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

2. 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

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

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

5. 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

6. 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

7. 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.

8. 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 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.

9. 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.

10. 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.

11. 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…)

12. 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.