Points of dispensing (PODs) sites located in schools or community buildings are a standard part of preparing to provide medication or vaccine to the public during an infectious disease outbreak or bioterrorist attack. Push methods – ways to get antibiotics or other forms of treatments to people's residences – are less common, yet may offer significant benefits in terms of social distancing, traffic control, and personal comfort during an emergency.
The Chesapeake Health Department (CHD) in southeastern Virginia serves a population of approximately 225,000 people, many of whom live in residential areas of the city. As part of a Cities Readiness Initiative (CRI) program, emergency planners developed a strategy to deliver antibiotic kits to all residences within the city limits during an emergency. CRI guidelines require a method designed to ensure access to medical countermeasures for city residents within 48 hours of a bioterrorist attack.
CHD developed a program to use public school buses filled with antibiotic kits to ensure that all 90,000 residences in Chesapeake would receive prophylaxis following a bioterrorist event. Volunteer staff were integral to the process of assembling and delivering the kits. When the plan was ready to be exercised, bus drivers and Medical Reserve Corps members volunteered their time, the City of Chesapeake offered the services of city employees, and schools graciously covered the cost of fuel for these public health efforts.
Annual exercises test CHD's proposed strategy for pushing emergency antibiotics during an anthrax attack. During the "Special Delivery" exercise in 2007, one bus driver and four volunteers were able to map city routes and deliver antibiotic kits to 934 residences by hanging the bagged kits on their doorknobs. Two follow-up exercises in 2008 involved numerous county agencies in Emergency Operations Center (EOC) planning and used distribution of antibiotic kits in mailboxes to reach rural and low-population areas of Chesapeake.
Planners have set aside eight hours for assembly and delivery of kits, although exercises have shown that a fleet of approximately 203 school buses staffed with four volunteers each can cover city residences in approximately five to six hours. The day-long exercises include just-in-time training for volunteers and assembly of kits containing 10 days of doxycycline tablets and instructions for their use, a description of the anthrax attack scenario being exercised, information about anthrax, and recommendations for treatment or prophylaxis in four languages. Volunteers delivered kits door-to-door based on GIS maps of 203 routes.
As demonstrated by annual exercises, CHD's push method requires significantly less time to complete compared to more traditional antibiotic "push" strategies. Other benefits to CHD's efficient method and use of city resources include preventing traffic congestion that might occur should residents be asked to visit a POD site within 48 hours of a bioterrorist attack, allowing people to remain with their families and receive antibiotic kits without scheduling a pick-up time, and using a relatively small number of volunteers for a single eight-hour shift. Additionally, CHD's push method may encourage social distancing if it were used to deliver prophylaxis, vaccine, or treatment during an infectious disease outbreak.
CHD's ability to create a successful push program relied not only on significant public health planning, but on the formation of partnerships with city employees, public schools, emergency management and law enforcement officials, and volunteers. The strategy depends heavily on the reliability of volunteers and workable transportation. CHD estimates that it will need the effort of approximately 1,000 city employees in a worst-case scenario. Other considerations for this type of a push program include potential need for increased security around buses filled with medical countermeasures and targeted communications for residences regarding their eligibility for the push program.
Although CHD still plans to operate traditional PODs in the event of an anthrax attack, the push method will play a large role in distributing antibiotics to much of the city's population. Volunteer involvement, partnerships with various governmental agencies, and significant support from city officials combined to form a strategy that considers the needs of both public health and the people it serves during an emergency.