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Gallatin County Unified Health Command
Meeting Minutes
May 14, 2009
8:00 – 9:00 am
Sapphire Room
Introductions
Mike Layman (Belgrade Urgent Care), Mark Winton, Steph Nelson, Tim Roark, Sid
Williamson, Jim Feist, Buck Taylor, Betty Kalakay, Leslie Teachout, Ita Killeen, Pam
Shrauger, Patrick Lonergan, Kevin Stickler, Sean Grabbe, Vickie Groeneweg
Review prior minutes
• H1N1 Update
A DPHHS HAN Update regarding changes in lab testing and Interim Guidelines for
Antiviral Drug Use for Influenza Infection were passed out. Answers to questions posed
to the state by infectious disease doctors regarding the local cache of state-owned
Tamiflu (574 courses are available to Gallatin County); 90% is allocated for community-
based distribution and 10% to hospital in-house care. Steph N. suggested that once the
question, “For Health Department’s without pharmacies, are there problems with
dispensing laws and rules?” is answered the infectious disease doctors could meet again
to discuss. Meet next week? Private supply is available at this time.
• MPI Progress Report
Pam reported that some doctors, Central Valley Fire and AMR met and discussed the
issues that were slowing the plan’s progress. Ironed out the different views and
consensus was achieved on operations for short-term MPI incidents. Draft plan will be
put together, reviewed in group and then sent to UHC.
Agency Updates:
Bozeman Deaconess Hospital
Winton discussed that a plan was in place for handling ill patients. The second tier of this
plan is to separate the sick from the rest by using a separate room, but no need to
implement this tier yet.
Sid discussed that Influenza A is not responding to Tamiflu. So give to prevent H1N1?
Leslie discussed that more masks were ordered.
C:\Documents and Settings\plonergan\Local Settings\Temporary Internet Files\Content.Outlook\49INRHDU\May 14 2009 UHC Minutes.doc Feist mentioned the phone calls increased whenever there is an article in the paper about
H1N1 and appreciates the handouts and current communication.
DES
Kevin reported from the pre-hospital aspect that there has been no influx of calls and
fitted masks are well stocked.
Pat noted that faxed information is hard to forward so he appreciates emailed
information.
Sean has masks and noted that dispatch is vigilant about capturing symptoms as
emergency staff is being sent out.
Gallatin City County Health Department
Steph N. reported that she met with the superintendents of schools and elected officials of
Gallatin County. GCCHD is working on communication – filtering what is coming in
and streamlining the communication/distribution to the field.
Surveillance has decreased from daily; free testing is no longer available; the focus is on
hospitalized patients. GCCHD will continue to distribute information and work on the
Tamiflu cache for treatment of ill persons. How will we know when local Tamiflu
supply dries up? Steph N. noted someone is tracking (Mike Bertagnolli) and Dr. Winton
will work on a communication procedure. Tamiflu costs $92, which is cost prohibitive
for some. A treatment recommendation is for seriously ill or high-risk factor persons.
See handout.
MSU
Most of the students are gone and now summer school. MSU appreciates the
communication from GCCHD.
Belgrade Urgent Care
Mike discussed that Belgrade Urgent Care is staying aware of influenza and the
appropriateness of testing, exploring how to handle sick patients, and how to get Tamiflu
for patients who cannot afford. Steph N. will facilitate an opportunity to discuss the role
of the urgent cares in a communicable disease event.
Pam added that other things to consider besides exploring roles and responsibilities
during a pandemic is a pandemic call center for communicating with those sick at home
and delivering necessities to those sick at home.
H1N1 Treatment
Dr. Winton discussed the timeframe of influenza illness to treatment, treatment strategies,
and the availability of Tamiflu and Relenza that is recommended for H1N1 treatment.
Dr. Layman added that H1N1 responds quickly to Tamiflu and Tamiflu is a good
treatment for influenza B.
H1N1 Communication
C:\Documents and Settings\plonergan\Local Settings\Temporary Internet Files\Content.Outlook\49INRHDU\May 14 2009 UHC Minutes.doc Are the hospitalists getting the emails or faxes? Leslie will work on this. She will ensure
that the information is posted in their office. They are a new group.
Kevin asked if something is extremely urgent to please mark as appropriate. SN noted
this is being discussed. The group continued to discuss the need to highlight what has
changed from the last communication. Perhaps an assignment of a person to read all
incoming communications and identify what has changed.
Buck asked if the status is hyper vigilant mode or waning? Steph N. discussed being
under public health emergency directive and the WHO pandemic alert is at level 5.
Vaccine started for H1N1 and decision about mixing trivalent is unknown. Currently,
things are calming down.
Steph N. talked with school principals about their plans, if any, to isolate children in the
school. With one nurse per district, it is difficult.
Tim noted CAN (Communication Advisory Network) to get the word out.
The group discussed approaching a provider in the community about being a sentinel site.
The state lab would work closely with the provider. This is a way to pickup influenza
early on. Dr. Layman would be open to the idea. To be discussed.
Next Steps
The technical committee will meet about the Tamiflu cache questions. Currently the
committee is waiting for a contact from the state board of pharmacy.
Pull in urgent cares and hospital emergency room regarding how to utilize in an event.
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Source: http://www.readygallatin.com/uhc/May%2014%202009%20UHC%20Minutes.pdf