8. Clinic Flow Diagrams

The following diagrams show patient treatment pathways through two different clinics, one for antibiotic dispensing in response to a non-communicable biological agent like anthrax, the other for vaccination for a communicable agent like smallpox. These diagrams detail the possible routes and associated stations through which an individual may travel. These are not physical layouts (for a sample physical layout of a smallpox vaccination clinic, see the next page). Circled letters refer to Event Scenarios/Population Proportions listed in Section 7: Summary of Scenarios. NOTE: For certain biological agents (e.g., pneumonic plague), elements of both clinic designs may be needed (with plague, this would include both antibiotic dispensing and contact precaution in the dispensing clinic). For these cases, planners should evaluate BERM outputs for both clinic types in formulating multi-hazard response plans.

1. Clinic Flow Diagram for Non-Communicable Agent (e.g., Anthrax)

A compilation of previously published plans from around the country, including Washington, D.C., New York City, California, and Florida. Patients arrive and are screened for visible signs of illness; those who are ill are sent to medical evaluation (A). The remaining patients are given any necessary forms and undergo triage, at which time they are sent to medical evaluation (B), mental health/crisis counseling (D) or patient briefings. A certain proportion of patients who undergo medical evaluation come back through the briefings, as well (C). Patients who are seriously ill are transported to hospital or other medical care facilities. Those who finish briefings are sent to the drug triage area where appropriate decisions are made regarding dispensing or vaccination. Uncomplicated cases may go to express drug dispensing tables, while complicated cases may require assistance of pharmacists or other health professionals. Prior to exit all forms and paperwork are collected in designated areas.

2. Clinic Flow Diagram for Communicable Agent (e.g.: Smallpox Vaccination)

Figure two shows the more complex Weill-Cornell Model Smallpox Vaccination Patient Flow Plan (copyright Weill Medical College of Cornell University, which can be adapted for use with other communicable disease agents and for non-vaccination dispensing campaigns. As with the previous figure, patients are greeted at the door of this clinic by screeners who ask is anyone is symptomatic or had contact with an affected individual. Those who are symptomatic or are suspected contacts are sent to a contact precaution area that is separate from the main area of activity in order to minimize the risk of contagion. Patients in the main (non-contact precaution area) are given any necessary forms and undergo briefings and triage. Clinics may offer testing including pregnancy and/or rapid HIV testing depending on the event, response, and availability of supplies and staff to perform tests. Written consent and vaccinations may need to be witnessed. Clinics may offer crisis/mental health counseling on site. Prior to exit, patients receive counseling on vaccination site care and/or follow-up and turn in forms. Patients in the contact precaution area are immediately taken to medical evaluation at which point they are classified as seriously ill requiring transfer to a hospital or other medical care facility, a suspect case or contact, or not a suspect case or contact. Patients in the latter two categories are then given necessary forms, briefings, triage, testing, vaccination or other dispensing, and exit counseling much like patients outside of the contact precaution area. One major difference is that suspected cases or contacts who refuse prophylactic medications or vaccinations may be placed in isolation depending on the setting and applicable public health regulations. The diagram includes special isolation counseling for these individuals

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