San Diego Medics Reach Out With Vaccinations
Nov. 03--Over the last three weeks a three-person team of San Diego paramedics has delivered 81 vaccinations in locations as diverse as Balboa Park canyons and downtown hotels.
Acting under special dispensation from the state, the team helps extend a long-running campaign of foot-team vaccinations conducted by nurses who work for the county health department in an effort to stop the spread of the city's hepatitis A outbreak which saw its death total hit 20 this week.
Standing on a city sidewalk on a recent morning, Capt. Michael De Guzman said that the experience has been singularly different than what he has experienced throughout his career.
Usually, he said, paramedics are called after a medical problem has occurred. Someone has fallen down due to a heart attack or asthma or a gunshot wound, and paramedics arrive to stabilize the patient and transport them to a hospital.
But in this case, paramedics are taking preventive action.
"Getting to reach out ahead of time, for me that has been pretty cool," De Guzman said.
State law usually does not allow paramedics to vaccinate their patients. But, on Oct. 4 under an emergency request from the county, the California Emergency Medical Services Authority granted a temporary expansion of paramedics' scope of practice, allowing them to administer hepatitis A vaccine while the outbreak continues.
To date, the city has only one paramedic team, made up of De Guzman, Capt. Cory Beckwith, a paramedic and Capt. Jodie Pierce, a paramedic and registered nurse.
It is Pierce's presence on this team that allows it to do its work. The temporary extension of vaccination powers requires oversight by an R.N. even though everyone involved knows very well how to give shots and each has received four hours of training from the health department in how to maintain the vaccine, which must be kept cold at all times, and in how to check and update the county's electronic vaccination registry.
Paramedic vaccination is not unheard of, though it is rare. In 2009, when the H1N1 flu virus caused a global pandemic, some paramedics were temporarily authorized to administer vaccine once it had been developed. Paramedics have also worked to deliver vaccinations after several recent hurricanes.
Dr. Vincent Mosesso, medical director of emergency medicine at at the University of Pennsylvania Medical Center, did a flu-vaccination trial in 2003 involving 73 different events. No adverse reactions were reported, and Mosesso said that paramedics have proven useful in situations where a public health threat necessitates a broad response.
"It's sort of like a mini-army that you can mobilize, and it's an important component of a mass vaccination effort," Mosesso said.
It's important, he said, for paramedics to watch for adverse vaccine reactions after vaccines are administered, and it's important to keep accurate records of who got what when. Maintenance of vaccine supply is another important part of the process, but, as long as there is appropriate training on these matters, paramedics have no trouble doing the work.
But he added that it is not clear that nurses are necessary to directly supervise the work of paramedics. In his 2003 trial, he said, physicians and nurses designed and delivered training, but paramedics were free to head out into the community and deliver doses on their own.
"We never even conceived of having nurses involved at that level. That would seem to defeat the purpose of being able to dramatically and quickly increase the number of health providers who can conduct vaccinations," Mosesso said.
Dr. Kristi Koenig, director of the San Diego County Emergency Medical Service, said Friday that the nurse requirement came from the state. And she said that, even with the requirement that a nurse be involved, having paramedics able to administer hepatitis A vaccinations does quickly multiply the number of hands that can get the work done.
"We're certainly seeing more vaccine does, but we also clearly want to comply with all of the state requirements," Koenig said.
At this point in the vaccination campaign, the paramedic team is focusing on group-living facilities scattered across the city. Many of them, such as single-room occupancy hotels and transition homes, have been visited several times by county foot teams or other vaccination workers.
Here, said De Guzman, the paramedic captain, is where his team shines. In a 27-year career, he said, he and his colleagues have learned to talk to people out in the community and assuage their concerns about various medical treatments. At this phase in the vaccination campaign, many have already said no to the hepatitis A vaccine several times, and the job is to eventually convince them to roll up a sleeve.
Flashing a toothy smile, De Guzman said there is a little selling in this job.
"As we're returning to some of these places, we're marketing our product and closing the sale," he said.