Communication, Disease Reporting and Collaboration Brigid O’Connor Lake County Health Department Flathead Reservation and Lake County TERC/LEPC

Lake County: Who we are 26,000 residents 25% Native American (approximately) 80% rural population “Open Reservation” Polson with 4,041 residents—largest community Salish Kootenai College Largest Employers: 1: Confederated Salish and Kootenai Tribes 2: Lake County Approx 5,000 registered Tribal Health recipients >60% land Tribally owned Pablo and Ronan ,2000 people LCHD 3.9 FTE RN’s (MCH, CD, Fam Planning, Director) THHS 4 Community Health Nurses

Lake County, Montana Lake County is in Western Montana, a closer view will show that it overlaps significantly with the Flathead Reservation

Tribal Areas in Lake County High-light Reservation note: Mostly in Lake Co, also in Sanders, Flathead and Missoula Counties

Internal: Develop a comprehensive Communicable Disease program in the Lake County Health Department External: Partner PH with local disaster responders through the TERC/LEPC Create/foster regional PH connections. Goals With the Emergency Preparedness dollars from CDC, we at the Lake County Health Dept had 3 primary aims: Within the Health Dept: While we have done Comm Dis follow-up over the decades, no one person was officially designated to that task. Assigning disease follow-up was based primarily on who happened to answer the phone! Outside the Health Department: we wanted Public Health to join in with County/Tribal DES planning for and responding to Disasters 1. For years Public and Tribal Health have responded as a team (in disease outbreaks and other classic public health issues), 2. and County and Tribal DES have responded as one team for years as well) 3. but Public Health side and DES side have not responded together. Outside the County: We also wanted to strengthen relationships and regular communication with our regional Public Health partners

Develop Communicable Disease Position within Health Department Part time position to be primary CD contact for Health Dept. and PH Emergency Preparedness Coordinator Improve communication between HD and local medical providers Build on the current team-work between LCHD and Tribal Health So for our internal efforts, the EP funding allowed us to create a 4 day a week position to lead and coordinate the County’s Communic Disease prevention and follow-up, and take on the newly created position of PH Emerg Prep Coordinator One critical step was to create a regular conversation between the HD and area medical providers regarding Infectious Dis and create an active surveillance environment in the valley A given component of this effort was our current working relationship with Tribal Health. Any Comm Dis program improvements would necessarily improve the Tribal Health disease follow-up, and our ongoing collaborative projects

Question A. Totally funded B. More than 50% local funding Does your Health Department have a Communicable Disease position supported by local funding? A. Totally funded B. More than 50% local funding C. Less than 50% local funding D. No local funding The emphasis here is on the word LOCAL.

Improve Communication Between HD and Local Medical Providers Develop relationship between providers and HD Offer useable information to them regularly Expect information from them HD Providers Be a conduit for info from other sources directly to providers Identify how to best get info to the NURSES! We went from a Comm Disease program that previously initiated communication with providers only when we had a case report to follow up on. We now e-mail Disease Updates to them every week or two, depending on the need, and keep them posted on disease issues occurring around the region and state. We bring to them the needed lab testing information, a heads up on any local clusters, treatment and prophylaxis recommendations, latest immunization information and any “Ah Ha’s”! Conduit from other sources (CDC, Rocky Mountain Labs, state immunization program…) It’s critical to get the info to the NURSES in the clinics and hospitals, to the lab personnel, as they are the primary ones to report. Figure out the best way to get info to them.

TERC/LEPC TERC began in 1990 1995 TERC/LEPC meeting monthly Spring 1996 Epi-Team created Autumn 2001 Health Subgroup of the TERC/LEPC born Early autumn 2002 CDC Emerg. Prep. Grants Late autumn 2002 Health Subgroup expanded Tribal/County Charter 1990 Tribal Emergency responders began meeting 1995 Tribal and County responders began meeting together every month 1996 County/Tribal Health joint Epi-Team born to respond to food borne outbreaks 2001 (post 9/11 and Anthrax events) County and Tribal Public Health officially begin the Health Subgroup of the TERC/LEPC 2002 we get some funding for Emergency Preparedness, so position created for someone to organize and really develop the Health Subgroup. We expanded the group to include a veterinarian, 2 hospitals, volunteer agencies, Red Cross, EMS and Sanders County Health Dept. and DES.) 2002 Flathead Reservation Tribal/County Charter. It is the first in the nation to mandate that any response within the Flathead Reservation, Lake or Sanders County borders, will be a joint response by all three governments, with shared resources.

Strengthen Regional Communication Send Communicable Disease notes to both providers and neighboring Health Departments Coordinate on significant press releases Collaborate on deliverables Share plans and templates We are making a more concerted effort to share the notes that we send to our local providers with our regional Public Health Partners. It keeps us as much on the same page as possible and reduces surprises, since they often see our patients (in the larger surrounding cities), and we get news from their news outlets (Missoula and Kalispell). Working closely with our neighboring counties encourages us to coordinate on significant issues, as was the case with the flu vaccine shortage last year. We found that working together on deliverables (Emergency Preparedness grant assignments) and sharing our plans, protocols and templates made so much sense, since we would be collaborating in a real event, and our plans would be more likely to mesh.

Challenges Policy issues Jurisdictional issues Meshing DES and PH Keeping tribal county policies up with advances in cooperation (County dispatch not OK paging THHS RN, Record sharing, dispatching policies… Quarantine ICS (structure and language) DES learning that PH emergencies may not have ground zero (mentality) PH learning when to ramp up to emergency mode (with insidious onsets…)

Successes Strengthened coordination between LCHD and THHS Established valued advisory group—Health Subgroup of the TERC/LEPC Managed Communicable Disease events as a team Assured a Public Health position in the TERC/LEPC Charter One joint PHERP One DES Response Plan TB team testing, increased cooperation on ongoing Chlamydia outbreak Joint Epi class, Salmonella, TB, Ct+… We (Public and Tribal Health) have created one joint Public Health Emergency Response Plan, and Tribal and County DES are working on one seamless Emergency Response Plan as well.