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Enhanced Surveillance to Detect Adverse Agents - early recognition of disease outbreaks
The covert or unannounced intentional release of a biological agent could result in a major infectious disease epidemic, but might not have the obvious initial events that would call the attention of public health officials and traditional first responders. The early recognition of disease outbreaks, clusters of related illnesses, or even single unusual events, relies on frequent and swift communication between medical providers and the Health Department.
The Philadelphia Department of Public Health (PDPH) and partners have developed systems that allow for the early identification of these events. These systems monitor both key at risk population groups as well as the possible exposure patters of the general population. With the goal of monitoring the entire population of Philadelphia, the PDPH Division of Disease Control (DDC) conducts disease surveillance. As mandated by the Philadelphia Health Code, routine surveillance activities are accomplished through the Notifiable Disease Surveillance System that requires the reporting of any unusual disease or group expression of illness that may be of public concern, whether or not it is known to be of communicable nature. Routine surveillance is also performed through sentinel providers (clinicians and laboratories) for certain conditions such as influenza (flu) and other respiratory viruses. Enhanced disease surveillance activities also ensure early detection of disease through syndromic surveillance and other means.
Laboratory Capacity - access to state-of-the-art testing for critical biological and chemical agents that can cause human illness
Access to sophisticated laboratory services is important for the quick identification of infectious diseases (biological agents) and chemical agents that threaten human health. The Pennsylvania Department of Health Bureau of Laboratories operates a state-of-the-art laboratory capable of detecting biological and chemical threats. This laboratory participates in the Centers for Disease Control and Prevention (CDC) Laboratory Response Network; all public health agencies throughout the Commonwealth rely on this laboratory for the detection of biological and chemical agents that might be used as terror. The laboratory also serves as a reference laboratory for routine and emergent public health issues, including outbreak investigations, confirmation of unusual pathogens or organisms, and typing of certain bacteria and viruses, including influenza.
The Philadelphia Department of Public Health (PDPH) also operates a smaller Public Health Laboratory that provides some of these services, and coordinates with the Pennsylvania-based laboratory. Plans to expand services at the Philadelphia Public Health Laboratory so that it can participate as part of the Laboratory Response Network are in progress.
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Mass Dispensing of Prophylactic Materials - plans for mass dispensing of medications and vaccines
Because many infectious diseases can be treated and controlled with both medications and vaccines, planning for infectious disease emergencies must provide the city with the capacity for mass dispensing or vaccination. In the event of a large-scale public health emergency requiring mass prophylaxis, the Philadelphia Department of Public Health (PDPH) is responsible for providing oral antibiotics and vaccinations to the entire Philadelphia population within 48 hours. Public health officials will determine the extent and magnitude of the event and plan the needed response. Philadelphia has prepared for the worst-case scenario and, in coordination with other city, state and federal agencies, is able to provide prophylaxis for the entire Philadelphia population.
The dispensing of medications and vaccines is a core function of the Strategic National Stockpile (SNS) (link to PDPH SNS document) and Cities Readiness Initiative (CRI) (link to PDPH CRI document) programs coordinated by the Centers for Disease Control and Prevention (CDC). To rapidly provide medications/vaccine, CDC's SNS Push Pack will arrive to Philadelphia within a maximum of 12 hours following a request from the Governor, and will provide 50 tons of pharmaceuticals and medical materials. These materials will arrive at a Receiving, Staging, and Storage (RSS) site and must be quickly distributed to pre-selected locations, including Points of Dispensing (PODs). In addition to the initial 12-hour Push Pack, the SNS program, through the Vendor Managed Inventory (VMI) system, will provide supplemental medications and material until Philadelphia can replenish and sustain medications and supplies locally.
Dispensing will occur at PODs (See Figure 1) established at a variety of venues such as and recreation facilities. PODs will be located in areas that are accessible to the communities and populations most affected by the emergency. The number and size of these dispensing sites are determined by factors such as the type of agent, geography, the number of people affected, communicability of the organism, and available personnel to staff the PODs. The PDPH and the Philadelphia Office of Emergency Management (OEM), in collaboration with the Philadelphia Police Department (PPD), will activate pre-selected PODs to coordinate and deliver the necessary medical response. Information about POD locations will be provided during emergencies, through radio, television, telephone call centers, on the Internet, and through community agencies.
If the public health emergency requires medication distribution, heads of households will be permitted to obtain medications for themselves and their families. For vaccine, PDPH will encourage every Philadelphia resident to go to the POD. Everyone who is in line will be provided with medication/vaccine. Information about the medication or vaccine that is being provided will be available at the POD, through the media, the Internet, through community agencies, and from healthcare providers. People with symptoms will be encouraged to go to the nearest hospital after they have received their medication. POD line staff will distribute a patient form and assist the patients in completing the forms and answering any questions. Line staff will direct patients to a screener who prescribes medication or recommends a vaccination. The patient is then directed to the medication dispensing or vaccination area.
The POD staff will follow a command structure lead by the POD Manager. (See Figure 2)
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Testing and Evaluating Public Health Emergency Preparedness Plans - practicing, assessing, and refining the emergency plans
In 2005, the Philadelphia Department of Public Health (PDPH) conducted two pilot tests to demonstrate the ability to provide oral antibiotics and vaccinations to large numbers of people in a short period of time.
Point of Dispensing (POD) Pilot Test April 2005 ? Oral Antibiotics distribution
In April 2005, the PDPH held a mass dispensing exercise and distributed oral antibiotics to volunteer patients. The exercise?s major objectives were to test the proposed PDPH Points of Dispensing (POD) operational model with a staff of 50 personnel; and to determine the number of individuals receiving medicine per hour using a head-of-household to collect medications for an entire household.
During this POD exercise, approximately 350 Heads of Households, representing 1000 individuals, received medication per hour. In a real life scenario, PDPH estimates that approximately 800 individuals are likely to be processed per hour due to staff fatigue, possibly fewer staff numbers, smaller space in the POD, and other factors.
This head-of-household approach to mass dispensing of antibiotics was an efficient way to dispense pills to a large population in a short period of time.
Point of Dispensing (POD) Pilot Test October 2005 - Vaccine distribution
In October 2005, the PDPH held a mass vaccination exercise and provide influenza vaccine to elderly Philadelphia residents. The major objectives were to test the proposed PDPH POD operational model with a staff of 100 personnel; and to determine the number of individuals receiving vaccine per hour. During the POD exercise, approximately 650 individuals were vaccinated per hour.
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Partnering with Government and Healthcare Organizations - coordinated efforts for security, staffing, and training for dispensing medical materials and services
The Philadelphia Department of Public Health (PDPH) works closely with Government, Community Organizations, and Healthcare Agencies. In the event of a public health emergency, coordinated responses can ensure that the large number of needed personnel are trained and ready to respond. On a regular basis, the PDPH meets with the Office of Emergency Management, Police, Fire and EMS Departments, hospitals, and other city agencies to communicate and coordinate emergency response plans.
Security
The Philadelphia Police Department (PPD) is tasked with providing security to the city of Philadelphia. The PPD has surveyed pre-identified sites within Philadelphia city limits, including a Receiving, Staging, Storing (RSS) site and Points of Dispensing (PODs), to determine that the sites can be properly secured during an emergency and with security staff at each facility.
Staffing &Training
The PDPH will meet the staffing requirements for an emergency response by utilizing the personnel resources from several agencies within Philadelphia, including PDPH employees and employees and volunteers from the city's health professional schools and health service organizations. The PDPH also collaborates with the newly established Citizens Corps, the Southeastern Pennsylvania Voluntary Organizations Active in Disaster (SEPA VOAD), and the Southeastern Pennsylvania Chapter of the American Red Cross. In addition, the PDPH has established a volunteer Medical Reserve Corps (MRC) (link to PDPH MRC website) to support POD staffing needs and surge capacity needs for related aspects of public health emergency response.
The PDPH provides in-person and web-based training programs to prepare staff for a health emergency response ahead of time. In addition, on-the-job training will also be provided during the response at each POD location.
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Communicating with Healthcare Providers - communication systems allow for coordination between the Philadelphia Department of Public Health, hospitals, and healthcare providers during public health emergencies
The Philadelphia Department of Public Health (PDPH) operates several list-servs that take advantage of broadcast alerting technology using urgent fax and email. These list-servs are used to convey critical information during public health emergencies. The network of recipients or users constitute a Health Alert Network (the Philadelphia Health Alert Network, or PHAN), and include healthcare providers, hospitals, government agencies involved in public safety, and community agencies that are engaged in either health service delivery or emergency response.
If you are a healthcare professional and wish to receive alerts through this network, contact the PDPH Division of Disease Control at (215) 685-6741.
Additionally, as emergency response staff are recruited, their emergency contact information is entered into the Roam Secure Alert Network (RSAN). RSAN is an emergency communication system that stores staff emergency contact information and has the ability to send text and voice messages quickly during an emergency. In the event of an emergency, staff will be notified by RSAN and asked to respond to the alert to indicate if they are available for response. If the staff are available to respond, the RSAN system will be used to send each staff member a message with instructions on where and when to report for the emergency response. This network is currently used for emergency notification within the Philadelphia region and in other locations in the mid-Atlantic states.
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Communicating with the Media, the Community, and Special Populations - broadcast communication systems allow for transmission of critical information to government agencies and the public
Media
In the event of a large-scale public health emergency, the Philadelphia Department of Public Health (PDPH) will work with the Mayor's Communication Office and anticipates that a Joint Information Center (JIC) will be set up locally to coordinate local, state and federal communication messages for the media. In addition, local media will provide residents with up-to-date information about Points of Dispensing (POD) locations, and medications/vaccines that are dispensed at the PODs.
Community
The PDPH works with community based organizations so that during a public health emergency, community leaders can assist in delivering messages to their communities and in providing POD staff, including translators. The PDPH will ensure that multi-lingual staff are available in the PODs, based on the predominant languages spoken in the geographic area surrounding the POD. Mental health counselors will also be available to address patients? anxiety or fear.
Special Needs Populations
The PDPH has identified groups with special needs that would either be unable to use PODs or would have difficulty accessing a POD. Such groups include: detention center residents; persons who are hearing impaired; persons with disabilities; frail elderly; homeless persons; hospital patients; mentally impaired persons; nursing home residents; university students; and tourists. The PDPH plans to provide medication and vaccination directly to these groups in their respective locations.
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