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Fri, 20 Dec 2002 10:34:46 -0800

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K

You are, as usual, 100% on the mark.  We have 'chosen' to make the
vaccination not only voluntary but also confidential!  I'm still trying to
figure out how someone is going to staff Trauma/Burn/ED and make certain you
have vaccinated staff onhand to screen any possible smallpox patients, when
no one is supposed to know who was/wasn't vaccinated.  And, we are one of
the sites that has requested nearly 200 doses.  Still don't know how we are
going to backfill the 25-30% of the ED staff who get the vaccine but then
get side effects that keep them from coming to work.

The horse is out of the barn and we are still discussing how to latch the
door!!

Greg Prouty

UC Irvine Medical Center

-----Original Message-----
From: KMATTOX@aol.com [mailto:KMATTOX@aol.com] 
Sent: Friday, December 20, 2002 7:54 AM
To: trauma-list@trauma.org
Subject: Re: Small Pox Vaccine, A New Question?

In my view, we have put the cart before the horse.   The public health
infrastructure should have been put into place prior to a Band-Aid approach.
We have basically asked each hospital to come up with a list of 50-100
persons in that hospital to receive a voluntary vaccination, to be
administered in a two week window by the local public health agency.   WHY?
What is the problem for which this is the solution?   If it is to protect a
community, there is are other questions that have to be answered first.  How
credible is the threat?   If there is a smoking gun of a small pox threat,
then tell the world, please, PLEASE and tell us sooner, rather than later.
Second,  what is the education of the public going to be to tell them what a
small pox case looks like and if they suspect that they have the di! sease,
or if an emergency room triage nurse thinks there is a case, the BEST thing
for the hospital and community would be to tell the patient to leave the
hospital and go to a single regionally designated facility for diagnosis and
if the diagnosis is positive, then go to the regional (NOT ONE OF THE
VALUABLE HOSPITALS) contagion for quarantining the patient.   Most states do
not even have a quarantine law in place.    

Third,  we have forced the least qualified facilities to come up with their
own small pox plans (the local hospitals) and these plans will ALL be
different.   There needs to be a public health lead,  meeting of the area
hospital administrators and chiefs of staff to receive a recommended, data
driven, public health plan.   Such is not in existence in any realistic
form.    

Fourth, if one is to protect the medical treatment force of large hospitals
in the nations cities, one could easily make an argument that they should
receive either NO vaccinations or a minimum of 1000 vaccinations.    

The issues of what vaccinating a group of hospital employees and doctors in
a two week window is going to do to the families and patients they are going
to continue to treat has not fully been answered.   This MUST be addressed
in the staging of the administration of vaccinations.    

I have not even brought up the issue of potential side effects of the
vaccine.  That is a totally different concern.   

My concern is the lack of a formalized standardized approach from the public
health standpoint.   Too many unanswered questions exist.   I would plead
that at the highest level, the public health systems of our nation, states,
and regions, provide us with information and leadership.    

Already on the web news services we are receiving conflicting information
and confusing effects of this voluntary program.   At least three of the
largest and most prestigious hospitals in the country have stated publicly
that NO ONE in their hospital is going to be vaccinated.     Other hospitals
have stated that the number of volunteers who want the vaccine far exceed
the 100 doses they will be receiving.    Interesting discordant approaches.

k

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<p class=MsoNormal><font size=2 color=navy face=Arial FAMILY=SANSSERIF><span
style='font-size:10.0pt;font-family:Arial;color:navy'>K</span></font></p>

<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>You are, as usual, 100% on the mark.&nbsp;
We have 'chosen' to make the vaccination not only voluntary but
also confidential!&nbsp; I'm still trying to figure out how someone is
going to staff Trauma/Burn/ED and make certain you have vaccinated staff onhand
to screen any possible smallpox patients, when no one is supposed to know who
was/wasn't vaccinated.&nbsp; And, we are one of the sites that has
requested nearly 200 doses.&nbsp; Still don't know how we are going to
backfill the 25-30% of the ED staff who get the vaccine but then get side
effects that keep them from coming to work.</span></font></p>

<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>&nbsp;</span></font></p>

<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>The horse is out of the barn and we are
still discussing how to latch the door!!</span></font></p>

<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>&nbsp;</span></font></p>

<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Greg Prouty</span></font></p>

<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>UC </span></font><font size=2 color=navy
  face=Arial><span style='font-size:10.0pt;font-family:Arial;color:navy'>Irvine</span></font><font
 size=2 color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
 color:navy'> </span></font><font size=2 color=navy face=Arial><span
  style='font-size:10.0pt;font-family:Arial;color:navy'>Medical</span></font><font
 size=2 color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
 color:navy'> </span></font><font size=2 color=navy face=Arial><span
  style='font-size:10.0pt;font-family:Arial;color:navy'>Center</span></font></p>

<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>&nbsp;</span></font></p>

<p class=MsoNormal style='margin-left:.5in'><font size=2 face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma'>-----Original Message-----<br>
<b><span style='font-weight:bold'>From:</span></b> KMATTOX@aol.com
[mailto:KMATTOX@aol.com] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Friday, December 20, 2002
7:54 AM<br>
<b><span style='font-weight:bold'>To:</span></b> trauma-list@trauma.org<br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: Small Pox Vaccine, A
New Question?</span></font></p>

<p class=MsoNormal style='margin-left:.5in'><font size=3 face="Times New Roman"><span
style='font-size:12.0pt'>&nbsp;</span></font></p>

In my view, we have put the cart
before the horse.&nbsp;&nbsp; The public health infrastructure should have been
put into place prior to a Band-Aid approach.&nbsp;&nbsp; We have basically
asked each hospital to come up with a list of 50-100 persons in that hospital
to receive a voluntary vaccination, to be administered in a two week window by
the local public health agency.&nbsp;&nbsp; WHY?&nbsp;&nbsp; What is the
problem for which this is the solution?&nbsp;&nbsp; If it is to protect a
community, there is are other questions that have to be answered first.&nbsp;
How credible is the threat?&nbsp;&nbsp; If there is a smoking gun of a small
pox threat, then tell the world, please, PLEASE and tell us sooner, rather than
later.&nbsp;&nbsp;&nbsp; Second,&nbsp; what is the education of the public
going to be to tell them what a small pox case looks like and if they suspect
that they have the di! sease, or if an emergency room triage nurse thinks there
is a case, the BEST thing for the hospital and community would be to tell the
patient to leave the hospital and go to a single regionally designated facility
for diagnosis and if the diagnosis is positive, then go to the regional (NOT
ONE OF THE VALUABLE HOSPITALS) contagion for quarantining the
patient.&nbsp;&nbsp; Most states do not even have a quarantine law in
place.&nbsp;&nbsp;&nbsp; 
 
Third,&nbsp; we have forced the least qualified facilities to come up with
their own small pox plans (the local hospitals) and these plans will ALL be
different.&nbsp;&nbsp; There needs to be a public health lead,&nbsp; meeting of
the area hospital administrators and chiefs of staff to receive a recommended,
data driven, public health plan.&nbsp;&nbsp; Such is not in existence in any
realistic form.&nbsp;&nbsp;&nbsp; 
 
Fourth, if one is to protect the medical treatment force of large hospitals in
the nations cities, one could easily make an argument that they should receive
either NO vaccinations or a minimum of 1000 vaccinations.&nbsp;&nbsp;&nbsp; 
 
The issues of what vaccinating a group of hospital employees and doctors in a
two week window is going to do to the families and patients they are going to
continue to treat has not fully been answered.&nbsp;&nbsp; This MUST be
addressed in the staging of the administration of
vaccinations.&nbsp;&nbsp;&nbsp; 
 
I have not even brought up the issue of potential side effects of the
vaccine.&nbsp; That is a totally different concern.&nbsp;&nbsp; 
 
My concern is the lack of a formalized standardized approach from the public
health standpoint.&nbsp;&nbsp; Too many unanswered questions exist.&nbsp;&nbsp;
I would plead that at the highest level, the public health systems of our
nation, states, and regions, provide us with information and leadership.&nbsp;&nbsp;&nbsp;
 
 
Already on the web news services we are receiving conflicting information and
confusing effects of this voluntary program.&nbsp;&nbsp; At least three of the
largest and most prestigious hospitals in the country have stated publicly that
NO ONE in their hospital is going to be vaccinated.&nbsp;&nbsp;&nbsp;&nbsp;
Other hospitals have stated that the number of volunteers who want the vaccine
far exceed the 100 doses they will be receiving.&nbsp;&nbsp;&nbsp; Interesting
discordant approaches.&nbsp; 
 
k

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