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Background: Hepatitis A cases have been regularly increasing in Florida since 2016, after remaining relatively stable for several years. Between January 1, 2019, and October 19, 2019, 2,847 cases of hepatitis were reported to the Florida Department of Health, including 2,209 hospitalizations and 41 deaths due to infection with hepatitis A1. At least 93% of these cases was acquired within the state of Florida.1 During this outbreak, Pasco County clearly emerged as a focal point for new cases. As of week 42 of 2019, Pasco County was the second-highest county for new cases (n = 484) and the leading county for deaths due to hepatitis A infection (n = 8). Risk factors identified from hepatitis A cases reported between January 1, 2019, and October 19, 2019, included any drug use (57%), injection drug use (37%), noninjection drug use (35%), homelessness (22%), and being a man who had sexual intercourse with other men (MSM, 4%).1 Moreover, 33% of newly reported cases were interviewed and denied risk factors; 1 (20%) had recently been incarcerated or was currently incarcerated.1 Individuals with these risk factors are often individuals who also require emergency medical services (EMS). On August 1, 2019, a public health emergency (PHE) was issued for the entire state of Florida. The existence of a PHE allows for paramedics to administer vaccine (with the approval of the fire rescue medical director). Pasco County Fire Rescue routinely operates 28 advanced life support (ALS) ambulances with either a crew of 2 paramedics or a paramedic/EMT pair. On October 7, 2019, the Pasco County Board of County Commissioners (BCC) approved a Memorandum of Understanding between the Florida Department of Health in Pasco County, the Pasco County Fire Rescue Medical Director, and the BCC for ALS crews to provide hepatitis A vaccination to noncritical (ie, basic life support) patients during routine contact. This effort appears to be the first within the of Florida. Pasco County Fire Rescue (PCFR) began stocking hepatitis A vaccine on January 1, 2020 and ceased participation in the program on March 1, 2020. During the window of participation, PCFR responded to approximately 6,570 calls in which the patient would have been non-critical and eligible for hepatitis A vaccination. Twelve hepatitis A vaccinations (0.18%) were administered. Crews verbalized concerns about adding vaccination to their job description, feelings of being overwhelmed with existing emergency medical services (EMS) responsibilities, apathy regarding the potential benefit of provision of vaccine, and perception that successful participation in a vaccine campaign would lead to additional community paramedicine responsibilities. The vaccine program was terminated early due to the significant demands on EMS as SARS-CoV2 impacted Pasco County. This trial highlights the need for crew investments and buy-in for future partial or full community paramedicine initiatives.1. Florida Department of Health, Hepatitis A Surveillance State Report, Week 42.Funding: NoneDisclosures: None

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The purpose of this study is to compare the forces required to activate retractable intramuscular safety syringes using healthcare worker researchers vs. a computer-controlled system. The force required to activate three commercially available retractable safety syringes was measured using two methods:(1) a manually-operated digital force gauge (DFG) and (2) a completely automatic computer-controlled universal testing machine (UTM). To simulate the clinical setting, saline was drawn into the barrel of each syringe before testing and ejected either during or before force measurements were recorded. There was a statistically significant difference in activation force between the two researchers and the UTM (p < 0:001) for 2/3 devices tested. There was a wide discrepancy in activation forces between the three brands of devices regardless of the testing method. The results imply that a human element exists in the injection process that cannot be discounted. Future studies should explore the sum of forces involved with an injection, the notion of training HCWs to modify these forces, and the relationship between force and occupationally-acquired hand and wrist injuries. 65 J. Musculoskelet. Res. 2010.13:65-74. Downloaded from www.worldscientific.com by UNIVERSITE LIBRE DE BRUXELLES on 08/10/15. For personal use only.healthcare worker who may give hundreds of injections per day with these syringes should be a priority for those involved in the health field.

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The experience of H1N1 vaccine delivery to public safety personnel in a suburban county in Florida suggests a relationship between the degree of hierarchy of an agency and successful implementation of a vaccination program for novel 2009 H1N1 influenza virus. This case study describes the structural organization of the Sheriff’s Office and Fire Rescue in County X, provides timelines for vaccine program implementation and numbers of personnel vaccinated, and illustrates the impact of autonomy on the timeliness of vaccine implementation. An “emergency approval pathway” is recommended for organizations or departments that are likely to encounter delays in disaster or pandemic response due to organizational structure.