Introduction
The Strategic National Stockpile (SNS) was formed in 2003 under the Department of Homeland Security (Esbitt, 2003). SNS uses Cities Readiness Initiative (CRI) to access large cities (Carbon County Montana Public Health, 2014). Point of Dispensing (PODs) is a post-incident strategy to provide life-sustaining supplies such as medicine, food, water, shelter, and the general public within 72 hours after the disaster (Khan& Richter, 2012).
This research paper explores existing state plans for mass prophylaxis using Points of Dispensing (PODs) during widespread national health emergencies such as disease outbreak and bioterrorism attacks, among others. There are two primary plans based on PODs that can be used during local mass prophylaxis in a public health emergency or during a terrorist attack. The plans are the Local Health Department (LHD) and the Field Operations Guide (FOG) (Khan & Richter, 2012; Oregon Public Health Division, 2012). This paper will discuss the two plans in detail to explain how they work. Each of the plans has its advantages and shortcomings. In an emergency, it is, therefore, imperative to analyze and determine the best model to be incorporated as the alternative of the main one used.
Local Health Department
Local Health Department POD is commonly used in a large metropolitan area because, as Khan and Richter (2012) allude, the challenges that this model is likely to encounter in a sparsely populated areas are quite different from the ones it would face in an urban setting which is densely populated. In offering mass prophylaxis to the general public in case of a health crisis or a terrorist attack, this plan is used to supply affected groups’ medical necessities. Although this model has numerous disadvantages as per Khan and Richter (2012), the Centers for Disease Control and Prevention and the Department of Health and Health Services still give credit to it as the ‘cornerstone’ of availing support in times of prophylaxis.
The CDC Division of the Strategic National Stockpile (DSNS) requires dispensing points to fulfill about three tests out of the possible seven. According to Khan and Richter (2012), out of the seven experiments, “four are directly related to POD activation, set-up, and throughput and complete one functional or full-scale exercise for each Cities Readiness Initiative Metropolitan Statistical Area (MSA) that tests key components of mass prophylaxis plans” (p. 2). These tests should be carried out by the Public Health Emergency Preparedness Grant year normally between August 10 of each year and August 9 of the following year. CDC recommends that dispensing sites should be places that the residents are familiar with, are accessible, and populous. These places could be community centers, schools and playing grounds among others (Khan & Richter, 2012). The dispensing sites come with advantages such as adequate space, proper security, and good climate. They should not be health centers as this will inhibit the medical personnel there from carrying out their duties in so far as the pandemic is concerned.
This model is scalable; it can readjust itself to accommodate more residents. On the other hand, this POD model has its shortcomings too. For example people with disabilities queue together with the rest of the population, which is terrible on the part of these people living with disabilities. Another drawback of this plan is that there could be inadequate sites to put up dispensing sites, and since mass prophylaxis should take place in places of essential services to the population, it becomes challenging. According to Khan and Richter (2012), it is time-consuming to put together the logistics in this operation. This could be disadvantageous in the already desperate situation that characterizes the general public.
Field Operations Guide
Field Operations Guide (FOG) is the other POD model adopted in the Oregon state to develop highly scalable dispensing points that meet the requirements of the Centers for Disease Control and Prevention and the Division for the Strategic National Stockpile (Oregon Public Health Division, 2012).
This POD plan uses a response tool known as Incident Command System to coordinate medical supplies’ mass dispensing. In this plan, mass prophylaxis is done in two PODs: medical PODs and non-medical PODs. Medical PODs involve screening the victims for medical conditions such as allergies and ulcers, among other medical conditions that would affect the kind of medication administered to these individuals. However, in non-medical PODs, individuals ‘self-screen’ themselves to establish whether or not they should be administered with the prescription.
Discussion
Having studied how the two POD plans operate, it can be seen that they are similar and also different in specific ways. Both POD plans are targeted towards offering rapid prophylaxis to the masses during times of emergency. While LHD is quite flexible and scalable, FOG seems to be relatively rigid in times of emergency. These could be detrimental to the process of dispensing supplies in a large-scale emergency. FOG is centralized in the sense that it receives directives from the Incident Command System. This can be time-consuming and counter-productive. FOG is state-specific, while the traditional LHD can be used in any part of the US in times of medical emergency. With these striking differences, a traditional LHD model of dispensing is the most preferable in a crisis. In as much as LHD is the best, it has its fair share of disadvantages, and it is, therefore, prudent to bring in alternative models. FOG PODs are kind of closed PODs in that the general population cannot be allowed to access them. In this way FOG attends to less people as compared to LHD (open PODs). At the time of writing Oregon Public Health Division (2012), there were fewer FOG dispensing sites as compared to LHD sites. The open PODs are way more complex and require more funds and planning to assess their readiness
Having a national standard for POD implementation using the traditional LHD POD plan will compound the problems that this model encounter even when dispensing at lower jurisdictions. A major issue that is likely to arise is shortage of staff to aid in the administration of medication countermeasures. This will mean that several dispensing sites should be identified all over the nation. Several memoranda of association with site owners will be signed and it is not guaranteed that every site owner will approve of this. The chain of command will also widen so that information from the top-most authority will have to go through several officers in the POD framework before reaching workers at the ground. This work therefore, does not support the idea of having a national standard of implementing PODs.
Conclusion
It is agreeable that LHD cannot fully handle the entire population in the stipulated time because of its challenges. The problems include inadequate staff, lack of security, a large population to offer medical help, unavailability of dispensing points, and other issues. In a practical situation, these challenges can be overcome by resorting to alternative models like dispensing in schools, homes and business premises among others. FOG, which is another prophylaxis approach, is state-specific. For example, this research considered the Oregon POD FOG. It is a standardized POD model that is destined to be effective in handling small populations. Medical emergencies or any disaster that comes with a widespread crisis is an unfortunate situation that should be met with much preparedness from state authorities to reduce helplessness among the general public if a disaster strikes.
References
Carbon County Montana Public Health. (2014). Point of Dispensing Operations [Video]. YouTube.
Esbitt, D. (2003). The Strategic National Stockpile: Roles and responsibilities of health care professionals for receiving the stockpile assets. Disaster Management & Response, 1(3), 68-70.
Khan, S., & Richter, A. (2012). Dispensing mass prophylaxis? The search for the perfect solution. Homeland Security Affairs, 8(1), 31-42.
Oregon Public Health Division. (2012). Mass prophylaxis point of dispensing (POD) field operation guide [PDF document].