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.
EVER