National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Evaluation of the Washington State National
Pharmaceutical Stockpile Dispensing Exercise1,2.
Part II – Dispensary Site Worker Findings
Randal D. Beaton, PhD, EMT, Research Professor
Dept. of Psychosocial & Community Health
University of Washington
Captain Andy Stevermer, MN, ARNP
Department of Health & Human Services
Office of Emergency Response
Julie Wicklund, MHP, Bioterrorism
Surveillance & Response Program Manager
Washington State Department of Health
David Owens, Contingency Planner
Office of Risk Management
Washington State Department of Health
Janice Boase, RN, MS, CIC, Assistant Chief
Communicable Disease Control
Epidemiology and Immunization Section
Public Health – Seattle and King County
&
Mark W. Oberle, MD, MPH, Professor & Associate Dean
School of Public Health & Community Medicine
University of Washington
This evaluation research was supported by the University of Washington School of Nursing, Dean’s Excellence in
Nursing award to the first author.
2
We would also like to acknowledge the assistance of L. Clark Johnson, Ph.D., Research Associate Professor of
Psychosocial Community Health for his significant contributions as data analyst.
1
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Abstract
On January 24, 2002 the Washington State Department of Health (DOH), in collaboration
with local and federal agencies, conducted an exercise of the CDC’s National Pharmaceutical
Stockpile (NPS) dispensing portion of the Washington State plan. This exercise included predrill planning, training and the orchestration of services of 40+ dispensary site workers. These
workers provided education and post exposure prophylaxis for over 230 patient volunteers in the
aftermath of a simulated exposure to B. anthracis. This article discusses findings of a post-drill
questionnaire completed by 90% of these dispensary site workers who provided triage,
education, dispensary, security and other services during this exercise. In general, this
dispensing drill promoted confidence in the worker participants and provided an opportunity for
these participants to coordinate their activities. This mock bioterrorist preparedness exercise
allowed worker participants and observers to review and evaluate the Washington State plan for
dispensing the NPS. This paper is apparently the first published account of dispensary site
worker’s subjective impressions and quantitative analysis of their post-drill opinions following a
simulated bioterrorist post exposure chemoprophylaxis dispensing exercise.
Key words: Medication dispensing Center, bioterrorist event, National Pharmaceutical Stockpile
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Introduction / Overview
In the aftermath of the anthrax attacks on the Eastern Seaboard of the US in the fall of
2001, public health authorities advised more than 30,000 individuals who may have been
exposed to anthrax spores to take oral antibiotics [1]. Medication dispensing centers were set up
in the affected metropolitan areas to triage and provide prophylaxis for individuals potentially
exposed to this bioterrorist agent [2]. Although the Department of Health and Human Services
now requires all states receiving federal bioterrorism funding to have plans “to receive and
distribute critical stockpile items and manage a mass distribution of . . . antibiotics . . .” in the
aftermath of a widespread bioterrorist attack, there has been very little research to date on how
these dispensing centers should be designed, staffed or operated [3]. The goal of this research
article is to describe and discuss selected outcomes from a large scale dispensing exercise from
the perspective of the participating site workers who screened, triaged and operated the
dispensing center in the aftermath of a simulated bioterrorist event.
On January 24th, 2002, the Washington State Department of Health (DOH) in
collaboration with the Public Health of Seattle, King County, the Seattle Fire Department, the
Department of Health and Human Services Office of Emergency Preparedness, the University of
Washington, Harborview Medical Center, U.S. Department of Defense, the Spokane Regional
Health District, the Tacoma – Pierce County Health department and many other local health
jurisdictions conducted a demonstration of bioterrorism preparedness, specifically designed to
test the dispensing portion of the National Pharmaceutical Stockpile of the Washington State
plan.
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
National Pharmaceutical Stockpile Program
The Centers for Disease Control & Prevention (CDC) has developed and is charged with
overseeing the National Pharmaceutical Stockpile Program. The mission of the CDC’s National
Pharmaceutical Stockpile program (NPS) is to ensure the availability of life saving
pharmaceuticals, antibiotics, chemical interventions, as well as medical supplies, and equipment
and their prompt delivery to the site of a disaster, anywhere in the United States. The NPS is
available to supplement the initial response to an incident of biological or chemical terrorism.
That response will come from local and state emergency, medical and public health personnel.
A primary purpose of the NPS is to provide critical drugs and medical material that would
otherwise be unavailable to local communities. CDC’s NPS is a unique resource available for
immediate deployment to any US location in the aftermath of a biological or chemical terrorist
attack directed against a civilian population [4].
Bioterrorism Preparedness: Mass Antibiotic Dispensing Exercise
The goal of this bioterrorism preparedness exercise was to demonstrate and test the State
of Washington State’s plan for dispensing the NPS. To accomplish this goal necessitated the
planning, cooperation and coordination of the activities of personnel from various state, local and
federal agencies as well as the orientation and training of the dispensary site workers. The
dispensary site worker groups included screeners, triage, educators, security, dispensing staff
(including pharmacists and pharmacy technicians) as well as other dispensary site workers who
provided ancillary and supportive services. The various duties, tasks and responsibilities of these
dispensing site workers conformed to the Washington State’s DOH dispensing site template and
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were expressly formulated to provide time sensitive education and post-exposure prophylaxis to
large numbers of actual victims of a bioterrorist event or, in the case of this exercise, to volunteer
patients in a simulated B. anthracis exposure. Each dispensary site worker group had a specific
set of job duties and responsibilities and all dispensary site workers received pre-drill training
and/or orientation.
More complex than a tabletop exercise [5], this NPS dispensing drill required an
extraordinary degree of interagency planning, a facility and the recruitment of human
subjects/volunteers. This dispensing drill also entailed the orientation and/or training as well as
the coordinated participation of over 40 dispensing site workers, a patient flow scheme and post
exposure prophylaxis of hundreds of simulated “anthrax exposed victims”. Part I of this two part
series of NPS exercise evaluation reports detailed the volunteer patient outcomes and illustrated
the distribution center’s patient flow floor plan [6]. The simulated mass distribution of
antibiotics consisted, in most cases, in the dispensing of individual packets of candy representing
the emergency rations of antibiotics that would, in all likelihood, be dispensed in the aftermath of
a mass exposure to B. anthracis aerosol [1].
The 18 confirmed bioterrorism-related cases of anthrax in New York, New Jersey,
Washington DC, Florida and Connecticut in October/November of 2001, illustrated that the
“threat” of bioterrorism was real [7, 8]. Guidelines for post exposure prophylaxis to prevent
inhalational anthrax following the release of B. anthracis aerosol have been promulgated by the
CDC and call for the administration of either ciprofloxacin or doxycycline as first line agents [9].
However, the epidemiological circumstances surrounding a particular B. anthracis aerosol
release and ongoing case monitoring are needed to identify high-risk groups and to direct needed
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follow-up care [10]. For example, on October 15th, 2001 a staff member opened a letter sent to
Senator Daschle in the Hart Senate Office Building. A white powder, which later tested positive
for anthrax, was aerosolized upon opening. Staff members in affected offices in the Hart Senate
Office Building were evacuated and later offered post exposure antibiotics [11].
The January 24th, 2002 NPS Dispensing Drill: Exposure Scenario
An anthrax exposure scenario similar to the October 15th, Hart Senate Office Building
exposure was created for the purposes of the NPS dispensing drill. In essence, the NPS drill
scenario described a plausible exposure to B. anthracis aerosol and is described in more detail in
Beaton et al [6]. Over 230 students, observers and University Staff members volunteered to roleplay a “potentially anthrax exposed” community member seeking antibiotics. Various patient
scenarios expressly created for purposes of the exercise are also described in Beaton et al [6].
Dispensary Site Worker Survey Instrument
The dispensing site worker survey was designed to assess the dispensing site workers’
appraisals and drill impressions immediately following the exercise. DOH and program
personnel felt it was important to survey dispensing site staff immediately post exercise to
discern what they felt “went right” and what “needed to be improved” in future drills (or in the
event of an actual large scale dispensing or inoculation effort.) The authors also felt it was
important to assess the psychosocial impact(s) of the drill process, if any, on the workers
participating in the drill.
In addition to basic demographic questions (gender and age), worker survey participants
were asked to respond to a total of 11 questions. Dispensing site worker survey participants
were asked to:
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1. Identify their specific role in the drill,
2. Evaluate the drill site in terms of how well it met their specific needs,
3. Evaluate the adequacy of their pre-drill training,
4. Estimate (in minutes) how long it took for them to “feel comfortable” with their specific
drill tasks and duties,
5. Rate the degree to which they felt that they had all of the equipment they needed “to do a
good job”,
6. Rate their physical comfort in their dispensary site workspace,
7. Estimate how long (in hours) they could perform their specific drill tasks (uninterrupted)
in an effective and safe manner,
8. Report if there were any distractors that interfered with their drill tasks (and if they
existed, to identify them),
9. Rate their confidence in their communities’ ability to respond to this type of bioterrorist
event in their community,
10. Rate the degree to which they felt this drill affected their perceived confidence in their
community’s ability to respond to this type of bioterrorist event in their community, and
11. Rate the degree to which they felt more or less prepared/competent after this drill.
Most of these dispensary site worker survey items employed a 0 – 100 visual analogue
scale (VAS) and asked respondents to rate the degree to which they agreed or disagreed with a
specific statement and/or to express their opinion using the VAS and explicit anchors. The VAS
is a self-report measure, which can yield a reliable, and a valid measure of a particular subjective
experience or opinion [12].
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All dispensary site workers were also asked to provide general and specific written
comments and feedback about the dispensing drill, but their qualitative remarks, with a few
exceptions, are not presented here. At the completion of the exercise dispensing site workers
were given the opportunity to respond to an anonymous “worker” survey. This dispensary site
worker survey and their anonymous participation as subjects conformed to the UW Human
Subjects Use Board Requirements.
DISPENSARY SITE WORKER FINDINGS
Sample/Sampling Procedures
All dispensing site workers (n = 48) were given the opportunity to complete
questionnaires on site immediately following the drill. All dispensary site workers had the
training, credentials and/or licensure required to perform their worker specific duties at the
exercise. The following findings are based on replies of dispensing site workers who completed
questionnaires (n = 43;  90% rate of response) after they had finished their duties. (Survey item
n’s ranged from 39 – 43 since some survey items for some respondents were left blank or were
unscorable). An equal number of men and women with a mean age of nearly 44 y.o. completed
dispensing site worker surveys. Table 1 documents the frequencies and respective percentages
of the various dispensing site worker roles reported by the worker survey respondent sample (n =
43).
Survey Results
Table 2 shows the content and descriptive statistics (means and standard deviations) for
dispensary site workers for survey items #2 - #11. As shown in Table 2, the majority of workers
“agreed” to “strongly agreed” with the statements that this dispensing site location met my needs
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(item #2), that my “workplace was physically comfortable” (item #6) and that “I had all of the
equipment needed to do a good job” (item 5). Regarding the latter, the specific equipment
“needed to do a good job” varied widely depending on the worker group, e.g. for the educators it
may have included an overhead projector and for security it may have included a portable radio.
There was a strong correlation (r = .62; p <.01) between these items #5 & #6 in the dispensary
site worker survey participants (n = 41). Also, as shown in Table 2 and in Figure 1, the majority
of dispensing workers felt their “training prior to the drill was adequate”; (>60% either “agreed”
to “strongly agreed” with item #3). A significant positive correlation existed (r = .40, p <.01)
between the worker participants’ perception of a physically comfortable workplace and their
subjective ratings of their pre-drill training. Figure 2 depicts the frequency histogram of the time
(in minutes) survey respondents felt “it took to feel competent with (their) assigned task” (item
#4). The reported times it took dispensary site workers to feel competent ranged from 0 – 30
minutes. However, the mean reported time required for site worker survey participants “to feel
competent” after the exercise began was just 11.0 minutes, with a mode of 0 minutes. The
majority (75%) of dispensing site workers reportedly felt that it took five minutes or less for
them “to feel competent with their assigned tasks”.
Figure 3 depicts the frequency histogram of the amount of time (in hours) that the
dispensary site worker survey respondents felt that they could continuously perform their
(specific) tasks safely and effectively (item #7). Though the mean for the respondents was
approximately 6.9 hours, approximately 25% of the workers felt they could work continuously
for only four hours or less. Figure 4 depicts results for item #7 by worker group with the
corresponding 95% confidence bars. Both education (n = 6) and triage (n = 5) worker groups
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
reported that they would continuously work safely and effectively for a significantly fewer
number of hours (mean  4 hours) compared to the security (n = 5) worker group (Scheffe post
hoc test; p’s <.05).
Most of the dispensing site workers were somewhat to completely confident (VAS 50 to
100) in the ability of their community to respond to a bioterrorist event like the one simulated in
this drill (See Figure 5). However, as shown in Figure 6 the perceived “community confidence”
ratings of the educator worker group was statistically lower (self-rated less confident) than that
reported by the security site worker group (Post hoc Scheffe test, p <.05). Finally, and
importantly, the vast majority of dispensing site worker survey participants reportedly felt their
“community/preparedness” to respond to a similar bioterrorist event had been enhanced by their
participation in the NPS drill (see Figure 7). There were no differences between the various
dispensary site worker groups on this measure of the psychological impact of drill participation.
DISCUSSION
A 90% rate of participation is generally considered good to excellent for survey samples
and strongly suggests that the worker sample was representative of the dispensing site worker
population present at the drill [13]. However, comparisons between the various dispensing site
“worker role” groups on individual survey items were problematic because of the small numbers
of participants in these worker groups and a corresponding lack of statistical power [14].
Most of the dispensing site workers in this investigation agreed that the dispensing site
location met their specific needs and that their training prior to the drill was adequate. Though a
small minority of dispensing site workers did not feel their pre-drill training had been adequate,
most dispensary site workers felt competent to perform their dispensing tasks within minutes
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
(mean = 11 minutes) after the drill had begun. Most dispensary site drill workers also felt their
workspace was comfortable and that they had all of the equipment they needed to do a good job.
There was, however, a wide range of estimates (from 2 – 14 hours) as to how long a given
dispensing site worker felt they could perform their specific duties continuously, safely and
effectively (See Figure 3). Educators and triage workers reported that they could work
continuously (safely and effectively) for fewer hours, on average, than other dispensing site
workers. This is important since staffing levels at a medication distribution center may be a
critical and limiting factor in sustaining a protracted (“24/7”) response for the aftermath of a
bioterrorist incident [15]. If this finding is replicated in future drill exercises it suggests some
differential scheduling and/or workforce planning considerations for specific dispensing site
worker groups.
About one third of dispensing site worker reported the presence of “distractors” that
interfered with their ability to perform their duties. From a review of their qualitative replies,
these reported distractors, primarily were limited to invited site observers, cameras and “noise”.
Again, the reported presence of distractors in even a minority of site workers in such a wellplanned and well-controlled exercise is of some concern since distractors could conceivably alter
their performance in a medication-dispensing center in the aftermath of an actual bioterrorist
attack.
Most dispensing site workers were “somewhat” to “completely confident” in the ability
of their community to respond to this type of bioterrorist event and most also felt that their
participation affected their related confidence to respond to this type of bioterrorist event to
“some degree” to “completely”. Importantly, the clear majority (70%+) of dispensing site
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
participants felt their participation as workers in the exercise enhanced their perception of how
prepared/competent they felt their community was to respond to this type of bioterrorist incident.
Only a single dispensing site worker participant (out of a total of 43 participants) felt much less
confident/competent after the NPS dispensing drill. Clearly, the dispensary site worker survey
participants felt that the drill was a process/event that had positively affected their perceptions of
how competent/prepared their community was to respond to a similar bioterrorist incident. This
important effect of enhanced confidence following a disaster training exercise has been
previously identified [16, 17, 18] and may be one of the most important outcomes of such
exercises.
The Top Officials (TOPOFF) exercise measured federal and state bioterrorism
preparedness to a simulated plague attack on the population in and around Denver CO, and
included a model antibiotic distribution center [19]. Also, while there have been a few prior
reports of mass immunization efforts in the aftermath of actual disease outbreaks [20, 21, 22],
and computer modeling of hypothetical antibiotic distribution center based on various
bioterrorism response scenarios [15], this is apparently the only report of dispensary site
worker’s subjective impressions and a quantitative analysis of their post-drill opinions following
a simulated bioterrorist post exposure chemoprophylaxis dispensing exercise.
In summary, this mock bioterrorist preparedness disaster exercise allowed participants
and observers to evaluate Washington State’s DOH plan for dispensing the NPS. It is important
to note that the dispensary site drill workers were the individuals who, in all likelihood, would
have been those involved had this been an actual bio-disaster [23]. This dispensing drill
promoted confidence in the participants and also offered an opportunity for worker groups and
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
participants to coordinate their activities [17]. It also allowed drill participants the opportunity to
review and evaluate the Washington State plan for dispensing the NPS. Finally, although these
dispensary worker findings support the conclusion the drill itself was relatively successful and
effective, care should be taken not to embrace a misplaced sense of security [24].
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Table 1. Frequency and percentage(s) of worker roles in respondent sample (n = 43)
Reported Worker
Frequency (n)
Percent
Cumulative Percent
1
6
6
11
3
5
3
1
7
43
2.3
14.0
14.0
25.6
7.0
11.6
7.0
2.3
16.3
100.00
2.3
16.3
30.2
55.8
62.8
74.4
81.4
83.7
100.0
-
Role(s)
Operations
Educator
Triage
Dispenser1
Registration
Security
Router
Greeter
Other
Total
1
Dispensers included both pharmacists and pharmacists’ aides.
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Table 2. Dispensing Site Worker Survey descriptive statistics for items #2 – #11.
Item
Item Content
Standard
Mean
Number
Deviation
2
The location chosen was well suited to your needs
85.81
13.1
3
The training I received prior to the drill was adequate
70.11
27.6
11.02
10.42
How long did it take to feel competent performing the specific
4
assigned tasks? (in minutes)
5
I had all equipment necessary to do a good job
80.31
22.2
6
I was physically comfortable in my workspace
79.61
20
6.93
3.33
How long (in hours) could you continuously perform your
7
specific drill tasks in a safe and effective manner?
Reported distractor (or distractors) that impaired drill
30%4
8
performance (even minimally)
How confident do you feel in your community’s ability to
9
64.75
21.3
64.06
26.1
72.37
17.9
respond to this type of bioterrorist incident?
Did your participation today’s drill affect your perceived
10
confidence?
After today’s drill did you feel your community is more or less
11
prepared/competent to respond to this type of bioterrorist
incident?
1
0 = strongly disagree; 25 = disagree; 50 = neither agree nor disagree; 75 = agree; 100 = strongly agree
in minutes
3
in hours
4
13/43 survey participants reported a distractor
5
0 = not at all confident; 50 = somewhat confident; 100 = completely confident
6
0 = not at all; 50 = to some degree; 100 = yes, completely
7
0 = much less prepared; 50 = about the same; 100 = much more prepared/competent
2
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
References
1. T. Inglesby, T. O’Toole, D. Henderson, J. Bartlett, M. Ascher, E. Eitzen, A. Friedlander,
J. Gerberding, J. Hauer, J. Hughes, J. McDade, M. Osterholm, G. Parker, T. Perl, P.
Russell, K. & Tonat. Consensus Statement – Anthrax as a biological weapon, 2002
Update Recommendations for Management. Journal of the American Medical
Association, 287 (17) (2002): 2236-2252.
2. R. Brookmeyer & N. Blades. Prevention of inhalation anthrax in the US outbreak
Science, 2002; 295 (5561): 1861.
3. Department of HHS Press release, January 31, 2002: HHS Announces $1.1 Billion in
funding to states for bioterrorism preparedness: Below accessed December 19, 2002
from http://www.hhs.gov/news/ (Go to Press releases/2002 Press Releases/January 31,
2002 Press release)
4. CDC NPS Program Website Available at: http://www.bt.cdc.gov/nceh/nps Accessed
December 19, 2002
5. T. O”Toole, M. Mair, & T. Inglesby. Shining light on “Dark Winter”. Clinical
Infectious Diseases, 34, (2002): 972 – 983.
6. R. Beaton, M. Oberle, V. Wicklund, A. Stevermer & D. Owens (2003). Evaluation of the
Washington State National Pharmaceutical Stockpile Dispensing Exercise. Part I –
Patient Volunteer Findings. Journal of Public Health Management and Practice,
September
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7. L. Gwerder, R. Beaton, & W. Daniell. Bioterrorism: Implications for the Occupational
and Environmental Health Nurse. American Association of Occupational Health Nurses
Journal, 49 (11), (2001): 512 – 518.
8. CDC Update: Investigation of bioterrorism – related anthrax and interim guidelines for
clinical evaluation of persons with possible anthrax. MMWR, 50 (43), (2001): 941 –
948.
9. CDC Update investigation of anthrax associated with intentional exposure and interim
public health guidelines. October 2001, MMWR; 50 (42), 889 – 897.
10. W. Perkins. Public health implications of airborne infection. Bacterial Review. (1961);
25: 347 – 355.
11. A. Anderson, & J. Eisold. Anthrax attack at the United States Capitol Front Line
Thoughts. American Association of Occupational Health Nurses Journal, 50 (4), (2002):
170 – 173.
12. A. Gift. Visual analogue scales: measurement of subjective phenomena. Nursing
Research, (1989); 38: 286 – 288.
13. L. C. Johnson, R. Beaton, S. Murphy & K. Pike. Sampling bias and other
methodological threats to the validity of health survey research. International Journal of
Stress Management, 7, (2000), 247 - 268.
14. J. Cohen. Statistical Power Analysis for the Behavioral Sciences. (2nd ed.). Hillsdale,
NJ: Erlbaum.
Page 17 of 26
National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
15. N. Hupert, A. Mushlin, M. Callahan. Modeling the public health response to
bioterrorism: Using discrete event simulation to design antibiotic distribution centers.
Medical Decision Making, 2002, Sept – Oct Supplement, s17 – s25.
16. R. Beaton & L. C. Johnson. Evaluation of domestic preparedness training for first
responders. Prehospital and Disaster Medicine, 2002, 17 (2).
17. D. Lehnhof. Planning mass casualty drills. In L. Garcia (Editor): Disaster Nursing:
Planning, Assessment and Intervention. Rockville, MD, 1985, Aspen
18. S. Hassmiller. Disaster Management. In M. Staphope and J. L. Lancaster (Editors)
Foundations of Community Health Nursing. St. Louis, MO, 2002, Mosby
19. T. V. Inglesby, R. Grossman & T. O’Toole. A plague on your city: Observations from
TOPOFF. Clinical Infectious Disease. 2001; 32 (3); 436 – 445.
20. M. T. Osterholm. How to vaccinate 30,000 people in three days: realities of outbreak
management. Public Health Reports, 2001; 116 (Supplement 2): 74 - 78.
21. Mass Immunization Campaigns: A “How to” Guide based on experience during the
February 2000 Capital Health Meningococcal Immunization Campaign. Alberta,
Canada: Capitol Health; 2000.
22. R. Atwood, M. Patnode, & L. Topel. Yakima Health District Meets the Challenge of
Meningococcal Epidemic. Washington Public Health, (1991), Winter, 2 – 6.
23. S. L. Berglin. Emergency nurses in Community disaster planning. Journal of Emergency
Nursing, 1996, 22: 184 – 189.
24. J. Waeckerle. Disaster planning and response. New England Journal of Medicine, 1991,
324 (12), 815 – 821.
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Figure Legends
Figure 1. Frequency histogram of dispensary site worker ratings of the degree to which they
felt the pre-drill training was adequate
Figure 2. Frequency histogram of dispensary site worker estimates of the time it took to feel
comfortable/competent with their assigned tasks (in minutes).
Figure 3. Frequency histogram of dispensary site worker estimates of the amount of time (in
hours) they felt they work continuously and perform tasks safely and effectively
Figure 4. Mean amount of time (in hours) and 95% confidence intervals dispensary site
worker groups felt they could work continuously and perform their duties safely
and effectively
Figure 5. Frequency histogram of dispensary site workers ratings of their self-reported
confidence that their community could respond to a similar bioterrorist incident
Figure 6. Mean confidence levels and 95% confidence intervals (in VAS units) of the worker
groups that their community could respond to a similar bioterrorist incident. (100
= completely competent; 50 = somewhat confident).
Figure 7. Frequency histogram of the dispensary site workers ratings of changes (if any) in
their self-reported confidence to respond to a similar bioterrorist incident
following and as a result of the drill.
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Fig. 1.
Count
30
20
10
0
Stongly
Disagree
Neither
Strongly
Agree
Training Prior to Drill was Adequate
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Fig 2
12
Count
9
6
3
0
<5
5-<10
10-<15 15-<20 20-<25
>25
Time it took to feel competent w/ assigned tasks
(min)
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Fig 3
Count
12
8
4
0
2-3
4-5
6-7
8-9
10-11
12-13
Continuous Safe / Effective Perform (hrs)
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Fig 4
14
12
10
8
6
4
2
0
-2
N=
6
5
11
5
15
Educator
Triage
Dispenser
Security
Other
Workers Role
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Fig 5
Count
30
20
10
0
Page 24 of 26
Completely
Somewhat
Not at All
Confident community can respond
to bioterrorist incident
National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Fig 6
120
100
80
60
40
20
N=
6
5
10
5
16
Educator
Triage
Dispenser
Security
Other
Worker's Role
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National Pharmaceutical Stockpile Dispensing: Part II – Dispensary Site Worker Findings
Fig 7
Count
30
20
10
0
Much
Less
No more
No Less
Much
More
Following the Drill I am ... Confident
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