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: Infectious Disease:
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. Staffing your clinic 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)

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 Communication Staff
When: prior to, during and after clinic
Who: all professionals and volunteers
How: face-to-face, , phones, walkie-talkies, social networking, HHAN
What: plans, dates, times, locations, trainings, roles, schedules, supplies

17. Internal Communication Local 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, , phones, walkie-talkies, ham radio, social networking, HHAN
What: times, locations, schedules, plans, trainings

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

19. External Communication Public
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. Choosing Sites 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

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:

24. 4/1/2017
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: 24 24

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. Suggested Vaccination/Medication Dispensing Stations Supplies
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

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 Documentation for 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:

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. 4/1/2017
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: 46 46

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. Emergency Supplies
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

50. Emergency Supplies, continued….
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

51. Exit Area Collect forms (if applicable)
Answer questions and report concerns
Complete exit survey (if applicable)

52. Exit Survey Consider surveying clients for relevant
information such as:
How did you hear about the clinic?
How did you get to the clinic?
How long did you wait?
What did you like?
What didn’t you like?
Where do you live?
CDC

53. Post Clinic Paperwork
Adhere to medical record retention rules for keeping administration records
Compile billing information (if applicable)
Complete MDPH Vaccine Aggregate Usage forms
Complete VAERS forms, incident and medication error reports if indicated
CDC

54. Post Clinic
Ensure proper storage and handling of unused vaccine/medication
Contact MDPH regarding unused and expired state-supplied vaccine/medication
Return equipment and unused supplies
Dispose of sharps and medical waste
Hold staff debrief/hotwash at end of clinic, or schedule a debriefing for later date
Ensure staff signs out
CDC

55. Staff Debriefing What worked? What didn’t work? Clinic challenges
Planning priorities for future
Future availability of resources
Additional suggestions/comments
CDC

56. Some Common Pitfalls in Planning
Assumption that everyone is on the same page
Different terms and concepts across disciplines
Too many spokespeople
Lack of training
Misinterpretation of roles

57. MDPH Contact Numbers MDPH Epidemiology/Immunization Program
4/1/2017
MDPH Contact Numbers
MDPH Epidemiology/Immunization Program
(24x7)
MDPH Vaccine Unit 57 57

58. Seasonal Flu Vaccine Reimbursement
Commonwealth Medicine (part of UMASS Medical School) is working with public & private health plans to provide reimbursement for the administration of the seasonal influenza vaccine in the public setting.
Complete one insurance form for each individual who receives a vaccination
Have vaccine recipient, or parent/guardian sign and date the form
Fill out info in the Clinic/Office Use section for providers and sign and date the form
Submit forms via or regular mail
Forms and more information available online at:

59. 4/1/2017
Online Resources
MDPH Guidelines for Compliance with Federal and State Vaccine Administration Requirements
MDPH General Protocol for Vaccine Storage, Administration, Standing Orders,& Immunization Clinics, Sept 2009
MMWR: General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices (ACIP), December
CDC Guidelines for Setting Up Vaccination Clinics
World Health Organization 59 59

60. Online Resources Massachusetts Department of Public Health (MDPH)
4/1/2017
Online Resources
Massachusetts Department of Public Health (MDPH)
MDPH Immunization Program
Immunization Action Coalition
Centers for Disease Control and Prevention (CDC)
Epidemiology and Prevention of Vaccine-Preventable Diseases, The Pink Book: Course Textbook (11th Edition), May
Vaccine Administration Errors to the Institute for Safe Medication Practices
Guide to Vaccine Contraindications and Precautions 60 60

61. Online Resources
MassPro for Flu clinic locations
Adverse Events to Vaccine Adverse Events Reporting System (VAERS)
School Located Vaccination: Information for planners
Massachusetts Division of Health Professions Licensure License Verification Site
Sharps disposal companies from the Massachusetts Department of Environmental Protection

62. Online Resources
Recommendations for Drawing-Up Vaccine and Other Documentations Requirements for Clinical Sessions or Large Clinics
CDC Guidelines for Large-Scale Influenza Vaccination Clinic Planning
Commonwealth of Massachusetts, Department of Public Health, Emergency Dispensing Site, Management and Operations
A Guide to the Massachusetts Public Records Law
MDPH: Holding a Vaccination Clinic

63. Please join us for the other training modules!
All-Staff Briefing & Just-In-Time Training: November 15th, 3:00-4:30
Vaccine Management, Storage and Handling: November 16th, 3:00-4:00
Vaccine and Medication Preparation and Administration: available online soon!
4/1/2017 63

64. 4/1/2017
QUESTIONS?? Thank You ! 64 64