Stories from the Field:Mass Vaccination Exercise

in Kodiak, Alaska

Ruth-Anne O'Gorman Darsha Spalinger

Kodiak Public Health Center

Island of Kodiak

Anchorage

Location of Kodiak

Objectives

Review what worked well in planning and operations

Describe the challenges encountered during the exercise

Explore changes for future mass prophylaxis clinic activities

Question

Have you participated in a real or mock exercise of a mass vaccination clinic?

A. Yes

B. NoWhat were one or two of the challenges you faced during the event or exercise?

Answer via text chat or over the phone.

Community Planning

Wide range of community/agency participants

Community/agency exercise objectives identified/met

Specialized Incident Command Systems (ICS) training received by Kodiak Emergency Operations Center staff

What Worked Well

State draft Mass Prophylaxis Plan: Useful planning tool

Local Police, Fire/EMS, Amateur Radio filled clinic support functions: Security, medical, communications

Pre-clinic and clinic communications coordinated between State PIO and local media

Community Planning

What Worked Well

Local PHNs presented to multiple community organizations and service groups

Use of local health fair one month before exercise to recruit volunteers

Informational and directional signage posted in three primary community languages

Community Planning

What Worked Well

Community Planning

Unable to test Emergency Operations Center due to borough staffing vacancies

Influenza vaccine shortage: flexed clinic operations to include high risk priority screening

Pre-event advertising in English only: future to include Tagalog and Spanish

Challenges: Lessons Learned

Fire code mandated maximum of 400 people in combined lobby/commons area: required monitoring by clinic safety team

Kodiak Emergency Operations Plan (EOP) needs revision to include mass prophylaxis/dispensing response

Community Planning

Challenges: Lessons Learned

Question

Do you know the name of yourfire chief/marshal?

A. Yes

B. No

Kodiak High School well known to residents

Lobby and commons adequate space to process flow rate of 500/hour

Floor plan/station placement: elevated area facilitated overall observation

Adequate room to locate family station for increased privacy, dedicated pediatric vaccination

Site Selection

What Worked Well

Fire Marshal walk-through resulted in floor plan compliance with fire code and evacuation requirements

Commons area served by elevator, shallow stairs: Supported access by mobility impaired elders, wheelchair, stroller access

Site Selection

What Worked Well

Site Selection

School also designated as emergency shelter: Need to clarify priority use

If symptomatic clients or disease exposure

Risk: designate screening area separate from clinic

Residents familiar with multiple school entrances: increase size and number of entry/exit signs

Challenges: Lessons Learned

Larger “Staff Only” entrance sign to reduce unauthorized persons entry into command station, volunteer area

Some elderly unable to access clinic due to lack of transportation: pre-arrange transportation, consider satellite or mobile clinics

Expand checkout station to reduce bottlenecks at exit

Site Selection

Challenges: Lessons Learned

Unable to utilize gym for exercise: in real event with bad weather or need to pre-screen symptomatic or exposed residents would use lobby or commons to pre-screen, operate clinic in gym

Short flight of stairs proved problematic for strollers, elevator inoperable. In future operate on one floor.

Site Selection

Challenges: Lessons Learned

Congestion at family station due to parents receiving immunizations with children. Have parents vaccinated at regular station first or insure that all vaccinators can vaccinate children safely…delete family station

Site Selection

Challenges: Lessons Learned

Supplies

Supply List from Mass Prophylaxis Annex used

Colored “pinnies” to identify work stations/staff very useful (would order larger size, consider additional identifier for team leaders, maybe a hat)

Signage (Information, Direction-three languages) Vaccine Information Forms (with ‘tear-away’ registration provided by State Section of Epidemiology)

What Worked Well

Signs and forms were clear, easy to post/use. Will reuse clinic signs as heavy duty laminated

Decision: No onsite data entry. Hard copy registration forms collected at exit, filed at Kodiak Public Health Center

Supplies

What Worked Well

Tagalog

PictorialSpanish

English

Question

Do you know the 3 or 4 most predominant languages in your community?

A. Yes

B. No

Supplies

Original supply order to cover 5,000 clients. Change in vaccine availability occurred after supply order placed…exercise scaled back…re-packaged non-perishables for future use

Need to identify community storage site for emergency response durable goods

Challenges: Lessons Learned

No supply team: This function blended with general clinic support/flow team. Need dedicated supply staff and spreadsheet to track use of vaccine, general clinic material

Supplies

Challenges: Lessons Learned

Staffing

Determined number of work stations/staff to fill stations based on available facility space

Volunteer recruitment per September Health Fair and word of mouth one month before exercise

Kodiak Red Cross drafted clinic staffing sheets, assigned volunteers to both shifts

What Worked Well

Question

How did you handle training prior to the exercise?

A. A week or more before the clinic

B. The week of the clinic

C. The day before the clinic

D. The day of the clinic

Why did you choose A, B, C, or D above and how would you change the training for the next exercise?

Clinic Staffing Schedule/Job Action Sheets: Modified from State Mass Prophylaxis Plan

Excellent volunteer turnout(CEUs offered to RN, LPN, EMS staff)

Volunteer orientation: One hour evening prior to clinic: 15 minute overview, 45 minute station specific training

Staffing

What Worked Well

Staffing

Fire code/building capacity biggest constraint on number of clinic stations

Needed to include Red Cross Volunteer recruiter in more of the pre-clinic communications

Day of clinic: Needed more staffing at volunteer station for staff check in/out, maintaining staffing rest area

Lions/Rotarians volunteered, underutilized for this one-day exercise

Challenges: Lessons Learned

Real event likely to pull from hospital/clinic RN volunteers, resulting in reduced vaccinating capacity

Kodiak EMS/Police staffed exercise medical/security. Real event may pull them to other duties: would increase use of safety team, nursing and other trained health care volunteers

Future: Consider posting “Station Activity Sheet” at each station

Future: Further modify JAS to use more “bullets”

Staffing

Challenges: Lessons Learned

JAS: “Triage Team Leader” would rework this description, assign RN who knows the community to staff this position

More translators/interpreters needed at each station

Future: Only one clinic manager on site

Some volunteers felt underutilized: Plan to cross train all staff for several stations

Staffing

Challenges: Lessons Learned

Operations

Good pre-clinic/exercise community outreach and education

Bayside Amateur Radio: communications technology good. Set up several station phones, established external link for vaccine re-order & secure shipment, closed circuit TV to monitor lobby/commons

Float position: Triage team facilitated client process through screening

What Worked Well

Rapid client processing through dispensing/ vaccinating station

Secure transport/storage vaccine with cold chain maintained: coordination Immunization Program Manager, State Pharmacy Depot, Alaska Airlines, US Coast Guard

Orange paddles used to indicate client-ready station, signaled clients from triage/screening line to vaccination station

Operations

What Worked Well

Orange Paddle

“Runner” position within Clinic Support Team worked well for supplies, back up for communicating messages within clinic

“Mobile Vaccinator Nurse” position within Dispensing/Vaccination Team good idea for vaccine administration to clients in vehicles (unable to access clinic due to compromised immune system)

Operations

What Worked Well

Operations

Need to include three primary community languages in all in all pre-clinic announcements

Arrange for bus/other transportation for elders/mildly disabled clients without personal transportation

Walkie-talkies between team leaders/clinic stations did not work well: static

Challenges: Lessons Learned

No planned team leader debriefing (partly due to brief 4 hour shifts). Would plan this in next exercise or real event

Dry erase “status board” not available as planned, chalk board not a good substitute

“Spread of triage positions” difficult for Triage Team Leader to monitor. Consider putting translators under “Clinic Support Team”

Operations

Challenges: Lessons Learned

Check In: Consider additional clinic support staff “Greeters” to maintain lines at registration, use tape for traffic direction

Check Out: Need to add another staff person to count processed clients

In real event would need to include JAS for vaccine supply position (filled at this exercise by State Immunization Program Manager)

Operations

Challenges: Lessons Learned

Increase number of Safety team staff to assist with external security, traffic direction, recognition of drive through clients

Mobile Vaccinator Nurse: better positioning needed to facilitate communications regarding arrival of clients in designated parking area

Teen runners best used for supply movement and as line monitors rather than message delivery

Operations

Challenges: Lessons Learned

Questions