The People, Process, & Progress Podcast - Best Practices in Mass Dispensing Operations Planning | BTS #44

Episode Date: November 9, 2019

Sharing lessons learned from my time having to prepare to provide a 10 day supply of medication to over 300,000 residents within 48 hours as a Public Health Emergency Coordinator.

Please silence your cell phones, hold all sidebar conversations to a minimum, and we'll get started with between the slides in three, two, one. Hey everybody, thank you for coming back. By this time, you all will be over the 5,000 and plus listeners, downloaders, et cetera. So thank you very much. That's pretty awesome. My kind of goal, just as an accomplishment as a person who started a podcast wanting to share some knowledge from what I used to do and what I do

now was it'd be cool to hit like 10,000. So we're halfway there. So that's all due to you folks. I don't think I've clicked that many times to contribute to my own podcast, but you never know. Thanks for coming in. So today is anatomy of a point of dispensing or pod. It is a way to give a bunch of folks pills or shots or something like that. What I'll talk about is how annually I and the state of Virginia I worked in helped plan for giving flu vaccinations and how those are really exercises for when something really bad happens like a big outbreak or an anthrax attack, where we have to get a bunch of people through an area where we give them some basic screening and where we give either shots or pills or something like that. So obviously for the flu shot, for adults, you get a shot.

For youngsters, if there's a vaccine available, you get a nasal mist. But what's behind that? What's the planning so that when you show up with or without insurance, you don't need it really? Just need to know if you have any allergies to certain things that affects the shot. You can just get a free one. So I would advise that for everybody that's listening to this, get your flu shot.

It's flu season. So it's a good time to get it if you haven't already. So again, we'll go kind of to the original concept. So the between the slides five here, looking at an order from a few years ago, point of dispensing, action plan so that's like a project management plan or really a mix between that and a charter kind of for project managers out there so it says here's our objective here's who's doing what here's how we'll

communicate scary the crossover right so again transferable skills between but we'll really focus on the the key elements that i found very very helpful when we planned and when we successfully gave flu shots. This example, the target was to give 800. That's how many we'd asked for. We had given, where I was there, where I worked, over 1,000 in one day, which is pretty awesome. I mean, that's just amazing. It was not long after the H1N1, so there was still some of that concern. There's been fluctuations in the percent of how much it works over the past few years, but it's better than 0%, right? So make your own choices,

but most local and state health departments give free ones, so it's a great option to consider if you don't have insurance, or even if you do, just to be able to show up and help your health department get better prepared. So first thing for anatomy of appointed dispensing, the first between the slides five, I would say, is always be smart with shared objectives, right? So everything starts with those objectives, those foundational four we've talked about, objectives, org chart, resources, communication.

Well, when you're planning to have a bunch of people come through lines and fill out paperwork and get a shot and then make sure they're not kind of getting faint from needles or a reaction or anything, you need to plan for that. And so that starts with really good objectives. And we had, I think, five, typically four or five. For the example, I looked at one.

I think this one was from 2013 or something. But similar, applicable, I think the two, applicable directly to points of dispensing. So if you're a public health person or public safety person or incident management person working with the health department, here's a couple specific beyond provide for the health and welfare, et cetera, et cetera,

the administrative overhead kind of objectives. So I would say that you definitely wanna have provide X amount or X number of vaccinations to could be the public or residents of the county, but really it's the public because unless you're going to screen for residency, that's a whole nother level. In this example, we actually had to provide X number of vaccinations to, and then we had an identified population. So underserved folks, so where we'd set up these points of dispensings were typically areas where there wasn't healthcare or we knew folks didn't have insurance. And that's the whole point. When

you give away free, primarily it's for folks that can't afford it or don't have the coverage or their job doesn't give that to them. So you don't have to be that specific in this objective. I would include the number. We want to provide however many you'd reserved for that year or the target. It's kind of like you're measurable for a project. And then are you just going to give them to the general public? So you're just trying to get rid of them. Or are you going to the underserved, underprivileged, or targeting the elderly, or targeting the young folks with the different kinds of vaccinations? And you can cater that to whatever's going to work for you all, what the needs in your community are. But I think some options there. And then another good one is, and this has to do with the partnership, right? Again, these are shared objectives. So the health department should

be deeply working with their locality, their emergency management, their public safety, every other department there. So that's police, fire, DMS, dispatchers. And if you are fortunate and you have a local or even regional work with your incident management team to fill all the non-public health positions, right? So one of the objectives we had was use LocalityX's incident management team for all non-public health positions as possible, right? So we still had some folks that were environmental health folks and they did logistics, right? They weren't doing like medical screening, even though they could and they could be trained in it. And then we partnered with our locality. So actually,

on this day, I swapped actually, my buddy Rob and I. So the first day I was a plan chief, and then he was deputy. And it also gives folks who maybe are coming up an opportunity in a pretty stable environment, but still with some some good moving pieces to get some experience and maybe some taskbook work. So if you're looking to get taskbook work, reach out to your public health department and see if you can supplement and help them as part of their annual flu vaccination. So first between the slides five is always be smart, specific, measurable, achievable, realistic, and time-based. You know, where that A we've talked about is could be, you know, agreed upon with shared objectives. You got to have those and they have to make sense. Second thing, second between the slides five is consider running more than one pod or

pointed dispensing at the same time. So this practice is one to give free flu shots, one to help, you know, vaccinate the public and have less sick people. The other thing is it helps you really do count as an annual exercise for, you know, the nightmare scenario that all public health departments is some disease, but the big one was anthrax. So you'd have to be able to give a 10 day supply of anthrax to however many people live where you are in 48 hours, right? So that's really what you're practicing for. But you're not going quite as hectic and things like that. It can

be when you get 800 1000 people that end up coming through during the day, you know, steady, you have to do all aspects of running a good incident or event or project, you know, getting folks some food and getting them a break, but keeping the throughput going, that's people coming through. So great advantage of doing more than one at a time. And if you're just getting started in points of dispensing, either planning or taking part in them or incident management team partnering, then you can start with one. But if you go to two, it provides more shots to the public in more places, which is excellent. It also is a great chance to exercise that worst case scenario because if you are giving a bunch of medications, whether it's shots or pills or tasimidine or whatever for radiological

issues to a lot of people, you're not going to do that at one place, whether it's a small town or a big town, meaning a lot of population or not, you're going to have to have more than one place. So this is a chance to say, you know what, let's give shots in the east part of the county and let's give shots in the west part of the county or north and south or whatever or your city. And it's just a great exercise to do. It also helps you communicate without having the ability to go face-to-face with every location. So if you can put your policy folks or maybe your contingency folks not at each site, so they have to communicate via radio communication or runners or something like that, then that adds complexity, which gives you better training and better capability.

And it also helps you work on your situational awareness. So you have to know pod one is at this number of shots given. We have this much inventory left. Pod two, same, you know, like that. And then you can also practice pulling that information, which we'll get into here in a little bit when you're doing your situation reports. So again, the more complex you can make it in kind of a smooth, controlled environment when it's not a horrible outbreak or something really bad, that's an excellent training opportunity there. The third thing is public health

people or person should be the operations section chief, right? This is a public health deal. It's preparing the public health department or state health, whatever configuration or level you have there. But that's the point. And it's largely their, not largely, it's really their operation. It's their resources. It's their expertise. It's just like fire stuff should be owned by fire led with ops. And we've talked about both myself alone, I think when Rob's been on here, having a generic person that can coordinate operations pretty well. But for something like this, I tend to be more, and maybe selfishly because I came up through public health, you want someone that's familiar, whether it's

like your nurse manager or nurse supervisor, somebody that's been around and done something like this before that has an understanding of how operations should go. And could someone that's just a good ops chief do this and then just trust in their pod managers and stuff and coordinate? Yep, absolutely. But I think for this, because it's disease, you can't see it. And again, this is flu vaccination clinics, so it's not that. But again, you're practicing for a disease and outbreaks out there or powder attack or something like that or radiological exposure. So you want someone that has trained for this quite a bit, I think. And so why not do that when you're exercising this? And the cool thing about this as an exercise is you're also actually giving flu shots. So you're doing great service for the public, but you're

also getting great practice for your people. And I say that public health folks, I think should lead operations. Cause there's probably still some, you know, old school holding on where public safety should always be operations. It's really going to be up to the relationship that you do or don't have between your departments. I would say establish a good one because you know, there, there shouldn't be fighting of who's going to be in charge of operations because there'll be other resources. And that's something to consider too, is in the state I'm in, at least, um, paramedics, uh, maybe intermediate intermediates, uh, but paramedics for sure can give vaccination. So could you also somehow blend paramedics in with your nurses to be able to give shots, which also gives them practice, you know, beyond,

although not super, you know, different, maybe the way that you give it and that, but like, you know, an insulin shot or something like that. But it's also another way to partner. So if the health department is short nurses, and you don't have a lot of medical reserve core, like we talked about in the last episode as a way to get involved, you can try and supplement with paramedics, you know, whether they are MRC volunteers, or they're actually from the fire department or EMS or whatever. So a potential org chart. So I mentioned, you know, trying to exercise more than one point of dispensing. And so here is a sample organizational chart that I, you know, has worked well in reality.

And it's to have so you have your operations section. And then each of your points of dispensing is its own group because it's functionally, and you can go either way, group or division, right? So group is functional, division is geographic. So you could have east pod, west pod, north pod, south pod, which is defined by maybe the area it's serving or where its location is. We went with groups thinking that, well, this pod one group, or it was really the name of the location group pod, and then on down the line is the function of it is the same in each spot, right? You're going to get people to come in, are they sick? Yes or no. Okay, you can keep going. We're going to screen, do a little paperwork.

We're going to give you the shot. We're going to make sure you're all right for a few minutes, and then you're going to leave. It's the same thing in each pod. So it's a very functional thing. So that's what we did. So we would have pod group one, pod group two, or you could say the name of the pod and its functions as a group. And then within those groups, we had strike teams. So we had administrative strike teams. So the folks that are filling up the clipboards with paper, making sure they have pens or pencils, pens really for that kind of paperwork, are moving the stuff up and down the line, are sitting there helping folks fill out the forms if need be. And that's a consideration too, not just for this, but for other things, but in particular for points of dispensing is you need to have forms in multiple language or at least the predominant language. So you can make sure that if you have folks, say you have a heavy Spanish-speaking population or Vietnamese or Korean or whatever that don't speak English or American English, that you can serve those folks and give them the flu shot.

And if you can, which is hard infrastructure-wise depending on the building, you could try and have kind of a language line service, that should probably be a separate line for maybe English as a second language line. And I say that because meaning the line that people waited to get their shots, because if you have a bunch of people waiting, and you're trying to work through translation, that's going to take a while. So you could have a separate English as a second language line, or different pod just for folks that are not primarily English speakers. And we've done that before too, so that the rest of the folks aren't bogged behind them while we're just trying to get translation services. But if you have the forms printed out in multiple languages, that makes a huge difference. So that admin strike

team doing just what it sounds like, administrative stuff, screening people, getting the paperwork where it needs to go. And then they're going to be working closely with, but a different strike team, the nursing strike team. So these are the folks that are going to verify your paperwork's good to go. They're going to give you the shot. They're going to make sure you feel okay. And then that's it. So the nursing strike team is exactly that. It's the public health nurses or medical reserve coordinator nurses. Again, they can also help. So that's another great augment of staff. And then the other strike teams we're going to have that typically we had was an external security strike team. So the folks outside helping with the lines, whether you've done a drive-through point of dispensing.

So you can actually have cars pull up, get their paperwork, and then in the next station they give it back. We make sure it's good to go. And then they just stick their arm out the window and get shot. So you want to talk about maximize speed of getting folks in and out. You could do that similarly down the road with pills. So that's another good way. But even if they're coming inside, the external strike team can help manage parking and everything else on the outside and all the stuff that an external security force would do. And what we actually did with that is we would have our police department that typically, at least where I was, were out on the roads, be the external. And so they handled anything security, anything law

enforcement outside. And then internally, we partnered also with the sheriff's office. And so we had deputies inside doing the internal security. So, you know, imagine during an outbreak or an attack or something that, you know, flu shot clinics are typically pretty tame. When something real bad's happening, think about all the, you know, different movies you've seen. But in reality, you know, folks want their medication. They want it for their kids. They're worried. They're scared. And so, folks, you know, can tend to get pretty emotional with that kind of thing. So, you want security on the inside. So again, our breakout, if you're looking at the point of dispensing itself, was the pod group.

And then within that, you would have an admin strike team, nursing strike team, external security strike team, and internal security strike team. And again, if you need more than one of the strike teams because you're spay and control, which again, optimal is five within each of those, but three to seven is your range that you want to look at, is that you just add another strike team. You could have admin strike team one, two, three, et cetera, and on down for the same thing. And then the other group we had kind of outside each pod but ready to go was a contingency group. So their whole job was to help coordinate any response

that needed to happen. Say something broke out, a domestic squabble or something at one of the pods had nothing to do with the service we were providing. They could augment as requested from either the external or internal security strike team. And that definitely you have to coordinate ahead of time too, right? Because that person that's heading your contingency group is also going to coordinate with the 911 centers and every other resource that's going to show up there. So another thing to consider is, are you going to have a whole contingency group on standby? And when you have a lot of moving parts

and your people are in the field and the public's involved, it's a good idea to have that ready because you never know how someone's going to react, even if it's a nice control environment where you're just giving shots or particularly if the stuff's hit the fan and it's actually really bad out there. Another thing to consider, so, you know, public health is ops. This is still that third of the between the slides five is that doing this helps, you know, make sure you build that trust in

relationships with your partners ahead of time so that, you know, when something that happens, you don't have to worry about it then. And so using these annual flu vaccinations to do that is an outstanding way for every discipline involved to partner, to get to know each other, to put faces with names, to build relationships. The relationships I built from doing these kind of things with emergency management, public safety, and other partners actually helped me leverage

that relationship to improve our folks when they were would go to this big sporting event twice a year and they had to walk around it was a big huge area and because I built relationships through good planning through my pods I was able to ask for them to get golf carts which made their job so much easier and more efficient and that's all based on building relationships and doing point and dissensing planning, but it could be planning for any event that you have, right? So that's a tangible value of down the road, making someone's life better, more efficient, safe, is you build a relationship for planning for whatever exercise, for a flu vaccine, for a festival, for whatever. And then come to find out, hey, you know what? When we go to this

thing every year, it's a lot of work and we don't get a cart or whatever. And I said, we know it. Let me reach out to the partners that I've built the relationships with and I may know them a little better. And then boom, now they have a cart. So it's a matter of who has a relationship and how you can leverage it. The ops person should be a senior person. I kind of mentioned that, public health person. Other positions to consider, other specialties from the health department to consider is train up your epidemiologist to be the safety officer, right? So imagine, again, we're in a flu outbreak for real, like H1N1 gave thousands and thousands of flu shots

in Virginia and in the district I was in alone. So the epidemiologist is the expert on disease, right? Them and with the health director, who typically has a, you know, a public health degree and is a doctor, but the epidemiologist's whole job is disease, disease prevention, investigation, a whole bunch of other stuff. It's pretty, pretty amazing what they have to do and what they do. So them being a safety officer is excellent because they can guide us on the personal protective equipment we should use, any precautions, you know, the washing of your hands, which, again, you'll hear, needle capping, all that stuff. And for epidemiologists, it's a great training opportunity in incident command system where they may not get to do it as much as maybe nurses out in the field or as an emergency planner or coordinator like I did that also had public safety experience. And so it's a great opportunity.

So have your consider your epidemiologist being the safety officer. And then for the leadership of this, for the incident command, you know, you can certainly have a unified command. So someone from the health department, someone from the locality. When you look within your health department, consider your managers, like your business manager, your environmental health manager, your nurse manager, somebody else that's in leadership to help train them up to be incident command. Certainly the health director will be the incident commander, you know, often, but, you know, maybe they want to train their folks up, which we all should as leaders, right? And so a good opportunity is look at the next layer down from the health director or from the

health department leader of who can lead this event and make sure you as the emergency planner or the incident management team professional is really enabling them for success. So the fourth of these between the slides five that I would say is helpful for points of dispensing planning is to empower your public health nurses as the point of dispensing or pod managers. And so the leadership position that we created, this is where the blend of pure incident command system, right, which would be a group supervisor, so it would be pod group supervisor, is the public health folks are more familiar with the terminology pod manager, right?

So that's what we called them, but they were working as group supervisors. Down the road, as their training evolved, as the relationship evolved, we could move folks to say hey you're actually the the pod group supervisor this means the same thing as a pod manager but it's kind of a little more NIMS compliant if you will so you know as you're planning just like you would anybody else coming up and as a group supervisor if your operations or a leader are planning you know you want to empower them so they're making the decisions they're helping drive what we're going to do. In the real world, they'll be leading that anyway when they're out

in the field in the disaster. So prep them up now. Make sure you focus and help them with command and control. They could be a nurse that works in a clinic all the time, but they're very experienced in giving shots or screening folks or something like that. And this is their first time up as being in charge of a whole location. So you set them up for success with knowing who to contact if they get stuck. Maybe have a senior person kind of shadow them or be there with them. Make sure they know everyone's contact information, right? Their cell phone numbers, how to use the radios, which I highly recommend doing. That's one thing I did, which is probably one of the best things I did for the health district is got us the same style and on the same network or same band as 800 megahertz as public safety and everybody else. So we could follow any incident. They could follow us. We got our own channel I requested. So again,

that was all through relationships and all through being able to show, look at the value this has provided all of us in learning more about these kind of incidents. So make sure your pod managers, your group supervisors, your nurses, you're going to put in those roles. And those definitely need to be public health nurses that know that whole process, that you've set them up for success for sure. So let them lead, but with support, knowing that they're not alone. I think that's a huge factor is we got to build up our folks

in public health that don't live in the incident management or incident command world, so that when we're not there as the planner or the director or other folks that do a lot more, they can run it on their own. Number five, the between the slides five, I would say for, you know, the anatomy of appointed dispensing is to track your throughput at least hourly, right? So there's many benefits to this, which I'll go over. But you can track it just simply on, you know, an Excel spreadsheet on Google Docs somewhere, something like that. I found whether it's an online thing like Dropbox, Google Doc, whatever platform you want to use, but that other folks in other areas can also look at

and it updates when you update the numbers, is super beneficial. So this is great for the situation unit, right? So if they're doing hourly situation reports, they can always be saying, here's how many we've given, here's how much inventory we have left, no reactions, negative reactions, you know, they can give the whole picture of what's going on, and how many people have come through or not

come through at each of the points of dispensing, and then roll that up into one big report. So, so many different ways you can chop up that information. Your public information officer would love to have this, right? So, whether's halfway through or right before or at the end, if you do a release, hey, everyone, we gave 1,100 and something shots today, right? That's a great nugget that's free. It was to the population you targeted to help them out. Your liaison officer, also good to know, how's the relationships going between all the agencies? Throughput wise to know, you know, how's the relationships going between all the agencies? You know, throughput wise to know, are you going to also vaccinate their folks? Are you going to send police and fire and whoever else wants one through your clinic to get numbers up or just to provide that service to them?

That's another option too. Probably most importantly for whoever's your logistics section chief or your supply unit leader for this endeavor. So vaccinations have to be refrigerated or frozen depending on what they are. So you have vaccination coolers that actually require them to be plugged in. And worst case, they could be just a cooler

with a bunch of cold packs. But these, if they get out of temp, you can't give them, you have to throw them away. So your logistics section for a public health, you know, or appointed dispensing or pod has to be able to also manage, okay, we're going to have these vaccination coolers that we're going to have to be able to plug in or have a bank of them. We're going to have to have enough ice packs to sit on the table to then sit the vaccines on to keep them cool or individual coolers per table. So did you budget for that? So hey, finance admin coming into play. But logistics has to think about all that

plus the mandates, the gauze, the tables, the chairs, the we actually bought with some grant money. Word escapes me. But you know, when you're waiting in line and the, you know, the little rope is there, we have the retractable one. So you could make the lines to kind of corral people and where to go. Stanchions, that's what they are. And hugely helpful. So I highly recommend that. Great use of grant money. That, colored vests. So logistics is going to know who's in what section, who's doing what, get the labels on the vest. So it's super clear for everybody involved who's doing what if they have any question. So that's my pretty quick, between the slides, five of how I think folks can be successful in doing their points of dispensing,

whether it's for flu vacs, which is what this is based off of, but you can easily expand this. It was very similar in my much bigger plans for, hey, we have to go to the whole high schools and give this to 300 plus thousand people in 48 hours. How are we going to do that? Bus routes, all that kind of stuff. It's all based on the same principle of always have the smart objectives.

Consider running more than one pot at a time when you're doing your flu shot exercises. Public health should probably be ops for this one. It's a great exercise for folks that aren't as operational in the field, depending on their job. And for something like this, where you can't see it, if it was a disease driven, you want folks that are really can tell you that. The fourth thing is empower your public health nurses as those pod managers or group supervisors or division supervisors, however you put that up. But in the public health world, pod managers is what most folks are familiar with and track your throughput at least hourly, right? So that's going to help

every section really, but practically it's going to make sure that you don't want to run out of vaccine. You got enough coolers, et cetera, et cetera. So I hope this was helpful. It's again, timely. I got my flu shot a couple of weeks ago and was just messaging with an old colleague about pods. So I figured, you know what, let's, let's break one down. Kind of basically didn't get into the weeds of every single part of it. Other key elements of the instant action plan should be there too, right? Your communications plan, your contingency channel, all that kind of stuff. And I think for pods, I had three. So I had a

security and operations and a contingency channel for this. If it's bigger, you can have more, you can have one for each pod. But there's not a lot of chatter on the radio because most of the interaction is happening in the pod itself. So that's it. Again, thank you everybody for listening. Just over 5,000 downloads, which is pretty cool. We are still on the Facebook at Between the Slides. Change in email address, though.

It's BetweenTheSlides at gmail.com. So if you have any questions, if you have requests, if you have positive, negative feedback, whatever it is, feel free to email me between the slides at gmail.com. Penelope KG on Twitter and Instagram. Thank you all for everything you do out there. Stay safe. Godspeed.