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User Help Page

The information contained on this page is written to aid the user both in data input and in understanding output data.

1. User Inputs The information provided on this page provides the basis for the model calculations. Changes in these inputs can be made at any time; these changes will impact the model outputs to varying degrees. The patient flow estimate (section III.1.) is critical in determining total number of clinics, total staff per clinic, and staff per station. Either method can be used and, regardless of method, the flow refers to the average flow over a period of time. Increasing flow will require more staff per clinic and more staff per station but fewer clinics. Again, this estimate can be changed at any point and will significantly impact the output. Finally, because the number of variables needed in this model (e.g.,station process times; population percentages), a number of assumptions have been made and grouped into "process time scenarios" and "event scenarios" to simplify user inputs. These assumptions can be viewed in Section 7:Summary of Scenarios.	Return	Bottom of Page
2. OVERALL MODEL OUTPUTS (CAMPAIGN AND CLINIC STAFFING) Presented here are estimates of total core staff per clinic and for the entire campaign. These calculations assume that all clinics in the campaign are identical—that each contains the same flow layout, the same stations, and operates for the same period of time (as determined in Section 1.User Inputs). Only the "core staff" is calculated. This is defined as those staff involved in direct patient contact at each Station within the clinic. Core Staff include: greeters; forms distributors and collectors; triage personnel; medical evaluators; counselors and testers (if applicable); transporters; and vaccinating or drug distributing personnel.	Return	Bottom of Page
3. STATION-SPECIFIC CLINIC STAFFING These are the "core" staff per station involved in direct patient contact. The particular stations within the clinic of this model are derived from published local plans, simulation exercises, and Weill Medical College of Cornell research. Additionally, Counseling and Testing (for pregnancy and/or HIV) may or may not be included as determined by the User Inputs. The particular placement of Medical Doctors, Nurses, and other Allied Health personnel is NOT calculated and left up to the discretion of local planners and available resources. The maximum number of core staff per clinic is an estimate derived from the physical limitations of the specific clinic (e.g., a basketball court). If the maximum number of core staff is less than that determined in the above section, the clinic will need to operate under a slower patient flow rate and the campaign will need to incorporate an increased number of clinics.	Return	Bottom of Page
4. SUPPORT/ANCILLARY STAFF CALCULATIONS: Rather than having a fixed number, this model calculates most support staff as a ratio to core staff. The user can determine the ratio of core staff to support staff (in most cases, this will be greater than 1, meaning a single support staff can serve more than 1 core staff). This ratio is based on a per shift, no downtime estimate of core staff. Additionally, a number of core staff, particularly those in managerial positions, are simply entered by the user and are thus fixed. The total support staff is thus calculated for one shift and assumes no downtime (i.e., 100% utilization)	Return	Bottom of Page
5. SUMMARY OF MODEL RESULTS These results are based on the User Inputs and present the core, support, and combined staff estimated per clinic and for the entire campaign. These estimates are functions of the many variables within the model, most importantly the flow rates (of the campaign and per clinic) and the station process time estimates. Thus, these staff estimates are meant to serve as a guide and point of reference for planners rather than as an absolute value.	Return	Bottom of Page
6. CAMPAIGN MODIFICATIONS DUE TO STAFFING CONSTRAINTS Planners may be aware of the maximum number of core staff available for a campaign. This number may be less than that recommended by the model outputs (as calculated from information provided in the User Inputs) and may thus affect the expected number of patients that can be processed and/or the duration of the campaign. The calculations contained in this section incorporate both number of shifts and downtime and estimate a) the expected total number of people to be processed by a campaign with the maximum number of core staff; and b) the number of days to process the initial population (from the User Inputs) by the maximum available core staff. Suggestions to achieve the campaign goals despite core staff limitations are offered; they include increasing the operating hours of each dispensing clinic (thus the work hours of each staff) and decreasing the station process times (e.g., shortening the length of the form).	Return	Bottom of Page
8. FLOW DIAGRAMS The anthrax model flow plan is based on a number of publicly available state plans, live exercises, and Weill Medical College of Cornell research. Because the disease is considered non-communicable (for purposes of mass prophylaxis) and the recommended treatments are to be used "on-label", the flow plan is relatively straight-forward. Smallpox is significantly more complex; therefore, flow design is broadly divided into pre-event and post-event scenarios. In the diagram (Part 2), stations, spoken text, and annotations in grey (located on the right in the diagram) would be used in a post-event scenario only. All other stations are used in both pre- and post-event settings. Pre-Event Patient Flow In a pre-event mass vaccination campaign, only the stations in the left-hand and center portion of this flow diagram would be used (i.e., only the un-shaded portion). All persons entering the vaccination center would be met by a greeter/screener and asked if they felt acutely ill (any positive response in this pre-event setting would indicate a non-smallpox intercurrent illness like acute asthma , myocardial infarction, acute panic, etc.). These symptomatic patients would be taken immediately to the medical evaluation area where health care professionals would assess the severity of symptoms and the likelihood of a serious underlying medical condition requiring further medical care. No uniform respiratory precautions would be needed for these symptomatic patients in a pre-event scenario. Acutely ill would be offered transportation to a medical care facility, while those with a negative medical evaluation either would be sent back through the standard processing line or would be sent to a duplicate set of stations with smaller staff in a separate area for symptomatic patients. Next, all potential vaccinees would be given forms and the means to fill them out (i.e., a writing instrument and either a clipboard or a tabletop on which to write). These individuals then would be directed to briefing areas where either videotaped or live briefings would take place with the opportunity for questions. At the briefing, persons with no self-identified contraindications to vaccination would be given the opportunity to sign the informed consent declarations for receipt of the vaccine, witnessed by the person sitting next to them. Individuals would exit the briefing area to the triage area, where persons with no contraindications would have their paperwork reviewed and approved and those with potential contraindications would be further questioned. From the triage station, rapid testing for pregnancy and/or HIV may be offered to those interested or those uncertain about their status. A certain percentage of persons may be denied vaccination due to contraindications or may decline vaccination due to personal weighing of its risk/benefit ratio. Others will proceed to vaccination stations where those who have not yet signed their consent form may do so and have it witnessed. Prior to exiting the vaccination center, individuals would proceed to the form collection and exit counseling station where clinic staff would reiterate key points of vaccination site care and would check completeness of forms for data entry (not shown on the diagram). At any point in proceeding from entry to exit, patients will have the opportunity to go to the mental health/crisis counseling station located on-site. Those persons who opt for counseling will have the option to re-enter the vaccination patient flow at the next appropriate station. Post-Event Patient Flow In a post-event setting, all symptomatic individuals and those who may have come in contact with a smallpox case would be physically separated from the main patient flow at the earliest possible station. This would be accomplished though use of the grey-shaded comments and stations on the flow diagram. The purpose of separating the processing of non-contact and “presumed contact” individuals is to minimize the potential exposure of healthy vaccine recipients to individuals with possible smallpox exposure or infection. As in the pre-event clinic operation, entry screeners would ask all individuals walking through the door whether they feel ill. In the post-event setting, these screeners would also ask whether individuals believe they may have been exposed to someone who has smallpox. Anyone responding to either question in the affirmative would be sent to the presumed contact area and would be instructed to put on an N95 mask to reduce the possibility of droplet transmission of the smallpox virus. These individuals would then undergo screening at the medical evaluation station where detailed questioning about symptoms and exposures and, if needed, an abbreviated physical examination can be performed. As shown in the diagram, these patients would be classified into one of four categories: 1. An acute non-smallpox illness such as myocardial infarction that would require immediate transport to a health care facility (labeled “CRITICAL” in the diagram) 2. A subacute illness that is not suggestive of smallpox and does not require immediate transport to a health care facility, or no significant illness 3. An illness syndrome that is suggestive of smallpox (e.g., fever and/or severe backache and/or rash) 4. Likely exposure to a case of smallpox Once sent to the presumed contact area, individuals in all four categories remain there and continue wearing a mask as they undergo briefing, vaccination, and exit counseling. Upon exit from the clinic, only those individuals with suspected smallpox or contact would be encouraged to maintain use of the mask until they reach a treatment or domiciliary facility as recommended by the CDC. These facilities may range from designated health care centers to the individual's home. Since there are no absolute contraindications to vaccination for presumed cases or contacts, predetermined protocols will be required to manage individuals in these categories who decline vaccination. Since under evolving federal and state protocols these unvaccinated patients may be required to undergo quarantine for a specified period of time, the clinic design includes a station for counseling and administrative processing of these individuals.	Return	Bottom of Page
9. SAMPLE PHYSICAL LAYOUT OF SMALLPOX VACCINATION CLINIC The floor plan diagram shows how the model smallpox clinic described here can be fit into the area of a typical high school basketball court, a possible site for clinic activities in the event of a large-scale prophylaxis campaign. Note that the presumed contact area, including a separate smaller briefing station, is physically distinct from the non-contact areas. This floor plan shows only one large briefing area in the non-contact area located on the court, although more could be set up in adjacent rooms. Vaccine preparation, data entry, and clinic supplies also may require use of adjoining rooms or staging areas. The floor plan is just one example of how to translate the patient flow plan into a blueprint for setting up a smallpox vaccination clinic. Situating the clinic in a confined space like a basketball court necessarily constrains the total number of staff working at the clinic at any given time.	Return	Bottom of Page

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