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Congress of Mobile

Medical Professionals
http://www.CoMMP.org
COVID-19 Immunization
Questions & Cautions
(Non-Prescriptive Guidance Inspired by Checklists)

Maggie Adams (PA) Dan Gerard (CA)


EMS Financial, Inc. Congress of Mobile Medical Professionals

Elizabeth Angeli (WI) Art Groux (VT)


Marquette University Bennington Rescue Squad

Clint Baysden (NC) Britt Lineberger (SC)


Evolve Ambulance Billing Solutions Chester County EMS

Michael Bennett (NY) Scott Moore (MA)


Thousand Islands Emergency Rescue EMS Resource Advisors

Eric Chase (OK) Wren Nealy (TX)


AAA Education Committee Cypress Creek EMS

Anthony Correia (NJ) Ron Nichols (TX)


Congress of Mobile Medical Professionals Chambers County EMS

Mark Deavers (NY) Victoria Reinhartz (FL)


Gouverneur Rescue Lake Erie College of Osteopathic Medicine

Christina DuBois (TX) Chris Sandoval (WI)


Cypress Creek EMS Wauwatosa Fire Department

John Farris (CO) Alan Shaw (CT)


Ute Pass Regional Health Service District EMT New Hope Fire Company

Jonathon Feit (CA) – Editor Chris Smetana (UT)


The BrainTrust of Fire & EMS Technologists IA MED, Inc.

Daniel Frey (TX) Michael Touchstone (PA)


FieldMed / IAFF / EMTF / NTTRAC Philadelphia Fire Dept. / NEMSMA

Erik Gaull (MD) Christian Witt (CA)


Cabin John Park VFD Beyond Lucid Technologies, Inc.
CONTENTS:

1. Purpose of this Document 5


2. Clinical 6
3. Pharmaceutical 8
4. Human Resources & Legal 10
5. Operations & Logistics 13
6. Technology & Data 15
7. Billing & Accounting 16
8. Education & Politics 18
9. References & Resources 20

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© 2020 by the Congress of Mobile Medical Professionals
(CoMMP). All rights reserved. United in Service.

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PURPOSE OF THIS DOCUMENT
This “living document” is being drafted just prior to the provision of COVID-19 vaccines to
Mobile Medical agencies across the U.S. It should therefore be expected to evolve with
changing policies and processes for administration of the vaccine. Many questions
remain. We aim to empower our colleagues to seek guidance from every available local,
state and federal resource to ensure safety, efficiency and compliance.

It is worth noting that our contributors cover the gamut of Mobile Medicine, from Fire
to EMS to Community Paramedicine to Public Health; public and private agencies across
the U.S. (as demonstrated through the identification of state affiliations in the author list);
technology, data, and health information exchange; billing, legal, and human resources;
clinical medicine, emergency operations, education, public affairs, and even pharmacy to
ensure that we give these vaccines the respect, and caution, they are due. One truth has
emerged without question as we aggregated these still-unanswered facets of inquiry:
Much of the knowledge of what to do now, and next, in the fight against COVID-19 is not
yet conclusive. In fact, the dividing lines of knowledge are themselves troubling: standard
operating procedures in California often do not match those in Texas or New York. Things
are quite different in the Carolinas, Arizona, and the Upper Midwest. One takeaway—
which is worth bringing to federal administrators—is the value of a cohesive national plan.

From the feasibility of “ultra-cold” storage, to whether freezers are even available (and if
so, how to pay for them), to whether a lack of field vaccination training or waiting to get a
vaccine that does not require an ultra-cold freezer exposes agencies to legal liability, to
the data that will track who got which vaccine and when—the members of the Congress
of Mobile Medical Professionals (CoMMP) has watched trade groups taking positions
about COVID-19 vaccination, who should administer them and to whom in what order.
This collective effort will not reinvent that wheel: our approach is to ask challenging
questions across a dozen critical dimensions. In the course of obtaining answers, Mobile
Medical agencies will build relationships with advocacy associations, community groups,
regulators, public health districts, and one another to build the necessary relationships—
quickly, while in a foxhole together—that we all know we need in order to beat this thing.

This document is not intended to provide answers or opinions.


Here we present questions that need to be addressed in order to
ensure that your region is prepared for duties that may be imposed
on you in the course of engaging in Mobile Medicine, including the
vaccination of the public—and within agencies—against COVID-19.

#InThisTogether #UnitedInService #UnitedWeServe

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1. Clinical
A. What is the vaccine’s impact on patients who have been (or currently are) infected
with COVID-19? Will antibodies generated by exposure to the vaccine be as
effective over time as antibodies stimulated by exposure to the virus itself?

B. If yes, then should those who were exposed to the virus environmentally be last in
line to receive the vaccine, since they already have antibodies? Or first, since they
have shown that they are susceptible to infection?

C. Must people who plan to take the vaccine be tested for COVID-19 first—and how
should the results of that test impact the order at which individuals are vaccinated?

D. What is the duration of protection following a vaccine booster in a patient who has
been infected before and therefore already has antibodies?

E. How long after virus infection and symptom resolution should clinicians wait before
administering a vaccine?

F. How should screening or vaccination protocols be adjusted where the patient is


now, or has recently, received antiviral therapies to treat influenza or other viruses?

G. How effective will the vaccine be against new strains of the virus?

H. What protocols are in place to facilitate at home supportive care, influenza testing,
vaccine side effect reporting, and follow-up monitoring?

I. Given the symptom overlap between COVID-19 and lookalikes—like the common
cold and influenza—if a patient gets a COVID-19 vaccine and subsequently
develops symptoms, what protocols are in place for clinicians to differentiate
between vaccine side effects versus an alternative viral infection?

J. People prone to allergic reactions were excluded from the Pfizer test; but people
who received the vaccine anyway experienced allergic reactions. What was the
rate and nature of allergic reactions among people who took part in the Pfizer trial?

a. On December 9, 2020, the UK’s Medicines and Healthcare Products


Regulatory Agency wrote that: “Any person with a history of anaphylaxis to a
vaccine, medicine or food should not receive the Pfizer/BioNTech vaccine. A
second dose should not be given to anyone who has experienced anaphylaxis
following administration of the first dose of this vaccine.” The agency explained
that “anaphylaxis is a known, although very rare, side effect with any vaccine.
Most people will not get anaphylaxis and the benefits in protecting people
against COVID-19 outweigh the risks.”

b. What reactions (besides allergy and reported fatigue, etc.) or drug interactions
should clinicians be looking for that were not seen in the trial?1

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K. Is the Moderna vaccine expected to have the same rate of allergic reaction as the
Pfizer vaccine (i.e., 2 in 38,000)?

L. Should the indeterminate risk of allergic or other reactions extend the monitoring
period for the PODs and delay the flow of the vaccine into the general population?

M. How is a vaccine that has been kept at -20°F absorbed through the body?

N. Is there risk for hypothermic reactions upon administration?

O. What would be the physiological effect of giving two different vaccines to the same
patient—either by mistake, or because the first vaccine proved ineffective (i.e., the
patient contracted COVID-19 anyway and became severely ill), or because an
individual wishes to “cover all the bases” by getting a course of both vaccinations?

P. How does getting just one of two required vaccination doses impact its efficacy?

a. According to Pfizer’s FDA filing, while data showed a vaccine efficacy rate of
52.4% after one week, there was no testing on patients who received just one
injection: “The efficacy observed after Dose 1 and before Dose 2, from a post-
hoc analysis, cannot support a conclusion on the efficacy of a single dose of
the vaccine, because the time of observation is limited by the fact that most of
the participants received a second dose after three weeks.”2

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2. Pharmaceutical
A. How prepared are we to address clinical unknowns of the vaccine? Operation
Warp Speed was founded in May 2020, roughly seven months before delivery of
the vaccine. Over the course of the next year, what staffing and financial support
systems are in place for Mobile Medical teams to continuously reevaluate vaccine
delivery, monitoring, and reporting protocols?

B. After the December 10, 2020, meeting of the FDA Statement on Vaccines and
Related Biological Products Advisory Committee, it was widely reported that
pregnant and nursing women, as well as children, were not included in the testing
protocol to date. What response and mitigation processes are we prepared to
implement if it turns out that the vaccine yields unanticipated birth defects, or harm
to pregnant (or potentially pregnant) women?

C. On December 11, 2020, the New York Times reported that UK “authorities also
said the shots should be given only in settings equipped to resuscitate patients if
needed.”3 According to filings via Health Canada, “As with all injectable vaccines,
appropriate medical treatment and supervision should always be readily available
in case of a rare anaphylactic event following the administration of this vaccine.”4
However, the plan to vaccinate larger numbers of people after those in the initial
tiers calls for the involvement of pharmacies like CVS and Walgreens. Will
personnel in those facilities be prepared to address severe allergic reactions?

a. There are two compensatory federal funds for cases where someone dies or
suffers an incapacitating illness relevant to vaccines deployed in the context of
a pandemic: the federal HRSA Countermeasures Injury Compensation
Program (CICP) and National Vaccine Injury Compensation Program (NVICP).

D. If the temperature control on the Pfizer vaccine exceeds the allowable “ultra-cold”
range, what is the process for determining the stability, safety, and efficacy of these
shipments, secondary to time-specific variations outside the “ultra-cold” range?

a. The cold chain for storage and transport is meant for the vaccine managers,
etc. They have both colorimetric and digital temperature control tags. If the
vaccine falls out of range for the designated time period, it should not be used.
After it is removed from sub-zero can be stored in a normal vaccine refrigerator
(temp between 36o and 46o F), the vaccine can then be used at room temp for
a short period, and returned to a normal vaccine refrigerator. It can only be
stored for five days after being removed from subzero storage.

E. If the temperature control on the Pfizer vaccine exceeds the allowable “ultra-cold”
range, how will clinicians distinguish a vaccine that was ineffective due to a
problem with the lot vs. a vaccine that was ineffective for a particular individual?

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F. Temperature fluctuations of ambulance-based refrigerators often go unnoticed.
How will Mobile Medical professionals ensure temperature requirements are met
during the various stages of vaccine thawing, reconstitution, and administration?

G. How will persons responsible for the vaccine across the cold chain identify freezer
equipment failure quickly enough to address it before the lot has to be wasted?

a. The ultra-cold storage standard inheres that only states and public health
organizations that are very familiar with cold-chain preservation should use the
Pfizer vaccine. There will be temperature data loggers with them at all times
when not in a freezer—and the freezer also logs temperature data. If a freezer
detects an out-of-range temperature, alarms and alerts will sound.

b. If the data logger demonstrates that a batch has exceeded its time outside the
cold-chain range, the batch should be documented as unusable. Once thawed
and diluted, a batch must be used within six (6) hours. In some locations, the
Pfizer vaccine will be thawed, mixed, and placed in syringes by pharmacy
technicians who are responsible to ensure that the syringe is used within 6
hours. Are they sufficiently trained for that responsibility?

H. What should be done if a booster is unavailable when it is scheduled (e.g., due to


supply constraints), or if the patient forgets to obtain it within the prescribed period?

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3. Human Resources & Legal

A. Should employers default to sending home colleagues who exhibit signs and/or
symptoms of COVID-19 on extended PTO—potentially as long as two weeks—
while they watch how conditions develop? Or, should the keep personnel on duty
but isolated, adhering to stricter protocols such as wearing PPE inside the station?

B. What should employers do if colleagues want to keep working, convinced that their
mild signs and/or symptoms of COVID-19 are actually seasonal allergy or influenza
—and will “go away shortly”? Some patients infected with COVID-19 show only
mild symptoms, then spread the virus to others who are more severely impacted.

C. What if an agency does not have a “strategic reserve” of personnel to step in for
colleagues who are showing signs and/or symptoms?

a. It has been suggested the max proportion of staff that should be vaccinated
any one time is 25% of a shift, but jurisdictions require that anyone exhibiting
signs of COVID-19 be sent home for a period of X days. The vaccine itself can
cause these effects. How should this guidance be modified for rural services?
(If a department only has only twenty people on its roster, sending home 25%
at any one time can impact operations.)

b. The Pfizer vaccine has an incubation period of two weeks (14 days) for the first
dose with 52% efficacy, and three weeks (21 days) for the second dose with
95% efficacy. Should agencies tailor specific policies around this time frame?

c. Are there any H.R. implications if an employee refuses to receive a vaccine—


then becomes infected by the virus and is sidelined for a longer period of time?

D. How should organizations determine which employees to vaccinate first?

a. The CDC suggests vaccinating older personnel and those with co-morbidities
first, and staff working in high risk areas or performing high risk procedures.

E. What is the risk of liability associated with employers choosing the order in which
personnel receive the vaccine? For example, if an EMT doing non-emergency
wheelchair transports is triaged lower on the list for the vaccine—but becomes
infected with the virus while waiting to receive it?

F. How do liabilities (immediate costs associated with overtime and even mutual aid)
compare between sending colleagues home vs. keeping them on shift—with more
stringent PPE rules, isolated living / eating, etc., and modified duty—if the latter
imparts higher risk that other personnel will be at risk in the future?

G. Does local public health offer a “waiver” or similar program that lets employees
keep working or have a shorter stay-home requirement if signs and/or symptoms
emerged within a specified time after receiving the vaccine (e.g., 48 hours)—and
so can be reasonably attributed to it, rather than to infection with the virus itself?
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a. What documentation / evidence of vaccination will departments require?

b. Will agencies require titers in the future to prove that the employee has been
vaccinated? Is there a way to measure titers or immunity?

H. Some regions have indicated that requiring a vaccine as a condition of employment


may be legal (i.e., “you are not forced to get the vaccine, but you are not forced to
work here either”). Just because it is legal, is it wise to require a vaccination?

a. What accommodations must be made for medical contraindications?

b. What accommodations must be made for religious or sincerely held belief?

c. Congress is still debating liability versus immunity with respect to COVID-19.


Could mandating a vaccine—or not mandating one—impact worker’s
compensation risk, given that if an injury did happen, a plaintiff could imply that
injuries, whether due to infection while waiting to receive the vaccine or due to
side effects of the vaccine itself, were tied to managerial decisions?

d. How might courts distinguish a vaccine that was incorrectly administered or


stored, versus one that simply proved ineffective for a particular patient?

e. How might courts distinguish between patient-specific adverse reactions,


versus risks that were generally unknown at the time of the administration? For
example, a vaccine that received Emergency Use Authorization from the FDA
has been deemed “safe and effective.” However, If the employer mandates the
vaccination and the employee suffers a negative outcome or side effect, this
would be considered a work-related illness/injury. The worker’s compensation
carrier, however, might try to subrogate damages from the vaccination
manufacturer, and an employer could face tort liability.

f. Will liability change by service type (e.g., governmental, private for-profit,


private non-profit, hospital-affiliated, fire- based) — will any have immunity? Is
immunity conferred as a result of a declared public health emergency?

g. Where is the line between personal and agency liability—e.g., with respect to
malpractice insurance—in the context of a public health emergency?

h. Whose responsibility is it to ensure that personnel receive both injections?

i. What are the potential employment consequences if an employee refuses to


get the second Pfizer injection, or does not obtain the second injection in a
timely manner?

j. How will teams staff accordingly if duties must be reassigned based on an


employee’s decision not to receive the second Pfizer injection—or if the
vaccination resulted in adverse reactions that require time away from work?

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k. What could be an employer’s liability in the case of “false negatives”? For
example, if an employee receives the vaccine and suffers no reaction, but the
employee thinks that he or she is “in the clear.” Meanwhile, due to the vaccine,
the employee is now an asymptomatic carrier and several colleagues that have
not received the vaccine fall ill. Could an employer be held responsible for
letting employees—after they are vaccinated—lower their guard prematurely?

l. Has anyone explained to the employer or employees that failure to receive both
vaccines may interfere with the employee’s ability to receive compensation
under the Countermeasures Injury Compensation Program (CICP) and the
National Vaccine Injury Compensation Program (VICP)?

• For more information about these programs and the degree to which
they may be applicable to your or your employees’ circumstances,
please visit: https://www.hrsa.gov/cicp

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4. Operations & Logistics
A. Will Mobile Medical agencies that have not already obtained an ultra-cold freezer
be able to do so in time to receive and handle the Pfizer vaccine, or do they need
to wait until the Moderna vaccine is potentially approved for distribution? It can be
politically challenging to tell constituents who want vaccine that they have to wait

B. Do agencies / regions have a POD plan in effect that can be implemented quickly?

a. Is the POD plan a FEMA / Homeland Security plan, or a Public Health plan?

b. How does a FEMA / Homeland Security differ from a Public Health plan?

c. What are the respective roles of Mobile Medical teams from FEMA, the U.S.
Public Health Service, and local Fire / EMS / Police / Public Health services?

C. If an agency or Point of Dispensing (POD) is able to obtain an ultra-cold freezer,


has it accounted for an availability of emergency repair vendors (just in case)?

D. What sorts of collaboration and affiliations with across agencies, states, counties,
health departments, etc., will benefit agencies tasked with administering vaccines?

E. How will reducing red tape associated with receiving authorization to administer
vaccines benefit the agencies undertaking the work, as well as their communities?

a. If agencies received rapid authorization to commence vaccine administration,


how ready are they to do so in terms of training, equipment, and manpower?
For example: Does the agency have enough personnel to maintain emergency
operations in parallel with taking crew members off the line to deliver vaccines?

F. A substantial concern is that public health agencies have advised employers to


mandate that symptomatic employees get tested, stay home, and abide by current
quarantine guidelines—however, this is this is problematic when both the Pfizer
and Moderna vaccines cause COVID-19 symptoms as anticipated side effects.
How will agencies survive the impact if X% of their workforce have symptoms and
require quarantine. Certain clinical committees are working on guidance language
that could provide employers some leeway, i.e., authorizing return to work if "you
received the vaccine, were previously asymptomatic, and have symptoms within
24 hours of the vaccine that resolve in 48 hours.” This language is a paraphrase.

G. What specialized personnel are needed to install, calibrate, and test the freezer?

H. How will agencies know that their freezer is working properly? Many agencies are
unaware at present that their standard refrigerator “wobbles” around temperature
thresholds based on various factors including ambient heat or cold, and humidity
(or, for example, the doors is simply opened too frequently or left open for too long).

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I. While there are controls in place for access to subzero freezers, what steps will be
used to minimize the impact of human error in dispensation?

J. Have all personnel involved in administering the Pfizer vaccine completed training
in its unique qualities, e.g., that it arrives freeze dried and must be reconstituted
with 0.9% normal saline?

K. What additional safety equipment and/or personal protective equipment are


necessary for safe inventory stocking, retrieval, thawing, reconstituting, and
transport of ultra-cold vaccinations? Are these supplies readily available for
ordering and have teams been trained to utilize safety gear accordingly?

L. How must distribution processes differ between urban and rural regions? What
are the public / health, and political implications of waiting for the Modern vaccine?

M. How long should Mobile Medical agencies continue to pursue vaccination efforts?
By percentage of population reached and vaccinated, or for a preset time frame?

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5. Technology & Data
A. How many agencies are using CDC’s “V-Safe After Vaccination Health Checker”?5

B. How will Mobile Medical agencies be able to identify patients who have already
had one vaccine, and require the second dose?

a. To the degree that data are stored in a single repository—such as Tiberius, a


Palantir product—it may be possible to query for tracking vaccine deployment,
even by patient. To what degree are such data query-able, and is the vendor
making such interface tools available to external systems with a need to know?

b. How will a central repository (e.g., Tiberius) interface—or not—with local data
stores? For example: CalRedie (the California Reportable Disease Information
Exchange); ImmTrac2 (the Texas Immunization Registry); and other federal /
state / county / local databases of vaccine distribution and patient interaction?
(This list should also include NEMSIS, the National EMS Information System,
and health information exchanges as well as interchanges, e.g., CareEquality.)

c. To what degree do local repositories even have the ability to share data (put a
different way, how many such repositories are still paper-based and manual)?

d. What are the risks faced by that central national repository, inasmuch as it is a
prime target for nefarious activities (e.g., hacking, data mining, exploitation)?

C. What plan is in place to identify, document, and report allergies, clinical effects, or
interactions that were not observed in the clinical trial population?

D. What data are needed to demonstrate the work that Mobile Medical agencies are
doing, vaccination program costs to each agency, and the value of such steps to
public health (for example, reaching homeless mental health patients living in tent
cities, who suffer from enhanced risk of rapid social transmission of COVID-19)?

E. Will Mobile Medical data regarding vaccinations and public health be accessible in
regional health information exchanges or the electronic health record systems of
area hospitals? If so, how will the data reach those systems, and how frequently?

F. Are local, state, and federal (etc.) organizations being proactive, transparent, and
accurate regarding aggregated syndromic surveillance data? Which organizations
have been the most lackadaisical with the facts, and therefore should be avoided?

G. What protocols have been developed to guide employees in appropriate use of


inventory systems to minimize waste, clinical reporting of adverse events, and
technical aids designed to track vaccine tolerability?

H. Is the agency taking care to document detailed data in case of possible recall,
including: lot numbers, administration details, location and route of administration,
vaccine name, dose, expiration date, and relevant PHI if an adverse event occurs?
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6. Billing & Accounting
A. Cash vs. reimbursement: If the deadline for CARES act funding is already passed,
what funding is available to pay for clearly related expenses such as ultra-cold
freezers and requisite PPE to provide vaccinations to the community in person?

a. While CARES and other COVID-related funding may reimburse organizations


for physical equipment (e.g., vaccine, syringes, PPE, etc.) and even some
operational expenses, smaller agencies in particular (e.g., rural EMS agencies)
have expressed concern about the unavailability of cash to make the payment,
prior to receiving reimbursement.

B. What resources are available to compensate agencies for community engagement


activities? What paperwork, certifications, etc., do Mobile Medical agencies need
in order to bill for public health and vaccination activities? For example:

a. Health Resources & Services Administration (HRSA) for the uninsured


b. Center for Medicare & Medicaid Services for Type 73 Mass Immunizations
c. HRSA Countermeasures Injury Compensation Program (CICP); and
d. HRSA National Vaccine Injury Compensation Program (NVICP). The latter two
cover vaccine-related injuries relevant to the declared public health emergency.

C. How much can Mobile Medical agencies get paid for their vaccination activities?
How do these revenues measure against the costs of servicing such vaccination
activities (e.g., upfront expenses including the vaccine and cost of time/overtime)?

D. Can Mobile Medical agencies efficiently share the cost of an ultra-cold freezer? If
so, how much should each agency expect to contribute financially? What is the
optimal number of partners on such critical but occasional-use capital equipment?

a. What are the security considerations in terms of access controls, for example?

b. Is there any return on investment after the public health emergency? Can ultra-
cold / subzero freezers be sold after use? What other uses do they have?

c. Can they be rented from facilities that are now using them for other purposes?

d. How can agencies defend (or promote) their need for emergency budget to
obtain occasional-use equipment like an ultra-cold freezer?

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7. Education
A. What is the most effective means for managers to convey the latest guidance to their
crews, while those facts and associated planning are in a state of frequent flux?

B. How reliable are the studies from the UK and other overseas countries? Are they
backed by IRB? Were any shortcuts involved to meet speed objectives? (If so, what
are they and what might be their ultimate impacts on data reliability and reporting?)

C. How can agencies avoid “mythmaking” (especially via social media) as personnel may
hear about practices in one location, without realizing that they apply differently in light
of local rules? For example: One state may provide top-down public health guidance,
whereas another state without central leadership relies heavily on local partnerships.6

D. How are communities at highest risk, and with the most vulnerable patients, being
engaged with education about and access to the vaccine?

E. Are the CDC guidelines appropriate and sufficient?

a. To what degree are officials following those guidelines—or not—particularly with


respect to vulnerable populations?

b. Is there verifiable data to show the impact of socioeconomic status on care and
education in the context of COVID-19. For example: the diffusion of details about,
and application of, CDC guidelines?

F. What, if any, standardization has occurred with respect to personnel training and KSA
(Knowledge, Skill & Ability) measurement in the context of mass vaccinations?

a. Vaccines are not covered in the NCCP model or DOT curriculum. Do Mobile
Medical care providers understand how vaccines work, possible and anticipated
side effects, so that they are ready participate in mass vaccinations?

b. What are the treatment protocols? What are the reporting and documentation
procedure? What technologies will provide the ability to capture the data needed
data to prove compliance with educational models and protocols?

c. Will training be provided for both / all vaccines or only the specific vaccine(s) that
are expected to be used in their region? What if that vaccine selection changes?

d. Is the standard for training to be set by each Mobile Medical agency, its medical
director, or its municipality / county / state, or at the federal level?

e. How are Mobile Medical agencies expected to document vaccine impact and onset
of side effects—and to align information about side effects that occurred
immediately after vaccination vs. those that occur 24 to 48 hours after vaccination?

f. What is the role of, and training for, dispatchers to identify COVID-19 side effects?

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G. What training is needed to facilitate effective patient education and counseling on
vaccine effectiveness, tolerability, and expectations?

H. What training is needed so that crews understand how the programs they are engaged
in were developed; what implementation steps will be required; how patients will be
screened; and how crews will be expected to report side effects that they themselves
experience and that they observe in colleagues and patients following vaccination?

I. Who absorbs the expense of such training? For example: Will CARES funding cover
vaccination-specific training costs?

J. Will vaccination training be required as part of employment continuing education?

K. What are the legal implications related to absent or lacking training around vaccination
programs, maintaining the cold chain, identifying COVID-19 signs and symptoms,
identifying and reporting adverse effects related to COVID-19 vaccines, etc.?

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8. Communication & Politics
A. How does a community’s perception of its infection risk impact Mobile Medical
operations?

a. Do patients in the community think they are safer than they are (i.e., more patients
call 9-1-1 for help when they are sicker than they otherwise might be)—or is the
community “on a hair trigger,” and paranoid about the risks of the virus (which can
manifest as patients calling 9-1-1 on the assumption that their signs and/or
symptoms suggest COVID-19, but they largely end up testing negative)?

B. What is the community impact of having to wait for the Moderna vaccine because the
Mobile Medical or public health agency does not have, or have the funds to purchase,
an ultra-cold freezer?

a. A perspective from one contributor: “A dearth of ultra-cold freezers, and


possibly insufficient dry ice to service traditional POD planning, combined with
complex packaging and rigid handling instructions for the Pfizer vaccine, creates
good reasons to wait for the Moderna vaccine. However, the trick is using the
correct wording and finding a trusted messaging source to let the public know.”

b. If Mobile Medical personnel are administering vaccines, they will be perceived by


most in the public, that we are appropriately trained and knowledgeable. Will
entities have the backing of the local, state and federal government when making
public statements, claims or requests for funding or status of the vaccine, and the
equipment, training and processes required to ensure safe administration?

C. How can agencies prevent backlash from “political opinion” vs. actual science on the
matter? What proactive measures should agencies have with their local media?

D. What are the most efficient methods for Mobile Medical agencies and their ecosystem
partners to coordinate, share knowledge, and identify subject matter experts (SMEs)?

a. A perspective from one contributor: “If this pandemic has taught us anything, it
is that public health issues effect the economy, our democratic processes, media
and information sharing, employment status and work environment, stability of the
healthcare system, fatality management planning, scarcity of goods and services,
availability of public safety elements, and social order. Now armed with this
knowledge, it would be a very good idea within local government and related
private agencies to develop liaison positions to the public health entities that
service your area - rural or urban. This would aid in obtaining the latest guidance,
pushing out vetted public information, deconflicting bottom-up information
(rumors), engagement with social leaders, local businesses and schools, and
creating beneficial partnerships toward future prevention and mitigation activities.”

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E. What sources of media engagement are most useful, and most harmful, with respect
to summarizing the activities of Mobile Medical agencies to prepare for their new role
as not just a reactive public safety agency but also a proactive proxy for public health?

F. Will CDC be providing resources for this vaccine as they have for previous ones, e.g.,
flu vaccine toolkit? https://www.cdc.gov/flu/resource-center/freeresources/toolkit.htm

G. How many public health agencies bought ultra-cold freezers even despite initial CDC
instructions not to do so?

H. Various trade and regional associations have released position statements in favor of
their constituencies. What is the most effective way to recognize the validity of multiple
perspectives, while highlighting the commonalities across all vantage points, like the
need for PPE, clear guidance on employment requirements, and diligent language the
honors the contribution of every “flavor” of Mobile Medicine to our collective efforts?

9. REFERENCES & RESOURCES:

1 https://www.gov.uk/government/news/confirmation-of-guidance-to-vaccination-centres-
on-managing-allergic-reactions-following-covid-19-vaccination-with-the-pfizer-
biontech-vaccine

2 “Vaccines and Related Biological Products Advisory Committee Meeting December


10, 2020 FDA Briefing Document Pfizer-BioNTech COVID-19 Vaccine.” Page 32.
https://www.fda.gov/media/144245/download

3 https://www.nytimes.com/2020/12/11/health/Covid-Pfizer-vaccine-allergies.html

4 https://covid-vaccine.canada.ca/info/pdf/pfizer-biontech-covid-19-vaccine-pm1-en.pdf

5 https://www.cdc.gov/coronavirus/2019-
ncov/vaccines/safety/vsafe.html#:~:text=V%2Dsafe%20is%20a%20smartphone,gettin
g%20the%20COVID%2D19%20vaccine

6
https://www.fema.gov/disasters/coronavirus/rumor-control

20