Perceived and Received Support by Academic Medicine Faculty During the COVID-19 Pandemic: A Single Institution Study.

OBJECTIVE: The COVID-19 pandemic negatively impacted healthcare worker well-being, leading to increased burnout and decreased workplace engagement. To combat expected stressors from the pandemic, our mid-sized academic health center implemented numerous institutional support, such as town halls, and virtual support groups. This study aimed to evaluate faculty utilization of institutional support, its association with perceived organizational support, received organizational support, and burnout. METHODS: A retrospective, cross-sectional survey was distributed to 630 faculty employed at our institution in September 2020, assessing participant demographics, institutional support utilized, perceived organizational support, and burnout, through a combination of self-report measures and qualitative responses. RESULTS: A total of 79 (12.5%) faculty provided complete responses and were included in the analysis. Qualitative analysis identified 4 primary themes: (1) flexibility and adjusted expectations, (2) direct communication, (3) sense of community, and (4) no support felt, with additional subthemes within each larger theme. Increased utilization of institutional support was associated with decreased odds of experiencing burnout. CONCLUSION: Flexibility, communication, and sense of community emerged as important strategies for maintaining faculty well-being and engagement during the early stages of the COVID-19 pandemic. This study suggests that utilization of workplace support is protective against burnout. Perceived support was not beneficial.

Computational modeling of first responders' willingness to accept radiation exposure during radiological or nuclear events.

Since the events of 9/11, a concerted interagency effort has been undertaken to create comprehensive emergency planning and preparedness strategies for the management of a radiological or nuclear event in the US. These planning guides include protective action guidelines, medical countermeasure recommendations, and systems for diagnosing and triaging radiation injury. Yet, key areas such as perception of risk from radiation exposure by first responders have not been addressed. In this study, we identify the need to model and develop new strategies for medical management of large-scale population exposures to radiation and examine the phenomena of radiation dread and its role in emergency response using an agent-based modeling approach. Using the computational modeling platform NetLogo, we developed a series of models examining factors affecting first responders' willingness to work (WTW) in the context of entering areas where radioactive contamination is present or triaging individuals potentially contaminated with radioactive materials. In these models, the presence of radiation subject matter experts (SMEs) was found to increase WTW. Degree of communication was found to be a dynamic variable with either positive or negative effects on WTW dependent on the initial WTW demographics of the test population. Our findings illustrate that radiation dread is a significant confounder for emergency response to radiological or nuclear events and that increasing the presence of radiation SME in the field and communication among first responders when such radiation SMEs are present will help mitigate the effect of radiation dread and improve first responder WTW during future radiological or nuclear events.

Modifications to student quarantine policies in K-12 schools implementing multiple COVID-19 prevention strategies restores in-person education without increasing SARS-CoV-2 transmission risk, January-March 2021.

OBJECTIVE: To determine whether modified K-12 student quarantine policies that allow some students to continue in-person education during their quarantine period increase schoolwide SARS-CoV-2 transmission risk following the increase in cases in winter 2020-2021. METHODS: We conducted a prospective cohort study of COVID-19 cases and close contacts among students and staff (n = 65,621) in 103 Missouri public schools. Participants were offered free, saliva-based RT-PCR testing. The projected number of school-based transmission events among untested close contacts was extrapolated from the percentage of events detected among tested asymptomatic close contacts and summed with the number of detected events for a projected total. An adjusted Cox regression model compared hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy. RESULTS: From January-March 2021, a projected 23 (1%) school-based transmission events occurred among 1,636 school close contacts. There was no difference in the adjusted hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy (hazard ratio = 1.00; 95% confidence interval: 0.97-1.03). DISCUSSION: School-based SARS-CoV-2 transmission was rare in 103 K-12 schools implementing multiple COVID-19 prevention strategies. Modified student quarantine policies were not associated with increased school incidence of COVID-19. Modifications to student quarantine policies may be a useful strategy for K-12 schools to safely reduce disruptions to in-person education during times of increased COVID-19 community incidence.

Utility of child physical characteristics and verbal descriptors to aid in family reunification during disasters.

OBJECTIVE: To identify physical and verbal descriptors that have the highest concordance between parents/guardians and a research team member to improve reunification during a disaster when a child arrives at the emergency department separated from their family. METHODS: Parent and child pairs were recruited between February 2020 and March 2020. Each parent and research team member simultaneously recorded the child's physical characteristics and clothing items. Verbal children were asked personally identifying questions. An inter-rater reliability Cohen's κ determined percent agreement between each researcher and parent/child pair. RESULTS: In total, 98 parent/child pairs participated. Child's gender, eye color measured as brown versus not brown eyes, and race had the highest concordance (κ = 0.92, 0.85, and 0.84, respectively; p < .001 for all). Skin color and all hair descriptors had low concordance. All or almost all verbal children correctly identified that they have a pet and a favorite stuffed animal or blanket (100 and 98.6 percent, respectively). DISCUSSION: Only apparent age, gender, race, and general eye color (brown versus nonbrown) had strong concordance between each researcher and parent/child pair. Other descriptors such as hair color, texture, length, and detailed eye color were discordant. Additionally, several pieces of personal information, such as a pet, could expedite reunification of verbal children. CONCLUSION: Not all physical characteristics are likely to be useful in accurately identifying a child, and some personal information may aid in reunification. Using the most concordant information should allow for more accurate and rapid reunification of children and their caregivers during disasters.

Challenges in managing, sustaining, and assessing closed point of dispensing sites: Findings from a qualitative study.

Most U.S. public health agencies rely upon closed points of dispensing (PODs) to aid in medical countermeasure (MCM) distribution. However, few studies have focused on how to assess closed POD preparedness and none have examined best practices for managing sites once they have been recruited. This study involved qualitative interviews with U.S. disaster planners to elucidate their approaches and challenges to managing, sustaining, and assessing existing closed POD sites. In all, 16 disaster planners participated. Common management practices included frequent communication with sites, providing formal and informal training, and assisting with POD exercises. Very few jurisdictions reported doing formal assessments of closed POD sites. The largest challenges identified were staff turnover and keeping sites engaged, sometimes leading to sites voluntarily withdrawing or needing to be removed from being a closed POD. Frequent communication and building partnerships with closed POD site personnel were recommended to maintain and sustain existing sites. Formal and informal assessments will provide assurance of deployment readiness. Closed POD management is a challenging, but essential process to ensure readiness to deploy. Practices outlined by this study can be implemented to enhance closed POD network management at other jurisdictions. This should increase the ability to distribute MCMs rapidly during a future event, contributing to stronger community resilience. Public health officials should continue expanding and improving closed POD networks to enable MCM delivery and minimize morbidity and mortality related to mass casualty events.

Non-Pediatric Nurses' Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals.

OBJECTIVE: To assess non-pediatric nurses' willingness to provide care to pediatric patients during a mass casualty event (MCE). METHODS: Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses' willingness to provide MCE pediatric care. RESULTS: In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital. CONCLUSION: Pediatric surge capacity is lacking among nurses. Increasing nurses' pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

SARS-CoV-2 Transmission to Masked and Unmasked Close Contacts of University Students with COVID-19 - St. Louis, Missouri, January-May 2021.

Universities open for in-person instruction during the 2020-21 academic year implemented a range of prevention strategies to limit the transmission of SARS-CoV-2, the virus that causes COVID-19, including physical distancing, mask use, vaccination, contact tracing, case investigation, and quarantine protocols (1). However, in some academic programs, such as health-related programs, aviation, and kindergarten through grade 12 (K-12) education, maintaining physical distance while still providing instruction is difficult; for universities with such programs, a single confirmed case of COVID-19 could result in a large number of students, staff members, and instructors being designated close contacts and requiring quarantine if they are not fully vaccinated, even if masks were worn when contact occurred. In January 2021, the St. Louis City Health Department allowed Saint Louis University (SLU) to implement a modified quarantine protocol that considered mask use when determining which close contacts required quarantine.* To assess the impact of the protocol, SLU assessed positive SARS-CoV-2 test result rates by masking status of the persons with COVID-19 and their close contacts. During January-May 2021, 265 students received a positive SARS-CoV-2 test result; these students named 378 close contacts. Compared with close contacts whose exposure only occurred when both persons were masked (7.7%), close contacts with any unmasked exposure (32.4%) had higher adjusted odds ratios (aORs) of receiving a positive SARS-CoV-2 test result (aOR = 4.9; 95% confidence interval [CI] = 1.4-31.1). Any additional exposures were associated with a 40.0% increase in odds of a positive test result (aOR = 1.4; 95% CI = 1.2-1.6). These findings reinforce that universal masking and having fewer encounters in close contact with persons with COVID-19 prevents the spread of SARS-CoV-2 in a university setting. Universities opening for in-person instruction could consider taking mask use into account when determining which unvaccinated close contacts require quarantine if enforced testing protocols are in place. However, this study was conducted before the B.1.617.2 (Delta) variant became the dominant strain of SARS-CoV-2 in the United States, which could have affected these findings given that the Delta variant has been found to be associated with increased transmissibility compared to previous variants.

Approaches, Successes, and Challenges in Recruiting Closed Points of Dispensing Sites: A Qualitative Study.

Closed points of dispensing (PODs) are an essential component of local public health preparedness programs because most local public health agencies lack the infrastructure to distribute medical countermeasures to all community members in a short period of time through open PODs alone. However, no study has examined closed POD recruitment strategies or approaches to determine best practices, such as how to select or recruit an agency, group, or business to become a closed POD site once a potential partner has been identified. We conducted qualitative interviews with US disaster planners to identify their approaches and challenges to recruiting closed POD sites. In total, 16 disaster planners participated. Recruitment considerations related to selecting sites, paperwork needed, and challenges faced in recruiting closed POD sites. Important selection criteria for sites included size, agencies or businesses with vulnerable or confined populations who lack access or ability to get to or through open POD sites, and critical infrastructure organizations. Major challenges to recruitment included difficulty convincing sites of closed POD importance, obstacles with recruiting sites that can administer mass vaccination, and fear of legal repercussions related to medical countermeasure dispensing or administration. Closed POD recruitment is a frequently challenging but highly necessary process both before and during the current pandemic. These recommendations can be used by other disaster planners intending to start or expand their closed POD network. Public health agencies should continue working toward improved distribution plans for medical countermeasures, both oral and vaccine, to minimize morbidity and mortality during mass casualty events.

Pilot Investigation of SARS-CoV-2 Secondary Transmission in Kindergarten Through Grade 12 Schools Implementing Mitigation Strategies - St. Louis County and City of Springfield, Missouri, December 2020.

Many kindergarten through grade 12 (K-12) schools offering in-person learning have adopted strategies to limit the spread of SARS-CoV-2, the virus that causes COVID-19 (1). These measures include mandating use of face masks, physical distancing in classrooms, increasing ventilation with outdoor air, identification of close contacts,* and following CDC isolation and quarantine guidance† (2). A 2-week pilot investigation was conducted to investigate occurrences of SARS-CoV-2 secondary transmission in K-12 schools in the city of Springfield, Missouri, and in St. Louis County, Missouri, during December 7-18, 2020. Schools in both locations implemented COVID-19 mitigation strategies; however, Springfield implemented a modified quarantine policy permitting student close contacts aged ≤18 years who had school-associated contact with a person with COVID-19 and met masking requirements during their exposure to continue in-person learning.§ Participating students, teachers, and staff members with COVID-19 (37) from 22 schools and their school-based close contacts (contacts) (156) were interviewed, and contacts were offered SARS-CoV-2 testing. Among 102 school-based contacts who received testing, two (2%) had positive test results indicating probable school-based SARS-CoV-2 secondary transmission. Both contacts were in Springfield and did not meet criteria to participate in the modified quarantine. In Springfield, 42 student contacts were permitted to continue in-person learning under the modified quarantine; among the 30 who were interviewed, 21 were tested, and none received a positive test result. Despite high community transmission, SARS-CoV-2 transmission in schools implementing COVID-19 mitigation strategies was lower than that in the community. Until additional data are available, K-12 schools should continue implementing CDC-recommended mitigation measures (2) and follow CDC isolation and quarantine guidance to minimize secondary transmission in schools offering in-person learning.

A Novel Partnership Between Physicians and Medical Librarians During the COVID-19 Pandemic.

An ongoing collaboration between physicians and librarians provided critical information during the COVID-19 pandemic. A development team, which consisted of the hospital and medical school disaster preparedness medical director, the medical library director, professional librarians, and the Departments of IT and Marketing in a multi-state healthcare system worked together to develop a shared website to distribute and curate timely resources during COVID-19. The initial impacts of this collaboration and the website show the benefits of this novel partnership.

US Hospital Preparedness to Manage Unidentified Individuals and Reunite Unaccompanied Minors with Family Members During Disasters: Results from a Nationwide Survey.

Unaccompanied minors and other unidentified individuals may present to hospitals during disasters and require reunification with family. Hospital preparedness for family reunification during disasters has never been assessed. We sent members of the Association of Healthcare Emergency Preparedness Professionals an anonymous online survey in July and August 2019 to assess their hospital's reunification readiness during a disaster. Scores on preparedness to manage unidentified patients were calculated based on 21 indicators, each with a score of 0 or 1. A multivariate linear regression was conducted to delineate factors associated with higher preparedness scores. In total, 88 individuals participated (response rate = 33.4%). All agreed that reunification preparedness is important, but far fewer (χ2 = 33.8, P < .001) believed their hospital was prepared to reunify unidentified individuals during a disaster (n = 58, 65.9%). Most (n = 56, 63.6%) had at least some written reunification plan. Preparedness scores ranged from 0 to 21 (mean = 8.0, standard deviation = 7.3). Predictors of preparedness included having a pediatrician on the hospital disaster planning committee, conducting a disaster exercise that simulated an unaccompanied minor scenario, and implementing the 2018 American Academy of Pediatrics Reunification Planning Tool. Findings from this study indicate that many US hospitals are not prepared to reunify unaccompanied minors or other separated family members during a disaster. The planning tool is a free resource that hospitals can use to improve their hospital reunification plans. Hospitals should prioritize development of reunification plans to ensure rapid response during a future event. Use of the planning tool can aid in development and improvement of these plans.

Willingness to Respond to Radiological Disasters Among First Responders in St. Louis, Missouri.

During radiological disasters, firefighters and emergency medical services personnel are expected to report to work and engage in response activities; however, prior research exploring willingness to respond to radiological disasters among first responders has considered only radiological terrorism scenarios and not nonterrorism radiological scenarios. The goal of this study was to compare willingness to respond to terrorism and nonterrorism radiological disaster scenarios among first responders in St. Louis, Missouri, and to explore determinants of willingness to respond. Firefighters and emergency medical services personnel were surveyed about their willingness to respond to a dirty bomb detonation (terrorism) and a radioactive landfill fire (nonterrorism). McNemar's tests were used to assess differences in individual willingness to respond between the 2 scenarios and differences if requested versus required to respond. Chi-square tests were used to identify significant individual predictors of willingness to respond. Multivariate logistic regressions were used to determine final models of willingness to respond for both scenarios. Willingness to respond was lower for the dirty bomb scenario than the landfill scenario if requested (68.4% vs 73.0%; P < .05). For both scenarios, willingness to respond was lower if requested versus required to respond (dirty bomb: 68.4% vs 85.2%, P < .001; landfill: 73.0% vs 87.3%, P < .001). Normative beliefs, perceived susceptibility, self-efficacy, and perceived barriers were significant predictors of willingness to respond in the final models. Willingness to respond among first responders differed significantly between terrorism and nonterrorism radiological disasters and if requested versus required to respond. Willingness to respond may be increased through interventions targeting significant attitudinal and belief predictors and by establishing organizational policies that define expectations of employee response during disasters.

Ready to Respond: A Survey of Interdisciplinary Health-Care Students and Administrators on Disaster Management Competencies.

BACKGROUND: A sense of competency and confidence in disaster management is linked to response willingness and efficacy. This study assessed current health-care student disaster competency curricula and resultant confidence. METHODS: A survey was sent to students and administrators in nurse practitioner (NP), master of public health (MPH), and medical/osteopathic schools (MD/DO), assessing curriculum coverage of 15 disaster management competencies (1-4, total 15-60), and confidence in performing 15 related behaviors (1-7, total 15-105). One-way analysis of variance with Tukey's post-hoc and Mann-Whitney U-tests were used to examine group differences. RESULTS: A total of 729 students and 72 administrators completed the survey. Low coverage of all topics was reported by both students and administrators (mean 24.4; SD 9.6). Among students, NP students (21.66 ± 8.56) scored significantly lower than MD/DO (23.32 ± 8.19; P < 0.001) and MPH students (26.58 ± 9.06; P < 0.001) on curriculum coverage. Both administrators and students expressed low confidence in competence, with students significantly lower (P < 0.001). NP students scored higher (63.12 ± 20.69; P < 0.001) than both MPH (54.85 ± 17.82) and MD/DO (51.17 ± 19.71; P < 0.001) students. CONCLUSIONS: Health-care students report low coverage of topics considered to be necessary disaster response competencies, as well as their confidence to execute functions. This may negatively impact willingness and ability of these professionals to respond effectively in a disaster.

Firefighters' and Emergency Medical Service Personnel's Knowledge and Training on Radiation Exposures and Safety: Results from a Survey.

Little is known about first responders' knowledge of radiation exposure and the training they receive regarding radiological events. Firefighters and emergency medical services (EMS) personnel were surveyed in July 2018 to February 2019 regarding their knowledge of radiation exposure and the radiological event training they had received. Knowledge was assessed using 15 true-false questions. Five types of radiological event training were assessed. A Mann-Whitney test assessed differences in training received by occupation. A linear regression identified predictors of knowledge scores. A total of 433 individuals completed the survey (response rate = 82.9%). Knowledge scores ranged from 5 to 13, with an average of 8.6. Predictors of knowledge included having received more training on radiological transportation incidents or improvised nuclear devices, and being a firefighter. About a quarter (23.6%, n = 102) had not received any of the 5 types of radiological event training. Firefighters received more training than EMS personnel except on nuclear reactor incidents. Only 14% had participated in a radiological event exercise. First responders' knowledge of radiation exposure and prevention measures is low, and many have received either no or very little training on radiological events. The lack of radiation exposure knowledge and radiological event training received, as identified in this study, could result in increased mortality rates. First responder agencies should provide additional radiological event training and exercise opportunities.

Zika and Flint Water Public Health Emergencies: Disaster Training Tool Kits Relevant to Pregnant Women and Children.

Pregnant women and children and individuals suffering from chronic illness are disproportionally impacted by public health emergencies. To meet the healthcare needs of these populations, the nursing workforce must be capable of responding in a timely and appropriate manner. The goal of this project was to create interactive and engaging evidence-based educational tool kits to advance healthcare provider readiness in the management of population health in response to the Zika and Flint Water crises. A multipronged, mixed-methods approach was used to identify essential education needs and required core competencies. Data were synthesized from discussion with key informants, review of relevant documents, and surveys of schools of nursing, public health, and medicine. The ADDIE model was used to integrate results into the development of the online learning tool kits using the ThingLink software program. An innovative online educational program to prepare healthcare providers to rapidly identify, mitigate, and manage the impact of the Zika and Flint Water crises upon pregnant women and children was implemented by the Society for the Advancement of Disaster Nursing. Innovative online learning tool kits can advance healthcare provider readiness by increasing knowledge and understanding of key components of specific public health emergencies.

Separated After a Disaster: Trust and Privacy Issues in Sharing Children's Personal Information.

BACKGROUND: After disasters, unaccompanied children may present to an emergency department requiring reunification. An effective reunification system depends on the willingness of guardians to utilize it. OBJECTIVE: Assess guardian willingness to share children's personal information for reunification purposes after a disaster, perceived concerns and beliefs, and trust in reunification agencies. METHODS: Guardians of children presenting to 2 pediatric emergency departments were approached to participate in a survey-based study. Willingness to share their children's personal information was scored on a scale of 1 to 19 (1 point per item). Perceived concerns about and importance of sharing information, level of trust in reunification agencies, and guardian demographics were collected. Chi-square was used to compare trust and attitudes/beliefs. Multivariate linear regression was used to determine factors associated with willingness to share information. RESULTS: A total of 363 surveys were completed (response rate, 80%). Most guardians (95.6%) were willing to share at least some information (mean, 16 items; range, 1-19). Half were concerned about protection (55.4%) or abuse (52.3%) of their child's information. Hospitals were trusted more than other reunification agencies (P < .001). Perception of reunification importance was associated with willingness to share (P < .001). CONCLUSIONS: Guardians are willing to share their children's information to facilitate reunification after disasters, but have privacy concerns.

Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments.

An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

The General Public's Attitudes and Beliefs Regarding Resource Management, Collaboration, and Community Assistance Centers During Disasters.

BACKGROUND: The key to resilience after disasters is the provision of coordinated care and resource distribution to the affected community. Past research indicates that the general public lacks an understanding regarding agencies' roles and responsibilities during disaster response.Study ObjectivesThis study's purpose was to explore the general public's beliefs regarding agencies or organizations' responsibilities related to resource management during disasters. In addition, the public's attitudes towards the management and use of community disaster assistance centers were explored. METHODS: Qualitative interviews were conducted with members of the general public. Interviews were audio-recorded and transcribed verbatim. Content analysis was used to analyze the data and identify themes that describe the public's expectations of disaster response agencies and the use of community disaster assistance centers. RESULTS: A total of 28 interviews were conducted. Half of the participants (n=14) were black, 57% (n=16) were female, and the mean age was 49 years. The general public has developed trust and distrust toward response organizations and governmental agencies based on past experiences during disasters. The public wishes to have local agencies to help lead disaster response, but expects a collaboration between all response organizations, including the government. The managing agency overseeing community disaster assistance centers was not perceived as important, but the proximity of these centers to community members was considered critical. CONCLUSIONS: The general public prefers that local agencies and leaders manage disaster response, and they expect collaboration among response agencies. Community assistance centers need to be located close to those in need, and be managed by agencies trusted by the general public. (Disaster Med Public Health Preparedness. 2018;12:446-449).

A trust approach for sharing research reagents.

The core feature of trusts-holding property for the benefit of others-is well suited to constructing a research community that treats reagents as public goods.

Feasibility of a Novel Combination of Influenza Vaccinations and Child Passenger Safety Seat Fittings in a Drive-through Clinic Setting.

OBJECTIVE: Public health preparedness is an ever-evolving area of medicine with the purpose of helping the masses quickly and efficiently. The drive-through clinic (DTC) model allows the distribution of supplies or services while participants remain in their cars. Influenza vaccination is the most common form of DTC and has been utilized successfully in metropolitan areas. METHODS: We hypothesized that combining influenza vaccinations and child passenger seat fittings in a DTC format would be both feasible and desired by the community. Each driver was verbally surveyed at each DTC station. The project was a combination of patient survey and observation. RESULTS: In the inaugural 6-hour DTC session, 86 cars were served and contained 161 children, of which 28 also participated in child passenger seat fittings. The median total clinic time regardless of services rendered was 9.0 minutes (interquartile range [IQR]: 6.0, 14.0 minutes). For those who received only an influenza vaccine, the median total time was 7.5 minutes (IQR: 6.0, 10.0 minutes). For those who received both services, the median total time was 27 minutes (IQR: 22.3, 33.5 minutes) with an average of 1.75 child passenger seat fittings per automobile. CONCLUSION: This was a pilot study involving 2 different services using the DTC model and the first of its kind in the literature. The DTC was successful in executing both services without sacrificing speed, convenience, or patient satisfaction. Additional studies are needed to further evaluate the efficacy of the multiple-service DTC model. (Disaster Med Public Health Preparedness. 2017;11:647-651).