Public Health Preparedness Modeling

When dispensing antibiotics, determining who should get which medication is an important question, but the rules can be confusing, and paper forms are not efficient.
Working closely with our partners at the Montgomery County, Maryland, Advanced Practice Center for Public Health Emergency Preparedness and Response, we have developed and released eMedCheck, an electronic medication screening form that can be run on a PDA.

The screening form determines who should receive Doxy, Cipro, or neither. The decision rules used in eMedCheck are identical to those in a medication screening form developed by the National Capital Region.

Instructions for downloading the software and installing it on your Palm PDA are included with the software.

How will global climate change affect public health departments? The National Association of County and City Health Officials (NACCHO), Environmental Defense Fund (EDF) and George Mason University have conducted a survey of local public health directors to answer this question. The report, published by EDF, shows that local public health directors worry that climate change will cause serious public health problems, believe that they are not ready to deal with the impacts of climate change that could occur, and desire additional resources to improve their preparedness. (Their most common concerns were heat waves, poor air quality, poor water quality, droughts, fires, and storms.) The report’s recommendations follow naturally from these beliefs. Included is the recommendation to “Develop improved climate and weather modeling capacity for local scale assessments.”

Interestingly, the report includes the following observation:

there are many opportunities for synergy between existing public health preparedness activities
(e.g. bioterrorism, pandemic flu, and all-hazard preparedness) and those addressing health threats from climate change.

If you have data on the time needed to dispense antibiotics (or other oral medications) in a drive-through POD, please let me know - we would like to include such data in our Clinic Planning Model Generator, and there are other planners who need that data also.  Thank you!

As always, my email is jwh2@umd.edu.

David Dickerson, a Strategic National Stockpile Coordinator at the Texas Department of State Health Services, has made available a set of resources for POD planning. In particular these tools are designed to help educate and recruit volunteers. You can access the resources at the following URL: www.snstools.info by using the user name “sns” and the password “tools” (note: Mr. Dickerson has given me permission to post this information).

In addition to brochures and posters to recruit volunteers, there is a large (10 MB), animated Powerpoint presentation that describes the SNS and PODs, when they would be used, and their operations. There are computer-generated videos and images of what a POD might look like if the whole thing (including a station for watching an educational video) were setup in a typical high school gymnasium, which was interesting because some jurisdictions plan to use many different rooms within a school. I’m not sure it would work very well in a gym due to possible congestion problems. But it is useful as a demonstration.

In general, the whole site is easy to use and navigate. I’m sure that public health planners around the country can benefit from these resources.

On April 3, I had the opportunity to present some of our recent work on POD resupply planning to some folks at the Metropolitan Washington Council of Governments. My presentation and the subsequent discussion focused on the operational phase, after PODs have received some initial supplies, but more needs to be delivered (because not everything arrived in time or because those directing the effort want to avoid distributing medication to the wrong place). The key idea of the plan I presented is that PODs would be continuously resupplied (from one or more local depots) during an event. Each POD would be assigned to a truck route, and each truck would continuously loop from a depot to the PODs on its route and back to the depot. At each POD, the truck would deliver just enough medication to bring the inventory at that POD back to a predetermined target level. I also presented a rough-cut planning model (implemented in a spreadsheet) for this type of operation.

The planning questions involve determining what size trucks are needed for each route (or, are evaluating whether the available trucks are large enough) and determining what the target inventory level should be at each POD. We also discussed the problem of what if deliveries to the depot (from the state or federal level) are delayed and issues related to PODs of different sizes.

If any planners are considering this problem and have developed models that they would like to share or would like more information about the models that we’re developing, please let me know at jwh2@umd.edu.

Over at LiveSmarter, Laura Milligan has included our blog in her list of top 100 academic medical blogs.  Her list covers a range of topics, including research, health news, medical technology, hospitals, and various medical conditions.  We thank her for noticing our work.

The folks at the Texas Department of State Health Services have created a vaccine refrigeration planning model that is available on their pandemic influenza web page. Dr. Cynthia Morgan led the development of the model. She emphasized in an email to me: “One important thing to note is the model takes thermodynamic into account for air circulation around master cartons. You can’t just pile them in the unit as tight as possible or there will be temperature problems.”

The model is a Microsoft Excel workbook that determines the storage space needed to keep vaccine refrigerated. The data inputs include the population to be served, the size of the vaccine storage cartons, and the type of shelving used. The model estimates the storage space needed in terms of cartons and shelves.

The Dekalb County, Georgia, Advanced Practice Center has created Master the Disaster, a tool that helps with the preparation of a tabletop exercise. According to Julie Smith, “What we wanted to do was take btCreate, which was extremely popular for several years after it came out, and create a sequel, updating it, adding more scenarios, expanding the resources section, providing better and greater interactivity, customization options and a lot more features. It also includes a 70-page Facilitator’s Guide that takes you step-by-step through everything you need to know to plan, design, conduct and evaluate a tabletop exercise, including a template for your After Action Report. The scenarios are: anthrax, botulism, hurricane, pandemic flu, plague, radiological dispersal device (RDD) and smallpox. Basically it’s btCreate on steroids.”

Julie would be happy to send you a free CD-ROM copy; her contact information is on the web site mentioned above.

Today’s webinar on the CDC stockpile routing portal to TourSolver just finished.  (There will be another one on April 2, 2008.) According to Kevin Callen, the moderator from C2Logix, there were 96 folks participating.  I was preregistered.  At the appointed time, I had to login to the website and then install the GoToWebinar viewer, which brought up a window on which I could see Kevin’s computer and a little window for asking questions.  Also, I dialed into the conference call, on which I could hear Kevin explaining everything.

He gave an overview of the software, which finds a set of routes for trucks to deliver fixed quantities to PODs in the shortest possible time.  A user has to register to get access to the software and then schedule a session (right now, only one person can use the CDC portal at a time, though that is supposed to change).  During a session, a user can link files on his computer to the software, run the optimization, get the results, change the data, and run it again to consider different scenarios.  The input data requires either street addresses or coordinates for the PODs and the RSS.  Different trucks can have different quantities and start from different locations (it appears).  The optimization cycle takes only a few minutes. The results include routes for each truck, maps, turn-by-turn directions, and the mileage chart between locations.  All can be exported to Excel, Word, or text.

Kevin answered questions and explained things clearly. Altogether, a nice webinar about a very useful planning model.

A manager at C2Logix, the developers of TourSolver, let me know that they are hosting a free seminar on their Emergency Management Logistics Routing Technology on Monday, March 31, 2008, from 1:30 to 3:30 PM at the Marriott Courtyard Dunn Loring Fairfax, 2722 Gallows Road, Vienna, Virginia 22180. If you are interested, contact Francois Coulombe at FCoulombe@C2Logix.com.