Transcript Kodiak Exercise Lessons Learned

Stories from the Field:
Mass Vaccination Exercise
in Kodiak, Alaska
Ruth-Anne O'Gorman
Darsha Spalinger
Kodiak Public Health Center
Location of Kodiak
Anchorage
Island of Kodiak
Objectives
 Review what worked
well in planning and
operations
 Describe the challenges
encountered during
the exercise
 Explore changes for future mass prophylaxis
clinic activities
Question
Have you participated in a real or mock
exercise of a mass vaccination clinic?
A. Yes
B. No
What were one or two of the challenges you faced
during the event or exercise?
Answer via text chat or over the phone.
Community Planning
What Worked Well
 Wide range of community/agency participants
 Community/agency exercise objectives
identified/met
 Specialized Incident Command Systems (ICS)
training received by Kodiak Emergency
Operations Center staff
Community Planning
What Worked Well
 State draft Mass
Prophylaxis Plan:
Useful planning tool
 Local Police, Fire/EMS,
Amateur Radio filled
clinic support functions:
Security, medical,
communications
 Pre-clinic and clinic communications
coordinated between State PIO and
local media
Community Planning
What Worked Well
 Local PHNs presented to multiple
community organizations and
service groups
 Use of local health fair one month
before exercise to recruit volunteers
 Informational and directional
signage posted in three primary
community languages
Community Planning
Challenges: Lessons Learned
 Unable to test Emergency Operations Center
due to borough staffing vacancies
 Influenza vaccine shortage: flexed clinic
operations to include high risk priority
screening
 Pre-event advertising in
English only: future to
include Tagalog and
Spanish
Community Planning
Challenges: Lessons Learned
 Fire code mandated maximum of 400 people
in combined lobby/commons area: required
monitoring by clinic safety team
 Kodiak Emergency Operations Plan (EOP)
needs revision to include
mass prophylaxis/
dispensing response
Question
Do you know the name of your
fire chief/marshal?
A. Yes
B. No
Site Selection
What Worked Well
 Kodiak High School well known to residents
 Lobby and commons adequate space to
process flow rate of 500/hour
 Floor plan/station placement: elevated area
facilitated overall observation
 Adequate room to
locate family station
for increased privacy,
dedicated pediatric
vaccination
Site Selection
What Worked Well
 Fire Marshal walk-through resulted in floor
plan compliance with fire code and
evacuation requirements
 Commons area served
by elevator, shallow
stairs: Supported access
by mobility impaired
elders, wheelchair,
stroller access
Site Selection
Challenges: Lessons Learned
 School also designated as emergency
shelter: Need to clarify priority use
 If symptomatic clients or disease exposure
 Risk: designate screening area separate
from clinic
 Residents familiar with multiple school
entrances: increase size and number of
entry/exit signs
Site Selection
Challenges: Lessons Learned
 Larger “Staff Only” entrance sign to reduce
unauthorized persons entry into command station,
volunteer area
 Some elderly unable to access clinic due to lack of
transportation: pre-arrange transportation, consider
satellite or mobile clinics
 Expand checkout station to
reduce bottlenecks at exit
Site Selection
Challenges: Lessons Learned
 Unable to utilize gym for exercise: in real
event with bad weather or need to prescreen symptomatic or exposed residents
would use lobby or commons to prescreen, operate clinic in gym
 Short flight of stairs proved problematic for
strollers, elevator inoperable. In future
operate on one floor.
Site Selection
Challenges: Lessons Learned
 Congestion at family station due to parents
receiving immunizations with children. Have
parents vaccinated at regular station first or
insure that all vaccinators can vaccinate
children safely…delete family station
Supplies
What Worked Well
 Supply List from Mass
Prophylaxis Annex used
 Colored “pinnies” to identify
work stations/staff very
useful (would order larger
size, consider additional identifier for team
leaders, maybe a hat)
 Signage (Information, Direction-three languages)
Vaccine Information Forms (with ‘tear-away’ registration
provided by State Section of Epidemiology)
Supplies
What Worked Well
 Signs and forms were clear, easy to post/use.
Will reuse clinic signs as heavy duty laminated
 Decision: No onsite data entry. Hard copy
registration forms collected at exit, filed at Kodiak
Public Health Center
Pictorial
English
Spanish
Tagalog
Question
Do you know the 3 or 4 most predominant
languages in your community?
A. Yes
B. No
Supplies
Challenges: Lessons Learned
 Original supply order to cover 5,000 clients.
Change in vaccine availability occurred after
supply order placed…exercise scaled back…
re-packaged non-perishables for
future use
 Need to identify community storage site for
emergency response durable goods
Supplies
Challenges: Lessons Learned
 No supply team: This function
blended with general clinic
support/flow team. Need
dedicated supply staff and
spreadsheet to track use of
vaccine, general clinic material
Staffing
What Worked Well
 Determined number of work stations/staff to fill
stations based on available facility space
 Volunteer recruitment per September Health
Fair and word of mouth one month before
exercise
 Kodiak Red Cross drafted clinic staffing sheets,
assigned volunteers to both shifts
Question
How did you handle training prior to the exercise?
A. A week or more before the clinic
B. The week of the clinic
C. The day before the clinic
D. The day of the clinic
Why did you choose A, B, C, or D above and
how would you change the training for the next
exercise?
Staffing
What Worked Well
 Clinic Staffing Schedule/Job Action Sheets: Modified
from State Mass Prophylaxis Plan
 Excellent volunteer turnout
(CEUs offered to RN, LPN, EMS staff)
 Volunteer orientation: One hour evening prior to clinic:
15 minute overview, 45 minute station specific training
Staffing
Challenges: Lessons Learned
 Fire code/building capacity biggest constraint on
number of clinic stations
 Needed to include Red Cross Volunteer recruiter in
more of the pre-clinic communications
 Day of clinic: Needed more staffing at volunteer station
for staff check in/out, maintaining
staffing rest area
 Lions/Rotarians volunteered,
underutilized for this one-day
exercise
Staffing
Challenges: Lessons Learned
 Real event likely to pull from hospital/clinic RN
volunteers, resulting in reduced vaccinating capacity
 Kodiak EMS/Police staffed exercise medical/security.
Real event may pull them to other duties: would
increase use of safety team, nursing and other trained
health care volunteers
 Future: Consider posting “Station Activity Sheet” at
each station
 Future: Further modify JAS to use more “bullets”
Staffing
Challenges: Lessons Learned
 JAS: “Triage Team Leader” would rework this
description, assign RN who knows the community to
staff this position
 More translators/interpreters needed at each station
 Future: Only one clinic manager on site
 Some volunteers felt underutilized: Plan to cross train
all staff for several stations
Operations
What Worked Well
 Good pre-clinic/exercise community outreach and
education
 Bayside Amateur Radio: communications technology
good. Set up several station phones, established
external link for vaccine re-order & secure shipment,
closed circuit TV to monitor lobby/commons
 Float position: Triage team
facilitated client process
through screening
Operations
What Worked Well
 Rapid client processing through dispensing/
vaccinating station
 Secure transport/storage vaccine with cold chain
maintained: coordination Immunization Program
Manager, State Pharmacy Depot, Alaska Airlines,
US Coast Guard
 Orange paddles used to indicate
client-ready station, signaled
clients from triage/screening
line to vaccination station
Orange Paddle
Operations
What Worked Well
 “Runner” position within Clinic
Support Team worked well for
supplies, back up for
communicating messages
within clinic
 “Mobile Vaccinator Nurse” position within
Dispensing/Vaccination Team good idea for vaccine
administration to clients in vehicles (unable to
access clinic due to compromised immune system)
Operations
Challenges: Lessons Learned
 Need to include three primary community languages
in all in all pre-clinic announcements
 Arrange for bus/other transportation for elders/mildly
disabled clients without personal transportation
 Walkie-talkies between team leaders/clinic stations
did not work well: static
Operations
Challenges: Lessons Learned
 No planned team leader debriefing (partly due to
brief 4 hour shifts). Would plan this in next exercise
or real event
 Dry erase “status board” not
available as planned, chalk
board not a good substitute
 “Spread of triage positions”
difficult for Triage Team
Leader to monitor. Consider
putting translators under
“Clinic Support Team”
Operations
Challenges: Lessons Learned
 Check In: Consider additional clinic support staff
“Greeters” to maintain lines at registration, use tape
for traffic direction
 Check Out: Need to add another staff person to
count processed clients
 In real event would need to include JAS for vaccine
supply position (filled at this exercise by State
Immunization Program Manager)
Operations
Challenges: Lessons Learned
 Increase number of Safety team staff to assist with
external security, traffic direction, recognition of drive
through clients
 Mobile Vaccinator Nurse: better positioning needed
to facilitate communications regarding arrival of
clients in designated parking area
 Teen runners best used for supply movement and as
line monitors rather than message delivery
Questions