Maine EMS Medivax Maine EMS Medivax EMS Vaccination ProgramEMS Vaccination Program

Objective

• To develop a protocol and process to allow licensed MEMS ALS personnel already trained to administer medications via the IM/SC/intranasal route to provide immunizations in an organized event authorized by a licensed Physician

• To be able to support / deliver vaccinations as force protection to essential personnel and the capabilities to deliver vaccination to the public is need is determined.

• To teach and instruct Maine EMS personnel, including the Emergency EMT Basic Level on the safe and proper delivery of vaccinations via the Intranasal Route.

Objectives

Basic EMTs who have completed the Maine EMS MediVax program are allowed to perform intranasal vaccine with the caveat that an ALS resource or equivalent (nurse physician, or NP/PA) with the resources to care for adverse effects (including allergic reactions) is available on scene. A basic service cannot host a vaccine clinic individually but Basic EMTs can be used under the auspices of a larger physician proscripted event to act as a resource for administering IN vaccine.

EMS Agency Requirements

• MEMS licensed service permitted at or above the intermediate level

• The service immunization program and the instructor for the Maine MEDIVAX program must both be approved by the service Medical Director

• Service must maintain all records for any vaccinations provided by the service to their personnel.

Service Medical Director

• EMS Services that want to provide vaccinations to their own personnel must have a Medical Director who authorizes the program.

• If the service does not have a service Medical Director, then they should approach a local Health Care Facility or the Regional Medical Director for assistance.

Sponsoring Agency Requirements

• Program must be authorized by a licensed Physician.

• Sponsoring Organization is required to provide all paperwork and maintain records for 7 years post vaccination.

EMS Provider Requirements

• MEMS licensed Basic EMT (IN vaccine only)- Intermediate, Critical Care, or Paramedic.

• Completed an approved* MEMS Vaccination Administration training program.* An approved program is one where the program

and instructor have been approved by the Service Medical Director.

Liability

• EMS Providers providing immunizations need to check with the sponsoring organization about liability coverage.

• Liability coverage may differ based upon changes in state/federal law, pandemic declarations, and employer coverage

Training Overview

• IM injection training (NHTSA National Standard Curriculum)

• Video Overview• Intranasal training• Administrative Requirements– Handbook– Lecture

• Nasal medication delivery takes a middle path between slow onset oral medications and invasive, highly skilled delivery of intravenous medications. Because the nasal mucosa is highly vascularized, delivery of a thin layer of medication across a broad surface area can result in rapid transmucosal absorption of the medication into the blood stream and cerebral spinal fluid.

Intranasal Administration

Procedure Instruction of Intranasal Medication Administration

Intranasal Vaccines at a Glance

Intranasal Vaccines at a Glance

Rubber Tip Protector

Dose Divider Clip

Intranasal Vaccines at a Glance

Clip in middle of medication plunger is known as Dose Divider Clip

Procedure

AKA, The Seasonal FluInfluenza (Inactivated) Vaccine

Influenza (Inactivated) Vaccine

Serious problems from influenza vaccine are very rare. The viruses in inactivated influenza vaccine have been killed, so you cannot get influenza from the vaccine.

Influenza (Inactivated) Vaccine

Mild problems:

•soreness, redness, or swelling where the shot was given •hoarseness, sore or red eyes, cough, itchiness •fever •aches

If these problems occur, they usually begin soon after the shot and last 1 to 2 days.

Influenza (Inactivated) Vaccine

Severe problems:

Life-threatening allergic reactions from vaccines are very rare. If they do occur, it is usually within a

few minutes to a few hours after the shot.

It is important to differentiate other, more common, nonallergic clinical syndromes from anaphylactic vaccine reactions. Vasovagal reactions with pallor, bradycardia, weakness, dizziness, and brief syncope may occur five to 15 minutes after vaccination. These reactions occur more often in adolescents and adults than in children.

Influenza (Inactivated) Vaccine

ANAPHLAXIS / ALLERGIC REACTIONS REVIEW

Allergic Reaction

An exaggerated reaction by the body’s immune system to any substance

ANAPHLAXIS / ALLERGIC REACTIONS REVIEW

AnaphylaxisA life-threatening allergic reaction which causes shock (hypoperfusion) and airway swelling

ANAPHLAXIS / ALLERGIC REACTIONS REVIEW

ALERT!!!!

The PEDIACTRIC Population that we will be working with, have the potential of a delayed anaphylactic reaction after the vaccine. Reactions can occur up to 15 minutes later!

Signs and Symptoms

Skin Itching

Hives

Flushing

Warm, tingling feeling

Swelling (especially face, neck, hands, feet, tongue)

Signs and Symptoms

Tightness in throat/chest

Cough

Rapid, labored, noisy breathing

Hoarseness

Stridor and wheezing

Respiratory

Signs and Symptoms

Increased heart rate

Low blood pressure

Cardiac

Signs and Symptoms

Itchy, watery eyes and runny nose

Headache

Sense of impending doom

GeneralizedFindings

Signs and Symptoms

Decreasing mental status

Signs and symptoms of shock (hypoperfusion) or respiratory distress

TREATMENT

• TREAT AS PER PROTOCOL MAINE EMS GOLD 1

Quick PEDI Drug Reference Chart

Protocol

• Complete vaccine administration record (VAR) and have recipient sign it

• Distribute a current season Vaccine Information Statement (VIS)

• Administer the vaccination via IM/SC/intranasal route per the drug package insert or the instructions of the Medical Director

Documentation Overview

1. Vaccination records will be maintained by the agency for 7 years

2. Sponsoring agencies will provide vaccinated individuals with copies of their vaccination administration records (VAR) on request

3. All VAR’s will be reviewed by the sponsoring agency medical director or their designee

Documents

1. Vaccine Administration Record (VAR)2. Vaccine Information Sheet (VIS)3. Vaccine Adverse Event Reposting System

(VAERS)

Vaccine Administration Record

• Tracking and consent documentation• Identifies risks and contraindications to

vaccine• Requires patient review and signature• Documents the vaccination– MFR lot #– Dose route site– Provider

Vaccine Information Statement (VIS)• http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf

• Patient information regarding the vaccine• To be reviewed by patient before vaccination

Vaccine Adverse Event Reporting System (VAERS)

• National program that monitors the safety of vaccines after they are licensed

• VAERS is used to watch and record patient “adverse events”

• Beware that often patient reported problems are unrelated to vaccination– EG. Contracting a cold after having an influenza

vaccine

Vaccine Adverse Event Reporting System (VAERS)

What events should be reported?• Any serious problem that occurs after

administration of a vaccine

Vaccine Adverse Event Reporting System (VAERS)

How do I report?• Hotline– (800) 822-7967

• Internet– Secure.vaers.org/vaersdataentryintro.htm

• Printable form– www.vaers.hhs.gov– VAERS, PO Box 1100, Rockville, MD 20849-1100

Review

• Organized, Physician-prescripted event only• Complete vaccine administration record (VAR)• Distribute Vaccine Information Statement

(VIS)• Perform the vaccination via IM injection• Report serious post vaccination problems

using VAERS

QUESTIONS???

References• Nursing Interventions and Clinical Skills, 3rd Ed., Mosby ©

2000 • www.webmd.Com• www.google.Com (Images)• Maine EMS Medivax Program Update August 2009• MAINE EMS PREHOSPITAL TREATMENT PROTOCOLS,

JULY 2008• Limmer, Emergency Care Update, 10th Ed, 2007, Pearson

Education. Inc.• MedImmune, H1N1 (Live Attenuated) Intranasal

Spray Vaccine Drug Insert Fact Sheet

Acknowledgements• Dan Batsie, EMT-P, Northeast EMS• Rick Petrie, EMT-P, Kennebec Valley & Northeast EMS• Lt. Nate Contreras, Scarborough Fire Dept.• Steve Diaz, MD, Maine EMS Medical Director• Matt Sholl, MD, Asst. Maine EMS Medical Director• Kerry Sousa Pomelow, Maine EMS

Updated 09/22/2011