Adverse Events and Emergency Protocols Ruth Carrico PhD RN FSHEA CIC Associate Professor Division of Infectious Diseases University of Louisville

Objectives Review emergency protocols that may be necessary following administration of vaccines Review emergency supplies and equipment

Emergency Protocols Adverse events – Injection site pain, syncope, anaphylaxis – Syncope (fainting) requires immediate assessment – Anaphylaxis requires immediate intervention Know where emergency equipment is located, know where emergency supplies are located, know how to use them, under what circumstances are they to be used, who is backup

Observing the Patient Organize process flow so vaccine recipients stay in the vicinity for about 15 minutes Most adverse events will occur within minutes of vaccine administration Observe the patients until they leave the area Devote time, attention, and resources to patient comfort as a preventive approach

Emergency Intervention Observe the patient Dizzy, diaphoretic No Issues Syncope 2 nd Line Tx Benadryl oral or injectable 1 st Line Tx 1:1000 Epi Home Recline Elevate feet Monitor Recline, Elevate feet, Monitor Activate 911 Home 911 Anaphylaxis

Emergency Supplies and Equipment   Syringes: 1 and 3 cc, 22 and 25g, 1”, 1½”, and 2” needles for epinephrine and diphenhydramine (Benadryl)  Alcohol wipes  Tourniquet  Adult airways (small, medium, and large)  Adult size pocket mask with one-way valve  Oxygen (if available)  Stethoscope  Sphygmomanometer (blood pressure measuring device) with adult-size and extra-large cuffs  Tongue depressors  Flashlight with extra batteries (for examination of the mouth and throat)  Wristwatch with ability to count seconds  Cell phone or access to onsite telephone or walkie talkie to call for help

Comfort Measures Ask about prior reactions to injections or venipuncture Often patient will let you know beforehand Listen to the patien! Maintain canned drinks and cookies/crackers on site Cold packs Identify an area where a patient may lie down

Automatic External Defibrillators Check for availability in the clinic area. Review operation

Reality Serious adverse events are unlikely Dizziness and fainting are more likely Observe the patients Have an emergency response plan ready and make sure it has been practiced Do not be afraid to call 911 Patient safety first