RCHC Community Project Abstracts

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Harney County Influenza Strategies 2009
Date of project: 10/12/2009

This project is a general outline of the organization of local resources and planning used during the 2009 Influenza Pandemic to provide adequate and appropriate care to citizens in Harney County in relation to influenza prevention, triage, and treatment. There was a large surge of influenza-like-illness (ILI) in the community in mid-October, during which time resources including vaccines, Tamiflu, and hospital space were of limited quantity and maintaining a high level of coordination between the hospital, clinic, pharmacies, and health department were all critical.

Harney County Tobacco Use, Perceptions, and Education: The Tar Wars Experience
Date of project: 9/7/2009

Tobacco use and abuse including cigarettes, cigars, and smokeless tobacco is the number one preventable cause of death in the United States. Smoking has been linked to approximately 1 of 5 deaths annually. Each day in the United States approximately 3,600 young people between the age of 12 and 17 try tobacco for the first time. It is estimated that 1,100 of these young people will become daily users. Currently 1 in 5 Americans use tobacco on a daily basis. Oregon’s average tobacco use is similar to that of the greater United States. However regions in Oregon, like Harney County, have data illustrating much higher use in both adults and school aged children. This project was designed to investigate the perceptions and educate school-aged children in Harney County. This included epidemiological data review from Harney Behavioral Health, state data, and national data. Next, a survey investigating perceptions of 135 students, representing 80 percent 4th and 5th graders from Harney County, was created and administered. The final aspect of the project included educating 4th and 5th graders about tobacco use through the Tar Wars curriculum so young adults can make educated decisions about tobacco use.

Cesarean Section Rates at Harney District Hospital
Date of project: 8/3/2009

Cesarean section rates as a proportion of live births continue to increase at a rather quick pace in the United States and in many other areas of the world. The CDC reported a 31.8 percent cesarean rate in the United States, a six-fold increase from cesarean section rates of the 1960s and 1970s, and the eleventh consecutive year with an increased rate. Cesarean sections are the most common surgical procedure performed in the United States, 1.4 million in 2007, yet the procedure enjoys very little scrutiny and analysis in comparison to other surgical procedures and medical interventions. Rates of cesarean section vary greatly between geographic areas and within cities at different facilities. Rural areas in the United States tend to have higher cesarean section rates compared with urban areas. This project compiled data from birth logs at Harney District Hospital between 2005 and 2009. The rate of cesarean sections as a proportion of live births increased steadily over this five year period. A further analysis of three years of live births at Harney District Hospital in Burns looked deeper into the indication for cesarean section at each delivery. The physicians who practice obstetrics at HDH had an interest in their cesarean section rate and how it compared with other facilities in Oregon but had not spent the time compiling the data

Updating Clinic Procedures and Policy regarding VFC vaccinations at the High Desert Medical Center
Date of project: 6/29/2009

Vaccines for Children is a division of DHS that offers vaccines to public and private clinics for dispersal to underserved kids. With the DHS’s current goal of vaccinating 90% of children in the US, providing vaccines at a discounted rate for economically disadvantaged children is vital for protecting the health care of many communities. 4 Up until recently, High Desert Medical Center in Burns, OR was offering VFC vaccines to their eligible clients. However, this spring the VFC recalled 2 years worth of vaccines given by the clinic from 2007 to 2009 due to a defective refrigerator. Part of the requirements of re-instating VFC vaccines at HDMC included a staff-wide review of VFC policies for administration, storage, and handling of the vaccines. The VFC guidelines were reviewed, and nurses in clinic were interviewed about current clinic vaccination procedures. An abbreviated version of VFC vaccination policy was created and presented at the clinic’s monthly nurses’ meeting. In addition, a clinic-specific SOP was created for administration and documentation of vaccinations during well-child checks for both VFC and privately insured children.

Identifying Children Vaccinated from March 2007-April 2009 at the High Desert Medical Center in Burns, OR
Date of project: 4/27/2009

When 2 years worth of vaccines from the Vaccines for Children program were retrospectively deemed defective due to refrigerator temperature irregularities, the High Desert Medical Center needed to identify the children who may need revaccination or titres from that time. 221 children were identified using billing codes for pediatric vaccine administration, representing over 1000 injections for the common childhood vaccinations. Estimated cost of VFC vaccines alone used in that period was over $45,000. Limits to identifying this population risk were an inability to identify payer type (private vs. the VFC) as only the VFC is recalling the vaccines.

Virtual Office Visits in Harney County - an assessment of attitudes and access to care
Date of project: 3/16/2009

Access to health care is a growing concern in the United States that disproportionately affects those in rural areas already working to overcome barriers in physical access. Technology has the ability to bridge some of these physical gaps and may be particularly effective at increasing access in geographically isolated areas. Virtual office visits – the online interaction between patient and physician – may be one of these technologies. This study was designed to evaluate patient and physician attitudes toward virtual office visits in Harney County and to gather logistical information to assist in the eventual development of a pilot project. A standardized survey was developed and data was collected over a two week period. Physicians and office staff were interviewed and models for virtual office visits in other locations were reviewed. Overwhelmingly, patients and physicians expressed interest in piloting virtual office visits in Harney County and felt that this technology would improve access to health care and consequently would improve health outcomes. Several common concerns were also identified and problem-solving strategies were discussed. At the completion of the study, a document with compiled results of the survey, synthesized data from the interviews, and suggested options for pursuing a pilot project was presented to staff at the High Desert Medical Center.

Profile of First Responder Program in Harney County
Date of project: 2/9/2009

Harney County Emergency Medical Services face unique challenges in providing emergency care to the remote areas of the Oregon’s largest and least densely populated county. The implementation of an all-volunteer First Responder Program around the county permits trained citizens to arrive on the scene sooner than EMS crews and begin to provide care to the patient and information to the crew en route. A profile and critical review of the First Responder Program demonstrates the importance and inherent challenges of maintaining this program that plays an integral role in providing emergency services in rural and frontier regions.

Burns Biggest Loser Part 2: Finding Reliable Healthy Weight Loss Information In a Small Rural Community
Date of project: 12/29/2008

Over 66% of Americans are overweight or obese. In urban areas, there are a variety of weight loss classes, clubs, and programs available to the individual motivated to lose weight. Paradoxically, in rural areas like Burns, Oregon the prevalence of overweight and obesity is greater than the national average, yet the weight loss resources are scarce. If a resident of Burns, Oregon wants healthy weight loss information there are few local resources, none of which offer free weight loss education, guidance, and monitoring. One option for such an individual is MyPyramid.gov, a free interactive web site that offers personalized diet and physical activity assessment, and encourages healthy self-monitoring behaviors.

Alcohol Use vs Dependence in Harney County
Date of project: 10/13/2008

Alcohol abuse and dependence is a commonly encountered problem in communities, particularly in Oregon vs. the U.S. This project was designed to investigate potential reasons for higher rates of alcohol consumption per capita in Harney County compared to other Oregon counties but equal rates of alcohol dependence between the two. Identifying potential contributing factors toward increased consumption yet equal rates of dependence between state and county was the primary goal. The design of this investigation included data review from the state epidemiological outcomes workgroup on alcohol statistics, 6 interviews with members in the community that encounter alcohol problems, a survey review of 52 high school students in Harney county, and observations of community advertisement/marketing adds. The data was collected and analyzed. Potential factors discussed in the interviews toward the disconnect between increased alcohol consumption and dependence were identified along with the number and locations of slogans/adds in the community. The final conclusion of the project was that contributions toward increases in alcohol consumption per capita in Harney County but equal rates of alcohol dependence are multi-factorial including community attitudes, attitudes toward rights of passage, marketing/advertising, potential loose law enforcement in the past, economic strains that potentiate alcohol use, and potential under diagnosis amongst clinicians. Recommendations that was used after considering the data was an information brochure to be administered to parents of older children, adolescents, and teenagers in routine doctor office visits promoting awareness about alcohol use amongst these groups in Harney County.

Burns's Biggest Loser: A real world program of education, increased physical activity and healthy food choices to lose weight.
Date of project: 9/8/2008

There is an epidemic of obesity across the United States including small communities like Burns, Oregon. One method to counteract obesity includes increasing activity and decreasing food intake. Members of the community of Burns desired a program to lose weight that incorporated health diet advice and physical activity suggestions. They also wanted a program that was fun, motivating and offered social support in their efforts to lose weight. Thus, a program to lose weight was developed that centered around making healthy food choices with portion control, increasing daily physical activity using a team competition approach. Additionally, the participants were offered education on the risks of obesity and methods to recognize and counteract barriers to physical activity as well as education in goal setting. This comprehensive program was implemented and the participants were followed for the first week which resulted in an average weight loss of just less than two pounds per participant.

Targeted Sexual Education in Rural Communities
Date of project: 8/4/2008

Youth growing up in our countries rural communities face a multifaceted challenge as they become sexually active. Statistically they are a high risk group - often with higher rates of alcohol use, earlier sexual debut, and frequently increased numbers of sexual partners at an earlier age. Compounding and interacting with this is the political climate in which these individuals come of age. Frequently, comprehensive sexual education is discouraged in traditionally conservative communities and school districts - often favoring abstinence-only based education that downplays the importance of contraception and discourages an open dialogue on topics of sexuality and sexual practices. These issues - along with socioeconomic forces at play in our rural counties and districts - lead to disproportionably high rates of teen pregnancy and STI transmission - even in areas where resources, providers, and adequate health care education are available and accessible. My project was designed to find the missing pieces of formal sexual education and directly target a short informational session to give students the skills and knowledge they need to make informed decisions about their health, their decision of how and when to engage sexually, and for those already sexually active - to serve as a reinforcing reminder on the importance of contraception and means of STD protection.

Crisis Pregnancy Resources in Harney County
Date of project: 6/30/2008

An unintended pregnancy can be a source of tremendous stress and angst for a woman and her family and may contribute to a poor pregnancy outcome such as preterm birth. The decision to continue the pregnancy begs the question of how one will obtain medical care, social and emotional support, childbirth and parenting education and the financial resources to support basic needs such as food, clothing, and diapers. In Harney County, resources outside of family support are limited. The goal of this project was to understand the breadth of and access to resources available in Harney County to women in a “crisis pregnancy” that choose not to abort. Crisis pregnancy was defined as an unplanned pregnancy in which a woman/family has insufficient personal financial, medical, educational, and emotional resources to provide for a healthy pregnancy and healthy child. Brief interviews were conducted with nurses, physicians, counselors, and community members that focused on what resources they had to offer in a crisis pregnancy situation, how many women access them for such resources, and what other agencies they would refer women to. Discovered resources were placed into four categories: medical, emotional/social support, educational, and financial/basic needs. All agencies could name a few other resources or programs applicable for referral, but none had detailed or comprehensive knowledge of the programs available. Recommendations were made for improvement in the access to and utilization of crisis pregnancy resources. A list of pregnancy resources and a binder of pamphlets was also compiled from the interviews for use at High Desert Medical Center.

"Every 15 Minutes” Program Immediate and Short Term Outcomes
Date of project: 4/28/2008

Underage drinking and driving remains a problem throughout the US, including Harney County. About 8.6% of eleventh graders in Harney County had drove under the influence in 2005-2006. Harney County high schools participated in the “Every 15 Minutes” program which focuses on making responsible decisions around driving and alcohol. High school students, sophomores, juniors and seniors, were surveyed approximately thirty days after involvement in the program. After the program students were more likely to be designated drivers and less likely to ride with someone who had been drinking. In general, the “Every 15 Minutes” program has had positive immediate and short-term outcomes. This data was compared with similar data from the 8th grade Oregon Healthy Teen Survey from 2005-2006 which these students participated in. Ongoing surveys would determine long-term effects of the program.

Recent Onset Cardio-pulmonary Disease in Three Fiberglass Plant Workers in Hines, Oregon
Date of project: 3/17/2008

In 2007-2008 High Desert Medical Clinic in Burns, Oregon saw 3 patients who presented with acute-onset respiratory and cardiovascular illness after working with fiberglass at the Monaco Coach Corporation’s plant in neighboring Hines, Oregon. Purpose of the study: (1) identify what substances are used in fiberglass manufacturing that may cause cardio-pulmonary disease, (2) evaluate methods of protection used by the Monaco plant against occupational exposure to these substances, (3) consider ways in which the local medical community and plant management can improve public health regarding the occupational hazards associated with fiberglass manufacturing. Conclusions: (1) the Monaco plant has a thorough exposure protection policy that exceeds the requirements set by law or insurer, (2) although styrene is the principal toxin used in fiberglass manufacturing that is measured by regulatory bodies, there are other agents, such as fire retardant filler, phthylates, and fiberglass dust particles, that may be associated with respiratory and cardiovascular illness in plant workers.

The Oregon Prescription Drug Plan & the Uninsured and Underinsured Residents of Harney County
Date of project: 12/31/2007

Senate Bill 362 is an amendment passed in the legislature in April, 2007 that expanded the Oregon Prescription Drug Plan (Ballot Measure 44). All Oregonians are now eligible for a free discount card for prescription drugs. Unfortunately, the bill did not include adequate funding to promote the program. Given the high costs of prescription drugs and the difficulty many Harney County residents have paying for their medications, this project was designed to increase local familiarization with the program and also to better understand the workings of the program. How well known is the program? How does it work and is there a true benefit? Is it possible for it to be sustainable in the long term? To answer these questions, staff members at the clinic and hospital were interviewed. Community resources to help patients pay for medications were evaluated, and interviews with the pharmacists in Burns, the director and assistant director of the OPDP, the executive director of the Oregon Pharmacies Association and a reporter from the Oregonian were conducted. In the end, two articles were written for the Burns Times Herald, the first informing citizens that the program is available with instructions to register. The second article focused on the details of the program, its funding and its future. Notifications were placed in several church bulletins in town, and the hospital, clinic and senior center were provided with resources to promote enrollment in the program. The benefits and drawbacks of the program were discussed with staff at the hospital and clinic so they could continue to educate patients in the future.

Implementation and Continuation of Sex Education in Harney County
Date of project: 10/15/2007

Teen pregnancy and teen STD transmission are both issues that are of great impact on individuals, communities and society as a whole. In Harney County Oregon, where social support networks are scarce and difficult to access, this is also true. Although rates of both teen pregnancy and STD transmission are both less than state and national averages1,2, the individuals involved are still greatly affected by these life changing events. Teen pregnancy is well correlated to individuals living in poverty and that must later be supported by a Welfare program that spends 9 billion dollars a year on family support of these individuals4. Seeing that there are 700,000 new teen pregnancies a year4, there is still a lot to do in the department of prevention. My project was aimed at that exact goal, and sought to better educate the middle school students of Hines Middle School following comprehensive national guidelines.

Pahe’yoo Meals of the Wadatika (Three Meals of the Burns Paiute Tribe)
Date of project: 9/10/2007

Significant morbidity and mortality can be avoided in chronic disease states such as Hypertension, Diabetes, and health complications from obesity with simple lifestyle modifications such as a healthy diet and increased exercise. Many studies have emphasized this. By using surrogate markers such as blood pressure as a measure of cardiovascular disease and Hemoglobin A1C as a measure of diabetes control, doctors can monitor the progression of disease in a population. However, the doctors in Harney County often lament the poor health and poor treatment plan compliance among their Native American patient population, based on measurements of those surrogate markers. Barriers must clearly exist to patient compliance among the stated population. These can include mistrust of the medical community, inability to pay for services and medications, misunderstanding of treatment principles, and what types of foods constitute a healthy diet. How do you gain the trust of a patient population to help them to modify their current diet in a way that is beneficial in terms of health goals, but is also feasible, financially and culturally for them? What can be done to increase compliance and decrease the disease burden among Native Americans? While I cannot attempt to answer these huge questions in a lifetime of medicine, I can ask a smaller question which lead patient and provider in the right direction. What are the current dietary habits of the population in question, i.e., the Burns Paiute Tribe?

Proposal to the Paiute Indians of Burns, Oregon
Date of project: 8/6/2007

While doing my clerkship in Burns, Oregon we encountered several cases of MRSA in patients, some of which required hospitalization to receive IV vancomycin. I did a chart review of all patients at HDMC that had been diagnosed with IC9 codes reflecting MRSA, cellulitis, and skin abscesses to determine the incidence of MRSA. We noted a 4.7% incidence from July 2007 to August 2007 of CA-MRSA in Paiute Tribal Members living on the reservation north of Burns. During the same period of time there was a 0.1% incidence of CA-MRSA among non Native American patients seen at the High Desert Medical Center (HDMC) in Burns. Previous annual incidences were between 0.23% and 0.33%. A literature search was then performed, and a proposal was written and submitted to the Paiute Indian Tribe to do nasal swabbing to determine the incidence of MRSA. An educational brochure was also created to be distributed to Tribal Members to help them decrease their chances of becoming infected and potentially hospitalized from MRSA.

Traumatic Brain Injury in Harney County Etiologies and Incidence of Emergency Department Visits, Hospitalizations and Deaths
Date of project: 7/2/2007

With a population of 7,660 people spread over 26,486km2, Harney County is the most sparsely populated county in the contiguous US and has a low enough population density to qualify it as a “frontier territory”. Given the abundance of uninhabited land, ranching, hunting, off-roading and other outdoor activities are an integral part of the Harney County culture. These pursuits however provide additional potential risk factors for head injuries and thus might predispose the population of Harney County to increased rates of traumatic brain injuries. The purpose of this study is to assess the impact of Harney County’s frontier-county lifestyles on the rates, etiologies, and outcomes of traumatic brain injuries in Harney County. An examination of national, state, and county data on TBI incidence, etiology, and outcome was performed for comparison. National and state data were obtained from online databases while Harney County information was obtained from Harney District Hospital records department. Analysis of primary data found that there is an increase in the incidence and overall proportion of traumatic brain injury from direct livestock-induced injury, secondary injury from MVA-livestock collisions, and off-road related ATV rollovers compared to other etiologies except falls. The overall incidence of TBI’s in Harney County was found to be slightly higher than that of the national or state incidence rate By identifying common causes of head trauma in Harney County, local providers can identify higher risk communities and at-risk individuals and can thus emphasize patient-specific strategies for prevention of future head trauma.

Interfacility transfers from Harney District Hospital, Burns, OR
Date of project: 4/30/2007

Harney District Hospital (HDH) is the lone health care center for the 7,600 people living in Harney County, the largest county in all of Oregon. They are able to handle most every medical and surgical problem; however, as a small hospital with limited resources, certain patients come through that require transfer to a tertiary care facility for additional care. The hospital’s ambulance service conducts these interfacility transports; however, they are never quite sure what type of patient to expect when they back their ambulance in. This uncertainty makes it difficult to train and educate ambulance crews, arrange crew configurations, and equip and supply the ambulances. Similar ambiguity exists for the hospital as well. This study aims to elucidate what patient problems require transfer to other facilities, from which setting they are transferred, and by which mode of transportation. Data on every patient which required interfacility transport between December 2005 and April 2007 were collected from hospital databases, and analyzed categorically. During the study period, HDH transferred 3.5% of their patients. The majority of these 171 patients were transferred by ambulance; however, a full 1/3 of patients were transported by air. 50% of all patient transfers were for patients with cardiac, orthopedic, or surgical problems: a large fraction of acute issues. Some problems, like psychiatric, infectious, and oncologic were rarely transferred out. Proportionally, more patients from the inpatient ward required transport than from the ED; however, any given transfer was equally likely to have originated from either setting. These data will hopefully help county EMS to focus education on the high yield and rare maladies, appreciate how to efficiently equip and supply ambulances, and balance the skill level of crewmembers with the anticipated acuity of patients. The hospital may also find valuable information in this project, elucidating where additional specialist care, equipment, and education may decrease the necessity of some transfers, allowing more patients to receive definitive care within their community.

Physical Activity in Harney County, Oregon: Attitudes toward, Self-Assessment of, and Barriers to a Physically Active Lifestyle
Date of project: 3/19/2007

Obesity and physical inactivity are quickly becoming major causes of morbidity and mortality in the United States. Rates of obesity and physical inactivity are increasing in the US every year. Citizens of rural communities have higher rates of obesity and physical inactivity than the overall population of the US. In order for small rural communities to take action against this slip into a culture of inactivity and obesity, they must identify trends, needs, and strengths within their communities. My project 1) assesses perceptions of and behaviors that affect health and physical activity, 2) identifies barriers to increased physical activity, and 3) solicits possible governmental/community solutions that can help citizens become more physically active. In order to elicit this information, I conducted interviews with a number of Harney County citizens, including health care staff, patients attending a health care facility, and local citizens in community spaces. I also surveyed patients attending High Desert Medical Center on the topics mentioned above. Surveys and Interviews indicated a number of trends. Citizens had a high personal value for health and physical activity, and had overall high average self-assessed levels of health and physical activity (especially high in the young). There was a slight fall off in self-assessed health and physical activity with increasing age, as well as a large decrease in at-home (as opposed to work/school-related) physical activity levels with increasing age. Walking, gardening, ranch work, bicycling, running, and swimming were the most commonly mentioned physical activities that citizens currently engage in. Swimming, walking, yoga/taichi, gardening, and bicycling were the most commonly mentioned activities that citizens would like to participate in. The most commonly mentioned barriers to physical activity were not having enough time, not having enough money, lack of year round facilities, lack of facilities appropriate to their activity of choice, medical conditions that prohibited their participation in an activity of choice. Most ideas submitted by patients were related to increasing availability of indoor facilities, increasing child-care availability at exercise facilities, and increasing hours of operation of facilities.

Implementing the New HPV Vaccine: developing informational resources for patients and clinic tools for its use
Date of project: 2/12/2007

A new vaccine is available that protects against the most common types of HPV that cause cervical cancer, but the patients of the High Desert Medical Center have limited information available to them about this vaccine, and the clinic itself has not begun using it. This project had two goals: first I attempted to help create informational resources about this new vaccine, and secondly, to help implement its use in the clinic. To achieve increased patient education, a brochure was developed to be distributed to patients at the clinic. An article about the vaccine and cervical cancer was also written that will run in the local newspaper. To help the clinic put the vaccine into use; I worked with IT staff to add reminders and schedule tracking of the new vaccine. I also acquired the cost information from the most commonly used insurance companies in the area.

Telecommunications Technology and Medicine in Burns, Oregon
Date of project: 1/1/2007

Telemedicine uses telecommunications technology for medical diagnosis, follow up, and therapeutic purposes when distance separates the patient from their doctor. It is ideal, in concept, for patients who live in rural ares, and are forced to travel long distances to see specialists typically centered in urban areas. Studies show that setting up this remote interaction is possible, but there is little evidence that is is an efficient and cost effective means of delivering care. High Desert Medical Center in Burns, Oregon was given equipment through various grants to set up telemedicine services, but little has been done in terms of implementing it into a useable practice. An analysis of the benefits of and barriers to creating a lasting operational telemedicine service was undertaken to help guide future efforts. A survey of patient opinion was performed, and a newsletter article was drafted to educate the public about telemedicine.

An estimate of the cost and need of the provision of chemotherapy in Harney County.
Date of project: 10/16/2006

Background: Each year approximately 150-250 people from Harney County (population about 7000) seek medical treatment for cancer. The long distance from home exposes patients to added risks during their treatment. Currently, Harney District Hospital (HDH) is researching the possibility of administering chemotherapy on site. This would result in saving cancer patients many hours on the road. Population: This project looked at a subset of Harney County cancer patients who are receiving treatment at Bend Medical Clinic (BMC), St. Charles Hospital. Type of study: Informational. Methods used: A cancer patient list was compiled by BMC, defined by cancer patients with Harney County address zip codes. This list was cross referenced with the EMR at the High Desert Medical Center (HDMC) in Burns to obtain patient's cancer diagnosis. A list of "safe" chemotherapy drugs were provided by BMC oncology staff. The cost of the drugs and administration were calculated. Results: The patient population is described. It appears that the administration of chemotherapy drugs at HDH would be fiscally feasible with chances for a net gain.

Streamlining and Clarification of Alcohol Withdrawal Standing Orders at Harney District Hospital
Date of project: 7/3/2006

Harney District Hospital (HDH) administration and medical staff were interested in providing better care for their patients experiencing alcohol withdrawal by revising their current alcohol withdrawal orders and educating their staff. In the recent past they had some increased morbidity from unrecognized alcohol withdrawal that the staff and administration found unacceptable. A comparison of alcohol withdrawal orders from HDH and a larger Portland-area trauma one emergency department revealed some improvements that could be made to help minimize confusion and aid in earlier recognition of alcohol withdrawal syndrome (AWS). Some improvements were addressed in a revision of the current orders that is under submission for the next medical staff meeting at HDH. As a second area of improvement, an in-service was given for HDH nursing staff on alcohol withdrawal syndrome and the proposed revision of the alcohol withdrawal orders. The in-service consisted of a a 30-45 minute PowerPoint presentation about AWS and the proposed revisions of the alcohol withdrawal orders. The nursing staff was informally polled at the in-service about their concerns with the revised orders with an eye toward further clarification of the protocol. This approach was well received by both physicians and support staff at the hospital.

Skin Cancer Educational Outreach in Harney County
Date of project: 5/1/2006

Harney County is a frontier county in Eastern Oregon with a culture predominated by desert cowboy culture and outdoor recreation. At an elevation of 4148 feet, and a climate consisting of 300 days of sunshine a year and 11 inches annual precipitation, the area attracts sun and outdoor lovers who will be exposed to high levels of ultraviolet (UV) radiation. Regular physician visits are rare for much of the population and little is known about skin cancer prevention awareness among residents of the county. In addition, the incidence of skin cancer is rising rapidly worldwide. Melanoma is the 5th most commonly diagnosed cancer and the 6th leading cause of cancer deaths in Oregon. Between 1999 and 2002, Oregon's melanoma mortality rate of 29.4 deaths per 100,000 people as the second highest in the nation. Skin cancer awareness is therefore a pertinent issue for residents of Harney County. A chart review was conducted in an effort to quantify the prevalence of melanoma and non-melanoma skin cancers in the clinic's patient population. As an attempt to reach out both to High Desert Medical Center patients and community members that do not regularly visit the local health clinic, a health fair educational display was developed. The display included focused skin cancer screening information, basic medical terminology describing development of skin lesions and methods of skin protection and cancer prevention. Information for the display was included from textbooks, journal articles and the High Desert Medical Center physician staff. Patient handouts were also developed for distribution at the health fair.

Medicare drug plans in Burns, Oregon
Date of project: 3/20/2006

In the town of Burns, Oregon, Medicare-eligible patients who had been receiving their medications for free from drug company patient assist programs (PAPs) were informed that most of the drug company assist programs would no longer provide their medications after the Medicare Part D deadline of May 15, 2006. In response to such news, there was much confusion for health care providers and patients. In addition to Medicare Part D, the federal government also instituted a separate subsidy program for the drug plan through Social Security to assist low-income patients. My project looked into all Medicare-eligible patients in the Burns health clinic who had received drug company assist in the past six months to see whether patients were deciding to join a drug plan and to gauge the extent of their knowledge of the additional help through Social Security as more patients on drug company assist would probably qualify for the extra subsidy than the general Medicare patient population. In Burns, there were a total of 163 patients who had received medications from drug company assist programs in the past six months, 116 (71%) of whom were Medicare-eligible. I conducted a phone survey to all the Medicare-eligible, PAPs patients and spoke to 71 patients (61%). Each patient was called at least twice over a course of three days.

Emergency Room Utilization in Harney County
Date of project: 2/13/2006

Proper utilization of emergency departments in rural communities is important due to the shortage of local doctors and lack of a full-time emergency medicine (EM) physician. When the same physician is caring for patients in clinic while on-call in the emergency department (ED), it is important that patients be using the emergency room (ER) for urgent, acute issues. I chose to investigate the patterns of emergency medicine use in Harney County, population 7000, over a 2-month interval. I looked at principal diagnosis and whether the patient was admitted to the hospital, put on a 23-hour observation, transferred to another hospital, or discharged directly from the ED. I designed graphs looking at top 10 diagnoses, common system-based diagnoses and outcome in terms of discharge. I discovered that the majority of patients in Harney County are utilizing the emergency room for urgent or acute issues. Principal diagnoses appear to be typical of any emergency department. Lastly, I identified some of the common diagnoses that probably did not warrant an ER visit and what we can do in the future to help decrease the volume and costs in the ED.

A Chronic Pain Survey: Defining chronic pain, its prevalence, and its severity
Date of project: 10/17/2005

Chronic pain is an intrinsically subjective disease. There are no objective methods to measure it. Chronic pain is a disease process that involves psychosocial as much as physical pathophysiology, if not more so. Moreover, there is little consensus among the different specialties and organizations in medicine on the definition, assessment, and management of chronic pain. Because of these, the prevalence rates of chronic pain range from 10 to 55%. A larger number compared to the 10 to 15% of the general population that seeks care for chronic pain, a disparity that is worth investigating. The available studies on large populations vastly out-number those on rural communities. Originally, this project was to analyze the appropriateness of chronic pain treatment in this community as compared to standard guidelines. However, with lack of widely accepted guidelines and little epidemiological data to compare, this analysis was difficult to pursue with the allotted time. The project focus shifted to addressing the prevalence, associated factors, and description of chronic pain in the “rural” community of Burns, Oregon. To accomplish this task, a patient survey was devised that was largely based on two prior descriptive studies on chronic pain in rural communities. The definition of chronic pain used in the survey is an adaptation on the definition by the International Association on the Study of Pain. To describe the more “physical” component of the pain, the survey asks to describe the pain’s location, sensation, intensity, perceived cause, duration, and frequency. To describe a more “psychosocial” aspect of the pain, the survey asks to answer questions from the Quality of Life Scale. Though there was inadequate time, the patient survey is ready and available for implementation. From this potential pool of data, certain outcomes can be ascertained, such as: the validity of this study’s definition of chronic pain and the appropriateness of using current guidelines in the assessment and treatment of chronic pain, including the use of opioid analgesics. Finally, the current chronic pain practice of rural physicians can be surveyed to compare to these guidelines.

Diabetes Mellitus Community Awareness
Date of project: 8/8/2005

There are over 18.2 million people in the United States with Diabetes Mellitus. Only 13 million or so of which have been diagnosed. This leaves about 1/3rd with untreated Diabetes. Diabetes itself is the fifth leading cause of death, and a vast contributor to increased morbidity in the form of “heart disease, blindness, kidney failure, extremity amputations, and other chronic diseases. ” The cost of DM to the health care economy is enormous, with over 92 billion per year in direct costs, and an additional 40 billion in indirect costs. Per capita, more than twice the amount of health care dollars are spent on someone with DM than someone without. Various methods are proposed to help eliminate or reduce these problems through better access to preventative care, more widespread diagnosis, more intensive disease management, and through the advent of new medical technologies. The possible results of this project seem pretty intangible. The articles will be going in the paper starting this week and going for the next four weeks. Best case scenario: some people that were previously untreated, like the patient I saw in clinic, will decide to talk to their doctor about their symptoms. Further expansion of this project could include additional articles on Diabetes, to measuring the effect of these articles by comparing rates of DM diagnosis before and after the articles, or by supplying newly diagnosed diabetics with questionnaires about why they came to the doctor. In addition, further outreach could be undertaken, such as ads on the local radio station, or a booth at the County Fair (the first week of Sep). Also, many other health topics are not popularly known, so additional education could be undertaken through the weekly column in the local paper.

Educating The Population Through The Media
Date of project: 4/25/2005

The project was suggested by my preceptor, Dr. Tom Fitzpatrick. It involves getting basic medical information out to the population of Burns by publishing a weekly column in the local newspaper. Contact was made with Toni Siegner, a local reporter, to coordinate the publication. An initial article was written, but this proved to be too long; the newspaper wanted the publication to be limited to between 150 and 300 words. Several articles were then written, which met the expectations of the newspaper. As of the end of the rotation, one article had appeared in the paper (an introductory article) and another was to appear in the paper on Sunday, May 29 (two days after the end of the rotation). Three more articles are in reserve, and Dr. Fitzpatrick will submit them for the following weeks. Follow up of this project can be undertaken by any student who goes to Burns; it would involve writing comprehensive, concise, interesting articles on healthcare subjects not yet covered.

Suicide in Harney County: Is it higher than metropolitan Portland?
Date of project: 3/21/2005

Suicide is a significant medical issue in the rural United States. This study compared the suicide rate in rural Oregon with more urban areas of Oregon from 1998-2004. It also attempted to answer the question of why the rural suicide rate is higher than urban areas. The design was retrospective review of Oregon vital statistics grouped by counties. Counties were separated into groups according to population. Mean yearly suicide rates for each group were calculated as well as overall suicide rate per group during the time period from 1998-2004. Statistics for variables thought to be associated with suicide rate were also obtained and compared to the group suicide rate in an attempt to determine if any relationship exists. Calculated suicide rates were generally higher in Oregon's rural counties than in urban counties. There was also a difference between the most rural and most urban counties in each variable obtained, however there did not appear to be a trend when looking at all groups by increasing urbanization. Therefore, there does appear to be an increased suicide rate in rural Oregon counties which is consistent with other rural areas worldwide, however no definite risk factors were identified.

Reported Stroke Mortality in Harney County: the perceived need for additional stroke education
Date of project: 2/7/2005

Cerebrovascular accident "Stroke" is one of the leading causes of Morbidity and mortality in the US. Unfortunately, Oregon stands out as a state with a disproportionate stroke-related burden of morbidity and mortality. As Harney County is one of the most rural counties in the state, the goal of this project was to use rough analysis of mortality data for the county and state to make assessments of relative stroke burden compared to stroke. What was revealed from the analysis was a significantly decreased level of stroke-related deaths reported for the county, than the state. Assuming that Harney County is not significantly healthier than the state at large, the disparity in reporting is hypothesized to be due to a relative lower level of stroke awareness and education, which may lead to lower frequency of presentation to available health system. Therefore, a newspaper article/public service announcement was written and information cards posted in the clinic in an effort to further educate the community to the signs, symptoms and risk factors associated with stroke. Thus, the intended long term outcome from this project developed into further education of the Harney County community regarding recognizing stroke and minimizing risk factors.

Skin Cancer Awareness in Harney County
Date of project: 1/3/2005

Burns is located in Harney County, which is part of the High Desert near the edge of the Great Basin. There is over 300 days of sun per year at the elevation of approximately 4,200 feet above sea level; obviously putting residents here are risk for increased ultraviolet radiation (UV) exposure. Presently in the United States skin cancer is the most common tumor diagnosis made each year with 1 in 5 Americans developing a skin cancer over his/her lifetime. Additionally, the incidence of skin cancer has been on the rise for the past 30 years with a doubling in the number of people diagnosed with melanoma every year. These facts combined with the unique climate of Harney County made working on skin cancer awareness an important topic. This project included making a patient friendly newspaper article to be published in the local newspaper that will run in conjunction with advertisements about an upcoming skin cancer screening clinic. The goal of the article was to inform the surrounding population about their risks for skin cancer, how to prevent it, and when they should seek medical attention. Research was conducted about the most up to date information about skin cancer then used to create the article to address the entire community, especially to inform those who may be at a higher risk of skin cancer. During this project input was sought from the providers here at the High Desert Medical Center and from the Dermatology Department at OHSU.

Fighting Childhood Obesity with Physical Education
Date of project: 9/13/2004

Obesity is a growing problem in all age groups, but particularly alarming are the growing numbers of overweight children. The rural community of Burns, Oregon has not escaped this dilemma. Many attempts to address this problem have been made, but the community has yet to incorporate an important resource: physical education. Recent studies have shown that by enhancing physical education class, especially at the elementary level, dramatic differences can be made in a child’s weight. The purpose of this project is to evaluate the current PE and nutrition programs at Slater Elementary School in Burns, and make suggestions for increasing their effectiveness. This will be done by suggesting means to increase funding and support, and through making a parent handout on easy ways to keep their child’s diet healthy.

The Forty Assets: A Needs Assessment for Adolescent Well-Being in Burns
Date of project: 8/9/2004

In response to a series of adolescent suicides in a single year, Burns developed the Positive Parenting Group to promote healthier adolescent development. They have modeled community interventions based on the Forty Assets program, as developed by the Search Institute. In this project, 124 students from Burns High School were surveyed to ascertain the extent to which adolescents in this community have developed positive assets. The strengths of adolescent development in Burns include family support, clear boundaries established by adults, high expectations by adults, and positive personal values. The community has fewer assets in the areas of adolescent empowerment, the constructive use of time by youth, and a sense of neighborhood support. This data can help community groups and future medical students develop interventions targeting teen involvement in service, community activities (social or religious), or school activities (including sports, arts, or other clubs). Service-related activities are encouraged to promote community interaction in a setting where resources are limited for the creation of new programs.

General Guidelines for Preventing Childhood Obesity, and a Closer Look at Progressive Resistance Training as a Therapy for Diabetic (Type II) Patients with Co-morbid Obesity
Date of project: 7/5/2004

Obesity in adolescents and children is a growing trend across the US. It is not an isolated phenomenon but is a co-morbid condition and even a causal factor for many other pathologic processes. Among the Native Americans, there is an extremely high prevalence of obesity and diabetes mellitus II. In Burns, there are efforts to make obesity more visible on the health awareness billboard. This will be a continuation of the project started by Alison Bahr, a former medical student in Burns. This project will provide two handouts. One handout will outline the guidelines for the prevention of childhood obesity, and will be made available for the Logician digital system at the clinic. The other handout will discuss options in physical activity as an adjunctive treatment of obese diabetic patients, and will be submitted to the Burns Times-Herald for public awareness.

Television and Childhood Obesity: Spreading the Message in Harney County
Date of project: 5/10/2004

Childhood obesity is a problem across the country with health implications for the present and future. Recent studies have shown that reduced time in front of the television for children and adolescents may help prevent obesity. While community groups and programs exist in Burns to promote youth fitness, no one has specifically outlined the role television viewing has on childhood obesity. The purpose of this project is to educate patients and the community about reducing time in front of the television and its potentially significant impact on childhood obesity prevention. This will be done through an article publication in the Burns Times-Herald and a public service announcement on local radio stations, KQHZ and KZZR, all in association with the physicians at High Desert Medical Center. In addition, a patient handout will be made available in clinic to help parents develop good television viewing habits with their children.

Hypothyroidism in Harney County
Date of project: 1/5/2004

Dr. Thomas Fitzpatrick is a family practice doctor in Burns, OR who has served the community for the past 14 years. In discussions soon after my arrival in Burns he and I sat down to discuss potential projects for the AHEC rotation. Dr. Fitzpatrick had a suspicion that there was an increased rate of hypothyroidism in the community he served. Based upon this clinical suspicion a chart review was conducted to determine the number of patients who have been diagnosed with hypothyroidism at HCH/HDMC. This study set out to examine the prevalence of hypothyroidism in the areas serviced by Harney County Hospital/High Desert Medical Center. Following the collection of epidemiological data, a comparison to national averages attempted to identify the presence or absence of an increased rate of this condition in the area. The data collected indicated that the area served by HCH/HDMC had an increased prevalence of the condition. With this information the specific characteristics that may predispose the patient population to this condition were examined.

Adolescent development in the community of Harney County, what is the community concerned about, and how can a medical student contribute to their efforts.
Date of project: 11/10/2003

Communitites across the US have always been concerned about how to encourage healthy- physically, socially, and mentally-development of youth. Countless programs and institutions have veen developed towards this effort, but at the same time people often feel overwhelmed with the problems facing adolescents. This project aimed to unveil the community's concerns about adolescents, establish their current efforts towards these concerns, and attempt to become effectively involved in this effort. It was identified that Harney County recently established a "Community Action Team" which is commited to creating a positive environment that will encourage and enagle the development of healthy, responsible, and caring adolescents. To become involved in their effort I met with the committee's memebers, attended their monthly meeting, and identified what role a medical student could play in working towards the goals of the committee. During this first meeting the "Community Action Team" identified and voted on the three most critical needs: underage alcohol and substance abuse, parental reponsibility, and truancy. Underage alcohol and substance abouse was the only problem voted on unanimously the the"Community Action Team", therefore, this became my project's focus. Through talking with community memebers it was decided that the greatest impact I could make was in working directly with teens. The majority of resources for teens with substance and alcohol problems and located at HBH. HBH coundsels youth who seekk counseling, but their major efforts involves a "Teen Alcohol and Drug Abuse" (A&D) group that is a court mandated group encounter for teens with criminal records involving substance use. This meeting was attended once for observation to identify educational needs of this group, and once to teach the group and ask questions to further understand how these adolescents believe they ended up in this court mandated group. During this obervation, teaching and interaction with the 6 teens in the A&D group I discovered that they too identify drugs and alcohol as the community's most critical need and saw the effects of parental influence, peer influence, and community acceptance leading them to where they currently sit. Therefore, it seems the "Community Action Team" goals coincide with those of adolescents most affected by substance use. Perhaps by working together their effort may contribute to healthier, more responsible youth.

Cancer Rates in Harney County: Is there an elevated incidence of cancer in this rural community?
Date of project: 8/18/2003

Cancer is arguably one of the most important medical issues in the United States today, with 1,334,100 new cases predicted to be diagnosed in 2003. In a Burns, Oregon, family medicine clinic, it has been noted that a frequent concern among patients is the belief that the cancer rate is abnormally high in this community. This study atempts to address these community concerns that Harney County's cancer rate is higher than that of Oregon as a whole. An examination of county, state, and national data was performed to make this comparison across various types of cancer. Statistics were obtained online from the Oregon Cancer Registry and the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Statistical analyses were done to assure the significance of the findings. It was found in Harney County, the incidence rates of breast, colon, lung, prostate, and urinary bladder cancers is not higher than that of the state of Oregon. Furthermore, the overall cancer mortality rate is not higher in Harney County. This information can be used to alleviate patient fears that living in Harney County poses a risk for the development of cancer. In the clinical setting, this can serve useful in patient education by helping to identifying true risk factors and how to individually minimize them.

Alcohol Abuse/Dependency Treatment in Harney County: An informal Survey of Available Services
Date of project: 9/23/2002

Alcohol/ substance abuse is a significant problem in rural communities, particularly in times of economic downturn. This project is an informal survey of services available in Harney County for alcohol abuse and how the different branches of the health care community communicate and respond to this issue. Personal interviews with the clinical directors at Harney Behavioral Health and Harney District Hospital as well as an administrator at the Sheriff’s Department and a counselor at the Indian Health Service were conducted at various times throughout the clerkship. From these interviews, a barrier to accessing mental health services was identified. Patients seen in the ER after hours for Substance abuse related health problems were not being referred to mental health services for substance abuse disorders. As a result of this observation and subsequent interview with the clinical director at Harney Behavioral Health, renewed efforts at improving communication between the hospital and HBH are being made. This will take the form of HBH sending a representative to monthly staffing meetings in order to network and increase access to mental health services.

Prescription Medication Patient Assistance Programs in Harney County, OR: Development of an Efficient Application System
Date of project: 8/12/2002

The access to prescription medications is an essential component of complete health care for our patients. Increasing drug costs, increased utilization, and the lack of bulk medication purchasing for the uninsured populations makes medication acquisition a growing problem, especially in rural areas. The patient population at the High Desert Medical Center in Burns, OR was evaluated for eligibility for existing pharmaceutical manufacturers’ patient assistance programs. Results indicate that 100 patients were receiving benefits, while up to 509 may be eligible. The labor required to complete applications and to distribute medications was cited as a barrier for efficient utilization of these assistance programs. Software was ordered and installed to help the clinic staff in administration of these programs. A patient handout summarizing the various options for obtaining affordable medications was constructed and published (http://www.geocities.com/mmacht/medhelp.pdf) so it could be used by patients and health care providers throughout the state. Further sources of aide, including grants from the Rural Health Foundation, were discussed with clinic staff. The handout was observed during the final three days of the rotation, and found to be extremely successful in educating patients and staff about the various assistance options, involving patients in the administrative process, and encouraging more eligible patients to seek assistance.

Prevention of Smoking, Tobacco, and Illicit Drug Use by Native American School Children and Adolescents.
Date of project: 7/1/2002

Smoking, alcohol, and illicit drug use cause significant health problems in society. These health problems not only affect the patient, but it affects the community as a whole. Often drugs of any kind are first tried when people are young. It has been found Native Americans on reservations have an increased rate of use of alcohol, tobacco, and illicit drugs. Additionally, many studies have found substance abuse by Native Americans whether they live on or off the reservation is increased compared to the general population. Adolescents who live on the reservation are most likely to use drugs followed by non-reservation Indian youth and finally non-Indian youth are least likely to use drugs in school. Reducing alcohol, tobacco, and illicit drug use could substantially increase the health status of Native American patients who live on or near the reservation. It has been found educating children about the effects of drugs on one's health and social relationships is an effective way to reduce substance abuse. However, it has also been noted starting the education program in high school is much too late. It is important to begin educating children while they are in elementary and middle school. This paper will outline the importance of an education program in the form of a lecture series that has medical, legal, and law enforcement contributions. A lecture was developed in conjunction with this research project to be used by my preceptor starting this fall for school aged children on the nearby Native American reservation. A basic survey was also constructed to help track the changes in substance use in the years following the initiation of this project.

Methamphetamine: Educating the Health Professionals of Rural Oregon
Date of project: 3/25/2002

Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpenseive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse. Methamphetamine abuse, long reported as the dominant drug problem in California, has now become a substantial drug problem in other sections of the Southwest and West, particularly Oregon. Portland consistently ranks 3rd-4th in major US metropolitan cities for positive urine drug screens at the time of arrest. However, recent data suggests that methamphetamine is rapidly becoming a larger problem in rural regions than urban centers. Methamphetamine use was traditionally associated with white, male, blue-collar workers, but is now being used by younger and more diverse population groups usually differing by geographic area. According to the 2000 National Household Survey on Drug Abuse, an estimated 8.8 million people (4.0% of the population) have tried methamphetamine at some time in their lives, and based on similar surveys it is thought that many of these people use on a regular basis. Another shocking result from the NHSDA survey found that an estimated 6.9% of US high school students have used methamphetamine at least once suggesting methamphetamine use is occurring more commonly in younger age groups. The purpose of this project was to put together recent national and statewide data in order to lead a discussion targeted to the health care professionals of Burns, Oregon about methamphetamine. Hopefully this information will increase their overall understanding of the drug, the increasing problem in rural America, the signs and symptoms of methamphetamine use, and some of the medical problems they are likely to see associated with it.

EMS in Harney County: Benefits of Transition from a City-run, Volunteer Fire Department Based Program to a Hospital-owned Program with Paid Personnel
Date of project: 2/11/2002

This report is a review of the changes made in recent years to the Emergency Medical Services (EMS) program in Harney county. In the past the City of Burns has been the responsible party for provision of EMS; the program has been run under the auspices of the Fire Department. For the most part EMS personnel have been voluntary and the levels of training among personnel have been quite varied. Rather than being run as a business, the service was run as a volunteer-based program. There were no full-time paid personnel whose responsibility it was to keep the service functioning at a level that provided a quality service to the public as well as keep the service solvent economically. Over the long run the service was a drain on the resources of the community: the service cost a great deal of money to provide and the City was still unable to maintain needed equipment and keep appropriately trained personnel. Two years ago Harney District Hospital took over the EMS program, hired a full-time paramedic to run the service, and with the help of the experience of the hospital administration and the new director began to bill appropriately, look at ways to qualify for government funds for purchase of equipment and education of personnel, and overall made changes directed at running the service as a business. Through the changes that have been made the quality of service has been greatly improved and the EMS program has become solvent. The following discussion is intended to examine the changes that have taken place and consider whether or not this program may function as a model for similar communities to improve their EMS systems.

An Anti-Smoking Campaign To The Paiute Indian Youth Boxing Team.
Date of project: 1/2/2002

The onset of smoking in all ethnic groups typically takes place during the teenage years, with thousands of teenagers each day becoming regular cigarette smokers. Current data shows that racial/ethnic smoking prevalence is highest among American Indian and Alaska Native teens when compared to other racial groups including Caucasians, Hispanics, Asian Americans and Pacific Islanders, and African Americans. Studies have shown that the onset of adolescent tobacco use can be curbed by education of the hazardous nature of smoking and through athletic participation. The goal of my community research project was to provide the educational aspect to a group of young men and women participating in a boxing program at the Burns Paiute Indian Reservation.

Harney County Health News "Patient Education Newsletter"
Date of project: 9/ 24/2001

The rural area of Harney County represents one of Oregon's underserved healthcare populations. Barriers to care in the county include a scarcity of healthcare providers, long travel distances to health care sites, low socioeconomic status, and a low education level. In an effort to overcome these barriers, it is important to provide county residents with an alternative means of communication that provides both general health care education and recommendations, as well as a summary of the healthcare resources that are available but may currently be underutilized. This would allow patients to take greater responsibility for their own healthcare needs and could potentially reduce the demand for acute medical care.

Educational Material For The Patient Population At High Desert Medical Clinic In Burns, Oregon.
Date of project: 8/13/2001

The objective of the project was to update the pre-existing handouts on the guideline of preventive measures for adult patients. This project focused upon age and gender specific preventive protocols for adult patients aged 18 years and older at the High Desert Medical Center.

Firefighter Injuries And The Impact On The Emergency Department And Physicians In Harney County
Date of project: 7/2/2001

OBJECTIVE: Harney District Hospital is the only emergency room for the 10,288 square mile Harney County. A high desert climate, many wildfires occur between May 15th - October 15th. The 2000 census showed the population of Harney County as 7,609; during the fire season this population can almost double. The impact of this influx can be substantial; the physicians are unaware of the type and rate of injuries that will be seen in the emergency room. The purpose of this project is to study the rate and type of firefighter injuries in Harney County that lead to visits. Reasons for the injuries will be compared with the national data. SETTINGS: Harney District Hospital in Burns, Oregon - Harney County. METHODS: Part I: Interviews with fire crews in Harney County. An average rate of injury was calculated from this as was the most common types of injuries, as were the role of stress and exhaustion on the injury occurring. Part II: A search of United States Forest Service (USFS) and Bureau of Land Management (BLM) injury files for the years 1999 and 2000 was done to show how many of these injuries were sent to the emergency room. Part III: A record search and susequent calculations were done to determine the number of emergency room visits for a fire season. RESULTS: Part I: An average injury rate of 0.7125 injuries per season per firefighter was shown. The season is defined at May 15th to October 15th, a 153 days. For the 150 firefighters stationed in Harney county, this is an estimated 107 injuries per season. Part II: Records from the BLM and USFS showed that 4% of these injuries were major enough to warrant a trip to the emergency room. Of the 107 injuries per season for the Harney county firecrews, five would result in emergency room visits per season. Part III: There were a total of 2,443 visits to the Harney District Hospital emergency room for the 365 days of the year 2000. This averages out to 6.7 visits to the emergency room per day, and for a fire season, that would be 1024 visits. CONCLUSIONS: The overall injury rate for a firefighter in Harney County is 0.7125 injuries per season. The five visits to the emergency room from the 150 firefighters stationed in Harney County account for only 0.5% of all visits. The influx of personal for the summer wildfires can increase the emergency room use by between 4% - 25%.

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