Mass Antibiotic Dispensing:
Streamlining POD Design and Operations
Originally aired
CDC
0414.05
>>>
CDC, OUR PLANNERS AND OUR PRESENTERS WISH TO
DISCLOSE
THEY HAVE NO FINANCIAL INTEREST OR OTHER RELATIONSHIP
WITH
THE MANUFACTURERS OF COMMERCIAL PRODUCTS, SUPPLIERS OF
COMMERCIAL SERVICES OR COMMERCIAL SUPPORTERS.
PRESENTATIONS
WILL NOT INCLUDE ANY DISCUSSION OF THE UNLABELED
USE OF A PRODUCT OR A PRODUCT UNDER INVESTIGATIONAL USE.
>>>
WELCOME TO THE THIRD SATELLITE BROADCAST IN OUR MASS
DISPENSING SERIES.
THE
FIRST PROGRAM WAS A PRIMER THAT COVERED GENERAL CONCEPTS OF
MASS ANTIBIOTIC DISPENSING.
THE
SECOND PROGRAM ADDRESSED RECRUITING, TRAINING, AND
MAINTAINING VOLUNTEERS.
THIS
BROADCAST WILL PROVIDE YOU IMPORTANT INFORMATION FOR
STREAMLINING
AND IMPROVING THE OPERATION OF POINTS OF DISPENSING, OR PODS.
YOU
MIGHT WONDER WHY THIS IS NECESSARY.
WELL, A
TERRORIST ATTACK USING THE ANTHRAX BACTERIUM OR THE
SMALLPOX
VIRUS WITHIN A DENSELY POPULATED AREA COULD REQUIRE THAT
HUNDREDS
OF THOUSANDS OF PEOPLE -- MAYBE MILLIONS -- RECEIVE
ANTIBIOTICS OR VACCINATIONS AS QUICKLY AS POSSIBLE.
FOR
EXAMPLE, THE 21 MAJOR METROPOLITAN AREAS PARTICIPATING IN THE
PILOT
PHASE OF THE CITIES READINESS INITIATIVE, OR CRI, SEEK TO
BE ABLE
TO DISTRIBUTE ANTIBIOTICS TO THEIR ENTIRE POPULATIONS IF
NECESSARY WITHIN 48 HOURS OF DECIDING TO DO SO.
THIS IS
A FORMIDABLE CHALLENGE, AND TO MEET IT, WE MUST FIND WAYS
TO DELIVER MASS PROPHYLAXIS MORE RAPIDLY THAN EVER BEFORE.
THIS
BROADCAST HAS BEEN PRODUCED TO SHARE SOME STRATEGIES TO DO
JUST THAT.
TO
ACHIEVE THE SPEED WE NEED WE MUST EXAMINE ALL ASPECTS OF THE
MASS
DISPENSING CAMPAIGN, INCLUDING NONTRADITIONAL STRATEGIES
THAT USE
MASS MEDIA AS THE FIRST LEVEL OF TRIAGE.
THEREBY,
SPREADING TO THE MASCULINICS THOSE WHO ARE WELL, BUT
POTENTIALLY
AT RISK AND DIRECTING TO HOSPITALS THOSE WHO HAVE
BECOME
ILL.
ANOTHER
STREAMLINING POSSIBILITY IS THE ELIMINATION OF SOME OF
THE
STATIONS WITHIN THE PODs THAT CAUSE THE GREATEST
BOTTLENECKS
AND LONGEST CUES.
WE'LL
HEAR HOW A CLOSER COLLABORATION WITH LAW ENFORCEMENT DURING
THE
RUNG OF PODs ASK INCLUDES THROUGHPUT, WHILE THE
POSSIBILITY
OF PANIC AND DISORDER.
THESE
STREAMLINING TECHNIQUES WILL HELP US MAXIMIZE EFFICIENCY,
AND
CONSEQUENTLY, EFFECTIVENESS, IN BOTH THE SETUP AND THE
OPERATION OF OUR PODS.
IN
TODAY'S BROADCAST, WE'LL EXAMINE TWO HIGH THROUGHPUT CLINIC
MODELS
THAT WILL HELP US MOVE TOWARD A SUCCESSFUL 48-HOUR PODS SCENARIO.
FIRST,
WE'LL LOOK AT THE STATE OF
PUBLIC
HEALTH OFFICIALS THERE PUT TOGETHER A LARGE POD EXERCISE
USING THE SMALLPOX MODEL WHILE ACTUALLY GIVING FLU VACCINATIONS.
BUT
THREE DAYS BEFORE THE CLINIC WAS TO OPEN, THEY LEARNED THEY'D
HAVE TO
SWITCH SITES.
AND TWO
DAYS BEFORE THE OPENING, CDC MADE THE ANNOUNCEMENT ABOUT
THIS SEASON'S FLU VACCINE SHORTAGE.
IN
SPITE OF THESE LAST-MINUTE OBSTACLES, THE
GREAT
SUCCESS BECAUSE ITS LEADERS HAD PLANNED FOR
ADAPTABILITY,
AND
THEIR PLANS INCLUDED SEVERAL SUCCESSFUL METHODS TO STREAMLINE
AND
IMPROVE THEIR POD.
SECOND,
WE'LL TURN TO
MOST
POPULATED
A BUSY
WORKDAY CAN SEE UP TO 6 MILLION PEOPLE IN
SURROUNDING MUNICIPALITIES.
IT'S A
STAGGERING NUMBER OF PEOPLE TO CONSIDER SENDING THROUGH
THE
PODS, BUT WE'LL HEAR ABOUT STRATEGIES FOR MAKING IT WORK.
AND
WE'LL LEARN TOGETHER HOW TO BEST APPLY THOSE PRACTICES IN
YOUR CITY AND STATE.
I'VE
SAID BEFORE THAT WE HOPE THERE'S NEVER A NEED TO PUT THESE
PLANS INTO USE.
BUT IN
HOPING FOR THE BEST, WE MUST PREPARE FOR THE WORST.
THIS
BROADCAST IS DESIGNED TO HELP YOU PREPARE BY PROVIDING
PRACTICAL
FIELD TEST AND STRATEGIES TO IMPROVE YOUR ABILITY TO
PROTECT
THE PUBLIC FROM HARM.
BY
COLLABORATING CLOSELY ACROSS ALL LEVELS OF GOVERNMENT
GOVERNMENT
-- LOCAL, STATE AND FEDERAL, WE WILL BE PREPARED FOR
THE WORST.
AND OUR
FAMILY, FRIENDS, AND NEIGHBORS WILL BE THE BENEFICIARIES
OF OUR DILIGENCE.
>>
HELLO, AND WELCOME TO THIS INTERACTIVE SATELLITE BROADCAST,
"MASS ANTIBIOTIC DISPENSING STREAMLINING OPERATIONS."
I'M JOE
WASHINGTON, YOUR MODERATOR FOR THIS PROGRAM, AND WE'RE
COMING
TO YOU LIVE FROM THE CENTERS FOR DISEASE CONTROL AND
PREVENTION IN
THANK
YOU, DR. RAUB, FOR FRAMING THE ISSUE WE'LL BE EXAMINING TODAY.
WE'RE
TAKING A CLOSE LOOK AT TWO DIFFERENT POD DESIGNS FROM
DIFFERENT PERSPECTIVES.
IN BOTH
WE'LL LEARN ABOUT SUCCESSFUL METHODS THEY'VE EMPLOYED TO
STREAMLINE
THEIR POINTS-OF-DISPENSING.
THE
DISPENSING PROCESS WOULD OCCUR IN THE EVENT OF A BIOTERRORISM
ATTACK,
WHEN LIFE-SAVING PHARMACEUTICALS, ANTIDOTES, MEDICAL
SUPPLIES
AND EQUIPMENT WOULD BE DISTRIBUTED IN TIME TO PREVENT
ILLNESS
AND SAVE LIVES.
THE
CDC'S DIVISION OF STRATEGIC NATIONAL STOCKPILE, OR DSNS, IS
CHARGED
WITH THE
ALL OF THESE MATERIALS IN THE EVENT OF AN EMERGENCY.
DSNS
ASSETS CAN REACH ANY AREA IN THE COUNTRY WITHIN 12 HOURS OR
LESS
FROM THE FEDERAL DECISION TO DEPLOY, EVEN IF THERE ARE
MULTIPLE EVENTS.
STATE
AND LOCAL PLANNERS HAVE TO BE READY TO PROVIDE MEDICATION
TO THE
COMMUNITY WHEN THOSE SHIPMENTS ARRIVE.
AND THEY
NEED TO DO IT IN TIME TO PROTECT PEOPLE WHO HAVE NOT YET
BEEN AFFECTED.
AS DR.
RAUB SAID, THAT WINDOW OF TIME COULD BE AS SHORT AS 48
HOURS.
SO WE
FACE A CHALLENGING TASK.
BUT WE
BELIEVE IT CAN BE DONE, AND TODAY WE'LL TALK ABOUT HOW.
WE
WELCOME YOU, ALONG WITH OTHER KEY MEMBERS OF YOUR PLANNING
TEAM, TO THIS BROADCAST.
TODAY
WE'LL TALK WITH DR. JACQUELYN MASON, THE CDC'S RESIDENT
EXPERT ON STREAMLINING POD SETUP AND OPERATIONS.
DR.
MASON, YOU'RE HERE TO TELL US THAT WE CAN LOOK TO INDUSTRIAL
ENGINEERING CONCEPTS FOR SOME GOOD IDEAS.
YES, WE
CAN LEARN A
IT
PASSES ALONG WITHOUT MISSING A BEAT, BUT IT'S MOVING PRODUCTS,
NOT
PEOPLE.
WE
CAN'T BE AS FAST AS A MECHANIZED ASSEMBLY LINE, AND WE
WOULDN'T
WANT TO BE, BUT WE CAN IMPROVE OUR NUMBER OF PATIENTS PER HOUR.
WE CAN
DO IT BY TAILORING THE TECHNIQUES OF INDUSTRY, WHILE
KEEPING
IN MIND THAT WE'LL BE DEALING WITH GREAT NUMBERS OF
WORRIED
PEOPLE WHO DESERVE A PATIENT AND PROFESSIONAL POD
WORKFORCE.
>>
THANKS, DR. MASON, AND WE'LL HEAR FROM DR. WILLIAM HACKER, THE
COMMISSIONER OF THE KENTUCKY DEPARTMENT FOR PUBLIC HEALTH.
DR.
HACKER, IT SOUNDS LIKE YOU CONDUCTED YOUR POD EXERCISE IN
SPITE OF SOME BIG OBSTACLES.
>>
WELL, YOU HAVE TO PLAN FOR ANYTHING AND EVERYTHING.
BUT
EVEN SO, WE COULDN'T HAVE ANTICIPATED THAT WE'D FACE THE
PARTICULAR CHALLENGES THAT WE DID.
BUT
THAT'S ONE OF THE WAYS YOU GET PREPARED, YOU DEVELOP STRONG
PARTNERSHIPS IN ADVANCE.
WE IN
PUBLIC HEALTH WERE FORTUNATE TO HAVE GREAT PARTNERS IN
LOCAL
AND STATE LAW ENFORCEMENT, AS WELL AS WITH EMERGENCY
MANAGEMENT OFFICIALS AND OUR ELECTED OFFICIALS.
WE ALL
WORKED IT OUT TOGETHER.
>>
THANKS, DR. HACKER.
WE'RE
LOOKING FORWARD TO HEARING HOW YOU PULLED IT OFF.
AFTER
WE HEAR ABOUT
PROGRAM, AND NOT JUST ANY COUNTY, BUT ONE OF THE BIGGEST IN THE
NATION.
DR.
MATT MINSON IS HEAD OF EMERGENCY MANAGEMENT AND MEDICAL
REVIEW
IN
DR.
MINSON, THE IDEA OF PROVIDING PRETREATMENT TO MORE THAN 5
MILLION
PEOPLE IS ALMOST MIND-BOGGLING!
>>
WELL, AS DR. HACKER SAID, YOU JUST HAVE TO PLAN FOR IT.
I
ADMIT, WE FACE A LARGE CHALLENGE, BUT WE DEVELOPED PLANS IN
ADVANCE
TO SMOOTH OUT ALL THE ROUGH SPOTS WE COULD THINK OF.
WE KNEW
ONE TASK WOULD BE TO FIND ENOUGH PEOPLE TO STAFF ALL THE
PODS
WE'D NEED.
WE ALSO
NEEDED TO
EFFECTIVELY
WITH THE MANY PEOPLE WHO'D BE COMING THROUGH THE PODS.
>>
THANKS, DR. MINSON, WE'RE LOOKING FORWARD TO HEARING MORE
ABOUT
YOUR
EXPERIENCE
IN
I WANT
TO THANK ALL OF YOU FOR TAKING TIME OUT OF YOUR SCHEDULES
TO JOIN US TODAY.
IN THIS
PROGRAM, WE'LL HEAR FROM OUR PRESENTERS ABOUT SPECIFIC
WAYS TO
INCREASE THE NUMBER OF PATIENTS PER HOUR, OR PPH, BY
IMPROVING THE PROCESSING OF PATIENTS THROUGH A POD.
TOWARD
THE END OF THE BROADCAST, WE'LL LIST RESOURCES FOR MORE
INFORMATION,
AND GATHER EVERYONE TOGETHER FOR AN IMPORTANT
QUESTION AND ANSWER SESSION.
NOW LET'S LOOK AT THE OBJECTIVES FOR THIS PROGRAM.
AFTER
VIEWING THIS BROADCAST, YOU SHOULD BE ABLE TO --
LIST
THE GOALS OF A MASS ANTIBIOTIC PROPHYLAXIS POD.
IDENTIFY
THREE METHODS FOR INCREASING POD EFFECTIVENESS AND
EFFICIENCY.
IDENTIFY
DEFINE
"BALANCING THE LINE."
AND
DETERMINE ONE METHOD FOR EVALUATING PROGRESS.
BEFORE
WE GET UNDERWAY, IF YOU'RE HAVING TECHNICAL DIFFICULTIES
DOWN
LINKING OUR SIGNAL, CALL US RIGHT AWAY AT --
1-800-728-8232.
THAT'S
1-800-728-8232.
THIS
PROGRAM CAN ALSO BE ACCESSED THROUGH THE PUBLIC HEALTH
TRAINING
NETWORK WEBSITE AFTER TODAY THROUGH AN ARCHIVED WEB
CAST, AS WELL AS ON VIDEOTAPE AND CD-ROM WITHIN A FEW WEEKS.
SPECIFIC
INFORMATION IS AVAILABLE ON THE PROGRAM WEBSITE.
A
LISTING OF THE DSNS SERVICES CONSULTANTS CAN ALSO BE DOWNLOADED
FROM THIS WEBSITE.
AS I
MENTIONED AT THE TOP OF THIS PROGRAM, THIS IS AN INTERACTIVE
BROADCAST.
WE
WELCOME YOUR QUESTIONS ABOUT THE TOPICS PRESENTED TODAY.
THE
LIVE QUESTION AND ANSWER SESSION WILL HAPPEN RIGHT BEFORE THE
CONCLUSION
OF TODAY'S PROGRAM, BUT I'M GOING TO GIVE OUT THOSE
PHONE
NUMBERS NOW SO YOU'LL HAVE THEM READY FOR THE Q AND A.
WE CAN
TAKE YOUR QUESTIONS BY PHONE, FAX, AND TTY SERVICE.
FOR
REGULAR VOICE CALLS, THE NUMBER IS --
800-793-8598.
YOU CAN
FAX YOUR QUESTION OR COMMENT TO US AT --
800-553-6323.
AND
FINALLY, OUR TTY NUMBER IS --
800-815-8152.
PLEASE
REMEMBER THAT THESE PUBLIC HEALTH TRAINING NETWORK NUMBERS
ARE
ANSWERED ONLY DURING PHTN SATELLITE BROADCASTS, SO PLEASE DO
NOT
ATTEMPT TO USE THEM AT OTHER TIMES.
REMEMBER,
IF YOU'RE VIEWING THIS PROGRAM ON ANY DAY OTHER THAN
NOW LET'S TALK BRIEFLY ABOUT SOME OF THE TERMS WE'LL BE USING
TODAY.
TO
GUIDE US, WE GO BACK TO DR. JACQUELYN MASON, WHO IS AN
INDUSTRIAL
ENGINEER IN THE ENVIRONMENTAL PUBLIC HEALTH READINESS
BRANCH AT THE
DR.
MASON, WALK US THROUGH THE TERMS AND THEIR DEFINITIONS SO
THAT WE
ALL UNDERSTAND WHAT WE'RE TALKING ABOUT.
>>
THANKS, JOE.
THE
MOMENTS AGO.
PPH, OR
"PATIENTS PER HOUR," IS PRETTY SELF-EXPLANATORY, AS IT
DESCRIBES
THE NUMBER OF PERSONS WHO ARE SUCCESSFULLY PUT THROUGH
THE POD IN ONE HOUR'S TIME.
WE'RE
TALKING TODAY ABOUT WAYS TO INCREASE THIS NUMBER.
"EFFECTIVENESS"
DESCRIBES HOW WELL A PROGRAM OR SERVICE IS ABLE
TO MEET ITS STATED GOALS AND OBJECTIVES.
LET'S
SAY A REALISTIC GOAL IS TO PROVIDE PROPHYLAXIS TO 95% OF
THE TARGET POPULATION WITHIN 48 HOURS, AND WE GET ANTIBIOTICS TO
92%.
WE MIGHT
DEEM THIS CAMPAIGN TO BE EFFECTIVE, SINCE WE REACHED 97%
OF OUR GOAL.
NOTE
THAT "EFFECTIVENESS" IS OFTEN QUALITATIVELY DETERMINED.
"EFFICIENT"
MEANS TO ACCOMPLISH A TASK WITH A MINIMUM OF EFFORT
AND
WASTE.
IN THE
CONTEXT OF MANAGING A POD, HAVING EFFICIENT OPERATIONS
MIGHT
MEAN THAT POD WORKERS ARE KEPT BUSY PERFORMING THEIR
DESIGNATED
TASKS, OR THAT CLIENT MOVEMENT THROUGH THE POD IS KEPT
AT A RELATIVELY CONSTANT LEVEL.
"EFFICIENCY"
IS THE RATIO OF OUTPUTS TO INPUTS.
IT'S
CALCULATED AS A PERCENTAGE AND IS DETERMINED USING THIS
SIMPLE FORMULA AS SHOWN HERE.
SAY,
THAT, BASED ON PREVIOUS OBSERVATIONS, YOU KNOW THAT A POD
SHOULD TYPICALLY PROVIDE PROPHYLAXIS TO 100 PEOPLE PER HOUR.
"100
PEOPLE PER HOUR" BECOMES YOUR INPUT.
IF A
POD ACTUALLY SERVES 75 PEOPLE PER HOUR, THEN THAT NUMBER
BECOMES YOUR OUTPUT.
THE
LABOR EFFICIENCY OF THIS SPECIFIC POD IS 75%.
"THROUGHPUT"
IS A TERM DESCRIBING THE NUMBER OF PATIENTS THAT CAN
BE
SERVICED IN THE POD SYSTEM, OR PORTION THEREOF, DURING A
SPECIFIED
PERIOD OF TIME, WHEN THE SYSTEM IS WORKING AT FULL CAPACITY.
LINE
BALANCING-ASSIGNING TASKS AMONG WORKERS THAT AN ASSEMBLY
LINE IS
FACE STATIONS SO THAT PERFORMANCE TIMES ARE MADE AS EQUAL
AS POSSIBLE.
THE
IDEA IS TO MINIMIZE IDLE TIME.
BALANCING
THE LINE IS AN ONGOING PROCESS AND MAY REQUIRE ADDING,
SUBTRACTING,
OR MOVING WORKERS AROUND WITHIN THE POD.
>>
THANKS FOR THAT, DR. MASON.
IN
LIGHT OF NEW INFORMATION ON BIOTERRORISM, PARTICULARLY
ANTHRAX,
WE KNOW THAT COMMUNITIES OF ALL SIZES ARE ENCOURAGED TO
WORK
TOWARD THE GOAL OF PROVIDING PROPHYLAXIS FOR THE TOTAL
POPULATION IN 48 HOURS.
TO DO
THIS, STATE AND LOCAL PLANNERS MUST UTILIZE NEW WAYS TO SEE
MORE
PATIENTS IN LESS TIME, WHILE STILL ADHERING TO CERTAIN
STANDARDS OF MEDICAL CARE.
SIMPLY
PUT, WE NEED TO PUT PILLS IN MORE PEOPLE IN LESS TIME.
THIS
BROADCAST HAS BEEN PRODUCED TO SHARE SOME STRATEGIES TO HELP DO THAT.
NOW
THAT WE'VE ESTABLISHED WHAT WE NEED TO DO, LET'S GET DOWN TO
THE
WHAT DO
WE NEED TO KNOW FIRST?
>>
THERE ARE TWO AREAS WHERE IMPROVEMENTS TO STREAMLINE THE
PROCESS
CAN BE MADE --
IN SETTING UP THE PODS AND IN OPERATING THE PODS.
FIRST,
LET'S TALK ABOUT THE SET-UP OF THE PODS.
WHAT
WE'RE LOOKING AT IS A MASS DISPENSING APPROACH THAT IS VERY
CLOSE TO THE CONCEPT OF MASS PRODUCTION IN THE MANUFACTURING
INDUSTRY.
THERE
ARE CERTAIN PRINCIPLES AND PRACTICES THAT PERTAIN TO
INDUSTRIAL
ENGINEERING THAT ARE GERMANE TO THE DESIGN OF PODS.
SO
WE'RE ADOPTING LESSONS LEARNED FROM INDUSTRIAL ENGINEERING,
WHERE
WE CAN GLEAN IMPORTANT LESSONS ABOUT HIGH VOLUME
PRODUCTION.
WE CAN
ADAPT SIMPLE ASSEMBLY LINE CONCEPTS TO POD SET-UP AND
DESIGN
THAT WILL IMPROVE EFFICIENCY, INCREASE THROUGHPUT AND SAVE
LIVES
AND PREVENT ILLNESS IN THE PROCESS.
>>
SO WE CAN SPEED UP THE NUMBER OF PATIENTS PER HOUR THROUGH
CHANGES IN SET-UP, BUT ALSO THROUGH OPERATION?
>>
YES, WE CAN MAKE IMPROVEMENTS ON BOTH FRONTS -- THROUGH HOW WE
DESIGN
THE PHYSICAL LAYOUT OF THE POD ITSELF AND THROUGH HOW WE
MAKE
THE POD WORK.
FOR
EXAMPLE, IF A POD IS DESIGNED SO THAT PATIENT FLOW MOVES IN
PARALLEL,
OR MULTIPLE LINES, RATHER THAN IN A SINGLE LINE TO ONE
OR MORE
STATIONS, THAT'S LIKELY TO INCREASE THROUGHPUT RATE.
ON THE
OTHER HAND, THERE ARE A NUMBER OF THINGS THAT CAN BE DONE
OPERATIONALLY
THAT WILL IMPACT THE NUMBER OF PATIENTS TREATED PER
HOUR,
AND WE'LL GET TO THAT IN A MOMENT.
>>
OKAY, FIRST LET'S START WITH THE DESIGN.
WHAT DO
WE NEED TO KNOW ABOUT IMPROVING THE POD SET-UP?
>>
TO UNDERSTAND WHERE TO MAKE THE IMPROVEMENTS THAT WILL
INCREASE
THE PPH, WE NEED TO LOOK FIRST AT THE TRADITIONAL
MEDICAL MODEL.
THIS
REPRESENTS THE GENESIS OF POD DESIGN.
THIS
MODEL IS BASED ON MEDICAL INTERVENTION OR TREATMENT BEING
CONDUCTED BY PHYSICIANS OR THEIR TRAINED ASSISTANTS.
SEVERAL
ASSUMPTIONS UNDERLIE THE MEDICAL MODEL.
THE
FIRST IS THAT EACH INDIVIDUAL IS UNIQUE, THEREFORE THE
TREATMENT
GIVEN SHOULD BE BASED ON A PERSONALIZED MEDICAL
EVALUATION,
EVEN WHEN THERE ARE ONLY ONE OR TWO TREATMENT OPTIONS
AVAILABLE.
THE
SECOND IS THAT THERE ARE FEW OR NO CONSTRAINTS IN THE TYPE OF
MEDICAL
STAFF AS WELL AS NO TIME CONSTRAINTS ON CONDUCTING
MEDICAL EVALUATIONS OR TREATMENTS.
THE
THIRD ASSUMPTION OF THE MEDICAL MODEL OF POD DESIGN IS THAT
MEDICAL
PROFESSIONALS HAVE THE NECESSARY TRAINING TO PROVIDE
MEDICAL CARE BASED ON CURRENT, BEST MEDICAL PRACTICES.
THE
MEDICAL MODEL IS WHAT'S TYPICALLY USED IN A TRADITIONAL
CLINICAL SETTING.
FRANKLY,
IT'S WHAT WE'RE USED TO, AND IT'S WHAT MOST OF US ARE
MOST COMFORTABLE WITH.
BUT IF
THE NUMBER OF PEOPLE NEEDING TREATMENT INCREASES
DRAMATICALLY,
AS COULD BE THE CASE IN A BIOTERRORISM ATTACK OR
OTHER
MAJOR DISASTER, THEN THE MEDICAL MODEL COULD BE
OVERWHELMED.
AND OF
COURSE THERE WOULD BE SIGNIFICANT CONSTRAINTS ON THE
NUMBER
OF TRAINED MEDICAL STAFF AVAILABLE TO PERFORM EVALUATIONS
AND
ADMINISTER TREATMENT.
REMEMBER,
THE APPROACH WE'D NORMALLY USE --
THE
THOROUGH, INDIVIDUAL-BASED, MEDICAL PRACTICE APPROACH -- IS
NOT
PRACTICAL IN DISASTER SITUATIONS INVOLVING MASS CASUALTIES
AND
MASS NUMBERS OF PEOPLE NEEDING PREVENTIVE TREATMENT.
TODAY
WE'RE TALKING ABOUT TWEAKING THAT APPROACH SO THAT IT'S
BETTER SUITED FOR A MASS PREVENTION EVENT.
>>
SO NOW WE'RE MOVING AWAY FROM THE TRADITIONAL MEDICAL MODEL TO
A MODIFIED VERSION THAT'S GOING TO WORK FASTER.
AND IF
I UNDERSTAND YOU CORRECTLY, WE MIGHT HAVE TO SHORTEN THE
SCREENING
PROCESS AND MAKE THE MEDICAL EVALUATIONS BRIEFER.
THAT'S
A CAUSE FOR SOME CONCERN, ISN'T IT?
>>
THE INTENTION IS NOT TO GIVE ANY PATIENT SHORT SHRIFT.
THE
CORE ISSUE HERE IS THAT A FAILURE TO MODIFY THE TRADITIONAL
MEDICAL
MODEL IS LIKELY TO RESULT IN LARGE NUMBERS OF PEOPLE NOT
RECEIVING
PRETREATMENT IN TIME TO BE SAFE.
REMEMBER,
WE'RE TALKING ABOUT AN EMERGENCY MASS PREVENTION EFFORT.
IT'S
VITAL THAT EVERY PERSON WHO NEEDS PRE-TREATMENT GETS IT.
THE
ONES WHO DON'T COULD DIE.
IN THAT
LIGHT, IT MAY BE PREFERABLE TO SLIGHTLY INCREASE
INDIVIDUAL
RISK BY SHORTENING TRIAGE AND CONDUCTING MORE CURSORY
MEDICAL
EVALUATIONS TO REDUCE OVERALL RISK IN THE POPULATION AS A WHOLE.
>>
SO ARE YOU TALKING ABOUT A COMPLETE OVERHAUL OF EXISTING POD
DESIGN AND OPERATION?
>>
ABSOLUTELY NOT.
THERE'S
NO NEED FOR AN OVERHAUL BECAUSE OUR PODS HAVE ALREADY
BEEN
MOVING IN THAT DIRECTION --
THAT
IS, AWAY FROM THE TRADITIONAL MEDICAL MODEL.
IN
FACT, I'D SAY THAT MOST OF THE PODS WE'VE DEVELOPED AND
TRAINED
WITH UNTIL NOW HAVE NOT BEEN STRICT TRADITIONAL MEDICAL
MODELS AT ALL.
WE'VE
BEEN STREAMLINING TO SOME DEGREE ALREADY.
SO
INSTEAD OF LOW-FLOW TRADITIONAL MODELS WHICH WERE DESIGNED TO
SERVICE
INDIVIDUALS, WE HAVE BEEN USING WHAT WE MIGHT CALL
MEDIUM-FLOW
MODELS --
A
MODIFIED MEDICAL MODEL SUCH AS WAS USED IN THE 2001 ANTHRAX ATTACKS.
WHAT
WE'RE TALKING ABOUT TODAY IS FURTHER MODIFYING THAT MODEL TO
TAKE US
TO A HIGH-FLOW POD MODEL CAPABLE OF TREATING VERY LARGE
NUMBERS OF PATIENTS.
>>
IT'S CLEAR FROM WHAT YOU'RE SAYING THAT WE'RE TALKING ABOUT A
PARADIGM SHIFT.
IT'S A
VERY DIFFERENT APPROACH, ISN'T IT?
>>
YES, IT IS, BUT THE SHIFT IS NECESSARY.
IN
CLINICAL MEDICINE, YOU HAVE
PATIENTS, EVEN DURING AN EMERGENCY.
BUT
THERE ARE DIFFERENT RULES IN A MASS CASUALTY SITUATION.
YOU
SIMPLY DON'T HAVE THE TIME OR RESOURCES TO DO IT THAT WAY.
WE NEED
TO MAKE THE DISTINCTION BETWEEN MEDICAL PRACTICE AND MASS
PROPHYLAXIS.
PUBLIC
HEALTH DOESN'T USUALLY@ THINK IN TERMS OF A MASS
PREVENTION
INITIATIVE, SO IT'S AN EFFORT TO SHIFT FROM THINKING
ABOUT
THE
UNDERLYING INTENT FOR BOTH IS STILL PREVENTION.
>>
THAT'S A KEY POINT.
EVEN
THOUGH OUR APPROACH TO DESIGNING AND OPERATING PODS IS
SHIFTING,
THE GOAL IS TO PREVENT DISEASE AND DEATH, JUST AS IT IS
IN OUR DAILY PUBLIC HEALTH WORK.
>>
OKAY, LET'S START BY TAKING A LOOK AT THE MODEL WE'VE
USED
UNTIL NOW.
>>
THIS IS A GENERIC POD MODEL THAT CONTAINS MANY OF THE CONCEPTS
ASSOCIATED WITH THE TRADITIONAL MEDICAL MODEL.
THE
STATIONS SHOWN HERE ARE GENERALLY REPRESENTATIVE OF A POD
SET-UP
WHEN THERE ARE A CONSIDERABLE NUMBER OF PEOPLE TO BE
TREATED
AND THERE ARE ADEQUATE RESOURCES, MOSTLY HEALTH STAFF, TO
OPERATE
THE CLINIC OR CLINICS.
THE
STATIONS ARE --
NUMBER
ONE, TRIAGE --
WHERE,
AS THEY MIGHT SAY IN INDUSTRIAL ENGINEERING, ALL THE
SORTING
HAPPENS.
IN OUR
CASE, IT'S DETERMINING IF THE PEOPLE WHO ARRIVE FOR
TREATMENT ARE IN THE PLACE THEY NEED TO BE.
THE
NEXT STATION, NUMBER TWO, IS PICK-UP FORMS AND INFORMATION SHEETS.
THEN,
ON TO NUMBER THREE --
ORIENTATION.
STATION
NUMBER FOUR IS FILLING OUT THE FORMS.
NUMBER
5 IS THE INITIAL MEDICAL SCREENING.
THIS IS
ACTUALLY THE SECOND SCREENING OF THE PROCESS, BUT IT'S
THE FIRST MEDICAL SCREENING.
PATIENTS
CAN THEN GO ON TO STATION 6, YET ANOTHER MEDICAL
SCREENING WHERE THEY MIGHT BE SENT DIRECTLY TO A HEALTHCARE
FACILITY.
OR BE
SENT DIRECTLY TO STATION SEVEN, QUALITY ASSURANCE REVIEW,
IN
WHICH A TRAINED PROFESSIONAL LOOKS OVER THE PATIENT'S
PAPERWORK
TO ENSURE THAT EVERYTHING IS PROPERLY SIGNED AND MAKES
SURE
THE PATIENT HAS BEEN PROPERLY CLEARED TO RECEIVE THE
PROPHYLAXIS.
AND
THEN ON TO GET THEIR MEDICATION AT STATION EIGHT.
AND
FINALLY TO NINE, THE LAST STATION, WHERE TRACKING INFORMATION
IS
COMPLETED AND THE PATIENT EXITS.
ALTHOUGH
THIS GENERIC MODEL CONTAINS MANY OF THE ELEMENTS OF A
TYPICAL
POD, I AM IN NO WAY SUGGESTING THAT IS THE ONLY WAY PODS
HAVE BEEN DESIGNED.
>>
LET'S LOOK FOR A MOMENT AT A LIST OF THE FUNCTIONS YOU'VE JUST
DESCRIBED.
WHAT
ARE SOME DIFFERENCES BETWEEN THE LOW-FLOW AND MEDIUM-FLOW MODELS?
>>
ONE DIFFERENCE HAS TO DO WITH THE NUMBER AND TYPE OF PEOPLE
WHO
STAFF THE RESPECTIVE CLINICS.
IN THE
LOW-FLOW MODEL, ONE OR TWO HIGHLY TRAINED PROFESSIONALS,
FOR
EXAMPLE A PHYSICIAN OR NURSE PRACTITIONER AND PHYSICIAN'S
ASSISTANT,
PERFORM ITEMS 1, 2, 4, AND 5.
IN THE
MEDIUM-FLOW MODEL, EACH OF THESE FUNCTIONS MAY BE CARRIED
OUT BY
DIFFERENT PEOPLE, SOME OF WHICH ARE TRAINED MEDICAL
PROFESSIONALS
AND SOME WHO ARE LIKELY TO BE NON-MEDICAL STAFF,
OFTEN VOLUNTEERS.
IN THE
TERMS OF INDUSTRIAL ENGINEERING, THE SERVICE PROCESS OF
TREATING
A PATIENT HAS UNDERGONE A DIVISION OF LABOR.
IT'S
BEEN DIVIDED INTO SEVERAL SMALLER JOBS, SO THAT IDENTIFIABLE
TASKS
CAN BE PERFORMED BY INDIVIDUAL WORKERS IN A REPETITIVE
FASHION, MUCH LIKE WORKERS ON AN ASSEMBLY LINE.
CLEARLY,
THE SKILL SET REQUIRED BY EACH INDIVIDUAL STAFF AT EACH
STATION
IN THE MEDIUM FLOW MODEL IS LESS THAN WHAT IS REQUIRED IN
THE CLINICAL MODEL.
>>
LET'S GO BACK TO THE ASSEMBLY LINE ANALOGY TO IDENTIFY SEVERAL
IMPORTANT IDEAS FOR MAKING PODS MORE EFFICIENT.
>>
FIRST, THE POD SHOULD BE SETUP TO DISPENSE MEDICATIONS TO ALL
WHO
NEED IT USING AS FEW STAFF AS REASONABLY REQUIRED.
SO WE
WANT THE STAFF TO BE ABLE TO ADEQUATELY PERFORM THE JOB
AT-HAND,
BUT WE DON'T WANT TOO MANY STAFF, WHICH WOULD RESULT IN
IDLE TIME.
WHEN
THEY DO THIS IN INDUSTRY IT'S KNOWN AS "BALANCING THE LINE."
BALANCING
THE LINE IN A SERVICE OPERATION SUCH AS A POD MEANS
ENSURING A CONSTANT MOVEMENT OF PATIENTS THROUGH THE SYSTEM.
THE
GOAL IS TO REDUCE OR ELIMINATE "BOTTLENECKS."
A
BOTTLENECK IS A STATION WHERE THERE IS BACKLOG OF PATIENTS
BECAUSE THEY ARRIVE FASTER THAN THEY'RE SERVED.
WHEN
THAT HAPPENS, IT LEADS TO STAFF AT THE BOTTLENECKED STATION
WORKING
NON-STOP, AND MAY RESULT IN THE UNDERUTILIZATION OF STAFF
WORKING DOWNSTREAM OF THE BOTTLENECK.
REMEMBER,
HOWEVER, THAT IF YOU RELIEVE A BOTTLENECK AT ONE
STATION
BY MOVING STAFF AROUND, IT MAY LEAD TO BOTTLENECKS IN
OTHER
PARTS OF THE POD, SO BALANCING THE LINE IS LIKELY TO BE AN
ONGOING PROCESS.
OUR
GUESTS FROM
REAL-LIFE
EXAMPLES OF BALANCING THE LINE AND RELIEVING
BOTTLENECKS IN JUST A FEW MINUTES.
>>
AND THEY ARE NOT ALONE IN ADOPTING STREAMLINING TECHNIQUES, ARE THEY?
>>
THAT'S CORRECT.
A
NUMBER OF PUBLIC HEALTH AGENCIES ARE MOVING TOWARD A HIGH-FLOW
OR MASS DISPENSING POD MODEL.
TAKING
A MASS DISPENSING APPROACH IS COMPARABLE TO MASS
PRODUCTION IN THE MANUFACTURING SECTOR.
THE
UNDERLYING CONCEPT IS THAT LARGE NUMBERS, WHETHER WE'RE
TALKING
PEOPLE OR PARTS, ARE PASSED FROM POINT-TO-POINT OR
STATION-TO-STATION.
GETTING
AS MANY PEOPLE THROUGH THE POD AS QUICKLY AS POSSIBLE SO
THAT WE
CAN TREAT EVERYONE IN THE SPECIFIED WINDOW OF TIME IS THE GOAL.
TO USE
ANOTHER INDUSTRIAL ENGINEERING IDEA, WE WANT THE POD TO
HAVE A
HIGH THROUGHPUT RATE.
ONE WAY
TO INCREASE PPH IS TO RELAX OUR CURRENT STANDARDS.
FOR
EXAMPLE, SHORTENING OR FOREGOING ORIENTATION, SIMPLIFYING
MEDICAL
FORMS, ELIMINATING SECONDARY MEDICAL SCREENING, OR
ABOLISHING
THE QUALITY ASSURANCE CHECK ARE ALL STEPS THAT MAY BE
TAKEN TO INCREASE OVERALL CLINIC THROUGHPUT RATE.
ANOTHER
STRATEGY FOR INCREASING THE PPH IS TO SEND PATIENTS WHO
EITHER
CANNOT BE TREATED OR WHO REQUIRE ALTERNATIVE TREATMENT
OPTIONS
TO REMOTE STATIONS LOCATED OUTSIDE THE POD.
WE CAN
ALSO INCREASE THE NUMBER OF PATIENTS TREATED PER HOUR BY
HAVING
POTENTIALLY
WOULD SLOW DOWN CLINIC OPERATIONS DUE TO THE FACTORS
THAT ARE
NOT MEDICALLY RELATED.
EXAMPLES
OF SUCH PATIENTS INCLUDE THOSE THAT EXHIBIT DISRUPTIVE
BEHAVIOR,
ARE PHYSICALLY DISABLED, ARE FUNCTIONALLY ILLITERATE,
AND DO
NOT SPEAK ENGLISH.
A
FOURTH METHOD IS TO IDENTIFY THE BOTTLENECKS IN THE SYSTEM --
THE
PLACES WHERE PEOPLE WAIT IN LONG LINES OR QUEUES --
AND ADD
ADDITIONAL RESOURCES TO HELP RELIEVE THE BOTTLENECKS.
DOING
THESE THINGS WILL SERVE TO IMPROVE POD OPERATIONS BY
REDUCING
OR EVEN ELIMINATING PATIENT PROCESSING TIMES, ENABLING
STANDARDIZATION WITHIN POD OPERATIONS, AND INCREASING THROUGHPUT.
>>
LET'S TURN NOW TO FIND OUT HOW ONE STATE HAS ENACTED A
STREAMLINED POD MODEL.
AND
THEY DID IT FACING A COUPLE OF 11TH-HOUR ROADBLOCKS THAT APPEARED.
DR.
WILLIAM HACKER, SET THE STAGE FOR US IN
>>
WELL,
WE HAVE
THREE MODERATELY URBAN AREAS WITH THE REST OF THE
POPULATION
LIVING IN RURAL AREAS, AND OUR CENTRAL LOCATION IN THE
COUNTRY
MAKES US A MAJOR TRANSPORTATION AND
LIKE
MANY OTHER STATES AND CITIES, WE STARTED PLANNING BACK IN
AUGUST FOR THE VACCINATION PLANS.
IN OUR
CASE WE PLANNED TO EXERCISE IN
COUNTY OF ABOUT 10,000 PEOPLE IN THE SOUTH-CENTRAL PART OF THE
STATE.
THE
LOCAL HEALTH DEPARTMENT DID THE VACCINATION CLINIC USING THE
SMALLPOX MODEL BUT WITH FLU SHOTS.
TWO
DAYS BEFORE THE CLINIC, THE CDC ANNOUNCED THE FLU VACCINE SHORTAGE.
IMMEDIATELY,
WE WENT TO LOCAL BROADCAST MEDIA TO ANNOUNCE A
CHANGE
IN PLANS.
WE'D
ALREADY BEEN WORKING CLOSELY WITH THEM TO PUBLICIZE THE FLU CLINICS.
NOW WE
NEEDED THEM TO LET THE PUBLIC KNOW THAT ONLY THOSE IN THE
HIGH-RISK
POPULATIONS IDENTIFIED BY THE CDC SHOULD SHOW UP.
>>
THAT'S A SIGNIFICANT ADJUSTMENT TO MAKE IN SUCH A SHORT TIME.
BUT YOU
WERE ALREADY DEALING WITH ANOTHER SET-BACK IN TERMS OF
LOCATION,
WEREN'T YOU?
>>
YES, THE DAY BEFORE THE CDC ANNOUNCED THE SHORTAGE OF FLU
VACCINES,
WE LEARNED THAT THE SCHOOL GYMNASIUM WHERE WE'D PLANNED
TO SET
UP OUR POD HAD JUST BEEN GIVEN A BRAND NEW FLOOR, AND WE
WOULDN'T BE ABLE TO WORK ON IT.
WE MADE
THE DECISION TO STAY AT THE SCHOOL BUT USE THE CAFETERIA INSTEAD.
THAT
MEANT CHANGING THE CONFIGURATION AND FLOW OF OUR POD TO FIT
THE NEW PHYSICAL SPACE.
SO WE
WERE DEALING WITH THAT WHEN WE GOT WORD THAT ONLY HIGH-RISK
PATIENTS
COULD GET FLU SHOTS.
SO
THESE TWO ISSUES TOGETHER FORCED US TO ADAPT VERY QUICKLY.
>>
SO YOU CHANGED LOCATIONS WITH JUST A COUPLE OF DAYS TO SPARE,
AND
THEN YOU HAD TO USE THE MEDIA TO LET THE PUBLIC KNOW THAT
ONLY
HIGH-RISK POPULATIONS IDENTIFIED BY CDC SHOULD COME TO THE CLINIC.
>>
RIGHT.
AND
THAT WAS DIFFICULT BECAUSE WE'D ALREADY BEEN USING THE MEDIA
TO GET
ANY ANYBODY AND EVERYBODY TO THE CLINIC, SO THE MEDIA
MESSAGE
CHANGED DRAMATICALLY.
IT
APPEARED TO WORK THOUGH, AND WE WERE ABLE TO PULL OFF A VERY
SUCCESSFUL EXERCISE.
>>
SO HOW DID YOU STREAMLINE YOUR SET-UP AND OPERATIONS?
>>
WE IMPLEMENTED THREE OVERALL APPROACHES TO STREAMLINING OUR POD.
THE
FIRST WAS THAT INSTEAD OF HAVING PATIENTS COME THROUGH ONE AT
A TIME,
WE HAD THEM GO THROUGH IN GROUPS OF 60.
IT WAS
A CONTINUOUS PROCESS, AND IT WORKED BETTER FOR US BECAUSE
THEY
COULD ALL GET THEIR EDUCATION AS A GROUP.
AND WE
FOUND THAT 60 PEOPLE MOVING THROUGH THE POD TOGETHER WENT
FASTER THAN 60 INDIVIDUALS MOVING THROUGH THE POD SEPARATELY.
AS TIME
WENT ON, WE ADJUSTED THE NUMBERS IN EACH GROUP TO
FACILITATE
THE BEST MOVEMENT THROUGH THE POD.
THE
SECOND THEME FOR STREAMLINING OUR APPROACH WAS THAT WE
BALANCED
THE LINE AS EVENTS UNFOLDED.
THIS
INVOLVED LOOKING FOR POTENTIALLY DISRUPTIVE PATIENTS AND
PULLING THEM OUT OF THE LINE FOR SPECIAL ATTENTION, JUST
MASON
DESCRIBED A FEW MINUTES AGO.
IT
REDUCED THE POSSIBILITY OF PANIC AND CONFLICT, AND IT SERVED
TO CALM THE OTHER PEOPLE IN LINE.
THE
THIRD STREAMLINING APPROACH WAS TO CONSISTENTLY MONITOR THE
STAFF
AND MOVE THEM AS NEEDED TO MAKE THE MOST EFFICIENT USE OF
THEIR TIME.
>>
BUT HOW DID YOU KNOW THOSE THREE APPROACHES WOULD WORK?
>>
WE CAME TO THOSE CONCLUSIONS THANKS TO DISCUSSIONS WE HAD
PRIOR TO THE EXERCISE WITH ALL PARTNERS AND VOLUNTEERS.
WE MET
WITH EVERYONE TWICE, SO BY THE TIME OF THE EXERCISE
EVERYONE
KNEW THEIR ROLES, AND ALL OUR EFFORTS WERE DEVELOPED TO
MEET
THE EXERCISE OBJECTIVES WE LAID OUT.
>>
LET'S TAKE A LOOK AT THOSE OBJECTIVES NOW.
WILL
YOU WALK US THROUGH THEM, PLEASE?
>>
SURE.
THE
FIRST OBJECTIVE WAS TO DETERMINE THE PREPAREDNESS OF THE
COMMUNITY
-- IN THIS
INFECTIOUS DISEASE OUTBREAK.
THE
SECOND OBJECTIVE WAS TO TEST THE EMERGENCY RESPONSE
CAPABILITIES
OF THE COUNTY'S ELECTED OFFICIALS, EMERGENCY
MANAGEMENT,
HEALTH DEPARTMENT, LAW ENFORCEMENT, FIRE DEPARTMENT,
OUTLINED IN THE COUNTY'S EMERGENCY OPERATION PLAN.
THE
THIRD WAS TO TEST THE PLAN BY DEMONSTRATING AN ABILITY TO
ESTABLISH
AND IMPLEMENT AN APPROPRIATE INCIDENT/UNIFIED COMMAND SYSTEM.
THE
FOURTH OBJECTIVE WAS TO TEST THE EMERGENCY OPERATION PLAN BY
DEMONSTRATING EFFECTIVE INTERAGENCY COORDINATION OF INFORMATION.
OBJECTIVE
FIVE WAS TO EXERCISE OUR PUBLIC INFORMATION PLAN.
OBJECTIVE
SIX WAS TO EXERCISE DEPLOYMENT OF THE STOCKPILE.
AND THE
FINAL OBJECTIVE WAS TO TEST THE COUNTY'S INFECTIOUS
DISEASE EMERGENCY RESPONSE PLAN.
THESE
OBJECTIVES DROVE THE ENTIRE PROCESS.
>>
YOUR EXERCISE WAS A SUCCESS, BUT YOU WERE SO SUCCESSFUL, YOU
ENDED
UP BEING HANDED AN EVEN BIGGER TASK, DIDN'T YOU?
>>
YES.
THE
DISTRICT HEALTH DIRECTOR THOUGHT THAT SINCE WE DID SUCH A
GOOD
JOB IN
EVERY COUNTY IN THE REGION -- ALL AT THE SAME TIME.
SO JUST
TEN DAYS AFTER THE
OUR MODEL IN NINE OTHER COUNTIES.
IT WAS
QUITE AN UNDERTAKING, BUT WE DID IT BY STICKING TO OUR
MODEL WHICH HAD WORKED SO WELL IN
WORKERS
FROM THE NINE OTHER COUNTIES HAD PARTICIPATED IN THE
FIRST
EXERCISE, AND THEY WENT BACK HOME AND TAUGHT WORKERS THERE
WHAT TO
DO.
>>
AND HOW DID THE EXERCISE GO IN THOSE NINE COUNTIES?
>>
OVERALL, VERY WELL.
THERE
WERE A COUPLE OF GLITCHES.
ONE OF
THE SITES DIDN'T HAVE ADEQUATE LAW ENFORCEMENT, SO THE
LINE OF
PATIENTS TENDED TO BLOCK THE POD ENTRANCE.
ONE
PATIENT SPENT ALL NIGHT IN THE PARKING LOT JUST TO GET HIS SHOT.
THIS
COULD HAVE BEEN AVOIDED HAD THERE BEEN BETTER EFFECTIVE
PUBLIC INFORMATION.
THESE
WERE RELATIVELY MINOR INCIDENTS AND THEY PROVIDED SOME GOOD
LESSONS
LEARNED.
>>
LET'S TAKE A LOOK AT
>>
HERE IN
MOSTLY
WE'RE A RURAL COMMUNITY.
THERE'S
LOTS OF FARMING.
WE HAVE
TWO MAJOR INDUSTRIAL,
I THINK
A
AREAS
THAT ARE VERY, VERY RURAL AND EVEN HERE IN
THE
STATE CAPITAL, THERE'S JUST 40, 44,000 PEOPLE IN THE WHOLE
WHAT WE
DID HERE IN
PLANNING
AND ALSO TO TIE THAT TOGETHER WITH OUR CDC INITIATIVES
AND THE
CRITICAL BENCH
ALREADY HAD ESTABLISHED WHAT WE CALL AREA MANAGEMENT DISTRICTS.
WE
PAIRED OUR DISTRICT UP ON THE SAME BOUNDARIES.
THESE FOLKS
ARE CHARGED WITH WRITING REGIONAL PLANS AND WE'RE
ALSO EMPLOYING ALL OF THE CDC CLINICAL CAPACITIES IN THAT.
WHAT WE
DID HERE IN
HAPPENS
ON THE LOCAL LEVEL AND THE FIRST RESPONSE HAS TO BE FROM
THE LOCAL LEVEL.
SO WE
HAVE TAKEN A VERY SIGNIFICANT AMOUNT OF OUR MONEY, PUBLIC
HEALTH
MONEY, CDC MONEY AND PUT OUT ON THE LOCAL LEVEL TO FUND
PUBLIC HEALTH PREPAREDNESS PLANNERS.
WE
FEEL, HERE IN
HAS TO
BE DONE AT THE LOCAL LEVEL WHERE THE RUBBER HITS THE ROAD.
>>
THE INITIAL TRAINING WE GOT THAT WAS URBAN ORIENTED, THE BIG
DIFFERENCE
WAS THE RESOURCES THAT THEY HAD AT THEIR DISPOSAL
VERSUS
THE RESOURCES WE HAD AND WITH THE TRAININGS WE WERE SEEING
WHOLE
TEAMS OF INDIVIDUALS COMING OUT IN THE MOON SUITS AND WE
SAW
LOTS OF SECURITY AND LOTS OF POLICE AND IN A RURAL AREA
YOU'VE
GOT VERY SMALL POLICE FORCE.
YOU
DON'T HAVE THAT SPECIALIZED EQUIPMENT.
YOU
DON'T HAVE THOSE RESOURCES AT YOUR DISPOSAL.
SO WE
HAD TO COME UP WITH
AN
>>
ONE OF THE THINGS THAT MADE THIS CLINIC SUCCESSFUL WAS THAT
LAW
ENFORCEMENT, THE DAY BEFORE, ACTUALLY WALKED THROUGH THE
PATIENT FLOW.
THEY'RE
USED TO CROWD CONTROL.
SO WE
NEEDED THEIR EXPERTISE AND WE FOLLOWED THEIR DECISIONS ON
CONTROLLING PATIENT FLOW.
>>
THE CLINIC WAS NOT JUST OPEN TO PEOPLE JUST TO FLOOD THROUGH.
THEY
ACTUALLY LOCKED IT DOWN AND THEY CONTROLLED THE ACCESS AND
LET SO
MANY PEOPLE IN AT A TIME.
>>
TO MOVE THE LINE, WE LET PEOPLE IN 60 AT A TIME.
WE
ALTERNATED THE ROTATION OF THOSE PEOPLE SO WE HAD A CONTINUOUS
LINE MOVING TO THE PROPHYLAXIS AREA.
SO THAT
WAS VERY SUCCESSFUL IN GETTING THAT CLINIC AND KEPT THE
LINE MOVING.
SO EVEN
THE PEOPLE WHO WERE COMPLETELY IN THE BACK OF THE LINE
OUTSIDE
WERE MOVING FORWARD AT A QUICK PACE.
ONCE WE
GOT THEM INTO THE BUILDING, THE POLICEMEN AND LAW
ENFORCEMENT
LET THEM INTO THE BUILDING, WE WOULD GIVE THEM A
SCREENING
FORM AND THEY WENT INTO A TEN-MINUTE EDUCATION VIDEO.
WE
EDUCATED THEM ON THE PROPHYLAXIS THEY WOULD RECEIVE.
WE HAD
NURSES IN THERE TO ANSWER ANY QUESTIONS AND TO HELP THEM
FILL
OUT THE FORMS.
>>
I'M SURPRISED WE ACTUALLY SIMULATED A NATIONAL STRATEGIC
STOCKPILE
MOVEMENT, IN
WHILE
HERE, WE HAD RED BINS THAT WE FOUND TO BE INVALUABLE AND WE
PUT
SUPPLIES IN THAT AND WE PUT IT UNDERNEATH EACH TABLE.
SO AS
THEY NEEDED MORE SUPPLIES THE CLERK AT THE STATION COULD
RESUPPLY
THE NURSES AND KEEP THEM MOVING.
>>
ONCE THEY RECEIVED THEIR PROPHYLAXIS, THEY WENT TO A PATIENT
WAITING AREA.
WE HAD
THEM WAIT FOR 20 MINUTES.
WHILE
THEY WERE WAITING WE HAD TELEVISIONS GOING WITH A
POWERPOINT
PRESENTATION THAT PRESENTED PATIENT EDUCATION, WHAT TO
DO
AFTER THEY RECEIVED THEIR PROPHYLAXIS.
IF THEY HAD ANY PROBLEM, WHO TO CALL.
THE
OTHER THING THAT MADE THIS CLINIC SO SUCCESSFUL IS THE CLINIC
AS A WHOLE PLANNED THE CLINIC.
IT
WASN'T JUST PUBLIC HEALTH.
EMERGENCY
MANAGEMENT HEALTH PLAN POLICE, SHERIFFS, EVEN THE MAYOR
PROVIDED
INPUT AND THE CORONER PROVIDED INPUT ON HOW TO GET THESE
PEOPLE INTO THE PROPHYLAXIS.
>>
EVERYBODY HAD A HAND.
>>
WE WERE RESPONSIBLE FOR SETTING UP THE CLINIC PART OF THE
OPERATION.
I WAS
ACTUALLY THE CHAIRPERSON AT THE
WORKED
WITH THE BIOTERRORISM PREPAREDNESS PLANNERS IN DEVELOPING
JOB DESCRIPTIONS FOR EACH ROLE THAT WE WERE GOING TO HAVE THAT
DAY.
WE
ACTUALLY PREPARED WRITTEN DESCRIPTIONS TO HAND OUT DURING OUR
BRIEFING
SESSION SO THAT EACH PERSON HAD SOMETHING IN FRONT OF
THEM
AND VIEWED WHAT THEIR ROLL AND POSITION WOULD BE FOR THE DAY.
>>
WE DID A SETUP THE DAY BEFORE AND CAME THAT MORNING AND DID
THE FINAL PREPARATIONS.
THERE
WERE PEOPLE HERE WHEN WE GOT HERE.
THE
POLICE WERE HERE TO DO CROWD CONTROL.
THE
COMMUNITY WAS WONDERFUL, I THOUGHT, PEOPLE WERE STANDING IN
LINE HELPING ONE ANOTHER.
EVERYBODY
THAT HELPED JUST WAS THERE TO MAKE SURE THAT THE PEOPLE
-- IT
WAS AS WONDERFUL OF AN EVENT AS POSSIBLE AND THAT SEEMED TO
BE A
PRIORITY OF NOT KEEPING PEOPLE WAITING LONGER THAN THEY HAD
TO AND
I THINK THE COMMUNITY APPRECIATED THAT PART OF IT.
>>
WE WERE MAKING CHANGES UP UNTIL -- I MEAN, THE MORNING OF.
EVEN,
WE WALKED THROUGH IN OUR MINDS AND EVEN IN THE FACILITY,
BUT AS
LATE AS
SITTING
AT THE DINNER TABLE AT A LOCAL RESTAURANT AND WALKING
THROUGH
ONCE AGAIN HOW WE WANTED THE WHOLE PROCEDURE TO GO AND
DECIDED
THAT THE WAY WE HAD OUR CLINIC FLOW WAS JUST NOT GOING TO WORK.
THAT
THERE WERE GOING TO BE PEOPLE WALKING BACK OVER AND CROSSING
THE PATH OF OTHERS.
SO AS
LATE AS, YOU KNOW, 13th HOUR THERE, WE WERE MAKING CHANGES
TO WHAT
WE THOUGHT WAS GOING TO BE THE BEST CLINIC FLOW AND FOUND
THAT IT
WASN'T.
SO WE
WERE TWEAKING IT RIGHT TO THE FINAL MOMENTS THERE.
>>
THE FINAL MOMENTS.
>>
IT WAS A JOINT VENTURE ON EVERYBODY'S PART.
IT
COULD NOT HAVE JUST BEEN ONE AGENCY OR THE OTHER.
I THINK
IT REALLY PULLED THIS TOWN TOGETHER AND ALL OF THE
AGENCIES
THAT WE HAVE SHOWING EACH OTHER WHAT THEIR JOBS WERE AND
HOW WE
COULD ALL WORK TOGETHER TOWARDS A COMMON GOAL AND I JUST
KEEP
HEARING GOOD THINGS FROM ALL OF THE PEOPLE WITH THE RESCUE
AND
FIRE CHIEF EXECUTIVE AND EVERYONE HELD POSITIVE AND ALL AND
EVEN
FROM THE PEOPLE FROM THE COMMUNITY THAT CAME THROUGH, THEY
ALL HAD
POSITIVE THINGS TO SAY AND HOW WELL IT RAN AND HOW POLITE
EVERYBODY
WAS TO THEM.
>>
WE'RE GOING TO COME BACK AND TALK ABOUT LESSONS LEARNED IN
JUST A
MOMENT, BUT BEFORE THAT, LET'S TURN TO A VERY DIFFERENT
EXAMPLE,
HARRIS
DIRECTOR OF THE DIVISION OF EMERGENCY MANAGEMENT AND MEDICAL
REVIEW.
DR.
MINSON, HOW DOES YOUR POD DESIGN OR OPERATION DIFFER FROM DR. HACKER'S?
>>
WELL, THE MAIN DIFFERENCE HAS TO DO WITH POPULATION, I THINK.
BETWEEN
THE CITY OF
UNINCORPORATED
AREAS, THE POPULATION EQUALS 3.5 MILLION.
WE
REALLY HAVE NO IDEA HOW LARGE THE TRANSITIONAL POPULATION WILL
BE, BUT
IT COULD BE AS HIGH AS 5 MILLION TO 6 MILLION EACH DAY.
WITH
THE POSSIBILITY OF HAVING TO PRE-TREAT MILLIONS OF PEOPLE
WITHIN
48 HOURS, WE KNEW THAT THE TRADITIONAL MEDICAL MODEL WOULD NOT WORK.
>>
WE KNEW THAT PEOPLE WHO DON'T GET MEDICATIONS ARE AT RISK FOR
DYING,
SO OUR APPROACH WAS GUIDED BY A PHILOSOPHY OF DOING THE
MOST
GOOD FOR THE MOST PEOPLE, AND THAT MEANT MAKING SOME CHANGES
IN HOW
WE STAFFED OUR PODS AS WELL AS HOW WE GOT PATIENTS TO THE PODS.
>>
SO GIVE US AN IDEA OF THE CHANGES YOU MADE.
>>
THERE WERE THREE MAIN AREAS WE MADE SOME CHANGES.
THE
FIRST WAS IN POD STAFFING.
IF WE
HAVE TO SET UP PODS, WE'RE OPERATING UNDER THE ASSUMPTION
THAT PEOPLE WILL BE SICK.
AND IF
THAT'S THE CASE, THE HOSPITALS WILL NEED TO REMAIN FULLY STAFFED.
AS MUCH
AS WE'D LIKE TO, IT'S HARD TO JUSTIFY BRINGING MEDICAL
STAFF AWAY FROM THEIR CLINICS AND HOSPITALS AT SUCH A TIME.
WE
NEEDED TO FIND NON-MEDICAL PEOPLE TO RUN OUR PODS.
WE
ASKED OUR POLITICAL LEADERS TO SUPPORT THE USE OF
NON-ESSENTIAL COUNTY PERSONNEL TO THE POD SITES.
THEY
AGREED TO THAT WITH NO PROBLEM, AND IT RESULTED IN BETWEEN
8,000
AND 9,000 PEOPLE TO HELP STAFF THE PODS.
>>
WAIT JUST A MINUTE.
NON-MEDICAL PEOPLE?
DOESN'T
THE WORK OF THE PODS REQUIRE TRAINED MEDICAL STAFF?
>>
TRAINED STAFF, CERTAINLY, BUT NOT NECESSARILY CLASSICALLY
TRAINED MEDICAL STAFF.
SINCE
THE PODS WE'RE TALKING ABOUT ARE PRE-TREATMENT CENTERS,
WE'RE
NOT DEALING WITH SICK PEOPLE HERE.
WE ARE
DISPENSING MEDICATIONS, JUST LIKE A UNIT DISPENSARY OR AN
OUTLET
PHARMACY, EXCEPT WE'RE DOING IT ON MASS SCALE IN A VERY
SHORT TIME.
>>
SO HOW DID YOU TRAIN NON-MEDICAL PERSONNEL TO STAFF YOUR PODS?
>>
WE CREATED A PLAN CALLED THE FIELD OPERATIONS GUIDE.
IT HAS
VERY SPECIFIC JOB DESCRIPTIONS AND SIMPLE FLOW DIAGRAMS
THAT
COULD BE TAILORED TO DIFFERENT TYPES OF STRUCTURES AND
FACILITIES.
BEING
ADAPTABLE IS AN IMPORTANT ELEMENT OF THE PLANNING.
>>
AND THE NON-TRADITIONAL RESPONDERS WERE TRAINED TO DO SPECIFIC
TASKS USING THE FIELD OPERATIONS GUIDE?
>>
YES, USING THE FIELD OPERATIONS GUIDE, WE WERE ABLE TO
INCORPORATE
PREVIOUSLY UNTRAINED INDIVIDUALS.
AND IT
ALSO SERVES AS A REFERENCE GUIDE FOR "JUST IN TIME"
APPLICATIONS.
THE
FIELD OPERATIONS GUIDE WAS THE WAY WE LAID OUT OUR DIVISION
OF
LABOR THAT DR. MASON TALKED ABOUT EARLIER.
OUR
NON-MEDICAL STAFF NEEDED CLEAR, SPECIFIC TASKS TO ACCOMPLISH.
THOSE
WERE SET OUT IN THE GUIDE.
THE
CULMINATION OF ALL THOSE SEPARATE TASKS LED TO A SUCCESSFUL
POD
OPERATION.
ANOTHER
THING WE DID WAS WORK CLOSELY WITH MEDIA TO ACT AS A
FIRST LEVEL OF TRIAGE.
WE HAVE
A GOOD PARTNERSHIP WITH THE LOCAL PBS TV STATION.
EVEN IF
YOU DON'T HAVE CABLE, ANYBODY WITH RABBIT EARS CAN PICK
UP
CHANNEL 8 ANYWHERE IN
AND
WE'LL USE THE EMERGENCY BROADCAST SYSTEM TO GET MESSAGES OUT
THROUGH ALL THE RADIO STATIONS IN THE COUNTY.
SINCE
WE'LL BE IN AN OUTBREAK, WE ASSUME THAT SOME PEOPLE WILL BE
SICK ALREADY.
WE
DON'T WANT THEM AT THE PODS.
THEY
NEED TO GO TO THE NEAREST HOSPITAL, AND THAT'S WHAT OUR
FIRST
LEVEL OF TRIAGE WILL ACCOMPLISH.
HOPEFULLY,
WE'LL STEER ANYONE WHO'S ALREADY SICK AWAY FROM US AND
TOWARD
THE MEDICAL HELP THEY NEED.
AND A
THIRD CHANGE WE MADE WAS ACTUALLY ANOTHER LEVEL OF TRIAGE.
THIS
OCCURS OUTSIDE THE PODS AS PEOPLE ARRIVE.
WE'LL
USE PUBLIC ADDRESS SYSTEMS TO BROADCAST A MESSAGE SAYING,
"THIS
IS A PRE-TREATMENT SITE.
IF YOU HAVE RECENTLY BECOME ILL, GO TO THE NEAREST HOSPITAL.
THE
MEDICATIONS AT THIS FACILITY WILL NOT HELP YOU."
SO WE
HAVE TRAINED NON-MEDICAL PERSONNEL AT THE PODS, WE USE THE
BROADCAST
MEDIA TO LET PEOPLE KNOW WHO SHOULD GO TO THE PODS AND
WHO
SHOULD GO TO THE HOSPITAL, AND WE USE RECORDED ANNOUNCEMENTS
ON
PUBLIC ADDRESS SYSTEMS AT THE PODS AS ANOTHER LEVEL OF TRIAGE.
>>
THIS LAST STEP, HOW USEFUL IS IT?
DON'T
PEOPLE ALREADY KNOW THROUGH THE BROADCAST MEDIA THAT IF
THEY'RE
SICK THEY SHOULD NOT REPORT TO THE PODS?
>>
YOU'RE RIGHT.
MOST OF
THE PEOPLE WHO COME TO THE PODS WILL BE THE PEOPLE WHO
SHOULD BE THERE.
BUT
JUST IN CASE PEOPLE DON'T GET THE MESSAGE THAT THE POD IS NOT
A
MEDICAL CLINIC, BUT A DISPENSING CENTER, WE NEED ANOTHER WAY OF
GETTING THAT MESSAGE TO THEM.
WE
FOUND THAT USING THE PRE-RECORDED ANNOUNCEMENTS ON THE PUBLIC
ADDRESS
SYSTEM OUTSIDE THE POD ACCOMPLISHES A COUPLE OF THINGS.
FIRST,
IT LETS PEOPLE WHO ARE SICK KNOW THAT THE MEDICINES INSIDE
THE POD
WON'T HELP THEM.
SECOND,
IT DIRECTS ILL PEOPLE TO THE HOSPITAL.
THE
WORDING IS VERY IMPORTANT.
WE SAY
"IF YOU HAVE RECENTLY BECOME ILL," SO HOPEFULLY THAT WILL
MEAN
THAT GRANDMA DOESN'T THINK HER ONGOING ARTHRITIS MEANS SHE
SHOULD REPORT TO THE HOSPITAL.
BUT BY
TELLING THEM "THE MEDICATIONS IN THIS FACILITY WILL NOT
HELP
YOU," WE'RE MAKING IT CLEAR THAT SERVICES AREN'T BEING
DENIED
TO ILL PEOPLE, THE PODS JUST AREN'T THE PLACE FOR THEM TO
RECEIVE
THE SERVICES THEY NEED.
THE
MORE PEOPLE WHO GET THAT MESSAGE, THE FEWER
GO THROUGH
THE POD, AND THAT WILL INCREASE OVERALL PPH.
ANOTHER
IMPORTANT THING THIS ACCOMPLISHES IS THAT IT FREES UP A
AND SAY
IT IN PERSON.
BY
USING RECORDINGS, WE'RE ABLE TO ASSIGN THOSE PEOPLE TO OTHER
TASKS INSIDE THE POD.
AND,
FRANKLY, IT HELPS TO HAVE ONE SANE, SENSIBLE VOICE WHICH
SAYS JUST THE WORDS THAT NEED TO BE SAID ON THE PUBLIC ADDRESS
SYSTEM.
TAKING
THIS APPROACH CUTS DOWN ON MISCOMMUNICATION AND IT LETS
PEOPLE
KNOW IN A SUCCINCT WAY WHETHER THEY SHOULD BE THERE OR NOT.
GETTING
THAT MESSAGE TO THEM WITHOUT USING A PERSON TO DO IT ALSO
REDUCES THE RISK OF INTERPERSONAL CONFLICT.
>>
SO, USING A TIERED SYSTEM OF TRIAGE, YOU BELIEVE YOU'LL BE
ABLE TO
KEEP OUT MANY OF THE PEOPLE WHO AREN'T SUPPOSED TO BE THERE.
>>
ABSOLUTELY.
IT'S
PART OF SHIFTING FROM A TRADITIONAL MEDICAL MODEL TO AN
ANALOGY OF A MASS CASUALTY MODEL.
FROM A
PUBLIC HEALTH POINT OF VIEW, IT'S A MASS PREVENTION EVENT.
THE
LARGE SCALE OF IT FORCES US TO CHANGE OUR METHODOLOGY.
AND
USING THE MEDIA TO DIRECT PEOPLE TO THE PODS IS PART OF THAT CHANGE.
>>
BUT YOUR MEDIA PARTNERSHIP ACCOMPLISHES ANOTHER GOAL, TOO,
DOESN'T
IT?
>>
YES.
WE'RE
USING THE BROADCAST MEDIA TO ASSIST WITH EDUCATION AND
INSTRUCTION
ABOUT TAKING THE MEDICATIONS, SO OUR PARTNERSHIP WITH
MEDIA
WILL STILL BE HELPING US AFTER PATIENTS HAVE GONE THROUGH THE PODS.
THEY'LL
BROADCAST INSTRUCTIONS FOR USING THE MEDICATIONS.
WE WANT
TO MAKE SURE TO REACH AS MANY PEOPLE AS POSSIBLE, SO THE
BROADCASTS
WILL RUN ON A
ENGLISH,
SPANISH, VIETNAMESE AND CANTONESE --
THE FOUR MOST-SPOKEN LANGUAGES IN
FOR
PEOPLE WHO DON'T SPEAK ANY OF THOSE LANGUAGES, WE'RE ALSO
USING THE NEW FEDERALLY APPROVED PICTOGRAMS FROM
PHARMACOPEIAS.
THESE
PICTOGRAMS WILL BE AVAILABLE ON A PIECE OF PAPER GIVEN TO
PATIENTS ALONG WITH THEIR MEDICATIONS.
ALL THE
STOCKPILE MEDICATIONS REQUIRE SIMILAR INSTRUCTIONS AS TO
THE AMOUNT TO TAKE AND WHEN TO TAKE THEM.
THAT
HELPED US IN PREPARING THE SCRIPTS, AND IT CUT DOWN ON THE
NUMBER
OF PRE-RECORDED ANNOUNCEMENTS WE NEEDED TO PRODUCE.
CASUALTY
SITUATION THAN THEY ARE OTHERWISE, EVEN DIFFERENT THAN
IN A TYPICAL EMERGENCY SETTING.
IN
THAT A
PREVENT
US FROM COMPLETING THE JOB.
THAT
KNOWLEDGE HELPED OUR FOLKS UNDERSTAND THERE ARE THINGS THEY
WOULD NOT BE ABLE TO DO BECAUSE THEY WOULDN'T HAVE TIME.
THAT
FREED THEM UP TO CONCENTRATE ON WHAT NEEDED TO BE DONE.
WE KNOW
THAT IF WE DON'T COMPLETE THE PROCESS, THEN SOME PEOPLE
WILL
NOT GET THE PRE-TREATMENT, AND THOSE WHO DON'T FACE THE REAL
POSSIBILITY OF DEATH.
THAT'S
NOT ACCEPTABLE.
WE'RE PROUD
OF THE PERSONAL INVESTMENT OF ALL THE FOLKS AT THE
HARRIS
DESIGN,
AND I WANT TO POINT OUT SOME UNIQUE FEATURES.
WE
INCORPORATED THE EMERGENCY ALERT SYSTEM DESIGNATES WHICH WILL
RESULT
IN AUTOMATIC ALERTS GOING OUT OVER ALL THE RADIO STATIONS
IN THE COUNTY.
WE ALSO
WORKED CLOSELY WITH PUBLIC BROADCASTING SERVICE, PBS,
AFFILIATES
FOR THE INFORMATION AND EDUCATION ASPECT OF THE
OPERATION.
MOST OF
THE OLDER POD MODELS HAD EDUCATORS ON-SITE, BUT IN OUR
COMMUNITY
THIS WAS A HUGE BOTTLE-NECK.
WE
PRODUCED BRIEF INFORMATION VIDEO SEGMENTS IN ADVANCE THAT WE
COULD SHOW ON A LOOP AS PEOPLE MADE THEIR WAY THROUGH THE POD.
>>
AND PRE-PRODUCED MESSAGES LIKE THAT ALLOWED YOU TO INFORM AND
EDUCATE
THOUSANDS OF PEOPLE IN JUST A FEW HOURS?
IT
SOUNDS LIKE YOU LEARNED A
TWO-DAY EXERCISE.
>>
WE DID.
AND NOW
WE'RE MAKING SOME REFINEMENTS BASED ON LESSONS LEARNED.
THE
TASK IS STILL EXTREMELY DAUNTING.
AND
WHILE THIS DESIGN APPEARS TO HAVE MADE SOME INROADS TOWARD
OUR
OBJECTIVE, IT IS FAR FROM A FINAL VERSION.
WE
CONDUCTED A SERIES OF EXTENDED TIME TRIALS EARLIER THIS MONTH
TO
DETERMINE BETTER DATA POINT ANALYSIS, AND TO TEST ASSUMPTIONS
FROM THE ORIGINAL EFFORT.
>>
OUR CAMERAS WERE THERE FOR THOSE TIME TRIALS AND SPOKE WITH
TWO LOCAL PLANNERS.
>>
ONE OF THE THINGS THAT WE'VE NOTICED FROM OUR PAST EXERCISE IS
THAT
SOMETIMES THERE'S CHOKEPOINTS OR ROADBLOCKS, IF YOU WILL, AT
A DISPENSING CLINIC THAT SLOWS THE PROCESS DOWN.
AT
TIMES OF EMERGENCY WHEN WE NEED TO MOVE A
THROUGH
THE CLINIC, WE NEED TO MAKE SURE THAT WE TRY TO GET THAT
DONE AS
QUICKLY AS WE CAN AND TRY TO ELIMINATE THOSE ROAD
ROADBLOCKS
TO GET THE EFFICIENCY THERE AND PROCESS A LARGE NUMBER
OF PEOPLE IN A SHORT PERIOD OF TIME.
THIS
IS, BASICALLY, A MODIFIED MEDICAL MODEL OF A DISPENSING CLINIC.
THE
FORM IS JUST ONE PIECE OF THAT.
WE'VE
TRIED TO TAKE ANY OF THE STEPS OUT THAT WOULD SLOW DOWN THE PROCESS.
SO WE
HAVE GREATLY SHORTENED THE FORM FOR PERTINENT INFORMATION
ONLY
THAT WE BELIEVE THAT WE NEED TO COLLECT FROM THE PERSON
COMING THROUGH THE DOOR.
NAME,
THE TIME OF DAY BECAUSE OF TRACKING PURPOSES AND
NUMBERS
AND THAT SORT OF THING AND THEN, BASICALLY, NOT A WHOLE
LOT MORE INFORMATION THAN THAT.
THE
REST OF THE INFORMATION COMES FROM ACTUALLY READING THE SIGN
HERE,
THE INFORMATION SHEETS AND ONCE YOU GET TO THE INFORMATION
TABLE
YOU'RE GIVEN ADDITIONAL INFORMATION.
WHAT WE
HAVE DONE IS THAT WE HAVE A PRE-RECORDED MESSAGE THAT
ACTUALLY
RUNS OVER THE PUBLIC ADDRESS SYSTEM HERE AT THE SCHOOL
ON THE
EXTERIOR BEFORE PEOPLE EVER GET INTO THE CLINIC AND THAT,
BASICALLY
SAYS THAT IF YOU'RE
YOU
NEED TO GO TO THE DOCTOR.
WE HAVE
IT IN DIFFERENT LANGUAGES.
SO THAT
IS BEING BROADCAST ON THE EXTERIOR OF THE BUILDING AS
PEOPLE
ARRIVE.
AND
THEN THAT'S HOW WE KIND OF TRIAGE WHETHER THEY SHOULD EVEN
COME
INTO THE CLINIC OR NOT.
WE
BELIEVE THAT THAT SHOULD HELP STREAMLINE THE PROCESS
SO THAT
WE
DON'T HAVE TO STOP AND THEN ACTUALLY DO TRIAGE INSIDE THE CLINIC.
IN THIS
PARTICULAR MODEL THAT WE'RE LOOKING AT TODAY, THERE'S
BASICALLY
THE MAINSTREAM OF FOLKS THAT DON'T HAVE SPECIAL NEEDS
THAT GO
DOWN ONE LINE AND THEY RECEIVE INFORMATION AND THEY
RECEIVE
THEIR MEDICATIONS AND THEN THEY'RE OUT THE DOOR AS
QUICKLY AS POSSIBLE SO THAT WE CAN PROCESS OTHER FOLKS.
FOR
THOSE PEOPLE THAT HAVE SPECIAL NEEDS LIKE CHILDREN, PERHAPS
THEY
HAVE PROBLEMS TAKING CPRO OR PERHAPS THEY NEED TO PICK UP,
THEY
HAVE A BABY WITH THEM OR THEY NEED TO PICK UP MEDICATIONS
FOR THEIR
ENTIRE FAMILY, THEN THEY GO INTO A SPECIAL NEEDS LINE
AND THE
SPECIAL NEEDS LINE IS THERE TO ANSWER THEIR QUESTIONS,
ADDRESS
THOSE SPECIAL NEEDS AND THEN DIRECT THEM TO THE RIGHT
MEDICATION
AND THEN GET THEM OUT THE DOOR QUICKLY, TOO.
AS FAR
AS THE PUBLIC EDUCATION PIECE, WE HAVE TRIED TO REMOVE
SOME OF THAT FROM THE CLINIC SO THAT WE CAN STREAMLINE OUR
PROCESS.
AGAIN,
WE'RE USING MULTIMEDIA TO GET THAT WORD OUT TO THE PUBLIC
ON A CONTINUOUS BASIS.
ONCE
THEY ARRIVED AT THE CLINIC, THEN WE HAVE LARGE SIGNAGE THAT
BASICALLY,
KIND OF REPEATS WHAT'S GOING ON IN THE MASS MEDIA.
THAT
INFORMATION IS ON LARGE POSTERS AND SIGNS HERE IN MULTIPLE
LANGUAGES
SO THAT THE PEOPLE THAT COME THROUGH THE DOOR, THEY'LL
BE ABLE
TO READ THESE SIGNS F THEY CAN READ, AND THEN ONCE
THEY'VE
READ THE SIGN, GETTING THE INFORMATION THEY MOVE TO THE
DISPENSING LINE.
ONCE
THEY GET TO THE DISPENSING LINE, IF THEY HAVE SPECIAL NEEDS
THEY GO
TO THE SPECIAL NEEDS CORRIDOR.
IF THEY
DON'T, THEY GO THROUGH THE STREAMLINE MAIN CORRIDOR OR
THAT WE
TRY TO MOVE AS MANY PEOPLE AS WE CAN DURING A SHORT
PERIOD OF TIME.
ONCE
THEY LEAVE HERE, THEY LEAVE HERE WITH AN INFORMATION SHEET
ON THE
MEDICATION THEY'VE BEEN GIVEN AND THEY'RE TOLD TO GO HOME,
WATCH
TV FOR THE REST OF THE INFORMATION.
OUR
FIRST-TIME TRIAL THIS MORNING WAS AN ATTEMPT TO IDENTIFY
BOTTLENECKS AND CHOKE POINTS THAT WOULD SLOW OUR PROCESS DOWN.
AFTER
WE DID OUR FIRST-TIME TRIAL THEN OUR PLANNING GROUP CAME
TOGETHER
AND WE RECOGNIZED THAT THERE WAS SOME AREAS THAT WE
MIGHT BE ABLE TO IMPROVE EFFICIENCY.
SO WE
MADE SOME ADJUSTS TO WHERE WE COULD INCREASE THE EFFICIENCY
AND INCREASE OUR.
THERE'S
NO SUBSTITUTE FOR REAL DATA.
HOPEFULLY
WE GET THROUGH WITH IS EXERCISE AND USE THE LESSONS
WE'VE
LEARNED THROUGH PAST EXERCISES WE'LL BE ABLE TO GET THIS
DOWN TO A MORE EXACT SCIENCE.
WE KNOW
OUR PROCESS IS NOT PERFECT, BUT THIS IS WHAT WORKS FOR
>>>
AT THE INSTRUCTIONS TABLE WE ARE PASSING OUT TWO FORMS.
WE
REALIZED WE DID NOT NEED TO PASS OUT THE SECOND FORM.
WE NOW,
AT TODAY'S DRILL ONLY PASSED OUT ONE FORM WHICH GAVE THE
PATIENT INFORMATION ON HOW TO TAKE THE MEDICATION.
WE HAVE
ALREADY INCORPORATED CHANGES AND WE HAVE TAKEN NOTES THAT
WE WILL
GO BACK AND WE WILL EVALUATE OUR PROCESS AND OUR
PROCEDURES
AND WE WILL MAKE CHANGES AND ADJUST OUR PROCESSES
BASED ON TODAY'S DRILL.
TODAY'S
DRILL WAS A BIG SUCCESS IN HELPING US UNDERSTAND WHERE
OUR
BOTTLENECKS MAY BE IN THE FUTURE AND HOW TO CORRECT THEM FOR
UPCOMING DRILLS.
>>>
DR. MASON, WHAT ARE SOME OF THE OTHER LESSONS WE CAN LEARNED
FROM THESE POD MODELS?
THE
FIRST THING THAT STANDS OUT HAS TO DO WITH HOW BOTH OF THESE
PROGRAMS
TOOK VERY DIFFERENT APPROACHES TO RESOLVE A SIMILAR PROBLEM.
THEY
BOTH HAD SIGNIFICANT BOTTLENECKS WHEN IT CAME TO THE
EDUCATION COMPONENT.
>>
YES, THE CHALLENGE IN
VERY IMPORTANT INFORMATION TO AN EXTREMELY LARGE NUMBER OF PEOPLE.
IT WAS
GOING TO TAKE A
IT
INSIDE THE PODS, WE'D HAVE SEVERE BOTTLENECKS.
SO OUR
SOLUTION WAS TO USE THE BROADCAST MEDIA.
WE HAVE
SOME MEDIA TEMPLATES WHICH CAN BE ACTIVATED IN 15 TO 30 MINUTES.
PEOPLE
WILL GET THEIR MEDICATION INSTRUCTIONS THIS WAY.
THE
MEDIA MESSAGES USE BOTH WORDS AND PICTOGRAMS.
IT'S
LIMITED, AND VERY SIMPLE, BUT IT'S EFFECTIVE.
>>
WE HAD THE SAME PROBLEM.
WE KNEW
THAT THE PAPERWORK AND THE EDUCATION PROCESS WOULD TAKE
UP THE
GREATEST RESOURCES, SO WE CREATED A SYSTEM TO SPEED IT UP.
WE
BROUGHT PEOPLE THROUGH OUR PODS IN GROUPS OF 60 TO BEGIN WITH.
AS WE
WENT ALONG WE IMPLEMENTED A FORM OF LINE-BALANCING.
WE
ADJUSTED THE NUMBER DOWN A LITTLE ON SOME OCCASIONS TO
"BALANCE
THE LINE" BASED ON THE NUMBER WAITING AND CHANGES IN THE
PACE OF THE FLOW THROUGH THE CLINIC.
WE
FOUND THAT USING TWO ROOMS YIELDED THE MOST CONSISTENT AND
STEADY
FLOW FOR US.
WE
BALANCED THE LINE AND ADJUSTED, AND THAT GREATLY REDUCED
BOTTLENECKS AT OUR EDUCATION STATIONS.
>>
BOTH THESE PROGRAMS FACED ANOTHER SIMILAR CHALLENGE, AND AGAIN
THEY
APPROACHED IT DIFFERENTLY.
WHILE
PODS TO
ACT AS A LEVEL OF TRIAGE,
PROBLEM BY WORKING WITH A RADIO DEEJAY ON-SITE.
THE
DEEJAY ANNOUNCED HOW THE LINE WOULD WORK, AND THE PATIENTS
GOT
THEIR INITIAL ROUND OF INFORMATION FROM THE DEEJAY.
BOTH
PROGRAMS RECOGNIZED POTENTIAL BOTTLENECKS AND SUCCESSFULLY
ADDRESSED THOSE USING DIFFERENT METHODS.
THE
LESSON IS, IF YOU KNOW SOMETHING WILL WORK FOR YOUR PROGRAM,
DON'T
BE AFRAID TO USE IT.
BOTH
THESE PROGRAMS TOOK CDC GUIDANCE, TAILORED IT USING A COMMON
SENSE
APPROACH AND APPLIED IT EFFECTIVELY.
THEY
PROVE THAT A PROACTIVE, PLANNED APPROACH WILL YIELD
EFFECTIVE STRATEGIES FOR STREAMLINING OUR POD OPERATIONS.
>>
LET'S TAKE A LOOK AT THE ALL-IMPORTANT PPH FIGURES FOR
EACH OF
TODAY'S
EXAMPLES.
DR.
HACKER, WHAT WAS THE POD THROUGHPUT LIKE DURING YOUR EXERCISE?
>>
WE EXPERIENCED A WIDE VARIATION IN PPH.
THE
FIRST EXERCISE TOOK PLACE IN A RURAL COUNTY OF ABOUT 20,000 PEOPLE.
OUR PPH
FOR THAT EXERCISE WAS 300.
ON THE
SECOND DATE, NINE EXERCISES OCCURRED SIMULTANEOUSLY IN
NINE ADJOINING COUNTIES.
THE
HIGH AS 270 AT ANOTHER SITE.
NOT
QUICK, BUT STEADY AND EFFICIENT, AND WE MET OUR GOALS.
KEEP IN
MIND, NOW, THAT THE PATIENTS WE WERE MOVING THROUGH THE
PODS
WERE NOT THE TYPICAL PATIENTS WE'D SEE DURING AN ACTUAL
BIOTERRORISM PRE-TREATMENT EVENT.
WE WERE
GIVING FLU SHOTS DURING A FLU VACCINE SHORTAGE, SO THE
PATIENTS
WERE ALL HIGH-RISK PATIENTS AS IDENTIFIED BY THE CDC --
THOSE
65 AND OLDER, THE VERY YOUNG, AND THOSE WITH SIGNIFICANT
MEDICAL CONDITIONS.
YOU CAN
WELL IMAGINE THAT THEY DIDN'T MOVE THROUGH THE POD AS
QUICKLY AS THE AVERAGE POPULATION WOULD.
AT
TIMES, OVER 300 PEOPLE WERE WAITING IN LINE.
FORTUNATELY,
DURING A PLANNING SESSION THE PREVIOUS DAY, WE
REALIZED
WE HAD FAILED TO PROVIDE FOR WHEELCHAIRS.
WE
CALLED THE
HOUR,
WE HAD 20 WHEELCHAIRS.
AND THE
WHEELCHAIRS WERE PUT TO GOOD USE DURING THE CLINIC.
BUT THE
SLOW-DOWN WASN'T JUST PHYSICAL.
THE
OLDER POPULATION REQUIRED MORE STAFF TIME FOR EDUCATION.
WITH A
YOUNGER POPULATION, THE LINE WOULD MOVE MORE QUICKLY.
>>
SO YOU WERE TAKEN BY SURPRISE WHEN IT CAME TO THE NEED FOR
WHEELCHAIRS,
BUT YOU ADAPTED QUICKLY.
>>
YES, WE HADN'T CONSIDERED THE GREAT NEED FOR WHEELCHAIRS UNTIL
WE
NEEDED THEM, BUT THE PARTNERSHIPS WE FORGED AHEAD OF THE
EXERCISE
PULLED US THROUGH THAT MOMENT.
AND
EVEN WITH THAT CHALLENGE, THE LINES STILL MOVED AT A GOOD CLIP.
WE
ENDED UP GIVING OUT 1,000 FLU SHOTS IN A LITTLE OVER THREE
HOURS IN ONE CLINIC.
WHEN WE
DID THE
5,000
SHOTS ON THE SAME DAY IN TWO HOURS DAY IN 120 MINUTES --
A CONSIDERABLE NUMBER FOR THE RURAL REGION WHERE WE EXERCISED.
DR. MINSON,
IN
RESPONDERS
USING THE FIELD OPERATIONS GUIDE, HOW WAS THE FLOW
THROUGH YOUR POD?
>>
WELL, WE CONDUCTED INCREMENTAL TIME TRIALS TO ESTIMATE HOW
LONG A
REAL TIME APPLICATION WOULD TAKE.
THE
EVENT ASSUMED A TERRORIST AEROSOL ATTACK WITH THE ORGANISM F.
TULARENSIS.
THE
SITES AND TRIALS WERE RUN IN ACCORDANCE WITH DUTY
ASSIGNMENTS,
AND WERE COMPLIANT WITH THE NATIONAL INCIDENT
MANAGEMENT
SYSTEM, OR NIMS.
KEEPING
IN MIND THERE ARE SOME SCIENTIFIC LIMITATIONS ON THE
NUMBERS,
WE AVERAGED ABOUT 500 PATIENTS PER HOUR.
IN OUR
SITUATION, THIS IS A SIGNIFICANT IMPROVEMENT.
LOOKING
AT THE CONCLUSIONS BASED ON CONFIDENCE INTERVALS, THE
RESULTS
INDICATE A RANGE IN THE NUMBER OF PATIENTS WHO COULD BE
PUT
THROUGH EACH POD, BETWEEN 375 AND JUST OVER 650 PPH.
THE
NUMBER OF PEOPLE NECESSARY TO OPERATE THE SITE WAS 100.
THIS
INCLUDED FRONTLINE STAFF, SUPPORT AND LOGISTICS PERSONNEL,
AND MANAGEMENT.
GIVEN
OUR ESTIMATED POPULATION, WE ANTICIPATE NEEDING -- A TO
OPERATE
BETWEEN ONE TO 200 PONDS BETWEEN THE 48-HOUR PERIOD.
>>
AND DID YOUR TIME TRIALS THIS MONTH SHOW ANY CHANGE IN PPH?
WE
UTILIZED LESSONS LEARNED AS WELL.
THIS
ESSENTIALLY REDUCED THE TIME NECESSARY TO OPERATE AS WELL.
IS
THERE AN ACCEPTED
>>
THAT'S A GOOD QUESTION.
AND DR.
MINSON RAISED AN IMPORTANT ISSUE IN DESCRIBING THE NUMBER
OF
PEOPLE PROCESSED THROUGH A POD.
WHEN IT
COMES TO HOW MANY PEOPLE A POD CAN PROCESS IN A SET
AMOUNT
OF TIME OR TO LOOK AT ANOTHER WAY, HOW LONG IT TAKES A
PERSON
TO GET THROUGH THE COMPLETE PROCESS, OFTEN THIS NUMBER IS
REPORTED IN TERMS OF AN AVERAGE OR MAIN VALUE.
THIS
FIGURE DOESN'T NECESSARILY CAPTURE THE TRUE CAPABILITIES OF A POD.
FACTORS
WILL VARY FROM POD TO POD OR EVEN ON A SINGLE POD FROM
DAY TO DAY.
SO THE
NUMBER WILL CHANGE BASED ON CIRCUMSTANCES THAT ARE BEYOND
THE CONTROL OF THE POD MANAGER.
ON AN
ASSEMBLY LINE, MACHINES ARE DESIGNED AND PEOPLE ARE TRAINED
SO
VARIABILITY IS KEPT TO A MINIMUM.
SPECIAL
TECHNIQUES ARE USED TO BALANCE THE LINE.
TAKEN
TOGETHER, THESE PRACTICES YIELD PRODUCTS THAT ARE PRODUCED
AS EFFICIENTLY AS POSSIBLE.
BUT WE
CAN'T EXERCISE SUCH STRINGENT CONTROL OVER POD OPERATIONS.
WE'RE
UNABLE TO CONTROL THE CONSIDERABLE VARIATION IN THE ACTIONS
OF BOTH
STAFF AND PATIENTS WHO ARE IN THE POD.
>>
SO WHAT'S THE
THAT WE
HAVE THE BEST ESTIMATES FOR PATIENTS-PER-HOUR?
>>
IT'S MORE ACCURATE TO REPORT WHAT IS KNOWN IN STATISTICS AS A
CONFIDENCE INTERVAL.
FOR
EXAMPLE, A POD DESIGNER MIGHT STATE THAT HE IS 95% CONFIDENT
THAT A
SINGLE POD CAN TREAT BETWEEN 3,300 AND 3,900 PEOPLE PER
HOUR,
RATHER THAN REPORTING THAT ON AVERAGE A SINGLE POD CAN
TREAT
3,600 PEOPLE PER HOUR.
THAT'S
A
THE
THING ABOUT STATISTICS IS THAT YOU NEED TO RUN LOTS OF
EXERCISES IN ORDER TO ARRIVE AT THE MOST ACCURATE RESULTS.
IT'S
IMPOSSIBLE TO DO THIS IN REAL LIFE, BECAUSE WE DON'T HAVE
ENOUGH TIME OR ENOUGH MONEY.
FORTUNATELY,
THERE'S ANOTHER INDUSTRIAL ENGINEERING TOOL,
COMPUTER
SIMULATION, WHICH CAN BE USED TO DEVELOP CONFIDENCE
INTERVALS
BASED ON DATA COLLECTED FROM EVEN ONE EXERCISE.
>>
THAT WOULD CERTAINLY SAVE TIME.
BUT HOW
DOES IT WORK?
>>
MANY DATA POINTS ARE COLLECTED ON HOW LONG INDIVIDUAL PATIENTS
SPEND
AT EACH STATION IN A POD.
THE
COLLECTION OF THIS DATA IS KNOWN AS A CONDUCTING A TIME STUDY.
IT IS A
LABOR-INTENSIVE PROCESS.
BUT
WHEN SUFFICIENT DATA ARE INPUTTED INTO A COMPUTER MODEL OF
THE
POD, THE COMPUTER CAN THEN RUN IT THROUGH HUNDREDS OF TIMES
TO SIMULATE HUNDREDS OF EXERCISES.
CDC HAS
BEEN WORKING WITH A
EASY-TO-USE SOFTWARE THAT WILL BE MADE FREE TO PUBLIC HEALTH
AGENCIES.
WE HOPE
TO HAVE ANOTHER SATELLITE BROADCAST IN THE NEAR FUTURE
ABOUT
USING COMPUTER SIMULATIONS FOR LARGE-SCALE DISPENSING OR
VACCINATION
CENTER DESIGN IN GENERAL, AND USING THE SOFTWARE IN
PARTICULAR.
UNTIL
THE SOFTWARE IS AVAILABLE, PUBLIC HEALTH AGENCIES THAT MAY
BE
INTERESTED IN USING IT SHOULD USE UPCOMING POD EXERCISES TO
COLLECT
TIME-STUDY DATA AT EACH STATION.
IN
CONTRAST, DOING A TIME STUDY OF THE OVERALL POD PROCESS --
THAT
IS, RECORDING POD ENTRY AND EXIT TIMES AND CALCULATING TOTAL
TIME
SPENT IN THE POD FOR A LARGE NUMBER OF INDIVIDUAL PATIENTS
-- WILL
ENABLE POD MANAGERS TO CALCULATE A CONFIDENCE INTERVAL
FOR OVERALL POD OPERATIONS.
THIS
CONFIDENCE INTERVAL WILL BE A MORE ACCURATE MEASURE OF HOW
LONG IT
TAKES TO PROCESS A PATIENT FROM START TO FINISH THAN A
SINGLE
POINT MEASURE.
>>
THE SOFTWARE IS GOING TO BE HELPFUL, BUT ARE THERE OTHER
RESOURCES FOR HELPING TO STREAMLINE POD OPERATION AND SET-UP?
>>
IT'S POSSIBLE THAT LOCAL AND STATE PLANNERS COULD PARTNER WITH
LOCAL INDUSTRIAL ENGINEERING SCHOOLS FOR ANALYSIS.
THESE
KINDS OF PARTNERSHIPS MAY BE HELPFUL WITH POD DESIGN.
CONTACTING
YOUR
A
SPECIAL PROJECT MIGHT BENEFIT THE CREATION OF THE POD
STRUCTURE.
>>
DR. MINSON, WHY WERE EACH OF YOUR EXERCISES SUCH A SUCCESS?
CAN YOU
BOIL IT DOWN TO JUST ONE OR TWO REASONS?
>>
PROBABLY NOT, BUT I CAN TRY.
WE JUST
THOUGHT ABOUT OUR EXERCISE DIFFERENTLY.
WE USE
THE WORD "CLINIC" TO DESCRIBE OUR PODS IN MANY CASES, AND
I THINK
THAT'S MISLEADING.
WHEN
MOST PEOPLE HEAR CLINIC THEY THINK OF DOCTORS.
OUR
CLINICS JUST HAVE MEDICINE.
AND
THAT MEDICINE IS ONLY GOING TO HELP PEOPLE WHO AREN'T ALREADY SICK.
WE
DON'T NEED DOCTORS AND NURSES TO GIVE THAT OUT, WE NEED THEM
AT THE HOSPITAL WITH THE SICK PEOPLE.
WE HAD
TO REALIZE THAT OUR PODS ARE JUST DISPENSING CENTERS, BIG
PHARMACIES
RUN BY A
TRAINED PHARMACISTS.
GETTING
INTO THAT MODE, PLUS USING THE MEDIA FOR TRIAGE WERE
IMPORTANT ELEMENTS OF OUR SUCCESS.
>>
DR. HACKER, WHAT'S YOUR TAKE ON THIS?
>>
WELL, FOR US, IT WAS THE GREAT PARTNERSHIP WE HAD WITH LOCAL
LAW ENFORCEMENT THROUGHOUT OUR PLANNING AND IMPLEMENTATION STAGES.
THEY
AND THE OTHER EMERGENCY RESPONDERS WERE INSTRUMENTAL IN
HELPING
TO MAINTAIN AN ENVIRONMENT IN WHICH THE PUBLIC HEALTH
PEOPLE
COULD DO THEIR JOBS.
THEY
MAINTAINED A SENSE OF ORDER, WHICH WOULD BE A NECESSITY
DURING A REAL EVENT.
WE ALSO
HAD MENTAL HEALTH WORKERS PRESENT, AND THEY PROVIDED THE
EXPERTISE
NEEDED FOR THAT ASPECT OF POD OPERATION.
WE KNOW
THAT PEOPLE WILL BE UPSET AND ANXIOUS, SO HAVING
PROFESSIONALS AT THE POD SITE ADDRESSES THAT.
IT HAS
THE ADDED ADVANTAGE OF PROVIDING THE REST OF THE STAFF AND
VOLUNTEERS
A MEASURE OF PSYCHOLOGICAL SUPPORT -- MORE THROUGH
THEIR
PRESENCE THAN THROUGH ANY ONE-ON-ONE INTERACTION, THOUGH IF
THAT
SHOULD BECOME NECESSARY, WE'LL HAVE THE RIGHT PEOPLE THERE
TO ADDRESS IT.
WE LAID
OUT OUR OBJECTIVES, HAD PLANNING MEETINGS THAT INVOLVED
ALL THE
KEY PLAYERS, AND WHEN WE GOT TO THE EXERCISE, WE WERE
ABLE TO
COMPLY WITH OUR CORE OBJECTIVES BECAUSE WE HAD BUILT-IN
FLEXIBILITY IN OUR PLANNING.
>>
YOU MENTIONED EARLIER THAT YOU'D LEARNED SOME LESSONS, TOO.
WHAT
WERE SOME OF THEM?
>>
MAKE SURE YOU HAVE ENOUGH PORTA-POTTIES!
PEOPLE
ARE GOING TO NEED THEM, AND WE LEARNED RIGHT AWAY THAT
GETTING
ENOUGH OF THEM IS VERY IMPORTANT.
OF
COURSE, THE GREATER YOUR RATE OF PATIENTS PER HOUR AT
THE POD,
THE
LESS NEED YOU'LL HAVE FOR PORTA-POTTIES.
KEEPING
YOUR PPH UP ALSO FREES UP PARKING AND OTHER RESOURCES.
WE
LEARNED WE NEEDED TO HAVE A LITTLE BETTER CONTROL OF
INVENTORY.
WE LOST
A WHEELCHAIR, FOR EXAMPLE.
WE
DIDN'T HAVE ENOUGH TWO-WAY RADIOS FOR COMMUNICATION INSIDE THE
POD BUILDING THAT FIRST DAY, SO WE REMEDIED THAT.
WE EVEN
WORKED OUT A CODE FOR THE RADIO TO CALL FOR HELP, THOUGH
WE
NEVER HAD TO USE IT.
CALLS
FOR A "RED FOLDER IN THE CAFETERIA" MEANT A NEED FOR
MEDICAL HELP.
A
"BLUE FOLDER IN THE CAFETERIA" MEANT A NEED FOR LAW ENFORCEMENT HELP.
WE
TRIED TO PLAN FOR ALL THE POSSIBLE SCENARIOS.
>>
JUST WHY DID THE PARTNERSHIP WITH LAW ENFORCEMENT WORK SO WELL?
>>
OFFICERS WERE AT THE ENTRANCE TO THE POD, AND THEY MADE SURE
THAT THE PEOPLE IN THE LINE WERE OKAY.
POLICE
SCANNED THE LINE AND EVEN GOT WHEELCHAIRS FOR THE PEOPLE
WHO
NEEDED THEM.
WE
ENDED UP HAVING VERY EFFECTIVE COMMUNICATION AND COOPERATION
BETWEEN PUBLIC HEALTH AND LAW ENFORCEMENT.
IT WAS
A POSITIVE EXPERIENCE FOR THE WHOLE COMMUNITY.
>>
YOUR EXERCISES WERE SUCCESSFUL AND YOUR PPH NUMBERS MET YOUR GOALS.
WHAT
KIND OF EVALUATION DID YOU PERFORM?
THE
STATE DEPARTMENT CON DUCKED EVALUATION OF THE EVALUATIONS
THEMSELVES.
WE
PARTNERED WITH THE
EFFECTIVENESS
OF OUR CORE COMPETENCY TRAINING AND TO IDENTIFY
OTHER TRAINING NEEDS.
>>>
DR. MASON, WOULD YOU LIKE TO COMMENT ON THAT?
>>
YES, JOE, I WOULD.
PARTNERING
WITH THE
EFFECTIVE WAY OF EVALUATING YOUR EXERCISE.
SETTING
UP AN INDEPENDENT, BUT PROFESSIONAL USE OF OBSERVERS
MIGHT ALSO BE USEFUL.
>>
THANK YOU, DR. MASON, DR. HACKER AND DR. MINSON.
OF
COURSE, THE WEBSITE PAGE FOR THIS BROADCAST LISTS ALL OF THESE
RESOURCES AND MORE.
THE
ADDRESS IS --
>>>
YOU NOW HAVE THE
PRESENTERS
AND WE ONCE AGAIN WELCOME DR. RAUB WHO HAS JOINED US
FOR Q & A.
THE
PHONE NUMBER HAVE BEEN APPEARING ACROSS THE BOTTOM OF
THE SCREEN.
YOU MAY
FAX AND USE TTY SERVICES AS WELL AS A TRADITIONAL PHONE CALL.
WHILE
WE'RE WAITING FOR A CALLER I'D LIKE TO KICK OFF THE
QUESTION
AND ANSWER SESSION BY READING A FEW OF THE QUESTIONS
THAT WERE
FAXED TO US DURING THE PROGRAM.
WE'LL
ADDRESS THIS FIRST ONE TO YOU, DR. RAUB.
THE
QUESTION IS WILL THE CITY'S READINESS INITIATIVE BE EXPANDED
TO OTHER CITIES NEXT YEAR?
>>
AS WE INDICATED EARLIER THE CITY'S READINESS INITIATIVE IS A
COLLABORATION INVOLVING 21 MAJOR METROPOLITAN AREAS.
WE ARE
NOW NEARING THE FINAL STAGES OF ASSESSMENTS, WORKING WITH
EACH OF THOSE CITIES.
WE'RE
OPTIMIST TAKE THIS PILOT EFFORT WILL LAY THE BASIS FOR AN
EXPANSION.
WE'RE
HOPEFUL OF MAKING THAT EXPANSION WITHIN THE NEXT YEAR, BUT
WE'VE
NOT YET DETERMINED THE EXACT PERIOD TO DO THAT.
WE
>>
OKAY.
THANK
YOU.
WE'LL
GET TO SOME OF OUR OTHER FAX QUESTIONS MOMENTARILY, BUT WE
DO HAVE
A CALLER ON THE LINE.
IT IS
WILLIAM FROM
WILLIAM,
WHAT IS YOUR QUESTION?
HELLO,
WILLIAM?
I'M --
>>
HELLO?
>>
YES, WILLIAM.
THANKS
FOR JOINING US.
WHAT'S
YOUR QUESTION.
>>
Caller: I CAN'T HEAR ANYTHING THROUGH THE PHONE, SO I'LL HAVE
TO LOOK AT THE TV.
WHAT
ABOUT ARE THE POINTS AND THE THREE METHODS THAT YOU
MENTIONED
THAT ARE THE DELIBERATE, MODIFIED AND THE EMERGENCY
METHOD IN HARRIS COUNTY IN
WE
DIDN'T HEAR ANY MENTION OF THE RALLY POINTS.
ARE YOU
FAMILIAR WITH THE CONCEPT I'M TALKING ABOUT?
>>
WOULD YOU LIKE TO ANSWER THAT?
>>
WE ARE ACQUAINTED WITH THE CONCEPT OF RALLY POINTS AND,
FRANKLY,
ORIGINALLY WHEN WE CONSIDERED THAT WE MIGHT BE USING
FIRST
RESPONDERS, THE CLASSIC FIRST RESPONDER, PARAMEDICS,
FIREFIGHTERS,
NURSES DOCTORS, RALLY POINTS WERE A REAL
CONSIDERATION.
IT'S
ENTIRELY POSSIBLE THAT COULD BE UTILIZED.
IN THE
DRILLS THAT WE RAN AND THE TESTS THAT WE'VE DONE TO THIS
POINT
WE REALIZED WE WERE LOOKING TOWARD TRYING TO USE OTHER
INDIVIDUALS.
RALLY
POINTS MIGHT BE A REASONABLE ALTERNATIVE OR AN ADJUNCT IN
THE SYSTEM.
THE
TRUTH IS YOU CAN ALSO HAVE THE FOLKS RALLY AT THE SITE AND IT
IS
ENTIRELY POSSIBLE GIVEN THE COMPRESSED TIMEFRAME, WE MIGHT
HAVE TO
DO THAT.
IF
YOU'RE TALKING IN A FIVE OR TEN-DAY SCENARIO, RALLY POINTS
WERE A
VIABLE ALTERNATIVE AND I'M NOT DISCOUNTING THEM.
BASED
ON THE MODEL, IT SEEMS RALLYING AT THE SITE WILL BE A
PREFERABLE MODEL.
>>
DR. HACKER, CAN YOU ADDRESS THAT?
>>
WELL, WITHIN RURAL AREAS THE OPPORTUNITIES FOR HAVING RALLY
POINTS ARE NOT QUITE AS IMPORTANT WHEN YOU'RE IN AN URBAN AREA.
SO WE
HAVE, IN OUR INNER CITY, FOR EXAMPLE, IN
THE
PARKING LOT OF A HOSPITAL -- I'M SORRY, THE UNIVERSITY'S
FOOTBALL
STADIUM WHERE THERE'S LARGE PARKING AND THEY SHUTTLE
PEOPLE
BACK AND FORTH TO PREVENT BOTTLENECKING AT THE RALLY --
I'M
SORRY, AT THE POD SITE.
BUT
WITHIN OUR CLINIC AND THE FLU SHOTS, WE WERE HAVING PEOPLE GO THERE.
WE USED
THE HIGH SCHOOL FOR THE LOCATION AND THE PARKING WAS
ADEQUATE
FOR WHAT WE WERE DOING WITH THE COMMUNITY SIZE WE WERE SERVING.
>>
OKAY.
THANKS
A
WE HAVE
ANOTHER CALLER.
IT IS
STEVE FROM
STEVE,
WHAT'S YOUR QUESTION.
>>
Caller: YES.
THANK
YOU FOR TAKING MY CALL.
THIS IS
FOR THE DOCTOR FROM
WHAT
WE'RE TRYING TO FIND OUT IS HIS TAKE ON HOW DID HARRIS
COUNSELING
AND DISPENSING AT THE PODS?
IT'S A
SITUATION THAT WE'RE FACING HERE IN THE STATE OF
>>
MOSS
KITE OWES.
WE HAD
STATUTORY PROVISIONS THAT WERE IN OUR FAVOR WITH REGARD TO
USING THE PUBLIC HEALTH AUTHORITY WITH THE DELEGATION AND ACTION.
THE
CONCEPT OF MEETING AND AGAIN WE'RE NOT DISCOUNTING THAT YOU
MIGHT
ACTUALLY HAVE PHARMACISTS AND YOU MIGHT HAVE POSITIONS
AVAILABLE.
WE
DON'T THINK WE WOULD.
IN THE
MIDST OF THE SITUATION WHEN PEOPLE WOULD BE ACTIVELY SICK,
WE
THINK THOSE FOLKS WILL BE DIVERTED ELSEWHERE.
THE
CONCEPT IS FOR THE DELEGATION.
THAT
MEANS WE HAVE TO BE VERY INVOLVED WITH OUR STATE
LEGISLATURE.
WE HAVE
TO BE ON TOP OF THINGS WITH REGARD TO OUR LOCAL POLITICAL
SITUATION,
BUT OUR PUBLIC HEALTH AUTHORITY POWERS, IF YOU WILL,
ACTUALLY
ALLOW FOR CERTAIN ACTIONS LIKE THAT TO
>>
Caller: OKAY.
THERE
IS, THEN, LEGISLATION THAT IS POSSIBLY DUPLICATE ABLE THAT
WOULD
BE ATTAINABLE?
>>
I WOULD HAVE TO -- I'M NOT A POLITICIAN, HAPPILY, EVERYBODY'S
HAPPY OF THAT.
WHAT
I'D HAVE TO SAY IS THAT IT BEHOOVES US TO TAKE AN ACTIVE
PLACE
AT THE TABLE AND TALK WITH YOUR POLITICAL FIGURES AND YOUR
LEGISLATORS.
THEY'RE
THE FOLKS WHO CAN MAKE THE BIG CHANGES AND I FEEL SILLY
EVEN
TALKING ABOUT IT BECAUSE I'M SITTING HERE WITH FOLKS THAT
HAVE
BIGGER PLAY IN THAT KIND OF ARENA.
I KNOW
IN OUR SITUATION IT'S REALLY A GOOD IDEA FOR US TO HAVE
BEEN
INVOLVED IN THE ACTIVE PROCESS OF FASHIONING THAT, AND I
WOULD
SAY, YES, THOUGH I DON'T NECESSARILY -- WOULDN'T PUT MYSELF
FORWARD AS THE CONTACT PERSON ON THAT.
TALK
WITH YOUR LEGISLATORS, TALK WITH YOUR LOCAL OFFICIAL AND
HAVE
THEM INVESTIGATE IT.
>>
Caller: WE REALLY DO AND WE APPRECIATE YOUR PRECEDENT WITH
REGARD
TO THIS ISSUE AND I APPRECIATE YOUR HELP.
>>
WE APPRECIATE YOUR QUESTION.
THANK
YOU.
OUR
NEXT CALLER IS FROM
JO ANNE
IS ON THE LINE.
>>
Caller: HELLO.
THANK
YOU FOR TAKING MY CALL.
THIS IS
FOR DR. MINSON ALSO.
WE'VE
ALREADY DONE ONE OF THESE DISPENSING CLINICS AND PROVIDED
BETWEEN
2 TO 400 AN HOUR, BUT MY QUESTION IS BUT D DID YOU ASK
FOR THE
CURRENT MEDICATIONS THE PATIENTS WERE ON OR ANY OF THE
DRUG
ALLERGIES BECAUSE WE GOT OUR NON-PROFESSIONAL STAFF DID NOT
ASK THE
QUESTIONS.
SO
CONSEQUENTLY WE WOULD HAVE HAD A FEW DEATHS CAUSED BY THAT.
>>
THAT'S A REALLY GOOD QUESTION.
IT WAS
A PRIME CONCERN FOR US.
WE
REALLY, BECAUSE WE'RE PARING A LOT OF THINGS DOWN IN THIS AND
I WANT
TO STRESS THAT WHAT WE'RE DOING WE'RE TALKING ABOUT A
SITUATION
THAT WE ANTICIPATE IF PEOPLE DON'T GET THE MEDICATIONS,
THEY'RE
AT RISK FOR DYING.
THAT'S
THE SCENARIO WE'VE BEEN GIVEN AND THE SITUATION WE'VE BEEN GIVEN.
YOU
NEED TO FIGURE OUT WHAT YOU WILL STREAMLINE.
I LIKEN
THIS TO THE CLINICAL ANALYSES.
WHAT I
NORMALLY WOULD DO IN AN EMERGENCY SITUATION ON THE SIDE OF
THE
ROAD WITH SEVEN AMBULANCES AND A BUNCH OF WOUNDED PEOPLE IS
RADICALLY
DIFFERENT THAN WHAT I WOULD DO IF I WERE IN A CLINICAL
SCENARIO
WHERE I HAD 1,000 DEAD AND DYING ON THE SCENE WITH
LIMITED ASSETS.
I'D
CHANGE THE WAY I TRIAGED AND THE WAY I'D BASICALLY TREAT THEM
ACCORDING TO TRIAGE.
IF YOU
THINK ABOUT THAT FROM THE PUBLIC STANDPOINT, WE'RE GOING
AGAINST
WHAT WE NORMALLY, DO DIRECTION TOWARD THE POPULATION
TOWARD
A MASS PREVENTION EVENT AND YOU HAVE TO SHIFT THE
MENTALITY THAT WAY.
WE DID
ASK QUESTIONS ABOUT ALLERGIES.
WE WERE
VERY CAREFUL IN TRYING TO STRESS THE IDEA, WE WERE
SPECIFICALLY TALKING ABOUT ANA FILL AXIS.
DO YOU
HAVE RESPIRATORY OR AIRWAY PROBLEMS.
IF AN
INDIVIDUAL SAID THAT, A
ALLERGY
WITH SIDE EFFECTS AND IF YOU ASK ABOUT ALLERGIES AND THEY
HAVE
AN UPSET STOMACH OR SOMETHING THEN THEY'RE MISSING THE POINT.
SO WE
STUCK WITH VERY SPECIFIC THINGS WITH REGARD TO THE
ALLERGIES.
DID YOU
STOP BREATHING?
DO YOU
HAVE DIFFICULTY BREATHING IF YOU TAKE THIS MEDICATION?
WE WERE
FORTUNATE.
WE
ASSIGNED MEDICAL PERSONNEL TO BE AT THE SITE TO BE A
SUPERVISOR
AND THEY'RE USING THIS FOG WE MANUALLY DESIGNED.
IF
THERE'S A QUESTION THAT FALLS OUTSIDE THAT FITS INTO THE
CHECKLIST,
IT'S REFERRED TO THE MEDICAL PROFESSIONAL.
IN THIS
CASE IT WAS THE PUBLIC HEALTH NURSES AND SOME OF THE
SCHOOL NURSES.
I'M
HAPPY TO SAY IN THIS MOST RECENT DRILL, WE DID NOT HAVE
ANYONE
THAT GOT THROUGH, THAT WOULD HAVE HAD A DELETERIOUS EFFECT.
>>
OKAY.
THANK
YOU.
PERRY
IS OUR NEXT CALLER AND PERRY IS IN
HELLO,
PERRY.
>>
Caller: HELLO.
THANKS
FOR TAKING MY CALL.
THIS IS
FOR ANY OF THE PANELISTS.
WE CAN
EXERCISE FOR A NUMBER OF THINGS, THE NUMBER OF PEOPLE
MOVING
THROUGH THE PODS, WHETHER THE POD WORKERS ARE ADEQUATELY
TRAINED
AND EXERCISING THE PUBLIC INFORMATION PLAN, BUT IT'S VERY
DIFFICULT
TO SIMULATE THE ANXIETY OR THE PANIC EVEN THAT WOULD
LIKELY
EXIST IN A REAL EVENT.
ARE
>>
YOU BRING UP A REALLY GOOD POINT.
IN
THESE EXERCISES, FOR THE MOST PART EVEN THOUGH YOU TRY TO
ACCOUNT
FOR SOME OF THE THINGS THAT MAY HAPPEN, YOU'RE RIGHT.
WE
DON'T LOOK AT PATIENTS COMING IN AND BEING BOISTEROUS OR DRUNK
OR
PASSING OUT OR ANY OF THOSE KINDS OF THINGS.
MY
GUESS, ONE THING YOU CAN DO IN AN ACTUAL EXERCISE IS TO JUST
THROW
SOME ACTORS IN THERE AND SEE HOW THEY HANDLE THAT.
YOU
KNOW, WE'LL MENTION IN THE LATER PART OF THE BROADCAST ABOUT
SIMULATION
AND ONE OF THE GOOD THINGS ABOUT SIMULATION IS THAT IT
ALLOWS
YOU TO PUT IN DISTRIBUTION, AND PROBABILITY DISTRIBUTIONS
THAT
CAN SORT OF ACCOUNT FOR THOSE.
THAT
YOU MIGHT HAVE A DISTRIBUTION WHERE THE DISTRIBUTION, WHERE
THE
AVERAGE THE AVERAGE TIME IT TAKES TO TREAT SOMEBODY AT A
PARTICULAR
SERVICE STATION MIGHT BE, LET'S SAY A HALF A SECOND,
BUT YOU
CAN PUT IN A FEW DATA POINTS WHERE IT MAY TAKE TEN
SECONDS BECAUSE THIS PERSON IS ACTING UP.
MAKE IT
MAYBE IT MIGHT TAKE FIVE MINUTES AND JUST SEE WHAT IT
DOES TO YOUR SYSTEM OVERALL.
THAT'S
ONE OF THE BENEFITS IN USING A SIMULATION THAT YOU CAN
TEST
OUT SOME OF THESE DIFFERENT THINGS AND SEE HOW THEY WOULD
AFFECT
YOUR SYSTEM.
>>
ALL RIGHT.
THAT'S
A GOOD QUESTION.
THANKS
A LOT.
WE HAVE
ANOTHER CALLER, CHRIS FROM
CHRIS,
WHAT'S YOUR QUESTION?
HELLO,
CHRIS.
CHRIS,
ARE YOU THERE WITH A QUESTION?
OKAY.
DO WE
WANT TO MOVE ON TO OUR NEXT CALLER?
LET'S
DO A FAX.
DR.
MINSON, COULD YOU EXPAND ON YOUR TERM MASS PREVENTION EVENT
AND HOW
IT'S DIFFERENT FROM CONVENTIONAL WORK-UP?
>>
SURE.
I'D
KIND OF GO BACK TO WHAT WE WERE TALKING ABOUT THE PREVIOUS
CALL
HER MENTIONED SOMETHING ABOUT, YOU KNOW, HOW WERE YOU ABLE
TO SORT
OF ABBREVIATE SOME OF THE STEPS AND THE TRUTH IS I REALLY
-- I
THINK WE HAD A TEMPLATE IN MEDICINE THAT IS GOING FROM WHAT
WE DO
CONVENTIONALLY TO WHAT WE DO IN CASE OF A MASS CASUALTY EVENT.
WE
ACTUALLY START TRIAGE WHICH IS CALLED START TRIAGE WHICH MEANS
WE'RE
DOING JUST A JAW THRUST.
WE'RE
LOOKING FOR CAPILLARY REFILL AND IMPLEMENTATION OF A
PATIENT
AND WE MAKE VERY COURSE DECISIONS ABOUT WHETHER THE
PERSON
GOES ON TO GET TREATMENT OR WHETHER THE PERSON IS A DECEDENT.
THAT'S
OBVIOUSLY UNCONSCIONABLE UNDER
WE HAVE
TO DO IT BECAUSE WE'RE TRYING TO DO THE MOST GOOD FOR THE
MOST PATIENTS ON THAT PARTICULAR SCENE OR IN THAT ENVIRONMENT.
THE
SAME THING REALLY HAPPENS WITH REGARD TO THIS PUBLIC HEALTH EVENT.
WE'RE
TALKING ABOUT DOING SOMETHING THAT PREVIOUSLY IS AN
INCONCEIVABLE EVENT.
THAT
IS, DOING A PREVENTIVE EVENT, A MASS PREVENTION EVENT, AN
MPE IF
YOU WANT TO CALL IT THAT FOR SO MANY PEOPLE IN SUCH A
COMPRESSED
PERIOD OF TIME THAT WE'LL HAVE TO GET OUR HEADS AROUND
THE CONCEPT IN A SLIGHTLY DIFFERENT FASHION.
THIS IS
HOW WE'VE BEEN ABLE TO DO IT AND AT LEAST GET A START
WITH THE THING.
>>
OKAY.
LET'S
TAKE ANOTHER FAX QUESTION HERE.
WHAT IS
-- THIS IS FOR YOU, DR. MASON, WHAT IS THE BEST PROCESS
FOR
EVALUATING POD EXERCISES AND WHERE DOES SIMULATION FIT IN AND
WE'VE
ALREADY KIND OF ANSWERED THAT PART.
>>
YEAH.
WE SORT
OF TOUCHED ON THAT.
AS FAR
AS EVALUATING YOUR EXERCISES THERE ARE A NUMBER OF THINGS
AND
PROBABLY A NUMBER OF THINGS YOU'D WANT TO DO ALTHOUGH I WOULD
SAY AT
THE OUTSET SOME OF THE THINGS REQUIRE EXTRA PEOPLE AND YOU
HAVE TO
FIND PEOPLE THAT CAN SERVE IN THIS THIS -- TO DO
THIS.
SO ONE
THING IS THAT YOU MAY WANT TO HAVE OBSERVERS WHO,
BASICALLY,
WALK AROUND THE EXERCISE AND TAKE NOTES.
YOU
WANT TO SEE HOW BUSY PEOPLE ARE.
YOU
WANT TO SEE IF THEIR CUBE IS BUILDING UP AND THAT KIND OF THING.
ONE OF
THE THINGS I'M DOING AM INTERESTED IN CONTINUING DOING TO
COLLECT
DATA AT THE INDIVIDUAL STATIONS SO THAT ULTIMATELY WHEN
WE GET
TO THE POINT OF DOING SIMULATIONS, I HAVE COLLECTED SOME
DATA THAT WILL BE USEFUL FOR THAT PURPOSE.
SO THIS
REQUIRES THAT YOU HAVE PEOPLE, BASICALLY, SITTING AROUND
WITH
PADS OF PAPER AND STOPWATCHES AND BASICALLY, YOU KNOW,
WRITING
DOWN WHAT TIME WHEN SOMEBODY COMES UP TO THE AND WHAT
TIME
THEY LEAVE.
THE
MORE PEOPLE YOU HAVE DOING THAT, THE MORE DATA YOU CAN
COLLECT
AND THE BETTER THE PROBABILITY OF THE DISTRIBUTIONS YOU
CAN GENERATE FROM THAT DATA.
YOU'RE
YOU MIGHT ALSO WANT TO HAVE SOME SORT OF MESSAGE FOR
TIMING
AND THEN YOU HAVE TO FOLLOW, BASICALLY, SO LET'S SAY,
MAYBE
YOU MIGHT GIVE PEOPLE, WHEN THEY COME UP JUST SORT OF
RANDOMLY
PICK A PERSON AND GIVE THEM A CARD THAT HAS THEIR
ARRIVAL
TIME ON IT AND THEN WHEN THAT PERSON GETS TO THE END OF
THE POD
THEY GIVE IT TO ANOTHER PERSON WHO WRITES DOWN THEIR EXIT
TIME SO
YOU CAN KEEP TRACK OF HOW LONG IT TAKES AS PEOPLE GO
THROUGH THE POD TOTALLY.
SO
THAT'S JUST A FEW OF THE THINGS THAT YOU CAN DO TO EVALUATE
YOUR
EXERCISE AND, AGAIN, A SIMULATION, IF YOU TEND TO COLLECT
THE
RIGHT KIND OF DATA AND I'LL HAVE TO BE FRANK.
YOU CAN
ALSO USE SIMULATION IN THE ABSENCE OF COLLECTING THE REAL DATA.
YOU CAN
MAKE SOME SORT OF GUESSTIMATES OF HOW LONG YOU THINK IT
WOULD
TAKE TO DO CERTAIN THINGS, BUT THAT'S NOT AS GOOD AS
COLLECTING THE REAL DATA.
>>
OKAY, THANKS FOR THAT.
LET'S
GO BACK TO THE PHONES.
STAN
FROM
STAN?
>>
Caller: YES.
THIS IS
A QUESTION REGARDING
BY
PUTTING A VERY STRONG FOCUS PROVIDING PUBLIC EDUCATION BEFORE
PEOPLE
ARRIVE AT THE POD AND THEN ALSO GIVING THEM INFORMATION AS
THEY'RE
LEAVING AND THUS, LIMITING THE EXTENT OF EDUCATION
DELIVERED
AT THE POD ITSELF, DO YOU THINK THERE'S ANY TRADEOFFS
IN
TERMS OF INCREASING THE NUMBER OF PEOPLE WHO GO INTO THE
SPECIAL
NEEDS LINE BECAUSE THEY'RE UNCERTAIN ABOUT THEIR PERSONAL
SITUATIONS?
>>
THAT'S A GOOD QUESTION.
I DON'T
KNOW HOW TO ANSWER THAT RIGHT OFF THE BAT.
I DON'T
KNOW WHAT THE CALL AT THAT TIME I -- QUALITATIVE TRADEOFF WOULD BE.
I KNOW
IN LOOKING AT THE QUANTITATIVE EFFECTS IT DIDN'T AFFECT
THE
NUMBER OF PEOPLE GOING TO THE SPECIAL NEEDS LINE.
I
SHOULD SAY AND WE REALLY DIDN'T HAVE TIME TO COVER IT ENTIRELY,
BUT
WE'VE UTILIZED A LOT OF MEASURES WITHIN THE POD INCLUDING SIGNAGE.
WE'VE
TRIED TO ADDRESS THE MAJOR POPULATIONS.
THE
CONCEPT BEHIND THE PRE-INFORMATION THAT WOULD GO DOWN USING
THE
MEDIA IS THEY'RE AS SORT OF A STEERING MECHANISM, BUT ALSO
THERE
ARE TEMPLATES FOR THE TRAINING AS WELL.
THIS IS
NOT THE ONLY MECHANISM THAT WOULD BE
THERE
ARE FOR INDIVIDUALS THAT HAVE ESOTERIC PROBLEMS THAT HAVE
SUBSEQUENTLY BEEN CALLED IN.
THE
COMPONENT IS TO TAKE THE BOTTLENECK OUT OF THE POD AND TO
DEAL
WITH IT IN A MORE COMPREHENSIVELY COMPLETE FASHION.
I THINK
IN A WEIRD WAY WE MIGHT HAVE IMPROVED THE QUALITY OF THE THING.
IT'S
DIFFICULT TO SAY THAT WITHOUT HARD EVIDENCE AS DR. MASON WAS
JUST
SAYING, BUT IT APPEARS THAT WE'RE NOT LOSING THAT MUCH AS A TRADEOFF.
>>
OKAY.
THANK
YOU.
DR.
HACKER, WE HAVE A FAX QUESTION FOR YOU.
IT
COMES FROM THE STATE OF
HOW DID
YOU BALANCE THE LINE WITH MEDICAL PERSONNEL, THOSE
ADMINISTERING VACCINATIONS.
WERE
ANY REASSIGNED TO CROWD CONTROL?
>>
WITHIN THE CLINIC WE DID NOT HAVE TO USE OUR CLINICAL PEOPLE
TO DO -- TO CONTROL THE LINE OR TO MOVE PEOPLE THROUGH.
WE HAD
OUR LOCAL LAW ENFORCEMENT AND OUR VOLUNTEERS WHO WERE ABLE
TO WALK
THE LINE, TO ASSIST AND, AGAIN, WITH THE ELDERLY
POPULATION,
HELP WITH WHEELCHAIRS OR HELP WITH PEOPLE WHO WERE
WALKING
AND HAVE ASSISTANCE.
OUR
CLINICAL PEOPLE WERE AT THE VACCINATION CLINIC STATIONS.
WE HAD
FIVE DIFFERENT STATIONS SET UP AT THE SAME TIME SO THE
GROUP
OF 60 CAME THROUGH, THEY WERE DISPERSED TO THE
OPEN BY
SOMEONE WHO WAS ACTUALLY CUING THE LINE THROUGH.
IT WAS
AN EFFECTIVE CLINIC FOR US AND IT WORKED VERY WELL.
>>
OKAY.
CAN YOU
DESCRIBE AND THIS IS ANOTHER QUESTION THAT COMES TO US VIA FAX.
CAN YOU
DESCRIBE THE AMOUNT OF STAFFING LEVELS THAT YOU NEEDED TO
ACCOMPLISH
THE THROUGHPUT THAT YOU HAD.
IN THE
CLINIC WORKING THE SITE.
6 IS 1
OF THOSE WERE HIRED STAFF OR PEOPLE ON SALARY WHO HAD 40
WITH
THE PUBLIC HEALTH DEPARTMENT, ONE MENTAL HEALTH WORKER AND
20
FIRST RESPONDERS.
THERE
WERE FOUR SENIOR CITIZEN VOLUNTEERS AND ONE SENIOR EXPLORER
VOLUNTEER
AND ONE THAT VOLUNTEERED TO BE A BACKUP IN A CLINICAL
SITUATION IN CASE SOMEONE HAD A REACTION TO THE VACCINE.
OUR
TOTAL WAS 67 PEOPLE.
>>
OKAY.
THAT'S
ALL THE TIME WE HAVE FOR QUESTIONS AND WE'D LIKE TO THANK
EVERYONE WHO CALLED OR SENT A FAX.
I THINK
WE SHARED SOME GREAT INFORMATION.
NOW IF
WE WEREN'T ABLE TO GET TO YOUR QUESTION TODAY, YOUR
STATE
COORDINATOR
CAN CONTACT YOU WITH THE RESPONSE.
FINALLY,
IF YOU'D LIKE TO FIND OUT MORE ABOUT UPCOMING PUBLIC
HEALTH
TRAINING NETWORK COURSES, VISIT THE PHOTON WEBSITE AT
WWW.CDC.GOV/PHTN.
I'D
LIKE TO TAKE THIS
MEMBERS
FOR SHARING THEIR VALUABLE INFORMATION WITH OUR WORLDWIDE
AUDIENCE
TODAY AND THANK YOU FOR JOINING US TODAY FOR THE SPECIAL
BROADCAST
MASS ANTIBIOTIC DISPENSING: STREAMLINING POD
OPERATIONS.
WE'LL
SEE YOU AGAIN FOR THE NEXT INSTALLMENT IN THE MASS
DISPENSING SERIES.
ENJOY
THE REST OF YOUR DAY.