Zombie Pandemic Mass Vaccination Point of Distribution Exercise

State: CA Type: Promising Practice Year: 2014

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Pandemic disease potentially is the greatest natural threat to life as witnessed by the experience of the 1918 pandemic influenza outbreak. Pandemic influenza would require a sustained response from Napa County over many months, including provision of mass prophylaxis/vaccination to prevent the spread of infection. The goal of the Zombie Pandemic Mass Vaccination/Point of Distribution (POD) exercise was to enhance the knowledge of Napa County staff, first responders, volunteers and other partner agencies to respond to an event requiring mass prophylaxis of the residents of Napa County through running a POD site to simulate mass vaccination of the population on October 31, 2012 from 1:00 p.m. – 4:00 p.m.

Zombies were incorporated into the planning scenario as an outreach tool to engage access and functional needs populations and other groups typically underrepresented at annual flu vaccination clinics because the successful "Zombie Apocalypse" social media campaign promoting emergency preparedness by the Centers for Disease Control and Prevention (CDC). The objectives of the exercise were linked to the Public Health Emergency Preparedness (PHEP) capabilities, including:

  • Emergency Public Information and Warning: Activate PIOs to coordinate dissemination of crisis and emergency risk communication (CERC) information to the media, public, partners and stakeholders;
  • Mass Prophylaxis/Medical Countermeasure Dispensing: Open a POD site on the Napa County Health and Human Services Agency campus with the capacity to accommodate at least 500 persons from the surrounding area;
  • Volunteer Management: Activate volunteers to support POD site set-up and operations. All of the objectives were met and the exercise was well received by both POD staff and members of the community.

 

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Napa County Health and Human Services Agency
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Zombie Pandemic Mass Vaccination Point of Distribution Exercise
The Napa County Public Health Division is located in California. Pandemic disease potentially is the greatest natural threat to life as witnessed by the experience of the 1918 pandemic influenza outbreak. Pandemic influenza would require a sustained response from Napa County over many months, including provision of mass prophylaxis/vaccination to prevent the spread of infection. The goal of the Zombie Pandemic Mass Vaccination/Point of Distribution (POD) exercise was to enhance the knowledge of Napa County staff, first responders, volunteers and other partner agencies to respond to an event requiring mass prophylaxis of the residents of Napa County through running a POD site to simulate mass vaccination of the population on October 31, 2012 from 1:00 p.m. – 4:00 p.m. Zombies were incorporated into the planning scenario as an outreach tool to engage access and functional needs populations and other groups typically underrepresented at annual flu vaccination clinics because the successful "Zombie Apocalypse" social media campaign promoting emergency preparedness by the Centers for Disease Control and Prevention (CDC). The objectives of the exercise were linked to the Public Health Emergency Preparedness (PHEP) capabilities, including: Emergency Public Information and Warning: Activate PIOs to coordinate dissemination of crisis and emergency risk communication (CERC) information to the media, public, partners and stakeholders; Mass Prophylaxis/Medical Countermeasure Dispensing: Open a POD site on the Napa County Health and Human Services Agency campus with the capacity to accommodate at least 500 persons from the surrounding area; Volunteer Management: Activate volunteers to support POD site set-up and operations. All of the objectives were met and the exercise was well received by both POD staff and members of the community. Coordination between the Napa County Public Health Division and the planning/exercise partners was an integral component of the exercise that helped strengthen the collaborative working relationship and provided valuable lessons for future POD site operations. The public health impact of the practice is an improved ability of the Napa County Public Health Division to activate and implement a response to an emergent disease such as pandemic influenza.
The Napa County Public Health Division is located in northern California and has a population of 136,484. The Zombie Pandemic Mass Vaccination/Point of Distribution Exercise was open to all residents of Napa County with specific emphasis on functional and access needs populations; specifically economically disadvantaged, limited language proficiency, cultural/geographic isolation and children. In an emergent disease or influenza pandemic certain groups are at higher risk for complication and/or death from influenza. During the 2009 H1N1 pandemic, certain minority populations, children (especially those with developmental disability), and adults with existing co-morbidities were at increased risk of severe outcomes. In addition, low income populations and non-English speakers may be less likely both to access a prophylactic vaccine and to receive timely antiviral treatment if they do become ill with influenza. In the past mass vaccination/point of distribution exercises have been conducted in conjunction with seasonal influenza vaccine clinics and in response to the 2009 H1N1 influenza pandemic. The Zombie Pandemic Mass Vaccination/Point of Distribution Exercise was an innovative enhancement of previous practices because of outreach activities to low income and primarily Latino neighborhoods around the location of the POD site and increased use of volunteers. The exercise scenario is an outbreak of “zombie flu”. The zombie flu virus is acquired through direct contact with zombies, most commonly through bites and scratches sustained during attacks perpetrated by the undead. Large numbers of people have become infected with this previously unknown virus and mass prophylaxis with the zombie flu vaccine is necessary to prevent a zombie world takeover. The scenario was based on the following timeline: October 18, 2012, 10:18 AM: Great Shake Out. A large earthquake in California releases a previously unknown virus. People exposed to the virus through injuries sustained in the earthquake transform into zombies within 24-48 hours; October 19, 2012: First unconfirmed zombie sightings are reported in several Bay Area counties; October 22, 2012: A rapidly spreading epidemic of zombie flu is confirmed by public health authorities in California. Zombies display erratic behavior and are aggressive. Transmission is occurring primarily through bites and scratches. It is estimated that at least 50 people within Napa County have been infected. The Centers for Disease Control and Prevention (CDC) has isolated the zombie virus and vaccine development has begun; October 26, 2012: Approximately 300 people in Napa County have been infected with zombie flu. The Napa County Emergency Operations Center (EOC) and Health and Human Services Agency Department Operations Center (DOC) are activated as a state of emergency is declared in the county; October 29, 2012, 10 AM: The Health Officer is notified that the CDC has developed a vaccine and that the first 1,000 doses will be available for distribution in Napa County by October 31. 2PM: A briefing for Public Information (PIO) staff is held; October 30, 2012, 10:30 AM: Public Health staff, City of Napa staff, and Medical Volunteers are notified that they have been activated to set-up and operate a Point of Distribution (POD) site for Zombie Flu vaccine from 1-4 PM on October 31; October 31, 2012: Zombie Vaccination Clinic (aka seasonal flu clinic). In advance of the exercise a multifaceted communication campaign was implemented to announce and promote the clinic including concentrated efforts to reach the access and functional needs populations (specifically economically disadvantaged, limited language proficiency, cultural/geographic isolation and children). Zombies were included in the exercise scenario as an innovative outreach tool based on the successful "Zombie Apocalypse" social media campaign promoting emergency preparedness by the CDC. Two primary messages of the outreach campaign were: If you're prepared for zombies you're prepared for any emergency Don't let the flu make you a zombie, get vaccinated. The campaign was successful in building relationships with media and other outreach sources (including the editor, two reporters and photographer from the local major newspaper the Napa Valley Register; the editor and a reporter from social media site Napa Valley Patch; a local TV talk show host; and two DJs on the local radio station, one English and one Spanish speaking) that may be used for future campaigns and/or emergency situations. In addition it was the first time that Napa County Public Health successfully demonstrated the ability to activate and operate a fully functional POD site on the Health and Human Services Agency Campus (where the LHD is located) administering 362 influenza vaccines in 3 hours. Although less than 500 community members were vaccinated, the objective was still considered to be met because the POD had the capacity of accommodating that number of people. The current practice is not evidence based.
The goal of the Zombie Pandemic Mass Vaccination/Point of Distribution Exercise (POD) exercise was to enhance the knowledge of Napa County staff, first responders, volunteers and other partner agencies to respond to an event requiring mass prophylaxis of the residents of Napa County through running a POD site to simulate mass vaccination of the population on October 31, 2012 from 1:00 p.m. – 4:00 p.m. This was achieved by designing the exercise to improve local capacity to activate capabilities required during a public health event requiring mass prophylaxis (vaccination) including testing the POD Field Operations Guide (FOG) and training City staff, MRC/medical volunteers and other volunteers to be POD workers. Zombies were incorporated into the planning scenario as an outreach tool to engage access and functional needs populations (AKA “at risk”) and other groups typically underrepresented at annual flu vaccination clinics. The objectives of the exercise were linked to the Public Health Emergency Preparedness (PHEP) capabilities: Emergency Public Information and Warning: Activate PIOs to coordinate dissemination of crisis and emergency risk communication emergency (CERC) information to the media, public, partners and stakeholders; Mass Prophylaxis/Medical Countermeasure Dispensing: Open a POD site on the Napa County Health and Human Services Agency campus to with the capacity to accommodate at least 500 persons from the surrounding area; Volunteer Management: Activate volunteers to support POD site set-up and operations. The exercise design team consisted of the Napa County Public Health Division (PHD) staff (Public Health Manager, Health Education Specialist, Epidemiologist, the Director of Public Health Nursing, and Public Health Immunization Clinic staff), Napa County Health and Human Services Agency (HHSA) Operations staff, Napa County Office of Emergency Services (OES) staff, City of Napa Fire staff and City of Napa Police staff. The design and conduct of the exercise followed the Incident Command System (ICS) and was a collaborative effort between Napa County HHSA, Napa County OES, City of Napa Fire and City of Napa Police. Some HHSA Department Operations Center (DOC) staff were included in the planning process as a training exercise, including staff assigned as DOC Public Information Officer and DOC Operations Section Chief. In addition, individuals from the following organizations participated as exercise staff: LHD, Napa County Chief Executive Office/OES, City of Napa Fire, City of Napa Police volunteers, Napa County Medical Reserve Corps volunteers, Napa Valley College nursing students, AMR Ambulance and the Napa County Red Cross. The exercise design team met on a monthly basis starting in August 2012 until October 2012, with more frequent section meetings as needed to develop a comprehensive exercise which would provide a training and evaluation opportunity. The functional exercise aimed to provide the participants (many of whom would be medical volunteers and students) with practical experience in set-up and operation of a POD site following ICS structure as would occur during a large-scale disaster where mass prophylaxis or vaccination was required. Congruent with the Homeland Security Exercise and Evaluation Program (HSEEP) guidelines, this exercise was designed to explore the effectiveness of planned response capabilities and protocols, and to identify areas for possible improvements. LHD Health Education Specialist from the Emergency Preparedness Program conducted targeted outreach to encourage attendance at the Zombie Point of Distribution (ZPOD) to populations that are economically disadvantaged, limited language proficiency, experience cultural/geographic isolation and are vulnerable due to age (children): English/Spanish ZPOD web pages, news and calendar items on the Napa County webpage; announcements via email and in person to community and faith-based partners/ Napa Valley Coalition of Non-Profit Agencies serving the above mentioned populations; English/Spanish posters advertising the ZPOD on all local buses; announcements in online and print versions of the local newspaper; English/Spanish slides announcing the clinic for the local TV community calendar; Posting on social media sites (Napa County Facebook, Napa Valley Patch,); posting on bilingual website Somos Napa; bilingual posters in neighborhood laundry mats, grocery stores, markets, coffee shops etc; bilingual fliers sent home with all students of Shearer Elementary School, River/Harvest Middle Schools (within walking distance of ZPOD site); “Zombie Preparedness” presentations 9/13/12 at HHSA and 10/24/12 at the Napa Library; 10/03/12 “Zombie Makeup” workshop at the Napa County Red Cross; 10/14/12 appearance on local Spanish language radio show announcing the clinic; 10/17/12 appearance on local TV talk show announcing the clinic; 10/17/12 presentation in Spanish to Shearer Elementary Parent Link meeting; 10/31/12 appearance on local radio morning show, provided flu vaccine on air to radio staff and announced clinic. In addition to free seasonal flu vaccine being provided at the ZPOD a free Halloween Health Fair was held as an extra incentive to increase attendance, especially families with young children. Health Fair participants included the Napa County Chapter of the American Red Cross (distributing emergency preparedness information and free pumpkins donated by a local pumpkin patch, zombie makeup artists trained at the Zombie Makeup Class workshop; a performance of Thriller by the Community Health Clinic Ole Zumba instructors promotoras; a Zombie walk of youth receiving services from the VOICES Youth Center; performance and hula hoop play by local instructor Sunglow Hoop Dance. All staff time from LHD and partners was donated in-kind. $2996.69 was budgeted in the Pandemic Flu grant however only $121.80 was spent on food for staff and volunteers at the POD. The rest of the cost was budgeted for renting a tent if needed to protect staff, volunteers and visitors from the weather, however it was not necessary.
The objectives of the exercise were linked to the Public Health Emergency Preparedness (PHEP) capabilities: Objective 1 Emergency Public Information and Warning: Activate PIOs to coordinate dissemination of crisis and emergency risk communication emergency (CERC) information to the media, public, partners and stakeholders; Objective 2 Mass Prophylaxis/Medical Countermeasure Dispensing: Open a POD site on the Napa County Health and Human Services Agency campus to accommodate at least 500 persons from the surrounding area; Objective 3 Volunteer Management: Activate volunteers to support POD site set-up and operations. The evaluation and After Action Report/Improvement plan highlighted strengths and area for improvement. The major strengths identified during this exercise are as follows: 1) In advance of the exercise a multifaceted communication campaign was implemented to announce and promote the clinic including concentrated efforts to reach the access and functional needs populations (specifically economically disadvantaged, limited language proficiency, cultural/geographic isolation and children). The campaign was successful in building relationships with media and other outreach sources that may be used for future campaigns and/or emergency situations; 2) Public Health successfully demonstrated the ability to activate and operate a fully functional POD site for the first time on the Health and Human Services Agency Campus, administering 362 influenza vaccines in 3 hours; 3)The majority of the POD mass vaccination clinic was staffed by volunteers from the Napa County Medical Reserve Corps, students Napa Valley College and staff/volunteers from the City of Napa Police and Fire Departments. When staffing from volunteer/partner agencies fell short additional Public Health staff was activated to fill the gap.In the AAR/IP Section 3: Analysis of Capabilities, activities associated with the different objectives were evaluated a following is a summary of the highlights. PHEP Capability 4: Emergency Public Information and Warning: Objective 1: Activate PIOs to coordinate dissemination of crisis and emergency risk communication emergency information to the media, public, partners and stakeholders. Activity: Provide emergency public information to populations that are economically disadvantaged, have limited language proficiency, have disabilities (physical, mental, sensory, or cognitive limitations), experience cultural or geographic isolation, or are vulnerable due to age. Strength: Public Health Education Specialist (HES) conducted targeted outreach to encourage attendance at the Zombie Point of Distribution to populations that are economically disadvantaged, limited language proficiency, experience cultural/geographic isolation and are vulnerable due to age (children). Analysis: The HES conducted a multifaceted communication campaign to announce and promote the clinic. The campaign was successful in building relationship that may be used for future campaigns and/or emergency situations. Recommendation: Continue to use the wide variety of media resources to conduct outreach to the public to develop recognition as a source of trusted information by the community. Area for Improvement: Besides announcing the clinic to community/faith based partners/Napa Valley Coalition of Non-Profit Agencies that serve people with disabilities (physical, mental, sensory, or cognitive limitations), no targeted outreach materials were developed or activities conducted. Analysis: There is room for improvement in conducting outreach to people with disabilities (physical, mental, sensory, or cognitive limitations). Recommendation: Improve outreach to people will disabilities by working with community- and faith-based organizations in the Public Health Outreach Network for Emergencies (PHONE) to develop material and activity standards for the populations they serve. Activity: Disseminate critical health and safety information designed to alert the public to clinical symptoms and reduce the risk of exposure to ongoing and potential hazards). Strength: In addition to the announcement of the ZPOD, the media campaign included other messages: 1) If you’re ready for zombies your ready for anything: Make a Plan, Build a Kit and Be Informed; 2) There’s no such thing as a zombie flu, but the flu can make you feel like a zombie so get vaccinated (with additional information). The “Zombie Preparedness” campaign (presentations 9/13/12 at HHSA, 10/03/12 at the “Zombie Makeup” workshop at the Napa County Red Cross and 10/24/12 at the Napa Library) included all-hazards and pandemic flu preparedness information. Both radio appearances (10/14/12 appearance on local Spanish language radio show; 10/17/12 appearance on local TV talk show providing flu vaccine on air) included information about the symptoms of and how to reduce risk of exposure to influenza. Analysis: The communication campaign/messages promoting the clinic were able to incorporate all-hazards and pandemic flu preparedness information. Recommendation: Continue to incorporate critical health and safety information designed to alert the public to clinical symptoms and reduce the risk of exposure to ongoing and potential hazards into current and future campaigns. PHEP CAPABILITY 8: Mass Prophylaxis/Medical Countermeasure Dispensing. Objective 2: Open a POD site on the Napa County Health and Human Services Agency campus to accommodate at least 500 persons from the surrounding area Activity: Identify dispensing strategy and initiate dispensing. Strength: Napa County Public Health was able to notify, plan, coordinate and initiate dispensing with partners (including HHSA Operations, Napa County CEO/OES, City of Napa Fire, City of Napa PD, Napa County Medical Reserve Corps volunteers, Napa Valley College nursing students) to identify roles and responsibilities for influenza vaccination based on the ZPOD scenario and timeline. Analysis: Dispensing strategy was based on a POD site at the HHSA campus and dispensing activities carried out by staff and volunteers. Recommendation: Continue to plan/exercise with partners to identify dispensing strategies and initiate dispensing. Activity: Dispense the appropriate medication and dosage to the population, including children, infants and special needs populations. Strength: Just-in-time training was completed by Team Leads (Screener, Vaccinator) and included review of job action sheets and verbal instructions. Determining which vaccine to dispense was covered by a two step process. Step 1) Individuals were screened by Screeners to determine which flu vaccine was appropriate to dispense (i.e. injection, P- free injection, flu mist). Authorization forms were filled out for all individuals receiving vaccine Step 2) The Vaccinator reviews the Screener’s determination of which vaccine to provide before administering the appropriate vaccine. Analysis: The two step process allowed for staff/volunteers to dispense the appropriate vaccine and dosage to the population Recommendation: Continue to use the two step process for dispensing appropriate vaccine at future mass vaccination events. Area for Improvement: Due to staffing limitations there was not additional bilingual staff available to collect demographic information (via the Live Healthy Napa County survey) to determine the needs of current clients and allow for planning for future clinics. Recommendation: Develop a form to complete as part of the screening/intake process to collect information on POD client demographics including but not limited to race/ethnicity, age, income and what part of Napa County they were from. PHEP CAPABILITY 15: Volunteer Management. Objective 3: Objective 3 Volunteer Management: Activate volunteers to support POD site set-up and operations Activity: Ensure adequate volunteer staffing levels for anticipated mass prophylaxis throughput Strength: Adequate volunteer staffing levels for anticipated mass prophylaxis throughput were coordinated through pre-existing volunteers from the Napa County Medical Reserve Corps, City of Napa Police and Napa Valley College nursing students. Analysis: Volunteer recruitment through the MRC and partner agencies matched staffing levels for anticipated mass prophylaxis throughput. Recommendation: Continue to engage and exercise existing volunteers. Area for Improvement: There were not enough bilingual volunteers via the MRC and Napa Valley College to fully staff positions requiring bilingual skills. Additional bilingual staff from the Public Health Division were activated to supplement volunteers. Analysis: More bilingual volunteers are needed. Recommendation: Encourage recruitment and training bilingual volunteers for roles in POD. Activity: Provide just-in-time training program for volunteers to perform required tasks). Strength: Just-in-time training was completed by Team Leads (Greeter/Line Monitor, Screener, Vaccinator and Pre-Filler) and included review of job action sheets and verbal instructions. Out of 33 evaluation post-surveys 68% (n = 23) strongly agree and 24% (n = 8) “received the training needed to perform assigned role.” Analysis: Just-in-time training was adequate for volunteers/staff to perform assigned role. Recommendation: Continue to use just-in-time training for volunteers/staff at PODs. Activity: Support response operations using volunteer resources and volunteered technical capabilities. Strength: Reponses operations using volunteer resources and volunteered technical capabilities were coordinated through pre-existing volunteers from the Napa County Medical Reserve Corps (technical capabilities = vaccination, pre-filling, roles requiring nursing license), City of Napa Police (technical capabilities = security, traffic control) and Napa Valley College nursing students (technical capabilities = screening, line monitoring, able to perform roles requiring nursing license under instructor supervision). Analysis: Volunteer recruitment through the MRC and partner agencies matched staffing levels for anticipated mass prophylaxis throughput Recommendation: Continue to support response/exercise operations using volunteer
Preparedness for public health emergencies is an important priority for Napa County. Functional exercises help increase Napa County’s ability and capacity to respond quickly and effectively to incidents that endanger the public. Functional exercises are instrumental in helping to refine response and coordination procedures/protocols, critical decision making processes, and communications. The overall purpose of the exercise was to improve local capacity to activate capabilities required during a public health event requiring mass prophylaxis (vaccination). The Napa County Public Health Division along with planning and exercise partners was able to conduct outreach to the Access and Functional Needs Population (AKA “At-risk”), test the POD Field Operations Guide and train City staff, MRC/medical volunteers and other volunteers to be POD workers. Napa County Public Health, in collaboration Napa County HHSA Operations, Napa County CEO/OES, City of Napa Fire, City of Napa Police. Napa County Medical Reserve Corps (MRC) volunteers and Napa Valley College nursing students and instructors, was able to successfully coordinate administration of mass vaccination. There were 362 members of the community vaccinated for influenza during this exercise. The exercise was also helpful in identifying lessons learned including the need to improve outreach efforts to people with disabilities through direct contact with service providers, improve external signage informing and directing public to POD site, ensure enough bilingual staff/volunteers are activated to ensure clinic throughput and collect more demographic information from clients at the POD for future planning and evaluation efforts. Partners involved in the exercise planning and implementation as well as the outreach campaign developed deeper cooperative relationships with Napa County Public Health, which will make connections and participation easier in future exercises and real events. The practice was an improvement on what has been done before because of the creative use of the zombies to attract attention and encourage participation among the public and partners. In the future, efforts should be made to develop creative themes to make exercises more engaging. The practice is sustainable because it incorporates the Public Health Emergency Preparedness and Pandemic Influenza workplan mandates for mass prophylaxis exercises. Stakeholders are committed to sustaining the practice of exercising for a mass prophylaxis/vaccination because of their role in opening and running a POD site when a real disaster occurs. The sustainability plan is to continue to incorporating creative and engaging elements on mandated activities and exercises to achieve workplan deliverables.
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