In 1974 the Los Angeles County Health Department implemented a mass jet injection vaccination campaign aimed to protect persons 65 years of age and older from influenza. The Clinic Manual for this event documented the protocols of a mass jet injection campaign and sheds light upon what these professionals knew about the presence of blood when using a Ped-O-Jet injector.
Within the manual, given to each volunteer, were instructions on the correct usage and trouble shooting of Ped-O-Jet injectors and specific instructions on the roles of the vaccination team.
Instructions For Use of Jet Injector Apparatus (Ped-O-Jet and Electric Models)
Most shockingly, within the instructional sheet for jet injectors is the omission that “Many patients will have a drop of vaccine and a drop of blood remaining on the arm after injection.” Here, during the wide-spread use of jet injectors, is acknowledgment that blood remained on the arm after injection. In other words, blood was on the arm while the nozzle of the jet injector was pressed upon the skin. Moreover, there is acknowledgment that the presence of blood was observed amongst many patients. Therefore, the jet injector was frequently exposed to blood during the vaccination campaign.
Just as appalling, under the heading “Common Errors to Avoid While Using Jet Injector,” is the instruction to “Never swab injector nozzle with cotton.” But no explanation is given as to why. Presumably a cloth could be used. Although the impression given within the manual connotes the nozzle should not be swabbed at all.
Roles of the Vaccination Team
Amongst the roles of the vaccination team were the Gun Operator and Arm Inspector.
1. Be responsible for giving the injections with the jet injection gun. RN’s and LVN’s will function as gun operators.
2. Inject immunization subcutaneously into the outer aspect of upper arm (see gun Instruction sheet). The injection site will have been prepared with acetone or other disinfectant by a volunteer.
3. See that an emergency kit is located near the guns. Each nurse should be familiar with the contents of the kit and its use. (Instructions are on the kit.)
Special Consideration: Leave adequate space between you and the gun operator’s station.
1. Place a cotton ball on the injection site and ask the patient to hold it tightly with the opposite hand.
2. Send the patient to the next station for an aftercare sheet.
It is important to point-out, after each injection a cotton ball was to be held firmly upon the injection site. The only reason to apply pressure to a vaccination site would be to stop bleeding.
The 1974 Los Angeles County Mass Influenza Campaign
The campaign came following the swift passing of the Thurman Act (California Bill AB-3157), which aimed to “provide an annual vaccination to populations having excess mortality rates from influenza complications.” At the time the elderly were the most at risk population.
Floyd Irons, in fulfilling his thesis for a master’s degree from California State University, documented the planning and implementation of this mass influenza vaccination campaign.
The planned three-day event across 150 locations was made possible through implementing 50 electric and foot pedal Ped-O-Jet devices. Through Irons’ thesis is a glimpse at how many Ped-O-Jet devices were owned by various government health agencies.
Los Angeles County maintains a stock of 15 guns, and the remainder of the 50, plus additional back-up guns [5-8 guns] would be borrowed from the Sate Department of Health and from neighboring states, as well as the Center for Disease Control in Atlanta.
The Health Department scheduled the mass vaccination campaign across three Thursdays within October of 1974 (Oct. 10th, 17th and 24th). The schedule also listed the Ped-O-Jets were to be sterilized by autoclaving only once on Oct. 9th.
Today a greater understanding of the inherent risks of jet injectors exist. These devices have been documented in transferring blood and blood-borne pathogens in microscopic levels not visible to the human eye. Even when these devices were used properly they still posed a risk. So the following is a moot point but nonetheless is still worth asking:
Why were the jet injectors, which were repeatedly exposed to blood, not autoclaved before the subsequent vaccination events?
Why didn’t the instructions state if the jet injector were to become contaminated with blood the gun should be removed from operation and sterilized?
Yet nowhere in the manual were instructions for removing and autoclaving jet injectors contaminated with blood.
Irons’ thesis has documented how jet injectors were used within a mass vaccination campaign. Moreover, his thesis serves as evidence that in the mid-1970s healthcare professionals knew Ped-O-Jet injectors caused patients to bleed during and after the injection. Nowhere in his thesis were any measures to prevent the transference of blood between patients. At the time knowledge of blood-borne pathogens was primitive, however since the mid-1950s medical professionals highly cautioned of the risk for transferring hepatitis and malaria from blood-to-blood contact. Therefore, there was a clear disregard for the risk of transferring blood to subsequent vaccinees within this vaccination campaign.
A copy of Floyd Irons 1976 these can be assessed here.