Dispensing Mass Prophylaxis — Going Beyond PODS

Local emergency planners are creating mass prophylaxis plans to prophylax their populations within forty eight hours in order to reduce morbidity and mortality after a bioterrorist attack. The Points of Dispensing (PODs) as recommended by the CDC are central to many regions' mass prophylaxis plans. In order to function well, PODs require regional and physical characteristics that are not present in all jurisdictions, especially major urban centers. PODs are limited by resource availability, in particular staffing, security and site locations, and additional alternate methods of dispensing are required to be meet prophylaxis targets. The CDC recommends several alternate modes of dispensing and there are several others that are regularly discussed on the SNS listserv. Alternate modes of dispensing fall into two broad categories - those which are open to the entire population and those which are closed, serving only a particular portion of the population. It will not be possible to implement all possible alternate modes of dispensing and choices will need to be made among them. We review the issues encountered with PODs in Los Angeles County and discuss the pros and cons of 10 alternate modes of dispensing from a large urban center's point of view.