In recognition of National Rural Health Day on Nov. 21, NACCHO interviewed Denise Bingham, RN MSN, Director of Nursing, at Three Rivers District Health Department in Kentucky about the unique preparedness needs of rural communities. In addition to her work at Three Rivers, Denise is on the Kentucky Department of Public Health Emergency Rapid Response Team and participates in the Kentucky Rural Health Association. She is also a member of NACCHO’s Risk Communications and Information Sharing workgroup,and has previously served as a Project Public Health Ready reviewer. Three Rivers District Health Department has approximately 60 staff and serves four counties in Kentucky with rural populations. Three Rivers has a strong partnership with NACCHO, with staff participating in workgroups and District Director Georgia Heise, DrPh, serving as the current President-Elect for NACCHO’s Board of Directors.
Does your health department have anything planned for National Rural Health Day? If not, are staffing or funding issues preventing you from conducting activities?
While we are not specifically conducting activities for National Rural Health Day, we are taking advantage of the attention on rural health to highlight some of our existing activities. For example, clinic staff are being certified to install car seats and on Friday there will be a special event where staff will install and check car seats for free. Our health educators are very involved in the communities they serve. They meet with community groups to determine priorities for activities that will provide the most benefit to their communities. One community prioritized working with the school system to make their campuses tobacco free. Funding is tight for specific promotional activities like National Rural Health Day.
Tell me about your work on the Kentucky Rural Health Association and the National Rural Health Association.
I got involved with the Kentucky Rural Health Association to better serve the rural communities within the Three Rivers District Health Department service area. I sit on the board, co-chair the legislative committee, and am a member of the smoke-free workgroup. The association has been a valuable partner for gaining access to providers and has helped us to build up and promote the providers that we already have. We have also improved our relationship with critical care hospitals.
This past February, I had the opportunity to attend the National Rural Health meeting in Washington, DC as a delegate from Kentucky. The meeting gave us a chance to express our concerns to our representative, Congressman Andy Barr, about the effects of sequestration and the implementation of the Affordable Care Act on rural communities. Our main concern was ensuring that funding cuts and the new healthcare law would not restrict access to critical care hospitals that are already struggling in rural communities. For example, there is some concern that critical care hospitals less than 50 miles away from each other may be perceived as serving duplicative needs. In Three Rivers, we have two critical care hospitals that are less than 50 miles from each other, but closing one of these hospitals would require patients to drive more than an hour to seek treatment. Every minute counts in an emergency. Congressman Barr supported our position on critical care hospitals in a newsletter and mentioned that it was the first time constituents had brought the issue of access to critical care hospitals to his attention.
What preparedness issues are you seeing at the state and national level that are universally affecting rural communities?
In Kentucky, preparedness coordinators have been regionalized. Because of budget cuts, local health departments no longer have the funding for their own preparedness coordinators. Three Rivers has been fortunate enough to retain funding for our preparedness coordinator which has helped ensure that the specific needs of our communities are met in emergency planning. Our regional planner assists with writing plans and training local health department staff.
Another challenge that is unique to rural communities is limited resources to provide consistent coverage through local amenities like the fire and police departments. For example, in one of the counties that I cover, they don’t have the funding to have police officers patrolling 24/7. Rural communities depend a lot on volunteers for emergency response.
Tell me about a recent preparedness challenge or success story that you or one of your colleagues has faced.
In March 2012 after a tornado hit a community in Northern Kentucky, the Emergency Manager for the county was able to organize a large group of volunteers by simply using his Twitter account. Even those who did not have a Twitter account received text messages with the same information. The capacity for this type of messaging was developed long before that tornado caused such massive destruction. The citizens in this county signed up to receive alerts of all kinds by simply providing their cell phone number on the county emergency management website. This proved to be beneficial in the aftermath of the tornado when everyone began showing up to volunteer for various jobs. The county Emergency Manager sent a tweet for anyone interested in volunteering to meet at a specific location and time so help could be sent to where it was needed. This is one simple way to reach a large number of people with the same message very quickly using social media and mobile technology.
Were there any lessons learned that you would like to share with other local health departments?
The most important message that I would like to share with other health departments is not to wait for a disaster to start establishing partnerships. The response to the tornado went as well as it did because of work that had already been completed long before the tornado hit, such as training and working with community partners, other agencies, and emergency management. Collecting over 5,000 community phone numbers ahead of time and establishing a following on our social media accounts allowed our Emergency Manager to deliver timely information to gain control of the situation very quickly and start organizing volunteers. Now he can use that information to help keep people safe by sending out information about tornado and flood warnings.
For our health department, we have seen the most benefit from having partnerships established before disasters strike. Then, when something like a tornado happens, our community partners know when to call the health department. For example, when a shelter opens, the health department needs to conduct an environmental inspection and may need to complete a medical needs assessment. Hospitals, emergency medical services, emergency management, and local elected officials all know who they can call at the health department. After a response, the community partners come together afterwards to conduct after action meetings and to discuss what worked and what didn’t so that next time, we are better prepared.
NACCHO resources to help local health departments build partnerships: