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Appendix Name Appendix Number Last Review Date Authorization

Policy:

It is the policy of ______Community Health Center to respond to CBRNE events, specifically biological events that may occur within our community. To respond to these events, this health center will use a Point of Distribution/Dispensing protocol in order to vaccinate or issue prophylaxis to large numbers of community members dependent on the incident and the recommendations of our medical staff and/or the recommendation of public health officials.

Policy on Volunteer Use:

It is the policy of this health center to not use external volunteers for routine seasonal influenza vaccination PODs. However, during a public health crisis, Access may utilize previously credentialed volunteers from the New York City Medical Reserve Corps as needed to respond to any biological crisis as defined by the New York City Department of Health and Mental Hygiene.

Responsibility and Review:

It is the responsibility of the Emergency Preparedness Committee at ______Community Health Center to plan for and review this policy, plan, and protocol annually. The Emergency Preparedness Committee will also review PODs and documents that have been completed and incorporate the lessons learned into this plan and schedule any retraining necessary for the CHC staff.

Purpose:

To create a procedure for the identification of emergency need within the community, to create a protocol for a POD system that would be deployable to any Access owned site or facility, or to create a protocol for the deployment of a POD to any mutually agreed upon alternate location where Access may have agreements of use.

The protocol will identify how it will receive, from the community or public health, the need for a POD deployment, the protocol will identify how it will activate a POD, request volunteer assistance, receive medication from either suppliers or public caches, deploy the POD, and track patients that may use the POD as their method of getting prophylaxis or immunized.

I. Planning

A. Preparedness – Planning Team

1. This health center will organize a POD Planning team which will consist of staff members who represent the various clinical and administrative branches of the organization. The team should be prepared to discuss staffing, workflow, infection control, financial issues, materials and supplies, communications both internally and externally, marketing and outreach, and mental health issues.

2. The planning team should customize this POD plan to all of its sites and account for staffing, architecture, and community.

3. The planning team shall train all organizational staff on POD deployment as is appropriate.

4. The planning team will identify alternate operations sites and oversee the creation of any agreements to use alternate sites such as schools, community centers, and local community based organizations.

5. The planning team will, upon the deployment of a POD, hold a “hot wash” to discuss the deployment and incorporate any lessons learned into this document.

6. The planning team shall design and conduct exercises based upon this plan.

7. Upon exercising this plan, the planning team shall conduct a “hot wash” and issue and present an after action report no later than 60 days post exercise.

8. The planning team shall incorporate lessons learned during exercises into this plan.

9. The planning team shall conduct revisions of the POD plans, train employees on changes to the POD plan, and conduct further exercising on those changes as needed.

10. The planning team shall assure proper refrigeration for vaccine as dictated by the CDC guidelines.

B. POD Design and Staffing – a POD’s design is dependent on the physical location of the POD itself. The design of the POD is dependent of the building’s or the land’s unique characteristics. PODs must have separate entrances and exits. II. Mitigation

1. The planning team shall identify any mitigation issues that may lessen the impact of a biological disaster.

2. The organization shall participate in mass communications networks such as the City wide Immunization Registry, HERDS, and the Health Alert Network.

3. The organization shall determine a method to either monitor its community for the presence of biological threats and will monitor public health surveillance models.

4. The organization shall develop a method of communicating with the community and reporting data to public health officials for reportable events.

III. Response and POD Operations

Activation: A POD shall be activated based upon credible information received from local public health sources or based on the opinion of the chief medical officer.

A. POD Description

Definition: A Point of Distribution/Dispensing operates through a series of stations through which individuals pass in order to receive the correct medication(s) or vaccination(s) in the quickest time possible, but with maximum effort made in minimizing possible adverse events. PODs are utilized as a method of distributing medications or vaccines to otherwise healthy individuals in an attempt to mitigate a biological event that has occurred or is threatened to occur. The CHC staff members are assigned roles at each station to help guide the individuals through the stations and maintain flow in an efficient and orderly fashion.

At any given station, the center may choose to combine POD job titles with CHC titles when short of staff. The same employee may act in two or more positions if necessary.

B. This POD plan shall include the following sites:

List all health center sites

C. There are five primary stations involved in the development of a POD. These stations are:

1. Waiting Line/Area Station 2. Screening Station/Registration 3. Medical Evaluation Station (if needed due to patient response on screening) 4. Dispensing Station 5. Command and Control – This station also includes the POD commander and the area known as pharmacy or POD medication cache.

D. POD Staffing

i. Waiting Line/Area Station – This is the station or area that is designed to create an orderly format for patients when they arrive at the location or when they enter the POD. It is at this station/area where people can be given numbers that correspond to the number of doses available at the POD. As soon as the last dose has been assigned, the PIO should announce to those without numbers to depart as they will not receive doses at that particular POD. This area is also the area where information is provided and guided in the practice of appropriate infection control precautions. Information that patients can be given in this area is as follows:

- Each patient can be given a number that may correspond to a dose in the POD. - Each patient can be given information about the medication they are about to receive. - Each patient can be given the medication’s precautions/side effects - Each patient can be given information about the biological event for which the POD has been created - Each patient can be given information about specific restrictions or dosing instructions that have been issued by public health officials - Any information the patient needs to make an informed decision.

1. Waiting Line/Area Station: This is the first station of the POD and is designed to create an orderly format for individuals when they enter the POD. At this station, individuals will be given numbers (optional), provided POD information and guided in the practice of appropriate infection control precautions.

Note: Centers with large spaces may choose not to have a stationary Waiting Line/Area Station, but rather to create a workflow so that the individuals seeking care walk through a line while monitors walk amongst them to answer questions or help with forms. Centers that choose this format must ensure adequate space for the monitors to walk amongst the individuals and space to allow consultation with individuals to the side if there are questions/problems that require longer assistance. A. Roles Needed/Personnel Suggested:

i. Greeter (1-2): These staff would be stationed at the entrance to POD line and serve as the first point of contact for the patients entering the POD. a. Staff Type: Any non-clinical (i.e. Admin, Custodial, Volunteer)

b. Should reflect the language needs of the patients being served (preferred) c. Distribute POD paperwork (i.e. vaccine information forms) and supplies (i.e. pens, clipboards) to patients d. Alert staff if there are physically challenged patients onsite so that accommodations, if needed, can be made e. Alert staff to the presence of representatives from the media f. Provide “Just in Time” marketing to passersby (optional)

ii. Waiting Area Flow Monitor (1-3): These staff ensure that the non-clinical needs of patients waiting to enter the POD are met: a. Staff Type: Any non-clinical (i.e. Admin, Custodial, Volunteer)

b. Should reflect the language needs of the community being served c. Answer non-clinical questions about the POD (i.e. forms, process, etc.) d. Collect items when individuals are done (i.e. clipboards, pens, etc.) e. Ensure the line is kept moving into the waiting area f. Ensure patients do not wander into non-POD areas

iii. Infection Control Monitor (1): These staff ensure that the clinical needs of patients waiting to enter the POD are met: a. Staff Type: Any clinical staff (i.e. RN, MD, PA)

b. Should reflect the language needs of the community being served c. Ability to answer clinical questions about the POD (i.e. vaccine) d. Ensure infection control measures are being followed by patients and staff in the waiting line / area station

B. Logistics: i. Signs that indicate where the POD site waiting area/line station begins should be posted at the entranceway to the center. Signs must be in languages appropriate to the community. ii. Infection Control Monitor will a. Ensure that source, administrative and engineering controls are maintained. b. Ensure that appropriate personal protective equipment is utilized.

C. Materials Needed at Station: i. POD and / or Vaccine Information sheets (language appropriate FAQs, medication information, if needed) ii. Identifiers for staff (arm bands, vests) iii. Caution tape or traffic cones to direct lines, if needed iv. Numbers – not reusable (optional) v. Tissue, alcohol hand hygiene products/dispensers, hands free wastebaskets (and additional infection control supplies, e.g. masks, as appropriate) vi. Communication equipment (e.g., walkie talkies for Waiting Area Flow Monitors to alert next station monitors of status of station, cell phones) vii. Chairs for patients who need it (i.e. elderly, disabled, pregnant)

2. Screening Station: The purpose of the screening station is to screen individuals for any contraindications for taking the medication or receiving the vaccination. No medical evaluation is conducted at this site.

Note: Bottlenecks here may be avoided by assigning the different screening tables with different colors or numbers, making it easier for the Pre-screening Flow Monitors to direct individuals to the individual screening tables.

A. Roles Needed/Personnel Suggested:

i. Pre-Screening Flow Monitor (1): Prepare patients for and direct them to Screeners: a. Staff Type: Any non-clinical (i.e. Admin, Custodial, Volunteer)

b. Ensure patients screening forms are complete for screeners c. Direct patients from the waiting area to the screening area or screener

ii. Screening Officer (at least 2): Seated at tables to review screening form for contraindications to taking the medication or receiving the vaccination a. Staff Type: Any non-clinical however clinical staff are helpful if available(i.e. RN, MD, PA)

b. Should reflect the language needs of the community being served (especially if screening forms are only in English) c. Use screening algorithm to determine if a patient will go to dispensing station or medical evaluation station

iii. Post-Screening Flow Monitor (1): Direct patients from screening to medical evaluation or dispensing station: a. Staff Type: Any non-clinical (i.e. Admin, Custodial, Volunteer)

b. Ensure patient screening forms are marked by screeners c. Direct patients from screeners to dispensing or medical evaluation (depending on determination of screeners)

B. Logistics: i. Pre-Screening Flow Monitor will a. Call numbers in sequential order (optional) b. Identifiers for staff c. Direct individuals to the next available Screening Officer 1. Screening officers will signal the pre-screening flow monitors (e.g. via raising a flag or sign) when they are available. ii. Screening Officer will a. Use the assessment algorithm to review and prominently mark the screening form (i.e. “red dot” goes to medical evaluation and “green dot” goes to dispensing) for each individual. 1. All persons with a possible contraindication to receiving the medication or vaccination will be sent to the Medical Evaluation station. 2. Any answer that is unclear or uncertain should be directed to the Medical Evaluation station. NOTE: The use of “red” and “green” dots to indicate cleared or contraindicated individual is only a suggestion. Centers may opt to have boxes on the Screening form that indicate as such. The advantage of the sticker system is to allow for quick identification. iii. Post-Screening Flow Monitor will direct the individual to the next appropriate location (Medical Evaluation Station or Screening Station) a. Identifiers for staff C. Materials Needed at Station: i. Tables/chairs for Screening Station; chairs are only for Screening Officers ii. Screening forms (examples may be provided by DOHMH) and pens iii. Index cards/colored stickers/colored markers (two colors) iv. Tissue, alcohol hand hygiene products/dispensers, hands free wastebaskets (and additional infection control supplies, e.g. masks, as appropriate)

3. Medical Evaluation Station: The purpose of the Medical Evaluation Station (MES) is for assessing those individuals identified by the Screening Officer as having a possible contraindication to the medication/vaccination or for whom there are unclear medical issues that may prevent the individual from taking the medication/receiving the vaccination. The MES will need to have quick access to communication with both the Command and Control Station and DOHMH (e.g. Provider Access Line at DOHMH).

It is strongly suggested that medical evaluators have a separate, private station in which to work. Data from previously performed CHC POD cycle times suggested that on average, individuals spend about 5-8 minutes with the medical evaluator.

It is also suggested that more than one medical evaluator be available at any time.

A. Roles Needed/Personnel Suggested: i. Medical Evaluator (1-2): Medical evaluators will evaluate all individuals directed to them for possible contraindications to the medication. a. Staff Type: Clinical staff (i.e. RN, MD, PA)

b. Should reflect the language needs of the community being served c. Evaluate patients for possible contraindications to the medication d. Dispense medication when no patients are waiting for Medical Evaluation Note: The Medical Evaluator can also dispense vaccine to patients they screen and clear instead of sending them to the dispensing station.

ii. Mental Health Staff (Optional – 1 or more): Based on the concerns of the patients (or staff), provide mental health services to those at the POD:

a. Staff Type: Social Services (i.e. counselor, psychologist) or Clinical staff (i.e. RN, MD, PA) b. Should reflect the language needs of the community being served c. Assist the Medical Evaluator (or other staff) with the mental health needs of staff and patients

B. Logistics: i. Individuals who are reevaluated and are deemed able to receive the medication/vaccination will have their screening form clearly marked (i.e. third color sticker or color), including the signature of the person authorizing the vaccine. Patients may receive the vaccine at the medical evaluation station or be directed to the Dispensing Station. ii. Patients who are reevaluated and do have a true contraindication to the medication/vaccination being distributed will be counseled on the risks and benefits of taking the medication/vaccination. Medical Evaluator can call DOHMH to receive guidance on management.

C. Materials Needed at Station: i. Tables, chairs ii. Separate room for privacy and counseling iii. Phone for calling out as needed iv. Tissue, alcohol hand hygiene products/dispensers, hands free wastebaskets (and additional infection control supplies, e.g. masks, as appropriate) v. Pens

4. Dispensing Station: The purpose of the Dispensing Station is to provide the medication/vaccination to the individuals who have been cleared by the Screening Officer and/or the Medical Evaluator.

Note: Bottlenecks here may be avoided by assigning the different dispensing tables with different colors or numbers, making it easier for the Post-Flow Screening Monitors to direct individuals to the individual dispensing tables.

A. Roles Needed/Personnel Suggested: This may be the most important area to be sure to have enough staffing. It is also important to make sure that staff members working at this station get breaks.

In consultation with Infection Control professionals, sites should determine how frequently each Dispensing Officer should take a break to wash their hands at a sink. Dispensing Officers would alert their backfill at the time of the encounter directly before a break is scheduled.

i. Dispensing Officer (5 or more): Dispensing Officers will hand out the medications or provide the vaccination to the patients: a. Staff Type: Clinical staff (i.e. RN, MD, PA)

b. Should reflect the language needs of the community being served c. Hand out medications or provide the vaccination to the patients (Reminder: Medical Evaluators should also serve as dispensers)

ii. Runner (1-2): Ensure the logistical needs of Medical Evaluators and dispensers are met a. Staff Type: Any non-clinical (i.e. Admin, Custodial, Volunteer)

b. Work with the dispensers to replenish supplies at the station. (Except for scheduled breaks, Dispensing Officers should not leave their station.) c. Work with custodial staff to insure trash and sharps are emptied regularly

iii. Post Dispensing Flow Monitor (1): Direct patients from dispensing to the waiting area (optional) or exit (including those who received their medication from the Medical Evaluator): a. Staff Type: Any non-clinical (i.e. Admin, Custodial, Volunteer)

b. Provide additional information for patients (i.e. other services at the health center, information on insurance, make appointments, etc.) (optional)

B. Logistics: i. Post-Screening Flow Monitor will require identifiers ii. Dispensing Officer will a. Hand each individual prepackaged medication and information sheet or provide vaccination. b. Track the medication/vaccination given (i.e., name, lot number, doses). Terms of tracking (i.e. mandatory versus voluntary) and guidance on tracking will come from DOHMH for all medications or vaccines distributed by DOHMH and may vary based on the medication or vaccine being utilized. When tracking is mandatory, guidance on tracking for publicly distributed medications or vaccines will come directly from DOHMH iii. Runners will a. Stay alert to the needs of the Dispensing Officers and replenish supplies as needed. iv. Individuals will be directed to the Exit when medication/vaccination received. Ensure that the EXITS are clearly marked to show individuals where to leave. Note: Be alert that family and friends may want to wait for one another; during very crowded times, this may become a bottleneck.

C. Materials Needed at Station: i. Medications/Vaccinations a. Supplies related to above ii. Medication/vaccination information sheets iii. Tracking sheets iv. Tables, chairs v. Tissue, alcohol hand hygiene products/dispensers, hands free wastebaskets (and additional infection control supplies, e.g. masks, as appropriate) vi. Pens/pencils

5. Command and Control Station: The purpose of the Command and Control Station is to provide oversight of all stations, to be the point of communication for external agencies if questions or concerns arise and to act as the supply storage site where all equipment and materials not being used are stored. Depending on the size and security of the room, the medication/vaccines not being used may also be stored here.

Centers may choose to have a “fluid” Command and Control Station by which the POD team leader, or one of the other suggested titles below, would circulate amongst the stations to assess the situation at hand. This may work best in smaller settings in which the physical space is conducive to such activities.

A. Personnel Suggested: i. POD Team Leader (1): Manage the POD and is in charge of overseeing all aspects of its planning and execution: a. Staff Type: Senior Management

b. Oversee the management team: Assistant POD Team Leader (optional), Flow Monitor Chief and Medical Affairs Chief) c. Troubleshoot items when the management team is unable d. Handle all media inquiries e. If no Assistant POD Team Leader, perform all of his or her duties ii. Assistant POD Team Leader (Optional – 1): Assist the POD Team Leader in managing the POD and all aspects of its planning and execution: a. Staff Type: Management

b. Prior to the POD, plan all staff breaks and shift changes in coordination with the management team. c. Ensure scheduled breaks and shift changes occur in coordination with the management team d. Assist the POD Team Leader with media inquiries e. Other duties as directed by the POD Team Leader iii. Flow Monitor Chief (1): Manages all aspects of the POD related to flow to ensure that it occurs at a smooth and even pace: a. Staff Type: Management

b. Oversee the Flow Team (Greeter, Waiting Area Flow Monitor, Pre Screen Flow Monitor, Post Screen Flow Monitor, and Post Dispensing Flow Monitor) c. Troubleshoot items related to flow. Utilize the POD Team Leader for issues that cannot be resolved d. Report to the POD Team Leader and keep him or her informed of the status of the flow and any issues that may arise iv. Medical Affairs Chief (1): Manages all clinical aspects of the POD to ensure safety and smooth operations: a. Staff Type: Clinical Management (Note: for those with limited staff, the Medical Evaluator can serve as the Medical Affairs Chief)

b. Oversee the Medical Affairs Team (Infection Control Monitor, Screener, Medical Evaluator, and Dispensers). c. Troubleshoot clinical issues. Utilize the POD Team Leader for issues that cannot be resolved d. Report to the POD Team Leader and keep him or her informed of the status of all clinical operations and any issues that may arise v. Flow Monitor Chief (1): The Flow Monitor Chief oversees the various staff responsible for ensuring that flow through the POD occurs at a smooth and even pace. The Waiting Area Monitor, Pre/Post-Screening Flow Monitor, and Line Monitor report to the Flow Monitor Chief. a. Staff Type: Management b. Oversee the Flow Team (Greeters, Waiting Area Monitor, Pre & Post Screening Flow Monitor, Post Dispensing Flow Monitor). c. Troubleshoot flow issues. Utilize the POD Team Leader for issues that cannot be resolved d. Report to the POD Team Leader and keep him or her informed of the status of all flow operations and any issues that may arise

B. Materials Needed at Station: i. Tables and chairs ii. Communication equipment (phones, cell phones, walkie-talkies) iii. Extra Forms (tracking, information sheets) iv. Medication/Vaccines supplies v. Tissue, alcohol hand hygiene products/dispensers, hands free wastebaskets (and additional infection control supplies, e.g. masks, as appropriate) Part III: Job Action Sheets (JAS):

For each title in bold in the guidance document, there is a corresponding job action sheet. Each job action sheet has a brief statement on purpose, who that person reports to as well as who reports to that person, if applicable. JASs also outline responsibilities at the start, during and end of the shift.

As the POD Planning Team customizes the guidance document for its center, centers may choose to revise or rename some of the job titles. If this is done, the POD Planning Team should ensure that a corresponding JAS is also created.

Note: In the early stages of POD implementation, centers may feel that some of the job titles are excessive. The suggested job titles were based on previous POD drills or mass vaccinations/screening events done. While the ultimate decision is left to the individual centers, centers are encouraged to include as much as the responsibilities suggested as possible.

How to Use the Job Action Sheets

1. The POD Planning Team should ensure that each role in their plan has a corresponding JAS.

2. Review the JAS to ensure that each individual knows to whom and to where to report, and what their responsibilities would be at the start, during and at the end of their shift. POD Team Leader - ______Name of Individual Filling Position

The POD Team Leader is the senior staff member at the POD. The Flow Monitor Chief and the Medical Affairs Chief report to the POD Team Leader.

POD Team Leader and Chiefs should start at the Command and Control Station.

At the Start of the Shift:  Check in with Incident Commander or designee for any situational updates.  Meet with POD Team Leader from prior shift, if applicable, in the Command Station to receive updates.  Meet with Flow Monitor Chief and Medical Affairs Chief to give situation updates. Create and review the schedule for shift changes and for scheduled breaks for the team. Ensure that there is staff to provide back up during the break time and shift changes.  The POD Team Leader should follow the first few people as they go through the POD to make sure that it is running smoothly and intervene if there is a problem.

During the Shift:  Coordinate all aspects of the POD o Perform routine troubleshooting o Coordinate personnel and supply needs with Flow Monitor Chief and Medical Affairs Chief o Request additional supplies as needed from Center personnel.  Inform Chiefs of any new developments  Inform Chiefs about 15 minutes before shift change so that they know that new staff is reporting in.

End of Shift:  Run debrief meeting with all Chiefs in the Command Station to discuss any incidents that arose during the shift.  Debrief with the incoming POD Team Leader in the Command Station. Flow Monitor Chief ______Name of Individual Filling Position

The Flow Monitor Chief works with the POD Team Leader to ensure that the flow of the POD proceeds at a smooth and coordinated manner. The Line Monitor, Waiting Area Monitor, Pre/Post Screening Monitor report to the Flow Monitor Chief.

Flow Monitor Chief should start at the Command and Control Station and meet with POD Team Leader and Medical Affairs Chief.

At the Start of the Shift:  Meet with POD Team Leader in the Command Station to receive updates and to plan shift changes and breaks for staff. o Receive any updates from Flow Monitor Chief from previous shift.  Meet with Line Monitor, Waiting Area Monitor, Pre/Post Screening Monitor at ____(insert location)______to review assignments and updates. o Review break schedule and shift changes  Assess current status of communication equipment.  The Flow Monitor Chief should follow the first few people as they go through the POD to make sure that the flow is coordinated.

During the Shift:  Coordinate all aspects of the POD flow. o Perform routine troubleshooting o Coordinate personnel needs POD Team Leader. o Request additional supplies as needed from POD Team Leader o Ensure that staff are getting breaks and are alerted to when shift changes occur  Inform POD Team Leader of any new developments

End of Shift:  Debrief with respective staff.  Debrief with POD Team Leader. Line Monitor ______Name of Individual Filling Position

The Line Monitor reports to the Flow Monitor Chief. The Line Monitor ensures that individuals do not wander into non-POD areas of the clinic.

At the Start of the Shift:  Meet with Flow Monitor Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are.  Assess communication equipment  Identify who the Waiting Area Monitors and the Infection Control Monitor are.  Understand the flow of the POD.

During Shift:  Maintain order in the waiting areas/lines.  Do not allow individuals access to non-POD locations.  Alert Flow Monitor Chief of any unsafe, hazardous or security related conditions.  Gently redirect individuals who stray from POD.  Perform frequent hand hygiene.

End of Shift:  Debrief with Flow Monitor Chief.  Debrief with replacement Line Monitor. Waiting Area Flow Monitor ______Name of Individual Filling Position

Waiting Area Flow Monitor reports to Flow Monitor Chief. The Waiting Area Flow Monitor greets the incoming individuals, provides them with a number, informational handouts, and directs them to the Waiting Area Station.

At the Start of the Shift:  Meet with Flow Monitor Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are.  Make sure that communication equipment/workflow, informational handouts/materials, numbers, supplies are ready.  Identify who the Line Monitors and the Infection Control Monitor are.  Understand the flow of the POD.

During Shift:  Ask each person coming to center if they are coming for the POD.  If they are coming to the POD, hand each individual a number, [Disease] information sheets.  Direct individual to Waiting Area.  When Pre-Screening Monitor ready for individual, direct them to the Screening Station.  Maintain frequent contact with Pre-Screening Flow Monitor (e.g., walkie talkie, cell phone) to help with identifying flow buildup.  Perform frequent hand hygiene.

End of Shift:  Debrief with Flow Monitor Chief.  Debrief with Waiting Area Flow Monitor taking the next shift. Pre Screening Flow Monitor ______Name of Individual Filling Position

Pre-Screening Flow Monitors report to Flow Monitor Chief. The Pre-Screening Flow Monitors move individuals from the Waiting Area Station to the Screening Station in a smooth and orderly fashion.

At the Start of the Shift:  Meet with Flow Monitor Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are.  Make sure that all communication equipment is in working order.  Identify who the Waiting Area Monitors, Screening Officers and the Infection Control Monitor are. Understand the flow of the POD.

During Shift: . Observe Screening Officers to see when they are ready for the next individual. . Signal to Waiting Area Monitor that next individual can be sent over to Screening. Individuals should be called over in the order of the numbers given. o Ideally to have 4-5 individuals in line at a time. o Keep families together. . Direct individuals to the next Screening officer . Perform frequent hand hygiene.

End of Shift:  Debrief with Flow Monitor Chief.  Debrief with Pre-Screening Flow Monitor taking over shift. Post-Screening Flow Monitor ______Name of Individual Filling Position

Post-Screening Flow Monitors report to Flow Monitor Chief. The Post-Screening Flow Monitors direct individuals from the Screening Station to either the Dispensing Station or the Medical Evaluation Station.

At the Start of the Shift:  Meet with Flow Monitor Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are.  Make sure that all communication equipment is in working order.  Identify who the Screening Officers, Dispensing Officers and the Medical Evaluators are.  Understand the flow of the POD.

During Shift: . When an individual or family is leaving the Screening Station, take a look at the index card that they should have received from the Screening Officer. o If the index card has a green sticker, direct them to the Dispensing Table. o If the index card has an orange sticker, direct them to the Medical Evaluation Station. . Perform frequent hand hygiene.

End of Shift:  Debrief with Flow Monitor Chief.  Debrief with Post Screening Flow Monitor taking over shift. Medical Affairs Chief ______Name of Individual Filling Position

The Medical Affairs Chief coordinates with the POD Team Leader to ensure that clinical issues (triaging, medical evaluation, and medical dispensing/vaccination) are performed in an efficient and safe manner. The Infection Control Monitor, Screening Officers, Medical Evaluator and Dispensing Officer report to the Medical Affairs Chief.

The Medical Affairs Chief should start at the Command and Control Station along with the POD Team Leader and the Flow Monitor Chief.

At the Start of the Shift:  Meet with POD Team Leader in the Command Station to receive updates and to plan shift changes and breaks for staff. o Receive any updates from Medical Affairs Chief from previous shift.  Meet with Screening Officers, Medical Evaluators, and Dispensing Officers at the ____(insert location)____ to review assignments and updates. o Review break schedule and shift changes.  Assess current status of communication equipment/workflow, materials/supplies needed.  The Medical Affairs Chief should follow the first few people as they go through the clinical POD stations to make sure that the workflow is coordinated.

During the Shift:  Coordinate the clinical aspects of the POD flow. o Includes routine troubleshooting of the clinical arena. o Coordinate personnel needs with POD Team Leader for clinical stations. o Request additional supplies as needed from POD Team Leader.  Inform POD Team Leader of any new developments

End of Shift:  Debrief with respective staff.  Debrief with POD Team Leader. Infection Control Monitor ______Name of Individual Filling Position

The Infection Control Monitor ensures that proper infection control procedures are being followed by individuals and staff and ensures that environmental infection control is being performed.

At the Start of the Shift: . Meet with Medical Affairs Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are. . Go to all the stations and ensure that infection control materials are available and measures are being followed. . During the Shift: . Make sure that Line Monitors, Waiting Area Monitors. Pre/Post Screening Monitors perform hand hygiene on a regular/frequent basis. Frequent reminding is key. . As each individual enters the center, ensure that infection control measures are being followed and assist with answering questions or initial medical concerns as able. have them perform hand hygiene and give them tissues. . Make sure that at regular intervals, you wipe down the door knobs, elevator buttons, chair arms, any environmental surface that is frequented by individuals coming in.

At the End of the Shift: . Debrief with Medical Affairs Chief. Screening Officer ______Name of Individual Filling Position

The Screening Officers screen individuals for contraindications to getting the medications/vaccinations, ensures that the Screening Form is filled out, and directs the individual to the next station in the POD based on the results of the Screening Form

At the start of the shift:  Meet with Medical Affairs Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are.  Make sure that you have the necessary equipment on hand: o Pens o Extra Screening Forms o Stickers: green, orange o Landline/cellphone/walkie-talkie to allow for communication if questions

During the Shift:  Raise your hand to let the Pre-Screening Flow Monitor know that you are free to see an individual.  Complete the Screening Form o If individual has no contraindications to taking the medications: . Place a green sticker on an index card. This indicates that the individual is cleared to go to the Dispensing Station to get the medications.  Explain to individual that you are sending them to the next station to get the medicines.  Give individual the Screening Form back and index card and direct them to the Post-Screening Flow Monitor to go to the Dispensing Station. o If an individual does have contraindications or questionable contraindications: . Place an orange sticker on an index card. This indicates that the individual needs to go to see the Medical Evaluator.  Explain to individual that you are sending them to the medical evaluator to make sure whether or not they can take the medication/receive the vaccination.  Give individual the Screening Form and index card and direct them to the Post-Screening Flow Monitor to go to the Medical evaluation station.

At the End of the Shift: Debrief with Medical Affairs Chief. Medical Evaluator ______Name of Individual Filling Position The Medical Evaluator assesses individuals sent by the Screening Station for possible contraindications for taking the medications.

At the start of the shift:  Meet with Medical Affairs Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are.  Make sure that communication equipment and materials are present at station.

During shift:  When individual comes to the station, ask for individual’s Screening Form. Review what contraindication was circled.  Evaluate individual for that contraindication and determine if patient would still be able to receive medication/vaccination (i.e., relative vs. absolute contraindications). o Call NYC DOHMH for assistance.  If individual able to take medication/receive vaccination, place green sticker on index card, give individuals the Screening Form and return individual to Post- Screening Monitor to go to Dispensing Station.  If individual unable to take medication/receive vaccination, explain risk to individual of taking medication/vaccination with that contraindication. o Keep screening form. o Direct individual to exit.

End of Shift:  Debrief with Medical Affairs Chief Dispensing Officer ______Name of Individual Filling Position

The Dispensing Officers give the medication/or vaccination as directed to individuals that come to Medical Dispensing Station.

At the Start of the Shift:  Meet with Medical Affairs Chief at ____ (insert location) ______to review assignment and to receive updates. o Understand when breaks and shift changes are.  Make sure that you have the necessary equipment on hand: o Pens o Medications/vaccinations presorted and packaged o Medication information sheets o Tracking Sheet o Hand hygiene materials

During the Shift:  When individual comes to station, ask for the index card from individual.  Make sure that a green sticker is on the index card.  Document vaccination given or medication given on the Tracking Sheet.  Keep the Screening Form.  Direct individual to the Exit.

At end of Shift:  Debrief with Medical Affairs Chief IV. Recovery

During the recovery phase, the following tasks must be completed:

1. Collect all screening documents and cross reference them with the amount of supply used.

2. Separate all pediatric patients under the age of 18 and report their immunization status to the NYC Department of Health and Mental Hygiene, for medical centers and operations within the City of New York via the Citywide Immunization Registry (CIR) or the NYS Department of Health on the NYSIIS network for medical centers throughout New York State.

3. Dispose of sharps in accordance with the health center’s policy. If the POD has been operated outside of the health center’s physical boundaries, seal, collect, and transport all sharps containers to appropriate location for disposal.

4. Create a database for documentation by using at least 2 identifiers of all patients serviced in the POD. Maintain records for potential reimbursement during disasters.

5. If the POD was routine, collect all billing data and enter into EHR at the convenience of the health center.

6. Re-order lost stock as a result of POD

7. If using volunteers;

a. Perform a quality review on all work completed by volunteers b. Release volunteers per health center’s discretion.

8. Perform a hot wash and note all issues related with the operation of the POD

9. Write an After Action Report (AAR) for review by the emergency management committee.