Stories from the Field:Mass Vaccination Exercise
in Kodiak, Alaska Ruth-Anne O'Gorman
Darsha SpalingerKodiak 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 PlanningWhat 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 PlanningWhat 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 PlanningChallenges: 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 SelectionWhat 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 SelectionWhat 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 SelectionChallenges: 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 SelectionChallenges: 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 SelectionChallenges: 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
SuppliesWhat 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
SuppliesChallenges: 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
StaffingWhat 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”
StaffingChallenges: 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
StaffingChallenges: 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
OperationsWhat 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)
OperationsWhat 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”
OperationsChallenges: 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)
OperationsChallenges: 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
OperationsChallenges: Lessons Learned
Questions