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NYSDOH Physician Guidelines Hurricane Sandy--Important Information


November 8, 2012

To: Physicians and Other Medical Practitioners

From: New York State Department of Health

HEALTH ADVISORY: Guidance on Immunizations, Vaccine Storage, Medical Records, Prescriptions, Diarrheal Illness and ServNY as a result of Hurricane Sandy

Please distribute to Physicians and Other Medical Practitioners

The purpose of the information below is to provide guidance to physicians and other medical practitioners in response to Hurricane Sandy including:

  • recommended immunizations for emergency responders, volunteers, and the public; documentation; billing and reimbursement
  • vaccine storage if power is lost
  • what to do if medical records are destroyed or steps to save wet medical records
  • prescription information if patientís pharmacy is not open or patient is a Medicaid member
  • potential increase in diarrheal illness
  • ServNY volunteers needed

Physicians and other medical practitioners with any additional questions should contact the Hurricane Sandy Provider Assistance Hotline at 1-866-544-1303.

IMMUNIZATIONS

1. Recommended Immunizations for Emergency Responders and Volunteers

To create these recommendations the New York State Department of Health (NYSDOH) utilized the Centers for Disease Control and Preventionís (CDC) Immunization Recommendations for Disaster Responders. This document can be found at: http://www.bt.cdc.gov/disasters/disease/responderimun.asp

Recommended immunizations for Hurricane Sandy adult emergency responders and volunteers are as follows:

  • Tetanus diphtheria toxoid and acellular pertussis (Tdap) or tetanus diphtheria toxoid (Td), if not up to date on the primary series or have not received a booster with Td or Tdap in the last 10 years. If history is unknown, Td or Tdap can be received without concern about the interval from the last dose. Tdap is preferred because of the additional protection conferred against pertussis.
  • Three appropriately spaced doses of Hepatitis B vaccine for persons who will be performing direct patient care or otherwise expected to have contact with bodily fluids. A booster for previously vaccinated responders or volunteers is not recommended, nor is Hepatitis B vaccine recommended for disaster responders or volunteers who do not have contact with human blood or bodily fluids.

There is no indication for the following vaccines given the anticipated conditions in the region:

  • Hepatitis A vaccine: There is a low probability of exposure in the United States (U.S.), even under these conditions. No transmission of hepatitis A from contaminated water has been identified in the U.S. since the 1980ís. Hepatitis A outbreaks have not occurred following other hurricanes or floods in other parts of the country, including the devastating hurricanes in Florida several years ago, Hurricane Katrina and the Midwestern floods of the late 1990ís. Even though the water and sewage systems are damaged or out of operation in many areas of New York State, the risk of a hepatitis A is extremely low. Vaccine will take at least one to two weeks to provide substantial immunity.
  • Typhoid vaccine: There is a low probability of exposure in the U.S., even under these conditions.
  • Cholera vaccine: There is a low probability of exposure in the U.S., even under these conditions, plus no licensed cholera vaccine is available in the U.S.
  • Meningococcal vaccine: There is no expectation of increased risk of meningococcal disease among emergency responders.
  • Rabies vaccine: There is no expectation of increased risk of rabies under these conditions. Persons who are exposed to potentially rabid animals should be evaluated and receive standard post-exposure prophylaxis, as clinically appropriate.

2. Recommended Immunizations for the Public

Local health departments and medical providers can offer Tdap or Td to members of the public who are concerned about their susceptibility to tetanus when repairing or cleaning homes or businesses.

For persons who are residing in congregate settings or shelters, influenza vaccine can be offered to all persons over the age of 6 months of age per the annual Advisory Committee on Immunization Practices (ACIP) recommendations available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm

3. Documentation

It is critical that all vaccines administered be properly documented. Immunization cards or records should be provided to individuals at the time of vaccination. Questions about immunization schedules, documentation, or procedures should be directed to the NYSDOH Bureau of Immunization at 518-473-4437.

4. Billing and Reimbursement Questions for Responder/Volunteer Immunizations

Questions about billing or reimbursement for vaccines provided to Hurricane Sandy responders or volunteers should be directed to the NYSDOH Bureau of Immunization at 518-473-4437.

VACCINE STORAGE

The following steps are recommended if a loss of power occurs to a vaccine storage unit:

  1. Keep all refrigerators and freezers closed during the power outage. DO NOT OPEN THE UNITS TO CHECK THE TEMPERATURE until power is restored.
  2. If possible continue to monitor temperatures of the refrigerator or freezer, but DO NOT OPEN THE UNITS to do this. If this is not possible, then record the temperature as soon as possible after power is restored. In addition, document the duration of the power outage. This will provide information about the maximum temperature the vaccine was exposed to and the duration of such exposure.
  3. Do not discard any vaccine.
  4. When power has been restored, clearly mark these vaccines and do not use them until you are able to consult with the vaccine manufacturers. Continue to store the vaccines at recommended temperatures in the event that they may still be viable.
  5. Call the vaccine manufacturers at their toll-free numbers for guidance about vaccine use: GSK 888-825-5249; Merck 800-672-6372; Sanofi Pasteur 800-822-2463; Pfizer 800-438-1985; Novartis 800-244-7668; and MedImmune 877-633-4411. For vaccine supplied by the NYS Dept. of Health notify the Vaccines for Children Program at 1-800-KID-SHOT (1-800-543-7468).
  6. If vaccine is determined to not be potent instructions will be provided about how to return the vaccine.

Information about managing vaccine storage during power outages is also available from the Centers for Disease Control and Preventionís web site at: www.bt.cdc.gov/disasters/poweroutage/vaccinestorage.asp

PRESCRIPTION INFORMATION

1. If your patientís pharmacy is not open:

  • If the patientís regular pharmacy is a business chain and their regular branch has been closed as a result of Hurricane Sandy, they should make every effort to visit the closest open branch of their regular pharmacy chain.
  • If the patientís regular pharmacy is NOT a drugstore chain and has closed as a result of Hurricane Sandy, they are being advised to contact their medical provider to have their prescription transferred to the nearest open pharmacy. If they can present reasonable evidence (labeled prescription vial, label receipt, etc. from a prescriber or a pharmacy in the affected area) that they were receiving a non-controlled substance from an inaccessible pharmacy, they may be provided with a limited quantity based upon the pharmacistís discretion.
  • If they have lost their prescription and need a replacement issued to the nearest open pharmacy, they are being advised to contact their medical provider.
  • If they do not have their prescription and are in need of maintenance medication, pharmacists may use their professional judgment to dispense limited quantities of non-controlled substances to patients who state they are in need of maintenance medications but have NO evidence such as a prescription vial, label or receipt.
  • If their primary care physician is unavailable, they should go to an urgent care or walk-in center to get new prescriptions issued. Patients are also advised not to go to an emergency department unless they have a medical emergency.

2. If your patient is a Medicaid member:

  • The patient should call their plan for any information regarding outstanding prescription benefits.
  • If they had a prescription filled from a pharmacy that is inaccessible due to the storm, they can obtain a new prescription/fiscal order from their prescriber or a refill of the prescription can be transferred to another Medicaid participating pharmacy.
  • If they are in need of new prescriptions/fiscal orders and are unable to access their prescriber(s), they should check with an urgent care or walk-in center to determine if they can provide new prescriptions. Patients should go to an emergency department only if they have a medical emergency.

MEDICAL RECORDS

1. Destroyed Medical Records

Legal Requirements for Record Retention. New York State Education Law section 6530(32) states that unless otherwise provided by law, physicians must maintain all patient records for at least six years. Obstetrical records and records of minor patients must be retained for at least six years, and until one year after the minor patient reaches the age of 18 years.

Similarly, Rules of the Board of Regents, 8 NYCRR section 29.2(a)(3), state that unless otherwise provided by law, non-physician health care practitioners must retain all patient records for at least six years. Obstetrical records and records of minor patients must be retained for at least six years, and until one year after the minor patient reaches the age of 21 years.

Department of Health regulations, 10 NYCRR section 405.10(a)(4), states that health care facilities (licensed under Public Health Law Article 28) must also retain medical records in their original or legally reproduced form for a period of at least six years from the date of discharge or three years after the patient's age of majority (18 years), whichever is longer, or at least six years after death.

Destroying Paper or Electronic Records. Before disposing of or abandoning medical records damaged due to the hurricane, the records must be rendered unusable, unreadable, or indecipherable. It is advised that an independent expert verify that the records are not salvageable. Health care providers should maintain evidence and documentation of the destruction and consult their attorney accordingly. Paper, film, or other hard copy records must be shredded or properly destroyed such that information that could be used to identify patients cannot be read or reconstructed.

Electronic health records damaged due to the hurricane must be cleared, purged or destroyed such that information that could be used to identify patients cannot be retrieved. It is advised that an independent expert verify that the records are not salvageable. Health care providers should maintain evidence and documentation of the destruction and consult their attorney accordingly.

Patient Requests for Records. Health care providers should maintain evidence and documentation of the destruction and be prepared to provide an explanation regarding the availability of the records to patients and other ďqualified personsĒ requesting patient information under Public Health Law section 18.

2. Saving Wet Medical Records

If medical records have been damaged by water, the following links from the Heritage Preservation and Conservation Center for Art and Historic Artifacts (CCAHA) websites may assist you in preserving these records.

Salvage wet books:
http://www.heritagepreservation.org/savewetbooks/index.html

Recovery methods: Freezing and drying
http://www.ccaha.org/uploads/media_items/ccaha-freezing-drying-techniques.original.pdf

Water damage preservation video:
http://www.heritagepreservation.org/PROGRAMS/WaterSegmentFG.HTM

DIARRHEAL ILLNESS

Increased incidence of diarrheal illness may occur following floods and situations where access to electricity, clean water and sanitary facilities are limited. In addition, usual hygiene practices may be disrupted.

The primary goal of treating any form of diarrhea -viral, bacteria, parasitic, or non-infectious - is preventing dehydration or appropriately rehydrating persons.

Please see CDC guidance at the following site: http://emergency.cdc.gov/disasters/disease/diarrheaguidelines.asp

Notify your local health department of any outbreaks or increased incidence of diarrheal illness with an onset date since October 30, 2012.

SERVNY: VOLUNTEERS NEEDED

ServNY is a registry of health care and mental health professionals who wish to volunteer during an emergency or major disaster. Your role as a volunteer will help ensure that people affected by a disaster will receive the public health and medical care needed.

If you are willing to volunteer your services during Hurricane Sandy response efforts, please go to the following site: https://apps.nyhealth.gov/vms/appmanager/vms/public

Physicians and other medical practitioners with any additional questions should contact the Hurricane Sandy Provider Assistance Hotline at 1-866-544-1303.


Posted 11-09-2012 at 2:52PM

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