Safe to Stick

     September 11, 2001, changed the way we view our safety and security. Prior to that day, contingency planning for weapons of mass destruction and large-scale mass-casualty incidents was not a priority. Small drills were run and mock disasters planned, but mostly without a sense of urgency. Over the years, media attention waxed and waned as reports of influenza outbreaks occasionally surfaced, only to fall back into obscurity. But with the attacks of September 11 and the events of the next few years—including continuing terrorist attacks on foreign soils and large-scale natural disasters like the 2004 Indian Ocean tsunami and Hurricane Katrina—both the government and the population at large began to realize the need for comprehensive disaster preparedness.

     The MEDICVAX study, completed by a consortium of EMS agencies in Pennsylvania in 1997, showed that large-scale immunizations are feasible.¹ The administration of vaccine in that study occurred at a variety of locations and included 10-minute observation periods in which no adverse effects were reported. No feasible plan for the long-term following of subjects was discussed. The MEDICVAX study also included provision for pre-administration education and practice dosing of intramuscular injections.

     This article describes research by which the authors hoped to demonstrate that paramedics can be safely utilized to provide mass immunizations in the event of an epidemic, pandemic or biologic event requiring mass prophylaxis.

     To test this idea, four licensed paramedics from three different EMS agencies administered intramuscular injections of the influenza vaccine to 125 hospital employees who presented for their yearly influenza vaccinations. For four weeks after the injections, the recipients were observed for complications. Their complication rate was then compared to the rate resulting from 1,600 injections given by hospital occupational health nurses with subsequent four-week observation periods.

     After four weeks of observation, none of the 125 study participants reported complications to their health as a result of the paramedic-administered influenza vaccines. There were also zero adverse reactions reported among the 1,600 injections administered by nurses. Accordingly, we conclude that the study, although limited in size, demonstrates that paramedic IM injections of a vaccine do not have a higher rate of complications than nurse IM injections, and paramedics can safely administer vaccines if mass immunizations are required.

     For our project, four state-licensed paramedics with varying levels of experience in direct patient care volunteered to give hospital employee influenza vaccine injections over a consecutive two-day period. Three of the paramedics were from two different surrounding ALS-transporting fire departments, and one was from the hospital EMS education department. The study participants were all adult hospital employees or hospital volunteers who presented freely during the work day for free immunizations available to all hospital employees.

     To keep the scenario as true to real life as possible, the paramedics received no new instructions on proper technique for intramuscular injections. No vaccine administration classes or teaching sessions were held—we relied solely on their previous experience and state-directed education on administering proper and safe intramuscular injections. Paramedics are allowed to administer vaccines in our state (Michigan) based on their scope of practice; this paper is therefore applicable only to those states in which paramedics' scope of practice includes IM injections.

     The paramedics were advised of the following exclusion criteria to screen patients for influenza vaccination: