Will your POD work when you need it?

Planning essential for Points of Distribution success

Points of Distribution, or POD, is a site designated for the distribution of medications or supplies in the event of a crisis or emergency. The pubic gathers at a give location or locations and materials are handed out.are the hub of pandemic planning in some communities. The POD system can be a viable option for medication distribution but is dependent on a number of factors for success.

The current points of distribution model is based on an earlier process used to receive, break down, repackage, and distribute materials/supplies from the National Pharmaceutical Stockpile (NPS). The idea was further refined for the use after experiences with SARS, H5N1 Highly Pathological Avian Flu and 2009 H1N1.

There are four basic assumptions to be considered in points of distribution planning. We assume that:

• the pathogen will be known 
• the appropriate medication/vaccine will be available
• staffing will be adequate
• civil order will be maintained

The assumption that the pathogen will be known or reliably predictable is key. Without this vital information there is little benefit to mass vaccination or prophylactic medication. We may also have to predict when a given pathogen is threatening and plan time to medicate/vaccinate our public. Many assumptions were based on a disease coming from a certain known area and estimating how long it may take for that disease to reach a given population. Many so called pandemic plans assume a disease like SARS or Avian Influenza will take weeks or months to reach us and we'll have sufficient time to put plans into action. Our experience with SARS and predictions of H5N1 and is rendered totally dysfunctional after experience with 2009 Swine Flu. To assume there will be a "lead-time" when we know a pathogen is coming is a mistake. As we have seen with H1N1 in 2009, the disease was present in various states with little or no lead-in. In that situation, we have to plan for the disease spreading beyond any given boundary by virtue of our modes of modern travel and limited surveillance ability. Without clear definition of the pathogen in question, bringing otherwise healthy people together into a central location for medication distribution may actually increase exposure. The key to success is to provide as much information as possible to the public and institute non pharmacological interventions to prevent disease spread during your distribution.  

Points of distribution planning must consider vaccine or medication availability. Vaccine or medication may not be available in quantities needed to meed the demand at a given POD site while others may be overstocked. One of the worst possible situations would be to run out of medication. Running out of medication leaves people standing in line and not getting protected, perhaps being exposed and certainly not meeting expectations. In the extreme situation, there is a risk of civil unrest (imagine being next in line and told "sorry, we just ran out) and certainly a blow to your public image.

Adequate staffing is major planning point. Staffing must be able to meet demand for service. Conducting you point of distribution under the NIMS model will be helpful. Incident Action Planning and Operation Period Planning are vital to determine staffing requirements. Managing the que and providing sanitation services, shelter from the environment, food, and medical care at POD locations are additional logistics that must be considered but may not be part of your points of distribution planning.  The people in line are y our concern and their needs must be addressed. Utilization of Federal Medical Stations as a model may be beneficial for points of distribution planning. Federal Medical Stations are part of the Centers for Disease Control and Preventions Strategic National Stockpile program and is designed to fill a gap that exists between disaster shelters and temporary hospitals. According to the CDC Works For You 24/7 Blog, Federal Medical Stations are non-emergency medical installations used during disaster situations to care for people with special medical needs and  chronic health conditions. They also include services for those with mental health issues. The CDC notes that FMS can be operational within 48 hours. See Federal Medical Stations, Mitigation Journal (December, 2012)

 Civil unrest and disobedience is a real problem that could threaten all aspects of points of distribution operation. Dealing with uncooperative persons, people with special needs, and those intent on causing problems is often beyond the scope of those working in a POD. Understand that the unrest can turn into a riot and become violent quickly especially if you run out of medication and needs are not met. Sufficient law enforcement resources must be in place to prevent or counter any disruptive situation. Law enforcement must also be able to manage traffic flow and parking.

In isolated situation  points of distribution were overwhelmed with people and had delays of several hours while other locations remained nearly silent. This may be due, in part, because  people did not know where to go, under what conditions to go, or did not understand direction. Plan for people not following direction. We can expect that once the media announces that site "A" is running with a ten-hour delay, many people will flood site "B".

Points of Distribution sites are difficult to manage and plan for. They are a part of pandemic planning, but only a part.

Additional resources:
Four pitfalls to avoid in biologic planning Mitigation Journal July, 2012
How to write you biologic plan Mitigation Journal October, 2010