VOLUNTEER TRAINING at Points of Dispensing Under the Direction of the PB County Health Department Office of Public Health Preparedness.

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VOLUNTEER TRAINING at Points of Dispensing Under the Direction of the PB County Health Department Office of Public Health Preparedness Slide 2 Overview What is Anthrax Anthrax As A Weapon Inhalational Anthrax Pathology Is it FLU of ANTHRAX How is Inhalation Anthrax Prevented/Treated Dosing Modalities Slide 3 Overview (continued) How Registration Forms are TRIAGED Acute Symptoms Screening Medication Selection Algorithm Affixing Labels to Medication Pre-Packs Patient Through-Put and Twice a Day Reporting to ESF-8 at the EOC Slide 4 What is Anthrax? Anthrax is a serious disease caused by Bacillus anthracis, a bacterium that forms spores. There are three types of anthrax: Skin (cutaneous) Lungs (inhalation) Ingestion (gastrointestinal) Slide 5 Slide 6 How Does One Get Anthrax? Anthrax is not known to spread from person to person. Humans can become infected with anthrax by Handling products from infected animals Breathing in anthrax spores from infected animal products, or intentional release Eating uncooked meat from infected animal Slide 7 Anthrax As A Weapon This happened in the US at the AMI Building, Boca Raton, in 2001 Anthrax was also delivered through the postal system by letters sent with powder containing anthrax. This caused 22 cases of anthrax infection, nationwide. Five people died of inhalation anthrax. Slide 8 Anthrax As A Weapon (contd) Causing: Widespread Fear and Anxiety Psychological Footprint greatly exceeded Medical Footprint Slide 9 Slide 10 How Dangerous Is Anthrax Anthrax is classified as a Category A Agent. Poses the greatest threat for a bad effect on public health May spread across a large area or need for public awareness Needs a great deal of planning to protect the publics health Slide 11 Inhalational Anthrax Pathology Spores enter the lungs Eventually they fall deep into the lungs and grow Bacteria multiply and release toxins Symptoms and eventually death occur Antibiotics must remain in your system to cover you as additional spores grow (60 days, if exposed) Slide 12 Slide 13 What Are The Symptoms Inhalation Anthrax, a bacteria, and Influenza (flu), a virus, can have similar symptoms. Many illnesses begin with flu-like symptoms. So, how does one distinguish between the flu and inhalation anthrax? Slide 14 Is it FLU of ANTHRAX? Symptom during past 7 daysFluAnthrax FeverYesYes AchesYesYes ChillsYesYes CoughYesPossible TirednessYesYes VomitingYesYes Runny NoseYesNo Shortness of BreathRareRapid Onset Chest discomfort/painRareRapid Onset Mediastinum WideningNoYes Slide 15 Anthrax Fatal Case Mediastinum Widening Slide 16 Laboratory Analysis of White Blood Cells Provides Clues Inhalation FluAnthrax Toxin: (Virus) (Bacteria) White Blood Cells: Counts Low High Lymphocytes High No Increase Neutrophils Low High Slide 17 Robert Stephens First Inhalation Death in US, 2008 Larry Bush, MD, Infectious Diseases at JFK Medical Center, diagnosed Mr. Stephens with Inhalation Anthrax just prior to his death. CXR Mediastinum Widening Lab Analysis of White Blood Cell Counts PCR Polymerase Chain Reaction CDC Lab Analysis provided FINAL confirmation Slide 18 Syndromic Surveillance Continual Monitoring of Chief Complaint upon Admission to Emergency Rooms coming soon to all Hospitals in Palm Beach County. ESSENCE Surveillance System was Developed by Johns Hopkins University. Slide 19 Treatment Options If Bacterial Infection (anthrax, plague), then treat with Antibiotics If Viral Infection (smallpox, bird flu), then treat with Vaccines or Anti-Virals (TamiFlu, Relenza) Slide 20 How is Inhalation Anthrax Prevented or Treated Three ORAL ANTIBIOTICS are available for the prevention/prophylaxis and treatment of Inhalation Anthrax: Doxycycline Cipro(floxacin) Amoxicillin Slide 21 Side Effects to Antibiotics Common side-effects to antibiotics include: Nausea Vomiting Diarrhea Loss of appetite Darkening of urine Headache Slide 22 Allergic Reactions If any of these allergic reactions occur, get emergency help immediately: Swelling of tongue, hands, or feet Fever Difficulty breathing Severe skin rash Slide 23 What if I Miss a Dose? Start again as soon as possible Skip only if too near your next scheduled dose Do NOT take 2 pills to make up for the missed dose Finish all your pills, even if you feel OK, unless your doctor tells you to stop If you stop taking this medicine too soon, you may become ill Slide 24 Doxycycline 100 mg OrallyTwice a Day For 10 Days A Tetracycline, NOT in the penicillin family Take with full glass of water Avoid taking antacids (Maalox, Mylanta, Tums), Questran, Colestid, dairy, iron or vitamins for 4 hours before or 2 hours after taking May make you more sensitive to sunlight wear protective clothing and sunscreen Do not take this medication if you are pregnant or suspect you may be pregnant Slide 25 Cipro(floxacin) 500 mg OrallyTwice a Day for 10 Days A Quinoline, NOT in the penicillin family Take 2 hours before/after a meal with full glass of water If nausea or upset stomach, take w/food Avoid dairy for 3 hours before/after taking May make you more sensitive to sunlight wear protective clothing and sunscreen If you take warfarin (Coumadin) to thin your blood, be sure to tell your doctor you are taking Cipro Slide 26 Amoxicillin 500 mg Orally Three Times a Day for 10 Days Do not take if allergic to penicillin or cephalosporins (Keflex, Ceclor), as Serious life-threatening reactions can occur with no previous history of allergy, including hives, swelling, and anaphylaxis Take with full glass of water Slide 27 Special Note For Children Cipro(floxacin) may cause joint problems in infants and children under 18 years of age. Report any joint pain to your doctor while child is taking Cipro. Doxycycline may cause permanent staining of the teeth in children younger than 8 years old. Teeth can become grayish in color and this color does not go away. Slide 28 Slide 29 Mixing Instructions for Infants and Children Put ONE tablet (or capsule) into small bowl Crush the tablet with back of spoon until no large pieces are seen, or open capsule and empty contents into bowl Add five (5) level teaspoons (tsps) of water or apple juice Stir until medication looks evenly mixed with liquid or juice Slide 30 Mixtures for Those Who Cannot Swallow Tablets or Capsules Prepare the mixture for only one day at a time Store mixture in a covered container and refrigerate Throw away any remaining mixture at end of each day Slide 31 Doxycycline for Infants and Children 2.2mg/kg Childs Weight (lbs.) Morning Dose Evening Dose Under 11 lbs teaspoon teaspoon 11 - 20 lbs 1 teaspoon 1 teaspoon 21 30 lbs 1-1/2 teaspoons 1-1/2 teaspoons 31 40 lbs 2 teaspoons 2 teaspoons 41 50 lbs 2-1/2 teaspoons 2-1/2 teaspoons 51 59 lbs 3 teaspoons 3 teaspoons 60 69 lbs 3-1/2 teaspoons 3-1/2 teaspoons 70 79 lbs 4 teaspoons 4 teaspoons 80 89 lbs 4-1/2 teaspoons 4-1/2 teaspoons 90 99 lbs 5 teaspoons 5 teaspoons Slide 32 Cipro(floxacin) for Infants and Children 15mg/kg Childs Weight (lbs.) Morning Dose Evening Dose Under 8 lbs teaspoon teaspoon 8 15 lbs 1 teaspoon 1 teaspoon 16 - 22 lbs 1-1/2 teaspoons 1-1/2 teaspoons 23 - 29 lbs 2 teaspoons 2 teaspoons 30 - 37 lbs 2-1/2 teaspoons 2-1/2 teaspoons 38 - 44 lbs 3 teaspoons 3 teaspoons 45 - 51 lbs 3-1/2 teaspoons 3-1/2 teaspoons 52 - 59 lbs 4 teaspoons 4 teaspoons 60 - 66 lbs 4-1/2 teaspoons 4-1/2 teaspoons 61 - 73 lbs 5 teaspoons 5 teaspoons Slide 33 Amoxicillin for Infants and Children 25mg/kg Childs Morning Afternoon Evening Weight (lbs.) Dose Dose Dose Under 10 lbs 1 tsp. 1 tsp. 1 tsp. 10 - 13 lbs 1-1/2 tsp. 1-1/2 tsp. 1-1/2 tsp. 14 - 18 lbs 2 tsp. 2 tsp. 2 tsp. 19 - 22 lbs 2-1/2 tsp. 2-1/2 tsp. 2-1/2 tsp. 23 - 26 lbs 3 tsp. 3 tsp. 3 tsp. 27 31 lbs 3-1/2 tsp. 3-1/2 tsp. 3-1/2 tsp. 32 - 35 lbs 4 tsp. 4 tsp. 4 tsp. 36 - 40 lbs 4-1/2 tsp. 4-1/2 tsp. 4-1/2 tsp. 41 - 44 lbs 5 tsp. 5 tsp. 5 tsp. Slide 34 Food and Drug Administration Discourages Widespread Use of Cipro Random prescribing and extensive use of Cipro could speed up the development of drug-resistant organisms, and the usefulness of Cipro as an antibiotics may be lost. Slide 35 Should Doctor Write an Advanced Prescription for Cipro for Emergency Use Food and Drug Administration strongly recommends that physicians NOT prescribe Cipro for individual patients to have on hand for possible use against inhaled anthrax Cipro should NOT be prescribed unless there is a clear need, so that the drug will be available when it is needed to treat other more common infections Slide 36 Incident Command System PODs POD Manager Planning Chief Greeter Situational Briefing Briefing Education Operations Chief Triage EMS Med Screening Eval Pharm Dispen Super Med Vaccine Disp Mental Health Sp Logistics Chief Staging Support Security Leader Patient Traffic Transportation Ldr Admin Chief Forms & Info Dist Communication/IT Communications Lead Public Info Officer -PIO Safety Officer Liaison Officer Slide 37 Notification via Telephone or E-Mail Palm Beach County Health Department will notify POD Managers/Contacts POD Managers/Contacts will notify POD Volunteers POD Communication System will notify constituents Slide 38 Patient Registration Form LIneLIne (Fill in Contact Information for Person listed on Line 1 at bottom of this form.) Last Name, First Name Age Age If Age Und er 19: Wei ght (in poun ds) Females: Is she: Pregnant or Breast Feeding? Yes or No PRINT First Letter of Symptom if Person had it in Last 7 Days: - Fever - Aches - Chills - Cough - Tiredness - Vomiting - No Symptoms PRINT First Letter of Medication to which Person is Allergic: - Cipro - Doxycycline - Amoxicillin - Penicillin - Tetracycline - Other - None Known St af f U se O nl y Medication Provided Do se (mg ) # of Da ys to Ta ke Qu an- tity Dis p- ens ed (#) Lot Number 1 Yes No 2 3 4 Slide 39 Authorization and Signature I am picking up medication for the person(s) listed above. If I am picking up medication for people other than myself, I am authorized to sign for these people and I agree to provide the medication and instructions to all of them. Home Address: __________________________________________ City: __________________________, ZipCode: ___________ Primary Phone #: ________________ Alternate Phone #: _____________ E-Mail: ______________________________________ Signature (of Person picking up medication): ______________________________ Printed Name:______________________________ Date: __________ Slide 40 First Priority Dispensing Volunteer arrives at POD location with a Family Member who is provided First Priority position. With a completed Patient Registration Form in hand, the Family Member proceeds through the Forms Triage and onto the Medication Dispensing Line. Slide 41 Following The Registration Form -1 Patient Registration Forms are distributed to all residents by the RA or HOA to be filled out prior to coming to the R-POD. Resident lists all members of household and possible others for whom medication will be picked up for a maximum of 15 people. To minimize traffic flow and congestion, one Family Member drives to clubhouse (the R- POD) and is directed as to where to park. Slide 42 Flow Rate Determine Weighted Average Number of People listed on Registration Forms Multiply by Number of Residences to get Estimate of Number of People To get Flow Rate, divide Number of Residences and Number of People, by Number of Hours POD will be Open Slide 43 Following The Registration Form - 2 Patient Registration Form is reviewed by a Triage volunteer who directs resident to one of three lines Express, Pregnant/ Breast or Children, Special Screening Family Member receives instruction on the medication to be provided for each member of household Family Member proceeds to Medication Check-Out line Slide 44 ACUTE SYMPTOMS SCREENING FORM For Anyone Who Presents With 3 Or More Acute Symptoms In Past 7 Days 1. Do you have a RUNNY NOSE? [ ] Yes [ ] No 2a. Have you recently found it DIFFICULT to BREATHE? [ ] Yes (Go To Q. 2b) [ ] No (Skip to Q.3a) 2b. Has it been getting worse? [ ] Yes [ ] No 2c. Do you have COPD? That is, do you have EMPHYSEMA or CHRONIC BRONCHITIS? [ ] Yes [ ] No 3a. Have you recently developed CHEST PAIN? [ ] Yes (Go to Q3b) [ ] No (End) 3b. Has it been getting worse? [ ] Yes [ ] No Summary of Responses (Circle Letters For All that Apply) A. Q.1 is NO B. Q.2a, is YES, and Q.2b ls YES, and Q.2c is NO C. Q.3a is YES, and Q.3b is YES REFER TO PHYSICIAN: Individual is to be advised to call his/her physician IMMEDIATELY, for assessment and evaluation, IF: A and B, or B only A and C, or C only A and B and C, or B and C. Dispense medication according to plan so that individual has it available for use after consulting with physician. Action Taken: Instructed Head of Household about Assessment and NEED for Consultation with Physician. [ ] Yes [ ] No Individuals Name_____________________ Interviewer Initials _____ Date ________ Slide 45 Following The Registration Form - 3 Antibiotics for entire household and other listed members/friends are picked up Each family members dose bottle is to be labeled with Name and Date Family Member exits POD and departs for home. Family Member carefully dispenses medication to family members based on label Slide 46 All Medication is Labeled with Name of Drug and Dosing DOH Palm Beach County Date and Patient DOH Surgeon General Date: _____ to be added by Patient: ______________________Head of Household HCD Pharmacies: (561) 209-2575 Each package will contain a 10-day supply of the Named medication, its dosage, and how many times a day it is to be taken. An Anthrax Treatment Information sheet explaining the medication and how is to be taken will be available at Point of Dispensing (POD). Slide 47 Head of Household Prints Date and Patients Name on Label Dept. of Health, Palm Beach County Dr. Surgeon General (FL) Date: ________ Patient: ____________________________ HCD Pharmacies: (561) 209-2575 Slide 48 Line starts outside Triage Registration Dispensing Exit Symptoms Evaluation Mental Health Symptoms well 3 plus Instructions Line 1 Line 2 Line 3 Check Out Exit Pregnant or Children Slide 49 Antibiotic Dispensing at Point of Dispensing Slide 50 Antibiotics Dispensing at POD Through-put Summaries to be prepared hourly Twice day reporting to ESF-8 at EOC, (561) 712-6408 Slide 51 Training Exercises with Consultation and Support from PBCHD - Office of Public Health Preparedness Table Top Exercise, similar to today Full Scale Exercises, to test Flow Rate Forms Triage Acute Symptoms Screening Medication Labeling and Dispensing Through-put Reporting Slide 52 Presented by The Office of Public Health Preparedness - Philip Levenstein