To protect community residents from influenza, the Greater Grand Forks Immunization Coalition, Grand Forks Public Health and Altru Health System sponsored a Drive-Through Flu Clinic.Vaccine shortages and delays decreased influenza immunization rates in community residents. Other barriers included parking, appointments, long lines, and weather. This novel clinic eliminated barriers and enticed residents. "Neither snow nor rain, sleet nor hail, will keep us from vaccinating you in your automobile," became the motto.
“Take Highway 2 and Beat the Flu” fliers and a Volkswagen, the “Flu Bug,” directed residents to the vaccination site, encouraging them to “roll down their windows and roll up their sleeves.” Residents received their “Sunday donut” afterwards.
Public and private provider collaboration improved community trust. Nurses enjoyed the challenging new healthcare delivery method. In privacy and comfort, 467 residents, ages 2 through 93 years old were vaccinated in their automobiles. This clinic will become an annual community event.
The goal of the Greater Grand Forks Immunization Coalition is to have all residents protected from vaccine-preventable diseases. In the United States, influenza and its complications cause 36,000 deaths per year. The Drive-Through Flu Clinic was designed to address barriers to vaccination in the community for residents six months of age and older. Specifically targeted high-risk groups, as identified by the Centers for Disease Control and Prevention, included children six through twenty-three months of age, adults fifty through sixty-four years of age with underlying medical conditions, and the elderly sixty-five years of age and older. Objectives of the Drive-Through Flu Clinic were to decrease hospitalizations and deaths due to influenza and its complications, to prepare residents for the next influenza pandemic by increasing annual influenza vaccination rates, and to protect all residents from influenza through herd immunity.
The Drive-Through Flu Clinic was a novel way to give and receive healthcare services. It was the first clinic of its kind in Grand Forks and in North Dakota. It was the first time public and private providers staffed a community outreach clinic together. Nursing students from both North Dakota and Minnesota volunteered to vaccinate. The clinic eliminated barriers to vaccination as identified by all age groups. No appointments were necessary, no standing in long lines and no parking problems. Since the clinic could be held outside or inside the vaccination site, weather posed no problems.
Grand Forks Public Health is the lead agency for the Greater Grand Forks Immunization Coalition. Grand Forks Public Health served as a catalyst for this activity. Community partners were brought to the table. The novelty of this activity received immediate buy-in. It was decided that a collaborative clinic promoting the same message and presenting a united front would build trust and respect between providers and community residents. Grand Forks Public Health staff provided the vision, leadership, and organizational skills necessary for a successful clinic.
Public and private healthcare providers, Headstart nurses, and nursing students from a local university and border state technical college provided approximately fifty vaccinators. The city of Grand Forks donated its Public Works Facility for the vaccination site. The Police Reserves directed traffic. The Fire Department provided a first responder unit in the event of an emergency. A local grocery store donated seven hundred donuts.
Two local high schools provided students to assemble information packets, distribute clipboards, and serve donuts to the vaccinated. Parish Nurses promoted the Drive-Through Flu clinic in their churches. A car dealership donated the use of a lime-green Volkswagen to be used as the “Flu Bug.” A pharmaceutical company provided sweatshirts for volunteers. Several local businesses donated supplies to be used at the clinic. The hospital’s auxiliary provided lunch for the volunteers. Altru Health System’s visual arts department designed and produced clinic fliers. Grand Forks City and Altru’s public information officers developed the clinic’s media campaign. Individual volunteers served as photographers and gophers during the clinic.
The immunization coalition purchased $700 in medical supplies which was enough for 1000 people to be vaccinated. Grand Forks Public Health purchased the vaccine and was reimbursed through Medicare, Medicaid, and the vaccination fee. All other supplies and services were in-kind contributions. Proceeds were also donated to the coalition.
The Drive-Through Clinic will be evaluated by the total number of residents vaccinated, the number of vaccinated children 6 through 23 months of age, the number of vaccinated county residents who are Medicare eligible, and the number of county residents diagnosed with influenza.At the time of submission, there was limited evaluation data available because the influenza disease burden and Medicare vaccination rates for county residents will not have been complied after submission. In 2001, a trial drive-through clinic yielded 100 vaccinated residents. This small number was due in large part to the timing of the clinic and vaccine availability. The 2002 clinic described above boasts 467 vaccinated residents.
The Drive-Through Flu Clinic will become an annual event in this community. The majority of its support will be in-kind contributions. The Healthcare Agency supplying the vaccine will be reimbursed. The coalition will continue to purchase the medical supplies. The clinic will become the major fundraising activity for the coalition.
Public and private healthcare providers needed to address malpractice insurance and Workman’s Compensation issues. It was determined that each agency would provide insurance coverage for its own staff. All medical staff at the Drive-Through Flu Clinic needed to be paid for working in order to be covered under Workman’s Compensation.Fall weather conditions necessitated that the clinic site be able to be enclosed. The Public Works building had two drive-through bays, which could accommodate up to twenty vehicles at a time. The building’s air exchange system was capable of eliminating carbon monoxide buildup.
Another challenge for the Drive-Through was deciding which day would be best attended. After much discussion, Sunday was chosen. The health department collaborated with area churches and the Parish Nurse Program to spread the immunization message.
Radios were used for communication among clinic workers. Multi-colored, helium-filled balloons on long strings were used to identify vaccination stations. Vaccine and medical supplies were placed on rolling carts to allow access to both sides of each vehicle. A blueprint of the clinic site and matchbox cars was used to decide clinic set-up. Residents were given vaccination information and consent forms on clipboards outside the facility. Upon entering the building, up to ten “cars” at a time were screened, educated and payment process determined; while ten additional “cars” were vaccinated. It was determined to move blocks of vehicles to avoid accidents.
The clinic vaccinated residents nine years of age and older because it was the first drive-through and younger children require more time when administering vaccine. However, there would be no missed opportunities so anyone who was six months of age or older was vaccinated. Pneumoccocal vaccine was administered to qualifying residents so as not to miss those opportunities.
The minimum elements to support a Drive-Through Flu Clinic for 1000 residents include: six weeks planning and preparation time to determine date, site and clinic logistics, design a media campaign, train and educate medical staff, recruit volunteers; five hours actual clinic time, 50 medical volunteers to vaccinate, draw vaccine, and screen; 20 non-medical volunteers to control traffic, respond to emergencies, perform administrative duties, prepare vaccine information packets, distribute clipboards, serve donuts, open garage doors, be gophers; policies for malpractice insurance, workman’s compensation, agency responsible for nursing students; resources to purchase vaccine and medical supplies; and in-kind support from the community to furnish other supplies and services.