RI Department of Health Medical Countermeasure Dispensing During - PDF document

RI Department of Health Medical Countermeasure Dispensing During Emergencies in Rhode Island 2014-2015 Disclosure Statement • CONFLICT OF INTEREST – The planners and presenters have declared no conflict of interest. • COMMERCIAL SUPPORT/SPONSORSHIP – There is no commercial support or sponsorship for this event. • CRITERIA FOR SUCCESSFUL COMPLETION includes attendance at the entire event and submission of a completed evaluation form. 1

Objectives Learners will: 1.Describe the Medical Emergency Distribution System (MEDS) in Rhode Island and identify examples of when MEDS has been utilized in Rhode Island 2.Summarize the concept of Points-of- Dispensing (POD) including the flow and function of a POD 3.Explain professional roles and responsibilities required to volunteer as staff in a POD. What are we preparing for? Emerging Infectious Diseases and Natural Disasters • Natural Disasters – Hurricanes – Tornadoes – Floods • Infectious Diseases – Influenza outbreaks requiring mass vaccination 2

What are we preparing for? Biological Agents • Bioterrorism agents are separated into three categories - A, B, or C Specific Agents: Category A Anthrax • Easily spread person to person Botulism • High death rates Pneumonic Plague • Major public health impact Small Pox • Social disruption Tularemia • Special action for public health Viral Hemorrhagic Fevers preparedness Federal Response to Biological Threats CDC’s Strategic National Stockpile (SNS) Federal Mission: Deliver critical medical assets to the site of a national emergency. • A national repository of medical countermeasures and supplies – Ciprofloxacin – Doxycycline – Amoxicillin • Types of inventory – 12 Hour push package – Managed inventory 3

Rhode Island’s Response Medical Emergency Distribution System plan (MEDS) HEALTH ’ s Mission: Coordinate distribution to PODs and dispensing at local PODs ALL RI Municipalities ’ Mission: To get the first pill in the last person in line within 48 hours! Timeline of MEDS Response Rhode Island MEDS/POD Activation Timeline Hour 0 Hour 6 Hour 12 Hour 12-48 Aware of Disease Notify SNS PODs threat & outbreak/ leaders to arrives; open to SNS Release activate Deploy to dispense assets of agent PODs PODs to public requested Declaration of Public Health Emergency 4

Rhode Island Dispensing Method Objectives within a POD Primary Objective: • Medicate/vaccinate the public • Educate the public • Patient history review / drug dispense decision making Secondary Objectives: • Keeping anxiety in check / not adding to anxiety levels • Keep accurate records Types of Dispensing • Open PODs – Open to the public – Each municipality opens at least one POD • Closed PODs – For a specific list of individuals – Usually a facility with their own medical professionals on staff – Examples: hospitals, Adult Correctional Institution • Alternate Dispensing – Possibly take countermeasures to homebound populations etc. 5

“ Open ” PODs Prophylaxis Prophylaxis POD 4 Simple Steps The Public Step 1: Fill out form Step 2: Have form reviewed Step 3: Get medication or vaccine Step 4: Exit (15 minute observation if vaccine) Symptomatic Treatment Individuals POD: Flow 11 6

Incident Command System (ICS) Standardized, on-scene, all-hazards incident management approach. POD Commander Medical Director Site Pharmacist Public Information Safety Officer 12 Operations Logistics Planning Finance Just-In-Time Training JITT is tailored to the specific threat and includes but is not limited to the following elements: – Infectious agent – Specific medical countermeasures being used at POD – Incident Command at POD – POD flow and policies ( functions of stations) – Communication devices being used (ex. Radios) – Job Action Sheets (explanation of assignments) 17 – Questions and Answers 7

RI-Specific POD Policies • No IDs will be asked for • No residency requirements • Unaccompanied minors OK • Head of Household (HoH) policy during a pill response (never vaccine) • POD workers and their families receive prophylaxis before POD opening Liability National Health Emergency • PAHPRA Act (2013) • PREP Act (Pub. L. 109-148) • Volunteer Protection Act (1997) • Emergency Use Authorization • Investigational New Drug Rhode Island • RIGL 30-15-15 states: • Governor's executive order • Expanded scope of practice 24 8

Why We Need You? Minimum # of Staff Needed for One Shift 1725 Dispensers 1725 25 Pill Dispensers or Dispensing 69 PODs (for a pill Stations response) 2898 Vaccinators ~ Per shift ~ in order to 42 2898 dispense/vaccinate 500 Vaccination 69 PODs Vaccinators Stations people per hour! 9- 10 Why We Need You? Roles and Responsibilities Forms Review - Review patient history; make countermeasure selection; and pass out information sheets Dispensing - 2 nd review of form- confirm proper drug/vaccine according to algorithm; refer special cases to medical director Inventory Management - Sign for countermeasures; ensuring proper storage, quarantine, and waste management; distribute to dispensing areas or alternate dispensing Medical Evaluation - Evaluate whether a person can be seen at POD; troubleshoot special cases; send patients to doctor or hospital as needed 11 9

Case Studies Station: Forms review station. Patient: 10 year old with 4 history forms Forms: Adult Male = good health, no allergies Adult Female = pregnant and has multiple allergies including eggs, and peanuts 2 Children = (ages 10 and 2) no allergies or medical problems According to the provided algorithm, what would the appropriate prescription be for each person? 20 - 22 Case Studies Station: Dispensing Problem: You are sitting at the dispensing station working along side two non-medical staff. You over hear one of the staff members telling a patient only to take the medication if they feel ill. What should your response to this be? 10

Case Studies Station: Observation area Additional Information: You are staffing the observation area during a vaccination POD. You notice a young man approximately 20 years old scratching his arms and legs. Who should be notified about this situation? Case Studies Station: Dispensing Patient: 19 year old Male One Form: Allergy to peanuts, no medical problems Additional Information: Patient arrives at your dispensing station, refusing to sit down, agitated, nervous and demanding more than ten days worth of medicine because he is “sure he has been exposed and has the disease” How would you handle this situation? 11

Get Involved • Contact your local Emergency Management Director to volunteer IN ADVANCE to work a POD • Take some ICS courses http://training.fema.gov/IS • Develop a personal preparedness plan www.ready.gov Next Step’s 50 additional day supply plan to re-open PODs. 12

Thank you! If you would like to volunteer at a POD or have any questions please contact: Brittan K. Bates-Manni Strategic National Stockpile Coordinator 401-222-4905 Brittan.Bates@health.ri.gov 13