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Story from the Field

Name of Health Department/Agency: El Paso County Department of Health and Environment
State: CO
Date Added: 10/26/2009
Themes: Communications - General H1N1,Vaccine Supply and Distribution
Issue Summary: LHD struggles with staffing, vaccine supply, and other issues
Description of Issue(s):

We are a county of about 615,000 and a health department with 180 FTE and only 28 nurses….it’s been interesting!!!!!

Actions taken to address the issue(s): What's going well:

1.Great relationships throughout the county with all our partners willing to help and have been helping. We established a Regional Command made up of the Health Dept and our County Office of Emergency Management and our Colorado Springs Office of Emergency Management. We hold joint ICS meetings each Wednesday. We have received staff and other assistance, free of charge, from both the County and the City.

2.We are holding weekly military/hospitals/EMS meetings to assure communication and to keep each other updated. We have 5 military bases (Ft. Carson, Air Force Academy, Peterson Air Force, Shriver Air Force, and Cheyenne Mountain). Each week we receive a situational update from the Health Dept medical director, updates from each base, updates from each hospital, and updates from the EMS system. We address issues (such as local physicians sending patients to the hospital ERs for flu tests or to be seen), agree on approaches, share resources. It's been great and I think has made a big difference in assuring a joint response. Military has agreed to vaccinate dependents and retirees which in our county is thousands of people.

3.Another great partnership we are developing and in process of writing a contract is with our local Community Health Center who has a Ronald McDonald mobile health van that will provide H1N1 vaccinations throughout our county. We think it will be a great way to meet some of the unique needs of rural El Paso County and a great recognition of this asset in our community.

4.Media coverage has been great. While at times this is a bit time consuming, we have fostered a strong working relationship with all media outlets in our county and strive to be available as often as possible with updates. We've done call in shows during the news for the public to call and ask questions, we've done lots of live radio programs, and tons of interviews. We pitch stories as often as they ask for stories. I think this has made a difference in that the media believes us when we say we don't have enough vaccine and is a partner in getting that message across.

Outcomes that resulted from actions taken: What hasn't worked well:

1.Vaccine supply of course. This has been a tremendous burden and headache. Over the years we've always planned to have the vaccine in huge quantities so we could administer via points of distribution (PODs). For us to establish a POD and only have a few hundred doses is not worth the time and the costs. Due to the likelihood that we'll see small amounts of vaccine over the winter months we are changing our strategy to include smaller "express clinics" at the Health Department most days of the week, getting vaccine out to pharmacies, working with partners such as VNA and Ronald McDonald van. Basically our strategy is to have as many access points as possible for the public.

2.The number of local physicians who agreed to provide H1N1 vaccination. We were a bit disappointed but in talking to the practice managers the reasons for not providing the vaccine included: workforce issues--physicians felt they would be slammed by the numbers of people ill and didn't feel they had enough staff to provide vaccinations as well; safety issues for their staff--in 2003 when seasonal flu was in short supply some office staff members were physically abused and police had to be called. In one instance a person lost sight in their eye after a pencil or pen was thrown when the person was told they were out of vaccine. News like that gets around the medical practices rather quickly and there is/was a fear that this may happen again.

3.Sites for PODs. When we planned our PODs in our pandemic flu plan we made the assumption that schools would be closed in a pandemic situation so using the school facility would be perfect. Since schools are open, access to them has been difficult. We have 15 different school districts with dozens and dozens of school buildings so providing school based clinics was impossible for us.

4.Public health staffing is an issue. Our health department has lost 70 FTE since 2000. While we can hire additional help you still need people who know public health to be in leadership positions and oversee the temporary help.

5.We had to close our Immunization and International Travel Clinic program so the 4 nurses and program assistants could develop and implement the vaccine tracking/control activities. Since so many local physicians only wanted vaccine for their staff and needed less than 100 doses we find this takes a fair amount of time to repackage and prepare for pickup. Plus this is the same group who assures vaccine arrived at the various points in the county as we thought we've had issues with vaccine not arriving and having to back track. The fact that there is not a tracking number has made it difficult to find out if the package got delivered somewhere else, didn't come at all, or what is going on.

6.Some parents are losing it with trying to get vaccine for their children with underlying medical conditions. While we're doing our best to get vaccine out to as many providers as we have vaccine there are parents who fall through the cracks. We've been threatened with law suits and many other things. Plus the public is not happy that we've had to cancel many routine public health services or can't do as many so they have verbally abused staff as well.

7.Key staff are running out of steam already. They are tired! While we have backups for all key positions, in a local health department you just have people who really know what's going on in their areas and there are conference calls and meetings all day, every day of the week just trying to stay updated on the changing situation, let alone getting the work done.

8.We've probably had to reduce routine public health services by 25% overall and in some areas (where we have nurses) 50% to 100%. This will affect us when contacts/grants come due and we haven't met all our deliverables. Many of our contracts are caseload based and if caseload goes down so does the money in the next contract. While I believe this has been discussed at federal and state levels I'm not seeing anything that makes me feel that our work on H1N1 won't have a negative effect on our funding for the upcoming year. While everyone states "We know you're so busy," they still want the same levels of information/reporting/services.

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