Analyzing Dispensing Plan for Emergency Medical Supplies in the Event of Bioterrorism By Young M. Lee

Focus of Paper Smallpox attack vaccination PODs examined Factors affecting POD success: – Proportion population served – Meeting mandated timeframes Examined different factors and how they affect success of POD plans

How Many PODs to Open Assumptions from Paper: Population distributed equally across PODs Throughput rate is constant Ability to transport SNS to POS is sufficient Supplies at each POD are sufficient Comment: Rather than focusing on the number of PODs, we should focus on the number of booths. Further, the number of booth-hours should be examined to facilitate flexibility in POD plans.

Simulation Model Stochastic factors considered: Quantity of SNS supplies shipped to local warehouse Quantity of supplies shipped from warehouse to PODs Delivery time to PODs Capacity of trucks used for delivery Cross shipping supplies from POD to POD Number of people showing up at each POD Arrival patterns of people at PODs Throughput at PODs

Base Case Simulation Assumptions CDC provides a number of vaccines equal to the total population The number of PODs are fixed, and vaccines are distributed equally among them The population is distributed equally among the PODs Mandated timeframe is 4 days (96 hours) People will not travel to another POD if their assigned POD is out of vaccines. 76.7% Dispensing start time is the longer of the POD activation time and SNS transport time to PODs.

Impact of Cross Shipping 96.7% Note: Fewer large surpluses or shortages Comments: How will you really know if you have a surplus? How do you determine the size of your surplus? Why not hold back a portion of the SNS at the warehouse and use it to resupply?

Impact of Variable Supply to PODs Comment: How is the author determining population distribution among PODs? 94.3%

Increased Throughput 95.5% 96.7% Cross shipping is used. Throughput increased by 40%

Impact of Safety Stock Allow for 50% more supply than demand. 94.6% 

Comments on Paper “… there would be no time to fix or adjust plan [sic] once the emergency event occurs.” “In fact, it would be very difficult to choose POD sites in such a way that the populations which each POD supports are almost the same.” Transportation of the population to the PODs is not considered.

Pilot Model: Juding Alternate Modes of Dispensing Prophylaxis in Los Angeles County By Anke Richter & Sinan Khan

POD Shortcomings and Alternatives Using PODs, LAC would need 167 geographically dispersed PODs and a staff of 48,096 Must examine alternate modes of dispensing – Delivery by US Postal Service (USPS) – Dispensing through local commercial pharmacies – Drive-thru PODs Examination based on – Speed of dispensing – Staff requirements – Security needs

USPS Delivery Security is an issue For high-crime areas, postal workers’ union demands one-on-one protection for all postal workers Voluntary for all workers, so a workforce of 25% of normal is assumed Each postal worker can reach 596 households per 24-hour period / 76 people per hour 25% * 3750 postal workers * 76 people/postal worker hour = 71,388 people/hour Compared to traditional POD, 100% staff reduction since all workers will be postal employees. (error likely due to rounding)

Dispensing through Local Commercial Pharmacies CDC (2002): There is a retail pharmacy within five miles of 95% of the US population Subset of pharmacies must be chosen to act as PODs Assuming only a single pharmacist at each location can be spared for POD dispensing, five support staff would be needed at each location (based on the 1:5 ratio of clinical:nonclinical at traditional PODs) Assuming throughput per clinical staff member is same as at traditional POD, each site can process 383 people/hour If only 5% of the 1,700 pharmacies in LAC are used, they can process 32,555/hour

Drive-Thru PODs Results from successful implementation in Orange County, FL adapted to LOC Throughput of 761 people/hour using 10 lanes, 12 medical and 58 nonmedical staff per shift. LAC average family size is 3.06, resulting in a potential of 2,328 doses distributed/per hour at each Drive-Thru POD Compared to traditional POD: nonclinical staff is reduced by 4%, no reduction in clinical staff

Comparing Alternatives

Comparing Security Using Survey of LAC Force Protection Committee Survey Committee established in 2002 to discuss and provide expert advice on all issues concerning the strategic national stockpile Includes representatives from local, state, and federal levels of the government and represents disciplines of public health, EMS, law enforcement, fire departments, and the military. Committee members were asked to rate security requirements of traditional PODs and the three alternatives from 1 (low security) to 10 (high security)

Quantitative Value Model Value functions are constructed with respect to the baseline of opening an additional traditional POD, scaling to range of [0,1], with 0 being same as opening another traditional POD.

Objectives Weighted by Force Protection Committee Each committee member was asked to weight the objectives by dividing poker chips among the objectives at each tier in the hierarchy and then recording their results

Baseline Analysis w i values came from Table 4 THE MODEL THE WEIGHTS THE TABLE

Baseline Analysis THE BAR GRAPH

One-way Sensitivity Analyses Weight of the x-axis variable/attribute was varied while holding the ratio of the other two attributes.

Two-Way Sensitivity Analysis

Varying % Postal Employees vs. Drive-Thru and Pharmacy Options

Varying % Pharmacies as PODs vs. Drive-Thru and USPS Options

Comments on this Paper If Postal Employees can be used without the need for clinical staff, why can’t PODs operate without clinical staff as well? Options favored are actually either methods of reducing the need for clinical staff (postal) or recruiting additional staff to fill the “clinical” role (pharmacies) No attention is paid to traffic concerns or parking situations Drive-Thru pharmacies?