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Story from the Field


Name of Health Department/Agency: Village of Skokie Health Department
State: IL
Date Added: 12/21/2009
Themes: Vaccine Planning and Administration,Vaccine Supply and Distribution
Issue Summary: LHD Opens Up Vaccination Clinics to High-Risk Groups Across the State
Description of Issue(s): On Nov 4, we received a memo from the state that LHDs could not restrict vaccination based upon jurisdictional borders. We were asked to minimize barriers to target group population receiving vaccine. This meant people from municipalities throughout Illinois could come to Skokie for vaccine at mass clinics scheduled for December. Skokie is a small municipality located in the midst of the 8 million population of the Chicago metropolitan area, shares a border with Chicago. We received an additional 20,000 doses. At that time, didn?t have a clear sense of how many residents in the target population were still unvaccinated. We set up a reverse 911 call system and gave residents an advanced opportunity to make an appointment to be vaccinated (set up online appointment system); 2,000 initially signed up.
Actions taken to address the issue(s): We planned for 4 mass clinics, vaccinating 5,000 people each over an eight-hour period. We set up online appointment system to minimize possibility of overwhelming clinics. We got in touch with the CDPH PIO and made an announcement made in the Chicago Tribune. News spread like wildfire. Appointments immediately filled up.
The first clinic had a bit of a bumpy start, with 600 persons in line one hour before the clinic was scheduled to open. For the remaining clinics we reorganized, planned to start one hour earlier than scheduled, sent a mass e-mail to all with appointments describing expectations, and set up a tent at the entrance to accommodate early arrivals (with so many coming a great distance it makes sense that they would be early).
We had substantial political and community stakeholder support (e.g., paramedics from neighboring communities, Village elected officials, members of Village Boards and Commissions) who volunteered at the mass clinics. We engaged a local nursing school and family medicine residency to send volunteers. A Health Department nurse joined the faculty of the nursing school and the Director became an affiliate of the hospital system to facilitate. Public works personnel helped with school and mass clinics. We had substantial support from school administration and parents for school clinics).
The policy in Skokie requires all public calls/queries to be answered by a live person. The Village of Skokie took responsibility for triaging calls, which took the burden off the health department. We had a total of 100 volunteers assisting at each clinic.
Outcomes that resulted from actions taken: The Skokie large-scale H1N1 clinics open to all residents from Illinois in the priority groups have gone off very well! Seventy-six percent of the appointments have been for non-Skokie residents from 193 Illinois municipalities. A few individuals from other states (Wisconsin, Iowa) have been vaccinated along with everyone else. It has been such a pleasure to serve everyone, we are really pleased to have had the opportunity.
We have been able to achieve a "continuous flow" state during the second and third clinics, despite severe weather, with waits for all attendees well under one hour. Overall 9,620 (75.4%) of the 12,760 persons with appointments came to the initial three clinics; they were all vaccinated.
This effort has been a phenomenal community building experience throughout, and has involved thousands of volunteers beginning with the school vaccination campaign and continuing through these large clinics.
Under PHER 4 funding, we could use an additional $50,000 to cover the unexpected costs of the phone bank, tent, online appointment scheduling system, and increased security/traffic control that were incurred as a result of opening the clinics to all.
Previous PHER funds have helped to:
  • Cover Department and Village personnel costs for all H1N1 vaccination clinics, including police for mass clinics
  • Set up the reverse 911 call system and lines for a mass conference call between the health department and schools
  • Purchase signs/billboards for publicizing mass clinic dates
  • Revamp of Village phone system to redirect Department calls to Village Manager's Office
  • Online appointment system
  • Establishing database and hiring experienced contract epidemiologist to support tracking of doses delivered
  • Made existing part-time FTEs into full-time FTEs to maintain ongoing functions of the health department
  • Hired one additional nurse
  • Additional vaccine storage (purchased four refrigerators, shelving units for supplies) and clinic non-medical supplies (40,000 consent forms on NCR paper, pens, copies of HIPAA and VIS forms, etc).

CHALLENGES/LESSONS LEARNED:
  • Anticipated receipt of substantial amount of injectable vaccine, but only nasal spray available. Mid-October notified parents that only nasal spray would be offered to children without contraindications during the school campaign, no longer able to support parental preference. Lead to numerous conversations regarding safety of nasal spray, hard for schools to switch mid-stream.
  • Receipt of second shipment of 20,000 doses uncertain, did not arrive until week prior to community clinics which were scheduled to begin immediately after Thanksgiving holiday. Spread word through local media that the clinics had been scaled back significantly, difficult to recover and notify residents/regional population that clinics were back on when vaccine was received.
  • Very challenging to hold off persons not in priority groups, especially those over 65 years of age with underlying health conditions. Some pointed out that nearly 20% of fatalities in Illinois were in their population.
  • Bumpy first community clinic, high anxiety in community regarding actual ability to receive vaccine, six hundred individuals in line outside in blizzard one hour prior to scheduled time to open doors. No one reassured by Director walking the line and requesting that they return in one hour, sufficient vaccine on hand for all with appointments. Pregnant women, parents with young infants and persons with disabilities willing to remain standing in cold to ensure vaccine receipt.
  • Needed additional vaccinators, estimated number based upon school clinics but more time required to remove coats from kids. Now have fourteen vaccinators and four persons pulling up injectable vaccine doses for each half day of clinic.
  • Needed outdoor shelter for early arrivals. For initial clinic squeezed as many as possible into building, few stood outdoors for long but led to inefficiency and increased stress with overcrowding. Not a comfortable situation.
  • Needed to plan to open one hour earlier.
  • Needed to communicate expectations to clinic attendees, mass e-mails sent out for later clinics.
  • After first clinic reorganized space to increase efficiency, new entrance with longer hallway utilized, separate "adults only" area established.
  • First mass clinic overall wait 1.5 -2 hours to receive vaccine, later clinics had less than one hour between arrival and back in car following vaccination.

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