Preparing for Smallpox: Postevent Smallpox Response

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Preparing for SmallpoxPost-event Smallpox
Response
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Smallpox

• Viral infection
• Person to person spread
• 30 death rate
• 1949 Last case in US
• 1972 Stopped routine vaccination in US
• 1977 Last naturally occurring case in world

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Smallpox

• Vaccination is effective in preventing infection
  if given in advance or within 3 days of exposure

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Smallpox

• Recent intelligence indicates four countries have
  stockpiles of the virus
• Iraq
• North Korea
• France
• Russia

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Mass Vaccination Plan

• We must be prepared for the possibility of a
  terrorist attack in which smallpox is used as a
  biological weapon
• The Centers for Disease Control (CDC) has
  instructed state public health agencies to
  develop and be ready to implement plans to
  immunize the entire population of the state in a
  10-day period if such an attack were to occur

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Mass Vaccination Plan

• Clinic demographics
• One clinic per 50,000 population, 117 clinics
  statewide
• Each clinic serves 5000 patients per day
• Each clinic operates 2 shifts per day, for 10
  days straight
• Each clinic staffed by over 200 people, over 100
  per shift

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Mass Vaccination Plan

• Where possible, the number of people identified
  to work in clinics should be increased by 20
  with cross-trained personnel to allow for
  no-shows, breaks, surge needs and other
  contingencies

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Clinic Volunteers

• 25,000-30,000 people needed to staff 117 clinics
  statewide
• Only 4,500 public health staff in the state
• In order to assure our ability to protect our
  families and communities, we need volunteers to
  work with public health staff to operate these
  clinics

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KNOX COUNTY MASS VACCINATION PLAN

• 8 Clinics planned in Knox County
• High school sites
• Transportation, parking, security plan
• Administration plan
• Two 8 hour shifts a day (16 hour days)
• Approximately 2,000 - 3,000 volunteers needed
• Volunteers would be vaccinated first, along with
  their family members

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Mass Vaccination Plan

• Clinic Flow
• Triage
• Forms Distribution
• Patient Education / Informed Consent
• Vaccination
• Exit Review
• Special Processes for Select Groups
• Patients with symptoms of smallpox
• Contacts to a case of smallpox
• Individuals with possible contraindications to
  vaccination

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Mass Vaccination Plan

• Clinic Support Functions
• Interpreter services
• Ability of deal with medical emergencies
• Security and traffic control
• Vaccine preparation
• Supply management
• Transportation plan
• Waste disposal plan
• Media plan

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Clinic Flow and Staff Functions

• Triage
• Screen out those individuals that may have
  smallpox (fever and rash) or contacts of a
  possible or confirmed case of smallpox and
  separate them from the mainstream clinic flow

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Clinic Flow and Staff Functions

• Ill Evaluation Area
• Evaluate/examine triaged ill persons and provide
  back-up to Medical Screeners and/or Contact
  Evaluation Area and/or EMT
• Possible cases of smallpox will be referred to
  hospital or other health care provider for
  diagnosis/treatment
• Patients approved for vaccination will reenter
  mainstream clinic flow
• Staff working in this area should be fitted for
  N-95 masks

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Clinic Flow and Staff Functions

• Contact Evaluation Area
• One-stop shopping for the most at-risk population
• Medical screening
• Vaccination
• Register for surveillance of symptoms
• Identification of contacts
• Education and special instructions
• On-site data entry

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Clinic Flow and Staff Functions

• Forms Distribution
• Put together and distribute patient forms and
  information packets
• Direct patients to video area

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Clinic Flow and Staff Functions

• Video Areas
• The same process takes place in staggered
  sessions in different locations where the
  patient
• Views educational video
• Completes informed consent
• Staff
• Run video
• Review informed consent forms
• Direct persons with all no checked boxes to
  vaccination area
• Direct persons with any yes or maybe checked
  box to either exit the clinic or to another area
  of the clinic for further evaluation

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Clinic Flow and Staff Functions

• Special Assistance Unit
• Patients with special needs (disability, literacy
  problem, language barrier, etc) are referred here
  for the same processes that occur in the other
  video areas
• Interpreter(s) will be available in this area

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Clinic Flow and Staff Functions

• Medical Screening and Counseling Area
• Patients with self-identified potential
  contraindications to vaccination are sent to this
  area if they they still desire vaccination or
  need/want further counseling
• Patients may either exit clinic from this area or
  proceed to vaccination area

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Clinic Flow and Staff Functions

• Vaccination Area
• Multiple vaccination stations per shift
• 2 Trained vaccinators at each station
• Ideally, 1 of the vaccinators at each station is
  a nurse
• During any given time period, 1 vaccinator is
  vaccinating while the other is dealing with
  paperwork and serving as a witness. The two will
  trade off on a regular basis.
• 1 Non-vaccinator support person at each station
  to assist in the compilation of paperwork and
  distribution of vaccine site care supplies

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Clinic Flow and Staff Functions

• Exit Review
• Staff answer any final questions about site care,
  adverse event symptoms, non-take reporting
  procedures, or other issues following vaccination
• Assures patients exit with all information sheets
  and instructions

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Other Clinic Support Staff

• Clinic Administration
• Assure smooth clinic operation
• Coordinate/communicate with regional public
  health office
• Address problems as they arise
• Supply Area
• Assure all clinic workstations have access to
  needed supplies
• Oversee vaccine storage and preparation

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Other Clinic Support Staff

• EMT to deal with medical emergencies
• Float nurse to oversee non-medical vaccinators
• Security / traffic control staff to maintain
  order

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Clinic Volunteers/Staff

• Should not have any contraindication to
  vaccination if they are going to work in the
  Illness Evaluation, Contact Evaluation or
  Vaccination Areas
• Volunteers and other members of their households
  will be the first to be offered vaccination in a
  post-event response

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Thank you for volunteering!

• Your help will be vital to the health and safety
  of our community.