Are US jurisdictions prepared to dispense medical countermeasures through open points of dispensing? Findings from a national study

Challenges in managing, sustaining, and assessing closed point of dispensing sites: Findings from a qualitative study

Most U.S. public health agencies rely upon closed points of dispensing (PODs) to aid in medical countermeasure (MCM) distribution. However, few studies have focused on how to assess closed POD preparedness and none have examined best practices for managing sites once they have been recruited. This study involved qualitative interviews with U.S. disaster planners to elucidate their approaches and challenges to managing, sustaining, and assessing existing closed POD sites. In all, 16 disaster planners participated. Common management practices included frequent communication with sites, providing formal and informal training, and assisting with POD exercises. Very few jurisdictions reported doing formal assessments of closed POD sites. The largest challenges identified were staff turnover and keeping sites engaged, sometimes leading to sites voluntarily withdrawing or needing to be removed from being a closed POD. Frequent communication and building partnerships with closed POD site personnel were recommended to maintain and sustain existing sites. Formal and informal assessments will provide assurance of deployment readiness. Closed POD management is a challenging, but essential process to ensure readiness to deploy. Practices outlined by this study can be implemented to enhance closed POD network management at other jurisdictions. This should increase the ability to distribute MCMs rapidly during a future event, contributing to stronger community resilience. Public health officials should continue expanding and improving closed POD networks to enable MCM delivery and minimize morbidity and mortality related to mass casualty events.

County-Level Planning for Efficient Distribution of Emergency Medical Countermeasures with RealOpt Software

Emergency preparedness systems plan for antibiotic distribution and vaccine administration to respond to public health threats. The arrival of a COVID-19 vaccine underscores the importance of organized logistics for rapid administration to populations. The US Centers for Disease Control and Prevention Cities Readiness Initiative encourages frontline responders from 72 US cities and metropolitan statistical areas to use planning software, such as RealOpt-POD-v8.0.2, to design dispensing operations and predict staffing needs. However, planning can be difficult for local jurisdictions given uncertainty about how long it may take to complete various processes during a dispensing operation, including assessment of countermeasure needs for each person (eg, based on age or pregnancy status) and the careful dispensing of countermeasures and accompanying education. The Union County Health Department in Ohio gathered data on the timing of typical processes for an anthrax medical countermeasures distribution site through a small-scale drill and used these data to parameterize a RealOpt model capable of serving the rural county's population of just over 50,000 people within 24 hours. Results help fill a gap in parameterizing RealOpt-based planning models by highlighting the use of a small-scale drill to inform time estimates, which can be applied to RealOpt as part of county-level planning in advance of larger-scale drills to evaluate dispensing capabilities and effectiveness. The findings provide a methodological basis of future resource typing for adaptable and scalable dispensing, particularly for rural areas. Both the approach and resulting antibiotics dispensing schematic presented here could be tailored to support planning for population-based countermeasure administration to combat emerging pandemics.

Challenges and Opportunities of Mass Vaccination Centers in COVID-19 Times: A Rapid Review of Literature

A mass vaccination center is a location, normally used for nonhealthcare activities, set up for high-volume and high-speed vaccinations during infectious disease emergencies. The high contagiousness and mortality of COVID-19 and the complete lack of population immunity posed an extraordinary threat for global health. The aim of our research was to collect and review previous experiences on mass vaccination centers. On 4 April 2021, we developed a rapid review searching four electronic databases: PubMed/Medline, Scopus, EMBASE, Google Scholar and medRxiv. From a total of 2312 papers, 15 of them were included in the current review. Among them, only one article described a COVID-19 vaccination center; all of the others referred to other vaccinations, in particular influenza. The majority were conducted in the United States, and were simulations or single-day experiences to practice a mass vaccination after bioterrorist attacks. Indeed, all of them were published after September 11 attacks. Regarding staff, timing and performance, the data were highly heterogenous. Several studies used as a model the Center for Disease Control and Prevention guidelines. Results highlighted the differences around the definition, layout and management of a mass vaccination center, but some aspects can be considered as a core aspect. In light of this, we suggested a potential definition. The current review answers to the urgency of organizing a mass vaccination center during the COVID-19 pandemic, highlighting the most important organizational aspects that should be considered in the planning.

Approaches, Successes, and Challenges in Recruiting Closed Points of Dispensing Sites: A Qualitative Study

Closed points of dispensing (PODs) are an essential component of local public health preparedness programs because most local public health agencies lack the infrastructure to distribute medical countermeasures to all community members in a short period of time through open PODs alone. However, no study has examined closed POD recruitment strategies or approaches to determine best practices, such as how to select or recruit an agency, group, or business to become a closed POD site once a potential partner has been identified. We conducted qualitative interviews with US disaster planners to identify their approaches and challenges to recruiting closed POD sites. In total, 16 disaster planners participated. Recruitment considerations related to selecting sites, paperwork needed, and challenges faced in recruiting closed POD sites. Important selection criteria for sites included size, agencies or businesses with vulnerable or confined populations who lack access or ability to get to or through open POD sites, and critical infrastructure organizations. Major challenges to recruitment included difficulty convincing sites of closed POD importance, obstacles with recruiting sites that can administer mass vaccination, and fear of legal repercussions related to medical countermeasure dispensing or administration. Closed POD recruitment is a frequently challenging but highly necessary process both before and during the current pandemic. These recommendations can be used by other disaster planners intending to start or expand their closed POD network. Public health agencies should continue working toward improved distribution plans for medical countermeasures, both oral and vaccine, to minimize morbidity and mortality during mass casualty events.

US Hospital Preparedness to Manage Unidentified Individuals and Reunite Unaccompanied Minors with Family Members During Disasters: Results from a Nationwide Survey

Unaccompanied minors and other unidentified individuals may present to hospitals during disasters and require reunification with family. Hospital preparedness for family reunification during disasters has never been assessed. We sent members of the Association of Healthcare Emergency Preparedness Professionals an anonymous online survey in July and August 2019 to assess their hospital's reunification readiness during a disaster. Scores on preparedness to manage unidentified patients were calculated based on 21 indicators, each with a score of 0 or 1. A multivariate linear regression was conducted to delineate factors associated with higher preparedness scores. In total, 88 individuals participated (response rate = 33.4%). All agreed that reunification preparedness is important, but far fewer (χ² = 33.8, P < .001) believed their hospital was prepared to reunify unidentified individuals during a disaster (n = 58, 65.9%). Most (n = 56, 63.6%) had at least some written reunification plan. Preparedness scores ranged from 0 to 21 (mean = 8.0, standard deviation = 7.3). Predictors of preparedness included having a pediatrician on the hospital disaster planning committee, conducting a disaster exercise that simulated an unaccompanied minor scenario, and implementing the 2018 American Academy of Pediatrics Reunification Planning Tool. Findings from this study indicate that many US hospitals are not prepared to reunify unaccompanied minors or other separated family members during a disaster. The planning tool is a free resource that hospitals can use to improve their hospital reunification plans. Hospitals should prioritize development of reunification plans to ensure rapid response during a future event. Use of the planning tool can aid in development and improvement of these plans.

In-Home Strategic National Stockpile Dispensing by Means of Home Health Agencies: An Alternative Means of Dispensing to Vulnerable Populations

The Federal Emergency Management Agency prescribes a 48-h timeline between the declaration of an emergency and the treatment of the last person with Strategic National Stockpile (SNS) medical countermeasures (MCM). Many states struggle to meet the 48-h window. Issues surrounding adequate staffing, critical to maintaining necessary Points Of Dispensing (POD) throughput, are noted in the literature. The use of public and private partnerships in the health-care sector may improve POD throughput. This study describes a novel strategy for partnering with home health agencies (HHAs) to augment MCM distribution. The HHA In-Home Dispensing Model we propose authorizes HHAs to act as Closed PODs following a head of household model. Here, we evaluate the effectiveness of the model using a case study. First, we provide an overview of the methods used to estimate the duration of in-home nurse dispensing shifts. We then present the results for our case study area. Next, we discuss how the model can be used and its limitations. We conclude that the HHA In-Home SNS Dispensing Model shows promise and should receive further consideration, as it can decrease demand at open PODs and increase the reach of MCMs to vulnerable populations who might otherwise have difficulty receiving them.

Use of Medical Countermeasures in Small-Scale Emergency Responses

It is well documented that long-standing focus on public health emergency preparedness medical countermeasures (MCMs) distribution and mass dispensing capabilities for mitigation of bioterrorism incidents and a lack of real-world opportunities to test national preparedness for large-scale emergencies has hindered development of a body of evidence-based practices in the United States. To encourage jurisdictions seeking innovative opportunities for continuous improvement, we describe instances when the MCM capabilities were used to address smaller-scale, more-frequent public health emergencies such as disease outbreaks, natural disasters, or routine influenza vaccination. We argue that small-scale events represent a critical opportunity that state, local, tribal, and territorial entities can utilize for greater gains in MCM operational readiness than through exercises or planned reviews. By using and evaluating MCM capabilities during a real response, jurisdictions can advance preparedness science and support the translation of research into practice, thereby increasing their capacity to scale up for larger, rarer, higher-consequence emergencies.

Taiwan's Annual Seasonal Influenza Mass Vaccination Program-Lessons for Pandemic Planning

Rapid medical countermeasure (MCM) dispensing is an important intervention during a public health emergency. In the United States, MCM planning and exercising efforts have largely focused on dispensing therapeutics, with less emphasis on mass vaccination operations that would require additional specialized staff and infrastructure. Difficulties in distributing vaccines during the 2009 H1N1 influenza pandemic highlighted the need for enhanced planning and exercising of plans for conducting mass vaccination campaigns. In Taiwan, seasonal influenza mass vaccination campaigns are conducted annually, which both mitigate the effects of seasonal influenza and serve as functional exercises for mass vaccination operations during a pandemic. To identify lessons that can be applied to mass vaccination planning in the United States and elsewhere, we conducted an in-person observation and data review of Taiwan's annual seasonal influenza mass vaccination efforts in October 2017. We offer findings and recommendations for enhancing preparedness for seasonal and pandemic influenza and other public health emergencies that would require mass vaccination.

Recommendations on How to Manage Anticipated Communication Dilemmas Involving Medical Countermeasures in an Emergency

National investments to facilitate prompt access to safe and effective medical countermeasures (MCMs) (ie, products used to diagnose, prevent, protect from, or treat conditions associated with chemical, biological, radiological, or nuclear threats, or emerging infectious diseases) have little merit if people are not willing to take a recommended MCM during an emergency or inadvertently misuse or miss out on a recommended MCM during an emergency. Informed by the Expert Working Group on MCM Emergency Communication, the Johns Hopkins Center for Health Security developed recommendations for achieving desired public health outcomes through improved MCM communication based on a review of model practices in risk communication, crisis communication, and public warnings; detailed analysis of recent health crises involving MCMs; and development of a scenario depicting future MCM communication dilemmas. The public's topics of concern, emotional requirements, capacity for processing information, and health needs will evolve as an emergency unfolds, from a pre-event period of routine conditions, to a crisis state, to a post-event period of reflection. Thus, MCM communication by public health authorities requires a phased approach that spans from building up a reputation as a trusted steward of MCMs between crises to developing recovery-focused messages about applying newly acquired data about MCM safety, efficacy, and accessibility to improve future situations.

Best Practices for Healthcare Facility and Regional Stockpile Maintenance and Sustainment: A Literature Review

Preparing for mass casualty incidents is essential to maximizing community resilience. Many US-based organizations and regions have developed stockpiles of medications, supplies, and equipment for mass casualty incident preparedness. The Centers for Disease Control and Prevention (CDC) assess and manage federally stockpiled materials, but hospitals, healthcare systems, and regional organizations are responsible for maintaining locally owned caches. The CDC has protocols for assessing and managing the Strategic National Stockpile, but no such guidance exists for local or geographical/regional stockpiles. This article outlines best practices and recommendations identified in the literature related to maintaining and sustaining a local or regional stockpile. Recommendations are provided on the timing and procedures for assessing, inventorying, storing, managing, tracking, and deploying materials stockpiled on site, in a trailer, or in a warehouse. In addition, alternative approaches for maintaining a local or regional cache, such as vendor- or user-managed inventory methods, are addressed. Management of local or regional caches requires an investment in infrastructure and training but is necessary to ensure the integrity of stockpiled medication and supplies and to enable rapid and appropriate activation during a mass casualty incident. Hospitals, healthcare systems, businesses, academic institutions, public health agencies, organizations, and regions can use the recommendations here to develop protocols or policies to properly manage their existing stockpiles, which should minimize costs related to damaged supplies.