Drive through clinics are not new to public health and provide quick and easy access to vaccinations for the public; however, drive though clinics are subject to weather hazards and safety concerns. Offering drive though clinics at a Fire/EMS stations offers an alleviation of both concerns, allows for EMS personnel to assist with clinics, and overall strengthens public health and public safety partnerships. Implementation consisted of serval phases to ensure a smooth implementation. Planning was conducted to develop a common operating picture, pre-registration and online appointments were utilized to streamline paperwork, and then the clinic was brought into operation.
During the planning phase, existing relationships with Fire/EMS Agencies were utilized. The Health District had weekly calls with public safety partners (EMA, EMS, Fire, and Law Enforcement) throughout the pandemic to discuss ongoing pandemic efforts. During one of these calls, the Health District described some initial plans to hold drive through clinics and expressed concerns with weather conditions, among other things. The Fire and EMS Chiefs on the call immediately offered their stations as a means to hold the drive through clinics, regardless of weather conditions, and in diverse locations. After this offer was made, Public Health officials visited the Fire/EMS stations and worked with Fire/EMS officials to design clinics using the bays of the stations. Once the clinic plan was agreed upon clinic maps and training documents were developed, distributed, and the clinic was ready to be activated. This planning allowed for Fire/EMS drive through clinics to start December 23, 2020; one day after vaccine was received by the Health District.
Pre-registration and appointments were required at all Fire/EMS drive through clinics. This increased throughput by limiting on site paperwork, ensured enough vaccine was available for each clinic, and allowed for the protection of the clinic site by only releasing location address information to those with appointments. Patients were told a region of the County when signing up for an appointment, but the exact address was not disclosed until the appointment was approved by Health District staff. Patient paperwork (e.g. consent forms) was estimated to add 10 minutes to each appointment; therefore, the Health District utilized an online form and approval process to eliminate this aspect of the appointment while the patient was physically at the Fire/EMS drive through clinic. Clinical staff would verify the information was correct with the patient on the day of appointment, but this reduced much of the time needed. Based on the number of appointments scheduled, clinical staff were able to bring the needed vaccine without worry of wastage. Because the form was web-based, this had the potential to create barriers to sign up. To reduce this barrier, the Delaware County District Library and SourcePoint (the local Agency on Aging) volunteered to assist those without internet access or difficulty using the system. Appointments were reserved for this population and the two agencies completed the registration for the patient over the telephone thus reducing internet/computer barriers.
General traffic flow included registration check, vaccination, and observation. Staff stationed at registration check were near the entrance of the location. Registration could be staffed by any personnel available. Registration would check the vehicle appointment cards (cards emailed prior to the appointment to the patient disclosing the location) upon arrival, allow those with appointment cards to enter the queue and turn away vehicles that came without an appointment. Once in the line vehicles would rely on traffic aids to navigate the queue. Driving towards a Fire/EMS bay is not natural for most people, therefore clear signage and traffic aids (e.g. cones, signs) were a key component of any clinic setup. Prior to releasing a vehicle into the queue, registration staff would supply the patient with a frequently asked questions document aimed to answer common questions while the patient was in line, preventing backups in the vaccination area. The vaccination area was the most controlled area of the clinic. This area was staffed by clinical personnel (nurses, EMTs, physicians, et cetera) inside the Fire/EMS bays. Multiple vehicles were accepted into a bay at a time. Vehicles were instructed to pull up as far as possible and another vehicle would be waived in behind them. As vehicles parked in the bay, the patient was asked to turn off the vehicle and the bay the doors were closed in the front and back until clinical staff released them to the next station. Once the vehicles were parked and turned off, the clinical staff approached the vehicle, verified the patient information, and gave the vaccination. For most patients, this was completed with the patient still in the vehicle, but chairs were available for those who needed to exit the vehicle. Once all vehicles in the bay were vaccinated the front bay door was opened and the vehicles were moved toward the observation area. Outside the bay, staff were stationed in observation to direct vehicles to appropriate parking and perform the post vaccine observation. Observation was staffed by any available personnel, but radios were utilized to provide immediate communication with clinical staff and EMS should a patient need assistance. In this area, the required observation time was completed, staff answered any final questions from the patients, and scheduled 2nd dose appointments, if applicable. Once the observation time had been completed, vehicles were released from the parking lot and exited the clinic. As these clinics required vehicles, a potential barrier existed for those without vehicles. To address this, Delaware County Transit provided free ride services to clinics for those who needed this assistance.
The implementation of the clinics required personnel from the Health District, Fire Department and/or Emergency Medical Services to work closely together to plan, coordinate, and ultimately execute the plan the day of the clinic. Health District and Fire/EMS staff worked closely together for months to accomplish the goal of vaccinating the community and built strong bonds for future collaborations. These partnerships facilitated collaboration after the Fire/EMS clinics were decommissioned, such as a partnerships to vaccinate home bound individuals and test public safety personnel.