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2003 Model Practice Application (Public)

Practice Title
The Marion MVPC Program
Submitting LHD/Agency/Organization
Marion County Health Department


In the event of a widespread infectious disease outbreak or weapons of mass destruction incident requiring the rapid vaccination or pharmaceutical prophylaxis of a large number of individuals, Marion City and County Health Departments have established a Mass Vaccination/Prophylaxis Clinic (MVPC) program to serve the public. Marion County has a population of nearly 100,000 people and there are only 40 staff members amongst the two health departments. While it might seen physically impossible for smaller health departments to meet the needs of their communities in times of need, with the proper planning an army of volunteers can be summoned and trained to provide service to the community. The MVPC procedures are organized in three stages and incorporate the incident/unified command system. Expeditious, yet thorough, volunteer training combined with command and control are the crux of the successful operation of MVPC.

Responsiveness and Innovation
The program is responsive to any public health threat requiring MVPC. The program allows the local health department to quickly organize and deliver the services required to drastically reduce the devastating effects of infectious disease outbreaks. This program relies on a collection of proven procedures. The majority of the program utilizes techniques drafted by the U.S. Army during mobile enemy prisoner of war (EPW) facility operations. Additionally, components of the program draw from the experiences of emergency management professionals and even fast-food operations. Pulling from a variety of backgrounds and experiences has enabled the Marion Health Departments to overcome many technical obstacles.

From volunteer recruitment to clinic breakdown, the program addresses most pressing issues associated with MVPC such as language barriers, physical disabilities and the need to provide services to essential personnel. The program is very low-tech yet efficient and effective. The program is not reliant on computer software that may be ineffective during power outages or plagued with technical problems. By utilizing simple procedures, large numbers of volunteers can be requested, trained, and functioning within a few hours.

The program can be contracted and expanded to meet a variety of needs. Whether vaccination or pharmaceutical distribution is required for 100 or 100,000 clients, the program can be adjusted to meet the requirements of any MVPC situation. The program is effective regardless of size and complexity due to a client’s special needs. The program enables the health departments to quickly organize their staff into trainers who in turn provide high-quality, immediate training to a large group of volunteers with a host of backgrounds. After volunteer training, the health department staff members become clinic coordinators who supervise the set-up and operations of MVPC sites. This minimizes pre-event staff training and eliminates pre-event volunteer training and meetings.

Agency Community Roles
The Marion Health Departments recognized early in the planning process that MVPC would be a collaborative effort amongst a multitude of agencies. The Emergency Preparedness Coordinator for the Marion Health Departments worked extensively with his counterparts in fire, EMS, EMA, law enforcement, County Engineering/Planning, civic organizations, and Marion General Hospital. For several months, meetings were held with groups of emergency planners, chiefs and department heads from these organizations to obtain a consensus on the responsibility each department would have in MVPC.

Costs and Expenditures
The costs of the program were almost exclusively payroll. There were minor costs associated with office supplies and vehicle mileage. However, the project is very labor-intensive. In order to meet the demands of meeting with several different agencies, program planners must be flexible. If a staff member has not been designated to perform emergency planning, other programs may suffer from inattentiveness.

The Marion Health Departments aimed to create a MVPC program that relied heavily on volunteers without having to select and maintain a core group of volunteers in advance. In the past, several civil defense initiatives were established to train groups of volunteers to respond to a variety of incidents. These programs were costly in terms of time and resources. In time, the groups dispersed and the programs were discontinued. However, the success of any business or program hinges on the training and qualifications of those who operate it. Additionally, time will almost always be of the essence. In a smallpox scenario during which most of the populace is exposed, the MVPC program would have to be set up and completed in four days. The MVPC addresses all of these issues. The program allows the expeditious and effective training of a large number of volunteers to ensure adequate delivery of services.

Outcome Process Evaluation
Data and information about MVPC procedures were extrapolated from a mixture of real world exercises performed by the U.S. Army's evaluation of EPW "inprocessing" procedures and local Smallpox Phase I implementation. Red Cross procedure and Version 9 of the NPS Procedures from the CDC were also reviewed. Additionally, a functional exercise of the volunteer training phase was planned in cooperation with a local high school and is scheduled for Fall 2003.

Lessons Learned
The Marion Health Departments identified the following challenges or technical barriers to effectively operate MVPC: Immediate need of staff in a time of crisis and staff availability for pre-event recurrent training, finite funding, training requirements for the successful operation of MVPC sites, and meeting the needs of a diverse population.

The biggest challenge to developing a MVPC program is to get "buy-in" from all the agencies involved. Local health departments need to realize the uniqueness of public safety agencies. EMS, fire, law enforcement and EMA agencies have been working together for years and are sensitive to "outsiders." Historically, public health has not taken part in emergency planning and/or exercises and may be a threatening presence with its new proactive stance. Be aware of these issues.

Key Elements Replication
Key elements to the success of preparing a MVPC program are putting someone in charge who can focus solely on this project, requiring that the planning coordinator have a background in emergency planning and/or response, giving the planning coordinator several months to complete the project, and obtaining typical office equipment and software.