Dispensing Medical Countermeasures for Public Health Emergencies Workshop Summary (2008) / Chapter Skim
Currently Skimming:
Workshop Summary
Workshop Summary
Pages 1-32
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
, spread by the bacterium's spores on contaminated mail. Although the death toll from the 2001 anthrax attack was limited, 2 with only five deaths across six locations nationwide, more than 32,000 potentially exposed people received prophylaxis with oral antibiotics.
|
From page 2... ...
The overall workshop objective was to review a range of solutions to provide medical countermeasures rapidly to large numbers of people to protect them before or during a public health emergency, such as a bioterrorist attack or infectious disease outbreak. In particular, the workshop goals were to: identify and discuss the most promising methods for dispensing medical countermeasures as well as their inherent strengths and challenges; identify nearterm opportunities for promoting efficient and effective dispensing mechanisms at the state and local level; and to bring invested stakeholders (including local, state, federal, nonprofit, and corporate representatives)
|
From page 3... ...
Independent of a closed or open POD, a POD may also be "medical" or "nonmedical." A medical POD would mostly be staffed by medical personnel, who would primarily be responsible for dispensing medica tion and conducting medical exams and triage procedures to determine whether cases are in the incubation stage or in need of hospitalization. In contrast, a nonmedical POD would be staffed by trained but nonmedical personnel, who would dispense medication and triage as appropriate, but would not conduct individualized medical assessments.
|
From page 4... ...
The anthrax attack also presents public health planners with extreme logistical challenges, including the short time line essential for effective prophylaxis and the size of the potentially exposed population (tens of thousands)
|
From page 5... ...
It is widely believed that upon activation, the federal government would be able to distribute the necessary SNS materiel to state and local agencies within 12 to 24 hours. Public health officials could then begin dispensing from local caches, thus meeting the ideal
|
From page 6... ...
Dispensing Medical Countermeasures The demands on local governments are extensive, and local officials may benefit from partnering with other sectors to develop solutions, noted Gregory Burel, the Senior Executive Service Director, Division of Strategic National Stockpile, CDC. A joint government–private partnership or a "community" response with government leadership is necessary to ensure the most positive outcome.
|
From page 7... ...
CURRENT PLANS AND GAPS REGARDING MEDICAL COUNTERMEASURE DISPENSING Under the current system, the dispensing of medical countermeasures at the local level is the final step in a complex and interactive process starting with federal, state, and local public health programs. For the system to work effectively, participants must understand the urgent nature of the public health threats, such as anthrax.
|
From page 8... ...
Public health planners have used PODs as the major framework for planning countermeasures dispensing, yet PODs pose some of the greatest challenges, including their location, design, operations, capacity, workforce, and a host of other factors. Dispensing Medical Countermeasures: Time Considerations The foremost problems arise from delays in starting and completing the initial dispensing of prophylaxis.
|
From page 9... ...
Another speaker, Dr. Nathaniel Hupert of Weill Cornell Medical College, discussed the relationship between the expected surge in hospital admissions after an anthrax attack and the tactics used in POD-based antibiotic dispensing campaigns.
|
From page 10... ...
. POD Models Cities Readiness Initiative The focus of the federal efforts to dispense medical countermeasures has been through the Strategic National Stockpile, as described by Burel.
|
From page 11... ...
Several of these concepts, including pull and push mechanisms are discussed in greater detail in the next section. Medical and Nonmedical PODs In addition to the time of initiation and the duration of the campaign, there are a host of other features for localities to consider in the design and operation of their PODs, as discussed by a number of speakers including Baccam, Burel, and Hupert.
|
From page 12... ...
Thus nonmedical PODs were described by many workshop participants, including Michael Robbins of the Chicago Department of Public Health, as the preferred approach because they can deliver countermeasures even though every person is not seen by a health professional. Nonmedical PODs can optimally dispense countermeasures at a rate that is approximately four times greater than that of medical PODs, while requiring only approximately one fourth the total number of staff and much fewer medical personnel.
|
From page 13... ...
Postal Service plan -- for example with regard to the impact of personal protective equipment on postal carrier effectiveness and the feasibility of obtaining necessary security details. 5 In the event of an anthrax attack, most communities plan to dispense enough antibiotics to a person or family to provide coverage for the first 10 days after an incident, thereby buying time for a second wave of dispensing.
|
From page 14... ...
Postal Service (USPS) using postal carriers to dispense to residences a short-term supply of medical countermeasures.
|
From page 15... ...
This option may include the development of retail PODs (operated by retail businesses to provide medical countermeasures to their employees and the public) or closed PODs (operated by organizations to provide medical countermeasures to their em ployees and their family members)
|
From page 16... ...
Hoff envisioned pull mechanisms for able-bodied individuals and push mechanisms for special needs populations. In summary, the integration of federal, state, tribal, and local efforts to distribute and dispense medical countermeasures is essential.
|
From page 17... ...
Patient tracking/registries: Systems are needed to account for all persons served at PODs. Rapid time frame: Optimally PODs would dispense countermeasures to a large population within 48 hours of the decision to initiate dispensing.
|
From page 18... ...
Other panels identified novel dispensing methods through new types of public–private partnerships or through push and pull mechanisms. Considering the high degree of overlap across these topics, the rest of this summary focuses on the dominant themes of adapting existing frameworks to augment dispensing sites, increasing staffing for PODs, fostering new types of public–private partnerships, and ensuring liability protection for private-sector partners.
|
From page 19... ...
The ability of nonprofit networks to dispense medical countermeasures critically depends on their current presence in any given community. Using the nation's vast network of home newspaper delivery contractors is yet another possible approach that could be employed as part of a layered communication and dispensing strategy, suggested John Murray, vice president of circulation marketing for the Newspaper Association of America.
|
From page 20... ...
They typically provide advantages for each party. The structure of the partnerships is equally broad, covering open or closed PODs, and PODs using other push or pull mechanisms.
|
From page 21... ...
Another example is prior placement of MedKits for in-home use at the beginning of a public health emergency, after which countermeasures could be dispensed at PODs or alternative sites, noted speakers Gregory Burel and Linda Neff of CDC. This concept was encouraged by a number of workshop participants, who noted that regardless of the additional methodology, enabling pre-positioning of MedKits would relieve pressure from the public health system during the initial 48 hours.
|
From page 22... ...
• Ensure liability protection for private-sector partners to distribute and dispense countermeasures. • Recruit a large workforce, train them, and ensure back-up to fill in if the regular workforce is inadequate or unavailable during an emer gency.
|
From page 23... ...
Potential dispensing sites for open PODs could even include sites such as McDonald's, Starbucks, and Wal-Mart, noted several panelists. Other sites might include restaurants, special pharmaceutical vending machines, retail stores, pharmacies, grocery stores, banks, automatic teller machines, and any other venue with drive-through facilities, Koonin said.
|
From page 24... ...
Pamela Blackwell, Director of the Center for Emergency Preparedness and Response for the Cobb and Douglas Boards of Health in Marietta, Georgia, estimated that the currently planned closed PODs in the metro Atlanta area might reduce the number of people who need access to open PODS in case of an event by 40 to 50 percent, allowing public health to focus on at-risk populations in places such as jails and nursing homes. There is even a multiplier effect, as the household members of the employee may also receive countermeasures at the closed POD.
|
From page 25... ...
Closed PODs have already proved to be appealing to large employers in Tarrant County in Texas. Panelist Teresa Bates reported that since 2006, she has been partnering with several local businesses and universities to create closed PODs.
|
From page 26... ...
By tracing epidemiological patterns of adverse effects, in other words, epidemiologists will be able to determine whether an adverse event is an isolated case or whether it is tied to a contaminated lot of the countermeasure, for which a recall might be necessary. PODs of any configuration can use information technology to dispense countermeasures in an efficient and swift manner.
|
From page 27... ...
In the Washington, DC, metropolitan area, many jurisdictions already mandate service by public employees in case of an emergency. In addition, individuals serving in the Medical Reserve Corps and Community Emergency Response Teams may also be called upon to assist in these efforts.
|
From page 28... ...
In the case of anthrax exposure, pressure on public and private PODs will be alleviated if exposed individuals know where to go to get medical countermeasures and how to seek medical attention if they are ill. All public health departments, for example, have pre-scripted messages that are ready to be sent out during a public health emergency; yet a multi-layered communication strategy is necessary to reach the greatest number of people.
|
From page 29... ...
A Secretarial public health emergency declaration, if appropriately drafted, could provide additional liability protection to the private sector for assisting in the dispensing of medical countermeasures.
|
From page 30... ...
Liability protections are necessary to enlist support of the private sector in public–private partnerships, such as dispensing countermeasures to their employees ("closed PODs")
|
From page 31... ...
Combining multiple strategies to create a layered approach may afford the most resilient and effective system to accomplish this goal. Parker noted that the United States is just about to reach the goal of having stockpiled sufficient antibiotics to provide post-exposure prophylaxis for 60 million people for 60 days in the event of an anthrax attack.
|
From page 32... ...
When a strategist considers the potential threats against this nation in the arena of terrorism, two scenarios stand out as "strategic" in their impact: the first is a nuclear attack and the second is a bioterrorist anthrax attack on a large metropolitan area, noted Parker. The effects on this society in terms of loss of life and productivity of life, economic and psychological impact, and sustainability of a way of life would be unparalleled and unprecedented in American history.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.