Introduction
The purpose of this paper is to develop a mass prophylaxis dispensing plan that will be used in Dallas County of Texas. The company that will be responsible for the dispensation plan will be the Federal Health Services Department in Dallas. To understand the dispensation plan, a definition of mass prophylaxis needs to be identified to better understand the term. Mass prophylaxis is the ability of a state agency or office to protect the health of its citizens through the proper administration of medical interventions that are meant to deal with a health emergency (Smith, 2007).
A mass prophylaxis plan is one that is meant to cover the whole city or state during a large-scale vaccine dispensing activity that is meant to respond to an infectious disease emergency. In the event such a health emergency arises, a point of dispensing is usually set up to ensure that the members of the public can receive emergency vaccines and medication immediately (Ryan & Glarum, 2008).
In America, the Center for Disease Control and Prevention (CDC) together with various state agencies has developed strategic national stockpile (SNS) plans that will be used in distributing and dispensing medication during a health emergency. CDC has incorporated the cities readiness initiative (CRI) into its stockpile plans to ensure that the maximum treatment throughput has been achieved in 21 states within the US.
The 2001 anthrax attacks and the recent H1N1 Influenza outbreak in the country increased the activities of CRI where attention was focused on the need to equip state and local public health authorities with the necessary equipment to deal with health emergencies rapidly and efficiently. Anthrax and influenza outbreaks spurred the United States Federal government to communicate to all state agencies the need to develop comprehensive mass prophylaxis plans that would ensure American citizens had access to vital vaccines and medications in the event of an emergency (Hupert, 2004).
Mass Prophylaxis Plan for Dallas, Texas
The State of Texas is among the 21 states and cities that are covered by the cities readiness initiative (CRI) and the strategic national stockpile plans. The various counties that fall under Texas include Anderson County, Austin County, Bailey County, Caldwell, Cherokee, Collingsworth, Harrison County, Mason County and Dallas County to mention but a few. These counties will have to plan for their dispensation plans to ensure that their populations are provided with vaccines and medical treatments within the first 48 hours of a medical emergency. During the first 24 hours of the emergency, all the counties will be provided with antibiotics that will be dispensed by SNS.
The county that will be focused on in this study will be Dallas where the mass prophylaxis plan will be used to outline the procedures needed to distribute and dispense vaccines to the citizens of Dallas. As identified earlier, the office that will be responsible for the mass prophylaxis plan will be the Federal Health Services Department in Dallas which will organize the management of any health emergencies in the county. The department is charged with the overall management of health care delivery and health care services by the various hospitals, clinics and healthcare facilities within the county (Manta, 2011). The plan will be organized into various stages or phases which are outlined below.
Phase I: The Decision to Provide Mass Prophylaxis
Providing mass prophylaxis to the residents of Dallas will be a collaborative effort between the health services department in Dallas and the Center for Disease Control and Prevention which is charged with deploying the strategic national stockpile (SNS) in the event of a health emergency. The first stage in deciding whether a mass prophylaxis plan should be considered will be to meet the criteria of health emergencies which are the confirmation of the etiologic agent, the potential of further exposure in the affected population and the availability of vaccines and medication to reduce secondary exposure of the disease to the remaining population.
The mass prophylaxis plan will only be considered once laboratory tests have confirmed the presence of an etiologic agent that is causing the disease. The confirmation of the etiologic agent will lead to the identification of appropriate prophylaxis treatments and vaccines to deal with the disease-causing agent (Madison County, 2010).
Once a potential health threat has been identified in the county, a state, and local response team will be established to develop dispensation plans as well as emergency action plans that are meant to reduce the rates of exposure. The state team that will be involved in the plan will include the Texas State epidemiologist, a medical officer, the Disaster Coordination team for the State of Texas and immunization program staff for the state. The local team that will be involved in the mass prophylaxis plan will include the Dallas medical officer, immunization specialists and emergency response team coordinator for the county(Madison County, 2010).
The points of dispensation within the county will be established based on factors such as the geographic distribution of the population in Dallas and the extent of the medical emergency in the county. According to the US Census Bureau, the population of Dallas has been estimated to be 2.2 million which has been spread out in a 974 square kilometer area. This will mean that the points of dispensation will be multiple to deal with the high numbers of people in the county during a health emergency. The modalities that will be used to deliver vaccines and antibiotics will include driving through clinics, collaboration with neighboring counties and worksite dispensation options (USCB, 2009).
Phase II: Coordination and Staffing for the Mass Prophylaxis
Once the decision to conduct mass prophylaxis has been approved, the next phase will require the response team coordinating and organizing mass prophylaxis activities with Dallas County clinics, the emergency operations center in Dallas and the public health hospitals in the various towns in Dallas. Communication systems will be developed to enable all the branches of healthcare to coordinate mass prophylaxis exercises with the state and local response teams.
An incident command structure will also be established to coordinate activities between the various units involved in the prophylaxis plan (ISDH, 2004). The coordination of activities with the Dallas County clinics will involve obtaining the relevant pharmaceuticals through the state Department of Health in Texas. This department which is covered by the cities readiness initiative is charged with the responsibility of obtaining medical supplies from the strategic national stockpile (SNS).
Once the pharmaceuticals have been obtained, the points of dispensation and clinics will be identified where the number of people meant to receive the vaccines will be estimated to determine the serving capacities of the dispensation points. These estimations will be conducted in conjunction with local health centers, clinics and hospitals such as the Baylor Medical Center, Charlton Methodist Hospital, Parkland Hospital, DHC Memorial and Jonsson Hospital to determine the size of the clinics, the accessibility of health care facilities and the adequacy of treatment rooms.
The formula which can be used to determine the maximum number of dispensing sites needed to administer prophylaxis treatments in the county will be:
Total population x 80% divided by 2 = no. of individuals to treat per day
No. of individuals to treat/day divided by 5,000 = maximum no. of dispensing sites
For example to determine the number of dispensation sites for the City of Addison, Dallas that has a population of 15,000 people and a throughput of 1,000 people per day the number of sites will be:
15,000 x 80% = 12,000 ÷ 2 days = 6,000 individuals to treat per day
6,000 ÷ 1,000 = 6 emergency dispensing sites
The results show that 6 number of dispensing sites will be needed in Addison to administer emergency prophylaxis treatments in the event of an emergency. Once the number of dispensation sites has been determined, public alerts will be issued by the Federal Health Services Department where the population in the county will be alerted on where to receive vaccines and antibiotics in the event of a disease outbreak. All the healthcare providers in Dallas and the neighboring counties will also be alerted of the emergency to deal with the high populations in the county (Massey, 2005).
The Federal Health Services Department (FHSD) will maintain an active monitoring system with all the laboratories, healthcare facilities and hospitals in the county to identify any new additional cases to the emergency. The department will issue press releases and fax statements to the various stakeholders of the mass prophylaxis exercise by providing adequate information that pertains to the disease and its prevention strategies. The department will also select the health care personnel that will be used in the various points of dispensation established within the county to administer vaccines to the citizens of Dallas. In the event the population becomes too overwhelming for this health care personnel, the FHSD must recruit volunteers that will be used to serve the Dallas community (Madison County, 2010).
The volunteers will need to undergo training on disease transmission, mass prophylaxis and immunization strategies which will be conducted by the FHSD to ensure that the volunteers can screen prospective patients for prophylaxis treatments and dispensation. The department will also ensure that the emergency response team coordinator has set up crowd control measures that will be used in directing people to the appropriate entrances in the points of dispensation. The Dallas law enforcement agency will be used to ensure security has been maintained during the mass prophylaxis in the event there is a pharmaceutical shortage (Massey, 2005).
The Dallas medical officer and the immunization specialists will be used by the department to receive the SNS packages for administering prophylaxis and immunization treatments to the public. The medical officer will review the information materials that will be used during the mass prophylaxis and will also act as a consultant for the county health officer. Once the planning for the points of destination and clinics has been completed, the next stage will involve setting up the clinics (Massey, 2005). The table below highlights the various workers that will be involved in running the prophylaxis clinics
Phase III: Conducting the Mass Prophylaxis
Once the appropriate staff has been selected to set up and run the prophylaxis clinics, the next phase will involve conducting the mass prophylaxis where the FHSD will collaborate with CDC to determine the scope of the disease outbreak based on the following criterion; the size of the initial exposure or disease outbreak, the number of people within the county that are meant to receive vaccine or prophylaxis medication, the supply of prophylaxis medication and the potential that new cases of the disease outbreak to the population will be identified based on epidemiologic surveillance.
In the event there are vaccine shortages, the state medical officer will prioritize prophylaxis administration based on the number of people who have been exposed to the disease. The medical officer will communicate this information to the workers within the county involved in the mass prophylaxis exercise to ensure that the magnitude of exposure has been dealt with (Madison County, 2010).
Before the workers administer prophylaxis treatments to the county’s population, they need to receive vaccines to the disease to reduce the exposure of the disease. Once this is done, the workers will commence screening the individual members of the population to determine their exposure to the etiologic agent. Based on these screenings the number of people in need of emergency medical services will be identified while the rest receive prophylaxis vaccines. A prioritization list will be developed based on aspects such as the one-time exposure of the individual to diseases such as anthrax or influenza or the one-time exposure of the individual from person-to-person transmission (South Nevada Health District, 2010).
During the exercise, the health information of all individuals screened and vaccinated will be collected for documentation into the county’s health systems. All the records collected from the dispensation sites will be used to monitor the exposure of the disease within the county. During the immunization exercise, runners or walkers together with the county police officers will delineate traffic patterns to ensure the queues move smoothly by erecting barriers and traffic cones. People on wheelchairs and the disabled will be directed towards separate areas of treatment to ensure that they receive specialized immunization services (Hupert, 2004).
Phase IV: Post Clinical Activities
Once the relevant workers have been selected and trained and the clinics have been set up, the next stage will involve compiling the expenditures needed to manage the clinics. In the event a health emergency is announced by the County Governor, the Federal Health Services Department in Dallas will comply with the County Emergency Finance Protocol developed for all counties by the Federal government in the United States. The department will also conduct active surveillance of the disease agents by referring to information on the last known disease outbreak within the county or the State of Texas. This will be important in determining the incubational period for the disease-causing agent during the emergency outbreak (Hupert, 2004).
With regards to protocols, the Epi Teams will be responsible for developing protocols that will be used to determine the level of communicable disease surveillance needed to manage the health crisis. The Epi Teams in Dallas County will be made up of the Public Health Officer, the Public Health Board of Dallas County, Baylor Medical Center Laboratory and Charlton Methodist Hospital. The Epi team will be contacted on the risks of the disease as well as the number of people within the county’s population that have been exposed to the disease. Once the last identified case of the disease outbreak has been dealt with, the FSHD will update the local media on any further cases of the disease outbreak and exposure as well as the control measures that will be used to manage the disease (Madison County, 2010).
The successful completion of the mass prophylaxis exercise will warrant an action review report of the various clinics involved in the dispensation exercise and their emergency response to the situation. This will enable the department of health services and other agencies involved in the mass prophylaxis exercise to determine whether the response was effective in dealing with disease exposures and whether there were any problems during the dispensation exercise. This will enable the Epi Team to adjust the protocols to ensure that future problems do not arise during mass prophylaxis within the county. The review will then be documented for distribution to the Public Board of Health in Dallas as well as to all the health institutions within the county (Madison County, 2010).
References
Hupert, N.H., (2004). Community-based mass prophylaxis: a planning guide for public health preparedness. New York: Diane Publishing Company Indiana State Department of Health (ISDH)(2004). Planning mass prophylaxis. Web.
Madison County (2010). Protocol for mass prophylaxis or immunization clinics. Web.
Manta (2011). Federal health service Texas department. Web.
Massey, M.S., (2005). Hospital-based first responder mass prophylaxis plan. California: Naval Postgraduate School.
Ryan, J.R., & Glarum, J.F., (2008). Biosecurity and bioterrorism: containing and preventing biological threats. Burlington, Massachusetts: Butterworth-Heinemann
South Nevada Health District (2010). Emergency operations plan: mass prophylaxis. Web.
Smith, C.L., (2007). Involving corporations in dispensing during mass prophylaxis.
Monterey, California: Naval Postgraduate School United States Census Bureau (USCB)(2009). Fact sheet: Dallas County, Texas. Web.