Clinic Leadership and Command

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Clinic Leadership and Command
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Clinic Organization Incident Command System

• All Points of Dispensing clinics use the same
  system to organize clinics called the Incident
  Command System.
• Incident Command System (ICS) ensures that
• A single incident commander provides overall
  direction to the clinic
• Each person knows his/her job and who s/he
  reports to.
• Each group has a well defined function
• The National Incident Management System (NIMS) is
  another system that is used to coordinate
  multiple clinics across jurisdictions.

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Your Role in the Clinic

• You will be given a specific job action sheet
  (JAS) that defines your role and tasks, and
  identifies your supervisor

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ICS Command and General Staff Positions

• There are five leadership sections in every
  Incident Command Structure, each with specific
  responsibilities. The leadership positions in
  each section are
• Clinic Commander
• Safety Officer
• Information Officer
• Liaison
• Scribe
• Operations Section Chief
• Planning Section Chief
• Logistics Section Chief
• Finance and Administration Section Chief

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Command Organizational Structure
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Operations Organizational Structure
Optional slide/advanced detail
Floater/Greeter Unit Leader
Security Task Force 1 (Interior)
Forms Distribution Unit Leader
Security Task Force 2 (Exterior)
Video Orientation Unit Leader (as required)
Exit/Evaluation Unit Leader
Child Care Unit Leader
Interior Clinic Traffic Control Unit
EMS/Transfer Unit Leader
Child Care Unit Leader
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Clinic Layout and Setup
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Setting up a Clinic

• Local Health Directors, their staff and partners
  ensure that the clinic can operate safely and
  effectively by planning ahead of time for the
• Selection of the location
• Clinic design and layout
• Staff Assignments Training
• Equipment and materials
• Security and Communication

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Selection of the Clinic Location

• A POD is usually located in a school or in
  another community building that is physically
  capable to handle large numbers of people.
• A visit to the selected clinic site is conducted
  to draw a diagram of the clinic flow, a floor
  plan and security needs.
• The designation of a clinic and its hours of
  operations will depend on the estimated number of
  people expected to come to the clinic during a
  specific event.

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Equipment and Materials

• Arrangements will be made for material and
  equipment needs.

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Clinic Layout and Patient Flow

• A clinic is arranged to move people through as
  quickly as possible from entrance to exit.
• Within a clinic, stations are set up with
  distinct purposes to help move people through.
• The clinic layout includes the fewest number of
  stations needed to accomplish the mission and to
  keep the individuals moving in an efficient,
  safe, and forward direction.
•  

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Clinic Throughput

• One of the earliest determinations that must
  be made is to estimate the number of individuals
  who are exposed or at risk in the community.
• This assessment helps establish the number of
  people expected at the POD clinic. That number is
  called the throughput.

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Core Clinic Stations

• The Core clinic stations are found in every
  clinic although they are sometimes called by
  different names. These core stations are
• Triage Individuals are identified who need
  medical or mental health evaluation.
• Medical Evaluation Individuals are evaluated
  who are ill in order to make medical decisions
  regarding treatment or referral.
• Dispensing or Vaccinating Medications are
  dispensed or vaccinations are administered to
  individuals.
• EMS or Transport Acutely ill individuals are
  stabilized and transported to acute care
  settings.

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Simple POD Design
TRIAGE
MEDICAL EVALUATION
DISPENSING OR VACCINATING
EMS OR TRANSPORT
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Additional Clinic Stations
Optional slide

• Additional stations that support the core
  stations are optional.
• Briefing - gives basic information about the
  clinic, the treatment, follow up and/or referral
• Greeting Screening Observes or asks questions
  about illness or exposure to the disease
• Forms Distribution Assists individuals to
  receive and complete the correct data collection
  forms
• Forms Collection May review forms for quality
  and completion.
• Behavioral Health May triage and identify
  individuals who are experiencing acute stress.
• Express Dispensing Dispences medication
  according to the protocol
• Assisted Dispensing Provides addditional
  edcuation, counsleign or medical evlaution before
  dispencing medication

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POD Clinic structure and layout
Optional slide
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Learner Questions

• An Incident Command System (ICS) provides
  structure and lines of authority within the
  response system that includes
• a) A single incident commander providing
  overall guidance and direction.
• b) Authority delegated through a chain of
  command composed of several functional divisions.
• c) Defined leadership positions in place to
  provide direction and supervision.
• d) All of the above
• 2. A job action sheet (JAS) defines your role
  and tasks, and identifies your supervisor.
• True False

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Learner Questions

• 3. Once a determination is made of the number of
  individuals who are exposed or at risk in the
  community that estimate will help establish how
  many individuals are expected at the POD clinic
  during a specific time period. This is called the
  THROUGHPUT
• True False
• 4. Only medical positions are necessary at a
  dispensing clinic.
• True False
• 5. You may be assigned to an area of a clinic
  such as
• a) Intake
• b) Screening
• c) Dispensing or vaccinating
• d ) Any of the above

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Training for Clinic Assignments
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Training for Preparedness Response

• Pre-identified Volunteers and Staff will register
  on a learning management system called CT.TRAIN
  (this system can only be accessed by computer, at
  http//ct.train.org)
• Your training may be enhanced through
  participation in local or regional exercises and
  drills
• Pharmacist, Nurse, and Physicians and other
  licensed professionals may receive specialized
  training
• Other volunteers will receive Just in Time
  training at the time of the incident

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Clinic Positions

• Each position in the clinic has a Job Action
  Sheet that includes
• Overall purpose
• Organizational unit
• Supervisor
• Location
• Qualifications
• Equipment
• Expected tasks

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Other Training Opportunities

• PRE-EVENT TRAINING
• Local and Regional drills exercises
• Other training opportunities
• Videos
• American Red Cross Introduction to Disaster
  Services
• Connecticut TRAIN
• CERT Citizen Emergency Response Teams
• Other volunteer organizations
• LHD newsletters, periodic contacts information
• POST-EVENT TRAINING
• Other volunteers will receive Just in Time
  training at the time of the incident

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Spontaneous Volunteers

• Staff and volunteers who have been pre-trained
  are essential to efficient clinic operations,
  however, some volunteers may arrive at the clinic
  who have not been previously recruited or
  trained.
• These spontaneous volunteers will be assigned to
  a position depending on the clinic staffing needs
  and their particular skills.
• These volunteers will receive just-in-time
  training which includes general overview and job
  specific training.

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Clinic Operations
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Before your Shift Staff Assignments Training

• Without volunteers, we would not be able to
  conduct mass dispensing they are a critically
  important resource in the community. local
  health director
• The clinic manager will institute the staff and
  volunteer call out procedure as soon as possible.
• Staff and Volunteers may be told to come to the
  clinic while others may be told to come to an
  alternate location or staging area for check-in
  procedures
• At 1 to 2 hours before opening and at regular
  intervals
• the Intake/Orientation Unit supervisor will
• Establish intake/orientation location
•   Establish opening time
• Notify EOC of location and opening time
• Receive volunteers
• Assess, badge and assign volunteers
• Conduct general briefings
• Train or arange for job specific assignments

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During Your Shift - Staff Volunteer Support

• There are many supports that will be available to
  you before, during, and after the clinic
  including
• Rest areas, food, and water
• Mental health support
• If you need assistance and are unsure how to
  obtain it, ask your supervisor.

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During your Shift Staff Volunteer Support

• During your shift, your supervisor will keep you
  informed regarding progress in the operations.  
• A POD can be a stressful experience Please be
  alert to signs of stress or fatigue in yourself
  and in others
• Lack of concentration
• Increasing number of noncritical errors
• Critical errors
• Irritabiltiy
• Worry
• Feel ill

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During your Shift Communication

• The clinic manager will ensure that internal
  clinic communications are tested prior to opening
  a POD clinic.
• Communication flow between volunteers and clinic
  staff should follow the clinic organizational
  structure.
• Personal/household communication needs of
  volunteers and staff will be addressed

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During your Shift Security

• Your safety and security is of utmost
  importance. Security measures will be in place to
  help address
• Crowd and traffic control both inside and outside
  of the POD
• Protection of staff, equipment, and supplies
• Identification of POD staff
• Volunteers and staff will be briefed on the
  available security plan and procedures.

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Personal Safety

• Safety officers will be on site to ensure that
  staff and volunteers are working in a safe
  environment
• Your job action sheet will address safety
  precautions or any necessary personal protective
  equipment (PPE)
• Protection of staff and volunteers may include
  PPE, prophylaxis or vaccination

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End of shift

• At the end of your shift or before you report off
  duty you will be asked to
• Brief your supervisor
• Turn in all reports and equipment
• Sign out per an established check-out procedure

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Your Role as a Volunteer

• Local Health Departments continue to identify
  volunteers and staff for critical clinic
  positions prior to an event, as many people are
  needed
• Recruitment of additional volunteers is necessary
  to identify community members willing to
  volunteer time and services if the need arises.
• Thank you for your continued support and
  commitment to serve in the event of a public
  health need.

Health departments cant respond to this type of
emergency alonebut with volunteer help, we can
all be protected. - local public health
emergency preparedness coordinator
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Internet Resources and References
http//www.ahrq.gov/research/cbmprophyl/cbmpro.htm
http//ct.train.org http//www.cadh.org http/
/www.bt.cdc.gov/agent/agentlist.asp
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• Thank You!
• None of this could be done without you!