The standards are geared toward 72 cities that take part in the federal government’s Cities Readiness Initiative (CRI), a program launched by the Centers for Disease Control and Prevention (CDC) in 2004 to prepare major cities and metropolitan areas to distribute antibiotics from the Strategic National Stockpile within 48 hours of a federal order to release them. Though federal law mandates that the standards be evidence-based, the Rand authors pointed out that the rarity of large-scale public health disasters means there is little evidence to base the standards on. Instead, the authors developed the standards by talking to practitioners, reviewing existing literatures, using mathematical modeling, and seeking feedback from an expert panel. Next stepsThe Rand authors suggest that HHS officials review the suggested standards, consider if changes are needed, then move forward to enact the standards. They also suggest that HHS consider whether the standards should apply to all locations that would receive antibiotics from the SNS, not just the 72 cities that participate in the CRI program. Oct 15, 2008 (CIDRAP News) The Rand Corp., responding to a request from the US Department of Health and Human Services (HHS), recently unveiled a set of proposed standards for cities to use as they establish plans to distribute antibiotics to the public in the event of a bioterrorist attack or other public health emergency. The 133-page technical report, which appears on Rand’s Web site, covers four main topics: the number and location of points of dispensing (PODs), internal POD operations, staffing, and security. PODs are places where members of the public would go to receive antibiotics or other countermeasures in an emergency. See also: Internal operationsThe scale of the public health emergency will likely guide the selection of a dispensing protocol, and the report acknowledges the need for flexibility as cities make their operational plans. But the standards would require cities to establish and exercise at least one rapid-dispensing protocol that minimizes the need for licensed medical workers and gives instructions for directing recipients through the process, selecting the medication to dispense, releasing information about the medication, and dispensing the medication. The standards are designed to allow communities to be flexible and innovative in how they meet the 48-hour dispensing goal, the report says. “Moreover, the standards are intended to provide minimal requirements and should not discourage CRI sites from exceeding them,” it states. Instead of setting targets for numbers of PODs, the standards call for cities to estimate the number of people who would go to individual PODs seeking antibiotics. Officials would then use a formula supplied in the report to determine how many PODs would be needed. Number and location of sitesThe authors recommend that the first planning step be to estimate the overall number of people who will likely come to PODs to pick up their medications, which will help them determine the number of PODs they will need. Estimating the number of people will likely depend on several factors that vary by location, such as tourism levels and the size of the urban workforce. Staffing provisionsThe authors predicted that recruiting adequate staffing for the PODs would probably be the most difficult aspect of conducting a mass dispensing operation and would present diverse challenges in different cities. “The standards development process revealed concern that uniform, one-size-fits-all staffing standards would fail to account for community differences, unnecessarily require jurisdictions to undo work already completed, and stifle innovation,” they wrote. Because rapid drug-dispensing actions are likely to push legal and liability boundaries, the standards require city officials to identify such conflicts and communicate them to those who have the authority to initiate legal changes. Another suggestion is that HHS establish an oversight committee to regularly review the standards in a way that engages stakeholders, seeks public input, and includes an appeal process. Security concernsThe standards would require cities to assess security at each POD, involve local law enforcement agencies in developing security plans, and provide for law enforcement presence at each site. In another nod to varying local needs, the authors give cities some leeway in the form of alternative standards regarding security staffing and formal law enforcement approval of security plans. For example, cities could use trained volunteers of private security firms if having sworn officers at every site were not feasible. “The standard assumes that individual jurisdictions are in the best position to define the scope of the population for whom they will be responsible for administering prophylaxis,” the Rand authors wrote. They also advised planners to factor in 12 hours for the CDC to get the drugs to warehouses and 12 hours to get the drugs to PODs. The Pandemic and All-Hazards Preparedness Act of 2006 requires HHS to develop performance standards for public health preparedness, and the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) asked Rand to develop the proposed standards, according to the report. Public health officials will also need to recruit enough staff to operate the PODs and perform quarterly drills to keep in contact with them. The authors said the staffing requirement may be very large for some locationsas many as 6,000 in some metropolitan areasso they offered an alternative standard under which officials would recruit and regularly contact only the core staff. Rand report on proposed antibiotic dispensing standards
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In light of growing concerns about the safety and security of citizens living and working along the border communities who complain of increasing attacks, particularly from the Venezuela-based Sindicato gang members, Minister of State, Joseph Harmon said that security forces were adequately equipped with resources to defend the border and protect citizens, but at the same time, they were struggling to determine the credibility of the reports they receive from those areas.“I would say that the disciplined forces there – the Police and the Army – they have the resources to respond quickly to these reports … the important thing is to getMinister of State, Joseph Harmonthese reports to them as quickly as possible so that they can respond.” And this, according to Harmon, is proving to be a challenge.The Minister of State told reporters at Thursday’s post-Cabinet press briefing that the security forces in the hinterland, particularly along the border communities, were struggling with regard to the time it takes for reports of attacks to get to them. He explained that often times when attacks occurred, the victims usually would make contact with relatives, friends, or even the media first before the security forces were able to get to the locations where the incident occurred to investigate.“It requires time (for the reports) to get to the security forces where they are based, for them to respond and to go to deal with these matters… And so, while there’s some build-up of information in Georgetown, sometimes the Policemen and the Army at Eteringbang and those locations there, they are not told right away,” the Minister noted.Added to this, Harmon, who also holds the portfolio of Secretary to the Defence Board, went on to say the security forces were faced with wastage of resources in verifying the reports of attacks that were being received.“There are also sometimes nuisance reports where persons who actually have private scores to settle make these reports to security forces and have them going after persons… So, all of these are matters which when these reports come, you have to make a careful analysis of the information before you consider it to be what you call actionable intelligence upon which the forces can be deployed,” the State Minister noted.Over recent months, there have been increased reports of attacks on Guyanese along the western border. In addition, there are also reports of the Venezuelan Army conducting exercises on its border with Guyana, raising security concerns among citizens here.However, Minister Harmon explained that without any credible evidence, Guyana was unable to approach international authorities regarding the reported actions taken by the neighbouring country to undermine its territorial sovereignty.“We cannot, as a nation, approach the international agencies, we cannot approach the United Nations with hearsay. We have to have credible information upon which we can file these reports, upon which we can dispatch note verbales, that is, things that are happening that affect the security of our borders and our citizens. But we have to have – and I want to emphasise this – credible information.“Imagine you have a report and in the era of “fake news” and all these things that are going on, and you take that and you go to the United Nations to say look this is what is happening and then you have the other side saying something like this never occurred. So, we have to have credible reports that are verifiable reports about things occurring on our border,” Minister Harmon stressed.Nevertheless, the Minister of State emphasised the importance of protecting the country’s border, and urged citizens in frontier communities to report incidents or attacks but to ensure that it is credible information and not hearsay.“Anything that occurs on the border is a matter of concern and we must pay attention to it, because we cannot have activities which threaten the territorial integrity of Guyana that goes unreported,” Harmon noted.Furthermore, in highlighting the importance of the safety and security of citizens along the border in light of these recent attacks, the Minister of State disclosed that the National Security Council earlier this week discussed the issue and coming out of that meeting was a high-level security visit to these border areas.“A very high-level delegation has gone in there, commanded by a Lieutenant Colonel from the Guyana Defence Force (GDF), a senior superintendent from the Guyana Police Force (GPF) and representatives from the Ministry of Natural Resources… They’ve had specific briefings at the Ministry of Foreign Affairs that basically deal with matters in relation to the border and the need for them to exercise caution in dealing with these matters.” He related.Meanwhile, a Parliamentary Oversight Committee on the Security Sector team, led by Public Security Minister Khemraj Ramjattan, recently visited the region. During that visit, the Committee, which comprises elements from both the Government and the Opposition, as well as personnel from the National Assembly, spoke with the ranks and the citizens in those border areas, assuring them that Central Government was addressing their concerns.Of recent, President David Granger has been visiting frontier communities along the border with Venezuela and has announced several measures to beef up security in those areas, including an increased presence of Community Policing Group (CPG) members.