The 2001 anthrax attacks, the 2005 Gulf Coast hurricanes, and the continuing threat of an avian flu pandemic have pushed public health emergency preparedness to the top of the national agenda. Accordingly, Congress and the White House have invested over $7 billion since the 9/11 attacks in efforts to upgrade the nation’s ability to address bioterrorism, natural disease outbreaks, and the health effects of natural disasters.

Despite encouraging anecdotes, the absence of performance standards and metrics for preparedness make it difficult to say whether the investments have left the country better prepared. The Pandemic and All-Hazards Preparedness Act (PAHPA) of...

As noted in Chapter One, the CRI program is predicated on the goal of ensuring that CRI sites can administer prophylaxis to their entire populations within 48 hours of the decision to do so. The challenge, therefore, is to identify minimal POD infrastructure standards that are likely to ensure that CRI sites are able to meet this goal during a real operation.

In this chapter, we describe the approach used to develop the proposed standards, including the sources that informed our process.

The rarity of large-scale public health emergencies, while fortunate, means that there is little experience on which to...

This chapter presents standards that apply to the entiresetof PODs to be located throughout a community.

First, the standards seek to ensure that thenumberof PODs in a community is sufficient to meet the CRI program goal of providing medications to the entire population within 48 hours of the decision to do so. This aggressive timeline will often require large numbers of PODs and it is essential that jurisdictions have clear guidance in identifying the minimum number needed. Second, the standards address thelocationof PODs. A motivation for location standards is to ensure that access to...

In routine circumstances, such as annual influenza vaccination clinics, PODs might include a fairly broad range of functions, including thorough client education and detailed screening for contraindications. In such circumstances, PODs prioritize accuracy over speed. In contrast, during a large-scale anthrax attack or similar scenario, PODs will have to provide a large number of people with prophylaxis in a short amount of time, often using as few POD staff as possible. The requirements of a large-scale emergency, especially the need to serve a large number of clients, may necessitate reducing the amount of time spent with each client and reducing...

Perhaps the most difficult aspect of conducting a mass prophylaxis operation in the CRI scenario is having sufficient staff³⁴ to operate the PODs. Jurisdictions must determine the number of staff needed to operate each POD at the level required to handle the number of people who will come to it seeking prophylaxis. Further, jurisdictions need to recruit staff in sufficient numbers and maintain the ability to contact them so that they can be quickly mobilized in the event of an emergency.

To that end, we recommend the following standards on the staffing of PODs. (In the case of Standards 3.3...

The main challenge in developing appropriate standards for POD security is to ensure that a comprehensive set of security measures is in place while also ensuring that the measures are not overly prescriptive in terms of how security operations are conducted. The latter point is especially important for security because many of the required security functions (e.g., crowd and traffic control) are provided by organizations outside of the traditional public health community and are conducted according to established standard operating procedures specific to each organization.

With these principles in mind, we recommend the following standards on POD security. In the...

This report presented recommended minimal infrastructure standards for PODs. The standards focus on the number and locations of PODs, internal POD operations, POD staffing, and POD security. This concluding chapter briefly summarizes key features of the recommended standards and offers next steps.

An overriding consideration that resulted from analysis and consultation with the expert panel and other stakeholders was that many different infrastructure configurations can lead to the same operational output. The expert panel counseled strongly against inflexible numerical thresholds and argued in favor of standards that provide appropriate flexibility and responsiveness to state and local needs.

Thus, rather than...