1. Preparing for Public Health Emergencies:
A Community Working Together
Stephanie Nelson, RN, MSN
Health Officer
Gallatin City-County Health Department (GCCHD) Bozeman, Montana

2. Objectives
Describe how a rural local public health system aligned resources to effectively address public health risks
Describe how this alignment worked to address last years influenza vaccine shortage

3. Gallatin, Montana
Montana is a rural frontier state with a population of 900,000
Gallatin County is one of the fastest growing counties has a population of 75,000.
35,000 reside in Bozeman (the county seat) which is were the University of Montana and its 12,000 students are located.
Besides the University system, the economy is supported by agriculture, tourism and small business.
Gallatin City-County Health Department has 33 employees, 11 in EH and 22 in HS. Our medical director is a contracted position.

4. Montana State University
MSU has a considerable amount of high tech, bio/medical research being done on campus.
Private labs adjacent to campus is doing research on an number of zoonic diseases, such as anthrax.

5. Public Health Challenges
Park management runs up against contentious issues.
YNP brings a whole set of challenges related to minimizing the risk to public health.
3 million visitors (many international) enter the park through West Yellowstone, a small community at the southern tip of the county.
In addition, the politics and often contentious issues involved with park management, such as the management of buffalo…
..and the animal protection and environment activists, place a special slant on terrorism.
For this reason, Gallatin County was ranked the second most vulnerable county in the state to terrorist activities.
Each year, 3 million visitors enter West Yellowstone.

6. Question
In my community, what is the most important area for improvement as we work with preparedness partners?
A. Formal Agreements
B. Communication
C. Leveraging Limited Resources
D. Real event problem-solving
It has formal MOU’s and participates in training and exercises to ensure or plans and emergency responses are coordinated.
Most importantly, it provides a process or framework for us to problem solve in real events.

7. Post 9/11 Incidents Anthrax on east coast
Mysterious powder on tomatoes at MSU and the Bozeman Post Office
Smallpox vaccination directive
In addition to the results of the vulnerability assessment, probably like many of you, a number of post September 11th events drew our community and most specifically our public health system into discussions around our local response to events that pose a risk.
This included a number of mysterious powder events and of course the smallpox fu pax.

8. Bozeman Deaconess Hospital
Unified Health Command (UHC)
Bozeman Deaconess Hospital
GCCHD
Advisory Team
Gallatin Community Clinic
Montana State University
This is a model of Gallatin County’s Unified Health Command.
The GCCHD Advisory Team includes the epi team, that include public health nurses and environmental health specialists, the medical director, a veterinarian, the county DES coordinator and other expertise as needed.
Bozeman Deaconess Hospital (ER, EMS,IC), Montana State University (SH) and the Gallatin Community Clinic (CHC).

9. UHC Strategies Align partners and expertise
Identify and leverage limited resources
Help create a single message
The UHC helped to:

10. UHC Strategies Memorandums of Understanding (MOUs)
Joint training and exercises
Real event problem solving
It has formal MOU’s and participates in training and exercises to ensure or plans and emergency responses are coordinated.
Most importantly, it provides a process or framework for us to problem solve in real events.

11. UHC in Action: Influenza Vaccine Shortage (2004-05)
Goal 1: Surveillance
Inventory vaccine
Identify high risk
This was most certainly the case in the influenza vaccine shortage.
Three goals were created by the UHC early on.
Surveillance:
This was assumed by the health department.
With in one hour from receiving word via the HAN the supply would be dramatically disrupted the health department called all providers or sources of vaccine and knew who had it and who did not.
The largest OB and internal medicine practice had none, as did a number of rest homes.

12. UHC in Action: Influenza Vaccine Shortage (2004-05)
Goal 2: Prevention & Containment
Prioritize CDC’s recommendation
Develop a tiered approach to immunize the public
Create a system by which providers would access vaccine as it became available
Members of the UHC and local HCP met that same day and realized that unless CDC’s recommendation were further prioritized the most at risk may not receive the vaccine.
This consensus from creditable leadership in medicine went a long way in getting compliance in HCP and the public.
We monitored the supply and developed a tiered approach to immunize the public.
We created a system by which providers could access vaccine as more became available.

13. UHC in Action: Influenza Vaccine Shortage (2004-05)
Goal 3: Communication
Dissemination of information
Posed the greatest challenges
Finally, using the UHC to create a single and uniform massage was extremely helpful.
The Cover Your Cough campaign was very successfully.
Communication to the public as to availability of vaccine in real time was also one of your greatest challenges.
The media was very helpful in this regard.