More than half the US population lives in cities and metropolitan areas. If a public health emergency, such as a bioterrorist attack or a disease epidemic, were to affect one of these areas, a significant number of people would require treatment and/or prophylaxis. CDC’s Cities Readiness Initiative (CRI) funds 72 metro areas to develop plans for providing antibiotics or antivirals to their entire population in the event of a large-scale emergency.
- Need for rapid response. In the event of a bioterrorist attack, metro areas participating in the CRI must provide antibiotics to their entire population within 48 hours of the event.
- Need for large-scale collaboration. Providing medication to an entire city population requires cooperation between diverse partners and thorough communication to the public.
Two Utah counties tested their ability to dispense antiviral and/or antibiotic medications to large numbers of people via bank drive-thru lanes.
Summit County Health Department and Tooele County Health Department worked with the Utah Department of Health to develop a CRI exercise that would allow two banks to function as Points of Dispensing (PODs). During “Operation Cache Out,” branches of Zions First National Bank and Heritage West Credit Union funneled exercise participants through their drive-thru lanes. Participants, including many families with young children, used cash-handling tubes to send filled-out information forms to planners inside the banks and then received fake medication via the same method. Children participating in the exercise received a one-dollar presidential coin. Each exercise occurred for 2 hours on two different Saturdays.
Aside from testing how many people could be served by a drive-thru dispensing model, the exercises also demonstrated how partners could:
- Communicate between each other
- Disseminate information to the public
- Maintain a secure environment at the banks
- Operate within the Incident Command System (ICS)
The health departments provided just-in-time training to public health, bank, and security staff working at each location.
Public information campaigns and marketing were significant components of each exercise. Because CRI activities hinge on distributing medication to every city resident, the ability to draw large numbers of people to PODs may predict how well certain locations might function as PODs in a real emergency.
Planners enlisted large groups of participants for the exercises by:
- Building public awareness. The health departments conducted a public awareness campaign during the month prior to the exercises.
- Alerting key community groups. Planners gave flyers and copies of the participant information form to area churches, schools, county buildings, and participating banks.
- Engaging the news media. Public information officers also distributed information to newspapers and radio stations.
- Using electronic media. Details about the exercises were featured prominently in the health departments’ e-mails and on their Web sites.
What made this practice possible?
- Funding from CDC’s CRI program
- A collaborative planning team including representatives from Summit County Health Department, Tooele County Health Department, the Utah Department of Health, Zions First National Bank, Heritage West Credit Union, and Avatar Solutions LLC. The exercises also involved personnel from law enforcement, fire/emergency services, search and rescue, and emergency management
- A comprehensive public information campaign involving several media outlets that communicated how important members of the public were to a successful exercise
- Engagement from both public and private partners and staff at all levels of the health department
- Planners collected data to monitor the efficiency and effectiveness of the exercises using CRI’s “Data Collection Spreadsheet for Assessing Mass Dispensing Capability in a POD Drill Using Time Studies.”
- Large-scale delivery of countermeasures. Exercises in both counties were able to provide “medication” to a total of 1,565 vehicles and 4,824 people with an average processing time of 1.28 minutes, demonstrating that banks can act as viable PODs.
- Successful engagement with banks. The effectiveness of using bank drive-thrus to distribute medications, along with Zions First National Bank’s willingness to have branches across the state collaborate with health departments, may allow other Utah counties to adapt this model for their own exercises and plans.
- Large-scale public-private collaboration. The exercises demonstrated that various agencies - public and private - could design and operate a POD, while also providing insight into additional local planning that will be required prior to an emergency.
- Improved understanding. Significant public participation bolstered the health departments’ understanding that they could effectively reach their constituents using a variety of media.
- While Utah was responsible for developing and conducting the exercises, planners wish to credit public health preparedness colleagues in North Dakota who first mentioned the idea of using bank drive-thrus for dispensing medication.
- Lessons learned by Tooele County Health Department included the observation that banks’ bigger size and prominent location required more attention being paid to traffic control and security. Tooele County also conducted their exercises while Heritage West Credit Union was open for business.