Public Medical Point of Dispensing Field Operations Manual ...

Public Medical Point of Dispensing Field Operations Manual:

COVID-19 Vaccine MegaPOD

January 2021

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD

Revised 1-18-2021 DRAFT

Contents Introduction ...................................................................................................................... 6

Purpose ....................................................................................................................... 6

Scope ........................................................................................................................... 6

On-site Screening for COVID-19 ......................................................................................... 7

Preparations ..................................................................................................................... 7

Site Walk-Through........................................................................................................ 8

Site Issues .............................................................................................................. 8

MPOD Supply Delivery.................................................................................................. 8

Site Set-up ................................................................................................................... 9

1. Staff Check-in with COVID-19 Screening .............................................................. 9

2. Tables and Chairs Set-up ....................................................................................10

3. Briefings ............................................................................................................11

4. Stock Stations ....................................................................................................12

5. On-site Training .................................................................................................12

Final Check..................................................................................................................13

Operations .......................................................................................................................14

Operational Briefings...................................................................................................14

Personal Protective Equipment (PPE) ...........................................................................14

Inventory Management ...............................................................................................15

Vaccine Storage and Handling for All Vaccines........................................................15

Moderna Vaccine Prep ..........................................................................................16

Pfizer Vaccine Prep ................................................................................................17

Maintaining Vaccine Coolers ..................................................................................18

Distributing Vaccines to Dispensing Stations...........................................................19

Vaccine Temperature Excursions............................................................................19

Supply Orders........................................................................................................20

Accommodations for Those with Access and Functional Needs (AFN) ...........................20

Service Animals .....................................................................................................20

Interpreter Services ...............................................................................................21

Forms Assistance ...................................................................................................22



Mobility Assistance................................................................................................22

Troubleshooting ..........................................................................................................22

Staffing Shortages .................................................................................................22

Client Bottleneck ...................................................................................................23

Angry Clients .........................................................................................................23

Clients with Fear of Needles/Vaccines ....................................................................24

Adverse Reactions to Vaccine Administration .........................................................25

Staff Breaks .................................................................................................................25

Coverage During Breaks .........................................................................................25

Restroom Breaks ...................................................................................................25

Rest Breaks ...........................................................................................................25

Meal Breaks ..........................................................................................................26

Shift Changes ...................................................................................................................27

Shift Change Briefings..................................................................................................27

Command Staff Shift Change Briefing .....................................................................27

Outgoing Staff Shift Change Briefing ......................................................................28

Incoming Staff Preparations.........................................................................................28

Final Shift Change Procedures......................................................................................28

Demobilization.................................................................................................................29

Staff Demobilization ....................................................................................................29

Debrief and Check-out ...........................................................................................29

Station Demobilization ................................................................................................29

Site Demobilization .....................................................................................................30

Returning Vaccines to the Health Department........................................................30

Appendix A: COVID-19 Vaccine MegaPOD Staffing (updated 1-12-2021) ..........................31

Organizational Chart....................................................................................................31

LACDPH Roles and Responsibilities ..............................................................................32

Appendix B: On-site Training Scripts.................................................................................34

Registration Training Script..........................................................................................34

Dispensing Training Script for IM Vaccines Using PrepMod ...........................................36

Vaccine Prep Training Script ........................................................................................39



Holding Training Script ................................................................................................43

Appendix C: Supply Lists...................................................................................................44

MPOD Kit ....................................................................................................................44

Personal Protective Equipment (PPE) ...........................................................................45

Vaccine Administration Supplies ..................................................................................45

Appendix D: Adverse Event Response Guide ....................................................................46

Adverse Event Response Overview ..............................................................................46

On-site Emergency Treatment for Adverse Reactions ...................................................47

Administering Epinephrine via Auto-Injector ..........................................................47

Administering Epinephrine via Injection .................................................................48

Adverse Event Reporting .............................................................................................48

Appendix E: Forms ...........................................................................................................49

MPOD/Emergency Medication Center Incident Report .................................................50

Medical Materiel Tracking Log .....................................................................................54

Hourly Vaccine Temperature Log .................................................................................56

Status Summary (MPOD ICS 209A) ...............................................................................57

Incident Check-in/Check-out Log (MPOD ICS 211A) ......................................................58

Team Check-in/Check-out Log (MPOD ICS 211A) ..........................................................59

General Message (ICS 213) ..........................................................................................60

Activity Log (ICS 214) ...................................................................................................61

COVID Vaccines Return Form .......................................................................................62

Appendix F: Job Action Sheets for LACDPH Staff Roles .....................................................63

Vaccine Prep Staff .......................................................................................................64

Dispensing Staff ..........................................................................................................69

Registration Staff.........................................................................................................73

Observation Staff ........................................................................................................75

MPOD Director…………………………………………………………………………………………………………..….62

Vaccine Unit Leader (coming soon)……………………………………………………………………………...….

Registration Leader…………………………………………………………………………………………………..……81

Vaccine Prep Leader………………………………………………………………………………………………….…84

Dispensing Leader…………………………………………………………………………………………………….…..91



Observation Leader…………………………………………………………………………………......………………95

Appendix G: MPOD Processes……………………………………………………………………….......………………98

MegaPOD Client/Site Process MapExtra Vaccine Usage Plan/Magic MountainExtra Vaccine Usage Plan/CSUNExtra Vaccine Usage Plan/DowneyExtra Vaccine Usage Plan/ForumExtra Vaccine Usage Plan/Pomona



Introduction Local health departments in Los Angeles County (i.e., Long Beach Department of Health and Human Services [LBDHHS], Los Angeles County Department of Public Health [LACDPH], and Pasadena Public Health Department [PPHD]) are responsible for dispensing life-saving preventive medications (i.e., vaccines or antibiotics) to the entire county population during public health emergencies.

One strategy to rapidly dispense such medications, and thereby reduce disease morbidity and mortality, involves collaborating with partners (e.g., cities) on the development of Public Medical Points of Dispensing (Public MPODs) throughout the county.

A Public MPOD is a facility that is used temporarily during public health emergencies to mass dispense preventive medication to potentially exposed individuals. These sites may be operated using a combination of volunteers, partner staff, and county staff. The decision to activate Public MPODs is determined under the authority of the Los Angeles County Health Officer in coordination with the Health Officers for the City of Long Beach and City of Pasadena.

Purpose The Public Medical Point of Dispensing Field Operations Manual: COVID-19 Vaccine MegaPOD provides step-by-step procedures for setting up, operating, and demobilizing Public MPODs to dispense vaccines under the COVID-19 MegaPOD Staffing Model. It incorporates public health guidance to reduce risk of COVID-19 transmission, including symptom screening for COVID-19, increased physical distancing, and cleaning/sanitation procedures.

Scope This document is specific to Public MPODs operated in partnership with the County of Los Angeles to mass dispense vaccines. It was written for Public MPODs operated under the COVID-19 MegaPOD Staffing Model.

The Public MPOD Field Operations Manual is designed to be used in conjunction with response-specific information provided in the Site Profile and Incident Action Plan.



On-site Screening for COVID-19 All MPOD staff are asked to self-screen for COVID-19 symptoms before reporting for their shift. Staff are directed to stay home if they are experiencing symptoms of COVID-19, under self-isolation, or in quarantine.

Upon arrival to the site, Command Staff will complete on-site screening for COVID-19, and will repeat this procedure for each staff member that reports to the site:

Take their temperature. It must be under 100.4°F (38°C).

Confirm that they have no other symptoms of COVID-19 (fatigue, difficultybreathing/shortness of breath, muscle or body aches, headache, new loss of taste orsmell, cough, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea).

Make note of staff that completed COVID-19 screening by putting a checkmark () tothe left of their name on the Incident Check-in/Check-out Log (MPOD ICS 211A).

Any MPOD staff with symptoms of COVID-19 must be sent home immediately andadvised to follow-up with their healthcare provider.

Use their signature line on the Incident Check-in/Check-out Log (MPOD ICS 211A) tomake a note that they “screened positive.”

See “Staffing Shortages,” on page 22, for more information.

Preparations Command Staff are deployed to the site ahead of other MPOD staff to:

Begin documenting actions in an Activity Log (ICS 214).

Review this document, the Site Profile, and the Incident Action Plan.

Conduct a site walk-through (see section on page 8).

Note: The Site Owner/Operator is responsible for providing facility support (i.e., access to the site, climate control, lighting, restroom maintenance). Some MPOD Partners may elect to have these responsibilities fulfilled by the Partner Leader or another facility support person. Questions regarding facility support should be directed to the Site Owner/Operator (see the “Facility Use Authorization” section of the Site Profile for contact information).



Site Walk-Through Command Staff begin site preparations by conducting a site walk-through in which they:

Identify all areas to be used for MPOD operations (as indicated in the maps provided inthe Incident Action Plan [IAP]).

Locate any MPOD supplies stored on-site (see Appendix C: Supply Lists on page 44).

Ensure hand sanitizer and cleaning products are available.

Limit points of entry to the site.

If indoor spaces will be used: Open windows and doors to increase ventilation.

If expecting a supply delivery, post a staff member at the Delivery Truck Parking area toalert the MPOD Director when it arrives (see “MPOD Supply Delivery,” below).

Site Issues If any issues are identified during the site walk-through, the MPOD Director will:

Document site issues in a Status Summary (MPOD ICS 209A).

Send the completed Status Summary (MPOD ICS 209A) to the Health DOC.

Make changes to the IAP as needed and share updates with the Health DOC.

MPOD Supply Delivery Vaccines will be packed following standard vaccine packing protocols as follows:

Vaccines will be packed in Cool Cubes or styrofoam containers with phase changematerials (PCMs) that maintain temperature better than standard cold packs.

Each transport container will include a digital data logger.

Vaccines will be in their original packaging with a beyond-use label.

Each site will also receive 2 extra containers of PCMs to refresh vaccine storage as needed.

If supplies are delivered to the site, the MPOD Director will perform the following at the time of delivery:

Check the packing list to confirm all supplies were received.

Document initial inventory amount on the Medical Materiel Tracking Log.

Check the digital data logger for current vaccine temperature to confirm that vaccineswere kept within the temperature range specified on the manufacturer’s package/insertduring shipment.

Document initial vaccine storage temperature on the Hourly Vaccine Temperature Log.

Provide delivery confirmation to the Health DOC with a Status Summary (MPOD ICS209A). If additional supplies are needed (e.g., due to error in shipment), follow theprocedures provided in “Supply Orders,” on page 20.



Site Set-up Site set-up is completed in 6 steps: (1) check-in staff, (2) set-up tables and chairs, (3) conduct briefings, (4) stock stations, (5) conduct on-site training, and (6) dispense to staff.

Note: Steps 1 and 2 are conducted at the same time.

1. Staff Check-in with COVID-19 ScreeningAll MPOD staff are asked to self-screen for COVID-19 symptoms before reporting for their shift.Staff are directed to stay home if they are experiencing symptoms of COVID-19, under self-isolation, or in quarantine.

All MPOD staff must check-in with the MPOD Director (or their designee) and complete COVID-19 screening before being assigned any tasks. Those in charge of check-in must:

Obtain the Incident Check-in/Check-out Log (MPOD ICS 211A) and Job Action Sheets.

Screen staff for COVID-19:


Ask if they have any other symptoms of COVID-19: fatigue, difficultybreathing/shortness of breath, muscle or body aches, headache, new loss of taste orsmell, cough, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea.

Make note of staff that completed COVID-19 screening by putting a checkmark ()to the left of their name on the Incident Check-in/Check-out Log (MPOD ICS 211A).

Direct any MPOD staff with symptoms of COVID-19 to return home immediately andfollow-up with their healthcare provider.

Use their signature line on the Incident Check-in/Check-out Log (MPOD ICS 211A) tomake a note that they “screened positive.”


Provide each staff member with their Job Action Sheet.

**For the first shift only: Provide checked-in MPOD staff with instructions for site set-up(see “2. Tables and Chairs Set-up,” on page 10).

If any MPOD staff have not reported to the site within 30 minutes of the designatedcheck-in time, see “Staffing Shortages,” on page 22.

Any additional staff sent by MPOD Partners are not accounted for on the Incident Check-in/Check-out Log (MPOD ICS 211A). These staff should see the appropriate Command Staff member and follow check-in procedures set by their affiliated agency.

Volunteers deployed from other jurisdictions to serve as MPOD Staff must check-in with their On-site Field Volunteer Coordinator.



2. Tables and Chairs Set-upCommand Staff will oversee site set-up and perform the following procedures with small batches of MPOD staff after they check-in:

Confirm that staff are physically able to move tables and chairs (those that are unable tolift may help with staff check-in if needed).

Review the “Tips for Safe Lifting” (below) with staff.

Direct teams of 2 to set-up tables and chairs according to the site layout provided in theIncident Action Plan, with 6-foot intervals marked in the Queuing Area.

Tips for Safe Lifting • Limit your load: Work in teams of 2 to move 1 table at a time. For folding chairs,

each person may carry up to 1 chair per arm.

• Slowly lift with your legs: When picking things up or setting them down, bend atyour hips and knees only. Keep your back straight, and don’t twist your body.

• Carry loads in your “power zone”: Carry items close to your body and near yourabdomen with your elbows close to your sides to reduce strain on your body.

Once all tables and chairs are set-up, the MPOD Director will ensure that all MPOD areas meet accessibility requirements:

Walkways are free of trip hazards (e.g., spills, clutter, loose cords, uneven floor mats).

Walkways are at least 36 inches wide and free of obstacles such as MPOD sign stands,trash cans, potted plants, and tables.

Any doors along the client route are at least 32 inches wide and held open by a doorstop(wedge or built-in).

Cones are placed beneath any wall-mounted objects hanging below 6 feet 8 inches.

The MPOD Director will also ensure that site set-up allows for physical distancing of MPOD staff and clients:

Client walk-up waiting areas have markers (e.g., painters’ tape) at 6-foot intervals.

Appropriate signage is used to remind clients to practice physical distancing and/or waitin their cars.

Staff chairs/stations are placed 6-feet from each other.

If any indoor spaces are used: Windows and doors are open (to increase ventilation).



3. BriefingsOnce staff check-in and tables and chairs set-up are complete, Command Staff will gather allMPOD Staff for briefings.

General Briefing Checklist The MPOD Director will provide a general briefing to include the following information from the Incident Briefing (MPOD ICS 201A) in the Incident Action Plan:

“Situation Summary”

“Current and Planned Objectives”

“MPOD Organization” (Note the chain of command/reporting structure.)

Safety Briefing Checklist The Law/Security Leader and Safety Info Liaison will provide a safety briefing to include the following information from the Incident Action Plan and Appendix D: Adverse Event Response Guide:

“Health and Safety Summary” (in the Incident Briefing [MPOD ICS 201A])

“Medical Emergency Procedures” (in the Medical Plan [MPOD ICS 206A])

“Site Safety Plan and Expanded Safety Message” (in the Safety Message/Plan [MPOD ICS208A])

An emergency plan, including:

How they will be alerted of an emergency (e.g., ringing alarm, flashing lights,announcement from Command Staff)

When evacuation would be necessary (e.g., fire, major earthquake)

Which path to use for emergency exit

Where to meet after evacuation

Any other emergency evacuation procedures

What to do in a shelter-in-place situation (e.g., active shooter)

“Adverse Event Response Overview” (in Appendix D: Adverse Event Response Guide, onpage 46)



Leader Introductions Once the briefings are complete, the MPOD Director will:

Introduce other Site Leads:

Group Supervisors

Vaccine Unit Leaders

Registration Team Leaders

Vaccine Prep Team Leaders

Dispensing Team Leaders

Holding Team Leaders

Base Camp Managers

Direct MPOD staff to pick-up station supplies indicated on their Job Action Sheets.

4. Stock StationsWhile staff are picking-up supplies, Vaccine Prep Staff will:

Prepare coolers for dispensing stations.

Begin preparing vaccines for dispensing based on the number of client registrations forthe first hour of operations.

Preparing Coolers for Dispensing Stations Extra cold packs, bubble wrap, and 9-quart coolers will be provided to maintain the cold chain at dispensing stations. Vaccine Prep Staff will prepare a cooler for each dispensing station to hold prepared vaccines at refrigerated temperatures just prior to dispensing as follows:

Ensure that cold packs are properly conditioned (not frozen).

Place enough conditioned cold packs to cover half of the bottom of the cooler.

Completely cover cold packs and cooler bottom with a 2-inch layer of bubble wrap.

Layer refrigerated vaccines on the bubble wrap.

Completely cover the vaccines with another 2-inch layer of bubble wrap.

Place conditioned cold packs to cover half of the bubble wrap.

Close the cooler.

5. On-site TrainingOnce all stations are stocked, Team Leaders will provide on-site training for their staff usingscripts provided in Appendix B: On-site Training Scripts, starting on page 34. Each Team Leadershould facilitate training for their direct reports, as indicated on their Job Action Sheets.

Note: On-site training for subsequent shifts will be held away from dispensing operations (e.g., in the Staff Breakroom or other area).



Final Check Command Staff conducts a final check to confirm that preparations are complete:

All MPOD areas meet accessibility requirements:

Walkways are free of trip hazards (e.g., spills, clutter, loose cords, uneven floormats).

Walkways are at least 36 inches wide and free of obstacles such as MPOD signstands, trash cans, potted plants, and tables.

Any doors along the client route are at least 32 inches wide and held open by adoorstop (wedge or built-in).

Cones are placed beneath any wall-mounted objects hanging below 6 feet 8 inches.

MPOD signage is placed in the corresponding areas and includes reminders to maintainphysical distancing and/or wait in their cars.

MPOD setup follows the layout provided in the Incident Action Plan and allows forphysical distancing of MPOD staff and clients:

Client walk-up waiting areas have markers (e.g., painters’ tape) at 6-foot intervals.

Staff chairs/stations are placed 6-feet from each other.

Stations are fully stocked with all required supplies, including PPE and handsanitizer/cleaning products.

All MPOD staff are at their assigned stations and wearing the appropriate PPE.

**For the first shift only: Once the final check is complete, the MPOD Director will:

Complete and submit a Status Summary (MPOD ICS 209A) to the Health DOC to informthem that the site is opening to the public.

Announce to all staff that the MPOD is opening.



Operations Operational Briefings Command Staff will conduct operational briefings with the Group Supervisor and Vaccine Unit Leaders to address any issues with the site, security, or operations. Operational briefings must be held immediately after any issues are identified and at least once per hour. See “Troubleshooting” on page 22, for guidance on resolving operational issues.

Operational briefings will include status updates regarding:

Estimated number of clients in line

Supply status (i.e., any deliveries received since the last operational briefing and numberof unopened boxes of vaccines)

Estimated number of vaccines dispensed

This information will be used by the MPOD Director to:

Complete a Status Summary (MPOD ICS 209A) to send to the Health DOC.

Determine if a supply order is needed (see “Supply Orders,” on page 20, for moreinformation).

Personal Protective Equipment (PPE) MPOD staff are directed to follow CDC recommendations for optimizing limited PPE supplies through extended use. More information about County policies on PPE are provided in the Safety Message/Plan (ICS 208) in the Incident Action Plan. The Safety Info Liaison is will oversee PPE supplies and work with the Vaccine Unit Leaders to direct staff to:

Remove and clean/disinfect their face shields before taking breaks.

Store their face mask in a paper bag while taking meal breaks.



Inventory Management Vaccine Prep Team Leaders are responsible for tracking medical materiel from receipt through the end of MPOD operations using the Medical Materiel Tracking Log.

Vaccine Storage and Handling for All Vaccines Vaccines are delivered in coolers with a digital data logger to measure temperature. Vaccine Prep Teams will ensure that vaccines adhere to cold chain requirements, manufacturer’s storage/handling instructions, and the following best practices:

Keep vaccine coolers closed as much as possible and out of direct sunlight.

Only remove the amount needed at one time for vaccine preparation andadministration.

Keep the digital data logger probe inside the cooler as close as possible to vaccines.

Keep the digital data logger display outside the cooler so temperatures can be readwithout opening coolers.

Record vaccine storage temperatures once every hour on the Hourly VaccineTemperature Log.

If the vaccine storage temperature starts to rise, remove the old phase change materials(PCMs) and insert new ones.

See “Vaccine Temperature Excursions,” on page 19, for information on responding tovaccine storage temperature excursions.



Moderna Vaccine Prep Defrosting Vaccines (Moderna) Vaccine Prep Staff will defrost frozen Moderna vaccines will defrost in 30 to 60 minutes at room temperature:

Remove vials needed to administer vaccines for appointments scheduled for the first hour from storage container, then make sure the storage container is completely closed.

Keeping vaccine vials upright, protected from light, and in the tray while thawing.

Once vaccines are thawed, they are ready to be drawn for use.

Do not refreeze thawed vaccines.

Drawing Vaccines (Moderna) Vaccine Prep Staff will prepare Moderna vaccines for administration:

Sanitize your hands and gather all the supplies needed: vaccine vial, alcohol prep pads, needles, and syringes. Keep vial out of direct sunlight.

Check vaccine label for correct product name and expiration/beyond-use label. Never use vaccine after the beyond-use label or expiration date.

With the vial upright, gently swirl the vaccine. Do not shake or roll in hands.

Examine the vaccine. It should be white to off-white in color and may contain white particles. Do not use if liquid contains other particulate matter or is discolored.

Remove the protective cap from the vial. Wipe the top of the vial with an alcohol prep pad and let it dry while you assemble/prepare a needle and syringe. Once dry, draw each dose as follows:

Uncap the needle and pull back the syringe plunger equal to one dose of vaccine.

Hold vaccine vial steady on the table, then insert the needle straight into the center of the stopper and inject air into the vial.

Invert vaccine vial so the needle tip is in the liquid and withdraw one dose (0.5 mL).

Return the needle and vial to the table, then withdraw the needle, tap the syringe, and push out any air. Ensure the syringe is not cold to the touch.

Recap the clean needle by placing the syringe and cap on the table and using a one-handed scooping technique to bring the needle into the cap. Never re-cap a needle using both hands.

Repeat, gently swirling the vaccine vial before withdrawing each dose. Discard vial when there is not enough vaccine to obtain a complete dose. Do not combine residual vaccine from multiple vials to obtain a dose.

Write a note with the manufacturer, lot number, and date/time drawn. Vaccines must be used within 6 hours of being drawn. Discard any unused vaccine after 6 hours.



Pfizer Vaccine Prep Defrosting Vaccines (Pfizer) Pfizer vaccines are stored at ultra-low temperatures and should be thawed prior to site distribution, otherwise they require additional safety precautions for handling. They take approximately 1 hour to thaw at room temperature, or about 2 hours and 30 minutes at refrigerated temperatures. Do not refreeze thawed vaccine.

Diluting Vaccines (Pfizer only) Vaccine Prep Staff will mix Pfizer vaccines with diluent (0.9% sodium chloride [normal saline, preservative-free]) as follows:

Sanitize your hands and gather all the supplies needed: vaccine vial, diluent vial, alcoholprep pad, needles, and syringes. Keep vials out of direct sunlight.

Allow the vaccine to come to room temperature. Vaccine vials can be held at roomtemperature for up to 2 hours before mixing. After 2 hours, return unmixed vials torefrigerated temperatures.

Check vaccine and diluent labels to verify that they are the correct products to mixtogether, correct volumes, and their expiration/beyond-use dates. Never use productsafter the beyond-use label or expiration date.

With the vaccine at room temperature, gently invert the vial 10 times. Do not shake thevial. If the vial is shaken, discard the vaccine into the sharps container.

Examine the vaccine. It should be white to off-white in color and may contain opaqueparticles. Do not use if liquid is discolored.

Remove the protective caps from the vials. Wipe the top of the vials with an alcoholprep pad and let them dry while you assemble/prepare a 21-gauge (or narrower) needleand syringe. Once dry, dilute the vaccine as follows:

Uncap the needle and hold the diluent vial steady on the table. Insert the needlestraight into the center of the vial stopper, then invert the vial and pull the needle backso the tip is in the liquid. Draw 1.8 mL of the diluent (0.9% sodium chloride [normalsaline, preservative-free]) into a mixing syringe, then withdraw the needle.

Discard diluent vial and any remaining diluent in the sharps container. Do not usebacteriostatic normal saline or other diluents to mix the vaccine.

Hold the vaccine vial steady on the table. Insert the needle into the center of the vialstopper and inject all the diluent from the syringe. Using the mixing syringe, remove 1.8mL of air from the vaccine vial to equalize the pressure in the vaccine vial.

Remove mixing syringe and needle from the vial and discard into the sharps container,then gently invert the vial with the vaccine and diluent 10 times. Do not shake. Thevaccine will be off-white in color. Do not use if discolored or contains particulate matter.If vial is shaken, discard the vaccine into the sharps container.

Write the date and time the vaccine was mixed on the vial.



Drawing Vaccines (Pfizer) Once mixed with diluent, Vaccine Prep Staff will draw Pfizer vaccines for administration:

Invert the vial with diluted vaccine and pull needle back so the tip is in the liquid, then withdraw one dose (0.3 mL).

Return the needle and vial to table, then withdraw the needle, tap the syringe, and push out any air. Ensure the syringe is not cold to the touch.

Recap the clean needle by placing the syringe and cap on the table and using a one-handed scooping technique to bring the needle into the cap. Never re-cap a needle using both hands. Repeat until all doses are drawn.

Discard empty used vials in the sharps container.

Write a note with the manufacturer, lot number, and date/time reconstituted. Vaccines must be used within 6 hours of dilution.

Maintaining Vaccine Coolers Extra cold packs, bubble wrap, and 9-quart coolers are provided to maintain the cold chain at the Supply Area and at dispensing stations. The Vaccine Prep Team will replace cold packs in vaccine coolers, as needed, to maintain proper storage temperatures.

For Refrigerated Vaccines:



Completely cover cold packs and cooler bottom with a 2-inch layer of bubble wrap.




Close the cooler.

For Frozen Vaccines:

Completely cover the bottom of the cooler with frozen cold packs.

Layer frozen vaccines directly on top of the frozen cold packs.

Completely cover the vaccines with frozen cold packs.

Close the cooler.



Distributing Vaccines to Dispensing Stations Vaccine Prep Team Leaders will deliver vaccines to dispensing stations, as needed. If client throughput is consistently high, you may wish to distribute more vaccines at one time:

Remove prepared vaccines from the vaccine storage unit at the Supply Area and placethem directly into a small tray or cooler with a cold pack layered with bubble wrap.

Carefully walk vaccines to dispensing stations and place them directly into dispensingstation vaccine coolers until ready for use.

Periodically check the cold packs in the vaccine coolers at dispensing stations andreplenish as needed.

Vaccine Temperature Excursions Vaccines must be stored at the temperature range specified on the manufacturer’s insert/packaging. Cold temperatures can damage vaccines immediately. Warm temperatures can damage vaccines cumulatively over time. Both can impact vaccine viability.

If a vaccine storage unit goes out of the specified temperature range, the Vaccine Prep Team Leader overseeing those supplies will:

Document the time and temperature on the Hourly Vaccine Temperature Log.

Add or remove cold packs to bring the storage unit within range.

Once the storage unit has returned to the specified temperature range, document thetime and temperature on the Hourly Vaccine Temperature Log.

Quarantine (and do not administer) any vaccines exposed to out-of-range temperaturesuntil confirming their viability.

Contact the manufacturer to determine whether vaccines are still viable.

Inform the Vaccine Unit Leader of the temperature excursion and manufacturer’sresponse to report up the chain to the Health DOC.

If the affected vaccines are no longer viable, the MPOD Director will coordinateresupply. See “Supply Orders,” on page 20, for more information.



Supply Orders If additional medical materiel or other supplies are needed, the MPOD Director will place a supply order through the Health DOC as soon as possible using a General Message (ICS 213).

Upon receipt of medical materiel from the Health Department, the MPOD Director will:

Check the packing list to confirm all medical materiel were received.

Document incoming inventory on the Medical Materiel Tracking Log.

Confirm that vaccines were kept within the temperature range specified on themanufacturer’s package/insert during shipment.


Document and follow-up on any issues with delivery.

Accommodations for Those with Access and Functional Needs (AFN) The Vaccine Unit Leader is responsible for ensuring that appropriate accommodations are offered to clients that may need them, including people with physical, developmental or intellectual disabilities, chronic conditions, or limited English proficiency; older adults, children, pregnant women, and persons experiencing homelessness (PEH).

Individuals with AFN may or may not self-identify, and some may not need additional accommodations. (For example, those with low literacy may not feel comfortable telling MPOD staff that they are unable to read written materials, and not all pregnant women will need mobility assistance.)

Any MPOD staff that suspects a client needs additional assistance must:

Introduce themselves by name and role.

Ask the client how they can help.

Inform the client about the MPOD process and what accommodations can be made.

Alert the Vaccine Unit Leader of anyone requesting accommodations.

Vaccine Unit Leaders are also responsible for ensuring that those in need of additional assistance are provided appropriate accommodations, as detailed in the following sections.

Service Animals Service animals are allowed at Public MPODs. To determine whether an animal is a service animal, staff may ask:

• Is this a service animal required because of a disability?

• What work or task has this animal been trained to perform?



Interpreter Services For clients that don’t speak English:

Present the client with the Language ID Card to identify their preferred language.

If client materials deployed to the site do not include the client’s preferred language: Report up to the MPOD Director to contact the Health DOC regarding materials in the client’s preferred language. If available, ask them to send you a copy (e.g., via email or fax) to share with the client.

Check the Incident Check-in/Check-out Log (MPOD ICS 211A) to see if there are any staff on-site that speak the client’s preferred language.

If there are MPOD staff available to provide interpretation: Ask them to accompany the client through the dispensing process (e.g., answer questions and interpret for Dispensing Staff).

If no one is available to provide interpretation: Follow the instructions provided on the Language ID Card to call an interpreter from a County-issued phone and accompany the client through the dispensing process.

For clients that are Deaf or hard of hearing:

Write a note to the client asking how they would like to be assisted. (They may ask for an interpreter or indicate that they would like to exchange notes.)

If they would like to exchange notes: Provide the client with a clean pen and clipboard to write their notes on. Use your own pen and clipboard to write your notes.

If a sign language interpreter is needed: Check the Incident Check-in/Check-out Log (MPOD ICS 211A) to see if there are any staff on-site that know sign language/ASL.

If there are MPOD staff available to provide interpretation: Ask them to accompany the client through the dispensing process (e.g., answer questions and interpret for Dispensing Staff).

If no one is available to provide interpretation: Follow the instructions provided on the Language ID Card to video conference with an interpreter from a County-issued phone and accompany the client through the dispensing process.



Forms Assistance For clients that are unable to read or write (e.g., due to physical disability or low literacy):

Review the Vaccine Information Statement (VIS) with the client.

Read the client sections of the form to the client and fill in each section with theinformation they provide.

Once the client sections of the form are complete, review the form with the client tocheck for any mistakes.

Mobility Assistance For clients that are unable to stand for long periods of time:

Ask if they would like a chair to sit in while waiting.

If they accept the chair, clean/disinfect the chair before providing it to them.

Clean/disinfect the chair once they are done using it.

For clients who are blind/have low vision that have requested assistance from a sighted guide:

Ask how they would like to be guided and follow their instruction. Most likely, the clientwill hold your arm just above the elbow or place their hand on your shoulder.

Walk on the opposite side of a service animal or cane and describe obstacles in the path.

Upon arrival to the destination, provide information to orient the client to theirsurroundings (e.g., we are now at the Dispensing station where you will receive yourvaccination. The nurse who will administer your vaccine is standing in front of you toyour right.).

Troubleshooting Staffing Shortages No shows, staff that screen positive for COVID-19, and staff that check-out early (e.g., due to dismissal, illness, injury, or emergency) create staffing shortages. Once a staffing shortage is identified, Command Staff will:

Document the staffing shortage on a Status Summary (MPOD ICS 209A).

Submit a General Message (ICS 213) to the Health DOC to request additional staffing.

Follow the guidance under “Reassigning MPOD Staff,” below, to reassign staff to criticalvacant positions.

Document changes to staff roles on the Organization Assignment (MPOD ICS 203A).

Reassigning MPOD Staff Public MPOD organizational charts are response/site-specific and provided in the Incident Action Plan. Staff assignments are indicated on the Incident Check-in/Check-out Log (MPOD ICS



211A). More information on each role (including license requirements) is provided in Appendix A: COVID-19 Vaccine MegaPOD Staffing (updated 1-12-2021), on page 31.

Volunteers deployed from partnering organizations (e.g., non-County staff) cannot be reassigned to another role and cannot take on duties for other positions. Duties for vacant positions may only be assigned to County or MPOD Partner staff that meet the licensing requirements for those roles. Any staff that are reassigned after on-site training is completed should receive the on-site training for their new position.

Vaccine Prep Staff and Dispensing Staff must have a license to administer vaccines and these roles may only be assigned to those with appropriate licensure. These positions are critical to achieving the target dispensing rate and should be filled immediately. If there are not enough licensed staff available, these roles may be combined so that each Vaccine Prep/Dispensing Staff prepares and dispenses vaccines.

Registration Staff in the Screening Area are also critical to avoiding client bottlenecks between stations. If there are not enough Registration Staff available, these responsibilities may be taken on by the Dispensing Staff so that they screen and dispense medication.

Client Bottleneck The Vaccine Unit Leader is responsible for overseeing operations and correcting any issues between client areas. Client bottlenecks may occur between Client Check-in and Dispensing Areas if Registration Staff check clients in faster than Dispensing Staff can handle.

Before making any changes to operations in these areas, allow time to see if the problem corrects itself. For prolonged or worsening client bottlenecks between these areas, direct the Registration Team to adjust their flow to alleviate client load on Dispensing Staff.

Angry Clients Every effort should be made to calm angry clients to maintain the health and safety of MPOD staff and other clients, however MPOD staff are highly valued partners in public health emergency response and are never expected to suffer abuse or tolerate angry behavior beyond their limit.

Clients that use racist slurs, hate speech, sexual harassment, or other threatening behaviors should be reported immediately to Command Staff for removal from the site. All incidents involving client removal must be reported to the Health DOC. See “Client Removal and Incident Reporting,” on page 24, for more information.



De-escalation Techniques Follow these steps to deescalate angry clients:

Stay calm and speak clearly, softly, and slowly. Take deep slow breaths and think of something that makes you feel happy or peaceful.

Use active listening and don’t interrupt. Let them vent and then summarize their concerns in your own words to show you are listening.

Be supportive and express empathy/understanding. Ask how you can help and offer alternatives, if possible, when you are not able to accommodate their request.

Wait until they can calm down. Ignore verbal challenges (e.g., “What’s wrong with you? Aren’t you listening to me?!”) and continue to be patient, listen, and be supportive.

Repeat the above steps as needed or continue to “Client Removal and Incident Reporting,” below.

Client Removal and Incident Reporting MPOD staff may use the “3-strikes rule” to ask any client exhibiting persistent negative behavior (e.g., yelling, profanity) to leave the MPOD as follows:

1. Start with a polite warning, such as, “I understand you are upset, and I want to help, but I can’t keep speaking with you if you continue to act this way.”

2. Give a final warning if they continue to act aggressively. You can say something like, “I’m sorry but I’ll have to ask you to leave if you continue to act this way.”

3. Ask the client to leave. “I’m sorry, but I’m going to ask you to leave. You are welcome to return when you are able to discuss the matter calmly.”

The MPOD Director is responsible for documenting any incident involving the removal of a client and reporting it to the Health DOC. Include the following in the incident report:

Time and date of incident

Name of MPOD staff involved in incident

Name and/or physical description of client(s) involved in incident

Incident summary/narrative, including whether the client used hate speech or the threat of violence and what methods MPOD staff used to deescalate the situation

Clients with Fear of Needles/Vaccines Some clients may have a fear of needles or vaccines which may lead to a delay in MPOD operations. It is important for MPOD staff to be understanding and supportive of fearful clients while still maintaining timely operations.

If a client uses racist slurs, hate speech, sexual harassment, or other threatening language, immediately alert Command Staff to have the client removed.



Dispensing Staff may use the following techniques to help calm anxious clients before administering a vaccine:

Explain the vaccination process to the client in easy-to-understand language and answer any questions that the client has before administering the vaccine.

Explain that the client may feel a pinch or pressure. (Avoid using words like “shot,” “needle,” or “pain.”) Reassure the client that the “pinch” will only last a few seconds.

Tell a short, positive, story to distract the client.

Encourage the client to take deep breaths.

Dispensing Staff should limit the amount of time spent attempting to comfort an anxious client to 2-3 minutes. If the client needs more than 3 minutes to prepare to receive the vaccine, politely request that the client return to the waiting area so that you may vaccinate other clients that are waiting.

Clients that choose not to receive a vaccination due to fear may exit the MPOD. This does not need to be reported in an incident report.

Adverse Reactions to Vaccine Administration See Appendix D: Adverse Event Response Guide, on page 46, for policies and procedures regarding adverse reactions to vaccine administration.

Staff Breaks MPOD staff must be relieved of all duties during their breaks. Although they are encouraged to use the Staff Breakroom for their breaks, they may leave the MPOD during this time.

Coverage During Breaks Command Staff may stagger rest breaks in small groups to ensure site coverage but may not deny or discourage rest breaks. Command Staff should take alternating breaks to provide coverage for each other.

Restroom Breaks Restroom breaks do not count toward rest break requirements and each MPOD staff member is entitled to as many restroom breaks as needed. Staff are to complete restroom breaks quickly and return to their duties as soon as possible.

Rest Breaks MPOD staff are responsible for requesting rest breaks as needed. Anyone wishing to take a break should request a rest break from their direct supervisor at the site and alert them upon their return. MPOD staff may choose to skip rest breaks but may not combine rest breaks with their meal break.

Each MPOD staff member is entitled to (1) 15-minute rest break for every 4 hours worked or major fraction thereof (over 2 hours). This means that someone working a 10-hour shift would



receive 2 rest breaks, because a 10-hour shift consists of (2) 4-hour periods plus 2 hours. If they worked more than 10 hours (and up to 12 hours) they would be entitled to 1 additional break, for a total of 3 rest breaks.

Meal Breaks Each MPOD staff member must take (1) 30-minute meal break (for shifts lasting 6 to 10 hours) or (2) 30-minute meal breaks (for shifts longer than 10 hours). Command Staff are responsible for initiating staff meal breaks at the appropriate time:

The first meal break must occur before the shift’s 6-hour mark.

For shifts longer than 10 hours, the second meal break must occur before the shift’s 10-hour mark.

All staff must check-out and back in for meal breaks on the Team Check-in/Check-out Log (MPOD ICS 211A) maintained by their direct supervisor at the site.



Shift Changes The following procedures apply if shift changes take place.

All MPOD staff are asked to self-screen for COVID-19 symptoms before reporting for their shift. Staff are directed to stay home if they are experiencing symptoms of COVID-19, under self-isolation, or in quarantine.

Upon arrival to the site, incoming Command Staff will complete on-site screening for COVID-19, and will repeat this procedure for each incoming staff member:


Confirm that they have no other symptoms of COVID-19 (fatigue, difficulty breathing/shortness of breath, muscle or body aches, headache, new loss of taste or smell, cough, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea).

Make note of staff that completed COVID-19 screening by putting a checkmark () to the left of their name on the Incident Check-in/Check-out Log (MPOD ICS 211A).

Any MPOD staff with symptoms of COVID-19 must be sent home immediately and advised to follow-up with their healthcare provider.

Use their signature line on the Incident Check-in/Check-out Log (MPOD ICS 211A) to make a note that they “screened positive.”


Outgoing Command Staff will prepare for a shift change:

Outgoing Vaccine Prep Team Leaders: Close out the Medical Materiel Tracking Log and Hourly Vaccine Temperature Log for their shift.

Outgoing MPOD Director: Compile all completed ICS forms, Medical Materiel Tracking Logs, Hourly Vaccine Temperature Logs, and client forms used during their shift to return to the Health DOC.

Outgoing MPOD Director: Draft a final Status Summary (MPOD ICS 209A).

Shift Change Briefings Command Staff Shift Change Briefing Incoming Command Staff will arrive ahead of other staff to meet with their outgoing counterparts for a command briefing where the:

Outgoing Command Staff will brief them on any changes to the Incident Action Plan or issues with the site, security, or operations.

Outgoing MPOD Director will send the final Status Summary (MPOD ICS 209A) to the Health DOC to provide notice of the change in command.



Outgoing Staff Shift Change Briefing Immediately following the Core Team shift change briefing, the outgoing Command Staff will read this shift change briefing to outgoing staff:

Operations will continue as normal while staff for the next shift arrive and prepare for their shift. Once they are ready to switch over, you will be asked to report to your direct supervisor at the site for debrief and check-out.

Incoming Staff Preparations After the shift change briefings, incoming Command Staff will:

Begin documenting actions in an Activity Log (ICS 214).

Review this document, the Site Profile, and Incident Action Plan.

Complete the following sections from preparations (on pages 7 to 12):

“Site Walk-Through”

“1. Staff Check-in”

“3. Briefings”

“5. On-site Training”

Final Shift Change Procedures Once incoming staff are prepared to assume operations, the outgoing MPOD Director will:

Direct all outgoing staff to report for debrief and check-out.

Facilitate demobilization of outgoing staff (see “Staff Demobilization,” on page 29).

Collect all documents used during their shift (e.g., ICS forms, client forms, Medical Materiel Tracking Logs, Hourly Vaccine Temperature Logs).

Return the documents listed above to Health DOC.



Demobilization Staff Demobilization MPOD leaders are responsible for ensuring that all staff:

Assist with station/site demobilization (if applicable).

Return their supplies to Logistics.

Debrief.

Check-out on the Incident Check-in/Check-out Log (MPOD ICS 211A).

Debrief and Check-out At the end of each shift, MPOD leaders will debrief their staff to identify any:

Referrals needed (e.g., to mental health services or other resources)

Strengths and weaknesses identified during MPOD operations, including any safety concerns encountered during the shift or anticipated for future shifts

Suggestions for improvement in MPOD processes

Once the debrief is complete, MPOD staff will:

Return any remaining supplies they checked out to Logistics.

Check-out on the Incident Check-in/Check-out Log (MPOD ICS 211A).

Station Demobilization Near the end of operations, Command Staff will work with the Group Supervisor to coordinate gradual demobilization of registration and dispensing stations according to client demand on the site. Any stations staffed by volunteers should be demobilized first.

To demobilize a station, MPOD staff working at that station will:

Return supplies and biohazardous waste from their station to Logistics.

Dispose of trash from their station in the on-site trashcans or dumpsters.

Undergo staff demobilization (see “Staff Demobilization,” above).



Site Demobilization Command Staff will announce MPOD closure at the end of operations. At this time, all remaining stations will be demobilized, and Command Staff will:

Report MPOD closure to the Health DOC and partner leadership (e.g., City EOC).

Confirm that all stations and staff were demobilized.

Confirm that all supplies were returned.

Ensure any remaining medical materiel, biohazardous waste, and MPOD documents (e.g., ICS forms, client forms, Medical Materiel Tracking Logs, Hourly Vaccine Temperature Logs) are returned to the Health Department/Health DOC for further processing/storage.

Returning Vaccines to the Health Department Any unused vaccine vials must be returned to the LACDPH warehouse. Be sure that excess vaccines were always kept within the appropriate temperature range. Vaccine Prep Team Leaders will follow these steps to prepare vaccines to be returned to the Health Department:

Place empty and punctured vials in sharps container.

Complete the COVID Vaccines Return Form for all unused vaccine vials that were not removed from the cooler.

For unused vaccine vials that were removed from the cooler:

Complete a separate COVID Vaccines Return Form for these vaccines, indicating how long the vaccines were out of the cooler/out of the storage temperature range.

Pack these vaccine vials separately from other unused vaccines.

Place any unused vaccine vials in their original box and bubble wrap boxes.

Pack vaccines in the same transport container they arrived in. (Do not combine all vaccines into one container.) If needed, pack with new phase change material (PCM) so that the vaccines arrive to the warehouse/pharmacy within temperature.

Make sure the digital data logger is attached to the storage container and note the temperature on the Hourly Vaccine Temperature Log prior to returning.

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix A: COVID-19 Vaccine MegaPOD Staffing


Appendix A: COVID-19 Vaccine MegaPOD Staffing (updated 1-12-2021)

Organizational Chart



LACDPH Roles and Responsibilities Role Responsibilities

MPOD Director *Medical license optional

• Communicate with Health Department Operations Center (DOC) to provide regular status updates.

• Work with the MPOD Branch (from Fire IMT) to oversee and direct MPOD operations at the site to meet the goals and objectives in the Incident Action Plan.

• Initiate meal breaks as scheduled. • Ensure that all documentation is returned to the Health DOC at the

end of each shift and MPOD supplies / medical materiel are returned to the Health Department at the close of MPOD operations.

Vaccine Unit Leader

• Participate in Operational Briefings with Command Staff. • Oversee and direct all operations directly applicable to the primary

mission of dispensing vaccines. • Coordinate meal breaks as scheduled.

Registration Team Leaders

• Answer questions about the process for receiving vaccines. • Oversee client screening and check-in. • Ensure that appropriate accommodations are offered to individuals

with access and functional needs. • Provide on-site training and supervision for Registration Staff.

Registration Staff • Screen clients for symptoms of COVID-19, check for client eligibility/appointments, assist clients in completing check-in, and answer any questions about the process.

• Help control flow to dispensing stations by directing clients to open dispensing stations.

Dispensing Team Leaders *Requires license for administering vaccines

• Oversee medication dispensing and perform periodic checks to ensure that staff follow procedures for safe vaccine dispensing.

• Provide on-site training and supervision for Dispensing Staff.

Dispensing Staff *Requires license for administering vaccines

• Review client forms, administer vaccines, and direct clients to the observation area.

• Follow safe vaccine administration practices.



Role Responsibilities

Vaccine Prep Leader *Requires licensefor administeringor managingvaccines

• Oversee vaccine preparation and ensure proper storage and handlingof vaccines, including temperature tracking.

• Provide on-site training and supervision for Vaccine Prep Staff.

Vaccine Prep Staff *Requires licensefor administeringvaccines

• Prepare vaccines for dispensing.• Ensure proper storage and handling of vaccines.

Holding Team Leaders *Requiresmedical license

• Monitor clients for adverse reactions after vaccine administration.• Provide medical support for clients experiencing adverse reactions.• Document adverse reactions according to applicable County policies.• Provide on-site training and supervision for Holding Staff.

Holding Staff • Monitor clients for adverse reactions after vaccine administration andalert Holding Team Leaders of clients experiencing adverse effects.

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix B: On-site Training Scripts


Appendix B: On-site Training Scripts

Registration Training Script Hello, my name is [name] and you will report directly to me today. Let’s do some quick introductions. Please tell us your name and the organization/department you deployed from. [Have all team members introduce themselves.]

An important part of your duties today is to help keep clients calm. You can do this by speaking in a calm voice, giving simple instructions, and providing reassurance. If a client makes you feel uncomfortable or unsafe, or you have any safety concerns, please report to me immediately.

Please also look out for clients that may need additional assistance, including those with disabilities, older adults, pregnant women, and those who cannot read or speak English. If you think a client may need additional assistance, simply introduce yourself by name and role, then ask the client if they need assistance in a particular area, like reading/filling out the form or getting through the MPOD. If they do, let me know and I will facilitate further accommodations.

Registration Staff are responsible for conducting COVID-19 symptom checks and ensuring that clients are eligible to receive the vaccine today. Here is the process you will follow for clients as they arrive to the site:

1. Maintain 6-feet distance from clients as much as possible.

2. Greet clients and thank them for waiting. Tell them that you are doing symptom checks for COVID-19, then take their temperature and ask if they have any other symptoms of COVID-19. (The list of symptoms is provided on your Job Action Sheet.)

If they have a fever of 100.4°F (38°C) or above, or any other symptoms of COVID-19, politely inform them that they will not be able to receive the vaccine today and direct them to return home and follow-up with their healthcare provider.

3. If they have no symptoms of COVID-19, ask the client whether they have an appointment. If not, check with me on whether we are able to take walk-ins.

4. If vaccines are being prioritized for a certain population, ask them to provide proof (e.g., badge, ID, etc.).

If they cannot provide proof, politely inform them that they will not be able to get the vaccine today and instruct them to return with proof and/or schedule an appointment for a future clinic when vaccinations open to other groups.



Registration Staff also check clients into the site on PrepMod and act as flow control to open dispensing stations. Let’s get you started on PrepMod:

1. Open Google Chrome and go to cw.calvax.org/users/sign_in

2. Enter your username and password. Your username should be your email address. If youcan’t remember your password, click “Forgot Password?” If that doesn’t work, let meknow and we can contact the PrepMod HelpDesk.

3. Once logged in, select “Manage Clinics and Users” icon.

4. In the Clinic Listing page, find the location and date we’re assigned to today.

5. Select “Registration List” to view all the clients registered for today. You’re now ready tostart checking people in.

Client Check-in

1. Call clients from the line as waiting areas for Dispensing Staff become available.

2. Inform them that you will check them into the site, then ask for their name. Search forthe client’s name on the PrepMod Registration List search window.

If you can’t find their name in the Registration List for this location, try searching for theclient though the “Record Search” option on the top menu to see if they are registeredat another location.

If the client is registered at another location, inform the client of the location, date, andtime where they are scheduled and direct them there. Let them know that you can alsocheck with me to see if we are able to take walk-ins, but they will have to verify they fallinto the priority group (if applicable, see step 3). If we are taking walk-ins and they can provide proof of priority status, you can help the client register to receive a vaccine hereby clicking the “Add More Patients +” button on PrepMod.

3. If vaccines are being prioritized for a certain population, ask them to provide proof (e.g.,badge, ID, etc.).

If they cannot provide proof, politely inform them that they will not be able to get thevaccine today and instruct them to return with proof and/or schedule an appointmentfor a future clinic when vaccinations open to other groups.

4. Direct the client to the next open waiting area for dispensing.

Questions?

Great, please let me know when you need a quick restroom break or 15-minute rest break so I can coordinate breaks among our team as needed. For a 10-hour shift, you will receive 2 rest breaks and 1 lunch break.



Dispensing Training Script for IM Vaccines Using PrepMod Hello, my name is [name] and you will report directly to me today. Let’s do some quick introductions. Please tell us your name and the organization/department you deployed from. [Have all team members introduce themselves.]


You will be working in the Dispensing Area. Your role is to review client information on PrepMod and screen the client for any contraindications to determine whether they are eligible for the vaccine. The vaccine(s) we have available today is/are [list vaccine options available]. Vaccine Prep Teams will prepare vaccines and those vaccines will be delivered to your station. If there are enough unlicensed staff available, you may be assigned a support person to help with documentation on PrepMod. To get setup on PrepMod:

1. Open Google Chrome and go to cw.calvax.org/users/sign_in

2. Enter your username and password. Your username should be your email address. If you can’t remember your password, click “Forgot Password?”

3. Once logged in, select “Manage Clinics and Users” icon.

4. In the Clinic Listing page, find the location and date we’re assigned to today.

5. Select “Clinic Activity” to view all the clients registered for today.

Here is the process you will follow with each client:

1. Greet clients and ask for their name. Search for their name using the search window.

2. When you find their name on the Registration List, hover over the question mark next to their name to see their answers to the screening questions. Ask the client:

a. Did you have any severe allergic reaction to any other vaccines in the past?

b. Do you feel sick today?

3. If they answer “yes,” politely inform them that they are unable to receive the COVID-19 vaccine today. Refer them to me if they have additional questions.

4. If the client’s name is displayed in bold text, you will need to ask for additional information on screening questions with “yes” or “I don’t know” answers. Inform clients that there are no studies on vaccine safety for pregnant people or people with chronic medical conditions, if applicable, but they can still receive the vaccine if they want it.

5. Note which dose of the vaccine the client is scheduled to receive. This information is provided in parenthesis next to their name on PrepMod.

6. Confirm with the client which vaccine they will receive (if any), which dose it is, and where it will be administered, then proceed to vaccine administration.



You will follow these steps to administer the vaccine:

1. Ensure you are following the 7 rights of medication administration: Right patient, right time, right medication, right dose, right route and technique, right site, and right documentation.

2. Clean hands with hand sanitizer and put on gloves.

3. Identify the site of vaccine administration and administer vaccine via intramuscular injection in the following steps:

a. Clean the injection site (the deltoid muscle of the upper arm) by using an alcohol prep pad to wipe from the center of the injection site out about 2-inches in one circular motion.

b. Throw away the alcohol pad into the trash can and allow the alcohol to air dry for several seconds. Don’t blow on or fan the client’s arm.

c. Hold the client’s deltoid muscle between your forefinger and thumb and insert the needle into the muscle. Inject the entire contents of the syringe slow and steady.

d. Remove the needle, activate the safety mechanism, and dispose into the sharps container immediately.

e. Apply light pressure to the injection site with a dry cotton ball and apply bandage.

4. Direct the client to wait for 15 minutes in the observation area if they have no history of anaphylaxis, or for 30 minutes if they have had anaphylaxis from any cause.

5. Remove and discard gloves in trash. Clean the client chair and the table with disinfecting wipes. Clean hands with hand sanitizer.

Finally, document vaccination in PrepMod:

1. Select “Vaccinated” next to the client’s name in PrepMod. A new window will open.

2. Select the correct vaccine and lot number.

3. Complete fields for route of administration, site of vaccine administration, reaction, vaccinator, and vaccination date. If your name is not on the list of vaccinators, please let me know so I can add your name to the list.

4. If this was the client’s second dose of a 2-dose vaccine (e.g., Moderna or Pfizer), select “yes” to “Does this vaccination complete the series?” If this was their first dose of a 2-dose vaccine, select “no.”

5. Once all fields are completed, select “Update” to save, then continue to the next client.

Remember to keep interactions short with minimal physical contact to reduce the risk of COVID-19 transmission. I will periodically collect and check forms for accuracy and facilitate additional assistance for clients in need of accommodations.



If you are having trouble communicating with a client or have any questions while dispensing, just wave to me for help. And please let me know when you need a quick restroom break or 15-minute rest break so I can coordinate breaks among our team as needed. For a 10-hour shift, you will receive 2 rest breaks and 1 lunch break.

Questions?



Vaccine Prep Training Script Hello, my name is [name] and you will report directly to me today. Let’s do some quick introductions. Please tell us your name and the organization/department you deployed from. [Have all team members introduce themselves.]

As Vaccine Prep Staff, you are responsible for preparing vaccines for dispensing while ensuring proper storage and handling. I will support you by overseeing supply distribution and tracking, including temperature tracking for vaccine storage.

Preparing Coolers for Dispensing Stations Extra cold packs, bubble wrap, and 9-quart coolers will be provided to maintain the cold chain at dispensing stations. While MPOD staff pick-up supplies from me during set-up, you will prepare a cooler for each dispensing station to hold prepared vaccines at refrigerated temperatures just prior to dispensing as follows:

1. Ensure that cold packs are properly conditioned (not frozen).

2. Place enough conditioned cold packs to cover half of the bottom of the cooler.

3. Completely cover cold packs and cooler bottom with a 2-inch layer of bubble wrap.

4. Layer refrigerated vaccines on the bubble wrap.

5. Completely cover the vaccines with another 2-inch layer of bubble wrap.

6. Place conditioned cold packs to cover half of the bubble wrap.

7. Close the cooler.

Ensuring Proper Vaccine Storage and Handling Vaccines are delivered in coolers with a digital data logger to measure temperature. Your job includes ensuring that vaccines adhere to cold chain requirements, manufacturer’s storage/handling instructions, and the following best practices:

1. Keep vaccine coolers closed as much as possible and out of direct sunlight.

2. Only remove the amount needed at one time for vaccine preparation and administration.

3. Keep the digital data logger probe inside the cooler as close as possible to vaccines.

4. Keep the digital data logger display outside the cooler so temperatures can be read without opening coolers.

5. Record vaccine storage temperatures on the Hourly Vaccine Temperature Log hourly.

6. If the vaccine storage temperature starts to rise, remove the old phase change materials (PCMs) and insert new ones.

7. Notify me of any vaccine storage temperature excursions.



Vaccine Prep The vaccine(s) we are working with is/are [list vaccine options available, e.g., thawed Pfizer, a refrigerated vaccine that must be mixed with diluent and/or Moderna, a refrigerated vaccine that requires no mixing].

Moderna Vaccines – Read this only if using Moderna vaccines

1. Sanitize your hands and gather all the supplies needed: vaccine vial, alcohol prep pads, needles, and syringes. Keep vial out of direct sunlight.

2. Check vaccine label for correct product name and expiration/beyond-use date. Never use a vaccine after the beyond-use label or expiration date.

3. With the vial upright, gently swirl the vaccine. Do not shake or roll in hands.

4. Examine the vaccine. It should be white to off-white in color and may contain white particles. Do not use if liquid contains other particulate matter or is discolored.

5. Remove the protective cap from the vial. Wipe the top of the vial with an alcohol prep pad and let it dry while you assemble/prepare a needle and syringe. Once dry, draw each dose as follows:

6. Uncap the needle and pull back the syringe plunger equal to one dose of vaccine (0.5 mL).

7. Hold vaccine vial steady on the table, then insert the needle straight into the center of the stopper and inject air into the vial.

8. Invert vaccine vial so the needle tip is in the liquid and withdraw one dose (0.5 mL).

9. Return the needle and vial to the table, then withdraw the needle, tap the syringe, and push out any air. Ensure the syringe is not cold to the touch.

10. Recap the clean needle by placing the syringe and cap on the table and using a one-handed scooping technique to bring the needle into the cap. Never re-cap a needle using both hands.

11. Repeat, gently swirling the vaccine vial before withdrawing each dose. Discard vial when there is not enough vaccine to obtain a complete dose. Do not combine residual vaccine from multiple vials to obtain a dose.

12. Write a note with the manufacturer, lot number, and date/time drawn. Vaccines must be used within 6 hours of being drawn. Discard any unused vaccine after 6 hours.

13. Discard empty used vaccine vials in the sharps container.



Pfizer Vaccines – Read this only if using Pfizer Vaccines

The Pfizer vaccine must be mixed with diluent (0.9% sodium chloride [normal saline, preservative-free]) before administration, as follows:

1. Sanitize your hands and gather all the supplies needed: vaccine vial, diluent vial, alcoholprep pad, needles, and syringes. Keep vials out of direct sunlight.

2. Allow the vaccine to come to room temperature. Vaccine vials can be held at roomtemperature for up to 2 hours before mixing. After 2 hours, return unmixed vials torefrigerated temperatures.

3. Check vaccine and diluent labels to verify that they are the correct products to mixtogether, correct volumes, and their expiration/beyond-use dates. Never use productsafter the beyond-use label or expiration date.

4. With the vaccine at room temperature, gently invert the vial 10 times. Do not shake thevial. If the vial is shaken, discard the vaccine into the sharps container.

5. Examine the vaccine. It should be white to off-white in color and may contain opaqueparticles. Do not use if liquid is discolored.

6. Remove the protective caps from the vials. Wipe the top of the vials with an alcoholprep pad and let them dry while you assemble/prepare a 21-gauge (or narrower) needleand syringe. Once dry, dilute the vaccine as follows:

7. Uncap the needle and hold the diluent vial steady on the table. Insert the needlestraight into the center of the vial stopper, then invert the vial and pull the needle backso the tip is in the liquid. Draw 1.8 mL of the diluent (0.9% sodium chloride [normalsaline, preservative-free]) into a mixing syringe, then withdraw the needle.

8. Discard diluent vial and any remaining diluent in the sharps container. Do not usebacteriostatic normal saline or other diluents to mix the vaccine.

9. Hold the vaccine vial steady on the table. Insert the needle into the center of the vialstopper and inject all the diluent from the syringe. Using the mixing syringe, remove 1.8 mL of air from the vaccine vial to equalize the pressure in the vaccine vial.

10. Remove mixing syringe and needle from the vial and discard into the sharps container,then gently invert the vial with the vaccine and diluent 10 times. Do not shake. Thevaccine will be off-white in color. Do not use if discolored or contains particulate matter.If vial is shaken, discard the vaccine into the sharps container.

11. Write the date and time the vaccine was mixed on the vial.



Once mixed with diluent, the Pfizer vaccine is ready to be drawn for administration:

1. Invert the vial with diluted vaccine and pull needle back so the tip is in the liquid, then withdraw one dose (0.3 mL).

2. Return the needle and vial to table, then withdraw the needle, tap the syringe, and push out any air. Ensure the syringe is not cold to the touch.

3. Recap the clean needle by placing the syringe and cap on the table and using a one-handed scooping technique to bring the needle into the cap. Never re-cap a needle using both hands. Repeat until all doses are drawn.

4. Discard empty used vials in the sharps container.

5. Write a note with the manufacturer, lot number, and date/time reconstituted. Vaccines must be used within 6 hours of dilution.

Questions?




Holding Training Script Hello, my name is [name] and I am one of the Holding Team Leaders. Let’s do some quick introductions. Please tell us your name and the organization/department you deployed from. [Have all team members introduce themselves.]


Holding Staff are responsible for monitoring clients for adverse reactions after they receive their vaccine. Dispensing Staff will direct clients to the observation area for holding after they receive the vaccine. They will instruct clients to wait here for 30 minutes if they have a history of severe allergic reactions from any cause, or for 15 minutes if they have no history of severe allergic reactions.

As Holding Staff, you will:

1. Walk around the holding area and observe clients for any adverse reactions to vaccine administration.

2. Immediately alert any of the Holding Team Leaders if you notice any clients experience an adverse reaction. Signs include:

• Signs that they have a headache, are lightheadedness, anxious, or agitated

• Fainting

• Raspy or strained voice, vibrating noise when breathing, wheezing, nasal congestion, sneezing, cough, hoarseness or shortness of breath, severe asthma attack, or swollen throat

• Reddening of the skin, rash, itching, hives, swelling, flushing, swelling

• Nausea, vomiting, or diarrhea

• Uterine or abdominal cramping

3. From there, one of the Holding Team Leaders will follow the Adverse Event Response Guide provided in our Field Operations Manual to assess the client and determine if it is a medical emergency.

Questions?


Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix C: Supply Lists


Appendix C: Supply Lists MPOD Kit The following supplies will be delivered in a rolling cage measuring 77” W x 20” D x 77” H:

Item Quantity Unit

Biohazard bag, 8 to 10-gallon 2 Box

Bullhorn 1 Count

Caution tape 4 Roll

Clipboard, 9” x 12.5” 8 Box of 10

Coleman cooler, 9-quart 5 Count

Delineator base, weighted 8 Count

Delineator post with loop on top 8 Count

Duct tape, 2” wide 4 60-yard Roll

Extension cord, 25-foot 4 Count

Flags, traffic 20 Count

Instrument tray 20 Count

Instrument tray cover 20 Count

Painter’s tape 3 Roll

Pen, black, medium point, ballpoint 20 Box of 12

Plastic tote, clear, 15 to 20-gallon 4 Count

Scissors 1 Pack of 2

Sharpie marker, black 1 Box of 12

Sharps container, 2-gallon 20 Count

Tablecloth, 3’ x 7’, white 2 Bag of 12

Tool kit (crescent wrench, hammer, needle nose pliers, screwdrivers, wire cutters, and wrench set) 1 Count

Trash bag, extra-large 1 Box of 24

Vest, colored 40 Count

Vest, white 2 Count

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix C: Supply Lists


Personal Protective Equipment (PPE) Item Quantity Unit

Face mask, N95 TBD Case, TBD

Face mask, surgical TBD Case, TBD

Face shield TBD Case, TBD

Gloves, small, hypoallergenic, non-latex, powder-free TBD Case, TBD

Gloves, medium, hypoallergenic, non-latex, powder-free TBD Case, TBD

Gloves, large, hypoallergenic, non-latex, powder-free TBD Case, TBD

Gloves, extra-large, hypoallergenic, non-latex, powder-free TBD Case, TBD

Gown, large TBD Case, TBD

Gown, extra-large TBD Case, TBD

Vaccine Administration Supplies Item Quantity Unit

Adhesive bandage, 3/4” x 3” TBD Case, TBD

Alcohol prep pad TBD Case, TBD

Bubble wrap, 1’ wide TBD 32-foot Roll

Cotton ball TBD Bag of 200

Hand sanitizer TBD Case, TBD

Instant cold pack, 6” x 9” TBD Count

Syringe TBD Case, TBD

Underpad, 3” x 36” TBD Case, TBD

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix D: Adverse Event Response Guide


Appendix D: Adverse Event Response Guide Adverse Event Response Overview Anyone suspected of experiencing an adverse response to vaccine administration will be assessed by a medically licensed MPOD staff member, preferably a LACDPH employee, to determine the reaction severity (mild to moderate or severe) and appropriate next steps.

1. Assess the individual to determine reaction severity.

a. Severe reactions often produce signs and symptoms within minutes of exposure to an allergen, but symptoms may develop more than 30 minutes after the exposure:

• Alert level of consciousness, headache, lightheadedness, dilated pupils, feeling of impending doom, anxiety, agitation

• Low blood pressure with or without fainting, rapid, weak, or irregular pulse

• Raspy or strained voice, vibrating noise when breathing, wheezing, sneezing, cough, hoarseness or shortness of breath, signs of complete or partial upper airway obstruction, severe asthma attack, swollen throat

• Reddening of the skin, itching, hives, swelling, flushing, fluid retention



b. Mild to moderate reactions often produce localized symptoms without respiratory or cardiovascular involvement, such as:

• Rash

• Hives (especially over the neck and face)

• Itching

• Nasal congestion

• Watery red eyes

2. If it is a medical emergency:

Dial 911.

Follow on-site emergency treatment protocol (on page 47) until emergency medical services arrive.

Report event to immediate supervisor.

MPOD Director is to be notified immediately through chain of command.

Follow Adverse Event Reporting procedures (on page 48).



3. If it is not a medical emergency:

Report event to immediate supervisor.

Refer the individual to their healthcare provider.

Follow Adverse Event Reporting procedures (on page 48).

On-site Emergency Treatment for Adverse Reactions Assess circulation, airway, breathing, and level of consciousness.

Provide basic life support, as necessary.

Have the individual lay on their back and elevate their legs. If they are in respiratory distress or vomiting, ask them to sit upright or in a comfortable position.

Administer epinephrine, if needed, via auto-injector (e.g., EpiPen) or injection.

Administering Epinephrine via Auto-Injector Epinephrine auto-injectors are available in 2 sizes and deliver a single dose of epinephrine:

• EpiPen® Auto-Injector (generic: Epinephrine, USP Auto-Injector 0.3 mg)

• EpiPen Jr® Auto-Injector (generic: Epinephrine, USP Auto-Injector 0.15 mg)

Appropriate dosage is based on patient body weight:

• 33 to 66 pounds: 0.15 mg/EpiPen Jr

• Over 66 pounds: 0.3 mg/EpiPen

To administer epinephrine via auto-injector:

Grasp the auto-injector firmly around its center.

Remove the safety cap.

Firmly push the needle end into the client’s upper/outer thigh until it clicks.

Hold in place for 10 seconds, then remove and check that the container has emptied.

Massage the injected area for 10 seconds.

Administer a second dose if symptoms don’t improve within 20 minutes.



Administering Epinephrine via Injection Epinephrine injections may only be provided by MPOD staff with a medical license.

Appropriate dosage is based on patient body weight: 0.01 mg aqueous solution of epinephrine hydrochloride 1:1,000 IM per kilogram of body weight, with a maximum of 0.5 mg per injection. If weight is unknown, age may be used to determine approximate dosage as follows:

Up to 6 months 0.05 mg 7 months to 3 years 0.10 mg 3 to 5 years 0.15 mg 5 to 7 years 0.20 mg 8 to 10 years 0.25 mg 11 to 12 years 0.35 mg 13 years and above 0.50 mg

To administer epinephrine via injection:

If the vaccine causing the adverse reaction was injected into the anterolateral thigh or deltoid, epinephrine can be injected into the same site to slow absorption.

For children under 4: Inject epinephrine to the anterolateral thigh.

For children over 4 and adults: Epinephrine may be injected to the anterolateral aspect of the thigh (i.e., vastus lateralis) or lateral shoulder (i.e., deltoid).

Doses may be given every 10 to 15 minutes for up to 3 doses, as needed.

Adverse Event Reporting The MPOD Director will:

Immediately report the adverse event to the Health DOC. Report may be verbal or via General Message (ICS 213).

Record the incident on the Activity Log (ICS 214).

Complete and submit the MPOD/Emergency Medication Center Incident Report (on pages 50 to 53) to the Health DOC.

Report the adverse event to the Vaccine Adverse Event Reporting System (VAERS) at vaers.hhs.gov

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E


Appendix E: Forms

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (MPOD/Emergency Medication Center Incident Report)


MPOD/Emergency Medication Center Incident Report NOTE: This form is confidential and shall not be made available to anyone other than the authorized recipients.

Site Information

MPOD Site Name: ____________________________ Date: ____/____/_______ Time: ____________

MPOD Director: ___________________________________________

Client Information

Client name (last, first): ____________________________________________________________________________

Client type (check one):

Public

Volunteer. Agency: ________________________________

County Workforce Member (volunteer, contracted employee, intern)

County Employee (classified civil service)

Age: ____________ Sex: _________ Weight: _____________lbs. Race/Ethnicity: _________________________

Phone number: ___________________________________________

Address: ________________________________________________________________________________________

Allergies (drug and non-drug): _______________________________________________________________________

Emergency contact (name and phone): ________________________________________________________________

Medical Status

Initial distress level (check one): Mild Moderate Severe

Level of consciousness (check one): Alert Unconscious

Client oriented to (check all that apply): Self Time Place

When did symptoms begin? _____________________________________________________________________

Has client ever had allergic reaction to medication/vaccination before? No Yes:____________________

What symptoms is the client experiencing? (check all that apply) Nasal congestion Watery red eyes

Headache Anxiety Low blood pressure Strained voice/hoarseness



Wheezing Sneezing/coughing Swollen throat Itching/hives/reddening of the skin Nausea Vomiting Diarrhea Uterine/abdominal cramping Other:

__________________________________

Adverse reaction related to (check one): Vaccine administration Oral medication

Event which preceded reaction: _____________________________________________________________________

Name of medication / vaccine: ____________________________ Brand: __________________________________

Lot number: __________________________ Manufacturer: ______________________________________________

Route of administration (check one): Oral Intramuscular Subcutaneous Nasal

Other: ______________________________________________

Treatment

Type of consent given for additional treatment (check one): Informed consent Implied consent

None (Client refused treatment)

EMS/911 called? Yes No (skip to CPR questions)

Called at (time): _____________________ Called by (full name): __________________________________

EMS/911 arrival time: ________________ Patient Contact Report Number (PCR): ____________________

CPR indicated? Yes No (skip to epinephrine questions)

CPR started at (time): _________________

CPR ended at (time): __________________

Epinephrine given? Yes No (skip to “Client Transportation” section)

Source of epinephrine (check all that apply): Patient’s personal EpiPen Site EpiPen

Site Anaphylaxis Kit Other: __________________



Epinephrine Injections Administered

Time Administered Dose Route Site

Transportation

Client left via (check one): Ambulance Personal vehicle Other:__________________________

Transport provider company name: ____________________________ Unit number: _________________

Driver name (last, first): _____________________________________________________________________

Name of hospital / facility client sent to: _____________________________________________________________

Phone number for hospital / facility: __________________________________________________________

Reporting Information

Was this adverse event reported to MedWatch (for medications) or the Vaccine Adverse Event Reporting System (VAERS) (for vaccines)?* Yes No (skip to “Comments” section)

Report filed by (full name): ____________________________________________

Time submitted: __________________ Date submitted: ____/_____/________

Comments (if any)

Worksheet Submission

MPOD Site Leader Signature: ________________________________________

Date submitted: ____/____/________ Time submitted: _________________



Receipt of Notification

Agency Name Received by whom? Time Received

LACDPH DOC

CEOC MH Branch / MHOAC

RDHMC

CDPH / Cal EMS

ASPR

Referral Information

Facility ER direct number: _________________________________________________________________________

Facility contact number to obtain records: ____________________________________________________________

Patient location/room assignment: __________________________________________________________________

MR/PR#: _______________________________________________________________________________________

County Employee (classified civil service) Information (if applicable)

Employee ID: ___________________________________________________

Department/program: ____________________________________________

Day-to-day Supervisor: ____________________________________________

Day-to-day Supervisor Notified? Yes No

County Workforce Member Information (if applicable)

Employee ID: ___________________________________________________

Type of Employee (circle one): Volunteer Contract Worker Intern Student Intern

Department/program: ____________________________________________

Day-to-day Supervisor: ____________________________________________

Day-to-day Supervisor Notified? Yes No

Contract Agency (if applicable): _____________________________________

Contract Agency Notified? Yes No

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (Medical Material Tracking Log)


Medical Materiel Tracking Log

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (Medical Material Tracking Log)


Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (Hourly Vaccine Temperature Log)


Hourly Vaccine Temperature Log

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (Status Summary [MPOD ICS 209A])


Status Summary (MPOD ICS 209A)

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (Incident Check-in/Check-out Log [MPOD ICS 211A])


Incident Check-in/Check-out Log (MPOD ICS 211A)

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (Team Check-in/Check-out Log [MPOD ICS 211A])


Team Check-in/Check-out Log (MPOD ICS 211A)

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (General Message [ICS 213])


General Message (ICS 213)

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (Activity Log [ICS 214])


Activity Log (ICS 214)

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix E: Forms (COVID Vaccines Return Form)


COVID Vaccines Return Form


Revised 1-17-2021

Appendix F: Job Action Sheets for LACDPH Staff Roles


Revised 1-17-2021

Vaccine Prep Staff Job Action Sheet

Mission Prepare vaccines for dispensing and ensure proper storage and handling of vaccines.

Reports to Vaccine Prep Team Leader

Delegates to None

Supplies From MPOD Kit:

Instrument tray

Instrument tray cover

Pen

Sharpie marker

Sharps container

Vest, colored

From Personal Protective Equipment:

Face mask, surgical

Gloves (non-latex, powder-free)

From Vaccine Administration Supplies:

Alcohol prep pad

Bubble wrap

Hand sanitizer

Instant cold packs

Syringes


Revised 1-17-2021

Duties

Initial Actions

Report for on-site screening of COVID-19 and to sign-in on the Incident Check-in/Check-out Log (MPOD ICS 211A).

Help set-up tables and chairs as directed.

Attend briefings.

Pick-up supplies and prepare coolers for dispensing stations (see below).

Prepare vaccines for dispensing based on the number of client registrations for thefirst hour of operations.

Attend on-site training.

Preparing Coolers for Dispensing Stations (Refrigerated Temperatures)



Completely cover cold packs and cooler bottom with 2-inches of bubble wrap.




Close the cooler.

Proper Vaccine Storage and Handling

Keep vaccine coolers closed as much as possible and out of direct sunlight.

Record vaccine storage temperatures on the Hourly Vaccine Temperature Log.

If the vaccine storage temperature starts to rise, remove the old phase changematerials (PCMs) and insert new ones.

Notify the Vaccine Prep Team Leader of any vaccine storage temperature excursions.


Revised 1-17-2021

Moderna Vaccine Prep – Drawing Vaccines (0.5 mL doses)

Sanitize your hands and gather all the supplies needed: vaccine vial, alcohol preppads, needles, and syringes. Keep vial out of direct sunlight.

Check vaccine label for correct product name and expiration/beyond-use label. Neveruse vaccine after the beyond-use label or expiration date.


Examine the vaccine. It should be white to off-white in color and may contain whiteparticles. Do not use if liquid contains other particulate matter or is discolored.

Remove the protective cap from the vial. Wipe the top of the vial with an alcohol preppad and let it dry while you assemble/prepare a needle and syringe. Once dry, draweach dose as follows:


Hold vaccine vial steady on the table, then insert the needle straight into the center ofthe stopper and inject air into the vial.


Return the needle and vial to the table, then withdraw the needle, tap the syringe,and push out any air. Ensure the syringe is not cold to the touch.

Recap the clean needle by placing the syringe and cap on the table and using a one-handed scooping technique to bring the needle into the cap. Never re-cap a needleusing both hands.

Repeat, gently swirling the vaccine vial before withdrawing each dose. Discard vialwhen there is not enough vaccine to obtain a complete dose. Do not combine residualvaccine from multiple vials to obtain a dose.

Write a note with the manufacturer, lot number, and date/time drawn. Vaccines mustbe used within 6 hours of being drawn. Discard any unused vaccine after 6 hours.


Revised 1-17-2021

Pfizer Vaccine Prep – Diluting Vaccines with 1.8 mL 0.9% sodium chloride

Sanitize your hands and gather all the supplies needed: vaccine vial, diluent vial, alcohol prep pad, needles, and syringes. Keep vials out of direct sunlight.

Allow the vaccine to come to room temperature. Vaccine vials can be held at room temperature for up to 2 hours before mixing. After 2 hours, return unmixed vials to refrigerated temperatures.

Check vaccine and diluent labels to verify that they are the correct products to mix together, correct volumes, and their expiration/beyond-use dates. Never use products after the beyond-use label or expiration date.

With the vaccine at room temperature, gently invert the vial 10 times. Do not shake the vial. If the vial is shaken, discard the vaccine into the sharps container.

Examine the vaccine. It should be white to off-white in color and may contain opaque particles. Do not use if liquid is discolored.

Remove the protective caps from the vials. Wipe the top of the vials with an alcohol prep pad and let them dry while you assemble/prepare a 21-gauge (or narrower) needle and syringe. Once dry, dilute the vaccine as follows:

Uncap the needle and hold the diluent vial steady on the table. Insert the needle straight into the center of the vial stopper, then invert the vial and pull the needle back so the tip is in the liquid. Draw 1.8 mL of the diluent (0.9% sodium chloride [normal saline, preservative-free]) into a mixing syringe, then withdraw the needle.

Discard diluent vial and any remaining diluent in the sharps container. Do not use bacteriostatic normal saline or other diluents to mix the vaccine.

Hold the vaccine vial steady on the table. Insert the needle into the center of the vial stopper and inject all the diluent from the syringe. Using the mixing syringe, remove 1.8 mL of air from the vaccine vial to equalize the pressure in the vaccine vial.

Remove mixing syringe and needle from the vial and discard into the sharps container, then gently invert the vial with the vaccine and diluent 10 times. Do not shake. The vaccine will be off-white in color. Do not use if discolored or contains particulate matter. If vial is shaken, discard the vaccine into the sharps container.



Revised 1-17-2021

Pfizer Vaccine Prep – Drawing Vaccines after Mixing with Diluent (0.3 mL doses)

Invert the vial with diluted vaccine and pull needle back so the tip is in the liquid, then withdraw one dose (0.3 mL).

Return the needle and vial to table, then withdraw the needle, tap the syringe, and push out any air. Ensure the syringe is not cold to the touch.

Recap the clean needle by placing the syringe and cap on the table and using a one-handed scooping technique to bring the needle into the cap. Never re-cap a needle using both hands. Repeat until all doses are drawn.


Write a note with the manufacturer, lot number, and date/time reconstituted. Vaccines must be used within 6 hours of dilution.

End of Shift

Dispose of trash from Supply Area in the on-site trash cans or dumpsters.

Attend debrief.

Sign-out on the Incident Check-in/Check-out Log (MPOD ICS 211A).


Revised 1-17-2021

Dispensing Staff Job Action Sheet

Mission Review client forms, administer vaccines, and direct clients to the observation area. Follow safe vaccine administration practices.

Reports to Dispensing Team Leader

Delegates to None


Coleman cooler (prepared with ice pack and bubble wrap)

Pen

Sharps container

Tablecloth

Trash bag

Vest, colored


Face mask, N95

Face shield

Gloves

Gown


Adhesive bandages

Alcohol prep pads

Cotton balls

Hand sanitizer

Underpad


Revised 1-17-2021

Duties

Initial Actions



Attend briefings.

Pick-up supplies.


Vaccine Screening

Confirm the client’s name and ask the 2 screening questions:

Did you have any severe allergic reaction to any other vaccines in the past?

Do you feel sick today?

If they answer “yes” to either, politely inform them that they are unable to receivethe COVID-19 vaccine today. Refer them to me if they have additional questions.

Clarify any screening questions that they answered “yes” or “I don’t know” to. Thereare no studies on vaccine safety for pregnant people or people with chronic medicalconditions, but they can still receive the vaccine if they want it.

Confirm with the client which vaccine they will receive (if any), which dose it is, andwhere it will be administered, then proceed to vaccine administration.


Revised 1-17-2021

Vaccine Administration

Ensure you are following the 7 rights of medication administration: Right patient, right time, right medication, right dose, right route and technique, right site, and right documentation.

Clean hands with hand sanitizer and put on gloves.

Identify the site of vaccine administration and administer vaccine via intramuscular injection in the following steps:

Clean the injection site (the deltoid muscle of the upper arm) by using an alcohol prep pad to wipe from the center of the injection site out about 2-inches in one circular motion.

Throw away the alcohol pad into the trash can and allow the alcohol to air dry for several seconds. Don’t blow on or fan the client’s arm.

Hold the client’s deltoid muscle between your forefinger and thumb and insert the needle into the muscle. Inject the entire contents of the syringe slow and steady.

Remove the needle, activate the safety mechanism, and dispose into the sharps container immediately.

Apply light pressure to the injection site with a dry cotton ball and apply bandage.

Direct the client to wait for 15 minutes in the observation area if they have no history of anaphylaxis, or for 30 minutes if they have had anaphylaxis from any cause.

Remove and discard gloves in trash. Clean the client chair and the table with disinfecting wipes. Clean hands with hand sanitizer.

PrepMod Documentation

Select “Vaccinated” next to the client’s name in PrepMod. A new window will open.

Select the correct vaccine and lot number.

Complete fields for route of administration, site of vaccine administration, reaction, vaccinator, vaccination date, and whether this vaccination completes the series.

Once all fields are completed, select “Update” to save.


Revised 1-17-2021

End of Shift

Dispose of trash from your station in the on-site trash cans or dumpsters.

Return supplies to Logistics.

Attend debrief.



Revised 1-17-2021

Registration Staff Job Action Sheet

Mission Screen clients for symptoms of COVID-19, check for client eligibility/appointments, assist clients in completing check-in, and answer any questions about the process. Help control flow to dispensing stations by directing clients to open dispensing stations.

Reports to Registration Team Leader

Delegates to None

Supplies

From MPOD Kit:

Clipboards

Pens

Vest, colored


Surgical mask

Face shield

Other:

Thermometer


Revised 1-17-2021

Duties

Initial Actions



Attend briefings.

Pick-up supplies.


Ongoing Tasks

Ensure all clients follow masking and physical distancing requirements.

Check clients for COVID-19 symptoms: temperature of 100.4°F (38°C) or more, fatigue, difficulty breathing/shortness of breath, muscle or body aches, headache, new loss of taste or smell, cough, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea.

Verify eligibility for appointment, if applicable.

Call clients from the line as waiting areas for dispensing stations are available.

Search for the client names on the PrepMod Registration List search window.

If you can’t find their name, use the “Record Search” option on the top menu to see if they are registered at another location. If we are taking walk-ins, click the “Add More Patients +” button on PrepMod to register them.

Direct clients to the open dispensing stations.

End of Shift

Dispose of trash from your station in the on-site trash cans or dumpsters.

Return supplies.

Attend debrief.



Revised 1-17-2021

Holding Staff Job Action Sheet

Mission Monitor clients for adverse reactions after vaccine administration and alert Holding Team Leaders of clients experiencing adverse effects.

Reports to Holding Team Leaders

Delegates to None


Vest, colored


Surgical mask

Face shield


Revised 1-17-2021

Duties

Initial Actions



Attend briefings.

Pick-up supplies.


Ongoing Tasks

Walk around the holding area and observe clients for any adverse reactions to vaccine administration. Signs include:

Signs that they have a headache, are lightheadedness, anxious, or agitated

Fainting

Raspy or strained voice, vibrating noise when breathing, wheezing, nasal congestion, sneezing, cough, hoarseness or shortness of breath, severe asthma attack, or swollen throat

Reddening of the skin, rash, itching, hives, swelling, flushing, swelling

Nausea, vomiting, or diarrhea

Uterine or abdominal cramping

Immediately alert any of the Holding Team Leaders if you notice any clients experience an adverse reaction.

End of Shift

Return supplies.

Attend debrief.



Revised 1-17-2021

MPOD Director Job Action Sheet

Mission Works in Unified Command with the MPOD Branch Director -Fire IMT. Communicate with the Operation’s Section Chief – DPH at the Health Department Operations Center (DOC) to provide regular status updates. Oversee and direct MPOD operations at the site. Initiate meal breaks for staff. Ensure that all documentation is returned to the Health DOC at the end of the shift and that MPOD supplies and medical materiel are returned to the Health Department at the close of MPOD operations.

Reports to Operations Section Chief – DPH

Delegates to MPOD Director Deputy; Vaccine Unit Leaders

Supplies

Documents:

Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD (FOM)

Incident Action Plan (IAP)

Site Profile

ICS forms (214: Activity Log, 213: General Message, and 209A: Status Summary)

From MPOD Kit:

Bullhorn

Clipboard

Pen

Vest, white


Face mask, surgical

Face shield


Revised 1-17-2021

Duties This Job Action Sheet provides a simple overview of MPOD Director duties. For detailed instructions, see the Public MPOD Field Operations Manual for COVID-19 Vaccine MegaPOD. (Bold text indicates sections in the FOM.)

Initial Actions

Conduct On-site Screening for COVID-19.

Sign-in via QR code and/or on the Incident Check-in/Check-out Log (MPOD ICS 211A), making note of COVID-19 screening.

Begin the Activity Log (ICS 214).

Review the Public MPOD Field Operations Manual for COVID-19 Vaccine MegaPOD, Site Profile, and Incident Action Plan.

Conduct the Site Walk-Through and document any Site Issues.

Provide delivery confirmation to the Health DOC with a Status Summary (MPOD ICS 209A).

Conduct 1. Staff Check-in with COVID-19 Screening.

Direct MPOD staff to complete 2. Tables and Chairs Set-up, ensuring that site set-up meets accessibility requirements and allows for physical distancing.

Work with the MPOD Branch Director – Fire IMT to provide 3. Briefings for all MPOD staff.

Direct staff to pick-up their supplies from the Logistics Leader.

Work with MegaPOD Leaders to conduct on-site training for MPOD staff using scripts provided in Appendix B of the FOM.

Coordinate vaccine dispensing to staff.

Conduct the Final Check to confirm that preparations are complete and staff are ready to open the site.

Contact the Health DOC to inform them that the site is ready to open.


Revised 1-17-2021

Ongoing Tasks

Coordinate Staff Breaks and initiate staff Meal Breaks at the appropriate time.

Update the Activity Log (ICS 214) with details of notable activities.

Conduct Operational Briefings at least once per hour to draft and send a StatusSummary (MPOD ICS 209A) to the Health DOC.

Work with the Logistics Leader to determine need for Supply Orders, and submit asneeded to the Health DOC.

Facilitate appropriate Accommodations for Those with Access and Functional Needs(AFN) as needed.

Coordinate with Vaccine Unit Leaders to identify leftover doses or a shortage of dosesby 1:30 pm. If additional doses required, call the Vaccine Warehouse at 213-288-7766.

Vaccine Warehouse will ship out additional doses and will be received by theMegaPOD by 3:30pm.

At end of day, POD Branch Director will coordinate with POD Unit Leaders and identifyleftover doses before 4:30pm and report to the IMT. Follow the Extra Vaccine UsagePlan.

Coordinate additional notification for additional walk-in vaccinations.

Address any issues in MPOD operations, including Staffing Shortages and ClientBottleneck between registration and medical dispensing. Offer assistance to MPODstaff that encounter Angry Clients or Clients with Fear of Needles/Vaccines.

Follow Appendix D: Adverse Event Response Guide if any vaccine recipientexperiences an adverse reaction to vaccine administration at the MPOD.


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End of Shift Duties for Shift Changes (Outgoing Staff)

Collect all completed ICS forms, Medical Materiel Tracking Logs, Hourly VaccineTemperature Logs, and client forms from your shift.

Draft a final Status Summary (MPOD ICS 209A) to provide notice of change incommand to the Health DOC.

Brief the incoming Core Team on any changes to the Incident Action Plan and anyissues with the site, security, or operations.

Provide the Outgoing Staff Shift Change Briefing.

Direct outgoing staff to give their staff identifier (e.g., vest) to their incomingcounterparts and report for debrief and check-out.

Conduct Staff Demobilization, including Debrief and Check-out.

Return all MPOD documents from your shift to the Health DOC.

End of Shift Duties for Site Demobilization

If there is low client demand on the site, conduct gradual demobilization ofregistration and medical dispensing staff through Station Demobilization. Otherwise,continue full staffing until the scheduled site closure time and conduct SiteDemobilization.

Report MPOD closure to the Health DOC.

Confirm with the Logistics Leader that all supplies were returned.

Conduct Staff Demobilization, including Debrief and Check-out.

Confirm that all stations and staff were demobilized.

Ensure that any remaining medical materiel, biohazardous waste, and MPODdocuments (e.g., ICS forms, client forms, Medical Material Tracking Logs, HourlyVaccine Temperature Logs) are returned to the Health DOC.


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Mission Screen clients for symptoms of COVID-19, check for client eligibility/appointments, assist clients in completing check-in, and answer any questions about the process. Help control flow to dispensing stations by directing clients to open dispensing stations.

Reports to Vaccine Unit Leader

Delegates to Registration staff

Supplies Documents:

ICS forms (214: Activity Log, 213: General Message, 211A: Team Check-in/Check-out Log, 209A: Status Summary)

From MPOD Kit:

Clipboards

Pens

Vest, colored


Surgical mask

Face shield

Other:

Thermometer

Registration Leader Job Action Sheet


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Duties

Initial Actions

Report for on-site screening of COVID-19 and sign-in.

Attend General Briefing and Report to Vaccine Unit Leader.

Review the Field Operations Manual (FOM) and Field Operation Guide (FOG).

Begin the Activity Log (ICS 214.)

Distribute supplies to staff.

Conduct on-site training for Registration Staff using the script provided in the FOM.

Ongoing Tasks

Assure all Registration Staff follow masking and physical distancing requirements.

Assure Registration Staff are assigned to and follow the three registration check point processes per the MegaPOD Client/Site Process Map: 1) client screening; 2) appointment check; 3) credential verification.

Oversees registration/check- in of clients and answer questions about theforms/process.

If walk-in services provided: Serve as a line monitor, ensure proper social distancingand wearing of face coverings by clients.

Ensure Registration Staff verify client has an appointment in PrepMOD.

• If no appointment, client must exit.

Ensure Registration Staff verify client has credentials. If no credentials, must tell client "atthis time, we are only providing vaccinations for those who meet the current eligibilitycriteria." Client must then exit.

Ensure Registration Staff perform Clinical Screening Questions.

• Client will be directed to a specified lane for Extended Observation (30minutes) or Clinical Observation (15 minutes) based on results of Clinical Screening Questions.


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End of Shift

Ensure that trash from the Registration area is disposed of in the on-site trash cans ordumpsters.

Return supplies.

Attend debrief.

Submit the Activity Log (ICS 214).

Sign-out.


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Vaccine Prep Leader Job Action Sheet

Mission Prepare vaccines for dispensing and ensure proper storage and handling of vaccines.


Delegates to Vaccine Prep Staff

Supplies Documents:


Medical Materiel Tracking Logs

Hourly Vaccine Temperature Logs

From MPOD Kit:

Instrument tray

Instrument tray cover

Pen

Sharpie marker

Sharps container

Vest, colored


Face mask, surgical

Gloves (non-latex, powder-free)


Alcohol prep pad

Bubble wrap

Hand sanitizer

Instant cold packs

Syringes


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Duties Initial Actions


Attend General Briefing and report to Vaccine Unit Leader.

Review the Field Operations Manual (FOM) and Field Operations Guide (FOG) found on the Vaccine Field Site training website.


Distribute supplies to staff.

Attend briefings conducted by the Vaccine Unit Leader

Direct Vaccine Prep Staff to begin preparing vaccines and coolers for medical dispensing stations while staff pick-up supplies during set-up.

Conduct on-site training for Vaccine Prep Staff using script found in the FOM.

MPOD Supply Delivery

Check the packing list to confirm all supplies were received.

Document initial inventory amount on the Medical Materiel Tracking Log.

Confirm that vaccines were kept within the temperature range specified on the manufacturer’s package/insert during shipment.


Work with the Taskforce Leader to provide delivery confirmation to the Operations - POD Unit.

Preparing Coolers for Dispensing Stations (Refrigerated Temperatures)

Oversee Vaccine Prep Staff ensure that cold packs are properly conditioned (notfrozen).

Ensure Vaccine Prep Staff place enough conditioned cold packs to cover half ofthe bottom of the cooler.

Ensure Vaccine Prep Staff completely cover cold packs and cooler bottomwith 2-inches of bubble wrap.


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Observe Vaccine Prep Staff layer refrigerated vaccines on the bubble wrap.

Observe Vaccine Prep Staff completely cover the vaccines with another 2-inch layer ofbubble wrap.

Observe Vaccine Prep Staff place conditioned cold packs to cover half of the bubblewrap.

Ensure Vaccine Prep Staff close the cooler.

Proper Vaccine Storage and Handling

Oversee Vaccine Prep Staff keep vaccine coolers closed as much as possible and outof direct sunlight.

Ensure Vaccine Prep Staff record vaccine storage temperatures on the Hourly VaccineTemperature Log.

Ensure Vaccine Prep Staff, notice if the vaccine storage temperature starts to rise, they remove the old phase change materials (PCMs) and insert new ones.


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Moderna Vaccine Prep – Drawing Vaccines (0.5 mL doses)

Sanitize your hands and gather all the supplies needed: vaccine vial, alcohol preppads, needles, and syringes. Keep vial out of direct sunlight.

Check vaccine label for correct product name and expiration/beyond-use label. Neveruse vaccine after the beyond-use label or expiration date.


Examine the vaccine. It should be white to off-white in color and may contain whiteparticles. Do not use if liquid contains other particulate matter or is discolored.

Remove the protective cap from the vial. Wipe the top of the vial with an alcohol preppad and let it dry while you assemble/prepare a needle and syringe. Once dry, draweach dose as follows:


Hold vaccine vial steady on the table, then insert the needle straight into the center ofthe stopper and inject air into the vial.


Return the needle and vial to the table, then withdraw the needle, tap the syringe,and push out any air. Ensure the syringe is not cold to the touch.

Recap the clean needle by placing the syringe and cap on the table and using a one- handed scooping technique to bring the needle into the cap. Never re-cap a needleusing both hands.

Repeat, gently swirling the vaccine vial before withdrawing each dose. Discard vialwhen there is not enough vaccine to obtain a complete dose. Do not combine residualvaccine from multiple vials to obtain a dose.

Write a note with the manufacturer, lot number, and date/time drawn. Vaccines must be used within 6 hours of being drawn. Discard any unused vaccine after 6 hours.


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Pfizer Vaccine Prep – Diluting Vaccines with 1.8 mL 0.9% sodium chloride

Sanitize your hands and gather all the supplies needed: vaccine vial, diluent vial, alcohol prep pad, needles, and syringes. Keep vials out of direct sunlight.

Allow the vaccine to come to room temperature. Vaccine vials can be held at room temperature for up to 2 hours before mixing. After 2 hours, return unmixed vials to refrigerated temperatures.

Check vaccine and diluent labels to verify that they are the correct products to mix together, correct volumes, and their expiration/beyond-use dates. Never use products after the beyond-use label or expiration date.

With the vaccine at room temperature, gently invert the vial 10 times. Do not shake the vial. If the vial is shaken, discard the vaccine into the sharps container.

Examine the vaccine. It should be white to off-white in color and may contain opaque particles. Do not use if liquid is discolored.

Remove the protective caps from the vials. Wipe the top of the vials with an alcohol prep pad and let them dry while you assemble/prepare a 21-gauge (or narrower) needle and syringe. Once dry, dilute the vaccine as follows:

Uncap the needle and hold the diluent vial steady on the table. Insert the needle straight into the center of the vial stopper, then invert the vial and pull the needle back so the tip is in the liquid. Draw 1.8 mL of the diluent (0.9% sodium chloride [normal saline, preservative-free]) into a mixing syringe, then withdraw the needle.

Discard diluent vial and any remaining diluent in the sharps container. Do not use bacteriostatic normal saline or other diluents to mix the vaccine.

Hold the vaccine vial steady on the table. Insert the needle into the center of the vial stopper and inject all the diluent from the syringe. Using the mixing syringe, remove 1.8 mL of air from the vaccine vial to equalize the pressure in the vaccine vial.

Remove mixing syringe and needle from the vial and discard into the sharps container, then gently invert the vial with the vaccine and diluent 10 times. Do not shake. The vaccine will be off-white in color. Do not use if discolored or contains particulate matter. If vial is shaken, discard the vaccine into the sharps container.



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Pfizer Vaccine Prep – Drawing Vaccines after Mixing with Diluent (0.3 mL doses)

Invert the vial with diluted vaccine and pull needle back so the tip is in the liquid, thenwithdraw one dose (0.3 mL).

Return the needle and vial to table, then withdraw the needle, tap the syringe, andpush out any air. Ensure the syringe is not cold to the touch.

Recap the clean needle by placing the syringe and cap on the table and using a one- handed scooping technique to bring the needle into the cap. Never re-cap a needleusing both hands. Repeat until all doses are drawn.


Write a note with the manufacturer, lot number, and date/time reconstituted.Vaccines must be used within 6 hours of dilution.

Ongoing Tasks

Participate in briefing with Vaccine Unit Leader to provide updates on supply status (i.e., number of vaccines dispensed and in the Supply Area).

Track medical materiel from receipt through the end of operations using the Medical Materiel Tracking Log.

Update the Hourly Vaccine Temperature Log hourly.

Ensure that vaccines adhere to manufacturer’s storage/handling instructions and Vaccine Storage and Handling best practices.

Immediately address any Vaccine Storage Temperature Excursions following the procedures in the FOM.

Replace cold packs in vaccine coolers in the Supply Area and at medical dispensing stations as needed to maintain proper storage temperatures.

Deliver vaccines to medical dispensing stations as needed.


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End of Shift Duties

Close out the Medical Materiel Tracking Log and Hourly Vaccine Temperature Log for your shift and provide them to the outgoing Vaccine Unit Leader.

For site demobilization: Repack any remaining vaccines (for return to the Health Department) and record the final temperature.

Ensure that trash from Vaccine Prep area is disposed of in the on-site trash cans.

Conduct Staff Demobilization, including Debrief and Check-out of Vaccine Prep Staff.

Attend debrief.

Sign-out.


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Dispensing Leader Job Action Sheet

Mission Review client forms, administer vaccines, and direct clients to the observation area. Follow safe vaccine administration practices.


Delegates to Vaccine Staff

Supplies

Documents:


From MPOD Kit:

Coleman cooler (prepared with ice pack and bubble wrap)

Pen

Sharps container

Tablecloth

Trash bag

Vest, colored


Face mask, N95

Face shield

Gloves

Gown


Adhesive bandages

Alcohol prep pads

Cotton balls

Hand sanitizer

Underpad


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Duties Initial Actions


Atten General Briefing and report to Vaccine Unit Leader.

Review the Field Operations Manual (FOM) and Field Operations Guide (FOG) found onthe Vaccine Field Site training website.


Attend briefings conducted by the Vaccine Unit Leader

Ongoing Tasks Oversees vaccine dispensing/administration.

Perform periodic checks to ensure that staff follow procedures for safe vaccinedispensing/administration.

Replace cold packs in vaccine coolers in the medical dispensing stations as needed tomaintain proper storage temperatures.

Vaccine Screening

Ensure and observe Dispensing Staff confirm the client’s name and ask the 2 screeningquestions:

Did you have any severe allergic reaction to any other vaccines in the past?

Do you feel sick today?

If they answer “yes” to either, politely inform them that they are unable to receivethe COVID-19 vaccine today. Refer them to Vaccine Unit Leader if they haveadditional questions.

Ensure and observe Dispensing Staff clarify any screening questions that wereanswered “yes” or “I don’t know” to. There are no studies on vaccine safety forpregnant people or people with chronic medical conditions, but they can still receivethe vaccine if they want it.

Ensure and observe Dispensing Staff confirm with the client which vaccine they willreceive (if any), which dose it is, and where it will be administered, then proceed tovaccine administration.


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Vaccine Administration

Ensure and observe Dispensing Staff are following the 7 rights of medicationadministration: Right patient, right time, right medication, right dose, right route andtechnique, right site, and right documentation.

Ensure and observe Dispensing Staff clean hands with hand sanitizer and put ongloves.

Ensure and observe Dispensing Staff identify the site of vaccine administration andadminister vaccine via intramuscular injection in the following steps:

Clean the injection site (the deltoid muscle of the upper arm) by using an alcoholprep pad to wipe from the center of the injection site out about 2-inches in onecircular motion.

Throw away the alcohol pad into the trash can and allow the alcohol to air dry forseveral seconds. Don’t blow on or fan the client’s arm.

Hold the client’s deltoid muscle between your forefinger and thumb and insert theneedle into the muscle. Inject the entire contents of the syringe slow and steady.

Remove the needle, activate the safety mechanism, and dispose into the sharpscontainer immediately.

Apply light pressure to the injection site with a dry cotton ball and apply bandage.

Ensure and observe Dispensing Staff direct the client to wait for 15 minutes in theobservation area if they have no history of anaphylaxis, or for 30 minutes if they havehad anaphylaxis from any cause.

Ensure and observe Dispensing Staff remove and discard gloves in trash.Clean the client chair and the table with disinfecting wipes. Clean hands withhand sanitizer.

PrepMod Documentation

Ensure the Dispensing Staff select “Vaccinated” next to the client’s name in PrepMod.A new window will open.

Ensure the Dispensing Staff select the correct vaccine and lot number.

Ensure the Dispensing Staff complete fields for route of administration, site ofvaccine administration, reaction, vaccinator, vaccination date, and whether thisvaccination completes the series.

Once all fields are completed, select “Update” to save.


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End of Shift

Ensure that trash from Dispensing area is disposed of in the on-site trash cans ordumpsters.

Return 214 forms (ICS 214).

Return supplies.

Attend debrief.

Sign-out.


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Observation Leader Job Action Sheet

Mission Monitor clients for adverse reactions after vaccine administration and alert Observation Team Leaders of clients experiencing adverse effects.


Delegates to Observation Staff

Supplies

From MPOD Kit: Vest, colored


Surgical mask

Face shield

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Public MPOD Field Operations Manual: COVID-19 Vaccine MegaPOD Appendix F: Job Action Sheets for LACDPH Staff Roles

Duties

Initial Actions


Attend General Briefing and report to Vaccine Unit Leader.

Review the Field Operations Manual (FOM) and Field Operations Guide (FOG) found inthe Vaccine Field Site training website.


Attend briefings conducted by the Vaccine Unit Leader.

Conduct on-site training for Observation Staff using the script found in the FOM.

Ongoing Tasks

Oversee the Observation Staff monitoring clients for adverse reactions in theClinical Observation area (15 minutes) and the Extended Clinical Observation (30 minutes).

Ensure Observation Staff:

Walk around the observation area and observe clients for any adverse reactionsto vaccine administration. Signs include:

• Signs that they have a headache, are lightheadedness, anxious, oragitated

• Fainting

• Raspy or strained voice, vibrating noise when breathing, wheezing,nasal congestion, sneezing, cough, hoarseness or shortness of breath,severe asthma attack, or swollen throat

• Reddening of the skin, rash, itching, hives, swelling, flushing, swelling



Observation Leader will follow the Adverse Event Response Guide provided inthe Field Operations Manual (FOM) to assess the client and determine if it is amedical emergency.

Revised 1-17-2021


End of Shift

Return the Activity Log (ICS 214).

Ensure that trash from the Observation area is disposed of in the on-site trash cans.

Attend debrief.

Sign-out.

Revised 1-17-2021


Extra dosageavailable

POD Directornotifies Branch

director

Branch Directornotifies local LEfrom contact list

LE Advised to beonsite by 5:00 pm

for vaccination

Extra Vaccine Usage Plan MPOD

Public Medical Point of Dispensing Field Operations Manual ...

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Transcript of Public Medical Point of Dispensing Field Operations Manual ...