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					  Preparing for Smallpox:
Post-event Smallpox Response




                               1
                 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
                                               2
             Smallpox
• Vaccination is effective in
  preventing infection if given in
  advance or within 3 days of
  exposure



                                     3
                Smallpox
• Recent intelligence indicates four
  countries have stockpiles of the virus
  –   Iraq
  –   North Korea
  –   France
  –   Russia



                                           4
      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
                                                    5
      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

                                                    6
      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




                                             7
          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

                                                8
      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,      9

  along with their family members
       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



                                                                       10
      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
                                                 11
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    12
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    13
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




                                                 14
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    15
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
                                                           16
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    17
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


                                                          18
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    19
Clinic Flow and Staff Functions
• Forms Distribution
  – Put together and distribute patient forms
    and information packets
  – Direct patients to video area




                                                20
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    21
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
                                                                      22
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    23
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



                                                    24
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    25
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


                                                  26
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    27
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

                                                                28
                                               TENNESSEE MODEL
           TRAFFIC
                                                                                                                        Security Staff
                                                               TRIAGE                                                   Public Health
                                                                 2 Staff
                                                                                                                           MD, NP, RN, Pharmacist
                                                                                                                         ( Not Necessairly PH )
      Ill Evaluation Area
                2 Staff                                                                                                  Non-Medical
            ( Minimum 1 MD )

                                                                  Forms
                                                               Distribution
                                                                  9 Staff




  Special                 Video                    Video                          Video                     Video                 Video
 Assistance               Area                     Area                           Area                      Area                  Area
    4 Staff
( 1 interpreter )         3 Staff                  3 Staff                        3 Staff                   3 Staff               3 Staff




                                 OK to Vacc


Medical                        Vaccination Area                             Vaccination Area                                      Contact
Screening &                    1 non med non vaccinator                     1 non med non vaccinator                              Evaluation
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
Counseling                                                                                                                        &
Area                                                                                                                              Vacc Area
                                                                                                                                  4 Staff
7 Staff                        Vaccination Area                             Vaccination Area                                          ( RN/Epi/
                               1 non med non vaccinator                     1 non med non vaccinator                                   PH Rep )
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )                         1 Data Entry




                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )

                                                                                                                      Clinic Administration
Supply Area                                                                                                           1 Manager
1 Manager                      Vaccination Area                             Vaccination Area                          1 Assistant Mgr
1 Asst Mgr                     1 non med non vaccinator                     1 non med non vaccinator                  1 Float Staff
2 Vacc Prep                    2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )
1 Float Staff


                               Vaccination Area                             Vaccination Area
                               1 non med non vaccinator                     1 non med non vaccinator
                               2 vaccinators ( prefer 1 RN )                2 vaccinators ( prefer 1 RN )               1 Emergency Medical
                                                                                                                            Technician

                                                         EXIT REVIEW
                                                                                                                         1 Float Staff ( RN )
                                                                  2 Staff

                                                                                                                                                    29
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


                                                  30
    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

                                                           31
   Other Clinic Support Staff
• EMT to deal with medical emergencies
• Float nurse to oversee non-medical
  vaccinators
• Security / traffic control staff to maintain
  order



                                             32
                                                                                     Public Health
                                                                                       Regional
                                                                                       Director
          Vaccination Clinic
          Organizational Chart
                                                                                       County
                                                                                       Health
                                                                                       Director



                                                              Float                   Clinic                        Asst Clinic
                                                              Staff                                                  Manager
                                                              (1)
                                                                                     Manager                           (1)
                                                                                       (1)




 Security /                       Administrative                                      Medical                              Contact                 Supply
  Traffic                           Support                                         Team Leader                           Eval / Vacc              Manager
Team Leader                       Team Leader                                                                            Team Leader                (1)


 Security /                Forms                 Triage                 Illness                      Medical                         Contact                 Asst Supply
  Traffic               Distribution           Staff ( 2 )            Evaluation                    Screeners /                     Eval / Vacc              Manager ( 1 )
Staff ( 22 )             Staff ( 9 )                                  Staff ( 2 )                 Counselors (7)                    Staff ( 4 )



                         Special                 Video /                                                 Exit                       Data Entry                 Vaccine
                        Assistance              Referral                 EMT                           Review                        Staff ( 1 )             Preparation
                        Staff ( 4 )            Staff ( 15 )              (1)                          Staff ( 2 )                                             Staff ( 2 )



                                                                      Vaccinator                      Vaccinators                                               Float
                                                                       Support                       ( 10 ) Medical                                           Staff ( 1 )
                                                                      Staff ( 10 )                      ( 10 ) Non
          Security Staff

          Public Health
                                                                                                         Float
          MD, NP, RN, Pharmacist                                                                          RN
                                                                                                         (1)
          Non-Medical
                                                                                                                                                             33
      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


                                               34
Thank you for volunteering!

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



                                         35

				
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