# Presentation: 666925

## Partnering with the Critter Clubs:“Lions, Eagles, Elks, Oh My!”

- Thurston-WA Region 3
- Medical Reserve Corps
- Olympia, WA

**Diana T. Yu, MD, MSPH****Lewis, Mason, and Thurston Counties’ Health Officer****Sammy B. Berg, RS****Strategic National Stockpile Coordinator**

**Notes:**
Contact information:Thurston County Public Health & Social Services Department
412 Lilly NE, Olympia, WA, 98506
360.786.5581
www.co.thurston.wa.us/health

## Thurston County, home to the state capitol and over 220,000 people.

**Olympia**

**Notes:**
[Photo credit: Aerial photo of the City of Olympia, looking northward. Undated photo on the City of Olympia website. No photographer information listed. www.ci.olympia.wa.us/information/gallery/photo8.asp]

[Map credit: www.bentler.us/eastern-washington/washington-state-map.htm
“Map Sources: Washington Gap Project 1991 Land Cover for Washington State, USGS shaded relief map of WashingtonPermission to copy map for printed displays and distribution is granted for educational use.Cartography by Fred Bentler”]

## The Thurston County Public Health & Social Services Department has 125 employees and has been successful in responding to past public health crises. 

- Norwalk virus at a popular summer swimming lake
- Hepatitis A immune globulin clinic over Christmas
- White powder calls!

**Notes:**
Difference in scales between past events and current scenarios we are preparing for.
We have also been fortunate to have few public health crises or community disasters (annual winter flooding and occasional snow/ice storm).
Even the 2001 Nisqually Earthquake was not large enough to shake folks into action around preparedness efforts and the potential scale of a necessary response.

[Photo credit: Thurston County Public Health & Social Services building, Olympia, WA. 2002. Staff photo.]

## Thurston-WA Region 3 Medical Reserve Corps

- Started in 2001 as the Medical Community BT Response Team
- The Medical Reserve Corps currently consists of 52 doctors, nurses, pharmacists, dentists, veterinarians, counselors, and others.

**Notes:**
In response to the flood of calls to the department concerning “white powder” in 2001, Dr. Yu worked with physicians to start a impromptu medical corps, presenting bioterrorism training to local providers and developing the core of the Medical Reserve Corps. With the help of grant money, Dr. Yu continued her efforts to establish an official MRC in the county in 2003.

MRC web site: www.co.thurston.wa.us/health/MRC/index.html

## Flyer posted in womens’ stalls at bars

**Notes:**
Late March 2004. A local public health crisis makes the national news (The Inquirer!)
This was the largest public health response the department had engaged in. This event started with the arrest of the a HIV positive male for ignoring a public health “cease and desist” order as he had tested positive for HIV/AIDS and was reported to be having unprotected sex. The department had just started training in emergency management organization (incident command system-ICS) and used that training to organize a response.
We held a response team meeting late Friday morning, scoping out resources and workloads. At 5 PM, the TV news media broke the story and it was front-page news in Saturday’s paper.
As part of our outreach efforts to potential partners of the case, this flyer was posted in ladies’ bathroom stalls at bars where he was reported to frequent. 

[Newspaper credit: Gutierrez, Scott. “Man suspected of HIV crime”. The Olympian 27 Mar 2004. www.theolympian.com]

## Over a ten day period, 170 possible contacts were investigated, 50 were counseled and tested, and 53 staff were reassigned to the case for a cost of over $50,000 in staff costs alone.

**Notes:**
In the end, additional staff were brought in from neighboring health departments, internal staff were reassigned and received just-in-time training, and we all stumbled though our first use of the incident command system. Overtime, reassignments, needing to catch up on two weeks of “normal” work; these were all outcomes of one patient with a contagious disease in the community.

The event highlighted the need for the department to be prepared to develop surge capacity to a larger scale than in the past, which consisted of usually bringing on one or two more staff.

[Newspaper credit: Michael, Sharon. “HIV-testing call inundate health office.” The Olympian 31 Mar 2004. www.theolympian.com ]

## Smallpox vaccination clinics, pandemic influenza, severe earthquake; any of these can overwhelm our resources and require a new planning and response paradigm.

- New paradigm:
- May need 100-1000 staff
- How many will need medical training? 20% or less?
- Dedicated federal funds to initiate planning and training efforts

- Former Incident Management Team was 10-20 staff
- Previous clinics were run entirely by health department staff
- Preparedness planning and training activities did not have dedicated funding and generally did not happen

**Notes:**
As we saw with the behavior endangering the public case in 2004, even normal local public health issues can severally tap the department’s resources; a planned response to a catastrophic event became the new target and a new way of thinking about how we might continue to fulfill our public health mission with. In terms of emergency response, we had been moved from up the “kids table” to be the lead for protecting our community in scenarios we were still struggling to grasp the scale of.

Again, these responses may involve many different types of activities. As the person tasked with developing mass clinic (vaccination or prophylaxis dispensing) plans, I will be focusing this presentation on using volunteers to help with these mass clinics. 

Hundreds of staff and volunteers may be needed in order to adequately respond to the next public health catastrophe.

We are moving from a purely medical model of response. Only a portion of the staff necessary for mass dispensing efforts will need to have medical training. The majority will be needed simply to help organize and smooth the flow of people through the clinic.

CDC preparedness funds and a grant for Medical Reserve Corps development currently fuel the paradigm shift. They will not last forever. Existing county public health funds will not support such focused planning and training activities, including the maintenance of a large public health volunteer group.

## POD – Point of Dispensing(shots or pills)

- POD – Point of Dispensing(shots or pills)

- Approximately 3,300 influenza vaccinations in one day

**Notes:**
For those of you not familiar with a Point of Dispensing (POD), this is a photo of one conducted in eastern Washington in 2004 (Benton Franklin Health District). These mass clinics are designed to dispense shots or pills to entire communities in a few days. At the Benton Franklin clinic, they gave out 10,000 doses of influenza vaccine in three days, with 89 staff and 100+ volunteers participating in an exercise of their mass clinic plans. On the first day of the vaccination clinic, they gave out 3,300 shots, with a maximum wait time of 5.5 hours. On the second day, after incorporating several key route and process changes, they gave out 3,700 shots with an maximum wait time of 1.5 hours.

Key roles in making an operation of this size efficient are: parking, flow monitors, and form assistants. These folks get people in line, help them stay in line, and keep the line moving in an orderly fashion. Flow monitors are human traffic regulators, controlling the line on a “one-out one-in” fashion. On day one of the clinic, the main area of the clinic was allowed to fill up as the process bogged down. When the need for changes became obvious, the space had become standing room only and it was not possible to alter the clinic processes until the space was cleared at the end of the day.

[Photo credits: 2004 Influenza Vaccination Clinic, Benton Franklin Health District. 11 Oct 2004. Staff photo. www.bfhd.wa.gov/base/index.ph ]

## Mass clinics: where will the bodies come from?

- Three groups of staff will be needed:
**Core public health leadership staff (5-10 per point of dispensing)**
**Vetted medical volunteers (10+ per)**
**Non-medical volunteers (dozens per)**

- 5-10
- 10+
- Lots

**Notes:**
Running a half dozen mass clinics for the county population will take hundreds of people. There will be three main groups of folk involved in the effort.

Core public health leadership staff will fill the lead positions at each point of dispensing (POD). This staff may be augmented by experienced staff from other county agencies or neighboring health departments.

Medical volunteers will be needed to give the shots, provide screening, etc. The Medical Reserve Corps will help in supplying pre-registered and vetted medical staff. If others are needed, they can pair up with trained staff, along with just-in-time training. The local Medical Reserve Corps is currently funded by CDC money and operated through the health department. Long-term maintenance of the roster will eventually be transferred to the Thurston-Mason Medical Society.

Non-medical volunteers will fill the bulk of the positions needed to help run the POD efficiently. Most of the positions needed at a mass clinic will pertain to the efficient queuing of people and their cars! Having 50 nurses to give shots does not help if the patients are all stuck in the parking lot looking for a place to park. We need people to be the guides, parking lot attendants, greeters, and just plain people herders to give these mass clinics a chance of success. 
These mass clinics are but one type of response local public health organizations are being tasked with planning. There are lots of other ways in which public health can and will eventually need and use large numbers of volunteers. 

We are still working on how to solicit, manage, train, and maintain these volunteers. We know that we cannot sustain the effort of creating and sustaining a large public health volunteer group (especially when the federal funds continuing to decline).

## Lions at the gate!

- The Olympia Host Lions Club approached the health department in 2005 with an offer of help if needed. The question was in what fashion could they be most helpful.

**Notes:**
There are 11 Lions Clubs in Thurston County, with approximately 500 members.

The Olympia Host Lions Club wanted to take on a substantial project to help the community. They saw the preparedness planning going on across the country and were looking for an opportunity to match their resources with an unmet need.

## Lions Club: a quick history

- Established in 1917, Lions Club International has 1.4 million members in 190 countries. The club has a major commitment to community health, focusing on blindness prevention worldwide, as well as drug abuse, diabetes, and helping communities in many other ways.
- More information at: _[www.LionsClubs.org](http://www.lionsclubs.org/)_

- Motto: “We serve”

## Olympia Host Lions Club

- A highly organized volunteer club with the ability to achieve large projects to the benefit of the community.

**Notes:**
It does not hurt to have our Health Officer be a member of the club!

When we are looking for help from the community, the Lions Club has a lot of attractive qualities: self-sustaining, motivated, have a health focus, large number of active members, and efficient and oft-used internal communication methods. I doubt that our Lions Club is unique in these regards. Use the “club locator” on the Lions web page to find what clubs are in your jurisdiction.

Collaborators with the health department:
  The Lions have supplied seed money for the development of a hand washing program that ended up being used nationally.
  The Lions are currently part of the department’s Healthy Steps Program, developing walking tours around the area to combine exercise, local history and diabetes awareness.

As an example of their organizational achievements:
Apple work - They repackage bulk apples and sell them to support the summer camp for children with diabetes, Camp Leo. This is an amazing feat as they: solicit eastern Washington apple growers for donations, get them shipped here, organize 100+ volunteers to repackage the apples, then sell the boxes. In 2005, they repackaged and sold 55 tons of apples ($61,000). While working at a clinic exercise, the club members recruited me to sell and repackage apples.

[Photo credits: Sorting apples for selling to support Camp Leo. Undated photo. No photographer information available.
--Lion Diana Yu with unnamed Lion in front of Olympia Host Lions food trailer at Olympia Air Show, July, 2004. No photographer information available]

## The club has been eager to help in past emergencies

- When a bad ice storm brought down thousands of tree limbs and trees in the area, the club contacted Thurston County and signed up to take care of a park.

- They also pulled together the “Great Apple and Pear Haul of 2005”

**Notes:**
(1996) The Olympia Host Lions Club took ownership/responsibility for that park. They did NOT just self-deploy; they contacted the right people, discussed how best they could help, and followed through.

Another emergency response came together around their apple sales. A non-Lion heard that the club was "into apples" and approached them about getting some fresh fruit to the Hurricane Katrina zone.  He said he would provide a refrigerated semi trailer and drive to the hurricane zone if they could provide the fruit.  That was an offer too good to pass up!

By using their Lions contacts in Louisiana and throughout eastern Washington, they were able to identify a town (Bayou LaBatre) in LA where the Lions were providing meals for 300 homeless, jobless people per day and providing school lunches. They connected with several growers in eastern Washington who donated a full semi truck load (thousands and thousands of pounds) of fresh apples and pears.  Lions from both western and eastern Washington met in the Yakima area to pack the fruit into boxes and onto the truck.  The entire project was handled quietly through the Lions internet and phone connections and within a week from the time the idea took hold they had a semi truck load of fruit moved from Washington to Louisiana and delivered to people in need.

[Photo credit: Iced-over branches from 1996 ice storm in Olympia, WA. 1996. Clipped from a personal web page. No photographer information listed.  www.galenorn.com/greenwood/olympia/ ]

## Advantages of the club’s organization

- Lions Clubs are international in scale, with an hieratical organization that brakes down to the local level.
- If the process works for this local club, similar club organization should allow other health departments to replicate the partnership with their Lions Clubs.

**Notes:**
Districts are about county level, with Thurston County being one district, with two zones and 11 clubs.

## Clinics with Lions and MRC members helping have greatly helped us do our routine jobs as well as prepare us for an emergency

**Notes:**
[Photo credits: 2005 Back to School Clinic at Yelm, WA. September 2005. Staff photos]

## Slide 16

**Notes:**
[Photo credits: (upper left) Nov 2004 Influenza vaccination clinic, TCPH&SS staff and MRC volunteer. Staff photo.
  (lower right) Dec 2005 Influenza vaccination clinic, TCPH&SS staff, MRC and Lions volunteers. Staff photo]

## What the Lions get out of this:

- -	a greater connection to the community,
- it is an important project,
- the publicity from this project has been helpful in member recruitment.

**Notes:**
Connection – being on top with some of the important community planning efforts
Importance – the members know that they are involved in a project that could be critical to the safety of their community, as well as a prototype for future projects (state, nationally). That means that the Lions feel good about what they are doing. That feeling of pride in their work is important in retaining strong Lion membership – and that strength translates builds into greater efforts throughout the club.
Recruitment – greater visibility for the club, participating in exciting projects with direct impact on the community
At the personal level, Lions that volunteer at our clinics and other trainings earn club service hours. So the club, which we do not have to sustain, also provides incentives and benefits to their members for helping us out.
[Photo credits: TCPHSS Fran Feil and Lion Carl Corbin at the Back-to-School Clinic. 2005. Staff photo.
--Lion Claire Thompson and TCPHSS Dolores Dorffeld at Back-to-School Clinic. 2005. Staff photo]

## What the Lions get out of this:

- -	a greater connection to the community,
- it is an important project,
- the publicity from this project has been helpful in member recruitment.

**Notes:**
Jointly-created press releases about the clinics generated publicity for the club
[Newspaper clippings: Telxeira, Cindy. “Immunization clinic tests ermergency [sic] response skills”. Nisqually Valley News 07 Sep 2005. www.yelmonline.com
--Masthead from The Olympian. www.theolympian.com ]

## Additional benefits to the club:

- The Lions generally meet either weekly or every other week. They need presenters!
- Upcoming presentations to the club will be on personal, family, and community preparedness. Training on mass clinic operations is also being prepared.
- We also presented information on pandemic influenza and will likely do another one on West Nile Virus this summer.

**Notes:**
As with most folks who have to fill speaker calendars, these clubs are usually very happy to have folks give them a presentation. 

As the partnership develops, the health department will be working with the club to help the club membership be better prepared, and thus better able to help us out if needed. We also will be giving presentations on health issues to them as appropriate. These visible and reoccurring interactions with the club membership reinforce the connections and mutual benefits of our partnership. They also are another conduit to the public for us to disseminate a public health message through.

## Conceptual framework

- Olympia Host Lions

- Other clubs in county

- Other volunteer groups in county

- Initial request for help from health department to club leadership

- Internal club phone tree

- Club to group phone tree

- Club to club phone tree

**Notes:**
The health department identifies a volunteer need.
--This could be for an emergency response, or an exercise, or a public information campaign.
The department contacts the Olympia Host Lions Club leadership. 
The health department will maintain 24/7 contact information for key Olympia Host Lions Club staff.
The club will use internal phone/email routes to recruit club members to help.
Greater volunteer needs will broaden the net.
All volunteers will be directed to a rally point for registration and training (coordinated through the county emergency operations center if necessary).
The Olympia Host Lions will take on the effort to maintain contact information for their membership, other Lions Clubs, and other community groups (updated at least twice a year?).
If it is expected that the event could result in a declared emergency, then Emergency Management would be notified and parallel requests for health and medical staff to other counties would be made.

## Is there room from more work on your public health plate?

**Notes:**
[Photo credit: Wilf’s Café web site, Kendel, UK, www.wilfs-cafe.co.uk/ oscatering.php ]

## In an emergency, there’s lots more where that came from!

**Notes:**
Health departments have enough work on their plates without going back for seconds. 
[Photo credit: Wendover Nugget Hotel and Casino web page, Wendover, NV, www.wendovernugget.com/dining_buffet.html ]

## Coordination

- It is vital to coordinate our volunteer activities with the county department of emergency management and other agencies.

- Thurston County Emergency Operations Center

## How it the partnership with the Lions has worked so far:

- Great!
- Lions have helped with three clinic exercises, in conjunction with the Medical Reserve Corps volunteers.
- The experience has provided a lot of feedback on our plans and procedures.

**Notes:**
Our volunteer registration process and paperwork needs much improvement. The basic clinic layout and volunteer positions work well, along with the job aids we use. We developed a just-in-time training for radio usage for staff and volunteers which received good comments on how to improve its clarity and remove unnecessary details.

## Under “normal” circumstances, this is the volunteer registration packet for the health department.

- The bureaucracy's happy place.

**Notes:**
FEEDBACK: Unfortunately, using volunteers for exercises or events that are not declared emergencies poses “normal” business rules issues.
The joke was that filling these forms out was the “stretching exercise” before working the clinic. We did not want to have any hand cramps.
Using Lions Club volunteers at a flu vaccination clinic as part of a mass clinic exercise, it took almost 20 minutes each for them to get registered, and then we still had to train them. Obviously we need to refine the paperwork to be more in tune with the situation. The volunteer packet was originally designed for long-term volunteers who would have patient interactions, drive department vehicles, etc.
We also discovered that we needed a dedicated staff person for volunteer management to ensure registration, training, and sign-out all occurred. They were placed under logistics.

These challenges are part of exercising the partnership and our preparedness plans. At small clinics and exercises is the perfect time to understand what does not work and attempt to resolve the issue, as opposed to trying to make it work in an emergency. It also makes the volunteer organization more comfortable in their role. We are not asking them to jump into an unfamiliar role and “help save lives” right off the bat. 

[Photo credits: Thurston County Public Health & Social Services Department volunteer registration packet. 2006. Sammy Berg.
--Registration packets at the smallpox clinic exercise. 2003. No photographer information available.]

## Slide 26

**Notes:**
Note the volunteer laboriously filling out the registration paperwork in the background.

[Photo credit: Lions Jan Norman and Wendy Lacey, TCPHSS Sammy Berg. Back-to-School Clinic. 2005. Staff photo. ]

## Long term visions of the future

- Future clinics will be planned and operated under the incident command system, with help from Medical Reserve Corps and Lions volunteers.
- Other public health initiatives:
- -  West Nile Virus surveillance and public information dissemination.

**Notes:**
Using routine (influenza or back-to-school)  clinics will aid in the feedback loop. The smaller scale makes it easier to work out the kinks, troubleshoot training, staffing, and logistics issues. 
We will certainly call on them for broader community exercises to see how things work at larger scales.

Other activities could include (and are still be tossed around) include: helping to collect dead crows for West Nile Virus monitoring, although the expected arrival of avian influenza this year to Washington will complicate the process. They could work the parks, handing out WNV information and cans of DEET.

## Next steps:

- We need to formalize the relationship with a written Memorandum of Understanding.
- Continue to refine the process.
- Advocate similar relationships in the region and state.
- Maintain the partnership, putting effort into creating opportunities for both parties to benefit from it.

**Notes:**
We need written procedures about: how we request help; how they solicit help, both internally and externally; frequency of exercises; and more.

## As with other community groups in your area, getting your foot in the door is half the battle. 
Are any of your staff members? How about elected officials? Neighbors?
Kiwanis, Rotary, non-animal clubs are welcome too!

- Are any of your staff members? How about elected officials? Neighbors?
- Kiwanis, Rotary, non-animal clubs are welcome too!

- How to attract Lions

**Notes:**
Fort Collins, CO: Rotary Club helped fund the creation and dissemination of a West Nile Virus educational program.

## How to attract Lions 

- These are only suggestions and should only be performed by trained professionals.

**Notes:**

[Graphic credits: (Spam costume) www.mardigrasoutlet.com/ details.asp?prodID=819 
--(Philly cheese steak hat) www.costume-party-shop.com/browseproducts/Cheesesteak-Hat.HTML ]

## Is this guy done talking yet?

- No...well almost.
- Final message: most health departments do not have the resources to develop and sustain the large volunteer groups necessary to staff the mass clinics we need to plan for. Using existing volunteer groups in your community can greatly add to your available resources. Use them.

**Notes:**
Thank you for your time and interest.

## Partnering with the Critter Clubs:“Lions, Eagles, Elks, Oh My!”

19 April 2006

Presented by:
Diana T. Yu
yud@co.thurston.wa.us
Sammy B. Berg
bergs@co.thurston.wa.us

Phone: 360.786.5581

- 19 April 2006
- Presented by:
- Diana T. Yu
- _[yud@co.thurston.wa.us](mailto:yud@co.thurston.wa.us)_
- Sammy B. Berg
- _[bergs@co.thurston.wa.us](mailto:bergs@co.thurston.wa.us)_
- Phone: 360.786.5581