1. Development of an Ebola response plan for Flathead City-County Health Department in Kalispell, Montana Theresa Majeski, MPH Public Health Advisor/PHAP Associate Public Health Associate Program Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 PHAP/PHPS Summer Seminar June 3, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Background  First Ebola case in United States – September 2014  Lack of Ebola-specific preparedness by health departments  Flathead City-County Health Department (FCCHD) did not have an Ebola response plan  Third most populous county in Montana, with a large medical center

3. Methods  Community partner meetings were held Fall 2014  FCCHD, 2 local hospitals, emergency services, law enforcement  FCCHD response plan developed to guide responders through all of the steps necessary to manage an Ebola patient or contact  Quarantine and Isolation Order power transferred  Checklists were developed  Flowchart algorithm was created

4. Methods Excerpt from FCCHD Ebola Response Plan Flowchart Algorithm

5. Methods  Developed Ebola contact/traveler monitoring protocol  Protocol included: Staff instructions Checklists Introduction packet for contact/traveler  Direct Active Monitoring and Active Monitoring Orders created  Trained four public health nurses to be Contact Investigators (monitoring personnel)  Held internal exercises

6. Methods Excerpts from FCCHD Ebola Monitoring Introduction Packet

7. Methods  Community-wide drills tested the response plan  First drill – December 2014 Tested response plan involving monitoring protocol and Contact Investigator duties Patient was “dry” and developed symptoms at home in presence of Contact Investigator  Second drill – January 2015 Tested response plan without involving the monitoring protocol or Contact Investigator Patient was “wet” and presented at a local emergency department Photo credit: Brenda Ahearn/Daily Inter Lake

8. Results  Community-wide drills  Highlighted communication deficiencies among partners and internally  Emphasized the need for partners to understand each other’s internal protocols to enhance coordination efforts  Monitoring protocol  Successes Video chatting Data collection forms  Identified unclear outside partner communication roles and responsibilities

9. Challenges Overcome  Rapidly changing CDC guidelines  Contact Investigators training  Unexpected challenges arose from an out of state healthcare worker staying in Flathead County for 21-day monitoring

10. Future Implications  Response plan is translatable to other health departments and other communicable diseases  Response plan can be scaled up as needed  Working with community partners on the Ebola response has led to discussions about preparing for the next known or unknown communicable disease outbreak

11. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Questions? Theresa Majeski, MPH Public Health Advisor/PHAP Associate CDC/OSTLTS/OD 1035 1 st Ave West Kalispell, MT 59901 406-260-4906 ypn6@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support