Thomas Jefferson Health District

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Thomas Jefferson Health District

• Mass Dispensing Site Exercise
• October 3, 2004

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Scenario Set-Up

• Approximately 600 people attending a play at the
  Culbreth theatre on the evening of September 28
• Both local hospitals have seen individuals
  presenting to ED exhibiting suspicious symptoms.
• Only commonality identified is attending the show

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Scenario development

• Preliminary diagnosis of inhalation Anthrax
• Presumptive identification Anthrax.
• Test results confirmed by DCLS as well as the
  CDC.
• Vendor managed inventory requested from the
  Strategic National Stockpile

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Scenario Cont.

• Vendor Managed Inventory mediations being
  released
• Charlottesville/Albemarle EOC opened as level I
• Decision to offer prophylactic medications to all
  who attended the theatre
• Dispensing site to be opened at the Cage at UVA
• Health District calls up staff, MRC and other
  volunteers to support dispensing operations.

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Operational details

• Will open dispensing site for approximately 600
  individuals to a non-communicable disease.
• Will provide Just in Time training to all staff
• Will operate under established leadership
  structure

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Dispensing Site Leadership Structure

• Command and Control
• Unit Leaders

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Dispensing Site Command and Control Positions
Site Manager
PIO at JIC
Safety Officer
Operations Section Chief
Logistics Section Chief
Administration/Finance Section Chief
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Command and ControlSite Manager

• Responsible for command and control of the
  dispensing site.
• Ensures highest level of efficiency
• Performs on site PIO activities
• Oversees Safety Officer and all Section Chiefs
• Communicates with Local EOC and HD ECC

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Command and Control Safety Officer

• Responsible for ensuring the dispensing site is
  free from health and safety hazards
• Collaborates with section chiefs regarding
  resolution of safety issues.

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Command and Control Public Information Officer

• Coordinates all media functions of the dispensing
  site(s) in conjunction with the site manager and
  local EOC or Joint Information Center (JIC)

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Command and Control Operations Section Chief

• Responsible for overview of all clinical
  operations of the site.
• Triage
• Medical Screening and Consultation
• Briefing/Education
• Dispensing/Vaccination
• Behavioral Health Support
• Emergency Medical Services

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Command and ControlLogistics Section Chief

• Responsible for oversight of logistical
  operations of the site.
• Security
• Pharmacy and Supplies
• Communications

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Command and ControlAdministration/Finance
Section Chief

• Responsible for oversight or admin/finance
  operations of the site
• Data Administration
• Time/Cost
• Patient Flow

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Operations Section (Medical)
Operations Section Chief
Briefing/ Education Unit leader
Griage and Medical Screening Unit leader
Dispensing Vaccination Unit leader
Medical Consultation Unit leader
Briefing/ Education Staff
Greeting Triage Staff
Medical Screening Staff
Med Dispensing Vaccination Staff
Behavioral Health Specialist
Sick Evaluation and Holding
EMS Transport
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Duties Griage (Greeting/Triage) Unit

• Greet people coming to dispensing site
• Perform triage
• Determine patients status
• Direct symptomatic (ill) persons to appropriate
  treatment center
• May be located inside or outside

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Duties Briefing Unit

• Provide patient education on
• Agent
• Type of Prophylaxis to be received
• Importance of taking the regimen
• Clinic flow process

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Duties Medical Screening Unit

• Review patient medical history forms
• Screen patients for contraindications to
  medications being dispensed
• Refer patients to Medical Consultation if
  necessary

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Duties Medical Evaluation Unit

• Provide consultation for patients with
  contraindications
• Perform limited physical exam as necessary
• Prescribe alternate medications as necessary
• Determine appropriate medication dosage for
  children under 12 and adults weighing less than
  100 lbs.

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Duties Medication/Vaccination Unit

• Review patient history forms
• Ensure patient gets correct medication
• Dispense medication/vaccine
• Review directions for taking medications

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Duties Behavioral Health Unit

• Ensure emotional needs of patients are met
• Augment Griage and Screening functions
• Triage and Evaluate Clients Requesting/ needing
  special support
• Assist with referrals for follow-up
• Provide counseling and support to staff during
  site operations
• Aid the Operations Section Leader in screening
  for fatigue and stress reactions in staff
• Educate staff in to caring/screening clients with
  emotional issues

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Duties Sick Holding Unit

• Provides medical assessment for symptomatic or
  ill patients
• Provides care and comfort until transported to
  treatment center
• Arranges for transport of these patients to an
  appropriate treatment center

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Duties Emergency Medical Services

• Provides on site access to care for sudden
  medical emergencies
• Provides transport for ill patients to treatment
  center as needed

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Logistics Section Chief

• Responsible for all support needs of the site to
  include
• Security
• Supplies
• Communications

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Logistics Section
Logistics Section Chief Chief
Security Unit Leader Unit leader
Pharmacy /Supply Unit leader
Communications Unit leader
Pharmacy Supply staff
General Supply staff
Security staff
Communications staff
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Duties Security Unit

• Responsible for staff, patient, and supply
  security inside the dispensing site
• Responsible for staff and patient security
  outside the dispensing site
• Staffed by local, state or federal law enforcement

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Duties Pharmacy/Supply Unit

• Responsible for maintaining adequate quantities
  of medications being dispensed
• Responsible for ensuring all necessary supplies
  are in place and additional supply needs are
  filled in a timely manner.

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Duties Communications

• Responsible for development of site
  communications protocol
• Issues and tracks communication equipment in the
  site
• Facilitates site communication process

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Administration/Finance Section Chief

• Responsible for patient records, staffing levels,
  time accounting, patient flow and other
  administrative needs.
• Time and cost
• Data Entry
• Patient Flow
• Translation services
• Ambulatory assistance
• Registration and exit

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Administration/Finance Section
Administration/Finance Section chief
Data Administration Unit leader
Time/Cost Unit leader
Patient Flow Unit leader
Time/cost staff
Data Entry staff
Registration and Forms Distribution staff
Forms Collection and Check Out staff
Special Needs (interpreters, patient
assistance staff
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Duties Data Entry Unit

• Responsible for entry of all patient information
• Maintains all paper and electronic versions of
  data

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Duties Time and Cost Unit

• Responsible for logging all staff time during the
  event (paid and volunteer)
• Responsible for tracking all costs associated
  with site operations

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Duties Patient Flow Unit

• Responsible for foot traffic and patient flow
  through the dispensing site process
• Provide patients directions to stations,
  restrooms, etc.
• Responsible for all registration and exit
  processes of the site
• Responsible for special assistance required such
  as interpretation, sight and mobility assistance

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Just-in-Time Training

• Will consist of
• Brief overview of site operations
• Chain of command
• Job specific training and job descriptions
• Resources needed for completing tasks

Photo courtesy of Eastern Shore HD drill 3/18/04
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Anthrax facts

• Anthrax is not contagious.
• Symptoms appear within 1-7 days after breathing
  in the spores.
• Onset of symptoms may be like those of the common
  cold or flu.
• Inhalation anthrax can be successfully treated.

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Non-Communicable Disease Dispensing Site Flow Plan
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Station 1 Greeter/Triage (Griage)

• Greet people entering the dispensing site
• If available, hand out information to patients
  waiting in line
• Contact special needs station for people needing
  mobility, sight or language assistance
• Direct patients who have been exposed to
  registration
• Give people not exposed a disease fact sheet,
  review reasoning for no need to treat and direct
  to exit

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Station 2Registration

• Distribute forms, pens and clipboards
• Direct patient to appropriate area for completing
  forms
• Instruct patients on which parts of forms to fill
  out
• Assist patients with reading, writing, or
  understanding the forms
• Direct patients with completed forms to
  Briefing/Education station
• NOTE Remember Do Not answer medical questions

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Station 3Briefing/Education

• Review disease and medication fact sheets
• If available run video
• Note
• in high flow periods do not start the briefing
  until the area is full
• Timing of briefings should be adjusted based on
  the line at forms review. If there is no line at
  forms review briefings should be held as patients
  arrive.
• Reminder Do Not answer medical questions unless
  you have approval from your unit leader
• Direct patients to next available forms reviewer

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Station 4Forms Review

• Review medical history forms for completeness,
  and assist if necessary
• Direct patients with all NOs to Dispensing
• Direct patients with any YESs to Medical
  Screener
• Direct family groups with children 12 yrs or
  under to Medical Evaluation
• Reminder- Do not answer medical questions

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Station 5Medical Screening

• Review all responses on medical history form
• Refer any questionable history, unusual
  allergies, etc., to Medical Evaluation
• Ensure patient is informed, has consented to
  treatment, and has signed the form
• Indicate appropriate medication on the form
• Direct to Medication Dispensing

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Station 6Medical Evaluation

• Obtain weights and ages of children 12 years or
  under
• Determine appropriate medication and dosage based
  upon age and weight
• For adults/children with questionable history,
  unusual allergies, etc. determine if medication
  should be recommended.
• If to receive medication determine drug of choice
  for history
• If recommend alternate medication-indicate which
  drug to be dispensed
• Direct to dispensing station or if deferred for
  treatment direct to forms collection/exit review

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Station 7Medication Dispensing

• Deliver appropriate medication as prescribed
• Give clear, understandable directions for taking
  medication
• Advise patient of any potential side effects of
  medication being dispensed
• Emphasize any special instructions for taking
  medication
• Answer any additional questions
• Advise patient of whom/when to call if signs and
  symptoms of illness develop
• Record the lot , medication name, strength, and
  of pills on the patient form
• Direct patient to forms collection/exit review

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Station 8Forms Collection/Exit Review

• Ensure patient has necessary paperwork to take
  home
• Make sure patients questions were answered
• Collect the medical history form
• Ensure patient has appropriate phone numbers for
  follow-up
• Ensure patient has a follow up appointment if
  indicated
• Thanks the patient and direct to exit