1. Mass Distribution and Vaccination Clinics Chris Mackie, MD Public health CBRN course

2. Why Plan for Mass Distribution and Vaccination Clinics? Likely worst case CBRN scenario in Canada for planning purposes : up to 100,000 people* Delay in vaccination can result in exponentially expanding epidemics –Smallpox, hep A Delay in treatment can result in significantly increased mortality –Anthrax, nuclear accident *Solicitor General of Canada, Developing Options to Strengthen National Consequence Management Response Capability for Terrorist Incidents, 2001

3. Goals of Session Describe key elements of a plan for mass distribution and vaccination clinics (DVCs) Discuss critical issues in implementation of DVCs Suggest some assessment mechanisms for a DVC plan Discuss cases

4. What is a Mass Distribution and Vaccination Clinic? System of delivering prophylaxis on a large scale NOT mass casualty clinic Could include delivery of: –Vaccine –Antibiotics –Other medication (eg. KI tabs)

5. Elements of a DVC Plan Who What Where When How

6. Who: Stakeholders External stakeholders –Population –Health care professionals and their organizations –Health care system representatives –Law enforcement –Media –Other levels of government Internal stakeholders –Public health –Emergency management –Legal services –Community relations –Liaison

7. What is required to run a DVC Staff Support infrastructure for staff Transportation Equipment and supplies –Medical and PPE

8. Where will the DVC be? Push, pull, or combination? Location – out of harms way Size Security Access Storage Staff support services Communication capacity Back up power

9. When will the DVC be activated? When to open DVC When to escalate to regional, provincial or federal involvement Criteria for closing DVC

10. How will you run the DVC? Overall plan tied to specific objectives Incident Management System (IMS) Public information plan Floor/flow plan Clinical protocols Other policies and procedures

11. Elements: Staffing Rapid recall for current staff Creative solutions to recruit additional staff –Neighbouring jurisdictions –Retired staff –Students –Non-traditional providers Volunteer list and clear guidelines for involving volunteers

12. Elements: Staffing Discussing unusual tasks and unfamiliar situations with unions and professional colleges in advance –Turf, safety, ethical imperatives, interpretation of contract language Staff orientation plan –Policies and procedures

13. Elements: Documents Clinic publicity information Medical/epidemiological risk screening sheet Information sheets on intervention with follow-up instructions Intervention record Orientation manuals with policies and procedures

14. Elements: Clinic Publicity Intervention and services offered and not Clinic location Hours of operation Target population Documentation of eligibility, if required Information for people not in target population When certain groups should present Proper clothing for easy immunization Access: parking, mass transit

15. Elements: External Communications Comprehensive media strategy Emergency broadcasting Information hotline Website

16. Elements: Facility Floor/ Flow Plan

18. Elements: Equipment and Supplies Medical equipment and supplies, PPE, administrative supplies Many resources for equipment and supplies, including: –Ontario Government Pharmacy –National Emergency Stockpile System

19. Elements: Generic Policies and Procedures Informed consent (see provincial policy) Mass informing? –Risks, benefits, contraindications Documentation of consent –Signature vs. verbal –Tick box vs. written description Data management –Clinic records – paper or electronic? –Protecting patient privacy Adverse event reporting

20. Elements: Generic Policies and Procedures Incident Management System (IMS) Command Operations Response Team(s) PlanningLogistics Finance / Administration SafetyInformation Liaison

21. Plan Management Development –Partner and stakeholder input –Building relationships and buy-in Dissemination Revision –Process to update plan regularly

22. Scenarios – Preparing to Implement a DVC Plan Genuine anthrax attack on government offices Nuclear plant releasing contaminated plume over populated area Other

23. Plan Implementation: Identifying Event and Intervention Determine a CBRN event has occurred Identify the nature of the substance involved Define temporal and spatial boundaries of the event Determine appropriate intervention and required follow-up

24. Plan Implementation: Facilities Select facility (facilities) Set timelines –When to open clinic (ASAP) –Expected duration of operation Establish clinic closure criteria

25. Plan Implementation: Who Needs the Intervention? Define exposure criteria Determine who should receive the intervention and prioritize groups –Cases –Contacts –Health care workers –First responders –Essential services personnel Determine criteria for proof of eligibility

26. Plan Implementation: Policy Review and Development Review generic policies and procedures and ensure they are appropriate –Medical directives –Consent –Data management Set policy for conflict resolution –Predictable: individuals want the intervention but dont meet criteria Set policy to address refusal of intervention –Is quarantine appropriate here?

27. Plan Implementation: Staffing and IMS Issues Arrange staffing for the facility –Clinical, security, IMS roles Media enquiries Law enforcement issues Security: risk of bomb on bomb

28. Plan Implementation: Logistics and Finance Determine mode of transportation for special populations Obtain necessary medical supplies and PPE Generate documents –Handouts regarding the intervention –Documentation forms Proposed funding mechanism

29. Go!

31. Key Concepts for DVCs Who What Where When How HIRA (CBRN-O) IMS Plan Management Floor/Flow Plan Creative Staffing Creative Policies/ Procedures/ Protocols