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Mass Vaccination Campaign Planning Outcomes of the San Francisco Department of Public Health Smallpox Mass Vaccination Exercise June 17, 2003 Ann Stangby.

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Presentation on theme: "Mass Vaccination Campaign Planning Outcomes of the San Francisco Department of Public Health Smallpox Mass Vaccination Exercise June 17, 2003 Ann Stangby."— Presentation transcript:

1 Mass Vaccination Campaign Planning Outcomes of the San Francisco Department of Public Health Smallpox Mass Vaccination Exercise June 17, 2003 Ann Stangby RN CEM Emergency Medical Specialist San Francisco Department of Public Health

2 Our motivators SFDPH estimates on staffing and clinic space were based on CDC estimates and post-event planning documents Hospitals in San Francisco wanted guidance on setting up their own clinics To test our assumptions –number of staff needed for one site –skill mix required –space needs –clinic layout –patient flow

3 Mass vaccination in San Francisco Vaccinate ~ 1million residents and visitors in 5 days Each site would operate 16 hours / day Each site would see 300-350 pts / hr Each site would accommodate ~26,000 people over 5 days –15-20,000 staff needed –Bilingual capabilities at each site

4 Defined goals of the exercise Test our ability to provide mass vaccination –300-350 pts / hour –Bilingual capabilities Test our ability to recruit volunteer patients Evaluate the drill and offer information to other jurisdictions interested in similar exercises or real event planning

5 Background facts 66 working days to plan and execute the exercise CDC Guidance for Post-Event Smallpox Planning was the guiding tool Steering committee developed Simple scenario with no tricks No observers allowed Media access encouraged

6 Recruitment Staff –all SF City and County workers are disaster service workers –Within SFDPH email and voice mail messages for volunteers administrative support letter to managers from Dr. Katz cabinet meetings word of mouth safety fair

7 Volunteer patients –neighborhood canvassing –banners / flyers –letters to city employees from Mayor –incentives / give away items –community groups –volunteer center –multi-media outlets

8 Using the media for good

9 Exercise Evaluation Time motion study Patient evaluation forms Staff feedback forms Area hot washes Staff debriefing

10 V-Day: June 17 8:00 am – DPH Staff Sign In 8:25 am – General Briefing, Staff Break Area 9:00 am – Break into designated Areas for Area trainings from Area Leaders 9:45 am – Area Leaders Reconvene in Clinic Management Area 10:00 am – Begin Seeing Patients (Doors Open) 11:30 am – Press Conference, Level 2 1:00 pm – VIP Briefing, Level 2 3:45 pm – End of Exercise. Direct all patients to Paperwork Drop-Off 4:15 pm – Hotwash in individual areas 4:30 pm – All staff gather in Staff Break Area for large group debriefing 5:00 pm – All staff leave the building

11 Staff sign in General briefing

12 Area Trainings Medical Screening

13 Doors open at 10 am

14 Vaccination Clinic Areas Triage Fever / Rash Contacts Paperwork Distribution Education Screening Line Medical Screening Vaccination Line Vaccination Stations Paperwork Drop-off Mental Health Security Pharmacy Clinic Management First Aid Data Entry Staff rest area*

15 Patient Flow Vary with location Vary by staffing, patient needs 5 primary stations –Paperwork distribution –Education –Medical Screening –Vaccination –Paperwork drop-off


17 Triage Paperwork Distribution

18 Educational sessions

19 Medical Screening


21 Paperwork drop off area Gifts, educational information, certificates of appreciation


23 Staff tools Area Leaders for oversight Job Action Sheets Maps / directions / time study forms Staff education tools Clinic site layout Emergency instructions

24 Results/Outcomes Time Motion Study Patient Perspective Staff Perspective Vaccination Costs Lessons Learned and Recommendations

25 Results – Time Motion Study 1,325 clients completed data entry forms Service Type# of Clients% of Total Clients Contact392.9% Contraindications17413% Fever/Rash Exit171.3% Fever/Rash Mainstreamed211.6% General1,03378% Incomplete/Inappropriate Flow403% Rash1.08% Total1,32599.88%

26 Results – Time Motion Study Bottlenecks and Waiting Times Clinic Stops# of Patients Served Mean Waiting Time Triage1,3122.73 Contacts7929.62 Fever/Rash5321.61 Video1,2258.89 Screening Line1,19914.14 Medical Screening9313.36 Contraindications4314.00 Vaccination Line6981.49 Immunizer/Vaccinator7113.70 Wound Dresser6940.43 First Aid38.00 Mental Health168.28

27 Time Motion Study : Staff Utilization

28 Recommendations from Time Motion Study Reduce the number of vaccinators Increase and simplify signage Differentiate runners from clinical staff Increase staff training Increase staff available to answer questions, direct traffic Stagger educational sessions Separate lines for languages, special needs

29 Results – Patients Approximately 1,400 patients came through the exercise: many patient volunteers repeated the procedure The median patient age was 42. The age range was 1 – 93 yrs., with 65 children < 18.

30 Language Spoken at home% Cantonese29% Other Chinese (unspecified)28% Spanish24% Tagalog8% American Sign Language4% Vietnamese2% Russian2% Korean1% French1% Portuguese1% Mandarin1% 12% of patients (n=129) did not speak English at home. Results – Patients

31 Question from Patient Evaluation Form % of All Patients who Agreed % of all Monolingual Patients who Agreed Medical History and Consent Form was easily understandable 63%57% Exercise was well organized and orderly 94%87% DPH Staff was confident and knowledgeable 90%77% Patient was able to understand all written information given 93%81% Results – Patient Evaluation Forms (n=1060)

32 Question from Patient Evaluation Form % of All Patients who Agreed % of all Monolingual Patients who Agreed Patient was given clear direction on movement through exercise 85%79% Patient was informed of right to decide for or against vaccination 87%78% Video was clear on risks and benefits of vaccination 86%80% Patient was given clear instruction on how to take care of vaccination site 76%70% Results – Patient Evaluation Forms (n=1060)

33 82% of staff agreed that the on-site training was satisfactory. 92% of staff agreed that the job action information they received was easy to understand. 96% of staff agreed that the floor plan of the site was easy to understand. 94% of staff agreed that the supervision of their work was satisfactory. 88% of staff agreed that the supplies provided to them were adequate. 82% of staff agreed that the message/communication system at the drill was effective. Results – Staff Feedback Forms (n=155)

34 Results – Costs Medical Supplies$2,632 General supplies, pinnies, traffic flow enhancers $5,202 Rent, rented equipment, ambulance$11,119 Materials translation and reproduction $8,466 Volunteer incentives, watches$4,918 Food, water, beverage for staff$4,782 Total$37,119

35 Results – Costs Time Motion Study $37,119Logistics Total $15,000 $10,000 PR firm for recruitment Computer equipment $33,000 $95,119

36 Staff estimates –Needed more security staff Add at least two to each area –Needed more mental health staff –Possible to decrease number of vaccinators –Data entry staff may not be used in actual emergency –Flexibility in assignments needed Lessons Learned

37 Lessons Learned – Staff Estimates Using conservative estimates (228 people per site) –2 shifts x 40 sites = 18,240 people needed for one day

38 Lessons Learned – Staff Training 45 minutes of training was allotted for the exercise – in reality, doors should not open until all staff are adequately trained. –Have staff watch video. –Staff must know activities that take place at interdependent areas. –Staff must know proper protocols for documentation Develop training curriculum in advance

39 Lessons Learned – Signage Clear large signage with creative display is of paramount importance in big open spaces –Use color coded balloons –Use poles –Use paddles to identify available medical screeners –Place colored tape on floor regardless of expense

40 Lessons Learned – Materials Needed to be more developmentally appropriate –Medical History and Consent Forms –Closed captioning on video –Smallpox educational materials

41 Lessons Learned – General Have a plan for checking medical licenses in advance to ensure that only licensed staff are giving injections and/or medical advice. Work out a plan for infectious waste clean-up and disposal in advance Not necessary to separate patients into hard or easy categories for screening

42 Lessons Learned – General Have separate lines for different languages and the disabled Have information available regarding self care if not vaccinated There is no such thing as too many bilingual staff It worked well to have the press and VIP briefings removed from the exercise Support from top management is extremely important

43 Conclusion – Next Steps Valuable experience overall –High level of camaraderie from diverse staff –On the spot problem solving –Beneficial to experience issues face to face Site layout worked in general

44 Conclusion – Next Steps Work on training curricula Work on developmentally appropriate materials and translations Maintain plans and contacts on paper for 40 different sites –Determine these sites –Develop MOUs –Develop site plans

45 Conclusion – Next Steps Develop labor pool of interested persons Develop PSAs, media announcements now (multilingual) Keep in touch with interested agencies or organizations Enhance our flexibility Share experiences

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