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Disseminating emergency preparedness planning models as automatically generated custom spreadsheets.

Article Excerpt
When public health officials requested OR models to help county health departments across the United States create plans for dispensing medications and vaccines during emergencies, we developed capacity planning and queueing network models. We then faced the challenge of distributing these models to people with minimal experience with OR techniques and no resources for acquiring and learning new software. To eliminate the most significant obstacles, we decided to use spreadsheets. We created a spreadsheet application that runs Visual Basic for Applications (VBA) macros to generate customized analytical models without the assistance of an OR professional; thus, users could evaluate a wide variety of plans. Developing spreadsheets for this type of application differs significantly from end-user modeling and typical spreadsheet applications. The software is available on our website for public health emergency preparedness planners to download.

Key words: health care: treatment; planning: government; queues: approximations. History: This paper was refereed.

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Montgomery County, Maryland, is home to one of eight Advanced Practice Centers (APCs) for public health preparedness. The APCs customize and package innovative tools for other local public health agencies to strengthen their bioterrorism planning and response capabilities. The Centers for Disease Control and Prevention (CDC) funds the APC programs; the National Association of County and City Health Officials (NACCHO) administers the programs and maintains an online clearinghouse of APC preparedness tools for local public health agencies (National Association of County and City Health Officers 2005). The APC's long-term goal is to create and disseminate a broad set of methods and guidelines to help county health departments create, assess, and improve their emergency preparedness and response plans.

Emergency preparedness includes carefully planning mass-dispensing and vaccination clinics, which we refer to as points of dispensing (PODs). When a clinic begins operations, the health department must assign the correct number of workers to various roles. It must also consider the capacity of each clinic (i.e., the number of residents that it can serve per hour) and the number of minutes that residents will spend in the clinic (i.e., time in system, flow time, and throughput time). Clinic capacity affects the number of clinics needed and the total time needed to vaccinate an affected population. The time in system affects the number of residents who will be inside the clinic waiting for treatment; too many residents in the clinic could cause crowding and confusion.

Evaluating clinic plans requires the use of OR models, such as capacity planning and queueing. We developed discrete-event simulation models and capacity planning and queueing network models to improve clinic planning in an ongoing collaboration with the University of Maryland (College Park) and the Montgomery County (Maryland) Public Health Services (PHS). Aaby et al. (2006b) provide additional information about these models.

In this paper, I discuss the challenge of distributing these models to people with minimal experience with OR techniques and no resources for acquiring and learning new software. Providing the models in a format they could use was critical. The options we evaluated included publishing a report that presented the mathematical models, developing an original piece of software, creating spreadsheets for common clinic layouts, and providing discrete-event simulation models. We decided to develop a spreadsheet application that allows users with no experience in building OR models to create and use customized, analytical capacity planning and queueing network models--without the assistance of an OR professional. Public health emergency preparedness planners can download the software from our website http://isr.umd.edu/Labs/CIM/projects/clinic/.

Emergency Preparedness Planning

Following the terrorist attacks of September 11, 2001, public health officials at the US federal, state, and county levels accelerated efforts to plan their responses to events such as bioterrorism attacks (e.g., the intentional release of smallpox or anthrax) and outbreaks of contagious disease (e.g., pandemic influenza). The resulting plans often call for PODs (Centers for Disease Control and Prevention 2002). Public health officials must create a set of clinic designs to prepare for a range of bioterrorism and contagious disease emergencies.

In the worst-case scenario (e.g., terrorists release a smallpox virus into the general population), everyone in the affected area would require vaccination within a few days. Kaplan et al. (2002) compare vaccination policies for responding to a smallpox attack; they show that in the...

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