Transcript Maine Medivax program - Tri

Maine EMS Medivax
EMS Vaccination Program
Objective
• To develop a protocol and
process to allow licensed
MEMS ALS personnel
already trained to
administer medications
via the IM/SC/intranasal
route to provide
immunizations in an
organized event
authorized by a licensed
Physician
Objectives
• To be able to support / deliver vaccinations as force
protection to essential personnel and the
capabilities to deliver vaccination to the public is
need is determined.
• To teach and instruct Maine EMS personnel,
including the Emergency EMT Basic Level on the
safe and proper delivery of vaccinations via the
Intranasal Route.
Basic EMTs who have completed the Maine EMS
MediVax program are allowed to perform intranasal
H1N1 vaccine in the 2009/2010 season with the
caveat that an ALS resource or equivalent (nurse
physician, or NP/PA) with the resources to care for
adverse effects (including allergic reactions) is
available on scene. A basic service cannot host a
vaccine clinic individually but Basic EMTs can be used
under the auspices of a larger physician proscripted
event to act as a resource for administering IN
vaccine.
EMS Agency Requirements
• MEMS licensed service permitted at or above
the intermediate level
• The service immunization program and the
instructor for the Maine MEDIVAX program
must both be approved by the service Medical
Director
• Service must maintain all records for any
vaccinations provided by the service to their
personnel.
Service Medical Director
• EMS Services that want to provide
vaccinations to their own personnel must have
a Medical Director who authorizes the
program.
• If the service does not have a service Medical
Director, then they should approach a local
Health Care Facility or the Regional Medical
Director for assistance.
Sponsoring Agency Requirements
• Program must be authorized by a licensed
Physician.
• Sponsoring Organization is required to provide
all paperwork and maintain records for 7 years
post vaccination.
EMS Provider Requirements
• MEMS licensed Basic EMT (IN vaccine only)Intermediate, Critical Care, or Paramedic.
• Completed an approved* MEMS Vaccination
Administration training program.
* An approved program is one where the program
and instructor have been approved by the Service
Medical Director.
Liability
• EMS Providers providing immunizations need
to check with the sponsoring organization
about liability coverage.
• Liability coverage may differ based upon
changes in state/federal law, pandemic
declarations, and employer coverage
Governor’s Executive Order
 Proclamation; Mission and Scope;
E. To the extent necessary to assure the timely
provision of seasonal influenza and 2009 Influenza A
(H1N1) vaccination in accordance with the guidance of
the federal Centers for Disease Control and
Prevention, the Maine Center for Disease Control and
the Department of Education, the Maine Emergency
Management Agency will exercise its authority
pursuant to 37-B M.R.S.A. 784-A to designate
appropriate health care workers licensed in the State
and authorized to administer influenza vaccines to
participate in the vaccination clinics in accordance with
the requirements of this Proclamation.
Liability
 F. All persons designated by the Maine
Emergency Management Agency to
participate in the vaccine administration
pursuant to Paragraph E shall. pursuant to
37-B M.R.S.A. 784-A, be deemed to be an
employee of the State and entitled to
immunity pursuant to 37-B M.R.S.A 822.
Training Overview
• IM injection training (NHTSA National
Standard Curriculum)
• Video Overview
• Intranasal training
• Administrative Requirements
– Handbook
– Lecture
Intranasal Administration
• Nasal medication delivery takes a middle path
between slow onset oral medications and invasive,
highly skilled delivery of intravenous medications.
Because the nasal mucosa is highly vascularized,
delivery of a thin layer of medication across a broad
surface area can result in rapid transmucosal
absorption of the medication into the blood stream
and cerebral spinal fluid.
Procedure Instruction of Intranasal
Medication Administration
H1N1 Intranasal Vaccines at a Glance
H1N1 Intranasal Vaccines at a Glance
Rubber Tip
Protector
Dose Divider
Clip
H1N1 Intranasal Vaccines at a Glance
Clip in middle of
medication plunger
is known as Dose
Divider Clip
Procedure
Influenza 2009 (Inactivated) Vaccine
AKA, The Seasonal Flu
Influenza 2009 (Inactivated) Vaccine
Serious problems from influenza vaccine
are very rare. The viruses in inactivated
influenza vaccine have been killed, so you
cannot get influenza from the vaccine.
Influenza 2009 (Inactivated) Vaccine
Mild problems:
•soreness, redness, or swelling where the shot was given
•hoarseness, sore or red eyes, cough, itchiness
•fever
•aches
If these problems occur, they usually begin soon
after the shot and last 1 to 2 days.
Influenza 2009 (Inactivated) Vaccine
Severe problems:
Life-threatening allergic reactions from vaccines
are very rare. If they do occur, it is usually within a
few minutes to a few hours after the shot.
Influenza 2009 (Inactivated) Vaccine
It is important to differentiate other, more
common, nonallergic clinical syndromes from
anaphylactic vaccine reactions. Vasovagal
reactions with pallor, bradycardia, weakness,
dizziness, and brief syncope may occur five to
15 minutes after vaccination. These reactions
occur more often in adolescents and adults than
in children.
2009 H1N1 (Inactivated) Vaccine
AKA, The Swine Flu
2009 H1N1 (Inactivated) Vaccine
A vaccine, like any medicine, could possibly
cause serious problems, such as severe
allergic reactions. The risk of a vaccine
causing serious harm, or death, is
extremely small.
2009 H1N1 (Inactivated) Vaccine
Serious problems from influenza vaccine
are very rare. The viruses in inactivated
influenza vaccine have been killed, so you
cannot get influenza from the vaccine.
2009 H1N1 (Inactivated) Vaccine
Mild problems:
•soreness, redness, or swelling where the shot was given
•hoarseness, sore or red eyes, cough, itchiness
•fever
•aches
If these problems occur, they usually begin soon
after the shot and last 1 to 2 days.
2009 H1N1 (Live, Attenuated) Vaccine
AKA, The Swine Flu
ANAPHLAXIS / ALLERGIC REACTIONS REVIEW
Allergic Reaction
An exaggerated reaction by the body’s
immune system to any substance
ANAPHLAXIS / ALLERGIC REACTIONS
REVIEW
Anaphylaxis
A life-threatening allergic reaction
which causes shock (hypoperfusion)
and airway swelling
ANAPHLAXIS / ALLERGIC REACTIONS
REVIEW
ALERT!!!!
The PEDIACTRIC Population that we
will be working with, have the
potential of a delayed anaphylactic
reaction after the vaccine. Reactions
can occur up to 15 minutes later!
Signs and Symptoms
Skin
Itching
Hives
Flushing
Warm, tingling feeling
Swelling (especially
face, neck, hands,
feet, tongue)
Signs and Symptoms
Respiratory
Tightness in throat/chest
Cough
Rapid, labored, noisy
breathing
Hoarseness
Stridor and wheezing
Signs and Symptoms
Cardiac
Increased heart rate
Low blood pressure
Signs and Symptoms
Generalized
Findings
Itchy, watery eyes and
runny nose
Headache
Sense of impending
doom
Signs and Symptoms
Decreasing mental status
Signs and symptoms of shock
(hypoperfusion) or respiratory distress
TREATMENT
• TREAT AS PER PROTOCOL
MAINE EMS GOLD 1
Quick PEDI Drug Reference Chart
Protocol
• Complete vaccine administration record (VAR)
and have recipient sign it
• Distribute a current season Vaccine
Information Statement (VIS)
• Administer the vaccination via
IM/SC/intranasal route per the drug package
insert or the instructions of the Medical
Director
Documentation Overview
1. Vaccination records will be maintained by
the agency for 7 years
2. Sponsoring agencies will provide vaccinated
individuals with copies of their vaccination
administration records (VAR) on request
3. All VAR’s will be reviewed by the sponsoring
agency medical director or their designee
Documents
1. Vaccine Administration Record (VAR)
2. Vaccine Information Sheet (VIS)
3. Vaccine Adverse Event Reposting System
(VAERS)
Vaccine Administration Record
• Tracking and consent documentation
• Identifies risks and contraindications to
vaccine
• Requires patient review and signature
• Documents the vaccination
– MFR lot #
– Dose route site
– Provider
Vaccine Information Statement (VIS)
• http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf
• Patient information regarding the vaccine
• To be reviewed by patient before vaccination
Vaccine Adverse Event Reporting
System (VAERS)
• National program that monitors the safety of
vaccines after they are licensed
• VAERS is used to watch and record patient
“adverse events”
• Beware that often patient reported problems
are unrelated to vaccination
– EG. Contracting a cold after having an influenza
vaccine
Vaccine Adverse Event Reporting
System (VAERS)
What events should be reported?
• Any serious problem that occurs after
administration of a vaccine
Vaccine Adverse Event Reporting
System (VAERS)
How do I report?
• Hotline
– (800) 822-7967
• Internet
– Secure.vaers.org/vaersdataentryintro.htm
• Printable form
– www.vaers.hhs.gov
– VAERS, PO Box 1100, Rockville, MD 20849-1100
Review
• Organized, Physician-prescripted event only
• Complete vaccine administration record (VAR)
• Distribute Vaccine Information Statement
(VIS)
• Perform the vaccination via IM injection
• Report serious post vaccination problems
using VAERS
QUESTIONS???
References
•
•
•
•
•
•
•
Nursing Interventions and Clinical Skills, 3rd Ed., Mosby ©
2000
www.webmd.Com
www.google.Com (Images)
Maine EMS Medivax Program Update August 2009
MAINE EMS PREHOSPITAL TREATMENT PROTOCOLS, JULY
2008
Limmer, Emergency Care Update, 10th Ed, 2007, Pearson
Education. Inc.
MedImmune, H1N1 (Live Attenuated) Intranasal
Spray Vaccine Drug Insert Fact Sheet
Acknowledgements
•
•
•
•
•
Dan Batsie, EMT-P, Northeast EMS
Rick Petrie, EMT-P, Kennebec Valley & Northeast EMS
Lt. Nate Contreras, Scarborough Fire Dept.
Steve Diaz, MD, Maine EMS Medical Director
Matt Sholl, MD, Asst. Maine EMS Medical Director