Planning and Mass Prophylaxis Clinic Operations

Abbey, Rachel L., et al. “Planning and Managing Mass Prophylaxis Clinic Operations.” Handbook of Healthcare Operations Management, edited by Brian T. Denton, vol. 184, Springer New York, 2013, pp. 319–48. DOI.org (Crossref), doi:10.1007/978-1-4614-5885-2_12.

Local health departments and state, tribal and federal governments are tasked to collaborate on emergency preparedness together (pg 320).

The National Response Framework (NRF) provides guidelines for governments and other organizations to provide a unified response. (pg 322)

  • ESF– Emergency Support Function (pg 322)
  • NIMS– National Incident Management System
  • PHEP– Public Health Emergency Preparedness
  • PODs– Points of Dispensing

Points of Dispensing serve as mass prophylaxis clinics for the rapid distribution medical countermeasures. (pg 323)

Centralized POD (Pull method): Local Health Department (LHD) sets up several locations where people can be treated. (pg 323)

Decentralized POD (Push method): LHD goes a location to administer treatments (e.g. going to school to distribute flu vaccines). (pg 323)

POD Cycle. (pg 320)

Step 1: Disease Detection, Identification, & Response Determination

Disease Detection and Identification:
  • Epidemiological data is crucial (pg 324)
  • Syndromic Surveillance (pg 325)
  • Health Alert Network for communication between organizations and the CDC
Prophylaxis Medication:
  • “The prevention of or protection from disease”. (pg 326)
  • Types, routes (oral/injection), and doses (size/number) of prophylaxis vary by disease
Target Populations:

It is crucial to determine which populations are most severely affected by the disease, as well as how to get treatments to them (pg 327)

Request SNS Assets and Dispensing Method:
  • SNS assets are located to be 12 hours away from any area that may need them (pg 328)
  • Recipients in charge of assets once they arrive
  • A solid dispensing plan must be made, as minimizing morbidity could require action within hours or days of the event.

Step 2: Planning Considerations and Identification of POD Resources

Design and Layout; Access and Security:

A POD site must be carefully planned. It must be accessible to everyone (e.g those in wheelchairs or the blind). It must have room for lines of people to wait, stations for different purposes (greeting, triage, paperwork, screening, dispensing etc…), as well as a flow to direct people through the site. The entrance must in a different location than the exit, so that treated people are passing through groups of people waiting to be treated. Considerations of the space, available staff, furniture, entrances and exits, etc, must all be made. (pgs 330-332)

Example POD. (pg 331)
Resource Planning Models:
Staffing:

Staffing readily depends on the scale of the operation, as seen below. Staff need to be recruited, trained and maintained beforehand. (pg 335)

Sample Staffing Organizational Chart. (pg 336)
Supplies and Logistics; Communications; Outside Partners:

All three of these aspect must be taken into consideration when constructing a POD. Supplies must either be used upon delivery or be stockpiled for later. There must be ready channels of communication not only between officials in the POD operation but also between those officials and the public. (pgs 337-338)

Step 3: POD Operations

  • On-Site Setup and Command Structure
    • Staff should arrive several hours before the POD opens to the public (pg 340)
  • Just-In-Time Training
    • Any last minute details and procedures should be discussed with the staff before the POD opens (pg 340)
  • Flexibility and Limitations
    • The POD will face challenges during the operation, so it is important to remain flexible. (pg 341)

Step 4: Post-analysis and Corrective Actions

After the POD closes for the day, it is best to hold a facilitated session with the staff to discuss what did and didn’t go well. The discussion should be recorded in an after-action report. Improvements should also be planned in light of any issues discussed. (pg 342)

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