Brief description of LHD- location, demographics of population served in your community. Our Health Department is located in Milton, Florida (Santa Rosa County) a predominantly rural county with an estimated population of 174,272, a median age of 39.5 and a poverty rate of 12.3%. The population of Santa Rosa County is approximately 83.1% White, 5.62% Black and 5.11% Hispanic. 5.83% of the population primarily speak a language other than English.
Describe public health issue. Rabies and Influenza are an ongoing public health issues which create significant morbidity burdens on Santa Rosa County residents and their pets. Since January 2015, Santa Rosa County has reported eight confirmed cases of animal rabies, including four raccoons, three cats, and one dog. From 2015-November 2018, rabies post-exposure prophylaxis was recommended for approximately 204 individuals following exposures to potentially rabid animals. Additionally, last influenza season Santa Rosa County, like many counties throughout the country, experienced historically high levels of influenza. At its peak, nearly 16% of all emergency department visits in Santa Rosa County were due to influenza-like illness. It is recommended that pets receive an annual (or three-year) rabies vaccination, and that individuals receive a flu shot annually; however, many rabies exposure investigations result in rabies testing due to the animal having no history of vaccination, and the CDC estimates that less than 50% of adults receive a flu vaccine each year.
Goals and objectives of the proposed practice. Since 2011, the LHD has conducted an annual Rabies Point of Dispensing (POD) Exercise, during which the LHD conducts a mass prophylaxis exercise where Rabies Vaccines for Cats and Dogs (by two local veterinarians are offered for only $10.00 per animal to the population of Santa Rosa County, in an effort to mitigate the on-going rabies issues in Santa Rosa County, and to exercise the LHD Point of Dispensing and Mass Prophylaxis Plans. This year, a decision was made to add Flu vaccinations at no charge to the attendees/participants in this annual exercise event. Our overall goal is to vaccinate as many animals as possible against rabies, and to vaccinate 100 people against the flu.
How was the practice implemented/activities. This practice was implemented and executed through the use of an annual point of dispensing mass prophylaxis exercise
Results/Outcomes (list process milestones and intended/actual outcomes and impacts. In order for the LHD to dispense prophylaxis to the population of Santa Rosa County in the event of a disease outbreak, the LHD would need to process 220 patients/clients per hour.
Were all of the objectives met? Among the objectives (in addition to the hourly target rate of 220 patients/clients per hour), other objectives include testing radio communications, remote data entry, set-up and tear down of the POD, use of Incident Command and all related ICS forms. Nearly all objectives were met - the target of 220 patients/clients was not met, but that number is solely based upon active participation of patients/clients bringing their animals for rabies vaccinations, and this year flu vaccines were included.
Historical Event Data
2018 405 total rabies vaccinations (202.5 patients/hour) Goal was 220/hour. 303 Dogs, 39 Cats, 63 Flu Vaccinations
2017
328 total patients (191/hour)
319 dogs, 63 cats
We broke last year's record which was our biggest effort since the Rabies POD exercises began in 2011 here is a little historical data:
2016 122 dogs + 14 cats = 136 vaccinated animals (65 cars)
2015 172 dogs + 18 cats = 190 vaccinated animals (car count not available)
2014 183 dogs + 39 cats = 222 vaccinated animals (115 cars)
2012 214 animals no distinctions between dogs and cats were made. (car count not available)
2011 197 animals no distinctions between dogs and cats were made. (car count not available)
What specific factors led to the success of this practice? In addition to seven years of experience in performing this annual event, after action improvement reports after each event which were implemented for each successive event, advertising along with collaborative relationships with county government and local veterinarians helped ensure the success of this event.
Public Health impact of practice. Successful rabies vaccinations to cats and dogs and a continuing rabies education to pet owners on the value of rabies vaccinations, and this year we vaccinated 60 people with the influenza and educating these recipients on the value of continuing yearly flu vaccinations.
Website for your program, or LHD. http://santarosa.floridahealth.gov/
The current estimated population of Santa Rosa County in the State of Florida is 174,272 - while there isn't a specific census number exclusive to pet owners for Santa Rosa County, it is estimated that 68% of U.S. families are pet owners (https://www.iii.org/fact-statistic/facts-statistics-pet-statistics) so an educated presumption would be that at least 2/3 of the county population are pet owners. This would be our target population for the rabies vaccine. The fee of $10.00 per vaccination is also very appealing to the more economically challenged residents of our county. Many hunters bring their dogs during this exercise, which is very beneficial, as these dogs are in the forested areas during hunting season (which coincides stategically with the annual date of the Rabies POD) and can be exposed to the rabies virus and therefore are afforded this necessary protection and keep it from spreading to both other domesticated pets and humans.
To the best of our knowledge, our LHD was one of the first health departments in the State of Florida to implement this drive-thru rabies vaccine point of dispensing (POD) as both a benefit to the public and to exercise our staff in POD set-up, execution, and demobilization in addition to exercising our Medical Counter Measures (MCM) plan. We have received inquiries from both the State Bureau of Preparedness & Response and other local health departments in the State Florida about our processes and structure of this annual event.
This year we added the influenza vaccination (at no charge) to enhance our offering to the public, (our target population being the population of our county, especially the more vulnerable segments of our population by offering the influenza vaccination at no charge), in our ongoing mitigation to combat both rabies and especially influenza which has been on the rise in recent years, not only in our county, but in the State of Florida and nationally as well.
The LHD in collaboration with Santa Rosa County Animal Control Services, Santa Rosa County Emergency Management, and local veterinarians developed the annual Rabies Vaccine Point of Distribution (PO) exercise which always takes place at some point during the last two weeks of October.
The POD is staffed by DOH-Santa Rosa County staff, Medical Reserve Corps Volunteers, in addition to participating staff from neighboring DOH-Escambia, Okaloosa, and Walton counties, Naval Air Station-Whiting Field, the Santa Rosa County School District, Santa Rosa County Animal Control Services, and Santa Rosa County Emergency Management Services.
The exercise follows the standards as prescribed by HSEEP and NIMS for Incident Command Systems, with the majority of the exercise costs being borne by LHD Preparedness Funds - the actual rabies vaccinations and related costs for the vaccinations are borne (and administered) by the participating local veterinarians and their respective staff. The facility for the exercise is provided by Santa Rosa County Animal Control Services.
Planning for the exercise begins approximately 3 months prior to the event and involves Santa Rosa County Animal Control Services, the local participating veterinarians, and DOH-Santa Rosa (Preparedness Staff and participating staff). When available, representatives from Santa Rosa County Emergency Management, the Santa Rosa County School District, and Naval Air Station-Whiting Field will attend planning sessions for the exercise.
The LHD Exercise Planning Team constructed design objectives that focus on improving understanding of an emergency response concept, identifying opportunities or problems, and/or achieving a collaborative attitude. Selected by the Exercise Planning Team, the exercise focused on the following general design objectives:
Test the DOH-Santa Rosa Incident Command positions in a real life drive thru POD.
Familiarize staff with the Mass Prophylaxis Immunization Plan/Point of Dispensing Plan.
Test Mass Prophylaxis Immunization Plan/Point of Dispensing Plan (MPIP/POD) Plan.
Practice use of ICS (Incident Command System) forms (ICS 214 unit log and Incident Action Plan).
Test the ability of the Public Information Officer (PIO) to release a message to the public regarding POD operations.
Evaluate the ability of the Point of Dispensing (POD) Command to efficiently establish and effectively run a drive thru POD operation.
Evaluate ability of Incident Commander to report to site and establish command within 60 minutes of notification/request.
Test fiscal and administrative processes such as purchasing card activation, purchasing, inventory, Disaster Timekeeping and Employee Activity Records (EARS)/Time coding.
Test specific POD operational functions.
Evaluate POD set-up and tear down actions.
Test on-site communication capabilities.
Evaluate the present cache of POD equipment and supplies for functionality and effectiveness.
Evaluate the overall layout and traffic flow.
Measure the number of cars that will make it through the POD in a 2 hour period.
Measure the amount of prophylaxis and flu shots dispensed in a 2 hour period.
Test the ability to remotely enter flu-shot data into Florida Shots and HMS.
These are the objectives that are tested in the Rabies/Influenza POD exercise. For the most part, all of these objectives are met, some with challenges. After each exercise, every participant is asked to complete a hotwash/evaluation document which asks for three things that went well during the exercise and three things that needed improvement during the exercise. Additionally, an after action hotwash session is conducted with the exercise participants. The results of that session along with the results from the hotwash/evaluation documents are integrated into the After Action Report Improvement Plan (AAR/IP) as prescribed by Homeland Security Exercise & Evaluation Program (HSEEP). Items needing improvement are assigned to the appropriate accountable person(s) and are addressed for mitigation/remediation in the next planning session for the next POD exercise. Over the years, continual improvements have been made to the communications (adding more radios), advertising efforts (more effective use of social media and targeting areas with flyers where potential clients for rabies vaccinations frequent, improvements in traffic & process efficiency flows and streamlining documentation efforts. As a result, we've seen increases in participation over the last two years. (Reference the overview module)
As described in detail in the previous module, sustainability is achieved through the aggressive and consistent use of our action reports and improvement plans as prescribed by HSEEP. We find this to be a valuable tool for the continual improvement and sustainability of this exercise. The Rabies and influenza viruses will always be a public health concern and as a LHD it is our commitment and duty to proactively educate and mitigate the effects of these viruses through the use of this annual exercise.
All of the stakeholders (as identified in the previous modules) are always eager to be actively engaged and participate in one way or another in this annual viable community event/exercise.
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