Don't miss the point

Administering vaccinations

According to CDC, around 385,000 sharps injuries occur annually. NIOSH developed two electronic tracking modules to help track sharps injuries, as well as blood and body fluid exposures. The CDC’s Occupational Health Safety Network (OHSN) analyzes data to identify the riskiest jobs and make them safer.

In 1962, one year before the measles vaccine was developed, the author Roald Dahl was playing with his seven year old daughter, Olivia, who had measles. He was teaching her how to create animals using pipe cleaners. He noticed she had trouble coordinating her fingers. When he asked how she was doing, she said she was tired. One hour later she was unconscious. Twelve hours later Olivia was dead. She succumbed to measles encephalitis. In 1986, Dahl wrote a letter promoting vaccination. The letter came to light again in 2015 after a measles outbreak at Disneyland in Anaheim, California sickened more than 100 children. In April of this year, Minnesota public health authorities requested 200 people to quarantine themselves after 12 cases of measles occurred within two weeks. All cases occurred in unvaccinated children under the age of 6. It’s not just little kids. A 17-year-old girl in Portugal died after the measles virus spread to her lungs. There have been surges in cases in Germany, Italy, and Romania. These are not exactly third world countries. How can this be? The vaccine has been around since 1963. In 2015 only 72% of toddlers in the United States received the seven key vaccines recommended by the CDC to prevent 11 potentially fatal diseases. As a portion of the general population remains at risk, we must keep in mind that our likelihood of exposure is enhanced, which increases not only personal danger of infection, but may make us vectors of transmission to our co-workers, patients, and families. Given these dangers, why isn’t everybody vaccinated?

Public figures, like Jenny McCarthy and Robert F. Kennedy, Jr., have written and spoken publicly about a purported relationship between thimerosal, a mercury- containing preservative and autism. In 1998, Dr. Andrew Wakefield published a report in The Lancet suggesting the MMR (measles, mumps, rubella) vaccine could trigger autism. Not only was Wakefield’s assertion proved false and the paper retraced, he was found to have falsified his data and lost his medical license. At the time he published his paper, he had a patent for a competing vaccine. A 2014 meta-analysis involving 1.3 million subjects showed no difference in the incidence of autism between vaccinated and un-vaccinated children.

Tetanus vaccination is associated with a life-threatening allergic reaction in 0.0006% of patients receiving the injection. The case fatality rate for tetanus in the U.S. is 13.2%.  In general, anaphylaxis occurs 1.3 times per million vaccinations, intussusception (an intestinal blockage) affects between 1 and 5 of every 100,000 children vaccinated for rotavirus, brachial neuritis (Parsonage-Turner Syndrome) happens in around 10 of every million tetanus vaccines, febrile seizures occur in up to 300 of each million children vaccinated for MMR and chickenpox but usually last only a couple of minutes and have no sequelae, and rarely Guillain-Barre’ Syndrome may occur with some influenza vaccines. The most common risk of vaccination is shoulder injury.

In 1986, legislation created the National Vaccine Injury Compensation Program (VICP).  This is a court system, funded by a government trust, which allows people hurt by vaccines to receive compensation without putting vaccine-makers out of business. Since 1988, the court has adjudicated 16,000 cases dismissing about 66% of them. In April of this year, the court amended its policies so that petitioners only need to document that within 48 hours of receiving the injection, they developed sudden-onset, motion-limiting pain. A common cause of shoulder injury is poor injection technique. AS EMS providers become more involved in community paramedicine and extend their scope of practice into the hospital, an awareness of good technique is critical.  You might think that an injection into the deltoid is a no brainer. You’re wrong. Review deltoid injections with your Medical Director. Here are a few common recommendations:

  • Patient and vaccinator both seated lower the risk of hitting sub-acromial or sub-deltoid bursae.
  • Aim for the middle of the triangle and avoid the upper third of the deltoid.
  • Use needle of proper length.
  • Insert at 90 degree angle with a dart-like motion.
  • Lift arm slightly out to side. This slides the bursa underneath the acromion.

We need a thoughtful approach with appropriate medical direction for both receiving and administering vaccinations.



  • Safety + Health, May 217, page 39.
  • Kupferschmidt, K., The Science of Persuasion. Science 356. 366-369, April, 2017
  • Wadman, M., Vaccines on Trial, Science 356, 3370-373, April, 2017
  • Wadman, M., You J., The Vaccine Wars, Science, 356, 364-365, April, 2017
Administering vaccinations
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