**Mass Antibiotic Dispensing: Streamlining POD Design and Operations**

**Originally aired April 14, 2005**

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 KENTUCKY.

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 KENTUCKY PROGRAM HAD

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 HARRIS COUNTY, TEXAS, WHICH IS THE THIRD

MOST POPULATED COUNTY IN THE NATION.

A BUSY WORKDAY CAN SEE UP TO 6 MILLION PEOPLE IN HOUSTON AND ITS

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 ATLANTA, GEORGIA.

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 MISSION OF PROCURING, MAINTAINING, AND DEPLOYING

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 LOT JUST FROM PICTURING AN ASSEMBLY LINE, FOR
INSTANCE.

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 KENTUCKY\'S PROGRAM, WE\'LL HEAR ABOUT A COUNTY

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 HARRIS COUNTY, TEXAS.

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 FIGURE OUT BETTER WAYS TO COMMUNICATE

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 HARRIS COUNTY AS WELL AS DR. HACKER\'S

EXPERIENCE IN KENTUCKY.

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 TWO WAYS TO INCREASE PATIENTS PER HOUR, OR PPH.

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

APRIL 14, 2005, YOU\'RE WATCHING AN ARCHIVED REBROADCAST!

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 NATIONAL CENTER FOR ENVIRONMENTAL HEALTH HERE AT CDC.

DR. MASON, WALK US THROUGH THE TERMS AND THEIR DEFINITIONS SO

THAT WE ALL UNDERSTAND WHAT WE\'RE TALKING ABOUT.

\>\> THANKS, JOE.

THE BEST PLACE TO START IS WITH THE TERM YOU USED JUST A FEW

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 MOST EFFECTIVE WAYS TO MAKE IT HAPPEN.

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 NORMAL THINGS YOU DO TO EVALUATE

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 NORMAL PUBLIC HEALTH ACTIVITIES TO A MASS PREVENTIVE EFFORT.

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 KENTUCKY AND TEXAS WILL BE GIVING US SOME

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 PROCESSES IN PLACE TO DEAL WITH OR REMOVE PATIENTS WHO

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 KENTUCKY.

\>\> WELL, KENTUCKY IS A MID-SIZED STATE OF ABOUT 4 MILLION PEOPLE.

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 INTERSTATE HIGHWAY HUB.

LIKE MANY OTHER STATES AND CITIES, WE STARTED PLANNING BACK IN

AUGUST FOR THE VACCINATION PLANS.

IN OUR CASE WE PLANNED TO EXERCISE IN TAYLOR COUNTY, A SMALL

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 AS DR.

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 CASE TAYLOR COUNTY \-- TO RESPOND TO AN

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,

EMS, MEDIA, PUBLIC UTILITIES, AND VOLUNTEER ORGANIZATIONS AS

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 ONE COUNTY THAT WE SHOULD BE ABLE TO DO THE SAME FOR

EVERY COUNTY IN THE REGION \-- ALL AT THE SAME TIME.

SO JUST TEN DAYS AFTER THE TAYLOR COUNTY EXERCISE, WE DUPLICATED

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 TAYLOR COUNTY.

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 KENTUCKY AND SOME OF THE KEY PLAYERS.

\>\> HERE IN KENTUCKY WE BASICALLY HAVE 4 MILLION PEOPLE.

MOSTLY WE\'RE A RURAL COMMUNITY.

THERE\'S LOTS OF FARMING.

WE HAVE TWO MAJOR INDUSTRIAL, METROPOLITAN CITIES, LEXINGTON AND

LOUISVILLE.

I THINK LOUISVILLE HAS 250,000 PEOPLE, BUT MOST OF IT IS, THERE\'S

A LOT OF FARM AND A LOT OF MOUNTAINS IN THE EASTERN KENTUCKY

AREAS THAT ARE VERY, VERY RURAL AND EVEN HERE IN FRANKFURT, IN

THE STATE CAPITAL, THERE\'S JUST 40, 44,000 PEOPLE IN THE WHOLE

COUNTY HERE.

WHAT WE DID HERE IN KENTUCKY TO MEET THE GOALS FOR THE REGIONAL

PLANNING AND ALSO TO TIE THAT TOGETHER WITH OUR CDC INITIATIVES

AND THE CRITICAL BENCH MARX, KENTUCKY EMERGENCY MANAGEMENT

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 KENTUCKY, WE REALIZED THAT EVERY INCIDENT

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 KENTUCKY, THAT THE MAJOR PART OF THE PLANNING

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 A WAY TO USE RESOURCES THAT WE HAD IN

AN EFFECTIVE WAY TO ACHIEVE THE OUTCOMES WE WERE LOOKING FOR.

\>\> ONE OF THE THINGS THAT MADE THIS CLINIC SUCCESSFUL WAS THAT

LAW ENFORCEMENT, THE DAY BEFORE, ACTUALLY WALKED THROUGH THE

WHOLE HIGH SCHOOL AND THEY DETERMINED HOW THEY WOULD CONTROL

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 SOMERSET AND TRANSPORTED THE SUPPLIES HERE.

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 INCIDENT COMMAND CENTER AND

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 8:00 THE NIGHT BEFORE OUR CLINIC BEGAN, WE WERE

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 COUNTY TEXAS, WHERE DR. MATT MINSON IS THE

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.

HARRIS COUNTY IS THE THIRD MOST POPULATED COUNTY IN THE UNITED STATES.

BETWEEN THE CITY OF HOUSTON, OTHER MUNICIPALITIES AND

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 HARRIS COUNTY.

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 ILL PEOPLE WILL

GO THROUGH THE POD, AND THAT WILL INCREASE OVERALL PPH.

ANOTHER IMPORTANT THING THIS ACCOMPLISHES IS THAT IT FREES UP A

LOT OF PEOPLE WHO\'D OTHERWISE BE FORCED TO STAND OUTSIDE THE PODS

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 LOOP IN FOUR DIFFERENT LANGUAGES \--

ENGLISH, SPANISH, VIETNAMESE AND CANTONESE \--

THE FOUR MOST-SPOKEN LANGUAGES IN HARRIS COUNTY.

FOR PEOPLE WHO DON\'T SPEAK ANY OF THOSE LANGUAGES, WE\'RE ALSO

USING THE NEW FEDERALLY APPROVED PICTOGRAMS FROM U.S.

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.

AS DR. MASON MENTIONED EARLIER, THE RULES ARE DIFFERENT IN A MASS

CASUALTY SITUATION THAN THEY ARE OTHERWISE, EVEN DIFFERENT THAN

IN A TYPICAL EMERGENCY SETTING.

IN HARRIS COUNTY, WE NEEDED THE STAFF AND THE VOLUNTEERS TO KNOW

THAT A NORMAL MEDICAL APPROACH WOULD ONLY SLOW US DOWN AND

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 COUNTY PUBLIC HEALTH AND ENVIRONMENTAL SERVICES IN THIS

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 LOT OF IMPORTANT LESSONS FROM THE

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 LOT OF PEOPLE

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 LOT

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 ILL, THIS MEDICINE WILL NOT HELP YOU.

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

HARRIS COUNTY, TEXAS.

\>\>\> 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 HARRIS COUNTY WAS TRYING TO COMMUNICATE

VERY IMPORTANT INFORMATION TO AN EXTREMELY LARGE NUMBER OF PEOPLE.

IT WAS GOING TO TAKE A LOT OF TIME AND RESOURCES, AND IF WE DID

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 HARRIS COUNTY USED PRE-RECORDED ANNOUNCEMENTS OUTSIDE THEIR

PODS TO ACT AS A LEVEL OF TRIAGE, KENTUCKY ADDRESSED THE SAME

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.

KENTUCKY HAD EXERCISES ON TWO DIFFERENT DATES.

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 RANGE OF PPH FOR THAT WAS AS LOW AS 150 AT ONE SITE AND AS

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 LOCAL EMERGENCY OPERATION CENTER AND WITHIN HALF AN

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 NINE- COUNTY EXERCISE THE FOLLOWING WEEK, WE GAVE

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 HARRIS COUNTY, WHERE YOU TRAINED NON-MEDICAL

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 BEST WAY?

\>\> 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 BEST WAY TO TAKE THAT VARIATION INTO ACCOUNT SO

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 WIDE RANGE.

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 LOCAL UNIVERSITY TO DEVELOP

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 LOCAL UNIVERSITY FOR INTERNS OR TO COLLABORATE ON

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 LOT OF SPECIFICALLY TRAINED BUT NOT MEDICALLY

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 UNIVERSITY OF KENTUCKY TO EVALUATE 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 LOCAL UNIVERSITY LIKE KENTUCKY HAS DONE IS AN

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 OPPORTUNITY TO ASK QUESTIONS TO ANY OF OUR

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 WANT A STRONG BASE IN PLACE FIRST BEFORE MOVING AHEAD.

\>\> 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 GEORGIA.

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 HOUSTON.

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 LEXINGTON,

KENTUCKY, THERE IS A STRATEGY IN PLACE TO HAVE PEOPLE RALLY AT

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 LOT FOR THAT QUESTION.

WE HAVE ANOTHER CALLER.

IT IS STEVE FROM OHIO.

STEVE, WHAT\'S YOUR QUESTION.

\>\> Caller: YES.

THANK YOU FOR TAKING MY CALL.

THIS IS FOR THE DOCTOR FROM HARRIS COUNTY.

WHAT WE\'RE TRYING TO FIND OUT IS HIS TAKE ON HOW DID HARRIS

COUNTY GET PAST AVOIDING A PHARMACIST AND THE MEDICAL DOCTOR

COUNSELING AND DISPENSING AT THE PODS?

IT\'S A SITUATION THAT WE\'RE FACING HERE IN THE STATE OF OHIO.

\>\> TEXAS HAS \-- TEXAS HAS CERTAIN DRAWBACKS, IT\'S HOT AND HAS

MOSS KITE OWES.

TEXAS HAS REAL BENEFITS.

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 TAKE PLACE.

\>\> 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 SOUTH CAROLINA.

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 LOT OF PEOPLE MIXED THE CONCEPT OF

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 TENNESSEE.

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 THERE WAYS TO BETTER INCORPORATE THAT INTO OUR EXERCISE?

\>\> 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 RHODE ISLAND.

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 NORMAL CIRCUMSTANCES, BUT

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 MICHIGAN IS STANDING BY.

STAN?

\>\> Caller: YES.

THIS IS A QUESTION REGARDING HARRIS COUNTY.

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 IN PLACE.

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 WASHINGTON.

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 FIRST PLACE

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 TAYLOR COUNTY EXERCISE, WE HAD 67 PEOPLE ACTUALLY AT 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 OPPORTUNITY TO THANK ALL OF THE PANEL

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.