POD Drive-Through Flu Clinics at College of the Canyons

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Beverly Kemmerling
Abstract: 

Being prepared for a threat to community health is of national concern in an era of possible bioterrorism and pandemic influenza. Community colleges are in a good position to be part of the public health response to protect the community from such threats, by participating in a Point of Dispensing or POD exercise. A successful campus POD involves campus and community volunteers, health professionals, fire and safety officers, public information officers, radio communications and traffic control experts and others. This article describes a POD exercise at College of the Canyons that gave college students and staff, city and county employees and residents an opportunity to practice skills needed to quickly dispense medication or vaccinations to a large number of residents in event of an emergency.

Article: 

College of the CanyonsCollege of the Canyons is a community college located in northern Los Angeles County in the City of Santa Clarita, California. It is a rapidly growing college with a reputation for high-quality education, innovation and ongoing campus-community partnerships to meet the needs of our students and our community. The enrollment for Fall, 2008 was over 24,000 students, up 19% from Fall, 2007. Our growing valley (current population 278,000), 25 miles north of Los Angeles, has one major freeway that connects Santa Clarita to Los Angeles County health department resources. In the 1994 Northridge Earthquake, this freeway was closed for weeks due to structural damage from the earthquake.

Background

In July, 2006, our college was approached by representatives of the City of Santa Clarita Emergency Services and Los Angeles County health department to discuss our being a POD, or Point of Dispensing, for emergency response in the event of a bioterrorism threat to our community. The POD’s function is to provide medications/vaccine to large segments of our population in just a few days after a large-scale event occurs. This is a core function of the Strategic National Stockpile (SNS) plan. It is the most complex and challenging of all the functions, largely due to the logistical challenges that must be overcome.

The national plan anticipates that one POD would be able to serve about 20,000 people, so in most areas of the country, many PODs would need to be activated to achieve dispensing goals. With so many potential PODs possibly in operation at a single time, the national plan also calls for a common command system to be used. On a national level, this system is called the National Incident Management System or NIMS. The state of California has further refined the system in its State Emergency Management System or SEMS.

Practice & Experience

A POD exercise is intended to allow participants practice in dispensing vaccines/medications on a large scale and also to provide experience in the logistics and communications needs required for effective operation of the Point of Dispensing.

In order to prepare for local response to potential events, the Emergency Service Supervisor of the City of Santa Clarita arranged a meeting at College of the Canyons that included representatives from the college’s Campus Safety, Student Health Center and Facilities Departments with medical and nursing personnel from County of Los Angeles Department of Health Services, Public Health. At the initial POD meeting, participants agreed that our community college with its easy access to a major freeway, large parking lots, gymnasium and other facilities would be a good location for a POD. College of the Canyons has a long history of working with city, county and non-profit agencies to respond to disasters such as fire and earthquake.

POD Exercises

Local POD exercises are held to determine readiness to respond to a bioterrorism threat, to give participants practice in the Incident Command System, and to gather data as to “through-put”, which is how many individuals can be passed through the Point of Dispensing per hour. The goal of the POD system is to provide medication to 1/3 of the population of an area within 12 hours of being notified of the threat. In event of a bioterrorism emergency, multiple PODS would operate simultaneously at various locations, served by a central Incident Command Center.

One POD exercise is to see how quickly a clinic can dispense antibiotics to treat anthrax. Individuals who walk in to a distribution center are screened for contraindications and given enough simulated medication for themselves and their family members. At a neighboring city in Fall, 2006, volunteers for the POD exercise had to pass through the clinic multiple times to generate the clinic volume expected in a real emergency.

Delivering Flu Vaccine

Another POD exercise is to deliver flu vaccine to participants as a counter measure to protect the populace from a bioterrorist threat that could be countered with vaccination.

We agreed to sponsor a POD exercise that would utilize two large north parking lots for a drive-through flu vaccine clinic at College of the Canyons in 2006. The planning committee met bi-monthly to plan our strategy. College of the Canyons participants included personnel from Allied Health (EMT and RN programs), Campus Safety, Student Health & Wellness Center, Public Information Office, Facilities (Events Services), and Community Service Learning. Community committee members included the City of Santa Clarita Emergency Service Supervisor and Traffic Engineer and County of Los Angeles Fire, Public Health and Sheriff’s Department representatives.

Goals of POD Clinic

The POD clinic’s goals included:

  • To sponsor a  three-hour drive-through flu clinic where “through-put” could be measured;
  • To determine whether the drive-through format was as effective as a walk-in clinic, in terms of numbers of shots given per hour;
  • To determine whether and how vaccines could be delivered safely in a drive-through clinic at College of the Canyons;
  • To give participants practice in the Incident Command System;
  • To limit access to the clinic to volunteers and drive-through participants only, with no unidentified persons on site, as in a real emergency;
  • To give several agencies practice working together as they would in an emergency;
  • To deliver flu vaccine only to persons in vehicles;
  • To give City and College volunteers more responsibility with each successive flu clinic, so that we could operate with minimal assistance from the health department in an emergency situation;
  • To inform the public about the clinic and educate them about what to expect in the event of an emergency.

At each POD drive-through clinic, observers from the health department/ Centers for Disease Control monitored activities and gave participants feedback at a “hot wash” about an hour after the clinic ended.

Recycling Line

In 2006, we planned for all clinic traffic to flow through a “recycling line.” Cars snaked around pylons in the first parking lot where student EMT’s and community CERT (Citizens Emergency Response Team) volunteers distributed consent forms to complete while participants waited for their shots. Campus Safety officers and the City Traffic Engineer monitored traffic and pedestrian safety and ensured there was not a backup of vehicles onto the city street.

In the next parking lot, volunteers directed cars to the area where RN students under supervision of nursing instructors gave the flu shots. Cars were three to a line, like a gas station. Persons with small children, pregnant women and people with additional questions or issues were directed to a separate line for their shots. This separate line backed up quickly, as many people brought vanloads of children. We changed the setup while the clinic was in progress, to send all cars to all lines, which relieved the backup in the pediatric line. However, a single person in the third car in line needed to wait until students gave shots to a carload of people in the first and second car, before they could leave. This slowed down the pace, but we did give 854 flu shots in 3 hours at this first POD drive-through clinic.

Refining the Plan

The second year, 2007, we began planning in late summer, involving the same agencies, but required fewer meetings to plan the drive-through. Clinic planners knew each other and plans proceeded with less effort. We met with all volunteers in advance, for training, and tried to give the nursing students extra practice in injecting by having a walk-in clinic for college students, staff and faculty two days before the event. However, due to the RN students’ schedules, those available to work on the day of the walk-in clinic were not the ones available on the day of the drive-through flu clinic. Since the parking lot is very large, we decided cars could flow through more efficiently if we expanded the number of “shooting stations” where flu shots were given, so that only one car at a time would occupy a station. With this change, we gave 1,083 flu shots in 3 hours at the second POD drive-through clinic.

Last year, in 2008, required even fewer meetings to set up the clinic. We continued the one car per station format, but had more supply areas for vaccinators, to avoid nursing students having to cross in front of cars to get supplies. We learned we needed more people to draw up vaccinations, in addition to nursing student “injectors.” Community response was enthusiastic; we changed our route to divert participants’ cars around the campus on the way to the clinic, to keep traffic from building up on the city street where cars entered the site. Our combined marketing efforts were so successful that we ran out of vaccine one hour before the clinic was to end, which required a 45-minute wait for more vaccine to arrive from the health department. People waiting for vaccine were given the choice of leaving, or waiting for the re-supply. Cars attempting to enter the clinic were turned away at this time; only those already in the parking lots were allowed to get their vaccine. Despite this “glitch,” by the end of the clinic we gave 1,292 flu shots at the third annual drive-through flu clinic.

Lessons Learned

A college-community POD drive-through flu clinic exercise is:

  • An excellent way to prepare campus and community partners to network and collaborate for the benefit of everyone, in the event of a real emergency;
  • Like live theatre: participants must be ready and willing to improvise and respond to what happens and what is needed while the clinic is in operation;
  • An opportunity for personnel from different agencies with different command structures to learn to work together under one Incident Commander;
  • A community service learning project for college students of any department;
  • A chance for everyone to practice radio communications skills;
  • An opportunity to give staff real-life training in the Incident Command System;
  • Exhausting, but fun!

On-line Resources

Introduction to the Incident Command System
http://training.fema.gov/EMIWeb/IS/IS100a.asp

Strategic National Stockpile
http://www.bt.cdc.gov/stockpile/

California State Emergency Management System
http://www.oes.ca.gov/Operational/OESHome.nsf/Content/B49435352108954488256C2A0071E038?OpenDocument

College of the Canyons
http://www.canyons.edu/

 


 

About the Author

Beverly Kemmerling
Director of the Student Health & Wellness Center
College of the Canyons, Santa Clarita, CA

Beverly Kemmerling, RN, MSN, MBA, Adult Nurse Practitioner, is Director of the Student Health & Wellness Center at College of the Canyons in Santa Clarita, CA. She is a self-described “optimistic pessimist” who believes if she prepares for the worst, it is less likely to happen. She has a bachelor’s degree from the University of Iowa, a master’s in nursing from the University of Rochester and a master’s degree in business administration from California Lutheran University. She is a member of Health Services Association of California Community Colleges, American College Health Association and California Coalition of Nurse Practitioners.
beverly.kemmerling@canyons.edu