Mass Distribution and Vaccination Clinics

Mass Distribution and Vaccination Clinics

Chris Mackie, MD

Public health CBRN course

Why Plan for Mass Distribution and Vaccination Clinics?Why Plan for Mass Distribution and Vaccination Clinics?

• Likely worst case CBRN scenario in Canada for planning purposes : up to 100,000 people*

• Delay in vaccination can result in exponentially expanding epidemics– Smallpox, hep A

• Delay in treatment can result in significantly increased mortality– Anthrax, nuclear accident

*Solicitor General of Canada, Developing Options to Strengthen National Consequence Management Response Capability for Terrorist Incidents, 2001

Goals of SessionGoals of Session

• Describe key elements of a plan for mass distribution and vaccination clinics (DVC’s)

• Discuss critical issues in implementation of DVC’s

• Suggest some assessment mechanisms for a DVC plan

• Discuss cases

What is a Mass Distribution and Vaccination Clinic?What is a Mass Distribution and Vaccination Clinic?

• System of delivering prophylaxis on a large scale

• NOT mass casualty clinic

• Could include delivery of:

– Vaccine

– Antibiotics

– Other medication (eg. KI tabs)

Elements of a DVC PlanElements of a DVC Plan

• Who

• What

• Where

• When

• How

Who: StakeholdersWho: Stakeholders

• External stakeholders– Population– Health care

professionals and their organizations

– Health care system representatives

– Law enforcement– Media– Other levels of

government

• Internal stakeholders– Public health– Emergency

management– Legal services– Community relations– Liaison

What is required to run a DVCWhat is required to run a DVC

• Staff

• Support infrastructure for staff

• Transportation

• Equipment and supplies– Medical and PPE

Where will the DVC be?Where will the DVC be?

• Push, pull, or combination?• Location – out of harm’s way• Size• Security• Access• Storage• Staff support services• Communication capacity• Back up power

When will the DVC be activated?When will the DVC be activated?

• When to open DVC

• When to escalate to regional, provincial or federal involvement

• Criteria for closing DVC

How will you run the DVC?How will you run the DVC?

• Overall plan tied to specific objectives

• Incident Management System (IMS)

• Public information plan

• Floor/flow plan

• Clinical protocols

• Other policies and procedures

Elements: StaffingElements: Staffing

• Rapid recall for current staff

• Creative solutions to recruit additional staff– Neighbouring jurisdictions– Retired staff– Students– Non-traditional providers

• Volunteer list and clear guidelines for involving volunteers

Elements: StaffingElements: Staffing

• Discussing unusual tasks and unfamiliar situations with unions and professional colleges in advance

– Turf, safety, ethical imperatives, interpretation of contract language

• Staff orientation plan

– Policies and procedures

Elements: DocumentsElements: Documents

• Clinic publicity information

• Medical/epidemiological risk screening sheet

• Information sheets on intervention with follow-up instructions

• Intervention record

• Orientation manuals with policies and procedures

Elements: Clinic PublicityElements: Clinic Publicity

• Intervention and services offered and not• Clinic location• Hours of operation• Target population• Documentation of eligibility, if required• Information for people not in target population • When certain groups should present• Proper clothing for easy immunization• Access: parking, mass transit

Elements: External CommunicationsElements: External Communications

• Comprehensive media strategy

• Emergency broadcasting

• Information hotline

• Website

Elements: Facility Floor/ Flow PlanElements: Facility Floor/ Flow Plan

Elements: Facility Floor/ Flow Plan

Elements: Facility Floor/ Flow Plan

Elements: Equipment and SuppliesElements: Equipment and Supplies

• Medical equipment and supplies, PPE, administrative supplies

• Many resources for equipment and supplies, including:– Ontario Government

Pharmacy– National Emergency

Stockpile System

Elements: Generic Policies and ProceduresElements: Generic Policies and Procedures

• Informed consent (see provincial policy)• Mass informing?

– Risks, benefits, contraindications• Documentation of consent

– Signature vs. verbal– Tick box vs. written description

• Data management– Clinic records – paper or electronic?– Protecting patient privacy

• Adverse event reporting

Elements: Generic Policies and ProceduresElements: Generic Policies and Procedures

• Incident Management System (IMS)

CommandCommand

OperationsOperations PlanningPlanning LogisticsLogistics Finance / Administration

Finance / Administration

ResponseTeam(s)

ResponseTeam(s)

Safety Safety InformationInformation

LiaisonLiaison

Plan ManagementPlan Management

• Development– Partner and stakeholder

input– Building relationships and

buy-in • Dissemination• Revision

– Process to update plan regularly

Scenarios – Preparing to Implement a DVC PlanScenarios – Preparing to Implement a DVC Plan

Genuine anthrax attack on government

offices

Nuclear plant releasing contaminated plume over

populated area

Other

Plan Implementation: Identifying Event and InterventionPlan Implementation: Identifying Event and Intervention

• Determine a CBRN event has occurred

• Identify the nature of the substance involved

• Define temporal and spatial boundaries of the event

• Determine appropriate intervention and required follow-up

Plan Implementation: FacilitiesPlan Implementation: Facilities

• Select facility (facilities)

• Set timelines

– When to open clinic (ASAP)

– Expected duration of operation

• Establish clinic closure criteria

Plan Implementation: Who Needs the Intervention?Plan Implementation: Who Needs the Intervention?

• Define exposure criteria• Determine who should receive the

intervention and prioritize groups– Cases– Contacts– Health care workers– First responders– Essential services personnel

• Determine criteria for proof of eligibility

Plan Implementation: Policy Review and DevelopmentPlan Implementation: Policy Review and Development

• Review generic policies and procedures and ensure they are appropriate

– Medical directives – Consent– Data management

• Set policy for conflict resolution – Predictable: individuals want the intervention

but don’t meet criteria• Set policy to address refusal of intervention

– Is quarantine appropriate here?

Plan Implementation: Staffing and IMS IssuesPlan Implementation: Staffing and IMS Issues

• Arrange staffing for the facility

– Clinical, security, IMS roles

• Media enquiries

• Law enforcement issues

• Security: risk of “bomb on bomb”

Plan Implementation: Logistics and FinancePlan Implementation: Logistics and Finance

• Determine mode of transportation for special populations

• Obtain necessary medical supplies and PPE

• Generate documents– Handouts regarding the intervention – Documentation forms

• Proposed funding mechanism

Go!Go!

Key Concepts for DVC’sKey Concepts for DVC’s

• Who

• What

• Where

• When

• How

• HIRA (CBRN-O)

• IMS

• Plan Management

• Floor/Flow Plan

• Creative Staffing

• Creative Policies/ Procedures/ Protocols