Anyone suspected of experiencing an adverse response to vaccine administration will be assessed by a medically-licensed staff member on site.

Access the LAUSD COVID Vaccine Clinic Anaphylactic Reaction Emergency Protocol for more information.

Medical Incidents Onsite

Medical Emergency:

• DIAL 911.
• Follow on-site emergency treatment protocol until emergency medical services arrive.
• Report event to immediate supervisor.
• Notify Site Medical Lead immediately.
• Follow Adverse Event Reporting procedures below.

NOT a Medical Emergency or Individual Declines Treatment:

• Report event to immediate supervisor.
• Refer the individual to their healthcare provider.
• Follow Adverse Event Reporting procedures below.

Onsite 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. (See next section.)

Epinephrine

Epinephrine may be provided via auto-injector (e.g., EpiPen) or injection.

Epinephrine Auto-Injectors

Epinephrine auto-injectors are available and deliver a single dose of epinephrine for individuals weighing over 66 pounds:

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

• 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 container has emptied.
• Massage the injected area for 10 seconds.
• A second dose of epinephrine may be given in 5- 15 minutes after the first, if symptoms have not subsided, or if response is inadequate and paramedics have not arrived.

Epinephrine Injection (NOT EpiPen)

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. For ages 13 and above, dosage is 0.50mg.

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 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 5 to 15 minutes for up to 3 doses, as needed.

Adverse Event Reporting

The Medical Site Leader will:

• Immediately report the adverse event to the VTOC.
• Record the incident in manner to be determined or required
• Report to VAERS Online or report using a PDF Form, including, but not limited to the following information:

1. Date and time of incident
2. Symptoms indicating need for initiating anaphylaxis procedures
3. Times, dosage, and site of medication given
4. Vital signs, including all blood pressure readings and times
5. Patient’s response
6. Medical Director’s or designee’s order/notification
7. Time and place patient was transported by paramedics and who accompanied, if applicable (parent, guardian, District personnel, etc.).

Staffing Model

The staffing model below is adapted from LA County Department of Public Health models. Staffing can be adjusted to meet the needs of each site, and may change over time. The model presumes that a school-based vaccination site has three vaccination stations, each staffed with a Vaccinator and a Vaccine Registrar, who work together and provide a 1:1 ratio of staff to screen/document and vaccinate. A three-station site has two Vaccine Preppers to prepare vaccine for dispensing, and one Runner to deliver prepared syringes to the vaccinators. Staffing is scaled based on the number of vaccine stations.

A fully staffed vaccination site includes the following full-time positions:

Health Care Roles:

• 1 Medical Site Leader
• 2 Vaccine Preppers (one as lead)
• 1 Vaccinator per vaccine station (3-station standard set up; one as lead)
• 1 Reaction Observer

A Vaccine Coordinator and Back-up Vaccine Coordinator must be designated from among qualified staff performing in other roles on site.

Non-Health Care (Logistician) Roles: 
Logisticians are non-medical staff who support in the following roles:

• 1 Site Support Leader (Site Leader from onsite COVID testing, if applicable)
• 1 Greeter
• 1 Gatekeeper
• 1 Vaccine Registrar per vaccination station
• 1 Vaccine Prep Runner
• 1 Observation Supporter

Staffing Reminder Highlights:

• Upon arrival at the vaccination site, staff are to check-in daily with the vaccination site supervisor/lead. Employees are responsible for daily time entry using the COVID 19 Vaccination Site Daily Sign in Sheet and submitting the completed forms to their regular time reporters.
• Vaccination site lead will ask current health screening questions found at http://www.lausd.org/covid19
  • If an employee answers "yes" to any screening question, they should be directed to return home and follow appropriate isolation/quarantine/illness procedures.
• Vaccination site lead will conduct the LA UNIFIED Daily COVID-19 Staff Briefing Checklist with staff for the first 20 minutes of each day.
• Employees should not have any direct contact with another person at any time.
• All personal valuables should be left at home. Items such as keys and wallets should be secured in pockets to maximize security.
• Employees must be aware of surroundings at all times. If something looks or seems suspicious, reports findings to the Site Lead immediately, or call 9-1-1.
• If students are present, staff must follow the District’s Code of Conduct with Students.
• Staff are to bring their own water, food and personal necessities. Communal amenities such as a refrigerator are not provided or to be used to reduce the chance of spread of infection. School site water fountains have been turned off to prevent communal use.
• Site staff are expected to comply with all Los Angeles County Public Health directives and other applicable health and safety guidelines.
  

Organizational Charts

This model was used to develop 6 template organizational charts that incorporate Incident Command System principles, including modular organization and manageable span of control.

Selecting an appropriate organizational chart depends on the variables listed above and vaccine administration field model utilized.