Picking the right POD design: Segmented or nonsegmented?

In the wake of a bioterrorism attack requiring the release of the Strategic National Stockpile (SNS), local planners will have to set up points of distribution (PODs) for antibiotics and other medicinal interventions. Though stressing there is no right or wrong answer to the question, planners must decide initially whether there PODs are going to be segmented or nonsegmented, noted Curtis Mast, MS, SNS exercise coordinator at the Centers for Disease Control and Prevention (CDC).

"Segmented operations mean physically separated pre-prophylaxis activities from the actual dispensing of medication," he explained during a satellite training broadcast. Under the segmented strategy, the public is instructed to gather in one location, where they could be screened, triaged, and given the required educational materials. Then they are transported in groups to the actual POD site to receive medication.

"The benefits of a segmented approach include reduced parking and traffic congestion at the POD, indirectly improving security at the POD by controlling access to it," Mast added. The segmented design also potentially decreases the number of worried well who show up for antibiotics, allowing a means to regulate the flow of people into the POD site and balance public flow to all sites.

"With a segmented approach, you have to consider the additional layer of logistics," he said. "You’ll need to provide buses, drivers, and fuel at the POD locations; and you must consider the cost for each of these items when planning." In a nonsegmented approach, all aspects of POD operations are conducted at one location. "POD sites must be large enough to keep several hundred or possibly even thousands of people under cover and out of the weather. Protecting people waiting in line from excessive heat, cold, rain, and snow is very important."

At a minimum, each site distributing antibiotics must have electricity, heat, and air conditioning, a receiving area for supplies that is out of the public view, plenty of water, and space for parking. "One big concern is parking," Mast noted. "One of the things that the SNS program discovered during our research was that the number of abandoned cars increased proportionally to the attack rate of the illness. Once you screen someone out of the crowd as being sick and transport them to the hospital, you have an abandoned car. How would you handle this? Are you planning to use tow trucks?"

One approach is to screen people in their cars, directing those who need medical care to area hospitals. "Another drawback to the nonsegregated approach is that the public — and not you — controls the access to the site," he added.