Local health departments and community organizations work with paramedics to provide flu vaccine to homebound individuals

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In Brief

Oregon’s "Taking H1N1 Vaccination to Vulnerable Populations" pilot project utilized nontraditional vaccinators, specifically paramedics affiliated with local ambulance services, as a strategy to improve influenza vaccination rates among homebound seniors and people with disabilities. Collaboration between local health departments, community-based organizations, and emergency medical service agencies provided flu vaccine to homebound individuals during a five-county pilot project in Oregon.


Each year, on average, some 5% to 20% of United States residents become ill from seasonal flu, and more than 200,000 people are hospitalized for flu-related complications. Most people will have mild illness; however, some individuals are at an elevated risk for developing flu-related complications, including adults 65 years of age and older and people who have certain medical conditions (eg, weakened immune system, heart disease, chronic lung disease). A challenge providing vaccine to many vulnerable people is being able to reach them.

Specific issue

Vulnerable populations do not have the same access to influenza immunizations and the H1N1 vaccine as the general population due to mobility, outreach, and communication barriers.

The practice

The "Taking H1N1 Vaccination to Vulnerable Populations" pilot project demonstrates that utilizing paramedics and ambulance services to vaccinate homebound/vulnerable populations can be an effective way to reach an otherwise hard-to-reach patient population.

In February 2010, the Oregon Department of Human Services Public Health Division formed a steering committee to discuss piloting a mobile vaccinator program. The agency invited members from the state’s immunization program, emergency medical services, and ambulance association.

The committee determined that commitment from three essential partners was needed for a successful program:

  1. An emergency medical services provider agency, ready and prepared to take on the role of scheduling vaccinations and deploying paramedics to provide immunizations 
  2. A local health department
  3. A local advocacy group, capable and supportive of providing outreach to an eligible homebound/vulnerable population


The committee considered all 36 counties in Oregon and narrowed the pilot down to five counties based on interest and commitment from the three essential partners listed above. The selected counties represented over 46% of the total H1N1 patients hospitalized and 34% of the deaths statewide in 2009.

After selecting the pilot counties, additional stakeholders were added to the steering committee to work on project development, including representatives from the county health departments, seniors and persons with disabilities community, and the local university. At this point committee members assigned a project coordinator who assembled a project agency resource manual covering all technical details for emergency medical services agencies and paramedics to follow, reviewed the manual with each agency, and conducted a site visit for quality control.

A work team was created in each county, consisting of representatives from the ambulance service, county health department, state public health, state ambulance association, and seniors and persons with disabilities community. The county teams held biweekly conference calls to monitor planning progress. Operational planning and training took approximately 4 weeks before the first immunization.

Community-based organizations, such as Meals on Wheels, were identified in each county by the seniors and persons with disabilities representative to distribute information to homebound clients about the program and how to sign up for a vaccination.

Three workflow models were utilized by emergency medical service agencies across the five counties, depending on the local infrastructure. Based on what county they were in, potential clients:

  1. Called the dispatch center and the call taker scheduled appointments 
  2. Called the State of Oregon Flu Hotline, which then referred the caller to the emergency medical services agency for scheduling an appointment
  3. Left a message with the business office of the emergency medical services agency, after which a paramedic coordinator returned calls for scheduling

All call takers screened for medical eligibility before sending staff to an appointment. After scheduling an appointment, all counties followed the same procedure: sending a paramedic, asking screening questions, administering the vaccine, and completing a survey during the 15-minute period in which vaccine recipients waited to assure they had no adverse reaction. Paramedics maintained a log book that included route times, arrival, location, and mileage.

What made this practice possible?
  • Relationship building and significant commitment among diverse partners and work groups created the foundation for the practice.
  • Assigning a project coordinator at the state level was key for managing and coordinating the project.
  • Developing county teams and assigning roles was instrumental in fostering good communication within the counties and back to the core steering committee.
  • A small steering committee allowed the project to start up faster; however, some stakeholders felt that they should have been brought into the planning process earlier.

Project partners reported that the collaboration was a positive experience that successfully reached homebound individuals and built commitment for future community health collaborations.

  • The collaboration demonstrated diverse agencies and organizations working together positively on community health initiatives.
  • Distributing flyers through community-based organizations, such as Meals on Wheels, Food for Friends, the Council of Governments, and the Agency on Aging worked well and will likely be used for future distributions of information.
  • 70 individuals met the criteria and were vaccinated during the pilot project.
  • Results from the survey completed during the 15-minute wait period showed that lack of availability of vaccine presented the single greatest barrier to initially being vaccinated for H1N1. The next greatest barrier to being vaccinated was lack of transportation, either from being homebound or not having transportation assistance.

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