Simple, school-based mass distribution as a small-town strategy


  • David Knauf, RS, MS, MPH
  • Scot Phelps, JD, MPH



point of dispensing, point of distribution, models, simple


Objective: Test a radically simple school-based point-of-dispensing model.
Design: Prospective study.
Setting: Community
Participants: Community residents with children at one middle school.
Interventions: Rapid dispensing of medication.
Main Outcome Measure(s): 1) Measure and extrapolate ability to distribute medications to Darien residents through school-based distribution model; 2) assess if using a limited staffing model with limited training was functional. Identify stress points; 3) understand the existing school communication model; 4) track and extrapolate the breakdown of adult-tochild doses distributed and compare to existing census data; and 5) measure throughput of school-based distribution model in the 50-minute drop-off period.
Results: 1) This exercise supported the concept that rapid medication distribution through the public schools is an appropriate strategy for health departments, particularly departments with limited resources. 2) Just-in-time briefing worked well as a training strategy. The primary stress points identified were in restock—if medication was in blister packs, we would not be able to stock vests with 100 of each as they are substantially bigger than mints. 3) The secure Darien Public School notification system was ideal for distributing information to parents since they tend to receive school communication on a regular basis and by definition, access is limited to town residents. 4) When asked about household size, most drivers indicated “two adults and two (or more) children.”We distributed medication for 784 adults and 963 children. This ratio was higher than the 2010 Census, which had an average household size of 3.08 in Darien. 5) In 50 minutes, using a mix of Health Department and school staff, medication was distributed to 1,747 residents, almost 10 percent of the population. The hourly throughput from this model was distribution to 2,096 people per hour or 699 people per distributor per hour. This compares favorably to almost every other nonmedical distribution model.
Conclusions: Using four Health Department staff and six public school staff, we distributed medication to 784 adults and 963 pediatric residents in 50 minutes at one school. If we extrapolated that across the six other public schools in Darien, we could provide medication to more than 10,000 residents within 8 hours. While we are cognizant of the limitations and drawbacks of this model, we strongly believe that it is the only practical solution to the problem of rapid distribution of medication to the entire community.

Author Biographies

David Knauf, RS, MS, MPH

Director of Health, Darien Health Department, Darien, Connecticut.

Scot Phelps, JD, MPH

Paramedic, CEM/CBCP/MBCI/MEP, Professor of Disaster Science, The Emergency Management Academy, Yonkers, New York.


National Association of County and City Health Officials: Size of an LHD Workforce. The Local Health Department Workforce: Findings from the 2008 National Profile of Local Health Departments, Chapter 2. National Association of County and City Health Officials. Available at NACCHO_WorkforceReport_FINAL.pdf. Accessed August 18, 2012.

Agency for Healthcare Research & Quality: Fundamentals of Dispensing/ Vaccination Clinic Design, Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness. Available at cbmprophyl/cbmpgde2.htm. Accessed August 13, 2012.

National Association of County and City Health Officials: Drive through point of dispensing planning guide. Available at http:/ / ThruPoDPlanningGuide_8-25-10.pdf. Accessed August 18, 2012.

National Center for Disaster Medicine and Public Health: Report on the Domestic Natural Disaster Health Workforce: 135. Available at Accessed October 1, 2012.

Postal Model for Medical Countermeasures Delivery and Distribution. Available at Accessed August 13, 2012.

Office of the Secretary of State, State of Connecticut: Available at Accessed August 13, 2012.

Connecticut Department of Public Health: Connecticut Local Health Web page. Available at: Accessed on August 13, 2012.

Darien Health Department: What do we do? Available at Microsoft_PowerPoint__Health_Dept__performance_presentation_2012.pdf. Accessed August 13, 2012.

Connecticut Department of Energy and Environmental Protection: What we do. Connecticut Department of Energy and Environmental Protection Web site. Available at Accessed on August 13, 2012.

Connecticut Department of Public Health: What we do. Connecticut Department of Public Health Web site. Available at cwp/view.asp?a_3115&q_468328&dphNav_|. Accessed August 13, 2012.

Burel G: Centers for Disease Control & Prevention. Available at Accessed September 25, 2013

US Census Bureau: 2010 Census Data. Available at Accessed July 23, 2012.

State of Connecticut: Town of Darien Profile of General Demographic Characteristics: 2000. Available at Accessed July 23, 2012.

Darien Public Schools: Darien Public Schools Current Enrollment Report, 2011 data.Available at Accessed July 23, 2012.

2010 Census data. Available at Accessed on September 25th, 2013.

US Census Bureau: 2010 Census data. Available at Accessed August 13, 2012.

Spitzer JD, Hupert N, Duckart J, et al.: Operational evaluation of high-throughput community-based mass prophylaxis using just-intime training. Public Health Rep. 2007; 122(5): 584-591.

Rinchiuso A: Just-in-time training for point-of- dispensing staff: The NYC experience. Available at training-for-point-of-dispensing-pod-staffthe-nyc-experience. Accessed July 24, 2012.

Davenport D,Faren S, Bazini-Barakat N, et al.: Improving Capacity for Mass Dispensing in Los Angeles County ABSTRACT.Available at Accessed July 24, 2012.

Hens N,Ayele GM, Goeyvaerts N, et al.: Estimating the impact of school closure on social mixing behaviour and the transmission of close contact infections in eight European countries. Available at http:// Accessed August 13, 2012.

Example of Influenza/Pneumococcal Immunization Consent Form of the New York State Department of Health, Bureau of Immunization. Available at Accessed August 13, 2012.

Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health & Human Services: Postal model for medical countermeasures delivery and distribution. Available at Accessed on August 13, 2012.



How to Cite

Knauf, RS, MS, MPH, D., and S. Phelps, JD, MPH. “Simple, School-Based Mass Distribution As a Small-Town Strategy”. American Journal of Disaster Medicine, vol. 8, no. 3, July 2013, pp. 213-21, doi:10.5055/ajdm.2013.0127.



Case Studies