Centers for Disease Control and Prevention

### Mass Antibiotic Dispensing

A Primer

An Interactive Satellite Broadcast

June 24, 2004 1 - 2:30 pm ET

**VIDEO AUDIO**

+-----+------------------------+--------------------------------------+
| 1   | 12:30 pm ET            |                                      |
| .   |                        |                                      |
|     | Color bars & tone up   |                                      |
|     | with countdown window  |                                      |
+-----+------------------------+--------------------------------------+
| 2   | 12:55 pm               | Theme music up                       |
| .   |                        |                                      |
|     | pre-program            |                                      |
|     | instruction graphics   |                                      |
|     | appear                 |                                      |
+-----+------------------------+--------------------------------------+
| 3   | **Dr. Raub Live        | RAUB:                                |
| .   | intro**                |                                      |
+-----+------------------------+--------------------------------------+
| 4   | Phs/PHTN animated open | SOT                                  |
| .   |                        |                                      |
|     | 00:00:30               |                                      |
+-----+------------------------+--------------------------------------+
| 5   | mASS ANTIBIOTIC        | SOT                                  |
| .   | dISPENSING ANIMATED    |                                      |
|     | OPEN                   |                                      |
|     |                        |                                      |
|     | 00:00:30               |                                      |
+-----+------------------------+--------------------------------------+
| 6   | VIDEO MONTAGE WITH     | SOT                                  |
| .   | MUSIC                  |                                      |
|     |                        |                                      |
|     | 00:01:20               |                                      |
+-----+------------------------+--------------------------------------+
| 7   | transition to          | (WASHINGTON)                         |
| .   | moderator              |                                      |
|     |                        | Hello, and welcome to this           |
|     | CG: Joe washington     | interactive satellite broadcast, \"  |
|     |                        | Mass Antibiotic Dispensing: A        |
|     | Moderator              | Primer.\"                            |
|     |                        |                                      |
|     |                        | 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.                    |
+-----+------------------------+--------------------------------------+
| 8   |                        | Thank you, Doctor Raub for           |
| .   |                        | introducing some of the topics for   |
|     |                        | discussion today. Doctor Raub will   |
|     |                        | join us on the panel during the      |
|     |                        | Question and Answer session near the |
|     |                        | end of our broadcast.                |
+-----+------------------------+--------------------------------------+
| 9   |                        | Let me expand on Doctor Raub's       |
| .   |                        | thoughts by adding that a large part |
|     |                        | of our bioterrorism preparedness     |
|     |                        | effort lies in the ability to take   |
|     |                        | action at the local and state level. |
|     |                        | In the event of a bioterrorism       |
|     |                        | attack, life-saving pharmaceuticals, |
|     |                        | antidotes, medical supplies and      |
|     |                        | equipment need to be distributed *in |
|     |                        | time*. Because - the clock starts    |
|     |                        | ticking when an agent is introduced  |
|     |                        | to a population.                     |
+-----+------------------------+--------------------------------------+
| 1   | ss#                    | The CDC's Strategic National         |
| 0.  |                        | Stockpile Program, or S-N-S, is      |
|     | sns = strategic        | charged with the mission of          |
|     | national stockpile     | procuring, maintaining, and          |
|     |                        | deploying all of these materials in  |
|     |                        | the event of an emergency.           |
+-----+------------------------+--------------------------------------+
| 1   |                        | (WASHINGTON)                         |
| 1.  |                        |                                      |
|     |                        | You should know that S-N-S assets    |
|     |                        | can reach any area in the country    |
|     |                        | within twelve 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 population |
|     |                        | when those shipments arrive.         |
|     |                        |                                      |
|     |                        | This isn't an easy job, but it is    |
|     |                        | vital to the country's overall       |
|     |                        | emergency preparedness efforts. We   |
|     |                        | welcome you, along with other key    |
|     |                        | members of your planning team, to    |
|     |                        | this broadcast.                      |
+-----+------------------------+--------------------------------------+
| 1   |                        | This is the first in a series of     |
| 2.  |                        | broadcasts on mass dispensing -      |
|     |                        | Today's program is an overview of    |
|     |                        | mass dispensing of oral antibiotics. |
|     |                        |                                      |
|     |                        | Dispensing medications is the most   |
|     |                        | complex and perhaps the most         |
|     |                        | important of all S-N-S planning      |
|     |                        | functions. During this broadcast,    |
|     |                        | we'll provide *only an* *overview*   |
|     |                        | of the planning requirements, and    |
|     |                        | discuss many of the factors you need |
|     |                        | to consider. Future programs will    |
|     |                        | cover these and other critical       |
|     |                        | issues in more detail.               |
+-----+------------------------+--------------------------------------+
| 1   |                        | In the studio today, we have several |
| 3.  |                        | experts to help discuss these issues |
|     |                        | and answer your questions; let's     |
|     |                        | meet them now.                       |
+-----+------------------------+--------------------------------------+
| 1   | cg: CURTIS Mast, MS,   | (WASHINGTON)                         |
| 4.  | EMT-P                  |                                      |
|     |                        | Curtis Mast is the Exercise          |
|     | exercise coordinator,  | Coordinator for the Strategic        |
|     |                        | National Stockpile here at the CDC.  |
|     | strategic national     | He's the primary instructor on       |
|     | stockpile, cdc         | Dispensing for S-N-S Preparedness    |
|     |                        | courses. Curtis has traveled around  |
|     |                        | the country, gaining valuable        |
|     |                        | experience from exercises and from   |
|     |                        | working with experts inside and      |
|     |                        | outside of public health.            |
+-----+------------------------+--------------------------------------+
| 1   | cg: Nathaniel Hupert,  | Doctor Nathaniel Hupert is an        |
| 5.  | MD, mph                | Assistant Professor of Public Health |
|     |                        | and Medicine in the Division of      |
|     | Asst. Professor of     | Outcomes and Effectiveness Research  |
|     | Public Health &        | at Weill Medical College of Cornell  |
|     | Medicine,              | University in New York City. He has  |
|     |                        | helped develop many mathematical     |
|     | Division of Outcomes & | models and computer-based planning   |
|     | Effectiveness          | tools with the goal of helping       |
|     | Research,              | Planners develop community-based     |
|     |                        | mass prophylaxis plans that are both |
|     | Weill Medical College  | scientifically based *and*           |
|     | of Cornell University, | practically workable.                |
|     | nyc                    |                                      |
|     |                        |                                      |
|     | joe: "WEILL" is        |                                      |
|     | pronounced as "while"  |                                      |
+-----+------------------------+--------------------------------------+
| 1   | cg: Ruth Thornburg,    | To my right is Ruth Thornburg, a     |
| 6.  | ma, ms                 | Public Information and Communication |
|     |                        | Specialist at the CDC. She is one of |
|     | Public information and | the S-N-S experts for public         |
|     | communications,        | information and communications.      |
|     | strategic national     |                                      |
|     | stockpile, cdc         |                                      |
+-----+------------------------+--------------------------------------+
| 1   | cg: LuAnnE mcNichols,  | A very important addition to our     |
| 7.  | bsn, mn                | panel is LuAnne McNichols, the       |
|     |                        | Bioterrorism Clinical Coordinator    |
|     | BioTerrorism Clinical  | for the state of Minnesota. LuAnne   |
|     | Coordinator, Minnesota | will give us first-hand accounts of  |
|     | Department of Health   | her experiences with each of the     |
|     |                        | topics we'll discuss today.          |
+-----+------------------------+--------------------------------------+
| 1   | cg: eileen malatino,   | And Eileen Malatino, a Health        |
| 8.  | BSN, health scientist  | Scientist with the Strategic         |
|     |                        | National Stockpile at the CDC.       |
|     | strategic national     |                                      |
|     | stockpile, CDC         | Thank you to all of the presenters   |
|     |                        | today.                               |
+-----+------------------------+--------------------------------------+
| 1   |                        | (WASHINGTON)                         |
| 9.  |                        |                                      |
|     |                        | In the middle of this program you'll |
|     |                        | watch an example of what a           |
|     |                        | bioterrorism attack in a large       |
|     |                        | metropolitan area might look like.   |
|     |                        | Think of how you and your team might |
|     |                        | plan for this event while the        |
|     |                        | presenters tackle some of the key    |
|     |                        | issues surrounding it. After the     |
|     |                        | speaker's presentations, we'll list  |
|     |                        | resources for more information, then |
|     |                        | gather everyone together for a       |
|     |                        | question and answer session.         |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 2   |                        | Thank you, panelists, for your       |
| 0.  |                        | valuable input. And of course,       |
|     |                        | thanks to everyone in our viewing    |
|     |                        | audience watching the broadcast via  |
|     |                        | satellite or the worldwide web.      |
+-----+------------------------+--------------------------------------+
| 2   |                        | Our first order of business is       |
| 1.  |                        | discussing the objectives for this   |
|     |                        | program. After viewing this          |
|     |                        | broadcast, you should be able to     |
|     |                        | describe:                            |
+-----+------------------------+--------------------------------------+
| 2   | SS#                    | What the S-N-S program does in the   |
| 2.  |                        | event of a deployment.               |
|     | -   what the sns...    |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 2   | SS#                    | Key factors used in determining the  |
| 3.  |                        | Points of Dispensing, also called    |
|     | -   key factors...     | PODs. We will use the term "POD"     |
|     |                        | throughout this broadcast to         |
|     | (Joe: pronounce "POD"  | universally refer to a mass          |
|     | as in "pea pod")       | dispensing clinic site.              |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 2   | SS#                    | (WASHINGTON)                         |
| 4.  |                        |                                      |
|     | -   critical...        | Critical POD planning considerations |
|     |                        | that impact S-N-S planning.          |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 2   | SS#                    | Three ways a public information and  |
| 5.  |                        | communications campaign impacts      |
|     | -   three ways...      | S-N-S planning.                      |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 2   | ss#                    | (WASHINGTON)                         |
| 6.  |                        |                                      |
|     | [technical             | Before we get underway, if you\'re   |
|     | a                      | having technical difficulties        |
|     | ssistance]{.underline} | downlinking our signal, call us      |
|     |                        | right away at 1-800 728- 82 32.      |
|     | In the U.s.: (800)     | That\'s 1-800 728- 82 32.            |
|     | 728-8232               |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 2   | ss#                    | There are different types of         |
| 7.  |                        | continuing education credits         |
|     | [credit                | available to you just by watching    |
|     | offered]{.underline}   | this program.                        |
|     |                        |                                      |
|     | -   cne                |                                      |
|     |                        |                                      |
|     | -   ceu                |                                      |
+-----+------------------------+--------------------------------------+
| 2   | ss#                    | If you wish to receive continuing    |
| 8.  |                        | education credit, you *must*         |
|     | [online credit         | register and complete the online     |
|     | requ                   | course evaluation. Continuing        |
|     | irements:]{.underline} | education credit for this program is |
|     |                        | available ONLY through the CDC's     |
|     | -   register           | Training and Continuing Education    |
|     |                        | Online system; we'll talk more about |
|     | -   complete           | this at the end of this broadcast.   |
|     |     evaluation         |                                      |
+-----+------------------------+--------------------------------------+
| 2   | ss#                    | This program can also be accessed    |
| 9.  |                        | through the Public Health Training   |
|     | [course overview       | Network website after today through  |
|     | website:]{.underline}  | an archived webcast, as well as on   |
|     |                        | videotape and CD-ROM within a few    |
|     | <http://www.phppo.cd   | weeks. Specific information is       |
|     | c.gov/phtn/antibiotic> | available on the course overview     |
|     |                        | website.                             |
+-----+------------------------+--------------------------------------+
| 3   |                        | As I said at the top of this         |
| 0.  |                        | 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    |
|     |                        | T-T-Y service.                       |
+-----+------------------------+--------------------------------------+
| 3   | ss#                    | For regular voice calls, the number  |
| 1.  |                        | is 800- 793- 8598.                   |
|     | [Phone                 |                                      |
|     | calls]{.underline}     |                                      |
|     |                        |                                      |
|     | \(800\) 793-8598       |                                      |
+-----+------------------------+--------------------------------------+
| 3   | ss#                    | You can fax your question or comment |
| 2.  |                        | to us at 800- 553- 6323.             |
|     | [fax]{.underline}      |                                      |
|     |                        |                                      |
|     | \(800\) 553-6323       |                                      |
+-----+------------------------+--------------------------------------+
| 3   | ss#                    | And finally, our T-T-Y number is     |
| 3.  |                        | 800- 815- 8152.                      |
|     | [TTY]{.underline}      |                                      |
|     |                        |                                      |
|     | \(800\) 815-8152       |                                      |
+-----+------------------------+--------------------------------------+
| 3   |                        | Please remember that these Public    |
| 4.  |                        | Health Training Network numbers are  |
|     |                        | answered *ONLY* during P-H-T-N       |
|     |                        | 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   |
|     |                        | June 24, 2004, you're watching an    |
|     |                        | archived rebroadcast!                |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 3   |                        | As you can imagine, there is a       |
| 5.  |                        | degree of chaos and confusion        |
|     |                        | surrounding a bioterrorism event.    |
|     |                        | That's why we're here today -- help  |
|     |                        | you fine-tune your dispensing plans. |
|     |                        |                                      |
|     |                        | Our first panelist has quite a bit   |
|     |                        | of experience with S-N-S operations. |
|     |                        | Curtis, can you talk about what the  |
|     |                        | S-N-S program does if a bioterrorism |
|     |                        | event occurs?                        |
+-----+------------------------+--------------------------------------+
| 3   | cg: CURTIS Mast, MS,   | (MAST)                               |
| 6.  | EMT-P                  |                                      |
|     |                        | Sure, Joe. If a large-scale          |
|     | exercise coordinator,  | bioterrorism event occurs, emergency |
|     |                        | response leaders in the community    |
|     | strategic national     | may quickly realize that they don't  |
|     | stockpile, cdc         | have enough medical supplies and     |
|     |                        | medications at the local or state    |
|     |                        | level to treat the entire            |
|     |                        | population; that's when you need     |
|     |                        | S-N-S Program assistance.            |
+-----+------------------------+--------------------------------------+
| 3   |                        | Your Governor can officially request |
| 7.  |                        | S-N-S material directly from the CDC |
|     |                        | with or without a Presidential       |
|     |                        | Disaster Declaration. A Federal      |
|     |                        | order will activate our Program, and |
|     |                        | the necessary materials will be on   |
|     |                        | their way.                           |
+-----+------------------------+--------------------------------------+
| 3   |                        | (WASHINGTON)                         |
| 8.  |                        |                                      |
|     |                        | What kinds of services and materials |
|     |                        | are available?                       |
+-----+------------------------+--------------------------------------+
| 3   |                        | (MAST)                               |
| 9.  |                        |                                      |
|     |                        | Our program is structured to offer a |
|     |                        | five-tiered response; I'll go over   |
|     |                        | three of the most important ones.    |
+-----+------------------------+--------------------------------------+
| 4   | ss#                    | The first is the "12-hour Push       |
| 0.  |                        | Package." Weighing over fifty tons,  |
|     | sns response           | and containing over 100 different    |
|     |                        | product lines, these packages are    |
|     | [12-Hour push          | strategically placed around the      |
|     | package]{.underline}   | country so that they can reach any   |
|     |                        | affected area in twelve hours or     |
|     | -   100 different      | less, once the Federal decision to   |
|     |     product lines      | deploy has been made. The Push       |
|     |                        | Packages provide broad support for   |
|     | -   delivered in 12    | an ill-defined threat in the early   |
|     |     hours or less      | hours of an event.                   |
+-----+------------------------+--------------------------------------+
| 4   | SS#                    | Our second element of response is    |
| 1.  |                        | called Vendor Managed Inventory, or  |
|     | sns response           | V-M-I. V-M-I is mass quantities of   |
|     |                        | pharmaceuticals and medical supplies |
|     | [vmi]{.underline}      | that are maintained by either one of |
|     |                        | our contract vendors or the S-N-S    |
|     | Vendor Managed         | Program. It can be shipped as        |
|     | Inventory              | follow-on to the Push Package, or as |
|     |                        | a tailored first response to a       |
|     |                        | smaller, well-defined event.         |
+-----+------------------------+--------------------------------------+
| 4   | freeze frame of taru   | (MAST)                               |
| 2.  | in action --           |                                      |
|     |                        | You need to know that we are always  |
|     | ss#                    | here to help you; and that's the     |
|     |                        | third part of our response effort.   |
|     | sns response           | The S-N-S Program provides on-site   |
|     |                        | technical assistance during and      |
|     | [TARU]{.underline} =   | after an emergency. A Technical      |
|     | Technical Advisory     | Advisory Response Unit, or TAY-roo,  |
|     | Respose Unit           | will arrive at the location before   |
|     |                        | the Push Package, to provide advice  |
|     |                        | in receiving, managing,              |
|     |                        | distributing, dispensing,            |
|     |                        | replenishing and repackaging S-N-S   |
|     |                        | Program assets. But remember - state |
|     |                        | and local teams are ultimately       |
|     |                        | responsible for storing,             |
|     |                        | distributing, and dispensing the     |
|     |                        | Stockpile assets.                    |
+-----+------------------------+--------------------------------------+
| 4   |                        | (WASHINGTON)\                        |
| 3.  |                        | It sounds like this is a major       |
|     |                        | planning effort that includes many   |
|     |                        | functions -- why are you focusing on |
|     |                        | mass dispensing first?               |
+-----+------------------------+--------------------------------------+
| 4   |                        | (MAST)                               |
| 4.  |                        |                                      |
|     |                        | Mass dispensing is where the "rubber |
|     |                        | meets the road" during a             |
|     |                        | bioterrorism attack. All other       |
|     |                        | emergency plans may work flawlessly, |
|     |                        | but if a community cannot rapidly    |
|     |                        | dispense medications to its          |
|     |                        | population, lives may be lost.       |
+-----+------------------------+--------------------------------------+
| 4   |                        | This is an evolving field which      |
| 5.  |                        | crosses several professional and     |
|     |                        | organizational boundaries, and while |
|     |                        | many of us are familiar with         |
|     |                        | dispensing clinics, this scenario    |
|     |                        | will be different because of the     |
|     |                        | quick ramp-up time required and the  |
|     |                        | almost overwhelming numbers of       |
|     |                        | people that would need medication*.* |
+-----+------------------------+--------------------------------------+
| 4   |                        | (WASHINGTON)\                        |
| 6.  |                        | Curtis, what's the basis of the      |
|     |                        | suggestions and recommendations that |
|     |                        | you'll share with us today?          |
+-----+------------------------+--------------------------------------+
| 4   |                        | (MAST)                               |
| 7.  |                        |                                      |
|     |                        | In our investigations, we started    |
|     |                        | with the basics of public health     |
|     |                        | clinic management, but needed to     |
|     |                        | figure out how to expand to deal     |
|     |                        | with the enormous nature of mass     |
|     |                        | dispensing operations. The S-N-S     |
|     |                        | Program sought expertise from        |
|     |                        | outside of our traditional arenas,   |
|     |                        | meeting with experts in              |
|     |                        | manufacturing, pedestrian and crowd  |
|     |                        | planning and management, computer    |
|     |                        | modeling and simulation, emergency   |
|     |                        | management, security, pharmacy, and  |
|     |                        | experts from the industrial          |
|     |                        | engineering field. We took their     |
|     |                        | "best practices" and incorporated    |
|     |                        | them into mass dispensing            |
|     |                        | strategies.                          |
|     |                        |                                      |
|     |                        | Remember, we can only *scratch the   |
|     |                        | surface* of mass dispensing          |
|     |                        | operations today.                    |
+-----+------------------------+--------------------------------------+
| 4   | ss#                    | Let's start with the goals for a     |
| 8.  |                        | mass dispensing program. Our first   |
|     | [goals of mass         | goal is to decrease the pool of      |
|     | d                      | individuals who might become ill.    |
|     | ispensing]{.underline} | So, the quicker you can set up POD   |
|     |                        | operations and dispensing, the       |
|     | -   set up pod         | better off we'll be. This is called, |
|     |     operations         | simply, "Pills in People."           |
|     |     quickly - "pills   |                                      |
|     |     in people"         |                                      |
+-----+------------------------+--------------------------------------+
| 4   | ss#                    | The second goal is to provide public |
| 9.  |                        | health information to the general    |
|     | [goals of mass         | public. Providing information and    |
|     | d                      | providing medication go              |
|     | ispensing]{.underline} | hand-in-hand. You will not have a    |
|     |                        | successful dispensing campaign if    |
|     | -   provide health     | you do not have a successful         |
|     |     information        | Media-Public Relations-Risk          |
|     |                        | Communications campaign. Ruth        |
|     |                        | Thornburg will address several       |
|     |                        | communications issues later in this  |
|     |                        | broadcast.                           |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 5   | ss#:                   | Here is the backbone of the program  |
| 0.  |                        | today, the key things that we'll be  |
|     | (reveal as spoken)     | talking about.                       |
|     |                        |                                      |
|     | -   Planning           | -   Planning Considerations: The     |
|     |     Considerations     |     things you need to figure out    |
|     |                        |     and resolve *before* an          |
|     | -   Site Selection     |     emergency happens.               |
|     |                        |                                      |
|     | -   Site Set Up and    | -   Site Selection. Where should the |
|     |     Design             |     Points of Dispensing be?         |
|     |                        |                                      |
|     | -   Public Information | -   Site Set Up and Design. Or, How  |
|     |     and Communication. |     to Avoid Bottlenecks.            |
|     |                        |                                      |
|     |                        | -   And Public Information and       |
|     |                        |     Communication, formerly called   |
|     |                        |     Health Communications.           |
+-----+------------------------+--------------------------------------+
| 5   | graphic/animation      | *Music stinger*                      |
| 1.  |                        |                                      |
|     | SECTION TITLE:         |                                      |
|     |                        |                                      |
|     | Planning               |                                      |
|     | Considerations         |                                      |
+-----+------------------------+--------------------------------------+
| 5   |                        | (WASHINGTON)                         |
| 2.  |                        |                                      |
|     |                        | Curtis, you've laid down the         |
|     |                        | groundwork. Now let's dig into       |
|     |                        | Planning Considerations.             |
+-----+------------------------+--------------------------------------+
| 5   |                        | (MAST)\                              |
| 3.  |                        | Yes, and there are *lots* of         |
|     |                        | planning considerations to discuss,  |
|     |                        | but because of the time constraints  |
|     |                        | of this broadcast, I'll review a few |
|     |                        | of the major ones. These are the     |
|     |                        | things to decide on *before* an      |
|     |                        | event happens, the homework          |
|     |                        | assignments that you can start       |
|     |                        | working on immediately after this    |
|     |                        | broadcast. Feel free to call or fax  |
|     |                        | in a question if I don't cover it    |
|     |                        | here.                                |
+-----+------------------------+--------------------------------------+
| 5   | ss#                    | The first point I'd like to bring up |
| 4.  |                        | is *policy uniformity* of your       |
|     | [Planning              | dispensing program in a community.   |
|     | Consi                  |                                      |
|     | derations]{.underline} | There a two benefits to doing this.  |
|     |                        | First, it will be perceived as fair  |
|     | -   policy uniformity  | and equitable by the public. Second, |
|     |     of dispensing --   | it's easier to plan and operate PODs |
|     |     work under the     | if they're all working under the     |
|     |     same guidelines    | same guidelines, such as the         |
|     |                        | medication delivered, hours of       |
|     |                        | operation, and medication "take      |
|     |                        | away" information. On the other      |
|     |                        | hand, if you don't have uniformity   |
|     |                        | like this, the public may            |
|     |                        | overwhelmingly favor a particular    |
|     |                        | POD due to perceived better service. |
+-----+------------------------+--------------------------------------+
| 5   |                        | That said, you must realize that the |
| 5.  |                        | POD you set up to prophylax a        |
|     |                        | thousand people in two days is NOT   |
|     |                        | going to look like the POD you set   |
|     |                        | up to prophylax 500 thousand people  |
|     |                        | in two days. It can\'t. Doctor       |
|     |                        | Hupert will be talking about models  |
|     |                        | for POD design as it relates to the  |
|     |                        | bioterrorism event scenario you'll   |
|     |                        | see later in this program.           |
+-----+------------------------+--------------------------------------+
| 5   | ss#                    | Your planning efforts should also    |
| 6.  |                        | address POD hours of operation. Are  |
|     | [Planning              | you assuming that your PODs will     |
|     | Consi                  | operate on a twenty-four hour        |
|     | derations]{.underline} | schedule? Or do you think it's going |
|     |                        | to be dependent on the event?        |
|     | -   hours of operation |                                      |
|     |                        | Twenty-four hour operation is a good |
|     |                        | thing, since it can process the most |
|     |                        | people in the smallest amount of     |
|     |                        | time. But it's very logistically     |
|     |                        | challenging. Can you rapidly open,   |
|     |                        | staff, and operate these sites 24    |
|     |                        | hours a day? What happens to the     |
|     |                        | people who show up five minutes      |
|     |                        | before the POD closes? These are     |
|     |                        | things you need to think about when  |
|     |                        | planning.                            |
+-----+------------------------+--------------------------------------+
| 5   | ss#                    | Another big issue that impacts       |
| 7.  |                        | planning is: who can dispense        |
|     | [Planning              | medication in your state under the   |
|     | Consi                  | current pharmacy laws? You'll need   |
|     | derations]{.underline} | to do some research on this one,     |
|     |                        | because those laws may be waived     |
|     | -   who can dispense?  | under a declaration of emergency.    |
|     |                        |                                      |
|     | -   will laws be       |                                      |
|     |     waived under a     |                                      |
|     |     state of           |                                      |
|     |     emergency?         |                                      |
+-----+------------------------+--------------------------------------+
| 5   | ss#                    | (MAST)                               |
| 8.  |                        |                                      |
|     | [Planning              | Now is that a county declaration, a  |
|     | Consi                  | state declaration, or a federal      |
|     | derations]{.underline} | declaration? It can vary greatly.    |
|     |                        | And how does the declaration of a    |
|     | -                      | public health emergency differ from  |
|     |   county/state/federal | a disaster declaration? Learn as     |
|     |     declaration:       | much as you can about emergency      |
|     |     different          | declarations in your state, and find |
|     |     terminology        | out if a public health emergency     |
|     |                        | gets different treatment, especially |
|     | -   public             | as it relates to mass dispensing of  |
|     |     health/disaster    | medications.                         |
|     |     declaration:       |                                      |
|     |     different          |                                      |
|     |     terminology        |                                      |
+-----+------------------------+--------------------------------------+
| 5   | ss#                    | To make the prescribing function     |
| 9.  |                        | work more smoothly, the S-N-S        |
|     | [Planning              | Program recommends listing *one*     |
|     | Consi                  | prescribing physician; for example,  |
|     | derations]{.underline} | the State Health Officer. Biological |
|     |                        | events will cross jurisdictional     |
|     | -   one prescribing    | borders without remorse. LuAnne, how |
|     |     physician          | does Minnesota deal with this issue? |
+-----+------------------------+--------------------------------------+
| 6   | cg: LuAnne mcNichols,  | (McNICHOLS)\                         |
| 0.  | bsn, mn                | In Minnesota, all of our standing    |
|     |                        | orders will be written by the State  |
|     | BioTerrorism Clinical  | Epidemiologist, who is also a        |
|     | Coordinator, Minnesota | physician.                           |
|     | Department of Health   |                                      |
|     |                        | We have eight regions that are       |
|     |                        | planning for mass dispensing. All of |
|     |                        | them are aware that an event will    |
|     |                        | cross all borders, so we're actively |
|     |                        | planning across regions, with        |
|     |                        | neighboring states, and with Canada  |
|     |                        | on all cross-border issues. As the   |
|     |                        | regions are choosing their POD       |
|     |                        | sites, they're predicting where      |
|     |                        | their populations will naturally go  |
|     |                        | in an event based on normal traffic  |
|     |                        | patterns and habits. As we work with |
|     |                        | neighboring states, we realize that  |
|     |                        | populations are often more apt to go |
|     |                        | to a bordering city that's nearby    |
|     |                        | rather than somewhere further away   |
|     |                        | in their own state.                  |
+-----+------------------------+--------------------------------------+
| 6   | ss#                    | (MAST)                               |
| 1.  |                        |                                      |
|     | [Planning              | I'd like to briefly mention          |
|     | Consi                  | something called the Push-Pull       |
|     | derations]{.underline} | theory here. When you set up a POD,  |
|     |                        | you are *Pulling* people into a      |
|     | [reaching the          | clinic site. This term comes from    |
|     | people]{.underline}    | traditional immunization and         |
|     |                        | outbreak clinics. In theory, the     |
|     | push/pull theory       | majority of the people will receive  |
|     |                        | medications this way.                |
|     |                        |                                      |
|     |                        | *"Push*," on the other hand, is      |
|     |                        | sending medications out to the       |
|     |                        | public *wherever they are*. This     |
|     |                        | includes mobile dispensing units or  |
|     |                        | other delivery systems to get the    |
|     |                        | meds to people who can't get to the  |
|     |                        | PODs.                                |
+-----+------------------------+--------------------------------------+
| 6   | ss#                    | And then there's the worried well,   |
| 2.  |                        | the people who weren't exposed to    |
|     | [Planning              | the agent, but are very concerned    |
|     | Consi                  | about it, and have shown up at your  |
|     | derations]{.underline} | POD requesting or even demanding     |
|     |                        | medications!                         |
|     | [reaching the          |                                      |
|     | people]{.underline}    | Don't you think that if there\'s a   |
|     |                        | bio-terrorism event in the United    |
|     | "worried well"         | States you're going to have a lot of |
|     |                        | people who become the "Worried       |
|     |                        | Well?"                               |
|     |                        |                                      |
|     |                        | And they're going to show up at POD! |
|     |                        | What do you do with them? Do you     |
|     |                        | turn them away because they don\'t   |
|     |                        | meet the exposure profile?           |
+-----+------------------------+--------------------------------------+
| 6   |                        | You'll have to have a response and   |
| 3.  |                        | information packet for the worried   |
|     |                        | well. Your response may be as simple |
|     |                        | as: "We understand your concern. You |
|     |                        | don\'t meet the criteria for         |
|     |                        | exposure that the health officer     |
|     |                        | defined, and because of that, you're |
|     |                        | not going to get medication today.   |
|     |                        | Here\'s a packet of information that |
|     |                        | includes a phone number and website  |
|     |                        | where you can receive more           |
|     |                        | information."                        |
+-----+------------------------+--------------------------------------+
| 6   |                        | (WASHINGTON)                         |
| 4.  |                        |                                      |
|     |                        | Curtis, I think we need to spend     |
|     |                        | some time talking about the unsung   |
|     |                        | hero in these efforts -- the         |
|     |                        | volunteer. How can everyone plan for |
|     |                        | recruiting and training volunteers?  |
+-----+------------------------+--------------------------------------+
| 6   | ss#                    | (MAST)                               |
| 5.  |                        |                                      |
|     | [Planning              | You're right, Joe, a trained         |
|     | Consi                  | volunteer staff is *critical* to     |
|     | derations]{.underline} | successful operations, and they      |
|     |                        | certainly don't get the recognition  |
|     | -   volunteers         | they deserve. Gregory Smith with the |
|     |                        | American Red Cross is quoted as      |
|     | ss#                    | saying, "There is no challenge in    |
|     |                        | getting individuals to volunteer.    |
|     | [american red          | Those who have the skill sets you    |
|     | cross:]{.underline}    | need, and those who do not. But the  |
|     |                        | main issue here is you have to have  |
|     | plan for dealing with  | a plan for dealing with that."       |
|     | volunteers on all      |                                      |
|     | skill levels           |                                      |
+-----+------------------------+--------------------------------------+
| 6   |                        | Recent major events in our country   |
| 6.  |                        | reveal the unabashed spirit of       |
|     |                        | helpfulness in America. Remember the |
|     |                        | blood drives after Nine-Eleven? The  |
|     |                        | Doctors and Nurses who rushed to     |
|     |                        | hospitals and clinics to offer their |
|     |                        | services? People came from all over  |
|     |                        | the country to help with the efforts |
|     |                        | of rescue and recovery. And citizens |
|     |                        | raised money to aid the victims and  |
|     |                        | their families.                      |
|     |                        |                                      |
|     |                        | Utilize this awesome resource to its |
|     |                        | full potential!                      |
+-----+------------------------+--------------------------------------+
| 6   | ss#                    | Volunteers can be divided into two   |
| 7.  |                        | groups: those who can be recruited   |
|     | [types of              | and trained prior to an event, and   |
|     | v                      | the "spontaneous volunteers" that    |
|     | olunteers]{.underline} | may show up to help out during an    |
|     |                        | event. Some have experience with     |
|     | -   recruited and      | emergency preparedness, like The     |
|     |     trained            | American Red Cross or The Salvation  |
|     |                        | Army, and others may just be         |
|     | -   spontaneous        | concerned groups of citizens or      |
|     |                        | individuals.                         |
+-----+------------------------+--------------------------------------+
| 6   | ss#                    | Make sure you know what you need the |
| 8.  |                        | volunteers to do. Consider these     |
|     | [v                     | questions: Which jobs *can* be done  |
|     | olunteers]{.underline} | by volunteers? What knowledge,       |
|     |                        | skills, and abilities are needed for |
|     | -   which jobs?        | each job? How will you match the     |
|     |                        | qualities with the job? And how will |
|     | -   what are the       | you train them?                      |
|     |     knowledge, skills, |                                      |
|     |     and abilities      | Training volunteers is an enormous   |
|     |     needed?            | task. How you will handle advance or |
|     |                        | spontaneous training is a question   |
|     | -   how to match the   | that must be answered in every       |
|     |     qualities & jobs?  | community.                           |
|     |                        |                                      |
|     | -   how will training  |                                      |
|     |     be done?           |                                      |
+-----+------------------------+--------------------------------------+
| 6   |                        | (WASHINGTON)                         |
| 9.  |                        |                                      |
|     |                        | Those are good points, Curtis.       |
|     |                        | LuAnne, can you give us insights     |
|     |                        | into how you plan to work with       |
|     |                        | volunteer staff in Minnesota?        |
+-----+------------------------+--------------------------------------+
| 7   |                        | (McNICHOLS)                          |
| 0.  |                        |                                      |
|     |                        | How to fit volunteers into mass      |
|     |                        | dispensing operations is certainly   |
|     |                        | one of our most daunting challenges. |
|     |                        | But if the roles and                 |
|     |                        | responsibilities of all volunteers   |
|     |                        | are consistent throughout the state, |
|     |                        | the task becomes easier. In          |
|     |                        | Minnesota, volunteer recruitment is  |
|     |                        | being planned through a statewide    |
|     |                        | registry, and a number of counties   |
|     |                        | already have Medical Reserve Corps,  |
|     |                        | or they're looking at forming them.  |
+-----+------------------------+--------------------------------------+
| 7   |                        | Counties must look at their          |
| 1.  |                        | organizational structure and choose  |
|     |                        | from their available staff to        |
|     |                        | identify who can best fill POD       |
|     |                        | operation posts, based on skill and  |
|     |                        | compatibility. These public health   |
|     |                        | and county staff are then prime      |
|     |                        | candidates for pre-training. Other   |
|     |                        | groups that can be pre-trained are   |
|     |                        | the volunteer corps (those on the    |
|     |                        | statewide registry and Medical       |
|     |                        | Reserve Corps). We realize that many |
|     |                        | PODs will still have staffing gaps.  |
|     |                        | It is our hope that volunteers will  |
|     |                        | come forward at the time of an event |
|     |                        | and then they'll be "Just in Time"   |
|     |                        | trained on site.                     |
+-----+------------------------+--------------------------------------+
| 7   | graphic/animation      | *Music stinger*                      |
| 2.  |                        |                                      |
|     | SECTION TITLE:         |                                      |
|     |                        |                                      |
|     | site selection         |                                      |
|     |                        |                                      |
|     | []{.mark}              |                                      |
+-----+------------------------+--------------------------------------+
| 7   |                        | (WASHINGTON)                         |
| 3.  |                        |                                      |
|     |                        | Now let's move on to Site Selection. |
|     |                        | Where would be a great place for a   |
|     |                        | POD?                                 |
+-----+------------------------+--------------------------------------+
| 7   | ss#                    | (MAST)                               |
| 4.  |                        |                                      |
|     | [site                  | Generally, you should pick sites     |
|     | selection]{.underline} | that are familiar to much of your    |
|     |                        | population, and that are easily      |
|     | -   familiar locations | accessible. Places like schools,     |
|     |                        | malls, voting locations, or other    |
|     | -   easily accessible  | commercial buildings are good        |
|     |                        | examples. Be sure to consider        |
|     |                        | accessibility issues when scouting   |
|     |                        | for potential POD sites in order to  |
|     |                        | provide coverage for people with     |
|     |                        | impaired mobility.                   |
+-----+------------------------+--------------------------------------+
| 7   | freeze frames of red   | An organization that does a          |
| 5.  | cross in action        | phenomenal job of pre-event site     |
|     |                        | selection and rapidly opening those  |
|     |                        | sites in an emergency is the         |
|     |                        | American Red Cross. The Red Cross is |
|     |                        | constantly working to find public    |
|     |                        | and private facilities that may be   |
|     |                        | suitable as shelters.                |
+-----+------------------------+--------------------------------------+
| 7   |                        | (WASHINGTON)                         |
| 6.  |                        |                                      |
|     |                        | LuAnne, can you tell us about the    |
|     |                        | system Minnesota has devised for     |
|     |                        | selecting POD sites?                 |
+-----+------------------------+--------------------------------------+
| 7   |                        | (McNICHOLS)\                         |
| 7.  |                        | Sure, Joe. Each region in Minnesota  |
|     |                        | has analyzed their population        |
|     |                        | density using geographic Information |
|     |                        | systems, or G-I-S. G-I-S enabled     |
|     |                        | them to use that data to estimate    |
|     |                        | the number of people they thought    |
|     |                        | they could treat at the POD. They    |
|     |                        | also considered the characteristics  |
|     |                        | of their regions, such as the size   |
|     |                        | of facilities, or the availability   |
|     |                        | of staff.                            |
+-----+------------------------+--------------------------------------+
| 7   | ss#                    | Minnesota has heavily-populated and  |
| 8.  |                        | rural regions. In the densely        |
|     | use luanne's slide #9  | populated metro region of            |
|     |                        | Minneapolis-St. Paul, which includes |
|     |                        | seven counties, planning estimates   |
|     |                        | were developed for the maximum       |
|     |                        | travel distance to a POD, because    |
|     |                        | the planning committee didn\'t want  |
|     |                        | anyone to drive more than five to    |
|     |                        | ten miles to get to a dispensing     |
|     |                        | site. Using G-I-S, they overlaid     |
|     |                        | that information with population     |
|     |                        | data. After working with this        |
|     |                        | system, they were able to decrease   |
|     |                        | the number of PODs and only fifteen  |
|     |                        | percent of the population had to     |
|     |                        | drive more than five miles to reach  |
|     |                        | a POD.                               |
+-----+------------------------+--------------------------------------+
| 7   | ss#                    | In rural areas, it was even more     |
| 9.  |                        | crucial to plan for travel to a POD. |
|     | use luanne's new rural | Some of the rural regions of         |
|     | slide                  | Minnesota cover large geographic     |
|     |                        | areas and have small populations.    |
|     |                        | Each region had to make a            |
|     |                        | "reasonable commute decision" for    |
|     |                        | their population: one hour, two      |
|     |                        | hours, or more than that? Some have  |
|     |                        | chosen to set up "traveling          |
|     |                        | dispensing units." G-I-S mapping was |
|     |                        | a great planning tool for the rural  |
|     |                        | regions, it really helped them       |
|     |                        | visualize optimal POD locations.     |
+-----+------------------------+--------------------------------------+
| 8   | to camera              | (WASHINGTON)                         |
| 0.  |                        |                                      |
|     |                        | Thanks, LuAnne.                      |
|     |                        |                                      |
|     |                        | As planners, those are some of the   |
|     |                        | decisions you'll have to make for    |
|     |                        | your community.                      |
|     |                        |                                      |
|     |                        | Curtis, what are some other things   |
|     |                        | to consider when looking for POD     |
|     |                        | sites?                               |
+-----+------------------------+--------------------------------------+
| 8   |                        | (MAST)                               |
| 1.  |                        |                                      |
|     |                        | We need to look at what forms of     |
|     |                        | transportation people will use to    |
|     |                        | get to the POD sites, and make plans |
|     |                        | for that, as well. For example,      |
|     |                        | automobiles are used most often in   |
|     |                        | rural and suburban settings, and     |
|     |                        | trains, buses, and taxis are used in |
|     |                        | urban settings.                      |
+-----+------------------------+--------------------------------------+
| 8   |                        | And once people arrive at the site,  |
| 2.  |                        | where will they go? A planning       |
|     |                        | decision every community should make |
|     |                        | is whether to have "segmented" or    |
|     |                        | "non-segmented" dispensing           |
|     |                        | operations.                          |
+-----+------------------------+--------------------------------------+
| 8   | ss#                    | Segmented operations means           |
| 3.  |                        | physically separating                |
|     | [segmented             | pre-prophylaxis activities from the  |
|     | o                      | actual dispensing of medication. The |
|     | perations]{.underline} | public would gather in one location, |
|     |                        | where they could be screened,        |
|     | -   public gathers     | triaged, and given the required      |
|     |     centrally          | education; then transported in       |
|     |                        | groups to the actual POD to receive  |
|     | -   screenEd           | medication.                          |
|     |                        |                                      |
|     | -   triaged            |                                      |
|     |                        |                                      |
|     | -   educated           |                                      |
|     |                        |                                      |
|     | -   transported        |                                      |
+-----+------------------------+--------------------------------------+
| 8   | ss#                    | The benefits to the segmented        |
| 4.  |                        | approach include:                    |
|     | [benefits of segmented |                                      |
|     | o                      | -   Reduced parking and traffic      |
|     | perations]{.underline} |     congestion at the POD,           |
|     |                        |                                      |
|     | -   Reduced            | -   Indirectly improving security at |
|     |     parking/traffic    |     the POD by controlling access to |
|     |                        |     it,                              |
|     | -   improving security |                                      |
|     |                        | -   Potentially decreasing the       |
|     | -   Decrease "worried  |     number of "worried well,"        |
|     |     well,"             |                                      |
|     |                        | -   Allowing a direct mechanism to   |
|     | -   regulate the       |     regulate the initial flow of     |
|     |     initial flow into  |     people into the POD, and         |
|     |     pod                |                                      |
|     |                        | -   The ability to balance public    |
|     | -   balance public     |     flow to (all of) the PODs.       |
|     |     flow to all sites  |                                      |
+-----+------------------------+--------------------------------------+
| 8   |                        | With a segmented approach, you have  |
| 5.  |                        | to consider the additional layer of  |
|     |                        | logistics: you'll need to provide    |
|     |                        | buses, drivers, and fuel at the POD  |
|     |                        | locations, and consider the cost for |
|     |                        | each of these items when planning.   |
+-----+------------------------+--------------------------------------+
| 8   | ss#                    | In the non-segmented approach, all   |
| 6.  |                        | aspects of POD operations are        |
|     | [non-segmented         | conducted at one location. A         |
|     | o                      | challenge of this approach is how to |
|     | perations]{.underline} | fairly distribute the public equally |
|     |                        | among all POD sites. Plan to         |
|     | -   all activities in  | distribute the population of the     |
|     |     one location       | community as equally as possible, or |
|     |                        | practicable, among all the available |
|     |                        | PODs.                                |
+-----+------------------------+--------------------------------------+
| 8   | ss#                    | (MAST)                               |
| 7.  |                        |                                      |
|     | graphic of parking lot | There are drawbacks to the           |
|     | with cars popping up,  | non-segmented approach as well. One  |
|     | abandoned              | big concern is parking. One of the   |
|     |                        | things that the S-N-S Program        |
|     |                        | discovered during our research was   |
|     |                        | that the number of abandoned cars    |
|     |                        | increased proportionally to the      |
|     |                        | attack rate of the illness. Once you |
|     |                        | screen someone out of the crowd as   |
|     |                        | being sick and transport them to the |
|     |                        | hospital, you have an abandoned car. |
|     |                        | How would you handle this? Are you   |
|     |                        | planning to use tow trucks? Another  |
|     |                        | way to avoid abandoned cars is to    |
|     |                        | perform triage while people are in   |
|     |                        | cars: greet, quickly examine, and    |
|     |                        | send sick people to the hospital in  |
|     |                        | their own cars.                      |
|     |                        |                                      |
|     |                        | Another drawback to the non          |
|     |                        | segmented approach is that the       |
|     |                        | public, not you, control access to   |
|     |                        | the site.                            |
+-----+------------------------+--------------------------------------+
| 8   |                        | There is no right or wrong decision  |
| 8.  |                        | when it comes to choosing between    |
|     |                        | segmented or non-segmented POD       |
|     |                        | operations. It all depends on the    |
|     |                        | available resources and policy       |
|     |                        | decisions in your community.         |
+-----+------------------------+--------------------------------------+
| 8   |                        | And now let's talk about a few key   |
| 9.  |                        | aspects of POD sites, and some of    |
|     |                        | the operational issues you'll need   |
|     |                        | to address.                          |
+-----+------------------------+--------------------------------------+
| 9   | ss#                    | First is POD building size. POD      |
| 0.  |                        | sites must be large enough to keep   |
|     | [pod site              | several hundred, or possibly even    |
|     | charac                 | thousands, of people under cover and |
|     | teristics]{.underline} | out of the weather. Some large-scale |
|     |                        | exercises have used PODs as large as |
|     | -   building size      | 60 thousand square feet. Protecting  |
|     |                        | people waiting in line from          |
|     | -   protection from    | excessive heat, cold, rain and snow  |
|     |     weather            | is very important.                   |
+-----+------------------------+--------------------------------------+
| 9   | SS#                    | (MAST)                               |
| 1.  |                        |                                      |
|     | [pod site              | At a minimum, each POD site should   |
|     | charac                 | have the following characteristics:  |
|     | teristics]{.underline} |                                      |
|     |                        | -   Electricity                      |
|     | -   Electricity        |                                      |
|     |                        | -   Heat and air conditioning units  |
|     | -   HVAC               |     to control room temperature,     |
|     |                        |                                      |
|     | -   Toilets            | -   Adequate toilets (1 for every 40 |
|     |                        |     people),                         |
|     | -   Private receiving  |                                      |
|     |     area               | -   A receiving area for supplies    |
|     |                        |     that is out of public view,      |
|     | -   Material handling  |                                      |
|     |     equipment,         | -   The appropriate number and types |
|     |                        |     of material handling equipment,  |
|     | -   Adequate parking   |     and                              |
|     |                        |                                      |
|     | -   Water              | -   Space for parking at or near the |
|     |                        |     POD.                             |
|     |                        |                                      |
|     |                        | -   Water                            |
+-----+------------------------+--------------------------------------+
| 9   |                        | These aren't the *only* issues that  |
| 2.  |                        | you'll encounter during the site     |
|     |                        | selection process; performing        |
|     |                        | exercises will bring more issues to  |
|     |                        | the surface.                         |
+-----+------------------------+--------------------------------------+
| 9   |                        | (WASHINGTON)                         |
| 3.  |                        |                                      |
|     |                        | Thanks for covering so many bases in |
|     |                        | site selection, Curtis.              |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
|     |                        |                                      |
|     |                        | Now let's take a look at the         |
|     |                        | bioterrorism scenario that we spoke  |
|     |                        | of earlier...                        |
+-----+------------------------+--------------------------------------+
| 9   | **roll-in**            | SOT                                  |
| 4.  |                        |                                      |
|     | **bt event here**      | Outcue:                              |
|     |                        |                                      |
|     | trt:                   |                                      |
|     |                        |                                      |
|     | **need to re-do event  |                                      |
|     | voiceover script**     |                                      |
|     |                        |                                      |
|     | super LED clock        |                                      |
|     | display with 0:00:00   |                                      |
|     | at lower left corner.  |                                      |
|     | clock starts running   |                                      |
|     | near end of roll-in    |                                      |
|     | (agent released)       |                                      |
+-----+------------------------+--------------------------------------+
| 9   |                        | (WASHINGTON)                         |
| 5.  |                        |                                      |
|     |                        | This is a pretty sobering            |
|     |                        | example...What do we do now? Curtis, |
|     |                        | help us out!                         |
+-----+------------------------+--------------------------------------+
| 9   | super led clock:       | (MAST)                               |
| 6.  | 02:00:00 (& running)   |                                      |
|     |                        | What you didn't see in this scenario |
|     |                        | is a subway patrolman finding one of |
|     |                        | the anthrax dispersion devices near  |
|     |                        | the train platform at nine thirty    |
|     |                        | a-m, two hours after the event       |
|     |                        | began. This makes our scenario       |
|     |                        | "overt;" *we know* that there has    |
|     |                        | been a substance released and it is  |
|     |                        | an *indoor* release. Field tests     |
|     |                        | show positive results for anthrax    |
|     |                        | spores, and samples are sent to a    |
|     |                        | regional laboratory and possibly,    |
|     |                        | the CDC.                             |
+-----+------------------------+--------------------------------------+
| 9   |                        | Keep in mind that when an event like |
| 7.  |                        | this occurs, the news media will go  |
|     |                        | into a spin, while various federal   |
|     |                        | agencies launch their Emergency      |
|     |                        | Response Teams. Experts we have      |
|     |                        | never seen or heard of before will   |
|     |                        | be all over the news. Rumors and     |
|     |                        | misinformation will run rampant.     |
+-----+------------------------+--------------------------------------+
| 9   |                        | Please remember that the CDC and the |
| 8.  |                        | S-N-S Program do not operate in a    |
|     |                        | vacuum. Health officials, clinics    |
|     |                        | and hospitals will be notified at    |
|     |                        | the local, state and federal levels  |
|     |                        | that unusual medical cases may begin |
|     |                        | to appear. Epidemiologists will help |
|     |                        | you assess what's going on.          |
+-----+------------------------+--------------------------------------+
| 9   | ss#                    | For your part, as soon as you think  |
| 9.  |                        | you have a problem, two things need  |
|     | [suspect bt            | to happen. First, start your         |
|     | event]{.underline}     | notification protocols. Second,      |
|     |                        | start initiating your dispensing     |
|     | -   start notification | operations.                          |
|     |     protocols          |                                      |
|     |                        |                                      |
|     | ```{=html}             |                                      |
|     | <!-- -->               |                                      |
|     | ```                    |                                      |
|     | -   start dispensing   |                                      |
|     |     operations         |                                      |
+-----+------------------------+--------------------------------------+
| 10  |                        | (MAST)                               |
| 0.  |                        |                                      |
|     |                        | There are four phases to the ramp-up |
|     |                        | of a dispensing program.             |
+-----+------------------------+--------------------------------------+
| 10  | ss#                    | In Phase one, Notify and recall all  |
| 1.  |                        | staff required for your dispensing   |
|     | [start-up phases of a  | program.                             |
|     | dispensing             |                                      |
|     | program]{.underline}   |                                      |
|     |                        |                                      |
|     | -   Phase              |                                      |
|     |     One-Notify/Recall  |                                      |
|     |     staff              |                                      |
+-----+------------------------+--------------------------------------+
| 10  | ss#                    | In Phase Two, Prophylax these staff  |
| 2.  |                        | and their families. People critical  |
|     | [start-up phases of a  | to the response infrastructure       |
|     | dispensing             | include Fire, police, emergency      |
|     | program]{.underline}   | medical services, hospitals, public  |
|     |                        | health, and emergency management.    |
|     | -   Phase              | Early, rapid prophylaxis of this     |
|     |     Two-Prophylaxis of | group and their families will ensure |
|     |     staff and critical | their availability as a resource for |
|     |     infrastructure     | our dispensing program efforts.      |
+-----+------------------------+--------------------------------------+
| 10  | ss#                    | Phase Three is the Set up of all the |
| 3.  |                        | necessary PODs.                      |
|     | [start-up phases of a  |                                      |
|     | dispensing             |                                      |
|     | program]{.underline}   |                                      |
|     |                        |                                      |
|     | -   Phase Three- Set   |                                      |
|     |     up PODs            |                                      |
+-----+------------------------+--------------------------------------+
| 10  | ss#                    | And in Phase Four, Notify the public |
| 4.  |                        | of POD openings. It's best to make a |
|     | [start-up phases of a  | simultaneous announcement of all POD |
|     | dispensing             | openings to avoid the sudden         |
|     | program]{.underline}   | overloading of one particular site.  |
|     |                        |                                      |
|     | -   Phase              |                                      |
|     |     Four-Notification  |                                      |
|     |     to public of POD   |                                      |
|     |     openings           |                                      |
+-----+------------------------+--------------------------------------+
| 10  | ss#                    | It's very important to set up mass   |
| 5.  |                        | dispensing operations *extremely     |
|     | [anthrax]{.underline}  | rapidly* in order to prevent         |
|     |                        | casualties. Agents like anthrax in   |
|     | -   first illnesses at | this example may cause illness as    |
|     |     24 hrs.            | soon as twenty-four hours after      |
|     |                        | exposure, leaving only *two to four  |
|     | ```{=html}             | days after exposure* for a mass      |
|     | <!-- -->               | prophylaxis campaign that can        |
|     | ```                    | prevent people from becoming         |
|     | -   2-4 days for mass  | critically ill.                      |
|     |     prophylaxis        |                                      |
+-----+------------------------+--------------------------------------+
| 10  | super led clock:       | (WASHINGTON)\                        |
| 6.  | 04:00:00               | The gears are turning now, at **hour |
|     |                        | four** after the anthrax release.    |
|     |                        | Curtis, what's next?                 |
+-----+------------------------+--------------------------------------+
| 10  |                        | (MAST)                               |
| 7.  |                        |                                      |
|     |                        | Because of good pre-event planning,  |
|     |                        | potential PODs have already been     |
|     |                        | identified and inspected. Now, which |
|     |                        | PODs need to be activated?           |
+-----+------------------------+--------------------------------------+
| 10  | **new**                | In this scenario, Metroville's       |
| 8.  |                        | population is three and a half       |
|     | SS#                    | million people, and 500 thousand of  |
|     |                        | them use the subway to get to work.  |
|     | METROVILLE ANTHRAX     | It's a safe assumption that many     |
|     | EVENT                  | people in this city will be          |
|     |                        | affected.                            |
|     | -   3.5 MILLION        |                                      |
|     |                        | POD Locations should be based the    |
|     | -   500 THOUSAND USE   | population distribution of each      |
|     |     SUBWAY             | area, so first determine where the   |
|     |                        | bulk of the population is located.   |
|     | -   ANTHRAX IN 7       | Can you reach all of them quickly?   |
|     |     SUBWAY LINES       |                                      |
+-----+------------------------+--------------------------------------+
| 10  |                        | Given this information, it would     |
| 9.  |                        | probably be wise to gear up          |
|     |                        | operations at all of your POD sites. |
|     |                        | Keep in mind, the quicker you can    |
|     |                        | complete your entire mass dispensing |
|     |                        | campaign, the better off the         |
|     |                        | population will be.                  |
+-----+------------------------+--------------------------------------+
| 11  | graphic/animation      | *Music stinger*                      |
| 0.  |                        |                                      |
|     | SECTION TITLE:         |                                      |
|     |                        |                                      |
|     | site set up and design |                                      |
|     |                        |                                      |
|     | super led clock:       |                                      |
|     | 06:00:00               |                                      |
|     |                        |                                      |
|     | in lower right corner  |                                      |
|     | super:                 |                                      |
|     |                        |                                      |
|     | now serving: 0         |                                      |
+-----+------------------------+--------------------------------------+
| 11  |                        | (WASHINGTON)                         |
| 1.  |                        |                                      |
|     |                        | Okay, now it's hour six in our       |
|     |                        | scenario. It's been six hours since  |
|     |                        | the anthrax release. Curtis, can you |
|     |                        | tell us what's happening?            |
+-----+------------------------+--------------------------------------+
| 11  |                        | (MAST)                               |
| 2.  |                        |                                      |
|     |                        | Yes, the S-N-S Program has been      |
|     |                        | called, stockpile assets and the     |
|     |                        | Tay-Roo are on their way, and the    |
|     |                        | local PODs are gearing up.           |
+-----+------------------------+--------------------------------------+
| 11  |                        | The public information and           |
| 3.  |                        | communications plans that were       |
|     |                        | prepared in advance are in full      |
|     |                        | swing, getting information to the    |
|     |                        | public. Ruth will talk more in-depth |
|     |                        | about communications issues later in |
|     |                        | this program.                        |
+-----+------------------------+--------------------------------------+
| 11  |                        | (WASHINGTON)\                        |
| 4.  |                        | Thanks for the update. Isn't         |
|     |                        | security a big concern on everyone's |
|     |                        | mind during POD set up and design?   |
+-----+------------------------+--------------------------------------+
| 11  | ss#                    | (MAST)                               |
| 5.  |                        |                                      |
|     | [security              | Yes, Joe, security *is* a big        |
|     | roles]{.underline}     | concern. Every POD must have some    |
|     |                        | sort of security to handle different |
|     | -   asset protection   | roles at the POD. These roles        |
|     |                        | include:                             |
|     | -   staff protection   |                                      |
|     |                        | -   Asset Protection. S-N-S          |
|     | -   traffic/parking    |     medications may become a highly  |
|     |     management         |     desirable commodity in an actual |
|     |                        |     event.                           |
|     | ```{=html}             |                                      |
|     | <!-- -->               | ```{=html}                           |
|     | ```                    | <!-- -->                             |
|     | -   maintain civil     | ```                                  |
|     |     order              | -   POD Staff Protection,            |
|     |                        |                                      |
|     |                        | -   Help with Traffic and Parking,   |
|     |                        |     and                              |
|     |                        |                                      |
|     |                        | -   Maintaining civil order inside   |
|     |                        |     the POD.                         |
+-----+------------------------+--------------------------------------+
| 11  |                        | Keep in mind that law enforcement    |
| 6.  |                        | officers are a valuable but limited  |
|     |                        | resource. They may not be able to    |
|     |                        | fill all the roles that are required |
|     |                        | for security at the POD.             |
|     |                        | Arrangements may have to be made to  |
|     |                        | utilize the National Guard, private  |
|     |                        | security companies, or non-law       |
|     |                        | enforcement personnel to help        |
|     |                        | fulfill these roles.                 |
+-----+------------------------+--------------------------------------+
| 11  | ss#                    | Another group that can provide       |
| 7.  |                        | assistance in planning for security  |
|     | usms logo              | is the United States Marshal         |
|     |                        | Service. The Marshal Service is      |
|     |                        | located throughout the 50 states and |
|     |                        | territories, and is well-known for   |
|     |                        | cooperating with other federal and   |
|     |                        | state agencies, like the Drug        |
|     |                        | Enforcement Agency, the Federal      |
|     |                        | Bureau of Investigation, Highway     |
|     |                        | patrols, police departments, and     |
|     |                        | sheriffs. The Marshal Service can    |
|     |                        | also provide valuable assistance in  |
|     |                        | determining the physical security    |
|     |                        | requirements for the stockpile       |
|     |                        | assets and POD sites. They can be    |
|     |                        | contacted through the SNS Program    |
|     |                        | Services Consultant that is assigned |
|     |                        | to your state. The Marshal Service   |
|     |                        | is also assigned to protect the Push |
|     |                        | Package and the Tay-Roo unit until   |
|     |                        | they arrive at the staging site.     |
+-----+------------------------+--------------------------------------+
| 11  |                        | (CURTIS)                             |
| 8.  |                        |                                      |
|     |                        | Contacting those persons and         |
|     |                        | agencies involved in providing       |
|     |                        | security *early* in the planning     |
|     |                        | process is highly recommended. As I  |
|     |                        | said before, they're a valuable      |
|     |                        | resource you'll want to tap into as  |
|     |                        | soon as possible.                    |
+-----+------------------------+--------------------------------------+
| 11  |                        | (WASHINGTON)                         |
| 9.  |                        |                                      |
|     |                        | Our next presenter, Doctor Nathaniel |
|     |                        | Hupert, has had close personal       |
|     |                        | experience with both terrorist       |
|     |                        | events in New York City in 2001; can |
|     |                        | you tell us about them?              |
+-----+------------------------+--------------------------------------+
| 12  | You will be talking to | (HUPERT)                             |
| 0.  | the moderator at this  |                                      |
|     | point, in conversation | Yes, Joe, in addition to living      |
|     |                        | about three blocks south of Ground   |
|     |                        | Zero and being one of the people who |
|     |                        | had to outrun the dust cloud, I also |
|     |                        | helped my colleagues at New York     |
|     |                        | City Department of Health and Mental |
|     |                        | Hygiene and Office of Emergency      |
|     |                        | Management set up a POD in our       |
|     |                        | hospital cafeteria when a mailroom   |
|     |                        | worker from a neighboring hospital   |
|     |                        | was identified as a victim of the    |
|     |                        | anthrax mailings.                    |
+-----+------------------------+--------------------------------------+
| 12  | []{.mark}              | (WASHINGTON)                         |
| 1.  |                        |                                      |
|     |                        | Those experiences certainly give you |
|     |                        | a unique perspective on all of this. |
|     |                        | Now let's talk about the models that |
|     |                        | you and your colleagues at           |
|     |                        | Weill-Cornell's Department of Public |
|     |                        | Health have developed to help        |
|     |                        | improve POD design and operations.   |
+-----+------------------------+--------------------------------------+
| 12  | cg:                    | (HUPERT)                             |
| 2.  |                        |                                      |
|     | Nathaniel Hupert, MD,  | Our research group at Cornell's      |
|     | mph                    | Weill Medical College has spent the  |
|     |                        | last four years working on a number  |
|     | Asst. Professor of     | of models that really address the    |
|     | Public Health &        | basic, practical questions having to |
|     | Medicine,              | do with PODs, including:             |
|     |                        |                                      |
|     | Division of Outcomes & | -   How many PODs do I need to treat |
|     | Effectiveness          |     the affected population?         |
|     | Research,              |                                      |
|     |                        | -   How many people will I need to   |
|     | Weill Medical College  |     operate the PODs?                |
|     | of Cornell University, |                                      |
|     | nyc                    | -   What can I do if I don't have    |
|     |                        |     enough staff?                    |
+-----+------------------------+--------------------------------------+
| 12  | ss#                    | The focus is, of course, on the      |
| 3.  |                        | patients. An effective POD design    |
|     | [3 pod patient         | addresses the needs of three         |
|     | groups]{.underline}    | potential patient groups:            |
|     |                        |                                      |
|     | -   "No Complications" | -   Otherwise healthy people         |
|     |     -- healthy         |     requiring prophylaxis, called    |
|     |                        |     "No Complications."              |
|     | -   "Complicated" --   |                                      |
|     |     pre-existing       | -   People with pre-existing         |
|     |                        |     illnesses or complicated medical |
|     |    illnesses/allergies |     histories, called "Complicated," |
|     |                        |                                      |
|     | -   "ACUTE" --         | -   People suffering from acute or   |
|     |     life-threatening   |     life-threatening illness due to  |
|     |     illnesses          |     the attack -- They're "Acute."   |
+-----+------------------------+--------------------------------------+
| 12  | ss#                    | Our primary clinic goal for healthy  |
| 4.  |                        | patients, or those with "No          |
|     | [healthy patient       | Complications" is to get them        |
|     | goals]{.underline}     | antibiotics quickly.                 |
|     |                        |                                      |
|     | "No Complications" --  |                                      |
|     |                        |                                      |
|     | quick antibiotics      |                                      |
+-----+------------------------+--------------------------------------+
| 12  | ss#                    | For "Complicated" patients, the key  |
| 5.  |                        | is to determine contraindications    |
|     | [healthy patient       | and / or dosage adjustments, and     |
|     | goals]{.underline}     | then to get them the correct         |
|     |                        | antibiotics quickly.                 |
|     | "Complicated" --       |                                      |
|     |                        |                                      |
|     | assess medical         |                                      |
|     | condition, get correct |                                      |
|     | antibiotics quickly    |                                      |
+-----+------------------------+--------------------------------------+
| 12  | ss#                    | For "Acute" patients, the goal is to |
| 6.  |                        | identify them at the POD, and get    |
|     | [healthy patient       | them to a health care facility where |
|     | goals]{.underline}     | they can get more advanced care      |
|     |                        | quickly.                             |
|     | "Acute" --             |                                      |
|     |                        |                                      |
|     | transport              |                                      |
+-----+------------------------+--------------------------------------+
| 12  | ss#                    | PODs may also address a number of    |
| 7.  |                        | secondary goals, if you have enough  |
|     | [Secondary pod         | time and staff. These include:       |
|     | goals]{.underline}     |                                      |
|     |                        | -   Crisis counseling and mental     |
|     | -   Crisis             |     health intervention, and         |
|     |     counseling/mental  |                                      |
|     |     health             | -   Record-keeping for patient       |
|     |     intervention       |     tracking and epidemiological     |
|     |                        |     investigation.                   |
|     | -   Record-keeping     |                                      |
+-----+------------------------+--------------------------------------+
| 12  |                        | Now it may surprise some members of  |
| 8.  |                        | this audience that I put             |
|     |                        | record-keeping as a secondary goal,  |
|     |                        | since it's so important to normal    |
|     |                        | public health and medical practice.  |
|     |                        | But if you're in a situation where   |
|     |                        | there has been a *covert,* or        |
|     |                        | hidden, release of an agent like     |
|     |                        | anthrax and people are starting to   |
|     |                        | become ill, you may need to move a   |
|     |                        | truly unprecedented amount of        |
|     |                        | antibiotics into the public's hands  |
|     |                        | in record time. It's a good strategy |
|     |                        | to think about what your plan would  |
|     |                        | be for the most extreme situations,  |
|     |                        | and then work backward to more       |
|     |                        | easily-managed scenarios.            |
+-----+------------------------+--------------------------------------+
| 12  | ss#                    | (HUPERT)                             |
| 9.  |                        |                                      |
|     | BERM = Bioterrorism    | This is where one of our models      |
|     | and Epidemic Outbreak  | comes in handy. It's called the      |
|     | Response Model         | Weill-Cornell Bioterrorism and       |
|     |                        | Epidemic Outbreak Model, or BERM for |
|     |                        | short. BERM is a D-H-H-S funded,     |
|     |                        | free-access model that you can       |
|     |                        | download via the Internet as a       |
|     |                        | spreadsheet program. All of the      |
|     |                        | information on how to get it will be |
|     |                        | given at the end of the broadcast,   |
|     |                        | as a part of the "More Resources"    |
|     |                        | section.                             |
|     |                        |                                      |
|     |                        | I'd like to show you how BERM can    |
|     |                        | help you estimate the number of PODs |
|     |                        | and necessary staff to accomplish    |
|     |                        | the task of getting "Pills in        |
|     |                        | People."                             |
+-----+------------------------+--------------------------------------+
| 13  |                        | First, let's assume that we have     |
| 0.  |                        | [two days]{.underline} to accomplish |
|     |                        | our mass dispensing campaign, based  |
|     |                        | on the anthrax scenario we saw       |
|     |                        | earlier. You'll need a substantial   |
|     |                        | amount of staff to accomplish this   |
|     |                        | task, but it will depend to a large  |
|     |                        | degree on what type of POD you want  |
|     |                        | to put into operation.               |
+-----+------------------------+--------------------------------------+
| 13  | ss#                    | Here is a floor plan for a very      |
| 1.  |                        | streamlined POD that does little     |
|     | see hupert's new       | more than try to get the right       |
|     | "streamlined pod" flow | medicine to the right person in the  |
|     | chart                  | shortest amount of time. It has      |
|     |                        | screeners standing at the entrance   |
|     |                        | to the clinic whose sole job is to   |
|     |                        | make sure that anyone who looks like |
|     |                        | they're in distress is immediately   |
|     |                        | sent to the medical evaluation area. |
|     |                        | Everyone else goes to the main       |
|     |                        | triage area, where they're asked a   |
|     |                        | series of questions to determine     |
|     |                        | whether they're experiencing         |
|     |                        | important symptoms that may be       |
|     |                        | related to the attack, or if they    |
|     |                        | have contraindications to the        |
|     |                        | prescribed medications.              |
+-----+------------------------+--------------------------------------+
| 13  | ss#                    | Some patients will be sent from      |
| 2.  |                        | triage to medical evaluation, but    |
|     | freeze frames of these | most will go straight to the drug    |
|     | actions                | dispensing table, where different    |
|     |                        | drugs and doses can be given out,    |
|     |                        | based on the results of their triage |
|     |                        | discussion.                          |
+-----+------------------------+--------------------------------------+
| 13  |                        | Here's a tip: Triage workers should  |
| 3.  |                        | use color-coded paper or notations   |
|     |                        | on an information sheet to tell      |
|     |                        | staff "down the line" what needs to  |
|     |                        | be dispensed.                        |
+-----+------------------------+--------------------------------------+
| 13  |                        | After receiving medication, the      |
| 4.  |                        | people leave. This POD design        |
|     |                        | assumes that the population will     |
|     |                        | find out from public information     |
|     |                        | campaigns details on where PODs are  |
|     |                        | located, how to take their           |
|     |                        | medications, and where to seek       |
|     |                        | further care.                        |
+-----+------------------------+--------------------------------------+
| 13  |                        | (HUPERT)                             |
| 5.  |                        |                                      |
|     |                        | By making some assumptions about how |
|     |                        | long each of these steps might take, |
|     |                        | and what percentage of patients will |
|     |                        | be experiencing symptoms of illness. |
|     |                        | Then you can start to make some      |
|     |                        | sense of how many PODs are needed,   |
|     |                        | and how many people will need to     |
|     |                        | staff them.                          |
+-----+------------------------+--------------------------------------+
| 13  | ss#:                   | Let's say that these PODs are going  |
| 6.  |                        | to be processing about five hundred  |
|     | patients per hour      | patients per hour, or five hundred   |
|     | (pph) = 500            | P-P-H. It's an ambitious but         |
|     |                        | reasonable goal.                     |
+-----+------------------------+--------------------------------------+
| 13  | SS#                    | We'd then need about one hundred and |
| 7.  |                        | forty-five PODs to prophylax the     |
|     | see hupert             | entire city of 3 point 5 million     |
|     | "Streamlined pod       | people in two days. Assuming         |
|     | estimates" for an      | twenty-four hour operation with two  |
|     | example                | shifts, each of these streamlined    |
|     |                        | PODs would need to have forty-five   |
|     |                        | core staff and fifteen support staff |
|     |                        | working at any given time during the |
|     |                        | campaign, with a total of one        |
|     |                        | hundred and thirty-nine assigned     |
|     |                        | staff per POD. This includes 3       |
|     |                        | greeters, twenty-four triage         |
|     |                        | personnel, 8 medical evaluators, and |
|     |                        | 8 drug dispensers working in each    |
|     |                        | shift.                               |
|     |                        |                                      |
|     |                        | The total number of staff estimated  |
|     |                        | for the entire two-day campaign      |
|     |                        | would be approximately twenty        |
|     |                        | thousand workers across all about    |
|     |                        | one hundred and forty-five PODs.     |
+-----+------------------------+--------------------------------------+
| 13  | ss#                    | Now let's look at what would happen  |
| 8.  |                        | to those numbers if a more complex   |
|     | see hupert's next      | POD design was chosen with more      |
|     | flowchart (no title    | functions, or more "layers." It      |
|     | given) --              | might look something like this...    |
+-----+------------------------+--------------------------------------+
| 13  | SS#                    | Again, in order to get staffing      |
| 9.  |                        | numbers, we need to give some        |
|     | Complex pod estimates  | estimates for how long each step     |
|     |                        | inside the POD takes, and what       |
|     |                        | proportion of patients will be going |
|     |                        | to each station in the POD. These    |
|     |                        | estimates represent averages over    |
|     |                        | the entire community for the         |
|     |                        | duration of the dispensing           |
|     |                        | operation.                           |
+-----+------------------------+--------------------------------------+
| 14  | ss #:                  | For this more complex POD to process |
| 0.  |                        | 500 patients per hour would require  |
|     | patients per hour      | ninety people working in each POD at |
|     | (pph) = 500            | any given time during the campaign.  |
|     |                        | This would include forty-four        |
|     |                        | medically-trained individuals and    |
|     |                        | about fifteen support personnel.     |
|     |                        | Dispensing medications for the       |
|     |                        | entire city in two days using this   |
|     |                        | plan would require about thirty      |
|     |                        | thousand staff, an increase of more  |
|     |                        | than ten thousand when compared to   |
|     |                        | the more streamlined POD plan.       |
+-----+------------------------+--------------------------------------+
| 14  |                        | (HUPERT)                             |
| 1.  |                        |                                      |
|     |                        | Now I realize these numbers may      |
|     |                        | sound quite large. They need to be   |
|     |                        | evaluated in light of all of the     |
|     |                        | other information that local public  |
|     |                        | health and emergency management      |
|     |                        | officials probably have, like the    |
|     |                        | results of prior dispensing          |
|     |                        | operations, such as flu vaccination  |
|     |                        | campaigns. The real value in         |
|     |                        | generating these types of            |
|     |                        | hypothetical results from the BERM   |
|     |                        | model is that they can provide a set |
|     |                        | of numerical estimates for exploring |
|     |                        | different response scenarios.        |
+-----+------------------------+--------------------------------------+
| 14  |                        | As with any model, the accuracy of   |
| 2.  |                        | these numbers also depends on the    |
|     |                        | quality of the underlying            |
|     |                        | assumptions and evidence, and here   |
|     |                        | we're often limited by the fact that |
|     |                        | there simply aren't many detailed    |
|     |                        | field reports of these types of      |
|     |                        | dispensing operations.               |
+-----+------------------------+--------------------------------------+
| 14  |                        | So now that we've run BERM, we may   |
| 3.  |                        | be able to go back and re-evaluate   |
|     |                        | our plans for responding to this     |
|     |                        | type of anthrax attack. It looks     |
|     |                        | like one critical variable is the    |
|     |                        | number of staff that can be put to   |
|     |                        | work on short notice. If your        |
|     |                        | community can get 30 thousand        |
|     |                        | workers together, then you can       |
|     |                        | operate those complex PODs. If the   |
|     |                        | number is more like 20 thousand      |
|     |                        | staff available, then you might want |
|     |                        | to think about doing the more        |
|     |                        | bare-bones approach, which has       |
|     |                        | important implications for how and   |
|     |                        | where you're going to carry out      |
|     |                        | epidemiological investigations and   |
|     |                        | follow-up care.                      |
+-----+------------------------+--------------------------------------+
| 14  |                        | (WASHINGTON)                         |
| 4.  |                        |                                      |
|     |                        | Thanks, Nathaniel. LuAnne, I         |
|     |                        | understand that you used Doctor      |
|     |                        | Hupert's model in Minnesota, can you |
|     |                        | tell us how?                         |
+-----+------------------------+--------------------------------------+
| 14  |                        | (McNICHOLS)                          |
| 5.  |                        |                                      |
|     |                        | Yes, we found that deciding on the   |
|     |                        | number of PODs we would need was a   |
|     |                        | huge challenge. We used the          |
|     |                        | Weill-Cornell BERM Model; it enabled |
|     |                        | us to manipulate variables to look   |
|     |                        | at multiple scenarios for mass       |
|     |                        | dispensing. It also helped the       |
|     |                        | regions look at their available      |
|     |                        | staff, population, and facilities,   |
|     |                        | and make a judgement as to how large |
|     |                        | their dispensing sites could be in   |
|     |                        | terms of throughput. They then chose |
|     |                        | the number of PODs necessary to do   |
|     |                        | mass dispensing for the entire       |
|     |                        | region most efficiently. We have     |
|     |                        | chosen a variety of potential sites: |
|     |                        | schools, conference centers, and     |
|     |                        | churches with throughputs ranging    |
|     |                        | from 250 per hour to one thousand    |
|     |                        | per hour. Of course, exercising the  |
|     |                        | actual throughput will be an         |
|     |                        | important component of the plan.     |
|     |                        | Will it be possible to have very     |
|     |                        | large dispensing sites that will be  |
|     |                        | able to prophylax everyone in a      |
|     |                        | short period of time? That's what    |
|     |                        | we're planning for!                  |
+-----+------------------------+--------------------------------------+
| 14  |                        | (WASHINGTON)                         |
| 6.  |                        |                                      |
|     |                        | And it sounds like you're all doing  |
|     |                        | a great job. Thank you, LuAnne.      |
|     |                        | Doctor Hupert, back to you.          |
+-----+------------------------+--------------------------------------+
| 14  |                        | (HUPERT)                             |
| 7.  |                        |                                      |
|     |                        | Now let's assume that you evaluated  |
|     |                        | staffing requirements like these     |
|     |                        | during the planning process PRIOR to |
|     |                        | any attack. Now there are spores in  |
|     |                        | the air at the release site, and     |
|     |                        | you've got to turn those nice POD    |
|     |                        | layouts into real-life clinics. In   |
|     |                        | my experience of planning and        |
|     |                        | observing PODs and POD exercises     |
|     |                        | around the country, I think there    |
|     |                        | are two practical goals at this      |
|     |                        | stage.                               |
+-----+------------------------+--------------------------------------+
| 14  | ss#                    | First, we need to design our floor   |
| 8.  |                        | plan with "express lanes" in         |
|     | (reveal as spoken)     | mind---that is, we should prioritize |
|     |                        | the layout to speed the "No          |
|     | [elements of POD       | Complications" patients through the  |
|     | design]{.underline}    | process. This will help with the     |
|     |                        | second goal, which is to avoid       |
|     | -   create "express    | bottlenecks.                         |
|     |     lanes"             |                                      |
|     |                        |                                      |
|     | -   Avoid bottlenecks  |                                      |
+-----+------------------------+--------------------------------------+
| 14  | ss#                    | Bottlenecks in PODs may be caused by |
| 9.  |                        | any or all of the following:         |
|     | [bottleneck            |                                      |
|     | causes]{.underline}    | -   Too many patients allowed into a |
|     |                        |     POD at a time, which can clog up |
|     | -   Too many patients  |     the whole operation,             |
|     |     in the pod         |                                      |
|     |                        | -   Too many patients at a station,  |
|     | -   Too many patients  |     which causes lines to form,      |
|     |     at a station       |                                      |
|     |                        | -   Too few staff at a station, or   |
|     | -   Too few staff      |                                      |
|     |                        | -   Too many things for staff to do  |
|     | -   Too many things to |     for each patient.                |
|     |     do per patient     |                                      |
+-----+------------------------+--------------------------------------+
| 15  |                        | There are two ways to avoid          |
| 0.  |                        | bottlenecks. First, pre-event        |
|     |                        | planning should include numerical    |
|     |                        | estimates of how many patients and   |
|     |                        | staff are involved at each POD. This |
|     |                        | is where models like BERM come in    |
|     |                        | handy, although there are            |
|     |                        | communities that have been able to   |
|     |                        | make these types of calculations     |
|     |                        | based on past immunization           |
|     |                        | campaigns.                           |
+-----+------------------------+--------------------------------------+
| 15  | ss#                    | The second way to avoid bottlenecks  |
| 1.  |                        | is to have a flexible command and    |
|     | nims = National        | control system in place that can     |
|     | Incident Management    | modify the number, staffing, and     |
|     | System                 | type of PODs you intend to open in   |
|     |                        | response to an event. The recently   |
|     |                        | published National Incident          |
|     |                        | Management System, or NIMS, is a     |
|     |                        | template for this type of            |
|     |                        | field-deployable, flexible command   |
|     |                        | infrastructure.                      |
+-----+------------------------+--------------------------------------+
| 15  | ss#                    | Finally, POD plans need to provide   |
| 2.  |                        | for prophylaxis of *ALL* members of  |
|     | incorporate special    | the community, including those who   |
|     | needs patients and     | may not be able or willing to come   |
|     | groups into your POD   | to a local POD for antibiotics.      |
|     | flow plan              | These "special needs" patients could |
|     |                        | be large families, people with       |
|     |                        | mobility impairment,                 |
|     |                        | institutionalized individuals, and   |
|     |                        | others. This may be where we change  |
|     |                        | from the "pull" to a "push" format   |
|     |                        | of dispensing that Curtis described  |
|     |                        | earlier. Take the medications out,   |
|     |                        | to say, a nursing home or prison,    |
|     |                        | instead of trying to work out the    |
|     |                        | logistics of bringing those people   |
|     |                        | to a POD.                            |
+-----+------------------------+--------------------------------------+
| 15  |                        | So we've gone from asking: "How do   |
| 3.  |                        | we respond to this attack?" to       |
|     |                        | having a good sense of what          |
|     |                        | resources are needed to mount a      |
|     |                        | couple of different mass dispensing  |
|     |                        | responses that should prevent most   |
|     |                        | of the members of Metroville's       |
|     |                        | community from becoming sick.        |
+-----+------------------------+--------------------------------------+
| 15  |                        | (WASHINGTON)                         |
| 4.  |                        |                                      |
|     |                        | Thank you Doctor Hupert, for your    |
|     |                        | insight and for sharing your         |
|     |                        | modeling program with us. LuAnne,    |
|     |                        | what were some of the major issues   |
|     |                        | Minnesota tackled when planning for  |
|     |                        | POD set up and design?               |
+-----+------------------------+--------------------------------------+
| 15  |                        | (McNICHOLS)                          |
| 5.  |                        |                                      |
|     |                        | Many of the things Curtis and Doctor |
|     |                        | Hupert already covered, but I'd like |
|     |                        | to add these three points:           |
+-----+------------------------+--------------------------------------+
| 15  |                        | Pre-planning is contingent on the    |
| 6.  |                        | type of county or state structure in |
|     |                        | place. Minnesota wasn't structured   |
|     |                        | to work on a regional basis until    |
|     |                        | the smallpox program began, at least |
|     |                        | not at this level of detail. Like    |
|     |                        | many states, Minnesota and its       |
|     |                        | counties quickly rallied to          |
|     |                        | implement the smallpox program using |
|     |                        | a regional approach, and now we're   |
|     |                        | moving forward using that same       |
|     |                        | regional structure with our mass     |
|     |                        | dispensing planning. We've developed |
|     |                        | regional and local interdisciplinary |
|     |                        | teams that include public health,    |
|     |                        | hospital, emergency management,      |
|     |                        | tribal, and volunteer (Red Cross)    |
|     |                        | input. It hasn't always been an easy |
|     |                        | process; we've had to learn to plan, |
|     |                        | work, and "do" in a different way.   |
+-----+------------------------+--------------------------------------+
| 15  |                        | Developing an incident command       |
| 7.  |                        | structure for the internal workings  |
|     |                        | of the PODs was our next necessary   |
|     |                        | step. We developed a detailed        |
|     |                        | incident command organizational      |
|     |                        | chart from NIMS that followed all of |
|     |                        | our clinic functions. Job Action     |
|     |                        | Sheets were then developed to        |
|     |                        | establish consistency of the job     |
|     |                        | duties between all of the PODs.      |
+-----+------------------------+--------------------------------------+
| 15  |                        | After all the structure is in place, |
| 8.  |                        | we were left with the *really* huge  |
|     |                        | challenge. Finding the people,       |
|     |                        | filling the positions with the       |
|     |                        | appropriate people, and, of course,  |
|     |                        | getting them trained. This is an     |
|     |                        | almost overwhelming task.            |
+-----+------------------------+--------------------------------------+
| 15  | SS#                    | (WASHINGTON)                         |
| 9.  |                        |                                      |
|     | Weights of dispensing  | I'll bet it is, LuAnne. Thanks for   |
|     |                        | sharing the state perspective with   |
|     |                        | us, it helps bring to light the      |
|     |                        | state and local issues that Planners |
|     |                        | must deal with.                      |
|     |                        |                                      |
|     |                        | Curtis, I understand you'd like to   |
|     |                        | add an illustration you use in your  |
|     |                        | classroom presentation.              |
|     |                        |                                      |
|     |                        | (MAST)                               |
|     |                        |                                      |
|     |                        | Yes, Joe, I do. Very similar to the  |
|     |                        | layers of POD clinics mentioned in   |
|     |                        | Dr. Hupert's work, we use an         |
|     |                        | illustration we call, "Weights of    |
|     |                        | Dispensing". This is based on the    |
|     |                        | business practice of Constraint      |
|     |                        | management.                          |
|     |                        |                                      |
|     |                        | Each weight represents an issue,     |
|     |                        | station, or policy related to        |
|     |                        | running a POD. Of course this is a   |
|     |                        | non-inclusive list and I'm sure you  |
|     |                        | can think of several other potential |
|     |                        | weights.                             |
|     |                        |                                      |
|     |                        | Now imaging I'm carrying all these   |
|     |                        | weights. Say, each weight weighs 10  |
|     |                        | pounds, and you ask me to run a 100  |
|     |                        | yard dash. My running speed is       |
|     |                        | analogous to POD throughput. Due to  |
|     |                        | the weight, I'm forced to run slow.  |
|     |                        | This is analogous to Dr. Hupert\'s   |
|     |                        | "High Complexity/Low Flow" layout.   |
|     |                        |                                      |
|     |                        | In order to increase my running      |
|     |                        | speed, for this dash, I need to lose |
|     |                        | some of these weights. Now I can     |
|     |                        | lose weights one of two ways---I can |
|     |                        | give someone a weight to carry for   |
|     |                        | me---This is an example of adding    |
|     |                        | staff to a station---Or I can drop   |
|     |                        | the weight all together---This would |
|     |                        | be removing a station, reducing the  |
|     |                        | number of data points on my medical  |
|     |                        | record, or removing a 20 minute      |
|     |                        | formal patient education briefing    |
|     |                        | from your POD layout.                |
+-----+------------------------+--------------------------------------+
| 16  |                        | It is very important to remember     |
| 0.  |                        | that throughput is not a static      |
|     |                        | number. Planning, modeling, and      |
|     |                        | estimates that result from           |
|     |                        | exercises, should be used only as a  |
|     |                        | starting point. Remember that        |
|     |                        |                                      |
|     |                        | the overall goal of dispensing       |
|     |                        | program is to prohylax every citizen |
|     |                        | within a limited time                |
|     |                        | period\--sometimes that time period  |
|     |                        | may be as limited as 48 hours. If    |
|     |                        | during an event, public health       |
|     |                        | leaders realize that POD throughputs |
|     |                        | are too low to meet this goal, POD   |
|     |                        | managers must make changes internal  |
|     |                        | to their POD design in order         |
|     |                        | increase throughputs immediately.    |
|     |                        |                                      |
|     |                        | These changes are outside the        |
|     |                        | traditional medical and pharmacy     |
|     |                        | model of clinic design and may be    |
|     |                        | uncomfortable for many planners. But |
|     |                        | we are talking about a large scale   |
|     |                        | bioterrorism attack that will        |
|     |                        | overwhelm our traditional responses. |
+-----+------------------------+--------------------------------------+
| 16  | graphic/animation      | *Music stinger*                      |
| 1.  |                        |                                      |
|     | section title:         |                                      |
|     |                        |                                      |
|     | public information and |                                      |
|     | communication          |                                      |
|     |                        |                                      |
|     | super led clock:       |                                      |
|     | 24:00:00               |                                      |
|     |                        |                                      |
|     | in lower right corner  |                                      |
|     | super:                 |                                      |
|     |                        |                                      |
|     | now serving: 5,000     |                                      |
+-----+------------------------+--------------------------------------+
| 16  |                        | (WASHINGTON)                         |
| 2.  |                        |                                      |
|     |                        | Things are really happening at the   |
|     |                        | PODs! Now we need to talk with Ruth  |
|     |                        | Thornburg about public information   |
|     |                        | and communication. Ruth, I think     |
|     |                        | everyone realizes just how important |
|     |                        | communication will be if an event    |
|     |                        | like this occurs.                    |
+-----+------------------------+--------------------------------------+
| 16  | cg:                    | (THORNBURG)                          |
| 3.  |                        |                                      |
|     | Ruth Thornburg, MA, MS | You're right, Joe, dispensing        |
|     |                        | information is *just as important*   |
|     | Public information and | as dispensing oral antibiotics. And  |
|     | communications (piC),  | here's why. During an event, it's    |
|     | strategic national     | safe to say that we'll be fighting   |
|     | stockpile, CDC         | fear, and possibly even wide-spread  |
|     |                        | panic. As Dr. Julie Gerberding, the  |
|     |                        | CDC's Director, said, "The best      |
|     |                        | antidote to fear is information." An |
|     |                        | informed and involved public is less |
|     |                        | likely to panic and more likely to   |
|     |                        | cooperate.                           |
+-----+------------------------+--------------------------------------+
| 16  | ss#                    | But our job is not *just* to inform  |
| 4.  |                        | the public. A good Public            |
|     | [public information    | Information and Communication Plan   |
|     | and communications     | will inform,                         |
|     | plan]{.underline}      |                                      |
|     |                        | mobilize                             |
|     | -   inform the public: |                                      |
|     |                        | and educate the public.              |
|     | when, where, and       |                                      |
|     |                        | We have to mobilize the public to    |
|     | what to bring          | come to the PODs at a specific time  |
|     |                        | and place, with certain things       |
|     |                        | in-hand, like the medications they   |
|     |                        | are taking, children's weights, and  |
|     |                        | more.                                |
+-----+------------------------+--------------------------------------+
| 16  |                        | The public also needs information    |
| 5.  |                        | that will get them through the       |
|     |                        | clinic and out the door quickly.     |
|     |                        | Motivating people to leave their     |
|     |                        | homes and head for a clinic to wait  |
|     |                        | in a long line for medicine is a     |
|     |                        | difficult job that requires          |
|     |                        | *planning*.                          |
+-----+------------------------+--------------------------------------+
| 16  | ss#                    | In addition to informing the general |
| 6.  |                        | public through the media, it's also  |
|     | [public information    | critical set up communication        |
|     | and communications     | channels to notify and inform health |
|     | plan]{.underline}      | care providers, emergency            |
|     |                        | responders, and community leaders.   |
|     | -   special channels   | They require more in-depth           |
|     |     for health care    | information about the clinical       |
|     |     providers,         | implications of the bioterrorism     |
|     |     emergency          | agent, disease, necessary            |
|     |     responders,        | prophylaxis, and treatment. These    |
|     |     community leaders  | groups also need to know where to    |
|     |                        | get medications for themselves and   |
|     |                        | their families, and the specific     |
|     |                        | details of the plan to provide       |
|     |                        | prophylaxis to the community.        |
+-----+------------------------+--------------------------------------+
| 16  |                        | Clearly, planning for an event       |
| 7.  |                        | includes preparing the communication |
|     |                        | materials for your community to be   |
|     |                        | used before, during and after the    |
|     |                        | event. Of course, they'll need to be |
|     |                        | tailored to the specific             |
|     |                        | demographics of your community, just |
|     |                        | as you do for all hazards or         |
|     |                        | disaster planning.                   |
+-----+------------------------+--------------------------------------+
| 16  |                        | Most communications materials should |
| 8.  |                        | be prepared in advance, so they'll   |
|     |                        | be "ready and waiting" on the shelf  |
|     |                        | when they're needed.                 |
+-----+------------------------+--------------------------------------+
| 16  |                        | Your Public Information and          |
| 9.  |                        | Communication plan should focus on   |
|     |                        | the informational materials needed   |
|     |                        | to educate, inform and mobilize the  |
|     |                        | public to go to dispensing sites,    |
|     |                        | and also move them through the       |
|     |                        | dispensing sites.                    |
+-----+------------------------+--------------------------------------+
| 17  | ss#                    | Your materials contain information   |
| 0.  |                        | about:                               |
|     | [handout               |                                      |
|     | info:]{.underline}     | -   The agent and the health threat, |
|     |                        |                                      |
|     | -   agent/threat       | -   Location of treatment and        |
|     |                        |     dispensing centers, how to get   |
|     | -   location of pods   |     there, parking, etc.             |
|     |                        |                                      |
|     | -   medications        | -   The medications used for         |
|     |                        |     prophylaxis                      |
|     | -   dangers of         |                                      |
|     |     over-medicating    | -   The dangers of over-medicating,  |
|     |                        |     and                              |
|     | -   medication         |                                      |
|     |     compliance         | -   The importance of completing the |
|     |                        |     entire prescription.             |
+-----+------------------------+--------------------------------------+
| 17  |                        | You'll also need to prepare          |
| 1.  |                        | information for special needs        |
|     |                        | groups, like those who are           |
|     |                        | physically challenged, visually or   |
|     |                        | hearing impaired, home-bound, and    |
|     |                        | others.                              |
|     |                        |                                      |
|     |                        | I'll talk more in-depth about all of |
|     |                        | these in a moment.                   |
+-----+------------------------+--------------------------------------+
| 17  | super led clock:       | But now we need to flash-back in     |
| 2.  | 08:00:00               | time to when the anthrax scenario    |
|     |                        | began. Our Public health information |
|     |                        | wheels were set into motion almost   |
|     |                        | *immediately*.                       |
+-----+------------------------+--------------------------------------+
| 17  |                        | (THORNBURG)                          |
| 3.  |                        |                                      |
|     |                        | As soon as there is any indication   |
|     |                        | that S-N-S assets may be deployed,   |
|     |                        | the local S-N-S Coordinator should   |
|     |                        | contact the local Public Information |
|     |                        | and Communications lead to implement |
|     |                        | the communications plan that they    |
|     |                        | prepared in advance. One of the      |
|     |                        | first steps is contacting local      |
|     |                        | media outlets to alert them about    |
|     |                        | the potential for starting up PODs,  |
|     |                        | ensuring that all messages are       |
|     |                        | consistent from the state level to   |
|     |                        | the local level.                     |
+-----+------------------------+--------------------------------------+
| 17  | ss#                    | It is important to provide specific, |
| 4.  |                        | accurate information to the public   |
|     | [public                | about the agent and about the PODs   |
|     | in                     | that will be set up.                 |
|     | formation]{.underline} |                                      |
|     |                        | Timing is very important here.       |
|     | -   bt agent used      | Releasing information too soon may   |
|     |                        | cause people to flood POD waiting    |
|     | -   pod information    | rooms and form lines long before the |
|     |     (Wait to release   | PODs even open. It's important to    |
|     |     locations &        | coordinate timing issues about the   |
|     |     opening)           | opening of PODs well before an event |
|     |                        | ever occurs.                         |
+-----+------------------------+--------------------------------------+
| 17  |                        | Let's take a moment to stop and      |
| 5.  |                        | think about the context that these   |
|     |                        | patient materials will be delivered. |
|     |                        | Remember the scene Dr. Hupert        |
|     |                        | created earlier? You'll recall he    |
|     |                        | mentioned that placement and flow    |
|     |                        | were key elements in the smooth      |
|     |                        | operation of a POD.                  |
|     |                        |                                      |
|     |                        | You have an overarching goal and     |
|     |                        | responsibility to provide a          |
|     |                        | smooth-running POD that gets people  |
|     |                        | through quickly *while providing     |
|     |                        | critical patient education.*         |
+-----+------------------------+--------------------------------------+
| 17  |                        | The S-N-S Program emphasizes that    |
| 6.  |                        | POD Managers have the responsibility |
|     |                        | of overseeing their staff, but they  |
|     |                        | must also direct much of their       |
|     |                        | attention to the lines, or "queues"  |
|     |                        | of patients waiting. Line management |
|     |                        | is an art and science unto itself.   |
|     |                        | This subject will be discussed in    |
|     |                        | depth in future programs, but I want |
|     |                        | to you to think about this...        |
+-----+------------------------+--------------------------------------+
| 17  |                        | There are two important things to    |
| 7.  |                        | remember when it comes to line       |
|     |                        | management: satisfaction and         |
|     |                        | stimulation. People are much more    |
|     |                        | inclined to stand in line for long   |
|     |                        | periods of time if they are          |
|     |                        | *satisfied* -- meaning that they     |
|     |                        | feel informed and believe they're    |
|     |                        | making substantial progress.         |
|     |                        | Stimulation comes from the items in  |
|     |                        | your public information and          |
|     |                        | communications campaign.             |
+-----+------------------------+--------------------------------------+
| 17  | freeze frames people   | Consider many patient education      |
| 8.  | waiting in line        | strategies to help move people       |
|     | watching kiosk         | through the line and the POD. While  |
|     |                        | people are waiting, "stimulate" them |
|     | ss#                    | with a series of kiosk presentations |
|     |                        | that repeat key information at       |
|     | [line                  | different points in the line.        |
|     | m                      | Present the messages in concise      |
|     | anagement]{.underline} | "chunks" that will allow people to   |
|     |                        | move in the line and not feel like   |
|     | -   kiosks             | they've missed something. The next   |
|     |                        | kiosk or station presents another    |
|     |                        | brief "chunk" of information. Kiosks |
|     |                        | can be arranged throughout the line  |
|     |                        | and in the POD. Have you have        |
|     |                        | watched cartoons or commercials on   |
|     |                        | monitors while waiting in line for a |
|     |                        | rollercoaster? It's the same         |
|     |                        | concept. Kiosks ensure constant      |
|     |                        | reinforcement of messages.           |
|     |                        |                                      |
|     |                        | There are two issues to keep in      |
|     |                        | mind, however: \--which language     |
|     |                        | will you use? You may have to use    |
|     |                        | several.                             |
|     |                        |                                      |
|     |                        | And how much noise is in the room?   |
|     |                        | \--Will people be able to hear the   |
|     |                        | presentations?                       |
+-----+------------------------+--------------------------------------+
| 17  |                        | How about an audiotaped message      |
| 9.  |                        | played on personal cassette player   |
|     |                        | with headset, like those in a        |
|     |                        | museum's special exhibit hall, can   |
|     |                        | serve the same function and may be   |
|     |                        | more appropriate, depending on the   |
|     |                        | setting.                             |
+-----+------------------------+--------------------------------------+
| 18  |                        | (THORNBURG)                          |
| 0.  |                        |                                      |
|     |                        | Using V-C-Rs, kiosks, or cassette    |
|     |                        | players can cut down on the staff    |
|     |                        | you will need to run the POD. You    |
|     |                        | are also reducing non-essential      |
|     |                        | staff-patient interaction, freeing   |
|     |                        | up your staff to interact with       |
|     |                        | people at more critical times.       |
|     |                        | Again, you'll need to have equipment |
|     |                        | plans and materials prepared *in     |
|     |                        | advance* of any emergency.           |
+-----+------------------------+--------------------------------------+
| 18  | ss#                    | Other easy methods to help           |
| 1.  |                        | "stimulate" the patients:            |
|     | [line                  |                                      |
|     | m                      | -   Large, easy-to-read signs, and   |
|     | anagement]{.underline} |                                      |
|     |                        | -   "Floaters:" People assigned to   |
|     | -   signage            |     walk around, answering questions |
|     |                        |     and checking up on patients.     |
|     | -   "floaters"         |                                      |
+-----+------------------------+--------------------------------------+
| 18  |                        | (WASHINGTON)                         |
| 2.  |                        |                                      |
|     |                        | Ruth, do you have any tips for       |
|     |                        | working with the media? They can be  |
|     |                        | a very important ally in a Public    |
|     |                        | Information and communications       |
|     |                        | campaign.                            |
+-----+------------------------+--------------------------------------+
| 18  |                        | (THORNBURG)                          |
| 3.  |                        |                                      |
|     |                        | Yes, maybe your *most* important     |
|     |                        | ally. Media outlets need open        |
|     |                        | channels of communication in order   |
|     |                        | to provide accurate, up-to-date      |
|     |                        | information. They have a job to do,  |
|     |                        | and it's in our best interest to     |
|     |                        | help them do it *well.* We have a    |
|     |                        | responsibility to keep them informed |
|     |                        | so that they can, in turn, inform    |
|     |                        | the public. If we don't meet this    |
|     |                        | responsibility, the media will be    |
|     |                        | forced to seek out other sources of  |
|     |                        | information that may not provide     |
|     |                        | them with the correct, consistent    |
|     |                        | information that's essential at the  |
|     |                        | time.                                |
+-----+------------------------+--------------------------------------+
| 18  | ss#                    | So, when working with the media,     |
| 4.  |                        | please respond in a timely manner.   |
|     | [media                 | Be sincere, honest, and accurate.    |
|     | contact]{.underline}   | Remember, we're all in this          |
|     |                        | together.                            |
|     | -   respond quickly    |                                      |
|     |                        |                                      |
|     | ```{=html}             |                                      |
|     | <!-- -->               |                                      |
|     | ```                    |                                      |
|     | -   be sincere,        |                                      |
|     |     honest, & accurate |                                      |
+-----+------------------------+--------------------------------------+
| 18  | ss#                    | Before an event, enlist the media's  |
| 5.  |                        | help by providing them with a "media |
|     | [media                 | kit." This kit can contain           |
|     | kit]{.underline}       | background information about the     |
|     |                        | various threat agents, signs and     |
|     | -   bt agent           | symptoms of the associated diseases, |
|     |     information        | and information about the drugs that |
|     |                        | might be used as prophylaxis. Also   |
|     | -   symptoms of        | include information about your       |
|     |     disease            | communications plan during an event, |
|     |                        | and list contact information for the |
|     | -   prophylactic drugs | public information officer who can   |
|     |                        | answer specific questions during     |
|     | -   communications     | that time. Don't forget to regularly |
|     |     plan               | update your contact information.     |
|     |                        |                                      |
|     | -   contact info for   |                                      |
|     |     public information |                                      |
|     |     officer            |                                      |
+-----+------------------------+--------------------------------------+
| 18  |                        | Determine a place for the media to   |
| 6.  |                        | "set up camp" at a POD or PODs.      |
|     |                        | You'll also need a designated area   |
|     |                        | for press briefings.                 |
+-----+------------------------+--------------------------------------+
| 18  | ss#                    | During an event, you may have to     |
| 7.  |                        | provide information through a        |
|     | [information           | variety of different channels. This  |
|     | channels]{.underline}  | includes continual updates to media  |
|     |                        | outlets like newspaper, radio, and   |
|     | -   newspaper          | television at regularly scheduled    |
|     |                        | intervals. Don't forget resources    |
|     | -   radio              | for people to seek out information   |
|     |                        | at their convenience, like web       |
|     | -   tv                 | sites, twenty-four hour hotlines, or |
|     |                        | other community sources. Include     |
|     | -   websites           | these elements in your               |
|     |                        | communications plan.                 |
|     | -   hotlines           |                                      |
|     |                        |                                      |
|     | -   community sources  |                                      |
+-----+------------------------+--------------------------------------+
| 18  | ss#                    | (THORNBURG)                          |
| 8.  |                        |                                      |
|     | [types of media        | Coordinate with the various media    |
|     | contact]{.underline}   | outlets in your community to         |
|     |                        | determine which communication        |
|     | -   phone call         | methods work best for them; for      |
|     |                        | example, phone calls, press          |
|     | -   press conference   | conferences, electronic press        |
|     |                        | releases, and so on.                 |
|     | -   electronic press   |                                      |
|     |     release            |                                      |
|     |                        |                                      |
|     | -   more               |                                      |
+-----+------------------------+--------------------------------------+
| 18  |                        | Identify the person or persons       |
| 9.  |                        | responsible for handling all media   |
|     |                        | inquiries. Ideally, this would be    |
|     |                        | the sole responsibility for this     |
|     |                        | individual or individuals, but it    |
|     |                        | may not always be possible. In any   |
|     |                        | case, someone must be accessible     |
|     |                        | twenty-four seven.                   |
+-----+------------------------+--------------------------------------+
| 19  |                        | Remember, don't be afraid of         |
| 0.  |                        | repetition. Information must be      |
|     |                        | repeated over and over again,        |
|     |                        | because although people may hear or  |
|     |                        | read it, they may not actually       |
|     |                        | absorb *what* they're hearing or     |
|     |                        | reading right away. This is          |
|     |                        | especially true if there's chaos or  |
|     |                        | fear surrounding an event. It's      |
|     |                        | better to give information too often |
|     |                        | than not often enough.               |
+-----+------------------------+--------------------------------------+
| 19  |                        | And now that you have plans to       |
| 1.  |                        | provide accurate information through |
|     |                        | the media, you need to plan to       |
|     |                        | monitor the reports to make sure     |
|     |                        | that critical information *will      |
|     |                        | continue* to be relayed. A Media     |
|     |                        | Monitoring group or committee can    |
|     |                        | respond to media messages as a       |
|     |                        | consumer would, and determine if the |
|     |                        | changes or clarifications are        |
|     |                        | necessary. This is also a            |
|     |                        | twenty-four seven activity.          |
+-----+------------------------+--------------------------------------+
| 19  | ss#                    | One last word about patient          |
| 2.  |                        | education materials., all patients   |
|     | [patient medication    | will need written descriptions,      |
|     | material]{.underline}  | instructions, and information about  |
|     |                        | possible side effects for the        |
|     | -   description        | medications they receive; this is    |
|     |                        | similar to the pamphlets that go     |
|     | -   instructions for   | with prescriptions from your local   |
|     |     use                | pharmacy.                            |
|     |                        |                                      |
|     | -   possible side      | The patient medication materials     |
|     |     effects            | should also stress medication        |
|     |                        | compliance. This is a big issue even |
|     | -   medication         | for so-called "normal" illnesses!    |
|     |     compliance         | But because of the time constraints  |
|     |                        | of this broadcast, we'll talk about  |
|     |                        | compliance in another program        |
+-----+------------------------+--------------------------------------+
| 19  |                        | (WASHINGTON)                         |
| 3.  |                        |                                      |
|     |                        | Thank you, Ruth. We'll talk about    |
|     |                        | some more resources that can help    |
|     |                        | you develop a Public Information and |
|     |                        | Communications plan coming up soon.  |
+-----+------------------------+--------------------------------------+
| 19  | section title:         | *Music stinger*                      |
| 4.  |                        |                                      |
|     | more resources         |                                      |
|     |                        |                                      |
|     | super led clock:       |                                      |
|     | 48:00:00               |                                      |
|     |                        |                                      |
|     | in lower right corner  |                                      |
|     | super:                 |                                      |
|     |                        |                                      |
|     | now serving: 20,000    |                                      |
+-----+------------------------+--------------------------------------+
| 19  |                        | (WASHINGTON)                         |
| 5.  |                        |                                      |
|     |                        | Curtis, could you give us an         |
|     |                        | overview of the issues we've         |
|     |                        | discussed today?                     |
+-----+------------------------+--------------------------------------+
| 19  | **Dispensing sign**    | (MAST)\                              |
| 6.  |                        | We covered some good ideas today.    |
|     | **large room**         |                                      |
|     |                        | -   We used videos, signs, and       |
|     | **leaning woman        |     posters,                         |
|     | talking to other       |                                      |
|     | woman**                | -   We designed the flow toward a    |
|     |                        |     minimum skill level,             |
|     | **people standing/     |                                      |
|     | sitting**              | -   We had a Triage area with        |
|     |                        |     appropriate staffing,            |
|     | **woman showing woman  |                                      |
|     | something**            | -   We had people to explain         |
|     |                        |     procedures or policies,          |
|     |                        |                                      |
|     |                        | -   And we gave out numerous         |
|     |                        |     educational handouts.            |
+-----+------------------------+--------------------------------------+
| 19  |                        | (WASHINGTON)                         |
| 7.  |                        |                                      |
|     |                        | Thanks, Curtis. Now I'd like to go   |
|     |                        | to Eileen Malatino. Eileen, what are |
|     |                        | some of the most frequently voiced   |
|     |                        | concerns about mass dispensing that  |
|     |                        | you deal with?                       |
+-----+------------------------+--------------------------------------+
| 19  |                        | (MALATINO)                           |
| 8.  |                        |                                      |
|     |                        | Two of the "hot topics" are          |
|     |                        | reconstituting oral suspensions for  |
|     |                        | children and labeling medications.   |
|     |                        | Let's start with the pediatric       |
|     |                        | formulary; we've developed this      |
|     |                        | short video to describe the process. |
+-----+------------------------+--------------------------------------+
| 19  | reconstitution         | SOT                                  |
| 9.  | roll-ins (transition   |                                      |
|     | between                | Outcue: "...that can be used with    |
|     | D                      | doxycycline or amoxicillin           |
|     | oxycycline/amoxicillin | suspensions."                        |
|     | piece and the          |                                      |
|     | Ciprofloxacin piece)   |                                      |
|     |                        |                                      |
|     | trt (both):            |                                      |
+-----+------------------------+--------------------------------------+
| 20  |                        | (MALATINO)                           |
| 0.  |                        |                                      |
|     |                        | This procedure would normally be     |
|     |                        | performed by pharmacists, but each   |
|     |                        | state has tailored its emergency     |
|     |                        | plan to utilize whoever is available |
|     |                        | to them. If someone other than a     |
|     |                        | pharmacist reconstitutes, it must be |
|     |                        | cleared with the appropriate         |
|     |                        | regulatory agencies within the       |
|     |                        | state.                               |
+-----+------------------------+--------------------------------------+
| 20  |                        | Along with reconstitution is the     |
| 1.  |                        | process of labeling. Even in the     |
|     |                        | event of an emergency, federal law   |
|     |                        | still requires specific information  |
|     |                        | to appear on every bottle of         |
|     |                        | prescription medication. This video  |
|     |                        | talks about the necessary            |
|     |                        | requirements...                      |
+-----+------------------------+--------------------------------------+
| 20  | labeling roll-in       | SOT                                  |
| 2.  |                        |                                      |
|     | trt:                   | Outcue: "...where an additional      |
|     |                        | label could be placed."              |
+-----+------------------------+--------------------------------------+
| 20  |                        | (WASHINGTON)                         |
| 3.  |                        |                                      |
|     |                        | Thanks for that important            |
|     |                        | information, Eileen.                 |
|     |                        |                                      |
|     |                        | I think everyone in our audience has |
|     |                        | learned quite a bit today. Let's     |
|     |                        | talk about where to go for           |
|     |                        | additional resources. Curtis?        |
+-----+------------------------+--------------------------------------+
| 20  | ss#                    | (MAST)                               |
| 4.  |                        |                                      |
|     | graphic u.s. map with  | You need to know that all of us at   |
|     | PPB Phone number, 404  | the S-N-S Program are here to help   |
|     | 687 - 6749             | *you*!                               |
|     |                        |                                      |
|     |                        | I think your most important resource |
|     |                        | as a State or Local planner is the   |
|     |                        | S-N-S Program's Program Services     |
|     |                        | Consultant for your state. Each      |
|     |                        | state has a Consultant assigned to   |
|     |                        | you at the Federal level. If you     |
|     |                        | don't know who that person is, call  |
|     |                        | 404 687 - 6749. .                    |
+-----+------------------------+--------------------------------------+
| 20  | SS#                    | Our website address is: W-W-W dot    |
| 5.  |                        | B-T dot C-D-C dot gov slash          |
|     | www                    | stockpile                            |
|     | .BT.cdc.gov\\stockpile |                                      |
|     |                        | Our e-mail address is S-N-S          |
|     | ss#                    | underscore P-P-B at C-D-C dot gov.   |
|     |                        |                                      |
|     | email:                 |                                      |
|     |                        |                                      |
|     | SNS_PPb@cdc.gov        |                                      |
+-----+------------------------+--------------------------------------+
| 20  |                        | A videotape program on Mass          |
| 6.  |                        | Dispensing Preparedness is in        |
|     |                        | development right now -- stay tuned! |
|     |                        | Check the S-N-S website for more     |
|     |                        | details.                             |
+-----+------------------------+--------------------------------------+

+-----+------------------------+--------------------------------------+
| 20  | ss#                    | (MAST)                               |
| 7.  |                        |                                      |
|     | ht                     | A planning guide entitled            |
|     | tp://www.astdhpphe.org | "**Receiving, Distributing, and      |
|     | /bioterr/bioterror.pdf | Dispensing the National              |
|     |                        | Pharmaceutical Stockpile; A Guide    |
|     |                        | for Planners",** Version 9 is also   |
|     |                        | available for state and local        |
|     |                        | planners through local planners      |
|     |                        | through the S-N-S Program Services   |
|     |                        | Consultants.                         |
+-----+------------------------+--------------------------------------+
| 20  | SS#                    | (HUPERT)\                            |
| 8.  |                        | The Bioterrorism and Epidemic        |
|     | [berm clinic modeling  | Outbreak Response Model, or B-E-R-M, |
|     | software]{.underline}  | that I used in my presentation is a  |
|     |                        | D-H-H-S funded, free-access model    |
|     | http://www.ahrq.gov    | that can be accessed at: W-W-W dot   |
|     | /research/biomodel.htm | A-H-R-Q dot gov slash, research,     |
|     |                        | slash B-I-O-M-O-D-E-L dot H-T-M.     |
+-----+------------------------+--------------------------------------+
| 20  | ss#                    | (THORNBURG)                          |
| 9.  |                        |                                      |
|     | CERC course            | For a special course about how to    |
|     | http://                | navigate the harsh realities of      |
|     | www.cdc.gov/communicat | communicating to the public, media,  |
|     | ion/emergency/cerc.htm | and other groups during a            |
|     |                        | bioterrorism event, check out the    |
|     |                        | Crisis and Emergency Risk            |
|     |                        | Communications (C-E-R-C) link on the |
|     |                        | CDC website. The address is W-W-W    |
|     |                        | dot CDC dot gov slash communication  |
|     |                        | slash emergency slash C-E-R-C dot    |
|     |                        | H-T-M.                               |
+-----+------------------------+--------------------------------------+
| 21  | ss#                    | If you'd like additional information |
| 0.  |                        | on communications efforts during the |
|     | http://www.gwu.edu/\   | 2001 anthrax attacks, read the       |
|     | ~cih/journal/contents/ | article titled, "Public Health       |
|     | V8/SUPP/toc_v8supp.htm | Communication During the September   |
|     |                        | 2001 Bioterrorism-Related Anthrax    |
|     |                        | Outbreaks: CDC Activities and        |
|     |                        | Lessons Learned." It's in the        |
|     |                        | Special Issue of the Journal of      |
|     |                        | Health Communication, Volume 8 --    |
|     |                        | Supplement, June, 2003. The web      |
|     |                        | address for abstracts is listed on   |
|     |                        | the screen.                          |
+-----+------------------------+--------------------------------------+
| 21  | ss#                    | (WASHINGTON)                         |
| 1.  |                        |                                      |
|     | -   medical reserve    | A few other places on the web to     |
|     |     corps:             | look for more information are:       |
|     |                        |                                      |
|     |   www.citizencorps.gov | -   The Medical Reserve Corps, at    |
|     |                        |     W-W-W dot Citizen Corps (spelled |
|     | -   american red       |     C-O-R-P-S) dot gov.              |
|     |     cross:             |                                      |
|     |     [http://           | -   The American Red Cross' website  |
|     | www.redcross.org](http |     is: W-W-W dot RED CROSS dot ORG. |
|     | ://www.redcross.org/). |                                      |
+-----+------------------------+--------------------------------------+
| 21  | SS#                    | Of course, the website page for this |
| 2.  |                        | broadcast lists all of these         |
|     | broadcast webpage:     | resources, and more. The address is: |
|     |                        | W-W-W dot P-H-P-P-O dot C-D-C dot    |
|     | <http://www.phppo.cd   | GOV slash P-H-T-N slash antibiotic.  |
|     | c.gov/phtn/antibiotic> |                                      |
+-----+------------------------+--------------------------------------+
| 21  | ss# (same as above)    | And there's additional information   |
| 3.  |                        | available on the S-N-S listserve.    |
|     | broadcast webpage:     | State and local planners will have   |
|     |                        | to register to gain access to the    |
|     | <http://www.phppo.cd   | listserve, it is password-protected. |
|     | c.gov/phtn/antibiotic> | To sign up, contact your S-N-S       |
|     |                        | Program Services Consultant or your  |
|     |                        | state S-N-S Coordinator. \[PAUSE\]   |
+-----+------------------------+--------------------------------------+
| 21  | Q&A 10:00              | You now have the opportunity to ask  |
| 4.  |                        | questions to any of our presenters,  |
|     | CG:                    | Including Dr. Raub, who has joined   |
|     |                        | our panel.                           |
|     | [Phone]{.underline}    |                                      |
|     |                        |                                      |
|     | \(800\) 793-8598       |                                      |
+-----+------------------------+--------------------------------------+
| 21  | CG:                    | You may have noticed the phone       |
| 5.  |                        | numbers across the bottom of your    |
|     | [fax]{.underline}      | screen. Remember that you may fax or |
|     |                        | use TTY services as well as the      |
|     | \(800\) 553-6323       | traditional phone call.              |
+-----+------------------------+--------------------------------------+
| 21  | CG:                    | While we're waiting for a caller,    |
| 6.  |                        | I'd like to kick off the question    |
|     | [TTY]{.underline}      | and answer session by reading a few  |
|     |                        | questions that were faxed to us      |
|     | \(800\) 815-8152       | during the program.                  |
+-----+------------------------+--------------------------------------+
| 21  |                        | A viewer from                        |
| 7.  |                        | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   |
|     |                        | has a question for                   |
|     |                        | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.  |
+-----+------------------------+--------------------------------------+
| 21  | CG                     | AD LIB LIVE CALLS AND FAXES          |
| 8.  |                        |                                      |
|     | CALLER                 | 10:00                                |
|     | F                      |                                      |
|     | ROM:\_\_\_\_\_\_\_\_\_ |                                      |
+-----+------------------------+--------------------------------------+
| 21  | email:                 | (WASHINGTON)                         |
| 9.  |                        |                                      |
|     | SNS_PPT@cdc.gov        | Well, that's all the time we have    |
|     |                        | for questions. Thanks to everyone    |
|     |                        | who called or sent a fax, I think    |
|     |                        | we've shared some great information. |
|     |                        |                                      |
|     |                        | If we weren't able to get to your    |
|     |                        | question today, please email them to |
|     |                        | SNS underscore PPB \@cdc.gov         |
+-----+------------------------+--------------------------------------+
| 22  |                        | Now let's talk about continuing      |
| 0.  |                        | education credit for this program.   |
|     |                        | As I mentioned before, you must      |
|     |                        | register and complete a program      |
|     |                        | evaluation to receive continuing     |
|     |                        | education credit for this program.   |
|     |                        | Continuing education credit for this |
|     |                        | program is available ONLY through    |
|     |                        | the CDC Continuing Education and     |
|     |                        | Training online system. Sorry, we no |
|     |                        | longer accept optical scan forms for |
|     |                        | satellite broadcasts.                |
+-----+------------------------+--------------------------------------+
| 22  | s.s#                   | To receive nursing or continuing     |
| 1.  |                        | education credit for this program    |
|     | satellite broadcast    | you need to know the course number.  |
|     |                        | It's very important, so write it     |
|     | course \# SB0158       | down now. \[PAUSE\]                  |
|     |                        |                                      |
|     | s.s#                   | The course number for this satellite |
|     |                        | broadcast is S-B (as in boy) zero    |
|     | live webcast           | 1-5-8.                               |
|     |                        |                                      |
|     | course \# WC0058       | Again, that's S-B zero 1-5-8.        |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
|     |                        |                                      |
|     |                        | The course number for the webcast is |
|     |                        | W-C (as in cat) zero zero 5-8.       |
|     |                        |                                      |
|     |                        | You will need one of these course    |
|     |                        | numbers to identify the correct      |
|     |                        | evaluation in the online system, so  |
|     |                        | please write it down now.            |
+-----+------------------------+--------------------------------------+
| 22  | ss#                    | The webcast will be shown as "live"  |
| 2.  |                        | on the broadcast website site for 30 |
|     | "live" webcast for 30  | days. After that 30 days, it will be |
|     | days, then archived on | archived on another site for three   |
|     | another site           | years.                               |
|     |                        |                                      |
|     | broadcast website:     | \[PAUSE\]                            |
|     | <http://www.phppo.cdc  |                                      |
|     | .gov/phtn/antibiotic>. |                                      |
+-----+------------------------+--------------------------------------+
| 22  | s.s#                   | You can also receive credit for the  |
| 3.  |                        | archived webcast, or "web on         |
|     | archived webcast/web   | demand", and videotape copies of     |
|     | on demand              | this program for up to three years   |
|     |                        | after this live broadcast. Those     |
|     | course \# WD0046       | course numbers are:                  |
|     |                        |                                      |
|     | videotape              | W-D (as in dog) zero zero 4-6 for    |
|     |                        | the archived webcast; and V (as in   |
|     | course \# VC0071       | Victor) C (as in cat) zero zero 7-1  |
|     |                        | for videotape copies.                |
+-----+------------------------+--------------------------------------+
| 22  |                        | Many of you are already familiar     |
| 4.  |                        | with our online evaluation system.   |
|     |                        | If you haven't used it before, you   |
|     |                        | can receive instructions through the |
|     |                        | CDC's "FAX BACK" system.             |
+-----+------------------------+--------------------------------------+
| 22  | s.s#                   | Call this toll free number using a   |
| 5.  |                        | touch-tone telephone: 888- CDC-      |
|     | cdc fax back system    | FAXX.                                |
|     |                        |                                      |
|     | Phone #: (888)         | When prompted for a document number, |
|     | cdc-faxx               | request document number              |
|     |                        | 1-3-zero-zero 3 zero and be prepared |
|     | document #: 130030     | to enter your return fax number.     |
|     |                        |                                      |
|     |                        | That's document number 1-3-zero-zero |
|     |                        | 3 zero.                              |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
|     |                        |                                      |
|     |                        | Then enter your fax number. The      |
|     |                        | document will be faxed to you in     |
|     |                        | just a few minutes.                  |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 22  | s.s#                   | Now here is the address for the CDC  |
| 6.  |                        | ATSDR training and continuing        |
|     | cdc/atsdr online       | education online system: W-W-W dot   |
|     | system                 | P - H - P - P -O dot CDC dot GOV     |
|     |                        | slash P - H - T - N online. Please   |
|     | [www.phppo.cdc.go      | verify what you've written with      |
|     | v/phtn](http://www.php | what's on the screen right now.      |
|     | po.cdc.gov/phtn)online |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 22  |                        |                                      |
| 7.  |                        |                                      |
+-----+------------------------+--------------------------------------+
| 22  |                        |                                      |
| 8.  |                        |                                      |
+-----+------------------------+--------------------------------------+
| 22  | s.s#                   | (WASHIINGTON)                        |
| 9.  |                        |                                      |
|     | online system          | In addition to the help systems, you |
|     | assistance             | can also ask for assistance over the |
|     |                        | telephone. If you have any problems  |
|     | call: (800) 41-train   | with the online system, call us toll |
|     |                        | free at 800- 41- TRAIN. This toll    |
|     | Monday-Friday          | free number is available Monday      |
|     | 8am-4:30pm eT          | through Friday from eight a-m until  |
|     |                        | 4:30 p-m Eastern Time.               |
+-----+------------------------+--------------------------------------+
| 23  | s.s#                   | Or you can also receive assistance   |
| 0.  |                        | by Email. Our address is C - E at    |
|     | online system          | CDC dot GOV. The continuing          |
|     | assistance             | education staff will be happy to     |
|     |                        | assist you with the login and        |
|     | e-mail: ce@cdc.gov     | registration process. The            |
|     |                        | registration and evaluation for this |
|     |                        | program will be active on the online |
|     |                        | system for up to three years, but we |
|     |                        | recommend you complete the process   |
|     |                        | *sooner* rather than later. Please   |
|     |                        | try to wrap it up in the next few    |
|     |                        | days if possible, while it's fresh   |
|     |                        | on your mind.                        |
|     |                        |                                      |
|     |                        | \[PAUSE\]                            |
+-----+------------------------+--------------------------------------+
| 23  |                        | We are in the process of developing  |
| 1.  |                        | more broadcasts like this one, and   |
|     |                        | rely on your feedback to create a    |
|     |                        | better product. So please fill out   |
|     |                        | the evaluation to get credit and so  |
|     |                        | that we can continue to bring better |
|     |                        | broadcasts to you.                   |
+-----+------------------------+--------------------------------------+
| 23  | s.s#                   | Finally, if you would like to find   |
| 2.  |                        | out more about upcoming Public       |
|     | PHTN Website           | Health Training Network courses,     |
|     |                        | visit the PHTN website at W-W-W-     |
|     | [www.cdc.gov/phtn](ht  | DOT- C-D-C- DOT- G-O-V slash         |
|     | tp://www.cdc.gov/phtn) | P-H-T-N.                             |
|     |                        |                                      |
|     |                        | \[SLIDE OUT\] \[PAUSE\]              |
|     |                        |                                      |
|     |                        | *creep in theme music*               |
+-----+------------------------+--------------------------------------+
| 23  | on camera              | I'd like to take this opportunity to |
| 3.  |                        | thank all of the panel members for   |
|     |                        | sharing their valuable information   |
|     |                        | with our worldwide audience today.   |
+-----+------------------------+--------------------------------------+
| 23  |                        | And thank you for joining us today   |
| 4.  |                        | for this special broadcast, "Mass    |
|     |                        | Antibiotic Dispensing: A Primer."    |
|     |                        | We'll see you again for the next     |
|     |                        | installment in the Mass Dispensing   |
|     |                        | series.                              |
|     |                        |                                      |
|     |                        | Enjoy the rest of your day!          |
+-----+------------------------+--------------------------------------+
| 23  | CREDITS                | *Music up full*                      |
| 5.  |                        |                                      |
|     | cdc/phppo              | *Music out*                          |
|     | animation/graphics     |                                      |
|     |                        |                                      |
|     | closing graphics       |                                      |
|     |                        |                                      |
|     | FADE TO BLACK          |                                      |
+-----+------------------------+--------------------------------------+
| 23  | \###                   |                                      |
| 6.  |                        |                                      |
+-----+------------------------+--------------------------------------+

**TOTAL APPROXIMATE RUNNING TIME: 1 hour, 30 minutes**

Loosely based on 1 minute per page