pod commander · web viewexamples of influenza viruses with pandemic potential include avian...

{Agency Name}

PrivatePoint of Dispensing (POD)

Plan

{date}

For Official Use Only

SIGNATURE PAGE

The {agency name} is in concurrence with the responsibilities outlined in the following plan:

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{Agency name} Private POD Plan - {date} Page 1

TABLE OF CONTENTS

Introduction …………………………………………………………………………………….3Administration and Logistics …………………………………………………………….4POD Operations and Assignments ……………………………………………………….5Demobilization …………………………………………………………………………….7Training and Exercises …………………………………………………………………….8Plan Development and Maintenance …………………………………………………….9

Appendices …………………………………………………………………………………...10Appendix A: Acronyms …………………………………………………………………...10Appendix B: Definition of Terms …………………………………………………………11Appendix C: Memorandum of Understanding …………………………………………...13Appendix D: POD Registry Form …………………………………………………………...16Appendix E: Dispensing Team …………………………………………………………18Appendix F: Organizational Chart s …………………………………………………...19Appendix G: Dispensing Site Set-Up ...…………………………………………………20 Appendix H: Dispensing Site Needs …………………………………………………...21Appendix I: Communications Plan …………………………………………………...22Appendix J: Security Plan …………………………………………………………………...23Appendix K: Job Action Sheets …………………………………………………………...25Appendix L: Forms …………………………………………………………………………...48Appendix M: Category A Agent and Pandemic Flu Fact Sheets …………………...56Appendix N: Medication Information Sheets …………………………………...71


INTRODUCTION

Purpose: This document outlines the plan to establish emergency Private POD sites at {Agency name} facilities in the event of a public health emergency where controlled medications must be dispensed to all or a portion of the population of Washoe County. {Agency name} will provide medication or vaccine to employees and employee family members as directed by the Washoe County Health District (Health District).

Scope: Applies to the distribution of medications, including antibiotic, antiviral, or vaccines as appropriate for the type, locality, and severity of the event.

Need for Mass Dispensing in a Public Health Emergency: Public health emergencies such as pandemic influenza or bioterrorism attacks can strike at any time. The Washoe County population may be at risk for such emergencies which would require that prophylactic medications be provided to the general public in order to prevent illness and death, in some cases within 48 hours of exposure to a biological threat.

{Agency name} has committed to being an active partner with the Health District. This includes hosting Private POD sites as a means to provide protection to {Agency name} employees and employee family members by means of dispensing medications/administering vaccine as outlined by the Health District.

Concept of Operations and Washoe County Health District Role: The Health District will notify the Nevada Division of Public and Behavioral Health (NDPBH) of the need for establishing Private POD sites based on the threat and the population affected. If Private POD sites are necessary, the Health District will notify each organization to be activated with the appropriate information regarding the incident and each organization will initiate their POD Plan. The Health District, in collaboration with NDPBH, provides all medications, supplies, and information regarding the medication and the threat. The Health District provides training and exercises to employees who will operate the POD.

Liability: Private PODs are covered under the Public Readiness and Emergency Preparedness Act (PREP Act). The PREP Act alleviates concerns about liability related to the manufacture, testing, development, distribution, administration and use of countermeasures against chemical, biological, radiological and nuclear agents of terrorism, epidemics, and pandemics. The PREP Act authorizes the Department of Health and Human Services (HHS) to declare a “PREP Act Declaration” providing immunity from tort liability. NRS Title 4, Chapter 414 and Title 3, Chapter 41 also provides protection of liability for the POD. Both NRS Title 4 Chapter 414 as well as Title 3 Chapter 41 provides civil liability protection for any worker providing services in relation to necessary emergency procedures or other precautionary measures enacted by any political subdivision of the state as long as their actions do not constitute gross negligence or willful misconduct.

Assumptions: • The Regional Emergency Operations Center (REOC) will be operational. County and City

resources will be mobilized to support the emergency.• The incident will be declared an emergency and the Strategic National Stockpile (SNS) will be

requested.• Medical materiel and necessary documentation needed for the incident will be provided as

described in the Health District’s Medical Countermeasures Distribution and Dispensing Plan upon receipt of federal assets.

• The Health District may provide support during training of personnel and may serve an advisory role to Private POD operations.


ADMINISTRATION AND LOGISTICS

The {Agency name} Private POD Plan will be activated during a public health emergency only when requested by the Health District.

Agreements: The {Agency name} has signed and will maintain an MOU with the Health District that outlines each agency’s responsibilities in participating in the Private POD program. A copy of this MOU can be found in Appendix C of this Plan.

Notification: In the event of a public health emergency where Private POD sites need to be utilized, a Health District Representative will notify the {Agency name} POD Commander, to request POD Dispensing site activation. Contact information for primary, secondary and tertiary POD Commanders is located on the Point of Dispensing Registry Form which is included as Appendix D of this Plan. The POD Commander will inform the Health District Representative if and when the POD site(s) is available to initiate dispensing operations.

Delivery and Receipt of Federal Assets and Supplies: The {Agency name} will receive the Federal assets from the SNS at the locations provided within the POD Registry Form included as Appendix D. The {Agency name} POD Commander will then take custody of the assets by signing a custody transfer form provided by the NDPBH. Upon receipt, the assets will be maintained in a secure, climate controlled area by the {Agency name}. The Health District Representative will provide an estimated time for delivery of the SNS assets.

Information and Communication: The {Agency name} will inform their employees of the activation of the Private Partner POD Sites as defined in the Communications Plan included as Appendix I.

Security: Controlling the movement of individuals into, throughout, and out of the Private POD site(s) during an emergency is essential to the safety of staff and staff family members as well as to the security of critical supplies, equipment, and utilities. Under certain circumstances, the Reno Police Department or other community and/or state agencies will be called in to assist the {Agency name} in the security of the facility. The Security Plan is included as Appendix J.

Inventory Control: The {Agency name} has identified the Medical Supply Unit Leader to maintain control of the SNS inventory. If more medication or other supplies are needed to complete dispensing operations, the Medical Supply Unit Leader will notify the POD Commander who will request the items from the Health District Representative. The Health District Representative will provide an estimated time of arrival for the requested items. Inventory control forms are located in Appendix L.


POD OPERATIONS AND ASSIGNMENTS

Organization: ICS is the model tool for command, control, and coordination of a response to an emergency. ICS is built around five major components: Command, Operations, Planning, Logistics, and Finance. Each of these components can expand or contract based on the needs of the incident. Therefore, the {Agency name} may choose to scale up or down or change dispensing operations to meet the needs of our business.

The {Agency name} Dispensing Site is listed in the POD Registry Form included as Appendix D, and is noted below:

{Name andAddress of Dispensing SiteCity, NV 89xxx }

Additional sites may open depending on the level of response needed.

Refer to Appendix G for a map of {Dispensing Site name above}.

Assignment of Responsibilities: The {Agency name} shall identify personnel to manage their dispensing site and coordinate with the Health District. The Health District will provide training to all identified personnel on dispensing medication/administering vaccine and running a POD site. While it is understood that additional {Agency name} staff will manage the event, the roles below are critical to on-site operations:

POD Commander• Coordinates the dispensing operation at the dispensing site.• Primary point of contact between the organization and the Health District in the development and

implementation of this plan. This is the person the Health District will contact to request activation of the Health Care Partner Dispensing Site.

• Maintains communication with the Health District’s Department Operations Center (DOC) during the emergency.

Medical Supply Unit Leader• Maintains control and security of SNS materiel.• Tracks SNS inventory throughout operations.• Requests re-supply of SNS materiel if necessary.

Greeters • Greet, direct and triage participants. • Provide information related to public health emergency. • Answer participant questions within scope of training and qualifications.

Educators • Provide Medical Screening Form or Vaccine Consent Form to those who do not bring a form with

them (forms will be available for download via the Health District website). Sample forms are included in Appendix L.

• Assist staff, staff family and others at Private POD site in completion of their Medical Screening Form or Vaccine Consent Form.


Screeners• Review client Medical Screening Form or Vaccine Consent Form for completeness and

contraindications. • Determine appropriate medication/vaccine to be dispensed/administered.

Dispensers/Vaccinators • Provide a second review of the client Medical Screening Form or Vaccine Consent Form and

contraindications.• Dispense/administer appropriate medication/vaccine.• Provide each individual with patient instructions. • THE INDIVIDUAL WILL LEAVE THE MEDICAL SCREENING FORM OR VACCINE CONSENT

FORM WITH POD STAFF, to be returned to the Health District in order for all patient data to be tracked and entered into WebIZ’s Countermeasure Response Administration (CRA).

First Aid Unit Coordinates the medical response for emergencies affecting either the public or POD staff onsite. Coordinates with local hospitals/clinics if needed.

*In some circumstances employees can obtain medication for their household rather than have everyone come to the dispensing site(s).

Job Actions Sheets for positions noted above are included in Appendix K.

Note: Depending on the size of POD operations, some the above positions may be combined, eliminated, or additional positions may be added. Furthermore, {Agency name} may request Medical Reserve Corps (MRC) or Community Emergency Response Team (CERT) volunteers through the Regional Emergency Operations Center to assist with POD operations.


DEMOBILIZATION

When POD operations are complete, the POD Commander will contact the Health District Representative to inform them that the dispensing site is closing and to schedule pick up of the remaining SNS assets. All Medical Screening Forms/Vaccine Consent Forms and all other documentation shall be submitted to the Health District.


TRAINING AND EXERCISES

Training: The Health District will provide training, as needed, to the {Agency name} POD Site Team on managing and operating the POD site. The Health District will provide the POD Site Team with just-in-time training materials.

Exercises: The {Agency name} shall participate in at least one tabletop, functional or full scale exercise in coordination with the Health District to test this plan. The Health District will provide assistance in developing this exercise and any other exercises the {Agency name} wishes to conduct regarding Private POD Sites.


PLAN DEVELOPMENT AND MAINTENANCE

This Private POD Plan will be developed, and maintained as appropriate by the {Agency name} POD Commander with assistance from a Health District Representative. Due to the constantly changing nature of CDC and Health District guidance, this plan will be updated as the biological/viral threats evolve and treatment plans evolve. The {Agency name} will provide the Health District Representative with a copy of the completed plan and any updates as they are made.


APPENDIX A: ACRONYMS

CDC Centers for Disease Control and Prevention

DOC Department Operations Center

ICS Incident Command System

MOU Memorandum of Understanding

NDPBH Nevada Division of Public and Behavioral Health

NIMS National Incident Management System

POD Point of Dispensing

PREP Act Public Readiness and Emergency Preparedness Act

REOC Regional Emergency Operations Center

RSS Receipt, Staging and Storage

SNS Strategic National Stockpile

WCHD Washoe County Health District


APPENDIX B: DEFINITION OF TERMS

Centers for Disease Control and Prevention – A federal agency under the Department of Health and Human Services. Its main goal is to protect public health and safety through the control and prevention of disease, injury and disability. CDC’s Office of Public Health Preparedness and Response leads the agency’s preparedness and response activities by providing strategic direction, support and coordination to build and strengthen a state’s capacity to adequately respond to threats.

Department Operations Center – The protected site from which Washoe County Health District officials coordinate, monitor, and direct emergency response activities in a public health emergency.

Incident Command System – A nationally used, standardized on-scene emergency management concept specifically designed to allow its user(s) to adopt an integrated organizational structure equal to the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the field-level component of NIMS. It is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, with responsibility for the management of resources to effectively accomplish stated objectives pertinent to an incident.

Nevada Division of Public and Behavioral Health – The mission of the Nevada DPBH is to protect, promote and improve the physical and behavioral health of the people in Nevada. The NDPBH Public Health Preparedness program assists Nevadans in preparation for a public health emergency, and is responsible for the dissemination of Strategic National Stockpile supplies to Private POD sites.

Emergency – A condition of disaster or of extreme peril to the safety of persons and property within the County, caused by such conditions as air pollution, fire, flood, hazardous material incident, storm, epidemic, riot, drought, sudden and severe energy shortage, plant or animal infestations or disease, an earthquake or other conditions.

Memorandum of Understanding – A document that expresses mutual accord on an issue between one or more parties.

National Incident Management System – NIMS identifies concepts and principles that answer how to manage emergencies form preparedness to recovery regardless of their cause, size, location or complexity. NIMS provides a consistent nationwide approach and vocabulary for multiple agencies or jurisdictions to work together to build, sustain and deliver the core capabilities needed to achieve a secure and resilient nation.

Point of Dispensing – A location where medications/vaccine from the Strategic National Stockpile can be provided to people in response to a public health emergency.

Public Readiness and Emergency Preparedness Act – The PREP Act authorizes the Secretary of the Department of Health and Human Services (Secretary) to issue a declaration (PREP Act declaration) that provides immunity from liability (except for willful misconduct) for claims of loss caused, arising out of, relating to, or resulting from administration or use of countermeasures to diseases, threats and conditions determined by the Secretary to constitute a present, or credible risk of a future public health emergency to entities and individuals involved in the development, manufacture, testing, distribution, administration, and use of such countermeasures.

Regional Emergency Operations Center – A single, permanently established, ready to operate Regional EOC in Washoe County to perform individual and/or integrated EOC response services in support of jurisdictional emergencies or larger regional emergencies and disasters involving two or more jurisdictions.


Receipt, Staging and Storage Site – The site where Strategic National Stockpile assets are delivered from the CDC to the State of Nevada. Strategic National Stockpile medications and supplies are stored and managed within this site prior to being delivered to public and private PODs.

Strategic National Stockpile – The Nation’s most important resource for provisioning critical medical materiel to protect the American public if there is a public health emergency (terrorist attack, pandemic) severe enough to cause local supplies to run out.

Washoe County Health District – Pursuant to NRS 439.410, the Health District is a public agency with jurisdiction over all public health matters within Washoe County, Nevada. The WCHD Public Health Preparedness program is responsible for coordinating activities relating to public health emergency preparedness and response.


APPENDIX C: MEMORANDUM OF UNDERSTANDING

Memorandum of UnderstandingBetween

Washoe County Health District And

{Agency name}

INSERT MOU HERE


APPENDIX D: POD REGISTRY FORM

Point of Dispensing (POD) Registry Form - INSERT HERE


APPENDIX E: DISPENSING TEAMS

The {Agency name} is anticipated to operate in two 12-hour shifts per 24-hour period until all employees and employee family members are medicated or vaccinated.

{POD site location} will be staffed according to the severity of the event, availability of medication/vaccine and the ability to maintain normal business operations. While the exact number of POD Site staff will be determined at the time of a public health emergency, the {Agency name} is committing to minimum staffing as described in the table below.

POD Site Position # Staff Required per Shift

POD Commander Complete numbers here

Medical Supply Unit Leader

Greeters

Educators

Screeners

Dispensers/Vaccinators

First Aid Unit

TOTAL STAFF REQUIRED (per shift)

APPENDIX F: PRIVATE POD ORGANIZATION CHART


APPENDIX G: POSSIBLE POD SITE SET-UP

Drive-Through Example: {POD location here}


INSERT MAP HERE

APPENDIX H: POD SITE NEEDS

The following items are examples of items needed at each dispensing site:

___ Adequate Parking___ ADA Accessible Restrooms___ Break Rooms for Staff___ Secure Medication Storage___ Notepads___ Photocopier/Paper___ Telephone Availability___ Computer and Printer___ Fax Machine___ File Folders and File Boxes___ Tables and Chairs___ First Aid___ Wastebaskets/Linings___ Office Supplies (pens, staplers, clipboards, etc.)___ List of Emergency Numbers (Health District, Law Enforcement, Emergency Medical Services)___ Signs to Identify Each Station___ Food and Water___ Vests (bright vest colors for those assisting with traffic flow during drive-through operations)___ Sunscreen, pop-up tents and/or umbrellas___ Cones and barricades for drive-through operations___ Stanchions for walk-through operations___ FAS and/or 800 MHz radios___ Extra ice chests for vaccine storage

*Medical supplies and medication/vaccine will be provided by the Center for Disease Control and Prevention via the Strategic National Stockpile. Medical Screening Forms and Vaccine Consent Forms will be provided by the Washoe County Health District.


APPENDIX I: COMMUNICATIONS PLAN FOR POD OPS

{Agency name} will utilize their current Communications Plan for calling staff in the event of an emergency.

OR INSERT PLAN HERE


APPENDIX J: SECURITY RECOMMENDATIONS

Overview: Security of a POD location is of critical importance during an event that requires its activation. When activating a Private POD, the {Agency name} will work through the Regional Emergency Operations Center (REOC) to augment security in an effort to safeguard the POD site(s), medication/vaccine, and personnel associated with the POD.

Vulnerability Assessments: A vulnerability assessment of Dispensing Site(s) should be conducted by the {Agency name} and appropriate action should be taken to address vulnerabilities. The {Agency name} may enlist the support of the Northern Nevada Regional Intelligence Center to conduct vulnerability assessments for each site.

Interior Physical Security: Upon activation of the POD site it is recommended to conduct a security sweep of the POD facility. Security should be maintained from that point forward until the POD site is closed. Additional security sweeps of the facility should be done upon discovery of any suspicious items or persons. Random security patrols of the site will provide visible security presence, as well as monitoring of the site security.

Security of the Strategic National Stockpile (SNS): Transport and security of the SNS materiel from a Nevada SNS Receipt, Staging, Storage site will be handled by the Nevada Highway Patrol, National Guard, or other authority delegated by the Nevada Division of Public and Behavioral Health.

The security of the SNS materiel at the POD site will be provided by locking the materiel in a secured room. Security will be posted at this room as necessary.

Crowd Management within the POD: All identified POD locations should have exterior lighting. If available exterior lighting is inadequate or if there is a power failure, additional lighting and generators may be provided by the {Agency name}, or by requests via the REOC.

Crowd management and movement within the POD site is designed to provide the most direct and safe movement of people within the facility. Safety and security of POD staff and {Agency name} employees is of paramount importance. The {Agency name} employees will require a combination of signage, verbal direction from POD staff, and other forms of information and communication regarding POD procedures.

Access into the POD site and dispensing area should be limited to one entrance and one exit. All other access points should be blocked.

Signage: POD signage should be used throughout the entire process to assist in crowd control. There are signs for use indoors and outdoors and these will help guide employees through the POD site.

Specialized Unit Needs: If it becomes necessary to utilize a traffic control unit at the {Agency name}’s private POD site(s), it will be handled by Security. Any other special unit needs are determined either through the original site vulnerability assessment or by Security on site at the time of the event.

Crowd Control Outside the Facility: Greeters and signs are recommended to be outside the facility to direct individuals to the POD entrance. Greeters will also be inside the POD distributing informational material and will be available to answer questions and direct individuals to the screening and dispensing areas.

Access Control to Facility: Access to the facility should be limited to one entrance and one exit. All other access points should be blocked off. Any {Agency name} employee may enter the POD site during


operational hours. It is recommended that only POD staff members, who are identified by {Agency name} identification are allowed to be in the facility when the POD is not operational.

Radios: If available, radios for communication with Security personnel with are utilized. The primary Talk Group channel is ??? and their secondary channel is ???.

Evacuation Plan: Egress out of the POD site when there is a security threat will be through any of the available doors leading to the facility’s exterior. Should fire alarms sound then all occupants will be directed to the nearest exits.

Irate Persons: Should employees or the public become irate while waiting in line and disrupt POD flow, the recommended policy is to:

1. Notify the highest in command in Security2. Use best judgment to determine if the person should be removed from the line3. Escort that person to a pre-designated area4. Remove them from the POD site


APPENDIX K: JOB ACTION SHEETS

The following Job Action Sheets are included in Appendix K:

• POD Commander• Medical Supply Unit Leader• Greeter• Educator• Screener• Dispenser/Vaccinator• First Aid Unit


POD COMMANDER

This job action sheet helps to explain some of the details surrounding what is expected of you in the position you have been assigned. Although this form describes many of the specifics surrounding your position, be prepared to have duties added or deleted during the duration of your assignment.

Name:

Functional Area you are assigned to in the POD: Incident Command

Position you are assigned to: POD Commander

Person you report to:

Person(s) who report(s) to you:

MISSIONThe mission of your POD site is to dispense as many pills or administer as many vaccines to the greatest number of people as safely and efficiently as possible. As the POD Commander, you serve as the lead person for the POD site with the ultimate responsibility for POD operations. You must help to ensure the POD carries out this mission by:

Ensuring appropriate communication and coordination with the Washoe County Health District (WCHD) Department Operations Center (DOC).

Managing and directing POD set-up, operations (staffing, throughput, logistics, communications, etc.), and demobilization.

UNIFORMDress appropriately for the job you are assigned to do and comfortably for the season. A color-coded vest will be issued to you.

IMMEDIATE ACTIONSPlease √ task when

completed

1. Sign in.2. Receive and put on POD Staff ID badge and vest that identifies you


as the POD Commander.3. Receive your staff packet, clipboard, and radio.

4. READ YOUR ENTIRE JOB ACTION SHEET.5. Upon determination of need, notify POD staff to report to the POD

site to assist with set-up and activation.6. Serve as the lead for initial check-in of POD staff. Ensure that all

POD staff have the appropriate staff packet that may include: Job Action Sheet POD Staff Assignment Map Organizational Chart

7. Confirm that all staff for your POD site are present.

8. Oversee initial set-up of all POD stations: Ensure adequate staffing Ensure appropriate signage Ensure adequate equipment and materials; station leads

should inventory their respective stations and report any resource or material needs to you or the assigned Logistics Section Chief

Review Security Plan with Security and Greeter staff Access the Communications Plan; if one does not exist,

create or delegate the development of a Communications Plan prior to POD opening

9. Lead a walk through/orientation of the POD site for all POD staff, review staffing and assignments at all stations, and provide just-in-time training where necessary.

10. Establish an ICS-based command structure at your POD site.

11. Synchronize your watch with POD staff.12. Perform a communications check with the WCHD DOC. Ensure

there is redundant means of communication.13. Direct POD staff to assemble at their stations, inventory their

stations, and conduct any necessary just-in-time training.14. Conduct an initial rehearsal of operations. Stations should rehearse

in conjunction with all the other POD sections/teams in chronological order of the POD. You, the POD Commander, can serve as ‘the client’ and walk through the entire flow of your POD site.

15. Make the determination that the POD site is ready to serve clients and notify the WCHD DOC to receive approval.

16. Open your site to clients. Record this time (you may choose to use the ICS 214 form)


INTERMEDIATE ACTIONSPlease √ task when

completed

1. Monitor POD flow and identify/eliminate problem areas. You have the authority to make decisions at any time to alter POD flow by making adjustments in the POD setup and/or layout to reduce bottlenecks.

2. Ensure adequate staffing and make appropriate adjustments. You have the authority to add, delete, or make any necessary adjustments in POD staffing. This includes reassigning POD staff, increasing or decreasing the numbers of positions filled, etc.

3. Respond to security concerns as needed and coordinate with Security as appropriate (ensure coordination with external security/law enforcement partners when necessary).

4. When possible, circulate throughout the entire POD site and check on each station and its assigned staff.

5. Coordinate breaks and mealtimes with POD staff; identify a backup when you need to take a break.

6. Coordinate and facilitate POD staff briefings as needed.

7. Monitor POD staff and clients for signs of fatigue and stress.

DEMOBILIZATIONPlease √ task when

completed

1. At the conclusion of your shift, brief your replacement on any issues that occurred during your shift if POD operations are ongoing. Ensure an activity log is submitted to the incoming POD Commander (you may choose to use the ICS 214 form). Leave forwarding phone number.

2. Coordinate with the WCHD DOC to determine appropriate time for POD closure.

3. Notify the WCHD DOC once the POD site is closed.

4. Oversee the demobilization of the entire POD site.

5. Ensure that the supplies and materials for the entire POD site are inventoried, organized, repacked, consolidated, and returned to WCHD.

6. If applicable, prepare an ICS Form 201 (Incident Briefing) for shift changeover.

7. Conduct a ‘Hotwash’ with all POD staff.


ADDITIONAL DUTIES


MEDICAL SUPPLY UNIT LEADER


Name:

Functional Area you are assigned to: Logistics Section

Position you are assigned to: Medical Supply Unit Leader



MISSIONThe mission of your POD site is to dispense as many pills or administer as many vaccines to the greatest number of people as safely and efficiently as possible. As the Medical Supplies Unit Leader you must ensure the POD has the medical supplies and materials it needs to carry out this mission by:

Managing all logistical aspects concerning medical supplies and materials for your POD site.

Assisting with requests for additional medical supplies as needed from the Logistics Section at the Health District’s Department Operations Center (DOC).

UNIFORMDress appropriately for the job you are assigned to do and comfortably for the season. A vest will be issued to you.


completed

1. Sign in.

2. Receive and put on POD Staff ID badge and vest that identifies you as the Medical Supply Unit Leader.

3. Receive your staff packet, which may include:


Organizational Chart Job Action Sheet POD Staff Assignment Map4. Refer to the “POD Staff Assignment Map” in your packet to show

the area of the POD where you will be working. Follow the POD signage to your assigned location.

5. READ YOUR ENTIRE JOB ACTION SHEET.

6. Check in with your assigned ICS Supervisor (most likely POD Commander or Logistics Section Chief). Obtain briefing and clarify authority regarding position assignment.

7. Participate in walk through/orientation of the POD site with all POD staff.

8. Synchronize your watch with POD staff.

9. Receive medication, vaccine and/or medical supplies from the Washoe County Health District or Nevada Division of Public and Behavioral Health, and sign for medication, vaccine and/or supplies.

10. Notify your assigned supervisor that medication, vaccine and/or medical supplies have arrived and been signed for.

11. Rehearse at your station: Practice method for tracking medication, vaccine and/or

medical supplies. Practice method for requesting additional medication, vaccine

and/or medical supplies.12. Participate in an initial rehearsal of POD operations with all POD

staff.

INTERMEDIATE ACTIONS Please √ task when completed

1. Supervise requests for additional medical supplies/resources.

2. Consolidate requests for additional medical supplies/resources as needed and provide these to the POD Commander.

3. The POD Commander may delegate tracking of medical supply requests for the DOC to you; stay on top of the DOC once you send requests for additional resources (make sure you have a Date/Time/Item # assigned to each request).

4. When vaccine or medication re-supply arrives at the POD, make sure you let the POD Commander know how much has arrived. This allows him/her to keep their status reports accurate and updated.


5. Maintain a unit log for your station (ICS Form 214) if advised by your assigned supervisor.

DEMOBILIZATION(Please √ task when completed)

1. If POD operations are ongoing at the conclusion of your shift, brief your replacement on any issues that occurred during your shift. Ensure that your activity log is submitted to your assigned supervisor.

2. Assist in the demobilization of your station.

3. Ensure that any supplies or materials are repacked and consolidated in a central location where they can be picked up.

4. Attend the POD ‘Hotwash’ as directed.

ADDITIONAL DUTIES AS ASSIGNED


GREETER


Name:

Functional Area you are assigned to in the POD: Operations

Position you are assigned to: Greeter



MISSIONThe mission of your POD site is to dispense as many pills or administer as many vaccines to the greatest number of people as safely and efficiently as possible. As a greeter you must ensure that the POD can carry out this mission by:

Making sure that clients who show signs or symptoms outlined in your case profile (provided by the DOC) do not enter the POD, and directing them instead to the nearest clinic/urgent care/hospital/emergency room.

Directing clients who do NOT show signs or symptoms outlined in the case profile to the Educator station.

Providing informational sheets to clients.



completed


as a Greeter.3. Receive your staff packet, which may include:


Job Action Sheet POD Staff Assignment Map Organizational Chart

4. Refer to the “POD Staff Assignment Map” in your packet to show the area at the POD where you will be working. Follow the POD signage to your assigned location.


6. Check in with your assigned ICS Supervisor (most likely POD Commander or Ops Section Chief). Obtain briefing and clarify authority regarding position assignment.

7. Participate in a walk through/orientation of the POD site with all POD staff.

8. Synchronize your watch with POD staff.9. Inventory your station(s). Based on this inventory, if any

equipment or materials are missing, write these on a list and submit this to your assigned supervisor.

10. Rehearse at your station: Review signs and symptoms outlined in the case profile.

11. Participate in an initial rehearsal of POD operations with all POD staff.

12. Notify the assigned supervisor when your station is ready to receive clients.


completed

1. Ensure that clients who present with symptoms outlined in the fact sheets provided by the Washoe County Health District do not enter the POD and are directed to the nearest clinic/hospital/ER.

2. Ensure clients who are NOT ill are directed to the Educator station.

3. Welcome clients to the POD and provide them with prepared informational sheets.

4. Advise your assigned supervisor on any greeting-related issues as they arise.

5. Participate in POD staff briefings as needed.

6. Coordinate breaks and mealtimes with security and other POD staff as appropriate.



completed



EDUCATOR


Name:


Position you are assigned to: Educator



MISSIONThe mission of your POD site is to dispense as many pills or administer as many vaccines to the greatest number of people as safely and efficiently as possible. As an Educator you must ensure that the POD can carry out this mission by:

Providing POD clients with the appropriate information and fact sheets on the POD process, the biological agent or pandemic of concern, and the medications or vaccinations provided at the POD.

Providing clients with the Screening Form, other necessary paperwork and instructions, and assisting clients in completing the paperwork.



completed


as an Educator.3. Receive your staff packet, which may include:

Job Action Sheet


POD Staff Assignment Map Organizational Chart


5. Receive a clipboard and pen.

6. READ YOUR ENTIRE ACTION SHEET.



9. Synchronize your watch with POD staff.10. Inventory your station(s). Based on this inventory, if any equipment

or materials are missing, write these on a list and submit this to your assigned supervisor.

11. Rehearse at your station:

Review the Medical Screening Form or Vaccine Consent Form

Study fact sheets for agent or pandemic of concern Study the DOC-approved protocol for the vaccine/drug

being dispensed12. Participate in an initial rehearsal of POD operations with all POD

staff.13. Notify the assigned supervisor when your station is ready to receive

clients.


completed

8. Provide POD clients with the Medication Screening Form or Vaccine Consent Form, provide instructions, and assist clients with its completion.

9. Advise your assigned supervisor on any education-related issues as they arise.


11. Coordinate breaks and mealtimes with POD staff as appropriate.



completed






ADDITIONAL DUITES AS ASSIGNED


SCREENER


Name:


Position you are assigned to: Screener



MISSIONThe mission of your POD site is to dispense as many pills or administer as many vaccines to the greatest number of people as safely and efficiently as possible. As a Screener, you must help to ensure that the POD carries out this mission by:

Reviewing contraindications/precautions detailed for the vaccine/medication being administered/dispensed to clients.

Selecting the appropriate prophylaxis for each client based on client contraindications/precautions.

Directing clients to Dispenser/Vaccinator or Medical Evaluator as appropriate.



completed


as a Screener.3. Receive your staff packet, which may include:

Job Action Sheet


POD Staff Assignment Map Organizational Chart


5. Receive a clipboard and pen.





or materials are missing, write these on a list and submit this to your assigned supervisor.



Study fact sheet for agent or pandemic of concern Study the DOC-approved protocol for the vaccine/drug

being administered/dispensed Review contraindications/precautions detailed for the

vaccine/medication being administered/dispensed12. Participate in an initial rehearsal of POD operations with all POD


clients.


completed

1. Ensure clients have accurately and completely filled out the Vaccine Consent Form or Medical Screening Form for themselves and any family members.

2. Review with clients any contraindications/precautions detailed for the vaccine/medication being administered/dispensed.

3. Select and document on the Medical Screening Form or Vaccine Consent Form the appropriate prophylaxis for each client.

4. Direct clients to the Dispenser/Vaccinator or Medical Evaluator as appropriate for client to receive prophylaxis.

5. Advise your assigned supervisor on any screening-related issues as they arise.






completed







DISPENSER/VACCINATOR


Name:


Position you are assigned to: Dispenser/Vaccinator



MISSIONThe mission of your POD site is to dispense as many pills or administer as many vaccines to the greatest number of people as safely and efficiently as possible. As a Dispenser/Vaccinator you must ensure the POD can carry out this mission by:

Reviewing screening forms to determine appropriate medications to be dispensed or vaccine to be administered.

Making corrections (if necessary) to Medical Screening Forms or Vaccine Consent Forms to ensure safety of clients that have been screened.

Properly dispensing medications or administering vaccines by following Universal Precautions.

Keeping the Medical Screening Forms or Vaccine Consent Forms for all clients.



completed


as a Dispenser or Vaccinator.


3. Receive your staff packet, which may include: Job Action Sheet POD Staff Assignment Map Organizational Chart






or materials are missing write these on a list and submit this to your assigned supervisor.



Study Fact Sheet for agent or pandemic of concern Study the DOC-approved protocol for the

medication/vaccine being dispensed/administered Review contraindications/precautions detailed for the

medication/vaccine being dispensed/administered Prepare your medications/vaccines and medical supplies as

needed11. Participate in an initial rehearsal of POD operations with all POD


clients.


completed

1. Review Medical Screening Form or Vaccine Consent Form of client to determine appropriate medications to be dispensed or vaccines to be administered.

2. Collect Medical Screening Forms or Vaccine Consent Forms from clients.

3. Properly dispense medication or administer vaccine following Universal Precautions.

4. Take the lot number sticker from the medication/vaccine container and affix to the Patient’s Medical Screening Form or Vaccine Consent Form.

5. Provide clients with Medication Fact Sheet or Vaccine Information Statement and HIPPA forms. Direct clients to the exit of the POD.


6. Advise your assigned supervisor on any dispensing-related issues as they arise.





completed







FIRST AID UNIT


Name:


Position you are assigned to: First Aid Unit



MISSIONThe mission of your POD site is to dispense as many pills or administer as many vaccines to the greatest number of people as safely and efficiently as possible. As the First Aid Unit you must ensure that the POD can carry out this mission by:

Coordinating the medical response for emergencies affecting either the public or the POD staff at your site.

Coordinating the medical evacuation of any members of the public or POD staff who may require medical attention off-site.

Coordinating with local hospitals/clinics if needed.



completed

1. Sign in.

2. Receive and put on POD Staff ID badge and vest that identifies you as the First Aid Unit.


3. Receive your staff packet, which may include: Organizational Chart Job Action Sheet POD Staff Assignment Map Medication Fact Sheets or Vaccine information related to

contraindications/precautions (from the DOC)4. Refer to the “POD Staff Assignment Map” in your packet to show

the area at the POD where you will be working. Follow the POD signage to your assigned location.


6. Check in with your assigned ICS supervisor (most likely POD Commander or Ops Section Chief). Obtain briefing and clarify authority regarding positions assignment.


8. Synchronize your watch with all POD staff.

9. Inventory your station. Based on this inventory, if any equipment or materials are missing write these on a list and submit this to your assigned supervisor.

10. Rehearse at your station: Study Fact Sheet for agent or pandemic of concern Study the DOC protocol for the medication/vaccine beings

dispensed/administered Review contraindications/precautions detailed for the

medication/vaccine being dispensed/administered11. Participate in an initial rehearsal of POD operations with all POD

staff.

12. Notify the assigned supervisor when your station is ready to receive clients.


completed

1. Respond when needed to medical emergencies on site.

2. Advise your assigned supervisor on any medical emergencies.






completed

5. If POD operations are ongoing at the conclusion of your shift, brief your replacement on any issues that occurred during tour shift. Ensure that your activity log is submitted to your assigned supervisor.






APPENDIX L: FORMS

The following Forms are included in Appendix K:• Sample Medical Screening Form• Sample Algorithm for Medical Screening Form• Sample Vaccine Consent Form• Sample Guidelines for Vaccine Contraindications• Inventory Control Form


Sample Medical Screening Form:


SAMPLE


7. MEDICAL CONSULT USE ONLYMedical Consultant: Please use the space below to document consultation findings.

NOTES:

XSignature of Medical Consultant Date

SAMPLE

Sample Algorithm for Medical Screening Form:

Washoe County Health District Point of Dispensing Medical Screening Form Algorithm*approximately 86% of clients will receive Doxy


Sample Vaccine Consent Form:


SAMPLE

Sample Guidelines for Vaccine Contraindications:

PRECAUTIONS AND CONTRAINDICATIONS: NOTES AND INSTRUCTIONS

Precautions for BOTH the Flu Shot (IM) and Nasal Spray: YES1. Is the person to be vaccinated sick today? Persons moderately or severely ill – defer. If they

have a cold or other URI, cannot receive FluMist (nasal spray), must receive flu shot (IM).

Contraindications for BOTH the Flu Shot (IM) and Nasal Spray: YES

2.Does the person to be vaccinated have an allergy to medications, food such as eggs, a vaccine component or latex? Please list allergies:

All flu vaccines contain egg protein except FluBlok. FluBlok is 100% egg free and may be used for persons aged 18-49 years who have no other contraindications. See flu vaccine product insert (PI) for a complete list of vaccine ingredients and latex content.

3. Has the person to be vaccinated ever had a serious reaction to a vaccine in the past?

A previous severe allergic reaction to influenza (flu) vaccine, regardless of the component suspected to be responsible for the reaction is a contraindication to future receipt of any type of flu vaccine. Refer to healthcare provider.

4. Has the person to be vaccinated ever had Guillain-Barré syndrome (GBS)?

History of GBS – all flu vaccines contraindicated. Refer to healthcare provider.

Contraindications for Nasal Spray: YES5. Is the person being vaccinated younger than 2 years of age or older

than 49 years of age?FluMist (nasal spray) only indicated for persons age 2 through 49 years, must receive flu shot (IM) if aged between 6-23 months or 50 years and older.

6. Does the person to be vaccinated have a long-term health problem with heart disease, lung disease, asthma, kidney disease, neurologic or neuromuscular disease, liver disease, metabolic disease (such as diabetes), or anemia or other blood disorders?

Cannot receive FluMist (nasal spray), must receive flu shot (IM).

7. If the person to be vaccinated is a child age 2 through 4 years, in the past 12 months, has a healthcare provider ever told you that he or she had wheezing or asthma?

Wheezing in this age group should be interpreted as asthma – cannot receive FluMist (nasal spray), must receive flu shot (IM).

8. Does the person to be vaccinated have a weakened immune system because of HIV/AIDS or another disease that affects the immune system, long-term treatment with drugs such as high-dose steroids, or cancer treatment with radiation or drugs?


9. Is the child or teen to be vaccinated receiving aspirin therapy or aspirin-containing therapy?


10. Is the person to be vaccinated pregnant or could she become pregnant within the next month?


11. Is the person being vaccinated receiving antiviral medications? Cannot receive FluMist (nasal spray) if receiving antiviral drugs 2 days before vaccination or 14 days after vaccination, must receive flu shot (IM).

12. Has the person to be vaccinated received any other vaccinations in the past 4 weeks?

If MMR, Varicella, or Yellow Fever received in the last 4 weeks, must receive flu shot (IM). There must be at least 4 weeks between the 1st and 2nd dose of flu vaccine for children under 9 years requiring 2 doses.

13. Does the person to be vaccinated live with or expect to have close contact with a person whose immune system is severely compromised and who must be in protective isolation (such as an isolation room of a bone marrow transplant unit)?



SAMPLE

Inventory Control Form:

Date Time # Doxy Dispensed

# Cipro Dispensed

# Amoxi Dispensed

TallyColumn

Initials


Inventory Control Form

Date Time # Doxy Dispensed

# Cipro Dispensed

# Amoxi Dispensed

TallyColumn

Initials

APPENDIX M: CATEGORY A AGENTS AND PAN FLU SHEETS

The following Informational Sheets are included in Appendix L:• Anthrax• Botulism• Plague• Smallpox• Tularemia• Viral Hemorrhagic Fever• Pandemic Influenza


What is Anthrax?

Anthrax is a serious disease that is caused by bacillus anthracis, a bacterium that forms spores that can survive dormant in the environment for long periods of time. Anthrax can be found naturally in soil and commonly affects domestic and wild animals such as cattle, sheep, goats, antelope, and deer. The animals become infected when they breathe in or ingest spores in contaminated soil, plants, or water. This allows the spores to multiply and spread the bacteria, producing toxins in the body which can cause serious illness and death. There are four types of Anthrax, depending on how anthrax enters the body:


ANTHRAX

Public Health Preparedness Program

• Cutaneous anthrax – enters the skin through a cut or scrape.• Inhalation anthrax – enters the lungs from breathing in spores; most deadly form.• Gastrointestinal anthrax – enters digestive system from ingestion of infected meat.• Injection anthrax – enters vein by injection; found in heroin-injecting drug users.

Why are we Concerned About Anthrax as a Bioweapon?

According to the Centers for Disease Control and Prevention, bacillus anthracis is one of the most likely agents to be used in a biological attack, because:

• Anthrax spores are easily found in nature, can be produced in a lab, and can last for a long time in the environment.

• Anthrax makes for a good weapon because it can be released quietly and without anyone knowing. The microscopic spores could be put into powders, sprays, food and water; because they are so small, you may not be able to see, smell, or taste them.

• Anthrax has been used as a weapon before.

An anthrax attack could take many forms. For example, in a powder form it could be placed in letters and mailed, as was done in 2001, it could be put into food or water, or it could be released into the air. If anthrax spores were released into the air, people could breathe them in and get sick with anthrax. It only takes a small amount of anthrax to infect a large number of people. Inhalation anthrax is the most serious form and can kill quickly if not treated immediately.

Transmission: How does Someone Become Infected with Anthrax?

Anthrax is not contagious, meaning it is NOT spread from one person to another person.

Anthrax from animals - Humans can become infected with anthrax through handling infected animals or other materials containing anthrax spores, or by breathing in spores from infected animal products (like wool, for example).Anthrax as a weapon - Anthrax could be put into our food or water supply, or released into the air. In an intentional exposure, such as a bioterrorism event, breathing in spores that have been released into the air is the most likely route of exposure.

What are the Signs and Symptoms of Anthrax?The symptoms of anthrax are different and depend on the type of infection. All types of anthrax have the potential, if untreated, to spread throughout the body and cause severe illness, even death.

Cutaneous Anthrax - Symptoms include a group of small blisters or bumps that may itch, found most often on the face, neck, arms, or hands. The blisters then develop into a painless skin sore with a black area in the center. Swelling can occur around the sore.Gastrointestinal Anthrax - Early symptoms include nausea, vomiting, loss of appetite, and fever, followed by abdominal pain or swelling, vomiting of blood, and severe diarrhea. Symptoms can also include fever and chills, swelling of neck or neck glands, sore throat, painful swallowing, hoarseness, headache, flushing red face and red eyes, and fainting.Inhalation Anthrax - Early symptoms may resemble those of flu or a common cold and include fever and chills/sweats, cough, sore throat, headache, body aches and weakness/tiredness, difficulty breathing and chest discomfort. Other symptoms could include confusion or dizziness, nausea, vomiting, or stomach pains. After several days, the symptoms may progress to severe breathing problems and shock.

How Soon do Infected People get Sick?


Symptoms can take anywhere from one day to more than two months to appear, but typically appear within seven days of coming in contact with the bacterium for all types of anthrax.

How is Anthrax Treated?All types of anthrax infection can be treated with antibiotics, including intravenous antibiotics. Another option that doctors have is antitoxin. Patients with serious cases of anthrax will need to be hospitalized. They may require aggressive treatment, such as continuous fluid drainage and help breathing through mechanical ventilation.

Can a Person Exposed to Anthrax Avoid Becoming Sick?

Yes. Antibiotics can prevent anthrax from developing in people who have been exposed but have not developed symptoms. Ciprofloxacin and doxycycline are two of the antibiotics that could be used to prevent anthrax. Those exposed must take antibiotics for 60 days. While there is a vaccine licensed to prevent anthrax, it is not typically available to the general public. However, if there were ever an anthrax emergency, people who are exposed might be given anthrax vaccine to help prevent disease by a special emergency protocol.

Would Enough Medication be Available in the Event of a Bioterrorism Attack?

Yes. National and state public health officials have large supplies of drugs needed in the event of a bioterrorism attack. These supplies can be sent anywhere in the United States within 12 hours.

What is the Washoe County Health District Doing to Prepare for an Anthrax Outbreak?

In the event of a weaponized anthrax attack or outbreak, the Washoe County Health District will announce detailed instructions on how to obtain preventive medication through a point of dispensing (POD) site. This information will be available through the media and the Washoe County Health District website.

What is Botulism?

Botulism is a rare but serious muscle paralyzing disease caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. This type of bacteria is found naturally in the soil. There are three main kinds of botulism:

Foodborne botulism is caused by eating foods that contain the botulinum toxin. Wound botulism is caused when wounds are infected by the toxin produced from

Clostridium botulinum. This can occur when a wound is contaminated during an outdoor injury by contact with contaminated soil. The bacteria can only infect damaged skin.

Infant botulism occurs in a small number of susceptible infants each year who harbor Clostridium botulinum bacteria in their intestinal tract.


Source: www.cdc.gov

BOTULISM


All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism is a public health emergency because the contaminated food source may be unknown and still available, and many additional people can be poisoned by eating the contaminated food.

Why are we Concerned About Botulism as a Bioweapon?

Botulism toxin could be used as a biological weapon because it can be spread through a food source and has the potential to be aerosolized.

Transmission: How does Someone Become Infected with Botulism?

Botulism is not contagious, meaning it is NOT spread from one person to another person.

Foodborne botulism is caused by eating foods that contain the botulinum toxin. You can also get botulism when the bacteria enter your skin through a wound. Most wound botulism cases are associated with black-tar heroin injection, especially in California.

A bioweapon carrying Clostridium botulinum is possible because it is easy to produce, though technical factors make dissemination difficult.

What are the Signs and Symptoms of Botulism?

Symptoms include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness that moves down the body, usually affecting the shoulders first, then the upper arms, lower arms, thighs, calves, etc. Finally, paralysis of breathing muscles can cause a person to stop breathing and die, unless assistance with breathing by mechanical ventilation is provided.

Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone, all symptoms of the muscle paralysis caused by the bacterial toxin. The first symptoms of foodborne botulism may also include nausea and vomiting.


With foodborne botulism, symptoms can begin within 6 hours to 10 days, but most commonly between 12 and 36 hours after eating food that contains the toxin. For wound botulism and infant botulism, it is difficult to estimate the incubation period because exposure times cannot be ascertained. The time of onset for inhalational botulism cannot be stated with certainty because so few cases have been observed.

How is Botulism Treated?

Botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. The antitoxin is most effective in reducing the severity of symptoms if administered early in the course of the disease.

Antitoxin for infants is available from the California Department of Public Health, and antitoxin for older children and adults is available through the Centers for Disease Control and Prevention. The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks or months, plus intensive medical and nursing care. If given before paralysis is complete, antitoxin can prevent worsening and shorten recovery


time. The paralysis slowly improves, and eventual recovery can take many months of supportive care.

Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria followed by administration of appropriate antibiotics. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.

Can a Person Exposed to Botulism Avoid Becoming Sick?

There is no vaccine or medication to prevent botulism. The preventive measures that will be taken in the event of a botulism outbreak will involve determining the source of exposure and isolation from that source.

Would Enough Antitoxin be Available in the Event of a Bioterrorism Attack?

National and state public health officials have large supplies of drugs needed in the event of a bioterrorism attack. These supplies can be sent anywhere in the United States within 12 hours.

What is the Washoe County Health District Doing to Prepare for a Botulism Outbreak?

In the event of a weaponized botulism attack or outbreak, the Washoe County Health District will work closely with the Nevada Division of Public and Behavioral Health and the Centers for Disease Control and Prevention (CDC) to provide community partners and the public with recommendations regarding infection control activities. This information will be available through the media and the Washoe County Health District website.

What is Plague?

Plague is a disease caused by Yersinia pestis (Y. pestis), a bacterium found in rodents and their fleas in many areas around the world, including most of the western United States.

There are three forms of plague: Bubonic – When the Y. pestis bacteria enter the body through the bite of an infected

flea, through a cut or break in the skin, the resulting disease is called bubonic plague. “Buboes” are swollen, painful lymph nodes. Bubonic plague is the most common form of the disease, and if left untreated, may progress to septicemic plague (see below).

Septicemic – When Y. pestis bacteria multiply and accumulate in the bloodstream, septic shock occurs and the resulting disease is called septicemic plague.


Sources: www.cdc.govJAMA, February 28, 2001 – Vol. 285, No. 8

PLAGUE


Pneumonic – When Y. pestis bacteria are inhaled, they lodge in the lungs and the resulting disease is called pneumonic plague.

Why are we Concerned About Plague as a Bioweapon?

Yersinia pestis used in an aerosol attack could cause cases of the pneumonic form of plague. One to six days after becoming infected with the bacteria, people would develop pneumonic plague. Once people have the disease, the bacteria can spread to others who have close contact with them. Because of the delay between exposure to the bacteria and becoming sick, people could travel over a large area before becoming contagious and possibly infecting others. Controlling the disease would then be more difficult.

A bioweapon carrying Y. pestis is possible because the bacterium occurs in nature and could be isolated and grown in quantity in a laboratory. Even so, manufacturing an effective weapon using Y. pestis would require advanced knowledge and technology.

Transmission: How does Someone Become Infected with Pneumonic Plague?

Pneumonic plague occurs when Yersinia pestis infects the lungs. Transmission can take place if someone breathes in Y. pestis particles, which could happen in an aerosol release during a bioterrorism attack. Pneumonic plague is also transmitted by breathing in Y. pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague. Respiratory droplets are spread most readily by coughing or sneezing. Becoming infected in this way usually requires direct and close (within 6 feet) contact with the ill person or animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs.

What are the Signs and Symptoms of Pneumonic Plague?

Patients usually have fever, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. Nausea, vomiting, and abdominal pain may also occur. Without early treatment, pneumonic plague usually leads to respiratory failure, shock, and rapid death.


Someone exposed to Yersinia pestis through the air – either from an intentional aerosol release or from close and direct exposure to someone with plague pneumonia – would show symptoms within 1 to 6 days of exposure.

How is Pneumonic Plague Treated?

Prompt treatment with the correct medications is critical to prevent complications or death. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. You should use antibiotics to prevent or treat plague only under the direction of your health care provider or local health department.

Several types of antibiotics are effective for curing the disease. Drugs of choice are streptomycin or gentamicin antibiotics for injection or intravenous use. Available oral


medications are tetracyclines (such as doxycycline) or fluoroquinolones (such as ciprofloxacin). Early in the response of a bioterrorism attack, these drugs would be tested to determine which is most effective against the particular weapon that was used.

Can a Person Exposed to Pneumonic Plague Avoid Becoming Sick?

Yes. People who have had close contact with an infected person can greatly reduce the chance of becoming sick if they begin treatment within 7 days of their exposure. Treatment consists of taking antibiotics for at least 7 days.



What is the Washoe County Health District Doing to Prepare for a Plague Outbreak?

In the event of a weaponized pneumonic plague attack or outbreak, the Washoe County Health District will announce detailed instructions on how to obtain preventive medication through a point of dispensing (POD) site. This information will be available through the media and the Washoe County Health District website

What is Smallpox?

Smallpox is a serious and sometimes fatal infectious disease caused by the variola virus. The pox part of smallpox is derived from the Latin word for “spotted” and refers to the raised bumps that appear on the face and body of an infected person.

There are two clinical forms of smallpox: Variola major is the severe and most common form of smallpox, with a more

extensive rash and higher fever. There are four types of variola major smallpox: o ordinary (the most frequent type, accounting for 90% or more of cases)o modified (mild and occurring in previously vaccinated persons)o flato and hemorrhagic (both rare and very severe).

Historically, variola major has an overall fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal.


Source: www.cdc.gov

SMALLPOX


Variola minor is a less common presentation of smallpox, and a much less severe disease, with the death rates historically being 1% or less.

Why are we Concerned About Smallpox as a Bioweapon?

Smallpox is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention.

However, in the aftermath of the events of September and October, 2001, there is heightened concern that the variola virus might be used as an agent of bioterrorism. For this reason, the U.S. government is taking precautions for dealing with a smallpox outbreak.

Transmission: How does Someone Become Infected with Smallpox?

Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another, by inhaling droplets released by the cough or sneeze of an infected person. Smallpox can also be spread through direct contact with infected bodily fluids, or with contaminated objects such as bedding or clothing. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Humans are the only natural hosts of variola. Smallpox is not known to be transmitted by insects or animals.

What are the Signs and Symptoms of Smallpox?

7-17 days after exposure, the first symptoms of smallpox appear. These include fever, tiredness, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101 to 104°F. At this time, people are usually too sick to carry on their normal activities. This stage may last for 2 to 4 days. Next, a rash appears, first as small red spots on the tongue and in the mouth. A rash then appears on the skin, starting on the face and spreading to the arms and legs and then to the hands and feet. Usually the rash spreads to all parts of the body within 24 hours. The rash becomes raised bumps and the bumps become “pustules”, which are raised, usually round and firm to the touch as if there’s a small round object under the skin. The pustules begin to form a crust and then scab. By the end of the second week after the rash appears, most of the sores have scabbed over. The scabs begin to fall off, leaving scars. Most scabs will have fallen off three weeks after the rash first appears.


Incubation period after exposure to the virus averages about 12-14 days but can range from 7-17 days. During the incubation period, a person is not contagious and may feel fine.

How is Smallpox Treated?


There is no proven treatment for smallpox. However, providing a patient supportive care can help alleviate some of the symptoms.

Can a Person Exposed to Smallpox Avoid Becoming Sick?

The smallpox vaccine, which was routinely administered to Americans until 1972, is a highly effective protection against the disease when given before exposure to the virus. If the vaccine is given to a person within four days of exposure to smallpox, it may lessen the severity of the disease, or possibly prevent illness.

Would Enough Vaccine be Available in the Event of a Smallpox Outbreak?

Yes. National and state public health officials have large supplies of vaccine needed in the event of a bioterrorism attack involving smallpox.

What is the Washoe County Health District Doing to Prepare for a Smallpox Outbreak?

In the event of a weaponized smallpox outbreak, the Washoe County Health District will announce detailed instructions on how to obtain vaccine through a point of dispensing (POD) site. This information will be available through the media and the Washoe County Health District website.

What is Tuleramia?

Tularemia is a potentially serious illness that occurs naturally in the United States. It is caused by the bacterium Francisella tularensis found in animals (especially rodents, rabbits, and hares) and is highly infectious. In the United States, tularemia is usually caused by being bitten by infected ticks or by handling infected animal tissue from sick or dead animals.

There are five different forms of tularemia: Ulceroglandular - skin ulcer at site of bite Glandular - no ulcer at site of bite Oculoglandular - bacteria enters through eye Oropharyngeal - results from eating or drinking contaminated food or water Pneumonic - breathing dusts or aerosols containing organism

Why are we Concerned About Tuleramia as a Bioweapon?

Francisella tularensis is very infectious. A small number (10-50 or so organisms) can cause disease. Tularemia has long been considered a potential biological weapon because of its extreme infectivity, ease of dissemination, and substantial capacity to cause illness and death. If F. tularensis was used as a weapon, the bacteria would likely be made airborne for exposure by inhalation. People who inhale an infectious aerosol would generally experience severe respiratory illness, including life-threatening pneumonia and systemic infection, if


Source: www.cdc.govTULAREMIA


they are not treated. The bacteria that cause tularemia occur widely in nature and could be isolated and grown in large quantity in a laboratory, although manufacturing an effective aerosol weapon would require considerable sophistication.

Transmission: How does Someone Become Infected with Tularemia?

People can get tularemia many different ways, including being bitten by an infected tick, deerfly or other insect, or by handling infected animal carcasses. The main concern for public health is the transmission of the disease through ingestion of water from a contaminated water supply and/or inhalation of contaminated dusts or aerosol, both of which are conducive to potential bioterrorism attacks.

Tularemia is not contagious, meaning it is NOT spread from one person to another person. People who have tularemia do not need to be isolated. People who have been exposed to the tularemia bacteria should be treated as soon as possible. The disease can be fatal if it is not treated with the right antibiotics.

What are the Signs and Symptoms of Tularemia?

The symptoms of tularemia vary depending on the type of exposure, and illness ranges from mild to life-threatening. If the bacteria that cause tularemia are inhaled in the form of dust or aerosol, it can cause an infection of the lungs (pneumonic). This is the most serious form, and may be used during a bioterrorism attack. Symptoms of tularemia may include sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, and progressive weakness. If pneumonia develops, people can also experience chest pain, bloody sputum, difficulty breathing, and even respiratory failure.

A biological attack may also lend itself to food or water contamination, resulting in the oropharyngeal form. After ingesting contaminated food or water, symptoms of this form of tularemia include sore throat, mouth ulcers, tonsillitis, and swelling of lymph glands in the neck.

F. tularensis can also infect humans through the skin or mucous membranes. When a person contracts the disease through this means, they may have symptoms that include swollen and painful lymph glands, or a skin ulcer.


Symptoms usually appear 3 to 5 days after exposure to the bacteria, but can take as long as 14 days.

How is Tularemia Treated?

Early treatment of tularemia with appropriate antibiotics is essential. Although tularemia can be life-threatening, most infections can be treated successfully with antibiotics. Antibiotics used to treat tularemia include streptomycin, gentamicin, doxycycline, and ciprofloxacin. Treatment usually lasts 10 to 21 days depending on the stage of illness and the medication used. Although symptoms may last for several weeks, most patients completely recover. Antibiotics must be taken only under the direction of your health care provider or local health department.

Can a Person Exposed to Tularemia Avoid Becoming Sick?


Yes. Antibiotics can prevent tularemia from developing in people who have been exposed but have not developed symptoms. A vaccine for tularemia is under review by the Food and Drug Administration, but is not currently available in the United States.



What is the Washoe County Health District Doing to Prepare for a Tularemia Outbreak?

In the event of a weaponized tularemia attack or outbreak, the Washoe County Health District will announce detailed instructions on how to obtain preventive medication through a point of dispensing (POD) site. This information will be available through the media and the Washoe County Health District website.

What is Viral Hemorrhagic Fever?

Viral hemorrhagic fevers (VHFs) refer to a group of illnesses that are caused by several distinct families of viruses. In general, the term "viral hemorrhagic fever" is used to describe a severe multisystem syndrome, as many different organs and systems in the body are affected. Characteristically, the overall vascular system is damaged, and the body's ability to regulate itself is impaired. These symptoms are often accompanied by hemorrhage (severe bleeding), which is why this group of illnesses is called hemorrhagic fevers. However, the bleeding itself is rarely life-threatening. While some types of hemorrhagic fever viruses can cause relatively mild illnesses, many of these viruses, such as Ebola and Marburg, cause severe, life-threatening disease.

Why are we Concerned About Viral Hemorrhagic Fevers as Bioweapons?

The Centers for Disease Control and Prevention identifies hemorrhagic fever viruses as agents that could be used as biological weapons because some are highly infectious, can be easily spread through the air, and have the potential to cause great numbers of illnesses and deaths. They are also known to have been the subject of biological weapons research.

Transmission: How does Someone Become Infected with a Viral Hemorrhagic Fever?


Source: www.cdc.govVIRAL HEMORRHAGIC FEVER


Most viruses causing hemorrhagic fever are zoonotic, which means they are initially transmitted to humans by animal or insect reservoir hosts. The viruses carried in rodent reservoirs are transmitted when humans have contact with urine, fecal matter, saliva, or other body excretions from the infected rodents, or when humans have contact with the bodies of infected animals, either dead or alive. The viruses associated with arthropod vectors are spread most often when the vector mosquito or tick bites a human, or when a human crushes a tick. However, some of these vectors may spread virus to animals, such as livestock. Humans then become infected when they care for or slaughter the animals.

Occasionally, an infected traveler may become infected in an area where the virus occurs naturally, and then travel to another area where the virus is not normally found. If the virus is a type that can be transmitted by person-to-person contact, the traveler can infect other people. Ebola, Marburg, Lassa and Crimean-Congo hemorrhagic fever viruses are examples. This type of secondary transmission of the virus can occur through direct contact with infected people or their body fluids. It can also occur indirectly, through contact with objects contaminated with infected body fluids, such as bedding used by a sick person, or contaminated syringes and needles.

Humans can contract viral hemorrhagic fever during a bioterrorist attack in which a VHF is weaponized.

What are the Signs and Symptoms of Viral Hemorrhagic Fever?

Specific signs and symptoms vary by the type of VHF, but initial signs and symptoms often include marked fever, dizziness, rashes, muscle aches, loss of strength, headache, and fatigue. Patients with severe cases of VHF often show signs of bleeding under the skin, in internal organs, or from body orifices like the mouth, eyes, or ears. However, although they may bleed from many sites around the body, patients rarely die because of blood loss. Severely ill patient cases may also show shock, nervous system malfunction, coma, delirium, and seizures. Some types of VHF are associated with renal (kidney) failure.


After an incubation period of 1-3 weeks, illness begins insidiously, with early symptoms of fever, sore throat, weakness, and malaise. Typically, symptoms develop within days but may not appear until several weeks after exposure.

How are Viral Hemorrhagic Fevers Treated?

Patients receive supportive therapy, but generally speaking, there is no other treatment or established cure for VHFs. Ribavirin, an antiviral drug, has been effective in treating some individuals with Lassa fever or hemorrhagic fever with renal syndrome. The only licensed, approved vaccines for VHFs are for yellow fever and Argentine hemorrhagic fever. To be successful in preventing the disease, the vaccine must be received prior to exposure. Experimental vaccines for several other VHFs are being studied, but are not yet licensed or approved for general use.

Can a Person Exposed to Viral Hemorrhagic Fever Avoid Becoming Sick?


With the exception of yellow fever and Argentine hemorrhagic fever, for which vaccines have been developed, no vaccines exist that can protect against these diseases. Therefore, prevention efforts must concentrate on avoiding contact with host species. If prevention methods fail and a case of VHF does occur, efforts should focus on preventing further transmission from person to person, if the virus can be transmitted in this way.

For those hemorrhagic fever viruses that can be transmitted from one person to another, avoiding close physical contact with infected people and their body fluids is the most important way of controlling the spread of disease. Infection control techniques include isolating infected individuals.

What is the Washoe County Health District Doing to Prepare for a VHF Outbreak?

In the event of a weaponized viral hemorrhagic fever attack or outbreak, the Washoe County Health District will work closely with the Nevada Division of Public and Behavioral Health and the Centers for Disease Control and Prevention (CDC) to provide community partners and the public with recommendations regarding infection control activities. This information will be available through the media and the Washoe County Health District website.

What is Pandemic Influenza?

An influenza pandemic can occur when a non-human (novel) influenza virus gains the ability for efficient and sustained human-to-human transmission and then spreads globally. Influenza viruses that have the potential to cause a pandemic are referred to as ‘influenza viruses with pandemic potential.’ Examples of influenza viruses with pandemic potential include avian influenza A (H5N1) and avian influenza (H7N9), which are two different “bird flu” viruses. These are non-human viruses (i.e., they are novel among humans and circulate in birds in parts of the world) so there is little to no immunity against these viruses among humans.

Why are we Concerned About Pandemic Flu?

Pandemic influenza is caused by a new virus, and vaccine to prevent the associated flu is not available. Therefore, more people are prone to falling ill. In addition, a pandemic virus strain can spread rapidly from person to person and, if severe, can cause high levels of disease and death around the world. For example, the most famous flu pandemic was the Great Pandemic of 1918. In a matter of weeks, influenza swept across the entire country. Approximately 675,000 people in the United States died, with high mortality rates among healthy adults 20 to 50 years of age.

Transmission: How does Someone Become Infected with the Flu?

Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are


Source: www.cdc.govPANDEMIC INFLUENZA


nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.

What are the Signs and Symptoms?

People who have the flu often feel some or all of the following signs and symptoms:• Fever or feeling feverish/chills• Cough• Sore throat• Runny or stuffy nose• Muscle or body aches• Headaches• Fatigue (very tired)• Some people may have vomiting and diarrhea, though this is more common in

children than adults


The incubation period for the flu can vary from one to four days, but symptoms normally appear two days after exposure to the virus.

How is Influenza Treated?

Flu symptoms can be eased with over-the-counter and prescription medications to help you feel better faster. Your healthcare provider may prescribe antiviral medications, such as Tamiflu, to help you feel better while dealing with the illness. If your flu has progressed to a bacterial infection, your health care provider may prescribe antibiotics.

Can Influenza be Prevented?

Influenza vaccines are administered annually to prevent the flu. However, influenza virus strains continuously evolve. Annual flu vaccines are designed to protect against specific, known influenza viruses in circulation among humans around the world.

An influenza pandemic occurs when a new virus emerges. A vaccine cannot be produced for this new virus until the virus has been identified. Developing, testing and producing a new vaccine can take up to six months.

Would Enough Vaccine be Available in the Event of a Pandemic?

Enough vaccine would be available once a vaccine was developed, tested and produced. This process could take six months, and then vaccine would be distributed to local health authorities for mass vaccination.

What is the Washoe County Health District Doing to Prepare for a Pandemic Outbreak?

In the event of pandemic influenza, the Washoe County Health District will announce detailed instructions on how to obtain vaccine through a point of dispensing (POD) site. This


information will be available through the media, news, and on this website.

APPENDIX N: MEDICATION INFORMATION SHEETS

The Washoe County Health District will provide appropriate Medication Information Sheets specific to the public health emergency if it becomes necessary to open Private POD sites. Below are examples.

• Amoxicillin (adult)• Ciprofloxacin (adult)• Doxycycline (adult)• Ciprofloxacin (child)• Doxycycline (child)


Source: www.cdc.gov

pod commander · web viewexamples of influenza viruses with pandemic potential include avian...

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