Local Extreme Heat Planning: an Interactive Tool to Examine a Heat Vulnerability Index for Philadelphia, Pennsylvania.

Exposure to extreme heat contributes to high morbidity and mortality relative to other climate hazards. The city of Philadelphia, PA is particularly vulnerable to the impacts of extreme heat, due to the urban heat island effect and high prevalence of sensitive populations. We developed a heat vulnerability index, which identified priority areas that are most at-risk of experiencing adverse heat-related health outcomes and in need of preparedness and mitigation interventions. An interactive website was created to display the maps and allow the public to navigate the data with links to potential resources for relief from extreme heat days. Such methods can be adapted for other cities that wish to identify and target long-term priority areas.

Public Health and the Pope's Visit to Philadelphia, 2015.

Pope Francis visited Philadelphia for 2 days during September 2015. Preparedness functions managed by the Philadelphia Department of Public Health (PDPH) were similar to those of other mass gatherings but also required accommodation of special security arrangements and the location of public events in central areas of the city. Public health planning involved collaborations with multiple city, state, and federal agencies and neighboring jurisdictions. PDPH preparations encompassed incident command procedures, contingency planning, disease surveillance and prevention, food safety, vector control, BioWatch air sampling, volunteer management for first-aid services, and continuity of operations. These were based on, or informed by, existing emergency plans and prior experiences in responding to public health crises, supporting large public events, managing regional preparedness exercises, engaging Medical Reserve Corps volunteers, and executing routine functions. Although the papal visit concluded without the occurrence of a substantial public health or healthcare emergency, lessons learned have and will continue to improve coordination with partner agencies in planning and executing large-scale events, as well as managing regional disease surveillance procedures and medical volunteer engagement. Another area identified for improvement concerns enhancing the role of local health departments in planning for responses to possible BioWatch alerts.

The 49th hour: analysis of a follow-up medication and vaccine dispensing field test.

Anthrax response plans, exercises, and assessments over the past decade have focused almost exclusively on the first 48 hours of the public health response following a jurisdiction-wide exposure and provision of an initial 10-day supply of antibiotics from the Strategic National Stockpile (SNS). But mass dispensing of the subsequent 50-day course of antibiotics and administration of the 3-dose vaccine series have received considerably less attention, although these follow-up activities may prove even more complex. In 2014, the Philadelphia Department of Public Health (PDPH) made its first foray into this next frontier of mass prophylaxis planning by: (1) researching patient safety and adherence considerations relevant to the antibiotics in the SNS; (2) designing a model for a second-visit antibiotic and vaccine point of dispensing (POD), including development of an enhanced screening protocol that assumes a higher level of medical responsibility; and (3) field testing this model during a real seasonal influenza vaccination clinic to assess throughput and accuracy and to evaluate the resources needed to operationalize this model. While the observations and data presented here provide some framework for local long-term mass prophylaxis planning efforts, many areas remain undefined, including the distribution of responsibilities among the public health and healthcare communities to ensure patient safety. In addition to presenting findings, the larger intent of this article is to initiate a dialogue with other stakeholders at the local, state, and federal levels to advance long-term mass prophylaxis planning.

Efficiency and effectiveness of using nonmedical staff during an urgent mass prophylaxis response.

Using a simulated anthrax scenario, the Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to its internal population. This closed POD had developed and exercised its mass prophylaxis plan in conjunction with the local health department twice before, and the department was interested in assessing the impact of having no onsite department involvement. Two sessions were conducted as part of the overall exercise. In session 1, agency staff ran POD operations with no department involvement. During session 2, department staff provided an hour-long training session and oversaw POD operations. Mean throughput and accuracy rates of the 2 sessions were then compared to a previous health department public POD exercise staffed by department personnel and medical volunteers. The closed POD would be able to process the entire internal population in an estimated mean time of 23.9 hours. The accuracy rates for dispensing the correct medication during session 1 was 84.7% and 92.4% during session 2 (p=0.0012). Overall accuracy was significantly higher in a previous local health department public POD exercise (88.6% vs. 96.9%, p < 0.0001), as was pediatric dosing accuracy (p < 0.0001). We concluded that nonmedical closed PODs are a valuable strategy during a public health emergency that requires large segments of a population to receive medication rapidly. They must be activated judiciously, however, as their use may increase adverse events and potentially result in discontinuation of antibiotic prophylaxis should people choose not to finish the course. Local health department training and oversight reduce errors but may not always be available.

Ready or not: analysis of a no-notice mass vaccination field response in Philadelphia.

Local health departments typically rely on exercises to test preparedness capacity; however, pre-scripted drills often lack the sense of urgency that a real event would engender. No-notice, unscripted exercises that challenge staff to think critically under pressure may provide a mechanism for a more realistic assessment of preparedness capacity. The very active influenza season of 2012-13 presented the Public Health Preparedness Program at the Philadelphia Department of Public Health with the opportunity to conduct an influenza vaccination clinic at a local boarding school. Program leaders used this opportunity to design a no-notice exercise to test the ability of staff to effectively coordinate an emergency field response while simultaneously delivering a real public health intervention. On the day of the exercise, staff members were given 6 hours to plan and execute a vaccination clinic without any guidance from program leaders. Best practices observed during the exercise included: (1) early identification and mitigation of rate-limiting steps, and (2) successful implementation of a previously untested high-throughput vaccination model. Although the primary intent of the exercise was to assess the ability of staff to respond to a no-notice event, this vaccination clinic also functioned as a microcosm of a larger response, revealing several considerations related to vaccine ordering, staff resources, and throughput rates that have broader implications for public health responses to large-scale biological attacks or pandemics.