# Presentation: 141724

## Activation of an MRC for a Senior Citizen Mass Vaccination Clinic 

***“******Where the Rubber Meets the Road”***

**Presented at the 2005 Annual Medical Reserve Corps**
** ****National Leadership Conference **
**San Francisco        April 21, 2005**
**Shelly Schechter, APRN, BC, Eileen Scanlon, R.N., BSN,  Terry Thomann Nassau County Department of Health, Mineola, New York**

## Slide 2

## Nassau County New York

**Nassau County, on Long Island, is 20 miles east of Manhattan**
**   **
** ****Population of 1.3 million people living in an area of 293 sq. miles**
**Nassau County is more populated than 10 US states.**

**The Nassau County Department of Health was established in 1938. **
**Currently staffed by 360 persons, it has five Main Divisions: ****	****	****Administration**
**             ****	****Environmental Health**
** ****	****	****Laboratory**
** ****	****	****Disease Control**
** ****	****	****Community Health. **
**In 2001, the Department established an Office of Emergency Preparedness that reports directly to the Commissioner of Health.**

## Drills and “Real Deals”

**8/2002   County Hospitals (12) tabletop**
**3/2003   Smallpox clinics**
**6/2003   Smallpox POD drill**
**4/2004    *SNS TED Pack Long Island exercise **
**4/2004    *Pill POD drill at Medical College**
**8/2004    Republican National Convention**
**8/2004    *1****st**** Raccoon Rabies on Long Island**
**11/2004  *Flu POD for Seniors**
*** Used Nassau County MRC volunteers**

## The mission of our  MRC is to address public health surge capacity and to assist in public health initiatives through primary recruitment of medical professionals.

## Development of our MRC

**Steering Committee**
**Indemnification**
**Credentialing**
**Recruitment**
**Training**

## Steering Committee

**One of the first steps in development of our MRC was to establish a Steering Committee, with the following membership: Medical and Nursing Schools, major health system, Hospital Council, Office of Emergency Management, Medical Society, ARC and a State legislator**

## Indemnification

**Under the municipal administrative code, Nassau County indemnifies MRC volunteers who are activated and deployed by the Nassau County Health Department for work in Nassau County.**

## Credentialing

**NYS Department of Education verification of current professional licensure and absence of misconduct**
**Nassau County Police Department criminal background check.  Police return a “yes or no” determination of fit for duty. **
**Photo/Signature ID and car decal provided **

## Nassau MRC Members Participate inPhoto Credentialing System

**Photo Identification System**

**Notes:**
Nassau County Medical Reserve Corps Lead Veterinary member assisted the Nassau County DOH in organizing all-day training held on Sunday, November 14, 2004.  Primary focus included various facets of Animal Bio Surveillance and Communicable Diseases.  Meeting was co-sponsored by Long Island Veterinary Association and New York City Dept. of Health.  North Shore-LIJ Health Systems hosted the event and provided refreshments.

## Recruitment

**Partnerships with professional organizations to do joint mailings to**
**Medical Society**
**Veterinarian Association**
**Pharmacy Association**
**Visiting Nurse Association**
**Dental Society**
**Fraternal Order of Police Surgeons**
**Primary focus to recruit community practitioners and avoid people with hospital commitments. **

## Training

**Steering Committee recommends standards of training for all MRC volunteers and specialty groups.**
**Contract with local university to develop core curriculum and web based training site.**
**Partnership with local health system for training opportunities and continuing ed credits.**

## Nassau County MRC 1st General Membership MeetingSeptember 20, 2004

**Nassau County MRC 1st General Membership Meeting****September 20, 2004**

**Notes:**
The first general membership meeting was held at a local catering facility with dinner sponsored by the local Health Care System.  Photo above depicts MRC members from L – R:  Pediatrician, Attorney, Center is the Commissioner of Health, Dentist & Veterinarian.

## Seminar for MRC Veterinarians on Zoonotic Diseases

- Nassau County Medical Reserve Corps Lead Veterinary member assisted the Nassau County DOH in organizing all-day training held on Sunday, November 14, 2004.  Primary focus included various facets of Animal Bio Surveillance and Communicable Diseases.  Meeting was co-sponsored by Long Island Veterinary Association and New York City Dept. of Health.  North Shore-LIJ Health Systems hosted the event and provided refreshments.

**PARTNERSHIP – PARTNERSHIP - PARTNERSHIP**
**Nassau County MRC Lead Veterinarian assisted the Nassau County DOH in organizing a seminar for Vets in November, 2004 on Animal Bio Surveillance and Communicable Diseases.**
**North Shore-LIJ Health Systems hosted the event and provided refreshments.  Meeting was co-sponsored by Long Island Veterinary Association, the Long Island Veterinary Disaster Response Team, and the New York State, New York City and Nassau County Departments of Health.  **

## COMMAND CENTER OBSERVATION 

- Nassau County DOH & some MRC members previously trained in Incident Command.  Various other agencies & Nursing students participated at POD also.  All integrated well utilizing Incident Command System Management tool.

**What happened in the Fall of 2004?**

**Notes:**
Nassau County DOH & some MRC members previously trained in Incident Command.  Various other agencies & Nursing students participated at POD also.  All integrated well utilizing Incident Command System Management tool. 

## Nassau County Senior Citizen Annual Flu Program Three Lead Agencies

_**Nassau University Medical Center**_** **
** ****	****staffing and medical supplies**
_**Department of Senior Citizen Affairs**_** ****coordination of senior center lists, appointments and staffing**
_**Nassau County Health Department**_**  **
**Purchase and supply flu vaccine **

## The 2004 Nationwide Influenza Vaccine Shortage

**The annual Nassau County Flu Program for Seniors had registered 20,000 seniors to be vaccinated at 84 community sites over an 8 week period in October and November, 2004.   **
**In early October, one of the two vaccine manufacturers stopped production**
**The County was forced to cancel the Senior Flu Program.**

## An very familiar sight in October, 2004

***An very familiar sight in October, 2004***

## 	In late October, the County Health Department was told by the State that we would receive half (10,000) the number of doses of flu vaccine for the senior citizen program.  

**	**
** **

**This vaccine would be available “sometime in November”!!!**

## Our challenge was to distribute this limited amount of vaccine quickly enough to permit the Seniors to develop immunity before the peak flu season.

**The Department of Senior Citizen Affairs conducted a lottery and issued appointment tickets to 10,000 seniors in mid November**

## Our BT Plan had a solution!

**	****A flu vaccine program was designed using the Point of Dispensing (POD) Plan.**
**	**

**POD’s are a part of public health bioterrorism (BT) planning and intended to dispense medication to large numbers of people in a short period of time.**

## Over a two day weekend, 

**7,624 older adults were vaccinated in a single site at the local community college. **

**The average age of these seniors was 75 years. **

## Senior Citizen Flu Vaccination Point of DistributionNovember 20-21, 2004

## V. Operations Section Chief
     A. Point of Distribution Branch Director

***     ******A. Point of Distribution Branch Director***

| POD Manager |  |   b. Clerical Coordinator | 1 |
| --- | --- | --- | --- |
| 1. Security Officer | 1 |        Clerk Liaison | 1 |
| 2. Physician Consultant | 1 |         Clerk | 8 |
|    a. Triage Officer | 1 |  c. Flow Controller Coordinator | 1 |
| 3. Counseling Unit Leader    | 1 |      External Officer | 1 |
|     a. Counselor | 1 |      Internal Officer | 1 |
| 4. Medication Unit Leader | 1 |      Flow Controllers | 10 |
|      a. Medication Supplier | 1 |  d. Runner/Coordinator | 1 |
|      b. Screener Coordinator | 1 |      Runner | 5 |
|           Screener | 7 |  e. Resource Coordinator | 1 |
|      c. Medication Staff Coordinator | 2 |       Communications Officer | 1 |
|          Vaccinator/Assistant         | 15 |       Supply Officer | 1 |
|      d. Educator Coordinator | 1 |        Food Officer | 1 |
|          Educator | 1 |        IT Officer | 1 |
| 5  Support Unit Leader | 1 | 6. Volunteer Unit Leader | 1 |
|      a. Check In/Out Recorder Coord | 1 |                    TOTAL  | 72 |

## The Health Department used the Incident Command System and activated a three POD design.  Staff administered 7,624 doses of flu vaccine over a weekend in two 8 hour shifts.

## 25 tables with 50 vaccinators

**Planned for 5,000 doses a day **
**Each vaccinator administers 30 shots an hour**
**At max in morning, throughput = 750/hour**
**Two day Average = 492/hour**

## This was the largest single vaccination clinic in New York State

## Activation of the MRC

**MRC newsletter addressing need**
**E-mail and telephone solicitation of volunteers from the existing database**
**Press Releases**
**	****A standardized scheduling database was critical to collate data on staff availability and to produce and communicate assignments in a coordinated and timely manner.  **

**During the 2 week planning period in early November**

## Nassau County Health Department’s Medical Reserve Corps

**39 Medical Reserve Corps volunteers participated in the 2 day activation.  This included**
**14 Nurses**
**12 Physicians**
**4 Dentists**
**4 Social Workers**
**1 Psychotherapist**
**1 Speech Pathologist**
**1 Attorney**
**2 HazMat specialists**

***Several worked both days!!!!***

## MRC Introduction to the POD 

**	****Integration of paid and volunteer staff worked well.**

**Orientation and “Just in time training” was done by the ICS supervisor according to the specific roles assigned (job action sheets).  This blended the MRC volunteers with staff from other agencies.**

## The Incident Command System facilitated the transition of MRC and staff from partner agencies.All staff functioned in a unified manner within their prescribed role.    

## Many Partner Agencies

**Nassau Community College**
**NC Police Department**
**North Shore-LIJ Emergency Medical Services**
**NC Department of Public Works**
**NC Printing and Graphics**
**NC Corrections**
**NC Office of Emergency Management**

## Other Volunteers

**24 CERT (Community Emergency Response Teams) volunteers**
**100 Adelphi University School of Nursing students and professors**
**13 Molloy College School of Nursing students and faculty **
**Salvation Army**

## Special Needs

**Mobility issues and toilet facilities**
**Size of POD and amount of walking**
**Transportation to POD**
**Family member to accompany Senior**

## Evaluation: After Action Report

**The evaluation was done under the direction of Dr. Kristine Qureshi, an Assistant Professor at the Adelphi University School of Nursing.  **
**Dr. Qureshi had previously performed two other disaster exercise evaluations for the Health Department, and was in a position to compare application of ICS across all three exercises. **
** ****She was assigned the ICS position of “Evaluator” and wore an ICS vest with that title.  **
**Data collection was done through a variety of mechanisms**

## Assessment Tools

**Direct observation and worker interview **
**Senior citizen exit survey**
**MRC exit survey at completion of each shift**
**Health Department worker survey  **
**After Action / Hot Wash meeting **

## Evaluation by MRC Volunteers

**28 (out of 39) MRC volunteers completed surveys**
**Very positive comments re: structure and organization of event (ICS)**
**“****Everyone worked well together” (Integration)**
**“****Team working together – sharing”**
**“****I felt good about being part of the program!  I felt professionally acknowledged and supported”**

## Lessons Learned

## PREPARE, PREPARE, PREPARE

## Know Your MRC 

**Of our current 224 credentialed MRC volunteers:**
**10% are fully retired**
**Majority are working, many self employed**
**A few are in non-health related professional fields and offer consultation (legal, IT, HazMat)**

**Training opportunities and curriculums must be tailored to individual’s availability and interest.  **

## The “Value Added” of MRC

**Building MRC relationships has greatly enhanced public health capacity to respond to new and emerging threats.**
**Examples such as Rabies, pharmacists for the SNS, mental health response teams.**

## The “Value Added” of MRC

**	****Networking with MRC professionals has opened many new doors for public health.  **
**	**
**	****Enhanced cooperation and new programs with partners such as the **
**NYS Medical Society**
**Schools of Nursing and Medicine**
**Veterinary Disaster Response Team**
**Fraternal Order of Police Surgeons  **

## Our MRC is a reliable and valuable asset in responding to public health emergencies.