Massachusetts Department Of Public Health Training Module

1. Massachusetts Department Of Public Health Training Module Planning a Clinic/EDS/POD In Response to Infectious Diseases, Emergencies, or Disasters Presented by: Katie Reilly, RN, BSN, MPH Infectious Disease Response Nurse Massachusetts Department of Public Health November 12, 2010

2. Learning Objectives • Identify potential emergencies and emergency response • List steps in planning and operating a clinic/EDS/POD • Identify possible community assets and resources in response to public health threats • Consider plans for internal and external communication

3. An All-Hazards Approach to Planning Are We Prepared? Think Globally, Act Locally!

4. What Could We Be Facing? • Bioterrorist Attack: • Anthrax, Plague… • Infectious Disease: • Influenza, SARS… • Local Infectious Disease Response: • Food Handler with Hepatitis A, Meningitis Case… • Natural or Man-Made Disaster: • Floods, Earthquakes, Nuclear events…

5. Local Response • Timeline and scope of response depends on type of disease or incident • Identify site(s) where the local community will receive vaccination/medication • Staffing provided by local volunteers and professionals

6. “The Team”

7. Incident Command System (ICS) • Establishes Chain of Command • Abbreviated version of ICS: • Flexibility • Scalability • Span of control • Most important thing to know: • Direct Supervisor

8. Pre-clinic Planning CDC

9. Planning team considerations • Target population • Required response • Capacity • Staff roles and job descriptions • Timeline • Location(s) and clinic flow • Communication • Security & safety issues • Process of vaccinating/dispensing

10. Planning team considerations • Legal Issues: • Jurisdiction • Public health laws, regulations & standards • Licensure regulations • Liability protection • Consent (minor & intellectually impaired) • HIPAA & FERPA (privacy protection laws) • CORI & SORI (criminal background check) • Record retention requirements

11. Develop an Operations Plan • Identify leadership • Identify space, location, dates, times of clinic • Obtain authorization from federal/state/local public health authorities (as needed) • Obtain signed standing orders (for vaccine or medication, and emergency) • Order and arrange for delivery and appropriate storage of vaccine/medication and clinic supplies CDC

12. Develop an Operations Plan (cont.) • Identify staff/volunteers, assignments, job descriptions, necessary training and schedules • Verify current credentials/licensure of staff (e.g. CPR) • Obtain necessary paperwork/documentation/information • Assign set up, breakdown, and clean up duties • Determine client flow from arrival to departure

13. Develop an Operations Plan (cont.) • Capacity and estimated throughput • Safety and security plans • Accommodations for individuals requiring additional assistance • Just In Time Training (JITT), briefing and debriefing of staff • System to report problems and concerns • Method for disposal of sharps/biohazards

14. Potential volunteer sources: Medical Reserve Corps (MRC) Massachusetts System for the Advance Registration (MSAR) of Volunteer Health Professionals (VHP) Civic organizations and faith-based groups Schools, colleges/universities Retired professionals Citizen Emergency Response Teams (CERT) Visiting Nurse Association (VNA) Occupational Health Nurses (OHN) American Red Cross (ARC) Staffing your clinic

15. Workforce Protection Plan • Developed to protect staff and encourage participation • Provides vaccine or prophylaxis to staff, responders, health care workers • Implement prior to opening site to the public • Use as opportunity to practice operations plan and modify as needed

16. Internal CommunicationStaff • When: prior to, during and after clinic • Who: all professionals and volunteers • How: face-to-face, email, phones, walkie-talkies, social networking, HHAN • What: plans, dates, times, locations, trainings, roles, schedules, supplies

17. Internal CommunicationLocal Partners • When: prior to, during and after clinic • Who: public health, police, fire, EMS, MRC, MSAR, hospitals, private providers, neighboring communities • How: face-to-face, email, phones, walkie-talkies, ham radio, social networking, HHAN • What: times, locations, schedules, plans, trainings

18. Internal CommunicationState and Federal Agencies • When: prior to, during and after clinic • Who: MDPH, MEMA, MSAR, FEMA, CDC • How: email, HHAN, websites, conference calls, webinars, webcasts, phones • What: recommendations, guidance, resources, policies, procedures, timeline, capacity, surveillance reporting

19. External CommunicationPublic • When: prior to, during and after clinic • Who: general/target/special populations • How: newspaper, radio, TV, signage, Emergency Broadcast System (EBS), reverse 911, local cable, PSA’s, Facebook, Twitter, blogs, websites, webcasts, webinars, interpreters, Connect - CTY • What: rationale, recommendations, strategies, plans, education, times and clinic locations

20. Staffing Considerations • Target population • Severity of threat • Timeline/capacity involved • Demographics/special populations • Amount of vaccine/medication available • Staff available and their competency level • Screening process • Possible new and related cases of disease or potential exposure identified in subsequent days • Paperwork required (pre-populated)

21. Readily available, not already committed Well known location(s) Adequate & accessible facilities; consider: Floor space Parking (staff/public) Public transportation Climate controlled Refrigeration Lighting Restrooms Kitchen area Security (inside and outside) Landline/cell phone reception/internet access Choosing Sites

22. Consider Scheduling Clinics with Other Events/Activities • Fairs • Sports events • Malls • Health screenings • Child safety events • Community events • Faith-based activities

23. Vaccine/Medication Management, Storage & Handling • Points for vaccine/medication manager to consider: • Security • Transportation • Storage requirements • Follow manufacturer’s/MDPH recommendations on management, storage, handling and transport of vaccine/medication • Vaccine Unit: 617-983-6828

24. Standing Orders • Use current standing orders that are reviewed and signed by a physician or medical director and have on-site (vaccine/medication specific & emergency orders) • Orders should include: name of vaccine/medication, dose, route/method of administration and inclusion/exclusion criteria • Model vaccine standing orders available at: http://www.mass.gov/dph/imm

25. Designated Areas of Clinic* • Parking/drop off • Entry • Registration • Screening • Vaccination/dispensing • Observation • Emergency treatment • Exit/collection of forms (optional) *Consider setting up in advance and combining areas and functions based upon staff, population, facility…. CDC

27. Suggested Supplies & Equipment • Tables, chairs, privacy screens • Refrigerator, coolers, thermometers • Office supplies and required forms • Phones/walkie-talkies • Paper towels, tissues, trash containers/bags • Signage • Refreshments for staff in a secure area

28. Vaccine/medication Cold packs w/plastic containers Needles (different sizes) Safety syringes Sharps/biohazard containers Latex free gloves Hand sanitizer Pill crusher Water/cups Medicine cups Teaspoons/bowls Alcohol wipes Gauze/bandages Adhesive tape Tissues/paper towels Table coverings Trash containers/bags Required forms/pens Suggested Vaccination/Medication Dispensing Stations Supplies

29. Safety & Security Planning • Maintain a list of authorized staff for each clinic • Establish staff sign-in/sign-out procedures, including identification (e.g. name tags, vests) • Develop policies and identify locations to secure vaccine/medication and supplies • Plan to flex staff to meet demand and avoid bottlenecks • Consider availability of police, fire and EMS CDC

30. Crowd Control Planning • Designate personnel for crowd & traffic control to: • Hand out forms • Maintain order/diffuse tension • Update crowd about wait times • Answer questions and concerns • Make accommodations for individuals in need of additional assistance • May use ropes & signage to direct traffic flow • Place Signage at a level where people can see CDC

31. Signage for: • Clinic location • Important information/instruction for target populations • One-way flow of traffic inside EDS • Diverse populations (use universal & specific languages) as needed • Designated clinic areas • Entrances, exits, restrooms • Inside and outside facility CDC

32. Clinic Set Up

33. Prior to Opening Clinic • Designate and set up areas and stations • Transport and secure vaccine/medication • Provide All-Staff Briefing and JITT • Ensure signage is posted and placed correctly • Vaccination/Medication provided to work force and their families

34. Staff Expectations: • Wear appropriate attire • Arrive on time for scheduled shift • Sign in-arrival time, name, address, etc. • Sign out for breaks and at end of shift • Have picture ID, name tag, or vest • Receive job assignment/job action sheet • Receive Direct Supervisor’s name • Attend All-Staff Briefing and Just In Time Training (JITT) • Set up stations CDC

35. Parking and Entry Area • Drop off for mobility impaired • Provide escorts/assistance • Parking instruction • Relay information to clients about: • Target population • Vaccine/medication available • Hours of operation • Clinic flow • Provide interpreters

36. Registration/Orientation Area • Distribute necessary forms, such as: • Disease Fact Sheet • Vaccination Information Statements (VIS) • Medication information sheets • Screening forms • Billing information forms (if applicable) • Consent forms (if applicable) • Release of information forms (if applicable) • Assist with form completion and answer questions as needed • Consider posting forms online ahead of time, and/or distributing at libraries, city hall, fire station, etc

37. Screening Area • Screen for contraindications or precautions to vaccine/medication • Answer questions or refer to Direct Supervisor • Protect confidentiality and privacy • Ask only “need to know” information for safe administration of vaccine or medication

38. Clinical/Dispensing Area • Appropriate forms should be completed before entry into clinical/dispensing area • Staff/signage will direct clients to appropriate station • Administer vaccine/dispense medication • Restrict access to this area in order to: • Reduce noise and confusion • Protect privacy and confidentiality • Support safety and security plans

39. Vaccine/Medication Preparation, Administration and/or Dispensing Points to consider: • Policies and procedures • Standing orders (signed) • Staff competencies • Vaccine/Medication Administration • Emergency Response • Medical • Facility • Manufacturers and formulations • Necessary documentation • Supplies

40. Clinical Documentation • Pre-populate forms if possible • Must be accurate, legible, and complete • Must be secured and retained • Consider electronic documentation • May provide vaccine/medication record to the client • Provide VIS to client for immunizations

41. Required Documentationfor Administration of Vaccine • Patient’s name • Vaccine name, manufacturer, lot number, expiration date and dose number • Publication date on VIS, date VIS was given • Anatomical site, route and dose amount • Date vaccine administered • Vaccinator’s name, initials, signature, and credentials • Clinic name, address and contact person • Signed consent is not required except when a parent/guardian is not present

42. Vaccine Information Statement (VIS) • Conveys risks and benefits of vaccine • Produced by CDC • Required by federal law • Vaccine specific • Must use current edition and not altered • Give before each dose of each vaccine • Provide an opportunity to ask questions • Available in multiple languages at: www.immunize.org/vis

43. Medication Documentation • Patient name • Age, weight (children) • Type of medication • Manufacturer • Lot number and expiration date • Date the medication was administered/dispensed • Dose and route • Name and address of the clinic site and contact person • Name, initials, signature, and credentials of dispenser

44. Medication Information Sheet • Name and formulation of medication • Directions for use • Dosing administration information • Signs & symptoms of adverse reaction/side effects • Contact information for questions or concerns

45. Observation Area • Observe for 15-20 minutes after vaccination • Especially if first time receiving vaccine • Monitor for signs and symptoms of adverse reactions • Provide educational materials, entertainment and refreshments (as available)

46. Expect The Unexpected Plan for emergencies with personnel, facilities and equipment/supplies Obtain signed and current Emergency Standing Orders from physician or medical director prior to clinic* *Model Emergency Standing Orders can be found at: http://www.mass.gov/dph/imm

47. Emergencies • Adverse reactions to vaccine/medication • Other medical emergencies • Police/Security emergencies • Fire emergencies

48. Emergency Response • Onsite emergency responders (whenever possible) • Community resources (ex. fire, EMS, police, local hospital) • Emergency medical equipment and supplies • Phone availability, location and 911 access

49. BP cuff and stethoscope (child & adult, extra-large cuffs) Cell phone or access to an on-site phone 3x3 gauze pads Alcohol wipes Bandages Hand sanitizer Latex free vinyl gloves (small, medium, large & extra large) Flashlight & batteries Thermometer & probe covers Instant cold packs Cots, Blankets, Pillows Wrist watch with second hand Emergency Supplies

50. Acetaminophen 325 mg tablets Ibuprofen 200mg tablets Diphenhydramine 25 mg tablets Diphenhydramine 50 mg injectable-(carpujet) Diphenhydramine elixir 12.5mg/5ml suspension 25mg/5ml Epipen & Epipen Jr. & Aqueous Epinephrine 1:1000 injectable 1mg/ml Syringes-3mL-1” 23g, 5/8” 25g, 1mL Ammonia inhalant Airways (large & small) Pocket masks with one way valve (adult & pediatric) Tongue depressors AED Emergency Supplies, continued….