EMS Operations at Alternate-Treatment Vaccination Centers

The administration of vaccines is a critical component of the response to many diseases – not only naturally occurring diseases such as influenza or chicken pox, but also terrorist attacks in which “bio-weapons” laced with such diseases as small pox or anthrax are used.

Planning for such events has revealed that staffing – more accurately, the lack of enough staff – will be one of the foremost problems likely to be encountered when a disease-centered disaster occurs. Although there would be numerous other problems to contend with – a shortage of medical facilities, for example, and/or various supply-chain deficiencies – the shortage of trained personnel may well be the most important: There simply will not be enough trained people on hand to administer the immense number of vaccinations required in the wake of a large-scale disaster that involves the sudden spread of an infectious disease.

The actual administration of a vaccination is not technically difficult, though, and is well within the skill set of most paramedics. Many state and local planners have, in fact, drawn up emergency procedures that call for the use of paramedics from local EMS (emergency medical services) agencies to provide the staffing needed to deal with the outbreak, intentional or accidental, of a deadly disease.

This approach may, of course, serve as a functional solution in smaller-scale local emergencies such as an isolated outbreak of measles, but dealing with an isolated outbreak is not a major problem in most areas of the country. In fact, the availability of public health nursing staff that can be brought to bear in most isolated events is usually sufficient to meet the probable need.

Fewer Resources Available at the Time of Greatest Need

An important factor to be considered is that any event large enough to stretch the nursing resources throughout an entire region also is likely to be stretching the EMS resources available throughout the same region at that same time. The current prime example of a worst-case scenario is the outbreak of a pandemic influenza – “pan flu,” for short. In a real flu pandemic, all areas of the entire country are likely to be in a crisis mode at the same time, leaving no unaffected area from which to draw additional staff – with a major increase in patient volume and an increase in absenteeism among the overall health care staff further exacerbating the problem.

Although paramedics can make a significant contribution by administering vaccines, the number of people who can “pinch hit” for the paramedics themselves – in an ambulance run, for example – is severely limited both by state laws and by the functional reality that several other EMS tasks must be carried out at the same time. Moreover, although many hospital-based caregivers are capable of providing the level of care provided in an ambulance, it is illogical to plan to use them to cover EMS staff personnel who are not available for ambulance duty because they are working in a hospital setting instead.

A better solution – the use of lay vaccinators or vaccine technicians for the annual flu vaccine programs – is already in place in some venues, fortunately. The vaccination technique is really rather simple, and well within the scope of what can be taught to anyone who has a modicum of common sense. But it is the screening of potential vaccines and the careful monitoring of post-vaccination patients for adverse effects that requires a more advanced level of technical knowledge, and trained medical staff should be assigned to these tasks.

New York State, to mention but one example of how one state has taken action to cope with the shortage of trained personnel to deal with the vaccination problem, already has a statute in place that specifically allows non-licensed staff to administer vaccines – when authorized to do so by a local or state health officer. This law, which is frequently cited in emergency planning, also is used to support the use of vaccine technicians in the annual flu-vaccine clinics carried out in an ever-increasing number of state and local agencies.

In short, new ways of thinking are going to be required to cope with future large-scale public health crises, and local planners will have no choice but to set aside entrenched labor-management positions and other current obstacles for the overall good of the community and the survival of as many infected citizens as possible.


EMS and the Mass Gathering

Any large collection of people requires emergency medical support because a number of people will get ill or injured. In addition, at points of vaccination a number of those vaccinated will have significant and often unpredictable reaction to the vaccine.


The most common form this support takes is the use of EMS technicians. The self-contained/self-sufficient nature of an ambulance and its crew makes it ideal for operations at such events. Even at events large enough to require more extensive operations, including the use of doctors and/or nursing staff, EMS personnel remain a necessary component because of their capacity to transport patients while continuing to provide care.


Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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