Wednesday Webinar: Understanding Mass Clinic Operations

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Wednesday Webinar Understanding Mass Clinic
Operations
Jay Shrader, Director Western Region Partnership
for Public Health PreparednessEmail
jasons_at_co.polk.wi.usTel [phone]Online at
www.wrpphp.org
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Learning Objectives

• Explain the purpose of a mass clinic
• Discuss current local public health department
  planning efforts
• Discuss the types and kinds of Mass Clinics
• Discuss the Mass Clinic Command Structure (ICS)
• Describe the six primary stations of a mass
  clinic
• Discuss LPHA expectations for upcoming
  Performance Measure Exercise

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Mass Clinic Purpose

• To distribute medical supplies and
  pharmaceuticals (e.g. medication and
  vaccinations) from the Strategic National
  Stockpile (SNS) to an entire jurisdictions
  population in just 48 hours following an act of
  bioterrorism or large scale disease outbreak.
  
• Distribute 3 day supply of pharmaceuticals to the
  emergency response community from the Interim
  Pharmaceutical Stockpile (IPS).
• Normal public health operations (e.g. annual
  flu clinics)
• Prophylaxis versus treatment

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Planning Efforts

• Operational Mass Clinic Plan
• CDC SNS Assessment
• Secured small, medium, and large scale sites
• Memorandums of Understanding (MOU)
• Patient clinic flow diagram
• Equipment purchased (radios, ICS vests, kits)
• Exercise and Training
• Security Plans
• Annual updates and reviews

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What might you expect?

• Chaos, confusion, and panic
• Influx of calls to the LPHA from the general
  public
• Media knocking at the LPHA door
• Policy makers wanting to know whats going
• Disease investigations
• Potential isolation and quarantine orders
• All of this while preparing for a mass clinic
  (throughput)
• County Population 43,270
• 2 day timeline to vaccinate or dispense
• 21,635 each day
• 901 per hour continuously for 48 hours (AKA
  Patient Throughput)
• 15 people per minutes

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Activation

• Confirmed act of bioterrorism or communicable
  disease that is highly contagious and has the
  potential to spread rapidly through a community.
• Local public health resource are overwhelmed
• Activating a mass clinic is a local decision.
  Ordering the SNS or IPS requires State
  consultation.
• Public Health will collaborate and coordinate
  with Emergency Management, the Division of Public
  Health, and Medical Partners to determine
  activation.

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Determining Level of Response

• Based on epidemiological investigations, scope,
  severity, and effected population
• LHD will do whatever is reasonable to control the
  spread of a communicable disease in order to
  protect the publics health. This includes mass
  vaccinating or dispensing medications using
• Stand Alone Mass Clinic
• Alternate Methods of Dispensing

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Primary Mass Clinic Operations

• Small Scale Mass Clinic Operations (Nlt1000)
• Example annual flu vaccination clinic at the
  local health department
• Medium Scale Mass Clinic Operations (N1000-5000)
• Example Dispensing Medications to emergency
  responders from the IPS at a community center
• Large Scale Mass Clinic Operations (Ngt5000)
• Example Administering smallpox vaccinations to
  the entire community from a High School

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Alternate Mass Clinic Operations

• Option1 Head of Household
• Household members can pick up medications for
  anyone living in their household
• Option 2 Business Mass Clinic
• closed mass clinic for employees and anyone
  living in their household of larger businesses.
• Option 3 Sheltered-In Mass Clinic
• Nursing homes, clinics, hospitals, residential
  based facilities
• Option 4 Satellite Mass Clinics
• Pre-determined clinic sites throughout the County
  strategically placed to reach populations in an
  area more quickly.
• Option 5 Drive Through Mass Clinic

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Getting the Ball Rolling

• Coordinate response with County Emergency
  Operations Center (EOC)
• Notify DPH and order SNS / IPS assets as
  necessary
• Notify Mass Clinic Site Point of Contact
• Notify pre-assigned mass clinic staff
• Implement Incident Command System
• Set up Mass Clinic Site (4 hours or less)
• Establish Public Information Center to notify
  public
• Dispense or vaccinate MC workers and family and
  other emergency responders
• Dispense or vaccinate public

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Coordinating a Mass Clinic

• Clinic will operate using the Incident Command
  System
• Command (Directors)
• Operations (Doers)
• Planning (Planners)
• Logistics (Supporters)
• Finance Administration (Recorders)

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What is your role?

• The LPHA worker role in a mass clinic setting is
  different from agency to agency.
• One thing is certain, everyone will be involved.
• Minimally, you should know what section of ICS
  you will be working in
• Ideally, you should know your exact role(s)

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Communication is Key!!!

• Effective and timely public information with
  detailed instructions
• Internal Communications inside the mass clinic
• External communications to partners and the EOC
• Clearly marked mass clinic sites

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ENTER
Entre - Recepción Kommen Sie Herein -
Willkommen Entrez - Bienvenue
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TRIAGE
1
Triage
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REGISTRATION
2
Registro Ausrichtung Enregistrement
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PATIENT EDUCATION
3
Educación Paciente Geduldige Ausbildung Éducation
Patiente
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HEALTH SCREENING
4
Investigación De La Salud Gesundheit
Siebung Criblage De Santé
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DISPENSING
5
Medicina Medizin Médecine
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VACCINATION
5
Vacunación Schutzimpfung Vaccination
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CHECK OUT
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Final Ende Finition
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EXIT
Salida - Adiós Ausgang - Auf Wiedersehen Sortie -
Au revoir
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FIRST AID
Primeros auxilios Erste ERSTE HILFE Premiers Soins
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WAITINGAREA
Área Que espera Unterstand Refuge
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INFORMATION
Información Informationen L'information
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BUS
Autobús Bus Autobus
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ARE YOU PREGNANT?
Es usted embarazado? Sind Sie schwanger? Êtes-vou
s enceinte ?
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ALLERGIES?
Es usted Alergic? Sind Sie Alergic? Êtes-vous
Alergic ?
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NO FOOD OR DRINK
Ningún alimento o bebida Keine Nahrung oder
Getränk Aucune nourriture ou boisson
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TRASH
Basura Abfall Détritus
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Stations of a Mass Clinic

• Station 1 Triage
• Station 2 Registration
• Station 3 Patient Education
• Station 4a Screening
• Station 4b Counseling
• Station 5a Dispensing Area
• Station 5b Vaccination Area
• Station 6 - Checkout

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Operational Assessment

• All mass clinics, whether stand-alone or
  alternate methods of mass clinic, will follow the
  same clinic flow, policies and procedures. The
  ultimate goal is to ensure the Clinic is reaching
  desired patient throughput. Non-critical
  stations may be altered or deleted in order to
  increase patient throughput to reach the public
  health target.

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Mass Clinic Operations

• Critical versus Non-critical Stations
• Operations Section Chief needs to monitor
  throughput
• If throughput is not reaching desired numbers,
  some stations may be reduced, eliminated or
  altered
• Express Lines versus Standard Lines
• Standard lines are for individuals that who may
  be taking medications, have contra-indicators,
  have questions, or need other assistance.
• Express lines are for individuals who have
  completed medical forms prior (e.g. LPHA
  website), do not have contra-indicators, and need
  only to pick up medications or get vaccination.

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Mass Clinic Stations

• Station 1 Triage
• Critical Station
• Remember, mass clinics are for prophylaxis
  purposes not treatment.
• Ideally, occurs away from MC entrance.
• Medical personnel perform initial assessment and
  separate symptomatic from asymptomatic clients.
• Symptomatic individuals directed to HC facility
  for treatment
• Asymptomatic individuals proceed to Station 2
  Registration

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Clinic Stations

• Station 2 Registration
• Non-Critical
• Individuals will be formally greeted, registered
  and given a packet of information including a
  Medical History Screening Form and other
  important information.
• Patients proceed to Station 3 Patient Education

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Clinic Stations

• Station 3 Patient Education
• Non-Critical Station
• Educate patients about the vaccine/medicines,
  discuss medical and legal information, answer
  patient questions, discuss contra-indicators,
  explain vaccine/medicine administration, care,
  and follow-up procedures accordingly.
• Ideally, conduct brief just-in-time sessions for
  25-30 individuals at a time
• Individuals proceed to Station 4 Screening and
  Counseling

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Clinic Stations

• Station 4A Screening
• Critical Station
• Individuals will proceed to Station 4A Screening
  with completed screening forms.
• If client answers positively to any of the listed
  contraindications for themselves or a family
  member, they will proceed to the Station 4B
  Counseling.
• If there are no identified contraindications, the
  client will sign applicable consent forms and
  proceed to Station 5 Dispensing / Vaccinating.

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Clinic Stations

• Station 4B Counseling
• Critical Station
• Offers private medical counseling for clients
  with contraindications to vaccine or medication
• If a client refuses or can not medically accept
  vaccine or medication, they will sign a refusal
  roster
• Provide client with appropriate case management
  information
• Patients will proceed to exit the clinic or to
  Station 5 Dispensing / Vaccinating.

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Clinic Stations

• Station 5 Dispensing
• Critical Station
• When possible have a pharmacist preside over
  dispensing operations.
• Separate lines for the elderly, disabled and
  others who may not be able to stand for long
  periods of time people with children (correct
  pediatric dosing takes longer than adult dosing.)
• Have clients sign consent forms

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Clinic Stations

• Station 5 Vaccinating
• Critical Station
• Clients will be asked to sign a consent roster
  indicating they have received patient education
  and had all questions addressed.
• Record those who received vaccination on hard
  copy for real-time for later entry in WIR or
  RECIN.
• Monitor for anaphylactic shock.
• Patients will proceed to Station 6 Checkout.

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Clinic Stations

• Station 6 Checkout
• Non-Critical Station
• Reminded about managing their treatment beyond
  the mass clinic.
• Review and collect all documentation.
• Make sure clients have all necessary forms and
  instructions.
• Answer final client questions, consulting with
  medical staff as necessary.
• Direct individual to exit Mass Clinic.

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Other Clinic Areas

• Incident Command Post
• Workforce Staging Area
• Staff Rest Area
• Security Station
• First Aid Station
• Receiving Area
• Pt. Overload Area
• Med or Vaccine Prep Area
• Food Preparation
• Media Room

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Sample County Mass Clinic Site Map
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2009 PM Exercise

• Similar to last years exercise
• Scenario based
• Timed responses
• New this year
• Activate a pre-identified mass clinic site (per
  MOU)
• Mass Clinic Staff Call-down
• Set up mass clinic site
• Develop an Incident Action Plan for new
  operational period

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Thank you!

• Next Wednesday Webinar
• Wednesday, April 29th
• Introduction to the new Public Health Emergency
  Plan
• Webinar will be archived at www.wrpphp.org
• Questions or Comments
• Raise your hand
• Text us a question