H1N1 vaccination question

[MedicCraig]

I'd like to hear from some other states about their vaccination plans. Currently, Louisiana EMS providers, both public and private, will receive the vaccinations. However, I just received an E-mail from our state bureau of EMS that says paramedics WILL NOT be able to give the injections. It says the injection must be given by a doctor or RN. Is this how other states are doing it? We do not intend to give the vaccinations to the public, just our own employees. If this pandemic does get bad, they are going to be overwelmed by the general public seeking shots, and the local health units can not handle it. Also, our state has allowed pharmasists to administer the shot. Are pharmasists train to administer meds, or just dispense them? I'm curious what other states are doing.

[Amanda B]

Here in ohio they are letting basics, intermediates and paramedics and paramedic students give the injections. We just had a course from the Department of Health on how to give them and what to watch out for and fun stuff like that. Our pharmacists here are giving regular flu shots, not sure about the H1N1 vaccines. We will be able to give them to other paramedics and EMTs and also the public from what the county of cuyahoga material says. We will only be giving the public that is at the highest risk for complications the vaccine from what i understand. hope this helps some.

[HERBIE1]

Good question. In order to vaccinate so many people, they will have to allow EMT's to do this, in the proper context- ie a clinic or outreach setting.

We already give IM, SL, SQ, and IV meds at the advanced levels, so I think all we need to know are possible reactions and contraindications. Medical directors simply need to sign off on this. In disaster situations, many rules are suspended for the sake of mitigating the situation quickly and if we see a pandemic, look for the same thing to happen.

[VentMedic]

We already give IM, SL, SQ, and IV meds at the advanced levels, so I think all we need to know are possible reactions and contraindications. Medical directors simply need to sign off on this. In disaster situations, many rules are suspended for the sake of mitigating the situation quickly and if we see a pandemic, look for the same thing to happen.

It is a little more than signing off on a "skill". To give the vaccination, there should be a public health clause in your statute which also provides for additional education.

When you give an IM,SL, SQ or IV med, you are acting under a certain set of protocols for a field diagnosis as signs and symptoms appear.

For a vaccine, you are working off of what if and must provide the necessary education for whatever patient population presents for them. As a parent I would be hesitant to have an EMT(P) who is only going by "I can give a shot" mentality vaccinate my child.

That being said, your state may already have established the legislation necessary.

Here are some updates:

http://www2a.cdc.gov/phlp/H1N1flu.asp

One another thread here, MA had passed a very comprehensive Bill which I am surprised LA doesn't have one similiar. Many of the other states updated their statutes for Public Health and Disaster Preparedness after they saw what happened with Katrina.

http://www.mass.gov/legis/bills/senate/186/st02/st02028.htm

Hurricanes are just one of the reasons Florida has vaccines in its statutes for EMS. However, it has still been controversial for allowing Paramedics to administer them to children. A couple of counties (Lee and Indian River) was even trying to be active in Public Health but eventually some of the momentum was lost and projects scrapped due to a lack of interest from the Paramedics as they did not want to do "clinic work".

[MedicCraig]

It is a little more than signing off on a "skill". To give the vaccination, there should be a public health clause in your statute which also provides for additional education.

When you give an IM,SL, SQ or IV med, you are acting under a certain set of protocols for a field diagnosis as signs and symptoms appear.

For a vaccine, you are working off of what if and must provide the necessary education for whatever patient population presents for them. As a parent I would be hesitant to have an EMT(P) who is only going by "I can give a shot" mentality vaccinate my child.

That being said, your state may already have established the legislation necessary.

Here are some updates:

http://www2a.cdc.gov/phlp/H1N1flu.asp

One another thread here, MA had passed a very comprehensive Bill which I am surprised LA doesn't have one similiar. Many of the other states updated their statutes for Public Health and Disaster Preparedness after they saw what happened with Katrina.

http://www.mass.gov/legis/bills/senate/186/st02/st02028.htm

Hurricanes are just one of the reasons Florida has vaccines in its statutes for EMS. However, it has still been controversial for allowing Paramedics to administer them to children. A couple of counties (Lee and Indian River) was even trying to be active in Public Health but eventually some of the momentum was lost and projects scrapped due to a lack of interest from the Paramedics as they did not want to do "clinic work".

Thanks everyone for your responses. I do agree that we should not be giving vaccinations to people just because we know which end of the needle goes towards the patient, but I would think that a short class would bring us up to speed. As of right now, there is no emergency declaration or any other order that will permit us to do it, but who knows what the future holds!! Currently, there are 1264 confirmed cases of H1N1 in Louisiana, but the CDC estimates that the actual number (unconfirmed cases) is about 70,000. I think I'll go wash my hands again.

[Chief1C]

Pennsylvania sent out a letter this week to EMS Providers, I'll paste it on below. They have it set up so that Paramedics can give the injections at the predesignated points of distribution.

DEPARTMENT OF HEALTH, HARRISBURG

September 29, 2009

Dear Provider:

The first doses of pandemic influenza A/H1N1 vaccine will soon be made available by the federal government for distribution in the United States, including Pennsylvania. The initial supplies of vaccine will be very limited in number, but are expected to rapidly increase in quantity throughout October and November. Based on the current information from the CDC, the first orders will be placed on September 30th, and then the manufacturers are expected to begin delivering vaccine for distribution on a weekly basis. By mid-November, all providers who have been certified (registered and signed provider agreement) to deliver pandemic H1N1 vaccine in Pennsylvania should be able to order and administer it for patients in the five priority vaccination groups.

However, because of the limited nature of the initial vaccine supplies, these doses will need to be highly focused in their distribution and use. The Pennsylvania Department of Health (PADOH) has developed criteria to decide how best to utilize the vaccine supply. These criteria include:

• The type of vaccine available and the indications for the use of available vaccine

• ACIP recommendations:

o Pregnant women

o Individuals six months to 24 years of age

o Healthcare providers and emergency medical services personnel

o Individuals who provide care for children under six months of age

o People under age 65 with underlying medical conditions.

• Maximizing impact using epidemiologic disease patterns (who is most affected and where is disease occurring) to control disease and reduce influenza complications

The federal government has indicated that the first available vaccine doses will be exclusively live attenuated influenza vaccine (LAIV). This vaccine is indicated for use primarily in healthy persons between the ages of 2-49 years. It is not indicated for pregnant women, persons with certain underlying health conditions, and health care workers who deal with severely immune suppressed persons.

The current epidemiology of pandemic H1N1 disease in Pennsylvania shows that the demographic patterns are similar to those of the first wave that occurred in the Spring. More

than 70 percent of all illness is occurring in children and young adults between the ages of 5-24 years. Disease spread appears to be largely driven by transmission in these age groups in aggregate settings, especially primary schools and higher education. Both settings have already experienced disease outbreaks in some locations. Disease surveillance also demonstrates that while illness is occurring throughout the Commonwealth, currently it is more frequent in the southwest, southeast, and north central areas of the state.

PADOH anticipates that disease activity in the coming weeks will continue to increase in schools and institutions of higher education. We also know that children are the most efficient transmitters of influenza to their families and to the general community. Furthermore, because children under 10 years of age will require two doses of pandemic influenza H1N1 vaccine (ideally given 28 days apart but a minimum of 21 days apart), PADOH believes it is very important to initiate vaccination of this population as early as possible.

Therefore, based upon the vaccine type and patterns of disease, PADOH will target the initial doses of LAIV primarily to school children between the ages of 5-9 years. A smaller proportion of the available supply may be used for college students in settings where disease outbreaks have occurred and are ongoing. Efforts will be made to distribute vaccine to the three areas of the state that are experiencing the highest numbers of cases of disease, namely the southeast, southwest and north central districts.

Please note that PADOH expects additional doses of vaccine to be made available by the federal government in the coming weeks and expects approximately 2.5 million doses by the end of October. This includes both the single dose, preservative free inactivated vaccine for use in the youngest targeted groups and the multi-dose vials of inactivated vaccine for use in other priority groups. While injectable inactivated vaccine can be used in all five priority groups, it is important to note that each of the three currently licensed inactivated products are targeted to different age groups. It will be very important to know which vaccine you are ordering and receiving and the licensed indications for that specific product. At the same time inactivated vaccine is being distributed, more shipments of LAIV will also be available. This will assure that those who require two doses of vaccine can receive the second dose of LAIV, and that vaccination coverage can be extended to other groups of healthy individuals (e.g. school children age 10 years and over).

We appreciate your assistance in agreeing to register as a vaccine provider. The response by providers throughout Pennsylvania has been exceptional and assures the vaccine will be widely available throughout the state. If you have not yet completed and returned the vaccine provider agreement (with your physician license number) and the vaccine user agreements, please do so immediately. These forms must be completed and returned prior to placing an order for H1N1 vaccine. We now need your cooperation in assuring the vaccine reaches individuals in the prioritized groups, especially early in the process, as this makes the greatest impact on reducing disease transmission and protecting individuals at higher risk of influenza complications.

If you have any questions about this information, please visit the pre-registration link at www.H1N1inPA.com or call 1-877-PA-HEALTH.

Sincerely,

Stephen Ostroff, MD,

Acting Physician General

Edited October 2, 2009 by 4c6

[Redcell19512]

If this pandemic does get bad, they are going to be overwelmed by the general public seeking shots, and the local health units can not handle it.

A large majority of my co-workers, friends, and family have NO plans to get vaccinated for H1N1 or seasonal influenza. These are the things I'm hearing people say:

• Vaccines weaken your immune system. Getting sick makes your immune system stronger.
  
• The government was in such a hurry to make the H1N1 vaccine that they didn't test it. It's not safe!
  
• So if I get a flu shot I can still get colds and stuff? What the hell's the point then?
  
• A friend of mine got the flu from the flu shot. I'll never get one.
  

I've given up trying to educate my co-workers by pointing them to reliable sources of information (like the CDC). I look at it this way, more available vaccine for me and my kids.

[Richard B the EMT]

Vaccines weaken your immune system. Getting sick makes your immune system stronger.

OK, I have not yet had my regular flu shot, but how can being dead make your immune system stronger?

Oh, yeah, you cannot get "dead-er".