Stories from the Field: Mass Vaccination Exercise in Kodiak, Alaska

1. Stories from the Field:Mass Vaccination Exercisein Kodiak, Alaska Ruth-Anne O'Gorman Darsha Spalinger Kodiak Public Health Center

2. Location of Kodiak Anchorage Island of Kodiak

3. Objectives • Reviewwhat worked well in planning and operations • Describe the challenges encountered during the exercise • Explore changes for future mass prophylaxis clinic activities

4. Question Have you participated in a real or mock exercise of a mass vaccination clinic? • Yes • No What were one or two of the challenges you faced during the event or exercise? Answer via text chat or over the phone.

5. Community Planning What Worked Well • 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

6. Community Planning 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

7. 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

8. Community Planning Challenges: Lessons Learned • 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

9. Community Planning 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

10. Question Do you know the name of yourfire chief/marshal? • Yes • No

11. Site Selection What Worked Well • 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

12. 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

13. Site Selection Challenges: Lessons Learned • 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

14. Site Selection 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

15. 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.

16. 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

17. Supplies What Worked Well • 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)

18. Spanish Pictorial English Tagalog Supplies 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

19. Question Do you know the 3 or 4 most predominant languages in your community? • Yes • No

20. Supplies Challenges: Lessons Learned • 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

21. Supplies 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

22. Staffing What Worked Well • 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

23. Question How did you handle training prior to the exercise? • A week or more before the clinic • The week of the clinic • The day before the clinic • 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?

24. Staffing What Worked Well • 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

25. Staffing Challenges: Lessons Learned • 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

26. Staffing 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”

27. 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

28. Operations What Worked Well • 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

29. Orange Paddle Operations 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

30. Operations What Worked Well • “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)

31. Operations Challenges: Lessons Learned • 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

32. Operations 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”

33. 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)

34. 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

35. Questions Questions? Comments?