Healthcare Surge Planning in a Frontier Setting

Submitted By

Linda Williams, Former Montana State University Chouteau County Extension Agent and Emergency Management Coordinator
Chouteau County Health Department, Montana, Montana
July 29, 2015

3,997 square miles, 5, 250 people, one county. Chouteau County, Montana is the definition of a frontier setting in public health. Their population density is a mere 1.3 people per square mile. For reference, an area is considered a frontier setting when it has 7 or fewer people per square mile.

With so much space and so few people, pandemic preparedness requires creative thinking, problem solving, and strong, long-standing partnerships and relationships between organizations and communities. Engaging the public and making sure that resources meet their needs is especially important in Chouteau County not only because of how spread out the population is, but also because the area includes specialized groups like the Rocky Boy Reservation and two Hutterite communities. The Hutterites, like the Amish, are a religious sect that believes in self-sufficiency, pacifism, and resilience.

A patient surge in this area could quickly become overwhelming to health care sector, as the only area hospitals are small and must transfer serious patients to a larger hospital in a neighboring county. . With that in mind, in May of 2015, Chouteau County hosted a workshop for healthcare surge planning in a frontier setting and invited participation and help from federal agencies, national organizations, and community partners. The goal of the workshop was to bring together the local decision makers and the groups that would be impacted by pandemic influenza in order to identify and address issues.

The workshop identified alternative care systems and options in the community that could assist in a healthcare surge. These include an infectious patient center, in-home care, triage centers in hospital emergency rooms, and a recovering noninfectious patient center. Utilization of these systems will provide much needed support to the traditional health care settings as well as increasing access for county residents. The workshop also identified and strengthened partnerships with community organizations, the Rocky Boy tribe, and the Hutterite communities, and these groups formed Mutual Aid Agreements with the county to provide facilities, resources, and support in the event of a pandemic. These partnerships will be critical to meeting the needs of the county.

A central challenge was found in the planning phase while trying to utilize the Community Assessment Tool and Resource Inventory provided by the Centers for Disease Control (CDC). These tools are standard for larger metropolitan areas, but for Chouteau, where an individual may be in charge of several positions or areas, and where certain resources may exist outside the county, it required officials to think about their resources and community in a new way. Even though they were unable to complete every section of the tool, and some sections were filled out by the same people, the tools provided extremely valuable feedback. In order to get this feedback, some customization occurred including combining categories and changing titles and names in order to incorporate county resources.

This was the first time such an in depth assessment was completed at the system level. The Community Assessment Tool and Resource Inventory did create the opportunity to solicit feedback and participation from the Rocky Boy tribe, the Hutterite communities, neighboring counties, and community partners.

As a result of this workshop, relationships were enhanced and strengthened, and Chouteau County officials were able to utilize the knowledge and expertise of the 21 participants from federal agencies and national organizations. The County was able to identify resources and gaps and evaluate their plans thanks to that feedback and participation. The next steps for the County include a continued review of the workshop in order to finalize the pandemic plans, plan additional exercises, and assist the CDC in reviewing Fact Sheets from the frontier public’s perspective.

Despite the challenges of operating in a frontier setting, Chouteau County public health officials and emergency managers have organized two major pandemic exercises, tested a local Point of Dispensing, organized three and five day long exercises to test long-term hospital surge capacity, and tested evacuation and sheltering operations for the county. These actions embody the frontier attitude of working together, resilience, and facing obstacles head on.

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