Using a small-scale replica, Franklin County Health Department supervisor Angie Ruther, left, pointed out where refrigerated medications would be stores within the Metamora Church of God as board member Jennifer Profitt looked on.  Staff photo by Debbie Blank
Using a small-scale replica, Franklin County Health Department supervisor Angie Ruther, left, pointed out where refrigerated medications would be stores within the Metamora Church of God as board member Jennifer Profitt looked on. Staff photo by Debbie Blank
BROOKVILLE – What looked like an elaborate board game or one-level dollhouse with tiny figures was placed on a long table at the Franklin County Emergency Management Agency office in the county annex next to the courthouse April 16.

The model actually was a Metamora Church of God replica. Franklin County Health Department public health coordinator Faye Hay "built this and she did a wonderful job," reported grant manager Linda Vaughan.

It was the focal point of a state-required Point of Dispensing (POD) exercise. Hay explained by email when asking for volunteers, "The objective of this roundtable exercise will be to activate a POD site to provide medical countermeasures to the public in response to an anthrax release ..."

Humans can become infected with anthrax, caused by a spore-forming bacterium, through contact with an infected animal or by inhaling spores. Symptoms can range from a skin ulcer to difficulty breathing. Antibiotic treatment cures most infections. Inhaled anthrax is harder to treat and can be fatal, reports the Centers for Disease Control and Prevention.

"This exercise is designed for us to work together with our local partners, including EMA, EMS, sheriff’s office, town police, fire department, health department board members and ... staff, in order to identify strengths and weaknesses during an emergency situation."

Besides 11 FCHD staff and board members, three attended: Dr. Emily Kraft, Reid Health, Richmond, emergency physician and EMS medical director; Ryan Williams, Reid Health director of EMS and trauma; and Matt Loeffler, Franklin County 911 dispatcher.

Nurse Mary Ellen King, R.N.,reported the church has a large gym. After county heads of households enter, they would go through stations in a horseshoe shape: triage (sorting victims to determine medical priority) with nurses, pick up forms, dispensing medications, education, return forms.

Supervisor Angie Ruther, R.N., said a volunteer escort may go and get the forms for anybody who requires additional assistance (slower than other people due to wheelchair or crutches) and then help the person to the dispensing area.

There also are five counseling rooms "in case people were upset or scared" of desire more information.

Workers and volunteers would have two-way radios to communicate the need for more forms or supplies.

Medications would be stored upstairs protected by security personnel. A security person downstairs would block steps "so nobody can come up."

Indiana State Police would be there to assist. Most likely in real life, "we're going to have hundreds of people" picking up medications for their families. "We would have tons of volunteers."

The building also contains a kitchen area, where food would be prepared for workers and volunteers, and two restrooms. The backyard has a bunkhouse with space for 150. Volunteers could take shifts sleeping and showering there.

King said, "It's a very, very nice facility in case anything happens."

If anthrax is released here, the CDC, Indiana State Department of Health and local department activate the strategic national stockpile to take action to prevent the illness by handing out enough meds to the entire population over 72 hours, according to Hay. King added, "We have three hours to get it set up."

For the practice, the public health coordinator said FCHD received 300 doxycycline doses and 200 ciprofloxacin doses (although they were not actually there).

Hay said, "We're going to run through some scenarios. As we go through, you need to discuss how this should be solved."

Vaughan quizzed the group: "Two individuals are belligerent and causing quite a ruckus. What would you do?" Williams suggested having officers assist.

What if sick persons arrive? Board member Jennifer Profitt, Brookville, answered, "Give them masks immediately." Vaughan added, "You want to remove them" so others aren't exposed to the illness. EMS would be there or sick persons could be contained in the FCHD trailer, parked nearby.

A mother sent a 12-year-old to pick up meds for the household. Vaughan said, "Someone is going to have to take that child home." Health officer Dr. Michael Fain, Brookville, disagreed. "There are 12-year-olds running around everywhere all the time. Unless there is a legal authority saying you are responsibility for their welfare, they got there that way and can go home that way. This is an emergency. I don't think we need to waste resources unless we absolutely have to."

Loeffler pointed out county dispatchers can contact the family. According to Ruther, "It's really supposed to be heads of household coming. In an ideal situation, you leave the kids home."

Department secretary/registrar Mary Burk read another scenario: "Jane Doe requests help in filling out a screening form for her household." A volunteer will assist.

Fain asked, "How are you going to communicate with people?" King replied, "We have a bull horn." Profitt recommended using signs and arrows to direct visitors. The supervisor observed, "The idea is to keep it moving like a herd of cattle."

Then Burk reported, "A teen begins to have what seems to be an asthma attack." Fain's response? "Call EMS."

Vaughan read, "A person complains about not feeling comfortable filling out the health form." Profitt urged sending the resident back to a counseling room for further education. The educator "has to be a doctor, nurse, pharmacist – somebody who's licensed," according to King.

Vaughan said an individual arrives who speaks only Spanish. "Anybody at this table speak Spanish?" Profitt and Fain raised their hands. Ruther pointed out, "We could use our phones" as translators.

Vaughan reported there was scuffle in line outside. Kraft replied, "Call law enforcement."

She continued with another scenario: A woman receiving both doxycycline and ciprofloxacin demanded the same meds for her entire family. That resident would be whisked to a counseling room, too.

Burk announced, "Two volunteers haven't arrived." Kraft suggested, "Initially make contact by phone. If you are concerned ... do a welfare check."

There is heavy rain with thunder and lightning while people are lined up outside. Hay said, "Put them in the gym or hall." The Reid Health director of EMS and trauma wondered, "Can we use the sanctuary if we had to?" Ruther answered, "As a last resort."

After four more what-ifs were handled, Burk read, "An unattended bag is outside the women's restroom. How do you address this?" In unison, attendees answered, "Call security!" The supervisor asked, "If the security person thinks it's something bad, what do we do?" Fain recommended, "Evacuate the building." Then he proposed a way to prevent that problem: "Is there a policy about bringing bags into the building?" Ruther agreed, "The monitor could say, 'You can't bring that bag in. Take it back to your car.'"

The exercise ended with the health officer providing totals: 221 ciprofloxacin doses, 322 doxycycline regimens and 16 medical consultations.

Ruther noted Hay had to complete the exercise as a deliverable for the ISDH grant.

Hay said, "Everybody pitched in and did a great job."

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