CONTINGENCY PLAN FOR MASS VACCINATION AND TREATMENT by KevenMealamu

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									                PUBLIC VERSION –
          LOCATION OF CENTRES REMOVED




         CONTINGENCY PLAN
                FOR
        MASS VACCINATION AND
             TREATMENT



THE LOCATION OF VACCINATION AND TREATMENT CENTRES IS SENSITIVE
INFORMATION, AND SHOULD BE TREATED AS SUCH. THEY WOULD BE EXEMPT
FROM FoIA REQUESTS UNDER SECTION 38 OF THE FREEDOM OF INFORMATION
ACT 2000
CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT




                        CONTENTS

INTRODUCTION & OWNERSHIP …………………………………..                              3

BACKGROUND ………………………………………………………                                      3

LEGISLATION ………………………………………………………..                                   3

ACTIVATION ………………………………………………………….                                    3

ROLES & RESPONSIBILITIES …………………………………….                              4

NHS organisations – Staffing profile ……………………………….                    4

Local authority & voluntary sector – Staffing profile ………………          4

COMMUNICATIONS …………………………………………………                                    4

TRAINING & EXERCISING ……………………………………..….                              5

AUDIT & REVIEW ………………………………………………..….                                 5

APPENDIX 1 – Capacity Assumptions …………………………….                        6

APPENDIX 2 – LA & Voluntary Sector Staffing profiles …….…....         8

APPENDIX 3 – List of Centres ……………………………….….…                         9

APPENDIX 4 - Typical patient flowchart …………………….….… 10

APPENDIX 5 – Action Cards ……………………………………..… 11




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT




1. INTRODUCTION & OWNERSHIP BACKGROUND
      “When the general population is threatened or affected by a medical epidemic, mass
                        vaccination of the public may be necessary.”
                                          DOH (2003)


1.1      This plan outlines a prepared programme of identified Vaccination Centres in this Local
         resilience Forum area. Each centre will be assessed as suitable in processing approximately
         1,000 - 3,000 people per day, in response to an extremely large-scale local incident, or more
         likely a regional, national or international outbreak. This may require vaccination or
         distribution of prophylaxis to many of the population within a determined timescale.

1.2      This plan is owned by the Local Resilience Forum.

2. BACKGROUND
2.1      The establishment, staffing and operation of local mass vaccination centres are key elements
         in local delivery plans. The number of centres required to maintain an effective mass
         vaccination/prophylaxis programme in each centre depends on a range of factors, including
         geography, access and population density.

2.2      The nature of an epidemic or threat to the population will determine how the process of
         vaccination takes place, however the process of immunising large numbers, will be similar for
         each type of threat. Basic considerations and requirements in building, staffing, security and
         health and safety issues have been defined by the regional framework.


2.3      Vaccination requirements for all staff working at a centre will be individually assessed,
         depending on the particular infection.

2.4      In a highly contagious/dangerous outbreak it may be necessary to vaccinate staff prior to
         opening a centre. (Which could delay centre opening)

2.5      The current process of pre vaccinating key health personnel in certain circumstances will
         ensure an effective response in the initial stages.

3. LEGISLATION
3.1      There is no specific legislation relating to this plan however, special powers granted to HM
         Government under the Civil Contingencies Act 2004 may apply.

4. ACTIVATION
4.1      The Regional Director of Public Health, (RDPH) acting on information and advice from the
         Department of Health and the Health Protection Agency (HPA) will make the decision to
         activate the mass vaccination / prophylaxis process. In this type of event the RDPH provides
         the health link to Regional Resilience mechanisms and will act as the Regional Nominated
         Co-ordinator. Depending on the circumstances, the HPA will request premises to be made
         available in particular geographical areas to provide mass vaccination facilities. All relevant
         agencies will be directed to respond according to their respective local plans. This plan will
         identify the co-ordinating aspects that cover the Local Resilience Area.

4.2      On receiving the decision to activate this plan, co-ordination of the working arrangements will
         be undertaken by a Tactical Co-ordinating Group, chaired in the first instance by a
         representative from the hosting Primary Care Trust or the HPA



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      CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT



4.3   This group will review the nature of the activation, and dependant upon need, decide which
      of the designated centres will be activated. Where appropriate, the pre-designated receipt
      and distribution points for temperature controlled storage will be alerted to be ready to
      receive delivery.

4.4   This group will also agree opening hours of centres, which will be dependant upon the
      numbers requiring treatment and the urgency of treatment. If necessary, the agencies
      involved should be ready to operate centres over the 24 hour period.


5. ROLES & RESPONSIBILITIES
5.1   In a mass vaccination / prophylaxis event organisational / multi-agency major incident plans
      will be activated. The Primary Care Trusts (PCTs) will be responsible for:

      • The provision of non-specialist (medical) supplies
      • Distribution and co-ordination of specialist medical supplies from the DH / HPA
      • Provision of medical, nursing and administrative staff to facilitate and manage the
        vaccination / prophylaxis process.
      • Removal from site of clinical waste
      • Co-ordination and direction of public information and advice will be health led, through
        organisational and multi-agency communications networks.

5.2   The HPA will provide the DsPH and PCTs with specialist support, guidance and advice.

5.3   Local Authorities will assist in providing suitable premises, administrative/support staff and
      available resources and general supplies to facilitate the process.

5.4   Police Services will advise on the security/safety aspects of each considered site and
      respond to public order situations.

5.5   Staffing profile: NHS organisations
      The limiting factor in the event of multiple centres being set up is likely to be the availability of
      suitably trained and experienced staff. Appendix 1 sets out the planning assumptions that
      have been used in identifying the capacity of each centre based on size and number of
      rooms. It also outlines what this will mean in terms of qualified / experienced staff.

5.6   Staffing profile: Local authority & voluntary sector
      The figures set out in Appendix 2 reflect the staffing profile for an ‘average’ centre – they
      may be adjusted to reflect the actual size and proposed throughput of individual premises.

6. COMMUNICATIONS
6.1   Communications concerning health issues in the first instance will be directed to RDPH by
      DH or via the Health Protection Teams and local Directors of Public Health

6.2   The pre-determined lead agency will co-ordinate public information and advice for
      dissemination through the multi-agency network.

6.3   The Strategic Co-ordinating Group will decide who will be the primary spokesperson in the
      interim set-up period; once the command and control structure is in place, this may transfer
      to a specific agency.

6.4   On-going communications (e.g. updating media statements, photo ops.) in terms of
      frequency, content and strategy to be agreed and signed off at the most senior level.

6.5   Communications and information delivered will be a part of the consent process



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      CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT


6.6   The PCTs and NHS East Midlands will ensure that local public communications inform the
      public of where to go and when to go for vaccination.

6.7   The SCG communicating plan will outline specific direction to:

      • Inform the public

          o   When to go for vaccination and what to bring (e.g. identification)
          o   Where and how individuals will be called for vaccination
          o   What to expect when they get there i.e. adverse reactions and where to get advice
          o   Who should not attend for vaccination, i.e. those with contraindications

      • Inform staff, as above, including those affected directly and elsewhere in both NHS and
        involved agencies.

6.8   Where time permits, communication to the public will be via written information sent to
      patients using the GP registration system (Exeter). In the event of a situation requiring more
      urgent communication with the public, messages will be relayed via local media, or by direct
      communications

7. TRAINING & EXERCISING
7.1   This plan will be subject to testing and review by multi agency exercise within as directed by
      the General Working Group of the LRF. As the plan refines, it will inform the planning by all
      agencies to respond to the need for mass treatment and vaccination

8. AUDIT & REVIEW
8.1   The plan will be subject to audit by any appropriate agency, and will be reviewed on an
      annual basis by the Local Resilience Forum.




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         CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT


APPENDIX 1 - Capacity Assumptions

Capacity Modelling for Mass Vaccination Centres

Planning assumptions for mass immunisation:

Vaccination sessions are carried out by teams of 4 people manning a single station. This would
consist of two administrative staff drawing up and completing the paperwork and two clinical staff
giving the immunisation.

Each station requires a table of approximately 1.5 m plus space for chairs to accommodate 4 people
and immunisation equipment etc.

For planning purposes a space of 3.5m by 2.5 m will accommodate 2 vaccine points.

See the table below for a breakdown of the numbers a vaccinator can see per hour based on differing
lengths of the vaccination time.


 Number of clinical staff                    1           20          30          40         50           60


 Number per hour (3 min per vac)            20           400        600         800        1000          1200


 Number per hour (5 min per vac)            12           240        360         480         600          720


The rate limiting factors are drawing up of vaccines and completion of paperwork – however an
immuniser can be supported by administrative staff .

At the above rate one station can complete 40 immunisations per hour (as there are two vaccinators
per station).

If a 12-hour shift is carried out staff can potentially vaccinate 480 people per day.

The number of people who can be immunised in a venue in a single day will depend on the number of
stations which can be fitted into the venue.

An example is given below based on floor space at the Arts centre and Teachers Centre


 Teachers centre                                              3 min per vac              5 min per vac

 Station per venue                                                   23                             23
 Clinical staff per station                                            2                            2
 Time per vaccination                                                  3                            5
 Vaccination per staff / hour                                        20                             12
 Vaccination per station / hour                                      40                             24
 Total per day (7.5 hours)                                         6900                           4140
 Total per day (12 hours)                                         11040                           6624
 Total per 5 day week (7.5 hours)                                 34500                        20700
 Total per 5 day week (12 hours)                                  55200                        33120




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT


 Harrow Arts Centre                                     3 min per vac               5 min per vac

 Station per venue                                              30                            30
 Clinical staff per station                                       2                            2
 Time per vaccination                                             3                            5
 Vaccination per staff / hour                                   20                            12
 Vaccination per station / hour                                 40                            24
 Total per day (7.5 hours)                                    9000                         5400
 Total per day (12 hours)                                    14400                         8640
 Total per 5 day week (7.5 hours)                            45000                        27000
 Total per 5 day week (12 hours)                             72000                        43200

Harrow Arts centre has a large hall which could accommodate at least 30 stations.

There are also outbuildings which could be used for recovery and confidential interviewing.

If the large hall were used for 12 hours per day then up to 72000 immunisations could be administered
per week.

See table for staffing per centre

 Staffing levels per day

                                                      Harrow Arts Centre          Teachers Centre
 Admin per station                                                2                            2
 Clinical per station                                             2                            2
 Total staff per station                                          4                            4
 Stations per venue                                             30                            30
 Total staff per venue                                         120                            92




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT


APPENDIX 2 - LOCAL AUTHORITY / VOLUNTARY SECTOR STAFFING


ROLE TITLE        ROLE                                 SOURCE               N0.      COMMENTS

Centre Manager    Overall responsibility for           Local Authority         1     Must be trained to
                  management of centre and                                           LRF standards
                  provision of nonmedical
                  resources


Facilities        Responsible for the general          Local Authority         1
Manager           management and all the
                  facilities used by the Centre


Parking Control   To direct people to appropriate      Local Authority         2     Require appropriate
                  parking facilities                                                 PPE


Entrance Usher    To guide people to the               Local Authority         1
                  registration station


Vetting Officer   To check registration forms and Local Authority              2     Will require specific
                  give appropriate guidance                                          training


Adverse           To escort people with adverse        • St. Johns             1
Reaction Usher    reactions to the first aid station   • Red Cross


Exit Usher        To guide people out of the           Local Authority         1
                  building


Waste             To assist with the removal of   Local Authority              1     Will require specific
Management        waste from vaccination stations                                    training
Assistant


Staff catering    To provide members of staff          WRVS                    1
                  with appropriate catering
                  provision


First Aid         To assist people suffering from      • St. Johns             2     Must be qualified
                  adverse reactions                    • Red Cross


Public order      To monitor public order              Police                  1     Maybe PCSO
                  situations either on-site or
                  surrounding the site




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     CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT


APPENDIX 3 – IDENTIFIED CENTRES

DETAILS REMOVED FROM PUBLIC VERSION




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     CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT


APPENDIX 4 – TYPICAL PATIENT FLOWCHART




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT


APPENDIX 5 – Action Cards


ACTION CARD – CENTRE MANAGER
The Centre Manager is responsible for ensuring that the Centre is set up and managed effectively to
care for the welfare of the people who will use it. The main function is to maintain a Strategic Overview
of the centre operation and to liaise with the Tactical Co-ordinating Group.

Duties include:

•    Liaise with the Facilities Manager, Assistant Manager and NHS staff to assess the needs of the
     people likely to use the centre and completion of risk assessment.

•    Identify any further staffing needs of the centre and alert Tactical Coordinating
     Group of the need.

•    Ensure outside signs indicating this is a centre are clearly visible

•    Ensure suitable rooms are allocated and set out appropriately

•    Ensure all equipment required is available. Anything needed, not available, should be requested
     via the Tactical Co-ordinating Group

•    Liaise with the voluntary organisations present to allocate duties and designate areas for their
     use

•    Ensure that logging systems are set up to record events, accidents and records kept of all
     expenditure

•    Information Tactical Co-ordinating Group when centre is up and running

•    Liaise regularly with the Tactical Co-ordinating Group

•    Conduct regular briefing meetings with staff and team leaders

•    Keep on eye on staff welfare issues, ensuring that suitable breaks are taken (including your
     own!)




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT



ACTION CARD – ASSISTANT CENTRE MANAGER
The Assistant Centre Manager is responsible for assisting the Manager to ensure that the Centre is
set up and managed effectively to care for the welfare needs of the people who will use it.

Duties include:

•    Liaise with Centre Manager, Facilities Manager, and NHS staff to assess
     the needs of the people likely to use the centre

•    Maintain the log of events (including expenditure incurred)

•    Ensure adequate seating is available in waiting areas. If additional furniture required, this should
     be requested through the Tactical Coordinating Group

•    Complete the set up of the Centre and maintain stocks of stationery and other consumables

•    Put out signs to the Centre and internal direction signs

•    Prepare a notice board displaying the layout of the centre and its facilities

•    Assist the reception staff to maintain contact with “clients” whilst they are in reception area,
     providing them with information and guidance

•    Continually review the needs of those waiting, especially if they have special requirements

•    Attend regular briefing meetings with Manager, completing incident log

•    Brief staff not able to attend the Manager’s briefing meetings to ensure information is passed on

•    Arrange refreshments and relief for all staff, as required




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT



ACTION CARD – FACILITIES MANAGER
The Facilities Manager is responsible for the general management and all the facilities used by the
Centre. They will assist the Centre Manager in the safe running of the Centre.

Duties include:

•    Carry out and document a dynamic risk assessment of the premises prior to its opening as an
     Emergency Centre and communicate residual concerns with Centre Manager

•    Liaise with the Centre Manager, Assistant Manager and NHS staff to assess the needs of the
     people likely to use the centre

•    Ensure that the Centre is set up in accordance with the agreed plan

•    Ensure that all utility systems are working and heating, if required and available, is at an
     appropriate temperature

•    Ensure that facilities, both public and staff, are clean and well stocked

•    Ensure that all necessary signs, notices and plans are posted

•    Manage the transfer of medical waste within the centre

•    Allocate staff for car parking duties

•    Provide the necessary security arrangements to prevent unauthorised access to restricted areas

•    Take part in staff briefings

•    Maintain a regular cleaning and replenishment schedule through the premises to take care of
     spillages, waste bins, toilets, etc.

•    Ensure centre is cleaned upon closure




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT



ACTION CARD – NHS CENTRE LEAD
The NHS lead in the centre is responsible for ensuring the smooth running of the centre from a clinical
aspect, and has oversight in clinical matters.

Duties include:

•    Liaise with the Centre Manager, Assistant Manager and Facilities Manager to assess the needs
     of the people likely to use the centre

•    Ensure that any clinical pre-assessment processes are undertaken to reduce risks of adverse
     reactions to treatment or vaccination

•    Assess capacity in the centre and liaise with PCT / HPA colleagues

•    Responsible for the welfare of NHS staff, including shift changes, rest periods and refreshments

•    Manage and oversee clinical process

•    Ensure appropriate collection of clinical waste from the centre




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT



ACTION CARD – VACCINATION SUPPORT STAFF
The support staff will work with the vaccinators to ensure prompt turnaround at the vaccination /
treatment station.

Duties include:

•    Collect / confirm demographic information on each patient, including data entry on PCs

•    Provide any pre-prepared information that is needed

•    Support vaccinators by drawing up injections if required

•    Ensure clinical and domestic waste is removed from each station to a central collection point
     within centre




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT



ACTION CARD – VACCINATION / TREATMENT CLINICIAN
This role will be undertaken, in most circumstances, by a heath professional that is suitable trained
and experienced in the relevant method of administration of medication.

Duties include:

•    Responsible for ensuring that any treatment is carried out with informed consent, which may or
     may not include written consent

•    Responsible for ensuring that no patient undergoes any treatment that may be contraindicated

•    Refer for full medical assessment any patient where there is doubt as to the suitability or
     appropriateness of treatment




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        CONTINGENCY PLAN FOR MASS VACCINATION ANDTREATMENT



ACTION CARD – CENTRE DOCTOR
The centre Doctor will provide medical cover for one or more centres.

Duties include:

•    Provide clinical support to members of the vaccination team

•    Respond/advise in medical emergencies e.g. adverse reactions

•    Assess patients suitability for vaccination if found to be unwell

•    Assess patients with complex medical histories and / or on multiple medication for suitability for
     vaccination

•    Document any care/advice given on the individual patient using the patient vaccination form




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