The Tarrant County Public Health Corporate POD initiative, launched in the summer of 2006, is an ongoing effort to achieve the vision of a rapid system for the dispensing of medications in an emergency requiring the activation of the Strategic National Stockpile. The Corporate Point Of Dispensing concept ensures a thorough, timely and effective response to any rapidly emerging or unexpected biological hazard by partnering with the local business community to establish PODS on the premises of participating large employers. While the corporate POD Initiative focuses on bioterrorism, this approach would also be useful in chemical or radiological terrorism.
The Corporate POD Initiative is an innovative way to rapidly reach a large portion of the county population – overcoming the resource limitations of both public health and the local medical community and assist in efficient mass dispensing of drugs in an emergency that requires activating the Strategic National Stockpile (SNS). Those resource limitations include both a lack of personnel for manning general public PODS and an ability to address time and logistical challenges of setting up multiple POD sites in time to dispense the life-saving drugs within 48 hours. By using existing infrastructure established by the county’s large employers, defined as those with (1) more than 600 employees, (2) staffed with full-time medical personnel, (3) a security department, and (4) a suitable campus/ building), Tarrant County Public Health determined that it could achieve a quantum leap in the number of people that could be medicated across Tarrant County within the mandated 48 hours.
Since the initiation of the project, 15 of the largest local employers have been contacted and have already, or are in the process of becoming a corporate POD site. Although the 15 employers only represent 27% of the identified candidates, they contain roughly 60% of the 160,000 identified workforce, which equals 96,000 employees, and if families are included, the potential impact would be 400,000 people. It is estimated that all 55 identified corporations will be apart of the initiative by mid 2008.
The Corporate POD Initiative responds to the unique challenges associated with the mass dispensing of drugs. Tarrant County Public Health is tasked with the oversight of the SNS deployment to medicate the entire county population within a 48-hour period. This monumental task is not easily accomplished with only agency staff and local volunteers, which is why the agency explored non-traditional ways of dispensing drugs. Previous calculations required 40 public POD sites, each able to treat 40,000 individuals. To be able to do so, the county would have to rely on approximately 5,000 volunteers, which is about 3,500 more than the number currently registered in the MRC program.
Empowering large, local employers with the necessary knowledge and infrastructure to dispense drugs provided by the SNS to their employees is a viable way for the county to more rapidly medicate the entire population and ease the burden at the general public POD’s. To verify efficacy of this idea, Tarrant County Public Health conducted a series of “beta tests.” Three local employers were selected to participate, each representing a small (700 employees), medium (2,000), and large business (16,500 employees). The beta test results yielded best practices and the model was adjusted accordingly.
The Corporate POD Initiative is new to the field of public health. Traditionally, local health departments were expected to exclusively rely on general public POD sites staffed by local community volunteers and spontaneous volunteers. These volunteers did not have specific knowledge of the site they would staff, and a generic plan was utilized for each site. The Corporate POD model addresses two major challenges: 1) managing the logistics of setting up and operating a POD site and 2) ensuring availability of well-trained, knowledgeable staff.
The innovativeness of the Corporate POD Initiative is evident in two broad benefits. Specifically, the program:
Extends SNS resources: The project lets the LHD utilize existing infrastructure in the form of participating businesses, avoiding a need to reinvent the wheel. Each participating business has mechanisms for communicating with staff and dispensing drugs to employees. Moreover, they can provide security and medical staff for their POD site. Each participating organization is responsible for providing personnel to be trained as MRC volunteers with site-specific training, which frees up local community MRC volunteers and lets them staff public POD sites, lowering the pressure on public POD sites.
Improves SNS effectiveness: The project lets the LHD assist the participating business in developing a site-specific plan. Because key personnel from each participating business are ultimately responsible for authoring their plan, they are uniquely positioned to capitalize on their organization’s specific strengths and able to avoid unexpected pitfalls. Employees and their families can be pre-screened to determine, for example, if any of the life-saving drugs likely to be dispensed at the site will have side effects or cause problems in light of their known, existing medications. Exercises can be tailor-made for each specific site, producing benefits not possible with a “generic” public POD site and plan.
Agency Community RolesTarrant County Public Health and its Preparedness Division played an essential role in developing the model practice in four areas: 1) Developing the initiative, 2) Determining and serving stakeholder needs, 3) Recommending a viable project approach, 4) Securing external and internal buy in.
The project has strengthened ties between the health department and an important stakeholder group that previously had not been engaged: the business community (especially large employers). Tarrant County Public Health has engaged a wide variety of organizations to function as POD sites, including public universities, private universities, defense contractors, federal agencies, manufacturing plants, and service providers. The county has also trained hundreds of MRC volunteers from the participating organizations, received material, held trainings and exercises on participant premises, been given access to employees with special skills that can assist the health department in emergencies (HAZMAT, physicians, law enforcement, etc), and fostered an environment of ongoing communication and respect. The exchange and collaboration with local businesses is extensive and not limited to setting up POD sites; other areas of collaboration have included assistance with planning, epidemiological surveillance, and community health promotion campaigns. Tarrant County Public Health is responsible for engaging targeted businesses, assessing their fit for the program, training them on POD operations, assisting them with SNS plans and overall project coordination. Participating organizations must allow a sufficient amount of employees to be trained as MRC volunteers, write a site specific plan (with the assistance of county planners), and participate in SNS exercises.
Costs and ExpendituresThe costs for the Corporate POD Initiative are manageable, involving only one salary for a Corporate Liaison, education, and production of information and training material. The CDC Preparedness Cooperative Agreement Grant has provided sufficient funding for those nominal project costs.
ImplementationSelecting, motivating, training, and assisting private entities to become POD sites is time- consuming and sometimes challenging, but Tarrant County Public Health has been able to keep the participants engaged and aware of the necessary steps to take. Achieving the goals and objectives of the Corporate POD Initiative requires successful execution of these steps:
Organizations that meet the criteria’s are selected by the Health Department as potential candidates and are contacted. Key stakeholders are asked to participate in an introductory meeting. During that meeting, the Corporate POD model is discussed and, if the organization chooses to participate, their key staff are interviewed and asked to fill out an assessment form.
The information from the prospective POD site is entered into a database and the Tarrant County Public Health Department assesses the organization’s suitability to serve as a POD.
Among organizations selected to serve as POD sites, a certain amount of staff members are trained as MRC volunteers. This ensures a sufficient core training and technical knowledge of POD operations. The number of staff trained is based on the number of employees in the participating organization.
Upon completion of MRC training, a site-specific POD plan is written by the participating organization with the assistance of Tarrant County Public Health. Once the POD plan is written, a site-specific tabletop is held with those in leadership positions. Based on the results of the tabletop, the POD plan is evaluated and revised.
Once the plan has been tested and revised by the participating business, approved by the health department, and a Memorandum of Understanding (MOU) is signed, the business is considered an “independent” corporate POD site. At that point, the site’s plan is added into the county SNS SOG.
The county holds regular SNS exercises where the participating businesses are expected to take part. After the business has become a Corporate POD site, the county provides ongoing training and assistance in all-hazards planning, biological hazards, containment measures, and continuity planning.
Objective 1: Recruit all 55 identified large, local employers to act as Corporate POD sites.
Performance Measures: Currently, 15 businesses are enrolled (which was the initial 6 month goal). The remaining 40 are expected to be enrolled by mid 2008.
Feedback: The SNS coordinator and Corporate Liaison received the MOU’s. To avoid confusion regarding MOU’s and specific legal questions, Q&A document was created to go with the MOU’s when first distributed.
Outcome: Currently, the project is on track and the intended 6 month goal was met. While achieved in the short term, this outcome applies to the long term as well.
Objective 2: Train 0.5% of the employees at participating organizations as site specific MRC volunteers.
Performance Measures: Currently, an average of 0.3% of the employees at the participating businesses have been trained as MRC volunteers.
Feedback: The data is received by the Corporate Liaison and the MRC Coordinator. To improve the quantity of volunteers, changes were made to training requirements and a MRC train-the-trainer program developed for the corporate participants.
Outcome: The MRC training has fallen slightly behind, mostly due to conflicting training schedules between business participants and the county. Once the specified number of MRC’s have been trained, the results are expected to be intermediate.
Objective 3: Ensure that each participating business has a site specific POD plan.
Performance Measures: Eight participating businesses have finalized their plans, and the remaining seven are in various stages of finalizing their POD plans.
Feedback: The plans received are given to the SNS Coordinator and the Corporate Liaison. To ease the plan writing process, several supporting documents are given to the participants (such as sample plans, screening forms, flow charts, etc).
Outcome: The writing and testing of plans is an ongoing process. Currently eight out of 15 enrolled participants have concluded their plans. Once a plan is finalized, the results must be seen as long term.
SustainabilityThe level of resources and stakeholder commitment to the model practice is adequate to ensure sustainability. Once a business has developed a site-specific plan and trained staff members to operate the POD site, all material are included in the Tarrant County SNS SOG. From a county perspective, the maintenance of the project is low cost (once a business has finished their part). Significant federal funding support is devoted to the development and maintenance of a regional SNS plan.
To ensure future participant interest and buy-in, the county has assigned one contact person for the various organizations. The role of the Corporate Liaison is to maintain communications with participants and prospects and address their needs and concerns. Mutual trust and confidence are byproducts that typically emerge quickly from a personal relationship between key stakeholders and the Corporate Liaison. Moreover, participating organizations can benefit from their involvement in several ways, chief among them being that:
They become better prepared to maintain operations during an emergency than non-participating companies, who would be forced to let their employees leave work to go to a public POD site. For the participating company, this means avoiding lost sales or other damages that otherwise could erode profit margins for weeks, months or even years.
They can maintain goodwill with employees, who will appreciate rapid and easy access to life-saving drugs for themselves and their family members, as well as the higher levels of security and education about emergency preparedness that the program provides.
Lessons LearnedUse of the corporate POD model is expected to create substantial cost savings and greater operational efficiency for Tarrant County. At this time, the county has concluded that eight general public POD sites could be removed from the local SNS plan as one favorable outcome of the Corporate POD Initiative. Several more public POD sites are expected to be removed from the plan as more local employers get recruited and trained to set up a POD site.