In the event of a pandemic flu, the need for mass immunizations will be vital to containing the spread of the disease and also decreasing the impact to the nation’s critical infrastructure. To operate a successful Point of Dispensing (POD), there are many considerations. Part one in this series discussed goals, planning considerations, site selection, and security for creating a successful POD. This article will discuss site setup, layout, staffing, and public information deployment.
Site setup
Prior to opening a POD, determining the type of site setup is important and consideration should be made concerning dispensing operations. As with all emergency medical operations, the focus of the POD needs to be on the patients that will be seeking treatment. A POD will have four potential patient groups arriving:
Group 1
Normally healthy people only requiring prophylaxis. This group can be termed “No Complications.”
Group 2
Those with complicated medical histories, potential drug interactions, pre-existing illnesses, or who present medical conditions not associated with the pandemic. This group can be termed “Complicated.”
Group 3
Those people arriving who are suffering from acute or life-threatening illness due to the pandemic. This group can be termed “Acute.”
Group 4
Those who may be dependences or caregivers of those in groups 1-3. This may include children and caregivers of elderly or disabled patients. These people may or may not need prophylaxis. This group can be termed “Family Support.” In addition, this group may also have pets that arrive with patients.
As people arrive, there will be varying numbers of each of the four groups. Two questions that need to be answered by the time patients arrive are:
• How will they be directed?
• How will patient flow be determined?
The answers to these questions will determine the site setup and layout. There are two methods for patient flow, and planners will need to determine if they will use either segmented or non-segmented patient flow for the POD operations.
Segmented operations means physically separating pre-prophylaxis activities from the actual dispensing of medication. The public would gather in one location, where they could be screened, triaged, given any required education, and then transported in groups to the actual POD to receive medication.
Segmented operations
• Public gathers centrally
• Screening
• Triaged
• Educated
• Transported to and from the actual POD for treatment
The benefits to the segmented approach include:
• Individuals who are very ill may be arriving to seek treatment, and can be transported directly to a health care facility, bypassing the POD
• Reduced parking and traffic congestion at the POD
• Control and access to the POD will improve security
• Potentially decreasing the number of “worried well” patients who may bog down POD operations
• Allowing a mechanism to regulate the initial flow of people into the POD
• The ability to balance and redirect public flow to the various PODs
• Allow PODs to have scheduled “down time” for resupply
• Decrease traffic congestion and abandoned vehicles at the POD
The challenges to the segmented approach include:
• Additional staffing for two locations (gathering and POD)
• Public may learn of POD locations from others and go directly to the POD
• Transportation issues may increase complexity such as providing buses and drivers fuel for transportation operations
• Additional fuel costs for transportation of people to and from the POD sites.
In the non-segmented approach, all aspects of POD operations are conducted at one location. This may be one or multiple POD locations. The information regarding the POD location(s) needs to be clearly conveyed to the public as well as details on where to park.
Non-segmented operations
• Public at the POD
• Screening, triage and education will all be done in one location
The benefits to the non-segmented approach include:
• Staff is only needed at the PODs
• No problem with transporting patients to multiple sites
• If critical numbers of people are ill, the Non-Segmented approach will require less staff to operate.
The challenges to the non-segmented approach include:
• Parking and traffic congestion at the POD
• Triage and regulation; the flow of people into the POD may include ill patients
• No ability to redirect public flow to the various PODs
• Difficult to distribute the public equally among all POD sites
• Public may congregate at a particular POD and controlling the crowd can be a challenge
• PODs will have to continue operations while resupplying, staff changes, and breaks
• Potential for traffic congestion and abandoned vehicles at the POD
• Planning for ensuring location of PODs are as equal as possible throughout the community
• Planning for problems for reallocation of supplies, staff, and security
There is no right or wrong decision when it comes to choosing between segmented or non-segmented POD operations. Depending on local resources and the ability of staffing, either method may work very effectively for your community.
Layout
The layout for a POD should be fairly consistent if multiple PODs are used. There are five basic areas or stations for a POD in a non-segmented design.
• Gathering and triage area. This is where people will initially gather when they arrive at the POD. It is here where they can be quickly triaged for those who may be arriving ill or need medical attention. This is also where new arrivals will be met by greeters to instruct them on the overall POD and basic things like where to go and necessities (bathrooms, pop machines, etc.)
• Education. An area for prevention of disease, disease spread, target groups, and any other additional information needed.
• Sign in and Registration. Patients will need to complete basic paperwork and be prepared for vaccination. Flow to the various vacation areas can be controlled by this station.
• Vaccination area. This is where vaccinations will be administered. This can be multiple areas, using tables to form lines that allow for the uniform movement of people through the areas.
• Post-vaccination area. An area where immunized patients can rest or be treated for any adverse reactions.
Staffing
Staffing will vary by the numbers of people seeking prophylaxis. Depending on the experience of those giving immunizations, the average person giving immunizations can give approximately 30 immunizations per hour. This will also depend on the population group being immunized (children may take longer), and weather conditions. Cold weather means people will be wearing more clothing that may need to be removed.
The following are the recommendations from the Centers for Disease Control and Prevention for staffing of a vaccination clinic with eight vaccination stations and total staff of 53. In an eight-hour day, this staffing level will immunize approximately 1,920 patients or 3,840 patients over 16 hours. Using this guideline, a planning group can determine the number of staff and hours needed for immunizing large population groups.
CDC Recommendations for a Vaccination Clinic with Eight vaccination stations
CDC Recommendations for a Vaccination Clinic with Eight vaccination stations
| Position | Number per 8 hr shift | Number per 16 hr day | Experience |
| Forms Distribution | 3 | 6 | Nonmedical |
| Orientation/Info / Greeter | 3 | 6 | Nonmedical |
| Medical Screeners | 1 | 2 | Medical: Nurse |
| Clinic Flow; Reviewer/ Forms Helper | 7 | 14 | Nonmedical: to assist with forms completion, collection, and clinic flow |
| Vaccinators | 9 | 18 | RNs, LPN, others as dictated by state laws |
| Vaccine Preparer | 8 | 16 | LPN, Medical Tech |
| Exit Review | 4 | 8 | RN or public health person for questions, instruction, observation and form verification |
| Medical Records / Data Entry | 8 | 16 | Nonmedical, vaccine info and doses administered data processed |
| Clinic Manager | 1 | 2 | Nonmedical Public Health / Immunization Program Manager |
| Supply Manager | 2 | 4 | Nonmedical |
| Security | 4 | 8 | Non-public health resource |
| Translator (not counted for total clinic staffing estimates) | At least one per language per shift |
| Language fluency |
| Float staff | 2 | 4 | Nonmedical volunteers |
| EMT | 1 | 2 | Medical |
| IT Support | On Call |
| Nonmedical |
| Total Personnel | 53 | 106 | Not counting translators |
Public information
The Public Information component is critical to a successful POD operation. The information that needs to be disseminated can be to both internal and external users of the POD. Internal users are those already at the POD seeking treatment. External users are the general public who have likely not yet been immunized.
Internal users would need information on:
• Disease spread
• Impacted groups
• Adverse reactions to treatment
• Signs and symptoms of the disease
• How soon will it take for their body to develop immunity to the disease
This information can be in print form to be given out during the check-in or in the education area of the POD. It also needs to be available in various formats, especially if there is a language barrier.
External users would be the general public. The PIO or group would need to prepare similar information, but their message would need to be geared to let people know the following:
• Who should seek treatment and why is it important to be treated?
• What can happen if a person does not seek treatment?
• Signs and symptoms of the disease
• Where they need to go and the location of a POD or a gather area
• Where are parking areas?
• What should they bring?
• How long they should expect to be at the POD
• Who will be giving the treatment
• Availability of food or beverages. For example, if people arrive over their lunch breaks from work
The competent setup and operation of PODs could be vital to the safety of a community. Pandemics will likely become a new fixture of disease spread, but the same concepts outlined in this series can be used in the mass treatment during a bioterrorism event. It is important to develop plans and for logistical groups to be able to rapidly put together a POD and to communicate vital information to the public. This series is only a brief overview of what should be considered and only through planning and thoughtful discussion can a community fully prepare itself to meet the challenges of setting up a POD.