Medical countermeasures dispensing: strategies for large-scale population protection

Planning for a catastrophe involving a disease outbreak with the potential for mass casualties is a significant challenge for emergency managers. For example, how should we perform rapid rescues and treat the sick? Where and how many distribution centers should we set up for food, shelter, medical supplies, and prophylactic dispensing? How should we staff the sites? How should we control disease spreading when a large affected population visits our sites? The time to respond, and the decisions made as an event unfolds, can spell the difference between life and death.

Since the anthrax attacks in the United States in 2001, over $70 billion has been spent on population protection, particularly on rapid detection of outbreaks and on mass dispensing of prophylactic medical countermeasures to contain biological and pandemic outbreaks. Despite these enormous efforts, we have little actual experience or firsthand knowledge to call upon to plan for these rare but potentially catastrophic events. Their rarity, cost, and complexity, and the added challenge of competing priorities are of great concern to policy makers who are aware of past failures to manage rapidly escalating catastrophes, failures that include ambiguity in communications and the unintended consequences of decisions that have been made at a higher level. Thus, having a powerful, realistic mathematical modeling and real-time decision support system for training, planning, and actual operations is of paramount importance.

We team with public health experts to address important aspects of mass dispensing: medical supply distribution, locations of dispensing facilities, optimal facility staffing and resource allocation, routing of the population, and dispensing methods. A software enterprise suite, RealOpt©, designed for tactical, strategic and operational planning has been developed. RealOpt can sift through massive amounts of data to better optimize decision-making during the event of an emergency scenario – especially in the case of a deadly outbreak. The system utilizes a number of data sets, including population demographics, socioeconomic information, hospital data and scientific literature regarding a range of infectious diseases – such as the flu, smallpox, anthrax, and more. With this information, the software can produce detailed instructions with very little input from the user.

RealOpt is an online interoperable information exchange and real-time decision support enterprise system. It consists of multiple components for diverse public health emergency capabilities. It accepts multi-factorial resource-environment-behavior-biological data. The system utilizes a broad spectrum of mathematical and computational technologies, including systems modeling, large-scale simulation, real-time dynamic optimization; compartmental epidemiological disease spread models, social and human behavioral sciences, along with cognitive and visual analytics.

The real-time capability of RealOpt© means that users can enter different parameters into the system and obtain results very quickly. This rapid computational time of RealOpt© facilitates analysis of "what-if" scenarios, thus it serves as an invaluable tool for planning, on-the-ground operations, and real-time re configurations.

Dr. Lee reviews RealOpt-Regional© capabilities with Dr. Mason and Mr. Pietz at CDC.

In the event that an infectious pathogen emerges, health officials can input into RealOpt information regarding what disease is spreading, the geographical area in need of service, and the resources at their disposal – and within seconds, the system will provide users with instructions on how to proceed. Social media influencing and human behavior (both the responders and the affected population) are elementary elements within the models.

Currently, there are over 14,000+ RealOpt user sites. RealOpt has been used for seasonal flu vaccination, smallpox and hepatitis vaccine dispensing, H1N1 mass vaccination, fire, flood and hurricane responses (for setting up shelters, food/medical/supply distribution sites, command-control logistics etc), Haiti earthquake emergency response relief, Japan Fukushima radiological response (rapid screening and decontamination, food/shelter, supplies distributions), optimizing Ebola treatment center operations, and predicting Zika disease spread. The system has also been used by numerous hospitals/clinics for optimizing workflow and operations efficiency. The system allows management of multiple resource types simultaneously, for example, labor, equipment, beds, financial investment, medical supplies, and countermeasures.

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RealOpt-POD© couples large-scale simulation and fast optimization routines into one decision support system for real-time resource allocation within medical facilities. The design of RealOpt-POD© directly addresses some of the computational bottlenecks of commercial software.

RealOpt-POD© is a real-time planning and operational system that enables emergency coordinators to

  • Design customized and efficient clinic/diagnostic/dispensing facility floor plans for regional needs via an automatic graph-drawing tool.

  • Determine optimal labor resources required and provide the most-efficient placement of staff at individual stations within the facility. The results maximize the number of people who can be treated, minimize the average time patients spend in the clinic, and equalize utilization/workload across clinic stations.

  • Determine the best location for emergency clinics based on population density and road accessibility, the most efficient facility layout, the number of health care professionals needed in certain areas, the number of medical countermeasures and supplies (e.g. vaccinations, antibiotics) needed and the time it will take to treat patients.

  • Process data in real time as the emergency event unfolds, and determine dynamic changes when necessary.

  • Perform disease propagation analysis, monitoring intra-facility infectivity, and derive dynamic response strategies to mitigate casualties.

  • Provide a framework for emergency healthcare managers to assess current resources and determine minimum needs to prepare for readiness in emergency situations for their regional population.

  • Allow large-scale virtual drills and performance analysis, and assist in the study, training and enhancement of emergency response, planning and treatment from terrorism, infectious disease outbreaks, and natural disasters.

A nurse applies flu mist in military vaccination clinic facility.

A dispensing site gave out vaccines to the pediatric population.

A healthcare worker explains medication to-be-dispensed to an individual.

A drive-through facility set up for dispensing hepatitis A vaccines at Erie Buffalo. 50,000 residents received hepatitis A vaccine due to a confirmed case of a grocery worker. The hepatitis A vaccine is given as two shots, six months apart.


RealOpt-Regional© is an interactive online software enterprise for large-scale regional medical dispensing and emergency preparedness. It features interactive visualization tools to assist with spatial understanding of important landmarks in the region, assess the population densities and demographic makeup of the region, and identify potential facility locations. It also features backend mathematical models for large-scale facility location problems; a backend novel and rapid solution engine for strategic and operational planning and real-time dynamic optimization, and a multi-level end-user secured login web portal.

The multi-level end-user login capability of RealOpt-Regional© allows granting different authorization levels to users. For example, emergency preparedness and response directors have different privileges than individual households and citizens. Specifically, public health emergency preparedness directors are able to:

  • Determine a network of optimal dispensing locations and the optimal combination of dispensing modalities (e.g. combinations of drive-through, walk-through, and mobile PODs) for best population coverage for regional preparedness.

  • Review demographics at each dispensing site and identify appropriate personnel (e.g. translators, pediatric assistants) needed for effective dispensing.

  • Determine in real-time a re-supply schedule for medical countermeasures across the network of dispensing sites through real-time feed of throughputs.

  • Determine the closest and feasible traffic routes to transport sick individuals from PODs to hospitals for treatment.

  • Identify region-wide budget and labor needs to accommodate an emergency situation, and determine recruitment needs of healthcare workers and volunteers.

  • Perform economic model analysis on multi-modality variations for optimal and cost-effective regional response strategies.

  • Analyze the adequacy of existing resources over a broad geographic region.

RealOpt-Regional© allows public users to:

  • Locate the nearest facilities for acquiring medical countermeasures.

  • Determine feasible traffic routes to access these facilities.

  • Review relevant information related to the specific medical countermeasures dispensed.

Vaccination (flu) dispensing sites that serve the City of Los Angeles are marked according to the demographics of the majority population they serve. “H” stands for “Hispanic/Latino”, and “A” stands for “Asian”.

During pandemic, the large influx of individuals in dispensing facilities raises the potential risk of intra-facility cross-infections. RealOpt traces the dynamics of intra-facility infection based on current operations and provide mitigation strategies to minimize the effect. These graphs show the number of individuals with each disease status over time for each of the processes in the dispensing site.


RealOpt-RSS© is a software modeling, simulation and optimization tool for the efficient management of the logistics of Receipt, Stage and Storage (RSS) facilities and Regional Distribution Nodes (RDN) for medical countermeasures. RealOpt-RSS© assists in planning quick and efficient strategies for processing medicines and/or equipment from the receiving point of the RSS to RSS vehicles for delivery. The software includes a warehouse design module, and specific computational modules related to the RSS facility, material handling equipment, staffing, and site configuration. Users can draw their specific warehouse layout, and place medical countermeasures into respective locations. Given a picklist, the system returns optimal sorting and paths within the warehouse.

During pandemic or healthcare disaster incidents, RealOpt-RSS is used for optimally distributing (supply and re-supply) medical countermeasures that are stored at managed inventory warehouse to infected region(s).


RealOpt-CRC© is a software module designed for radiological population monitoring purposes. RealOpt-CRC© couples graphic-drawing tools, large-scale simulation and fast optimization routines into a decision support system for real-time resource allocation for establishment of community reception centers for population monitoring within the context of radiological emergency planning and response. RealOpt-CRC© shares many key components with RealOpt-POD©. It includes added components to deal with radiological screening and decontamination logistics.

A key requirement for population monitoring involves the setting up of community reception centers that run efficiently. Within these centers, individuals will be assessed for presence of contamination on body or clothing, and for intake of radioactive materials. Removal of external and/or internal contamination (decontamination) must be carried out, and radiation dose received and risk of health effects must be assessed. Registration will be performed to facilitate long-term health effects monitoring. The system can also be used to optimize decontamination operations for emergency responders whose radiation exposure level must be monitored. This is critically demonstrated in the 2011 Fukushima Japan disaster where over 3000 emergency workers were involved and inside the nuclear plants to assist with handling of emergency situations.

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Copyright© 2003 - 2021 RealOpt© and its documentation are copyrighted with all rights reserved by the authors, Lee, and her research team. No parts of this manual can be reproduced without consent of the authors.