Site Considerations for Points of Dispensing after Biological Terrorist Attack

The use of points of dispensing (PODs) is commonly considered a means of dispensing medication or prophylaxis after a biological attack or disease outbreak. The ability to dispense postexposure prophylaxis (PEP) quickly through multiple PODs could save a large proportion of those who were exposed; failure in the PEP dispensing campaign could have dire public health consequences. Although preevent planning is critical to ensure a successful POD implementation, many planning efforts required to facilitate the timely dispensing of PEP have focused on staffing needs and the internal structure within PODs. Less attention has been placed on the logistical challenges of operations that occur outside PODs. This study proposed consideration of an external process (e.g., parking and traffic control) of POD planning with the internal process (e.g., staffing and equipment allocation for medical service) in an integrated manner. A VISSIM-based modeling tool was developed to implement this concept by simulating the entire process of POD operation. The interaction of vehicles movements, patients' behavior, and internal medical service procedures was successfully modeled through VISSIM's component objective model programmable interface. With generation of detailed performance measures (e.g., traffic and people queues), the impacts of planning assumptions and the implementation strategy on the effectiveness of planning for POD can be studied. A case study was conducted to evaluate use of a POD plan in West Roxbury, Massachusetts, with the modeling tool developed. This tool was able to identify the bottlenecks in POD operation and provide insights for future improvement.