Ithaca College Public Health Initiatives

State: NY Type: Model Practice Year: 2019

Tompkins County Health Department (TCHD), located in Central New York, serves a population of approximately 101,500 residents. The county hosts three institutions of higher learning: Cornell University, Ithaca College, and Tompkins Cortland Community College (TC3) with a combined student population of approximately 28,000 annually. The combined total of staff, faculty and students working, studying and/or living on a college campus in Tompkins County can range from 40,000 42,000 any given year; approximately 40% of the county's population. Year round, a significant percentage of the colleges' faculty and students travel abroad, increasing the risk of disease transmission from all areas of the world, where the funding for vaccination programs may be inadequate or where the commitment to vaccinate may not be popular. Additionally, infectious disease tends to spread wherever large groups of people gather, putting college campuses inherently at risk for disease outbreaks. In recent years, college campuses across the county have reported outbreaks of serogroup B meningococcal disease, and recent data shows slightly higher risk for meningococcal disease in college students than in other teens and young adults who are not attending college. In 2013, TCHD began to collaborate with Ithaca College on achieving the goal: Independently respond to a public health emergency to mitigate loss of health and/or life to Ithaca College students, faculty and staff. The objectives to meet this goal are 1) provide public health responder training to students, staff, and faculty, 2) increase the number of trained public health volunteer responders on campus, 3) develop a public health response plan, 4) exercise the public health response plan annually, 5) sign an agreement with the local health department to operate a Closed Point of Dispensing (POD) in the case of a county wide public health emergency. To date objectives 1, 2, and 4 have been met. Implementation activities initially centered around the following: incorporating public health preparedness and response learning objectives into curriculum; developing medical countermeasure planning and point of dispensing operations trainings; coordinating with the Central New York (CNY) Medical Reserve Corps (MRC) for guidance on recruitment; and conducting meetings to support exercise design, development, and execution. Key milestones reached towards this practice include incorporating public health response training into established curriculum, receiving priority status to resources for an annual exercise, and authorization for student volunteers to participate in the exercises. Ongoing efforts towards achieving milestones include determining appropriate wording for Closed POD agreement and increasing exercise support in the form of people attending the event and receiving their annual flu vaccination. Through the Community Health undergraduate course and Health Education graduate program, this practice has exposed college students to the concepts of public health preparedness and response, which are scarcely, if at all, mentioned in today's undergraduate and graduate textbooks. Some Ithaca College students are exploring career options in public health preparedness, as seen by one student using her experiences gained by this practice to obtain employment in New York as a county public health preparedness coordinator. Each year this practice is implemented, the exercise data supports the foundation for a mass vaccination or dispensing of medication plan that would not only support the Ithaca College campus, but also Tompkins County or Central New York residents during a county or regional public health emergency. The most important factor to the college's success has been continual collaboration. Internal college collaboration occurs between the College's Department of Health Promotion and Physical Education, Hammond Health Center, Human Resources Department, and Office of Public Safety. External collaboration occurs between the college and TCHD and CNY MRC. This continued collaboration supports the college's willingness to allow students to become trained as part of an academic plan, encouraging them to actively participate as public health responders, thus demonstrating that Ithaca College staff, faculty, and students can unite to respond to a public health emergency effectively.
Both colleges and the university in Tompkins County hire faculty and accept students from across the globe in addition to supporting study abroad programs. Although international travel can build opportunities for students and faculty to discover, think, and act in concert with the world, it also introduces the risk of infectious disease transmission during and after travel. Yet, a person does not have to travel outside the U.S. to be exposed to contagious diseases. In the fall of 2017, Central NY experienced a mumps outbreak on the Syracuse University (SU) campus. Discussions with SU officials revealed what public health officials already knew – disease outbreaks consume more personnel and financial resources than expected. TCHD encourages the colleges and university to develop public health response protocols and procedures to incorporate into their established All Hazards Emergency Response Plan. During discussions with the colleges and the university health and emergency management staff, a couple of key assumptions were made: 1) if a disease outbreak occurred on a college campus that did not constitute a county level public health emergency then limited county resources would be available to assist in the response to the campus event, and 2) if a disease outbreak occurred in Tompkins County, constituting a county public health emergency, health department staff would have a priority to focus on the execution of a countywide public health response, meaning college's could only rely on themselves or the county's implementations of plans in response to the event. Regardless, the colleges and university realized that the development of an internal public health response plan guaranteed public health support to the campus during a public health emergency. In 2013, TCHD and Ithaca College began a series of collaborative meetings resulting in training and exercise activities to improve the college's ability to respond to a public health emergency. The Ithaca College campus population averages 8,422: 726 faculty, 1,032 staff, and 6,654 students any given year. Prior to 2013, neither a specific plan nor planning data existed to support how the college might immunize the entire campus population should a disease outbreak occur among the campus community. Additionally, before this practice no formal public health responder training for staff, faculty, or students existed on campus. Prior to 2014, the Ithaca College health clinic only provided flu vaccinations to students during normal clinic hours and to both faculty and staff during the annual employee benefits fair conducted each fall. The benefits fair represented the only opportunity for faculty and staff to receive their flu vaccine from the college clinic. Many students wait to receive their annual flu vaccination when they return home on fall break, while many staff and faculty receive their annual flu vaccination at their primary care physician's office or at various local pharmacies. Today as a result of this practice, Ithaca College holds an annual flu vaccination exercise to provide the flu vaccine to staff, faculty, and students. This also provides the college opportunities to test their ability to immunize the campus population. Ithaca College has annually conducted vaccination exercises from 2014-2018 with the following results: 2014 – 504 recipients; 2015 – 555 recipients; 2016 – 915 recipients; 2017 – 801 recipients; 2018 – 933 recipients. Even though recipient throughput has increased over the years, the exercise team does not believe the system has been truly stressed, and that improvement can only occur if participation increases. The annual vaccination exercise has replaced the vaccination opportunity at the annual employee benefits fair in an attempt to encourage employees to participate in the exercise. In the past three years, the communications campaign for the flu vaccination exercise has included information such as, The POD exercise is an important part of the Ithaca College emergency preparedness plan, and tests our ability to deliver potentially lifesaving medication quickly and efficiently in the event of an emergency or disaster incident that poses a threat to public health”. The exercise data from the past five years regarding equipment resources, personnel requirements and throughput data has improved the college's ability to develop a solid mass vaccination plan. Beginning in 2014, approximately 15-30 Ithaca College students annually become CNY MRC Volunteers and received public health responder training for mass prophylaxis events. In the past two exercises, MRC volunteers from previous semesters have answered the call to sign up nas POD workers, strengthening their public health response experience. In 2018, Ithaca College's Public Health Club members participated in the exercise for the first time. Further discussions with the club's faculty advisor will determine future incorporation of club members. This practice better situates Ithaca College to respond to a public health emergency requiring mass vaccination, practically guaranteeing a successful outcome in comparison to colleges or universities that have not tested or rehearsed the execution of a mass vaccination plan, have not trained internal public health responders, and have not developed site plans for possible mass vaccination locations on campus. In 2015 a collaborative team began developing exercise tools that could also be used in the classroom as part of public health responder training. One of these tools, the Ithaca College Vaccination Exercise Just-in-Time Training Manual (JITT), now provides community health students with a visual understanding of the personnel requirement to exercise a vaccination POD and the tasks POD workers accomplish during the exercise. Ithaca College students fill 75-80% of the POD worker positions, including three of the six leadership positions. During the 2016 exercise, the community health class experienced a spike in enrollment compared to previous years, so the exercise design team created a new POD worker position called ‘Vaccinator Assistant' to ensure all of the students gained POD and exercise experience. The efficiency created at the vaccination stations by this new position were seen as too valuable to lose; a Job Action Sheet was created for the position and included in the exercise JITT manual. In the fall of 2016, TCHD began collaboration with another Ithaca College professor teaching the freshman level course, Introduction to Public Health, on how to introduce the Public Health Preparedness Capabilities to students earlier in the academic program. This collaboration resulted in the following learning objectives being added to the Introduction to Public Health Course: 1) Consider the role of public health in emergency planning and response, 2) Understand the CDC public health preparedness capabilities, and 3) Practice applying the CDC public health preparedness capabilities to a public health emergency scenario. Using skills learned in the Federal Emergency Management Agency (FEMA) sponsored course, Exercise Design (G-139), TCHD assisted in the development of a 2-hour table top exercise to support the professor's learning objectives. This seemingly small addition to the practice may have a big impact, as it exposes public health students to preparedness concepts they will further explore in the junior and senior level Community Health course. The Centers for Disease Control and Prevention (CDC) supports public health partner involvement in medical countermeasure planning and the execution of those plans, evident by the information provided in their Point of Dispensing (POD) Standards” and their guidance document Introduction to Closed Points of Dispensing Planning”. Additionally, the CDC has incorporated the concept of Closed PODs into the curriculum of the two-day Mass Prophylaxis Preparedness and Planning Course (MGT-319). Counties are being encouraged to approach colleges, universities, private industry, faith-based organizations, government agencies, and community-based agencies to support the county's Medical Countermeasure Plan. The CDC's Public Health Preparedness Capabilities provide the foundation for the practice. This practice supports Capabilities 1, 8, and 15: Community Preparedness, Medical Countermeasures, and Volunteer Management respectively. In future years, the incorporation of other capabilities could be included, resulting in a more comprehensive exercise and overall public health responder training program. Although other colleges and universities may be collaborating with local health department on mass vaccination and dispensing planning and exercise, Ithaca College's incorporation of student trained public health responders differentiates their public health preparedness efforts from other colleges and universities. The public health preparedness training described further in this document provides the platform upon which many students demonstrate knowledge and experience in public health core competencies.
In 2013, Ithaca College began working towards the goal: Independently respond to a public health emergency to mitigate loss of health and/or life to Ithaca College students, faculty and staff.”Because of the fluidity of students and occasionally faculty, the objectives to meet this goal are focused upon annually. One of the keys to the success of this practice includes college and local health department long term collaboration. To assist the college's achievement of this goal, TCHD sought out a professor from the Department of Health Promotion and Physical Education willing to collaborate on concepts increasing student awareness regarding public health preparedness and response. This professor teaches the Community Health Course and other courses within the Health Education graduate program. Throughout 2013, collaborative efforts grew to include representatives from the college's Hammond Health Center, the Human Resource Department and the Office of Public Safety. Today this group, known as the Ithaca College POD Exercise Design Team, meets regularly to collaborate on activities in support of this goal. Objective 1: Provide public health responder training to students, staff, and faculty. In 2014 TCHD coordinated the two-day FEMA sponsored Mass Prophylaxis Preparedness and Planning Course (MGT-319) to be taught on campus for three consecutive years. This course emphasized the resource and personnel alignment required for efficient POD planning and management. Community Health undergraduate students and Health Education graduate students attended this course each year. Faculty, staff and other community members took advantage of this course being held locally on campus as well. Since 2014, the professor of the Community Health Course has scheduled two public health preparedness lectures each fall semester. These lectures focus on public health volunteer organizations, volunteer training requirements, medical countermeasures planning, and fundamentals of point of dispensing operations. The lecturer introduces students to the Medical Reserve Corps (MRC), a national network of volunteers organized locally to improve the health and safety of their communities nationwide. MRC volunteers include medical and public health professionals, as well as other community members without healthcare backgrounds. After the lectures, the lecturer provides diagrams of a potential POD site on campus and breaks students into small groups to construct POD diagrams, annotating where the four primary POD functions of Intake, Screening, Vaccinating, and Flow will take place, and where flow monitors should be positioned to ensure POD efficiency. Groups share their ideas, prior to being provided with the actual POD exercise diagrams. The lecturer also provides a POD organization chart and Just-in-Time Training (JITT) manual, which contains a job action sheet for each POD worker position. The lecturer advises the students to review the various positions, as they will receive instructions on how to sign up for POD worker positions 1-2 weeks prior to the exercise via a Google Document. The Exercise Design Team creates the POD worker sign-up sheet based on the class schedule the day of the exercise. This allows for students to sign up for more than one position, and allows students from past semesters to sign up to assist should they not have a class conflict during the time of the exercise. ???????Objective 2: Increase the number of trained public health volunteer responders on campus. The professor of the Community Health Course also requires students to register as Central New York (CNY) Medical Reserve Corps (MRC) volunteers and complete all Level 3 training requirements, as the CNY MRC only calls upon Level 3 or 4 trained volunteers for activation during a public health emergency. CNY MRC Level 3 training requirements include: program orientation; community and personal preparedness training; and receiving a certificate in Psychological First Aid, the Incident Command System, and the National Incident Management System. Prior to the annual exercise, the CNY MRC Coordinator conducts a communications drill requesting volunteer support for the Ithaca College Flu Vaccination Exercise.For the past two years, students, previously enrolled in the Community Health Course, also received the notification and have been encouraged to support the exercise.Most POD exercises conducted by local health departments do not exceed a 2-hour operational period.In comparison the POD exercise executed by Ithaca College students lasts for a 4-hour operational period. Students have two shift changes during the 4-hour exercise increasing their exposure to various POD worker positions.Shift changes correlate with the day's class schedule, facilitating participation from previous year's student volunteers. Although these shift changes could be viewed as an injected artificiality, they may in fact introduce a method proven to be useful during a real event should the college want to minimize disruption to the student volunteers' class schedule.Students are coached on how to conduct shift change briefings with their replacement in a way to not interrupt POD operations, and they do so successfully throughout the exercise.Typically the local health department's preparedness coordinator organizes the shift changes to ensure they do not occur simultaneously and ensure that appropriate shift change briefs are conducted.However in 2018, students in the POD leadership positions, specifically the Flow Leader position, took a greater responsibility for shift changes while the TCHD Preparedness Coordinator remained available to answer questions or provide insight. 3: Develop a public health response plan. Ithaca College has responded to localized flu outbreaks on campus. The college's responses have reinforced risk communications and clinical protocols, in addition to reinforcing partnerships with other colleges, universities, and the local health department. In 2015 the Exercise Design Team discussed the need for an exercise plan (EXPLAN) in accordance with the Homeland Security Exercise and Evaluation Program (HSEEP). Beginning in 2016, the TCHD Preparedness Coordinator along with Ithaca College interns began the development of an Ithaca College Vaccination Exercise Plan using the information from the previous year's exercise. This Vaccination Exercise Plan can be easily updated each year and in conjunction with the exercise JITT Manual, lays the foundation for the development of a public health response plan. Objective 4: Exercise the public health response plan annually. Ithaca College has annually conducted a mass vaccination exercise for the past five years. The Exercise Design Team comprises the Hammond Health Center's Operations Officer, the Hammond Health Center's Nursing and Clinical Manager, the professor of the Community Health Course, representatives from the college's Department of Human Resources and Office of Public Safety, and the TCHD Preparedness Coordinator. Annually this team meets to coordinate the training of POD Workers (student volunteers) and other activities related to the execution of the exercise. Specific factors leading to the success of this annual exercise have been: 1) annual planning meetings; 2) collaboration between college staff and faculty to ensure student support of the exercise; 3) collaboration between faculty and the health department for class lectures and volunteer training requirements; 4) willingness of the CNYMRC Coordinator to test responsiveness of MRC Volunteers to support this event; and 5) faculty excusing students from class to participate in this half day event. In accordance with HSEEP a debriefing is conducted with all POD worker's immediately after the exercise and the Exercise Design Team conducts an after action meeting prior to the end of the year. Objective 5: Sign an agreement with the local health department to be able to operate a Closed Point of Dispensing (POD) in the case of county wide public health emergency. Although as of the date of this submission Ithaca College has not yet signed a formal Closed POD agreement, advances have been made in the past months to move the college closer to this objective. The largest start up cost for this practice has been time.Time seems to always be the largest cost of any high pay off project, and when the high pay off is a relationship, an organization must dedicate the necessary time to build and foster that relationship, transforming it into a long-term partnership.Small local health departments typically have a preparedness office with one full time employee or two part time employees.All preparedness coordinators focus their activities around meeting their grant deliverables, which depending on the time of the year; can leave very little time for other tasks or projects.Taking the time to continually touch base with collaborators and making sure to provide a health department presence at all meetings goes a long way. TCHD has established a rhythm of fostering collaborative efforts to support this practice.Collaborative activities to support goal objectives are conducted throughout each year using a phased approach.Phase 1 (Summer Activities): participate in exercise planning meetings, assist in updating the exercise plan based on the previous year's after action reviews, review public health responder trainings, updating as necessary.Phase 2 (Fall Activities): schedule and conductpublic health responder and public health volunteer trainings,participate in exercise planning meeting, coordinate for volunteer notifications and the activation of volunteers through the CNY MRC, facilitate POD worker assignments for the exercise, conduct JITT training for POD workers, facilitate and evaluate the vaccination exercise, conduct exercise debriefing with POD Workers, and participate in after action meeting with the exercise team.When requested, TCHD has provided vaccinator support to the annual exercise. This provides an additional training opportunity for TCHD nurses, who do not provide vaccinations on a regular basis. Phase 3 (Winter and Spring Activities):Use public health interns to develop updated training products, assist with updating exercise plans, incorporate after action notes and identified improvements into exercise documents, and brainstorm ideas for the following year. Additionally a TCHD representative, when requested, assists in facilitating the Introduction to Public Health table top exercise in both the spring and fall semesters. This exercise introduces freshman and sophomore students to the Public Health Preparedness Capabilities, specifically the Medical Countermeasures Capability, prior to enrollment in the Community Health course. Ithaca College takes the lead on exercise planning, exercise coordination, and MRC and POD Worker training coordination.Hammond Health Center plans for and orders all medical supplies to support the exercise, in addition to scheduling all planning meetings.The representative from the Human Resources Department coordinates for all public information messaging to encourage participation in the exercise.Several methods of communications have been used, such as, mass email to faculty and staff and notices in the college's online Community Information Center.The Office of Public Safety provides the POD's Safety Officer each year and assists in the early morning set up of the POD site. As possible, TCHD coordinates for exercise participation from the other college and the university. For example, one year a nurse from Tompkins Cortland Community College participated as a vaccinator.On another occasion a Cornell University professor from the School of Operations Research and Information Engineering, attended the vaccination exercise with his students to conduct a time study and analysis of POD operations to determine process improvements. TCHD collaborates with both colleges and the university in Tompkins County regarding public health preparedness. Practices being developed and activities being conducted differ based on each institution's interests and needs.
This practice introduces fundamental and higher order public health concepts and theory to Ithaca College students enrolled in the Introduction to Public Health and Community Health Courses and the Health Education Graduate Program. These same students apply classroom learning in simulation scenarios and hands on experiences during table top and full scale exercises. The partnership between TCHD and Ithaca College provides opportunities for undergraduate and graduate students to connect directly with the public health department. Research shows that such partnerships can improve student competencies and enhance career opportunities (Erwin, Harris, Wong, Plepys & Brownson, 2016). Currently an Ithaca College graduate, who attended the FEMA sponsored Mass Prophylaxis Preparedness and Planning Course hosted by Ithaca College, became a CNY MRC volunteer, and participated as a POD worker during the college's mass vaccination exercise, works as a county public health preparedness coordinator in a neighboring county. Throughout the years, TCHD and Ithaca College have forged a closer working relationship, which benefits the Tompkins County community. This practice has not only gained TCHD a reliable public health partner but has provided the region with more knowledgeable and skilled public health responders. ???????Objective 1: Provide public health responder training to students, staff, and faculty. To date over 100 Ithaca College students have completed Level 3 Medical Reserve Corps training, in addition to receiving training on medical countermeasure planning and fundamentals of POD operations. Through this practice 13 undergraduate and 3 graduate students have been selected as TCHD public health preparedness interns, extending their public health responder training beyond the classroom and into the professional world of public health. Tasked with project work that directly supports the TCHD mission, these students gain resume building experiences, such as: assist in the development of the TCHD's Ebola Response Plan; assist in the design and execution of public health trainings, drills, and full scale exercises in accordance with the Homeland Security Exercise and Evaluation Program (HSEEP); design and develop Zika Virus risk communications products, currently displayed in the Ithaca-Tompkins Regional Airport; revise TCHD's Infection Control Policy and Universal Precautions Policy; develop a capability-based critique tool for exercise evaluators to assess TCHD's ability to develop, coordinate, and disseminate information, alerts, warnings, and notifications to the public; assist in the development of a tool for identifying the needs of individuals and families in isolation and quarantine; and develop a preparedness information sheet for the Medicaid Obstetric Maternal Services (MOMS) Program. Objective 2: Increase the number of trained public health volunteer responders on campus. Over 100 Ithaca College students have been trained and have gained hands on experience as public health responders thus far. The number of public health responders on campus grows each year. Depending on when a trained volunteer graduates, Ithaca College may have from 20-40 trained MRC student volunteers on campus any given semester. A growing number of students, who received the trainings in past semesters, are volunteering to support the vaccination exercise in following years, adding to their public health responder experience. Some Ithaca College students continue to volunteer throughout the year to support health department activities throughout the CNY region. Ithaca College students have volunteered to support large scale drive through PODs and other full scale exercises in locations such as Syracuse, New York. This additional exposure to public health responder activities provides them with valuable experience, better preparing these students to support Ithaca College and their community during a real event. Objective 3: Develop a public health response plan. The development of a public health response plan has been secondary to achieving Objectives 1, 2, and 4. Most would disagree with this as an approach, particularly since exercises are meant to test plans, and without a plan one would argue the purpose of the exercise. Objectives 1 and 2 were supported by college course learning objectives and health department efforts towards the public health preparedness capabilities of community preparedness and volunteer management. The groundwork for Objective 4 has always been there, as year after year the Hammond Health Center demonstrates their commitment to campus health, providing the annual flu vaccine to faculty, staff and students. Objective 3, not yet in tangible form, has 5 years of exercise data to support its conceptualization. Each year, exercise after action notes are integrated into next year's exercise documents, which will in turn be integrated into the future Ithaca College Public Health Response Plan. Objective 4: Exercise the public health response plan annually. An annual vaccination exercise has been conducted from 2014 2018, and the 2019 exercise is tentatively on the college's Conference and Event Services' calendar. Objective 5: Sign an agreement with the local health department to be able to operate a Closed Point of Dispensing (POD) in the case of county wide public health emergency. Due to key personnel turnovers in the college, the signing of a Closed POD memorandum of agreement has been delayed, but recently regained momentum. Collaborative tools are used to evaluate all portions of the practice, such as the Homeland Security Exercise Evaluation Program's after action process: debriefings, written feedback from exercise participants, and an after action meeting. The preparedness coordinator provides students with training feedback forms to receive input on sustaining and improving the classroom instruction received each fall prior the exercise. This feedback drives any needed changes to the following year's classroom instruction and training. Student feedback has improved the quality of the lecture presentations and resulted in the development of a short table top exercise related to designing POD layouts that support efficient POD flow. Immediately following the annual exercise, the preparedness coordinator conducts a debriefing with all POD workers. To follow up, the preparedness coordinator provides a POD Worker Feedback Form, which asks POD Workers to provide at least two strengths and two areas of improvement for the exercise. Should a POD worker list an area of improvement, the form provides a space for recommendations on how this improvement could be accomplished. In the future the design team hopes to do a better job of ensuring a formal written after action report after each exercise. The design team pays close attention to all recommendations provided by the student POD workers since they have proven to be valuable every year. Improvements made as a result of POD worker feedback include: large station sign numbers on brightly colored cardstock placed on raised poles by each station table; development of a large poster size graphic depicting where the vaccine will be administered and also containing the message Please help us save time by having your arm ready. The shot will be administered here (arrow pointing to deltoid). Please consider sweater, jackets, ties and buttons.” A student intern designed and developed this poster the same semester the feedback was provided, and Ithaca College now maintains one of these signs with their POD supplies. A key observation by one student POD worker in 2017 changed the layout of the Intake Section and the types of tables for this section. The student noted that recipients, who sat at a table to fill out the Influenza Screening Form, took much longer to complete their form than those recipients who stood at taller tables with no chairs. For the 2018 exercise, the design team coordinated for tall tables to replace some of the short tables with chairs. During set up, the short tables with chairs were placed closest to the entrance of the Intake Section. A student POD Worker, who was aware of the reason for the change in tables, made a quick assessment in the first hour of the POD that the short tables with chairs should not have been placed near the Intake entrance. As recipients entered the Intake Section, they immediately gravitated towards the short tables with chairs. The Intake Leader made an on the spot correction and moved the tall tables near the Intake Section Entrance and the shorter tables with chairs further away, resulting in an immediate change of behavior. Recipients began to use the tall tables closest to the Intake entrance, decreasing the time it was taking recipients to full out the screening paperwork and moving to the Vaccination Section area. The Exercise Design Team meets 1-2 months after the exercise to review and discuss POD worker feedback and overall execution of the exercise. Exercise design team members self appoint responsibilities to make adjustments or modifications to the various planning documents or to develop or purchase additional supplies. The design team then reviews any updates made over the winter and spring during the summer meetings. Summer meetings provide further opportunities to discuss the upcoming fall exercise. The team may meet once or twice over the summer. During the summer the team ensures that key improvements identified in the fall have been made or will be made by the time of the exercise. The annual exercise has been held in two locations over the years. The initial exercise was held in a gymnasium. Gymnasiums do not typically have quality sound absorbing materials, and can in effect be noisy when a large number of people gather in them. In more recent years, the design team moved the exercise to a large conference venue that can be partitioned into three separate areas. One area is a designated break area for POD worker, the second the Vaccination Section, and the third an exit survey area, where students administer a survey to vaccination recipients. During a real event requiring a larger vaccination section area, the space for the exit survey could be used. This particular venue has a dedicated wide hallway just outside the conference venue perfect for Intake Section activities, and careful considerations regarding which doors are used, which ones are not used, and where flow monitors are positioned has been a constant learning curve, but the team gets closer to the perfect solution each year. The exercise design team collects throughput data on each vaccination station. Supplies provided to each vaccination station include sticky notes and paper clips. Every half hour vaccination assistants clip all of the Influenza Immunization Consent Forms together, place a sticky note on top of the stack, and write down the station number and the time of submission, i.e., 9:00 or 9:30. The Supply Section, specifically the Forms Collector, collects these from each vaccination station every half hour throughout POD operations. The purpose of this is to track how many vaccinations were administered at each station every half hour during the exercise. The Forms Collector counts the number of forms from each station and annotates this number on the data log provided on the Forms Collector Job Action Sheet. Although no modifications to the practice have been made due to the throughput data, the data has been used to estimate throughput for a larger scale event. Based on this data, Ithaca College could vaccinate their entire student population in three days using 8-hour operational periods. Exercise data over the past five years confirm that six vaccination stations would be required. This same plan, modified to execute over five to seven 8-hour operational periods could be used to support the vaccination of the entire campus, including students, faculty and staff. Any expansion beyond the 4-hour operational period would require an increase in vaccinators to mitigate vaccinator fatigue in order to maintain current throughput. Additionally, a dedicated volunteer manager to oversee the scheduling of POD workers would prove beneficial for a larger scaled event. In the future, Ithaca College hopes to develop a ‘dispensing' plan to support the campus, which will align with the county's Medical Countermeasure planning goal to dispense a prophylaxis to the entire county's population within 48 hours. Citation: Erwin, P.C., Harris, J., Wong, R., Plepys, C.M., & Brownson, R.C. (2016).The academic health department: academic-practice partnerships among accredited schools and programs of public health, 2015. Public Health Reports, 131, (4) 530-636. DOI:10.1177/0033354916662223_
For this practice to be successful the health department's public health director, preparedness coordinator and directors of divisions with nurses must remain committed. Senior leaders set the tone for support for any activity within an organization, and TCHD leadership at all levels have consistently expressed their support and dedication for this practice. Without this support, the preparedness coordinator would have a difficult time collaborating with the college successfully and may lose motivation to see all aspects of the practice through. In retrospect, TCHD could have met with senior college leadership sooner to establish the rapport necessary to facilitate the signing of a signed Closed POD agreement; those relationships are being built now. For this practice to have a chance of being considered by other health departments and their education partners, collaboration between the health department and the appropriate academic department must be initiated and sustained. In regards to Ithaca College, the collaboration began between the TCHD Preparedness Coordinator and a professor from the Department of Health Promotion and Physical Education, but collaborative relationships can include other health department division employees and other types of academic programs, where relationships have already been established. For example, a health department nurse may have a close working relationship with the department chair of a nursing school. Health departments should look at all of the various academic programs offered by the local colleges and universities to determine what programs might support this type of practice. Academic programs, such as nursing and pharmacy are ideal, but as TCHD and Ithaca College have demonstrated, a professional licensing program is not necessary. Any programs related to public health can successfully support this program. No matter the academic program, the right mix of college staff should be included in the collaboration. Ithaca College's success has been in including the health clinic, the human resources department and the office of public safety. In retrospect, the exercise design team wishes they had been more adamant in including a representative from the college's public information office, as the college has not yet received the appropriate public acknowledgement for their five years of accomplishments. TCHD has included their participation in this practice as part of their long range preparedness planning and events calendar, and nursing staff anticipate the annual request to support the exercise. Hammond Health Center has demonstrated their commitment to this practice by coordinating all planning meetings and including the exercise in their annual budget for the required exercise supplies and vaccine. The Chair for the Department of Health Promotion and Physical Education and the professor of the Community Health Course consistently provided support and accolades for this practice. Many other professors within the department have demonstrated their support for the practice by allowing students to miss their class to be a POD Worker, and by allowing students to use class time to come to the event and receive their annual flu vaccine. The Human Resource Department has supported this practice, advocating it as an important aspect of campus preparedness, despite the occasional comments from staff or faculty regarding vaccinations no longer being provided at the employee benefits fair. The Office of Public Safety continually encourages everyone's commitment to this practice and ensures representation at all planning meetings. It only took the creative flare of one professor, who adamantly wanted her students to gain practical experience, to merge academia with an ongoing campus public health mission and to spur into existence a mass vaccination exercise using trained student volunteers. Yet it is everyone directly and indirectly in support of this practice that has made it a seamless success year after year.
Colleague in my LHD