 when PODs are activated. The
message includes the description and location of POD facilities.
2. Pre-Event/Event Messaging
Uniform messages about the X County POD plan will be presented to
the public through state, local and possibly national television and
radio networks and newspapers. Messages must convey what the
potential problem is and the plan developed to deal with it. Messages
must be consistent at all levels and should be delivered by state, local
and federal authorities, depending on the circumstances, through a
combination of new releases, news conferences, expert interviews,
informational videos, public service announcements, the web,
presentations, reverse 911 and other means. Message distribution
would be primarily through the reverse 911 and the news media. The
news media would be handled at both state and local levels.
a. Pre-event messages will be developed which advise the
population on disease prevention and treatment and preparatory
steps being taken by federal, state and local public health
agencies via a vaccination/medication plan. The messages can
also include education about the “shelter in place” concept that
families can use to decrease the risk of disease transmission until
clinics are operational in the case of an outbreak. Information will
be shared on methods to be used to inform the public and plan for
vaccination/medication in case of an event. The public must be
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reassured that the national vaccine/medication supply is
adequate, and that a plan for rapid delivery to each state
vaccination/medication site is in place. Information about the
need and use of community volunteers may be conveyed.
b. Event messages will inform the public that the state and regional
SNS plans and the local POD plan are being put into operation
and the reason for it along with an explanation of the clinic
process. The messages should convey urgency, but not panic,
about getting the vaccinations/medications to prevent the disease
and other vaccination/medication related information. The
messages should include a list of the POD sites, hours of
operation, the CDPHE number to call for more information, the
timing of the vaccine to prevent disease, adequacy of the
vaccine/medication supply, adequacy of the plan and the
community resources devoted to carry out the plan. Email
messages, signs, posters and flyers about the clinics may be
distributed to government offices, school districts, major
employers, health departments and medical centers. Notice
should be given about public event cancellations if necessary or
about arrangements for transporting people to and from the clinic
sites. During the POD process, frequent updates should be given
about numbers of people vaccinated, the status of active cases of
disease and continued reassurance to the community about
responding to the outbreak.
c. Post-event messages will inform the public that the POD process
has ended, the number of people who developed the disease,
where to go or who to call in the event of adverse reactions to the
vaccinations/medications, the number of volunteers and staff who
worked at the clinics and how public health officials will monitor
further activity.
D. Security
1. Transportation of Materiel
Describe the movement of assets from the RTP to the POD including the
# of drivers, # and type of trucks, time needed to distribute. Is there
availability of sufficient material handling equipment for loading and offloading? Identify distribution staff. Document that they have been
trained in SNS specific distribution functions including chain of custody.
2. Documentation of Materiel
What chain of custody form is being used? What is the protocol for the
use of these forms?
3. Credentialing
What process do you have in place to screen volunteers? Do you have a
database of volunteers? Have they been trained and possess proper ID?
Are you anticipating using volunteers from the Nurse Alert System or
local Medical Reserve Corps? Does your insurance coverage require that
volunteers be credentialed? How are they covered for exercising, training
and response?
Example:
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The volunteers have been pre-screened and have completed a Public
Health Civil Defense Volunteer Registration Form. This provides some
protection to the county if the volunteer is injured during exercises or
actual events. Being a registered civil defense volunteer puts an injured
person in a position to file a claim with the State Workers Compensation
program (Pinnacol Assurance), if needed.
4. POD Security
Refer to the Security checklist in Appendix X.
This information is/was used to develop the POD security plan with law
enforcement.
a. Protection of staff
How many personnel will be used to protect workers?
b. Crowd Control
Do descriptive details for crowd control addressing the questions
who will do it, where it will be done, how many people will be
involved in doing it, what will be done (signs, information, etc),
when will it be done? (in anticipation of the crowd arriving? After
the crowd arrives?)
c. Traffic control
Who will provide traffic control? Consider close parking for those
with limited mobility.
d. Site Security
More than likely, the facilities you use for POD operations are
offsite from your public health agency. Managing operations to
assure safety and reduce opportunities for injury, theft, and illness
are your responsibility. Describe who is responsible for what.
Example:
The parking and perimeter area will be secured through the local
sheriff’s office.
E. Safety
1. Facility Safety
A Safety Officer should be appointed by the Incident Commander with
the following responsibilities:
a. Exercise emergency authority to stop and prevent unsafe acts.
b. Keep all staff alert to the need to identify and report all hazards
and unsafe conditions and insure that all accidents involving
personnel are investigated and actions and observations
documented.
c. Arrange with Logistics to secure areas all areas as needed to
limit unauthorized access
d. Advise the Incident Commander and Section Chiefs immediately
of any unsafe, hazardous situation (review Hazardous Materials
Plan).
e. Develop safety guidelines for each operational period.
2. Sanitation/Housekeeping
Plans will be made for trash and medical waste on-site receptacles,
and regular, frequent trash and medical waste removal. Each
vaccination/ medication station will have ready access to an adequate
supply of sharps containers and biohazard trash containers. In
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addition, an approved disinfectant will be readily available to use if
equipment or surfaces are contaminated with blood or body fluids.
Arrangements will also be made for routine and frequent cleaning and
maintenance of the POD site. This should include attention to entries
and sidewalks (clearing snow, etc), keeping floors clean and free of
water or ice, dirt, or litter. Bathrooms, food preparation areas, and
staff break or rest areas will be maintained regularly throughout the
duration of the clinic. In particular, the actual clinic area(s) will be kept
clean and orderly, with regular trash and medical waste removal.
3. Food Service
Consumer protection guidelines should be followed to insure proper
handling and storing of food.
4. Individual Safety
Dependent upon the nature of the incident, the safety of the individual
may be protected using various methods. Under the direction of
CDPHE and the local epidemiologist, the POD will implement the
incident-specific safety measures. Universal Precautions should be
used throughout the POD. These precautions prevent direct contact
with all body fluids (including blood), secretions, excretions, non-intact
skin including rashes, and mucous membranes. Universal
Precautions routinely practiced by healthcare workers may include the
following:
a. Gloves and hand-washing. Clean, non-sterile gloves must be
worn when touching blood, body fluid, secretions, excretions,
mucous membranes and non-intact skin. Gove are put on just
before patient contact is made. Hands are washed
immediately after removal of gloves to minimize transfer of
micro-organisms to other subsequent patients
b. Masks. N-95 disposable half-face respirators may be
available in the clinic for use by staff and the affected patient if
there is a potential risk for exposure. Increased efficacy will be
achieved if staff members are fit-tested with the appropriate
mask during pre-event training.
c. Eye protection and disposable gowns. These items should be
available in the POD in anticipation of an unforeseen
emergency, which might require additional protection for the
healthcare worker(s).
F. POD Facility Set Up
Example:
1. Facilities (Site Specification)
The POD site will be: ACME Pill Company, 1234 Main St, Here, CO
81234. This site was selected using the CDC recommended Site
Selection Checklist. Please refer to Appendix 123
2. Floor plans/Clinic Flow
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The floor plan has been developed to maintain the safety of workers and
patients. Please refer to Appendix 124 for the POD floor plan and
Appendix 125 for a clinic flow diagram.
3. Estimated Throughput and Staffing Requirements
A model staffing pattern is included in Appendix C, with job action
sheets in Appendix B. The staffing model shown is designed to
vaccinate/medicate 30 patients/hour, or 2 minutes/patient at each
vaccination station. This staffing model will allow X Nursing
Service/Health Dept to vaccinate/medicate all individuals in X
County’s permanent population of approximately X in 2 days.
The staff level at X Nursing Service is not sufficient to meet
appropriate clinic staff levels. X will solicit assistance from (fill in other
organizations).
Some suggestions are Emergency Medical Technicians, hospitals,
clinics, Medical Reserve Corps (MRCs), Citizen Corps Councils,
Community Emergency Response Teams (CERTs), and other service
organizations. Other personnel may be available through Mutual Aid
Agreements. CDPHE maintains a Public Health and Medical
Volunteer System that includes MRCs and other groups and
individuals who are willing to volunteer during an emergency.
4. Staff Support
An area removed from clinic activities will be provided to enable staff to
relax, rest, eat, and drink during breaks at the time they are working in
the POD. It will have adequate accommodations, food, and
water/beverages. It will be private so that conversations can be
conducted without being overheard by clinic patients. It will have
adequate lighting and be accessible from the clinic area.
G. Controlling Inventory, ordering and re-ordering assets
Describe the process. What authorities must be obtained prior to ordering from
SNS? Is this coordinated through the County Emergency Manager? How is
information transmitted to the Regional RTP Site? Include a communication flow
chart that graphically depicts flow of asset request from POD to RTP. What
arrangements have been made for assets not included in SNS that are necessary
for POD operations (e.g., non-medical support supplies such as paper towels,
office supplies)
H. Treatment Centers
Include a table identifying locations of treatment centers (outpatients), and
another table listing the hospitals (inpatients). Reference MOUs in place for those
treatment centers. Refer to protocols described in earlier section (POD
Protocols,Triage and Medical Transport)
VI. Plan Development and Maintenance
There is a sheet in the front of this plan to document the date the plan was updated and
what changes were made. There is also a sheet to identify what individuals or agencies
have received copies (specific version) of the plan. People change jobs and training on
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these plans is important. How current is your plan, and who has a copy of it? You
should review your plan annually and develop a procedure for making updates.
VII. Training and Exercises
A. Training
Describe who will be trained on this plan, training schedules. Be sure to include
partner agencies, staff, volunteers, and elected officials. Who is responsible for
training? You need to document training of POD leads, back-ups and core
workers. Develop a Just-in-time POD worker-training plan.
B. Exercises
Do you have a three-year exercise schedule? Has the plan been exercised lately?
Who is responsible for exercising the plan? In a progressive exercise schedule,
various types of exercises will meet the needs of your community to address
improved preparation. Table tops, narrowly focused drills, or full scale exercises
vary in capabilities, stress levels, time commitments and funding requirements.
VIII. Glossary of Acronyms
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