POINT OF DISPENSING (POD)
POINT OFDISPENSING (POD)STANDARDSAPRIL 2008For the convenience of our state and local public health partners this documenthas been excerpted (with minor modifications) from the draft report entitled:Recommended Infrastructure Standards for Mass Antibiotic Dispensing C. Nelson, E.Chan, A. Chandra, et al., RAND Corporation.Funded by the Department of Health and Humans Services Contract #DRR 14-43,2008.COORDINATING OFFICE FOR TERRORISM PREPAREDNESS AND EMERGENCY RESPONSEDIVISION OF STRATEGIC NATIONAL STOCKPILE
TABLE OF CONTENTSPREFACESTANDARDSPAGESNUMBER AND LOCATION OF PODS1.1, 1.2, 1.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4INTERNAL POD OPERATIONS2.1, 2.2, 2.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-6POD STAFFING3.1, 3.2, 3.3, 3.4. . . . . . . . . . . . . . . . . . . . . . . . . . . . .7POD SECURITY4.1, 4.2, 4.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8APPENDIXPAGESAPPENDIX A1.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-12APPENDIX B1.2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13-14APPENDIX C1.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15APPENDIX D2.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-18APPENDIX E2.2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-20APPENDIX F2.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21APPENDIX G3.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22APPENDIX H3.2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23-25APPENDIX I3.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26APPENDIX J3.4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27APPENDIX K4.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28APPENDIX L4.2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29APPENDIX M4.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30NOTES2
PREFACETHE MASS ANTIBIOTIC DISPENSING STANDARDS WERE DEVELOPED IN COLLABORATION WITH FEDERAL, STATE, AND LOCALAGENCIESThe Rand Corporation, under contract to the U.S. Department of Health and Human Services (HHS), was directed to develop Point of Dispensing (POD)infrastructure standards in collaboration with HHS/Assistant Secretary for Preparedness and Response (HHS/ASPR), Centers for Disease Control andPrevention/Division of Strategic National Stockpile (CDC/DSNS), and state and local agencies that are current Cities Readiness Initiative (CRI) awardees. Assuch, CDC/DSNS collaborated closely in formulation and execution of the project, and HHS/ASPR was consulted on a regular basis. Federal, state, and localhealth officials were represented on an expert panel that was convened to provide guidance on the standards development process, and CRI sites were providedwith an opportunity to comment on the draft standards. Detailed information on the development of the standards will be published in a public forum within thenext six months.THE STANDARDS ARE ALIGNED WITH THE CITIES READINESS INITIATIVE “48 HOUR” GOALCRI is organized around the planning scenario of an outdoor aerosolized anthrax attack. Anthrax is a particularly challenging scenario because, to be effective,prophylaxis must occur prior to the onset of symptoms. Based on available evidence, it was determined that providing oral antibiotics within 48 hours ofexposure would be likely to prevent 95 percent or more anthrax cases. i Thus, CRI’s ultimate goal is that awarded MSAs are able to administer prophylaxis totheir entire populations within 48 hours of the decision to do so.Compliance with the following POD infrastructure standards help to build the capacity to meet the overall 48 hour CRI program goal. Throughout the report wedistinguish standards for specific elements of POD infrastructure from the more general 48 hour goal of providing prophylaxis to the entire CRI MSA.
NUMBER AND LOCATION OF PODSSTANDARDEXPLANATION1.1The jurisdiction shall estimate thenumber of people who will likely cometo PODs to pick up medication, alongwith their geographic distribution.To ensure that the number of PODs is sufficient to provide initial prophylaxiswithin 48 hours, it is first necessary to develop an accurate estimate of the size ofthe population to be served via PODs. Thus, Standard 1.1 requires that CRI sitesprovide a systematic analysis of likely demand for PODs, including both (a) thetotal number of likely POD visitors and (b) their geographic distribution. Thestandard assumes that individual jurisdictions are in the best position to define thescope of the population for whom they will be responsible for administeringprophylaxis.1.2The number of PODs shall be greaterthan or equal to (a) the number ofpersons needing to receive prophylaxisat PODs divided by (b) per PODthroughput multiplied by 24 hours (48hours minus 12 hours for initial CDCdelivery to warehouse and 12 hours toget materiel from warehouse to PODs).Standard 1.2 requires jurisdictions to combine the population analysis developedpursuant to Standard 1.1 with estimates of hourly POD throughput in order toensure that the supply of PODs matches demand. Specifically, the followingrelationship among these four factors must hold:Number of PODs SUGGESTEDDOCUMENTATIONReference Appendix: AReference Appendix: BPopulation visiting PODs in personHourly per POD throughput * 24 hoursThe estimate of 24 hours for POD operations (in the denominator) is based on theCDC’s assumption that it might take up to 12 hours for initial delivery of materielfrom the DSNS and the Target Capabilities List’s assumption that it might takeup to 12 hours to get materiel from warehouses to PODs.1.3All POD locations shall meet relevantSNS site guidelines and securitycriteria.Standard 1.3 specifies that planned POD locations shall meet the basic site andinfrastructure requirements in the DSNS guidance document, Receiving,Distributing, and Dispensing Strategic National Stockpile Assets: A Guide forPreparedness Version 10.02.4Reference Appendix: C
INTERNAL POD OPERATIONSSTANDARDEXPLANATION2.1Jurisdictions shall have at least one viableand exercised rapid dispensing ii protocolthat addresses the following minimalfunctions: (a) directing clients through thePOD, (b) deciding which medication todispense, (c) dispensing medication, and (d)disseminating information about themedication. Note that this standard doesnot mandate that these functions beprovided by medically licensed personnel,and does not mandate that all of thesefunctions be provided in-person or on-siteat the POD.Standard 2.1 defines the minimal functions that a POD must perform. Giventhat a wide variety of POD designs can produce the same throughput, thestandard lists a set of essential functions but allows jurisdictions considerableflexibility in determining how to fulfill those functions. This includes thedecision as to whether functions are to be provided in-person at the POD.The functions include: (a) messages that clearly communicate to clients PODlocation instructions and where to go if they are exhibiting symptoms; (b) aprocess for deciding which medications each client should receive; (c)mechanisms for handing over medications to clients; and (d) mechanisms forproviding information about how to take the drug, and what to do and whereto go if an adverse reaction is experienced.2.2Jurisdictions shall ensure that legal andliability barriers to rapid dispensing areidentified, assessed, prioritized, andcommunicated to those with the authorityto address such issues. Such issues includestandards of care, licensing, documentationof care, civil liability for volunteers,compensation for health department staff,rules governing the switch betweendispensing protocols, and appropriation ofproperty needed for dispensingmedications.The POD protocols required to provide medication to an entire metropolitanarea within 48 hours (e.g., relaxed screening and recordkeepingrequirements, use of non-medically trained personnel) might conflict withroutine legal strictures. Thus, Standard 2.2 requires that jurisdictions workwith relevant state and local authorities to ensure that they have the legalauthority to operate rapid dispensing PODs during a public healthemergency. Note that the standard does not require CRI jurisdictions orother health departments to change laws – only to “identify, assess,prioritize, and communicate” such issues to those who do have the authorityto change them.5SUGGESTEDDOCUMENTATIONReference Appendix: DReference Appendix: E
INTERNAL POD OPERATIONSSTANDARD2.3Jurisdictions shall have viable andexercised procedures for selecting anappropriate dispensing protocol (e.g.,medical model vs. rapid dispensing).EXPLANATIONWhile the need to provide prophylaxis to an entire metropolitan area within48 hours argues for streamlined, rapid dispensing protocols, changingcircumstances might require more time, skill, and attention to be applied toeach client. For instance, as jurisdictions move out of the initial 48 hourperiod further epidemiological investigation might suggest follow-upprophylaxis of only a limited portion of the population. This and otherchanges in the situation might necessitate a different balance betweendispensing speed and screening accuracy. Thus, Standard 2.3 requires thatjurisdictions have clear procedures for moving to and from streamlinedprophylaxis operations.6SUGGESTEDDOCUMENTATIONReference Appendix: F
POD eference Appendix: G3.1Jurisdictions shall estimate the number ofindividuals who are likely to visit eachPOD location and determine the requiredhourly throughput at each POD.The first step in determining the staffing required for PODs is to determinethe throughput that will be required at each POD. Thus, Standard 3.1requires an estimate of the number of people who will likely come to eachPOD seeking prophylaxis. It should be noted that the standard does notrequire individuals to be assigned particular to PODs to pick up theirmedications; it only requires that jurisdictions’ plans be based on estimates ofthe number of individuals likely to come to each POD.3.2Using a combination of exercises and/orcomputer models, jurisdictions shalldetermine and verify the number of staffrequired to administer prophylaxis to thepopulation identified pursuant to Standard1.1.Standard 3.2 requires jurisdictions to estimate staffing requirements for eachPOD, given estimated throughput requirements (see Standard 3.1). Ratherthan mandating a particular staffing configuration, this standard adopts a“show me” approach, allowing jurisdictions to demonstrate that their PODdesigns and staffing configurations will produce the necessary throughput.Jurisdictions may use a combination of timed drills and computer simulationmodeling software.Reference Appendix: H3.3Jurisdictions shall recruit sufficientcommand staff, and provide plans forrecruiting and training of spontaneousunaffiliated volunteers, in sufficientnumbers to operate all the planned PODsin the jurisdiction at the levels ofthroughput required to meet the CRItimeline.Standard 3.3 requires jurisdictions to identify and recruit the staff necessaryto implement their mass prophylaxis plan, and enter them into a call-downroster.Reference Appendix: I3.4Jurisdictions shall assess the availability ofthe command staff on their call-downrosters on a quarterly basis, via a no-noticecall-down drill.Standard 3.4 requires that jurisdictions demonstrate, via quarterly no-noticecall-down drills, that they can promptly contact and assemble the requirednumber of people to staff PODs within the first few hours of the decision toconduct mass prophylaxis operations.Reference Appendix: J7
POD SECURITYAdequate security planning is essential to the safety of POD staff and clients, the sustainability of operations, and the safeguarding of countermeasures beingdispensed. The main challenge in developing appropriate standards for POD security is to ensure that a comprehensive set of security measures are in place,while recognizing that state and local law enforcement agencies often have policies, procedures, and doctrine for performing many of these tasks. Thus, theproposed POD security standards favor flexible approaches over strict numerical ON4.1Site security assessments shall beconducted on every POD location incoordination with the agency (ies)responsible for security functions at thePODs.Standard 4.1 requires site assessments for each facility, coordinated withthe agency or agencies responsible for security functions at the PODs(which in most cases will be the local law enforcement agency).Reference Appendix: K4.2The agency (ies) responsible for securityfunctions at PODs shall be consulted onthe security aspects of the overall massprophylaxis plan.Effective security planning requires consultation with the partiesresponsible for security at PODs (whether law enforcement or otherwise).Reference Appendix: L4.3Law enforcement in the form of swornuniformed officers shall maintain aphysical presence at each POD location.This requirement may be waived with awritten attestation from the partiesresponsible for POD security. Theattestation shall include evidence thatcompliance with the standard as written isinfeasible and that alternate measuresdesigned to ensure adequate security arein place at each POD site.Standard 4.3 requires physical presence of law enforcement at each POD.However, if this requirement is determined to be infeasible for somejurisdictions, alternate plans, developed by local law enforcement, areacceptable.Reference Appendix: M8
APPENDIX9
APPENDIX A: STANDARD 1.1Standard 1.1: The jurisdiction shall estimate the number of people who will likely come to PODs to pick up medication, along with their geographicdistribution.EXPLANATIONTo ensure that the number of PODs is sufficient to provide initial prophylaxis within 48 hours, it is first necessary to develop an accurate estimate of the size ofthe population to be served via PODs. Furthermore, when considering the placement of PODs and the throughput required at each, jurisdictions need tocharacterize the geographic distribution of the population so that variations in population density among regions within the jurisdiction can be taken into account.The standard assumes individual jurisdictions are in the best position to estimate the population for whom they will be responsible for administering prophylaxis.SUGGESTED DOCUMENTATIONCompliance with this standard requires documentation of the population characteristics shown in the Sample Spreadsheet for Population Estimate on page 11(note that several of the estimates are optional and may not be applicable to all jurisdictions). These estimates should be provided for smaller geographic units –such as census tracts or ZIP codes – and then summed for the service region as a whole. Estimates should be reviewed annually and updated whenever new dataare available (e.g., from the U.S. Census or from local metropolitan planning organizations).Decisions about who should be included in calculating the relevant population for the purposes of this standard will often vary by community. Thus, SampleSpreadsheet for Population Estimate suggests that jurisdictions begin with residential population and then make upward and downward adjustments, asappropriate. For instance, the number of people requiring prophylaxis at PODs may have to be adjusted upward to take into account daytime workingpopulation and tourists; depending on the jurisdiction or the specific area within the jurisdiction (consider, for example, downtown Manhattan), daytime workerand visitor populations may vastly exceed the nighttime residential population. Similarly, some jurisdictions might also expect to receive fleeing populationsduring an emergency.Conversely, the number of people requiring prophylaxis at PODs may also be adjusted downward if “push” modalities – such as United States Postal Service(USPS) Postal Option – postal delivery to residences or direct delivery to institutions such as large companies, nursing homes, treatment centers, etc. – areemployed to reduce the pressure on PODs. Many, although not all, CRI jurisdictions also allow for “head-of-household” dispensing, where one person ispermitted to pick up medications for other members of his or her household. The standard allows jurisdictions to decrease the number of people who areanticipated to come in person to PODs according to any of these considerations.10
APPENDIX A: STANDARD 1.1 (CONTINUED)SAMPLE SPREADSHEET FOR POPULATION ESTIMATES1.2.3.4.5.6.7.Residential population: At minimum, this represents the number of individuals who reside within each geographic unit of analysis. In addition,university students, persons living in patient care facilities, and others who maintain some sort of regular presence in the jurisdiction may need to beincluded.Worker population (if applicable):This represents the number of employeeswho work in each geographic unit ofanalysis (the workers may resideelsewhere). It should be included if thejurisdiction plans to provide prophylaxisto people near their places of work.Visitor population (if applicable): Thisrepresents the average number of touristsor other visitors who may be lodgingwithin a geographic area on any givenday. It should be included if significantnumbers of out-of-town visitors mightneed to receive medication in PODs. Itmight be useful to provide estimates byseasons or time of year, as appropriate,given fluctuations in the touristpopulation.Adjusted base population: This is the total number of people within each geographic unit of analysis who need to receive prophylaxis, taking intoconsideration residential (1), worker (2), and visitor (3) population estimates.Population served via postal delivery (if applicable): If a jurisdiction will be using the USPS Postal Option to supplement PODs, this column shouldlist the number of individuals in each geographic unit of analysis who will receive regimens via postal delivery, and therefore will not need to receivemedications at PODs during the first 48 hoursPopulation served by other push strategies (if applicable): This represents the number of people in each geographic area who will receive regimensvia other push strategies (for instance, on-site delivery to large companies, military installations, prisons or nursing homes, or first responders givenprophylaxis out of local caches) and therefore will not need to receive medications at PODs during the first 48 hours.Population served by PODs: This represents the total expected number of people in each geographic unit of analysis who will receive their regimensfrom PODs. It is calculated by starting with the adjusted base population estimate (4) and then subtracting both the population to be served via postaldelivery (5) and the population to be served via other push strategies (6).11
APPENDIX A: STANDARD 1.1 (CONTINUED)8.Population expected to visit PODs (if applicable): This represents an estimate of the number of people from each geographic unit of analysis whowill come to a POD location in person. If the jurisdiction plans to follow a "head-of-household" dispensing procedure, where one individual can pick upmultiple regimens for other members of the household, then this estimate should be substantially smaller than the number of individuals who willreceive their regimens (directly or indirectly) from PODs. In this case, jurisdictions should develop an estimate of the average number of regimens to bepicked up by each person who visits a POD (which might be related, for example, to the average household size with
prophylaxis must occur prior to the onset of symptoms. Based on available evidence, it was determined that providing oral anti biotics within 48 hours of exposure would be likely to prevent 95 percent or more anthrax cases. i Thus, CRI’s ultimate goal is that awarded MSAs are able to administer prophylaxis to
OpenStack and Kubernetes Kevin Zhao Senior Software Engineer on Arm. OpenStack Zun Core Reviewer kevin.zhao@arm.com 22.05.2018. What is Serverless Container Cloud . architecture VM VM Pod Pod Pod Pod Pod Pod Pod Pod Pod Pod Pod Pod. Node1 N
v 1.3 COMPATIBILITY Per the Line 6 MIDI Continuous Controller Reference guide, SIXY is compatible with Floor POD Plus, POD 2.0, POD Pro, POD XT, Bass POD XT, POD X3 Live, POD X3 Pro, Vetta II, Vetta II HD, Flextone III, HD 147, Pocket POD, and Gear Box Software. SIXY also works with works with Behringer V-Amp, T-Rex Replica Delay, and Free The .
Welcome to the POD Network Conference for 2018 4 POD Network Executive and Core Committees 7 POD Network Mission Statement 9 Conference Sponsors 10 Plenary Session 12 Session Formats / Types 13 Special Sessions 14 POD Network Session Tracks: Topics, Audiences, and SIG/Committee Themes 14 POD Unconference (POD-U) 16
Basic Router Pod, Basic Switch Pod, and Advanced Router Pod. This guide documents the NETLABAE Basic Router Pod, used with CCNA 3.x Basic Router Configuration Labs. You may have up to eight Basic Router Pods per NETLABAE system. The NETLABAE Basic Router Pod features direct access to the console of routers R1, R2, and R3. 9/3/2005 Page 3 of 23
Guide to Good Dispensing Practice: 2016 Page 4 3. Dispensing Process Adherence to good dispensing procedures is vital in ensuring that medicines are dispensed correctly and any potential/ real errors which may occur during the dispensing process are detected and rectified before medicines reach the patient.
To put POD HD500 Edit to work, connect your POD HD500 device to your computer’s USB 2.0 port to establish two-way communication. Exit any Line 6 applications that might be running, and with your POD HD500 device powered on, launch POD HD500 Edit: On Mac , go
Please Note: Line 6 , POD , POD xt, POD xt Live, Bass POD xt Live, POD xt Pro, A.I.R. , FBV , FBV Express , FBV Shortboard , FB4 , FBV2 , Amp .
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