Medical Reserve Corps Registered Nurse JobSpecific Training rev
Medical Reserve Corps Registered Nurse Job-Specific Training rev 6. 1
Objectives n Review Category A Agents n Outline specific duties of a nurse volunteer n Review Unit Leader role and duties n Review basic technique for smallpox vaccine administration n Utilize displays and staff for gaining additional information and answering questions
Review of BT Agents
Criteria for Public Health Preparedness Priority n Public health impact n Delivery potential to large populations n Public perception n Special public health preparedness needs
Category A Agent Criteria n n Greatest potential for adverse public health impact with mass casualties Require broad-based public health preparedness efforts Moderate to high potential for large-scale dissemination Heightened general public awareness that could cause mass public fear and civil disruption
Category A Agents Biological Agent Disease Variola major Smallpox Bacillus anthracis Anthrax Yersinia pestis Plague Clostridium botulinum Botulism Francisella tularensis Tularemia Filoviruses and Arenaviruses (e. g. Ebola) Viral hemorrhagic fevers
Category B Agents Criteria n Also have some potential for large-scale dissemination with resulting illness n Generally cause less illness and death n Lower medical and public health impact n Lower general public awareness n Require fewer special public health preparedness efforts
Category B Agents Biological Agent Disease Coxiella burnetti Q fever Brucella spp. Brucellosis Burkholderia mallei Glanders Burkholderia psuedomallei Melioidosis Alphaviruses (VEE, EEE, WEE) Encephalitis Rickettsia prowazekii Typhus fever Toxins (e. g. Ricin) Toxic syndromes Chlamydia psittaci Psittacosis Food Safety Threats Water Safety Threats
Category C Agents Criteria n Not currently believed to present a high bioterrorism risk to public health n Could emerge as future threats n Agents will be addressed nonspecifically through overall bioterrorism preparedness efforts n Emerging threat agents (e. g. Nipah virus, hantavirus, tick-borne hemorrhagic fever)
More Info on BT Agents n History of Bioterrorism Video - CDC http: //www. bt. cdc. gov/training/historyofbt/index. asp n Information on BT Agents - CDC http: //www. bt. cdc. gov/agentlist. asp
Dispensing Site Nurse-Specific Duties
MRC Training Recap n 1 team per shift per high school n 12 hour shifts n 3 -5 day duration n Public bused to high school – From elem, middle schools, 4 satellite locations – All regular high school stops n Volunteer parking on-site
Dispensing Site Flow Intake Unit Contact Unit Education and Registration Unit Screening Unit Data Entry Unit Interpreter Unit Vaccination/ Medication Dispensing Unit Mental Health Unit Special Needs Unit Flow Control Unit Pharmacy Unit Post-vaccination/ Dispensing Holding Unit
Intake Unit n Purpose: Screen individuals for – Those with sick contacts – Symptomatic persons – Disabilities/assistance needs – Non-English speakers n Staffing – 1 Unit Leader, Nurse Practitioner – 3 Registered Nurses – 12 Dispensing Site Assistants (DSAs)
RN Duties – Intake Unit n Review completed intake forms n Request interpreters if needed n Apply appropriate color wrist band n Direct flow • Isolate ill persons • Contacts to ill persons • All Others n Other duties as needed Sick holding area Contact Unit Holding Unit
Sick Persons n IMMEDIATELY isolate any individual who is symptomatic in sick holding area – Complete a registration form – Provide disease fact sheet – Direct individual to seek care § At designated HCF, home, etc …. as appropriate n Ensure clinic individuals do not proceed into
Contact Unit n Purpose: Registration and education of contacts to ill persons – Surveillance/tracking of symptoms – Education on symptoms to watch for, travel restrictions, reporting requirements n Staffing – 1 Unit Leader (Public Health Interviewer) – 5 Public Health Interviewers (PHNs or EHSs) – 6 Dispensing Site Assistants (DSA)
PHN Duties – Contact Unit Assist with completion of Contact Investigation Forms packet n Answer questions n – Internet/website listing available n Assess/Triage – Determine if symptomatic – Review screening form for flags or contraindications – If flags, refer to MD to determine if vaccine/prophylaxis appropriate
If Vaccine/Prophylaxis is… NOT Appropriate Complete Demographic Form n Give Deferral of Treatment Form n Give Disease Fact Sheet n To Education Unit Return to home Shelter in place
Education/Registration Unit n Purpose – – n Provide info on disease of concern Explain risks/benefits of vaccine or medication Distribute, explain forms to be completed Provide overview of clinic process Staffing – – 1 RN Unit Leader 5 Registered Nurses 9 Dispensing Site Assistants (DSA) 6 Interpreters (5 most common No. Va languages + 1 ASL)
RN Duties – Educ/Regis Unit n Distribute information, forms packet n Provide orientation – Clinic process – Vaccine/medication to be dispensed – Forms to be completed
RN Education Duties n Review and answer questions on: – Symptoms – Reporting requirements – Travel restrictions – Vaccine site care n Explain risks and benefits – Possible side effects – Potential adverse reactions – Contraindications
Education n Multiple classrooms will be set up n 30 min sessions: video + Q&A – Videos in top 5 languages and ASL – Tele-interpreters available for others – Can repeat session if they want – Individual questions referred to Q&A area n Proceed to Screening Unit
Screening Unit n Purpose: Identify and evaluate those who may have contraindications to receiving vaccine/medication n Staffing – 1 Physician Unit Leader – 3 MDs – 2 Registered Nurses – 8 Dispensing Site Assistants
RN Duties – Screening Unit n Effectively understand convey vaccine/medication information n Review forms for completeness n Ensure consent signed n Identify and direct to MD those who: – may have contraindications – have marked YES to any screening question on medical screening form – have questions re: interactions with their regular medications
RN Duties – Screening Unit n Sign off on forms if no flags n Retain appropriate forms n Direct individuals – To Dispensing unit OR – To Home (with Deferral of Tmt Letter) n Other unit duties as needed
Dispensing Unit n Purpose: Administer vaccine or prophylactic medication n Staffing – 1 RN Unit Leader – 18 Registered nurses – 28 Dispensing Site Assistants
RN Duties – Dispensing Unit n Understand benefits, risks, side effects, contraindications n Administer vaccine or medication n Document as appropriate n Other unit duties as needed
Post-Dispensing Unit n Purpose – Observe for immediate reaction/adverse effect – Provide supportive nursing care if needed – Answer questions re: vaccine site care and side effects of medication n Staffing – 1 RN Unit Leader – 1 Registered nurse – 4 Dispensing Site Assistants
RN Duties – Post-Dispensing Unit n Be prepared to respond to medical emergencies n Notify Command Post if health emergency – Request MD/EMS if needed
RN Duties – Post-Dispensing Unit n As appropriate, provide info on smallpox vaccine site care and “take” n Provide info on side effects of medication n Direct to transportation pre-boarding area
Special Needs Unit n Purpose: Provide education, vaccination and/or medication to those individuals with: – Vision or hearing needs – Physical disabilities – Other disabilities n Staff – – – 1 Physician Unit Leader 1 NP/PA 7 Registered Nurses 4 Dispensing Site Assistants 6 Special Needs Assistants
Special Needs Unit - Operation n Will provide all services in a centralized location n Trained Special Needs Assistants available n MD available as needed
Unit Leader Role and Duties
Unit Leader Role n General overview for all nurses n Introduction for those who will serve as Unit Leaders n Separate Leadership Training will be provided
Unit Leader Duties n Understand purpose of unit n Continually assess unit priorities – address/adjust as needed n Provide communication link between unit and command structure – Effectively utilize walkie-talkies n Coordinate w/other units as necessary n Direct and coordinate staff and materials
Unit Leader Duties – Staff n Know jobs performed by each staff n Monitor well-being, provide meal breaks and rest periods n Ensure adequate staff available n Oversee smooth operation of unit
Unit Leader Duties - Resources n Ensure adequate supplies, resources n Request needed resources via Command Post n Request clinic support staff/interpreters as needed n Request counseling support as needed
Add’l Unit Leader Duties n If unit is staged outdoors, re-deploy inside in event of bad weather – How – Where n Other duties as needed
Smallpox Vaccine Administration
Smallpox Vaccine n Made from live vaccinia virus, a pox-type virus similar to smallpox n Does not contain smallpox (variola) virus n Can prevent or lessen disease if given within days of exposure n Provides 95% immunity lasting 3 -5 years
Smallpox Vaccine Administration Given with bifurcated needle n Dip needle into vial n Site: Upper arm deltoid region n – No skin prep needed- can deactivate vaccine n Multiple rapid skin pricks – 5 mm area – 15 perpendicular insertions Trace blood drop should appear n Absorb excess vaccine n Cover vaccine site with porous bandage n
Contraindications – Post Event Smallpox: Direct Exposure NO CONTRAINDICATIONS Risk of disease is worse than adverse event Smallpox: Mass Response Risk/Benefit Balance CDC guidelines based on event
Contraindications – Post Event Doxycycline/Ciprofloxacin Reassess ALL contraindications Use alternatives for pregnant women and young children, if available and susceptibility unknown Risk/Benefit balance
Online Resources Vaccination Training Module http: //www. bt. cdc. gov/training/smallpoxvac cine/reactions/laboratory_testing. html Web cast – Vaccine Administration http: //www. bt. cdc. gov/agent/smallpox/vacci nation/administration-video/index. asp
Additional information See displays set up around the room Talk with a HD Staff Member here today Call the Fairfax County Health Department (703) 246 - 2433
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