RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Health Provider Emergency Preparedness to Swine Flu in Lebanon Project Date: 4/27/2009 This project is a report on how health providers in Lebanon prepared and responded to the H1N1 influenza outbreak. The resources available to the health providers were the recommendation and guidelines from the CDC, the Oregon Department of Health, the Linn County Health Department and the Samaritan Health Services. Health providers encouraged patients to follow the CDC recommendations on practicing good hygiene habits. They stayed informed by following the daily updates of the Oregon Department of Health and Linn County Health department websites. Health providers implemented the triage guidelines from the Samaritan Health Service officials to prevent over utilization of the clinic. As a result of these strategies health providers in Lebanon were able to efficiently respond to the small surge in medical demand and at the same time continue providing their usual medical care. Preparing a Rural Community for Emergency and Outbreak Project Date: 4/27/2009 When faced with a large scale Emergency or an Infectious disease outbreak a small community is still held to the same standards of preparedness as compared to a more urban medical community but must do so with some unique challenges. The recent global outbreak of H1N1 influenza has proved a catalyst to ensure hospitals are up to par with regards to Emergency and Outbreak response plans and Madras Mountain View Hospital is no exception. This community project has three primary endpoints including: 1) To Conduct interviews with hospital personnel to educate myself with regards to rural hospital preparedness for emergencies and infection disease 2) To identify strengths and weaknesses inherent to the response plans 3) To develop information fliers for medical staff education, outlining levels of the response plans including medical staff responsibilities. Assessment of Baker High School Students' Perception of the Appropriateness of Antibiotic Use for Upper Respiratory Tract Infections Project Date: 3/20/2006 Antibiotic resistance is no less a public health problem in rural settings than it is in urban settings. One factor contributing to the development of antibiotic resistance is inappropriate prescription of these drugs for viral respiratory tract infections. In this study I developed a short presentation focusing on the differences between viruses and bacteria and the most frequent causes of respiratory tract infections. The presentation was given to high school sophomores in health classes at Baker City High School. A pre- and post-presentation questionnaire was employed to gauge the success of this presentation; post-test results indicate that students had a better understanding of the differences between viruses and bacteria after the presentation. Health Literacy in Rural and Underserved Populations Project Date: 8/8/2005 Does offering health information on topics that are in high prevalence in underserved populations and have more negative outcomes in those populations, improve the health of the population, and are those services readily utilized? Health Literacy regarding diagnosis, disease pathology and treatment options are at a low in rural populations. Without an awareness of what disease processes may be occurring in a patient, it becomes more difficult for patients to help themselves, do the things that are within their own capacity to reduce their morbidity, with respect to their disease. Health Literacy is a key component to health care outcomes, and directly relates to compliance of treatment protocols and adherence to prescribed regimens. Without health literacy, it is more difficult for patients to understand the importance of adherence and more likely for adverse effects to result, and decreased efficacy in treatment outcomes. Low health literacy has also been shown to directly impact the overall health of a community and health education has been shown to improve specific outcomes like reduction in unnecessary office visits, poor health resource utilization and medication compliance. A questionnaire was designed to ascertain the general perception of the patient population of health literacy, and was given to patients as they checked in for visits. When a disease process was identified in a patient that was addressed at the conference, the patient was counseled as to the importance of health information and invited to attend BRIDGING THE GAP NORTHWEST 2005, free of charge. Bridging the Gap is a community education forum, bringing information, tools and resources to the community at large, specifically targeting those underserved populations that are at the highest risk for negative health outcomes based on literacy and economic status. Patients were also offered information on their specific condition, and were asked if they understood the information that was provided. Health Literacy in John Day, Oregon: A Patient Screen and an Evaluation of Educational Resources Project Date: 8/8/2005 According to the National Assessment of Adult Literacy (NAAL), forty-six to fifty-one percent of adult Americans are illiterate or functionally illiterate. This adds up to 90 million Americans who cannot synthesize information from complex or lengthy texts and cannot consistently perform quantitative tasks requiring two or more steps. The inadequate literacy skills of Americans are impacting health care in a big way. Numerous studies have linked low literacy with important negative outcomes in healthcare, including higher medical expenses and poorer management of chronic illness. This link between literacy and health has lead to the defining of health literacy as a separate component of functional literacy, and the responsibility to recognize and accommodate patients with low health literacy now lies with health care providers. The problem this project aims to address is that of assessing the health literacy among adult patients of the Strawberry Wilderness Clinic in John Day, Oregon and evaluating resources available both in the clinic and the community for patients with low literacy skills. The results of a health literacy screen of 74 patients using the Rapid Estimate of Adult Literacy in Medicine - revised show that 23% of adult patients in John Day read at or below the 6th grade level and are thus expected to have significant difficulty comprehending most written and oral medical information. There was no significant difference in literacy skills between elderly and young adults. An assessment of written materials available for distribution at the clinic revealed that there were no printed patient education materials designed for patients with low literacy. Finally, local adult basic education resources were found to be more than adequate for meeting the needs of adults wishing to improve their literacy at no cost. However, few people seem to be aware of these education resources. "No Shows" at the West Salem Clinic Project Date: 5/5/2003 This paper compares the national rate of patients not showing up for their doctors appointment with the rate of no shows at the West Salem Clinic located in West Salem, Oregon. This project was completed with the hope that this comparative information can be used by the administration of the West Salem Clinic to make any needed adjustments in their patient management practices. Method: Comparison of published research concerning no show percentages with internal clinic documents describing the percentage of no shows at the clinic. Results: A review of the research literature revealed a no show rate of 6% to 55% nationally. The average no show rate was in the low to middle 20% range. West Salem Clinic has a no show rate over the past six months of 12.43%. In the month of May 2003 the no show rate for the clinic was 13%. West Salem Clinic has a lower rate of no shows when compared with the national average. Cardiovascular Rehabilitation in Coos Bay: Does Program Compliance Effect Hospital Readmission Rates? Project Date: 3/24/2003 Cardiovascular disease is the number one cause of morbidity and mortality in the United States today. Although some 7 million Americans with the clinical spectrum of coronary heart disease are eligible for cardiac rehabilitation, only 11-20% are estimated to participate. Cardiac rehabilitation offers a variety of different benefits, from physical training to lifestyle modification education. The main goals of current day cardiac rehabilitation programs are to allow the patient to resume normal activities, modify and reduce risk factors such as hyperlipidemia, hypertension, and smoking cessation, and thus, lower morbidity and mortality. This study is an observational study which reviewed sixty geographically-matched patients who had been hospitalized for coronary heart disease between 1997 and 1999. The experimental group was defined as thirty patients who had enrolled in rehab initially but who had failed to complete more than 10 of the sessions. They were compared with thirty patients who had completed the program (36 sessions over a 12 week span) to see if either group had more hospitalizations for subsequent coronary events. 17% of the control patients had hospitalizations during the next three years compared with 27% of the patients who did not complete the program. Additionally, the patients who were non-compliant had more than one additional hospitalization overall than did the compliant patients. Conclusion: Cardiac rehabilitation program non-compliance was a negative predictor for future hospitalizations for acute coronary events in a small sample population. Program non-compliance also was a negative predictor for total hospitalizations during a fixed time frame. Is The Grass Really Greener On The Other Side? A Descriptive Analysis Of The Perception Of Health Care In Newport, OR. Project Date: 2/10/2003 Rural environments are historically thought of as engendering a strong sense of belonging where the residents support each other both social and financially. However, the residents of Newport do not get all their services from within their community. They frequently venture to the larger cities to buy goods where selection is greater. The present study sought to answer the question whether people in rural communities also seek care locally or go to larger communities, and what their views are regarding the quality of care offered. Methods: Residents within the community were randomly selected to answer a 12 item forced-choice questionnaire to access their overall satisfaction with healthcare in Newport, use of local community resources, and attitude towards access to care in the rural setting. Likewise, a retrospective analysis of the hospital database across all surgical procedures between 1/1/02 - 12/31/02 was performed to evaluate the complication rate at Samaritan Pacific Community Hospital. Results: Interestingly, patient satisfaction was overall very positive. Furthermore, outcomes from the local hospital are comparative to nationally published data. Conclusion: Most residents seek care locally and are very satisfied, yet a prevailing belief that they are at a disadvantage living rurally may continue to undermine rural health in Newport despite the efforts of the healthcare community. Nutrition and Fitness: Development of a Program to Supplement Physician Intervention in Management of the Health Risks of Obesity. Project Date: 12/30/2002 Obesity and its many associated health risks is a growing problem in the United States. This study attempted to identify strategies for physicians to increase their effectiveness in promoting dietary modification and weight loss for overweight patients at a family practice clinic in John Day, Oregon. The design was observation of physician interaction with overweight patients motivated to lose weight, and one on one dietary counseling with self selected patients. Community resources available for patients include a dietitian who visits the community monthly, and a new fitness center. Additionally patient handout availability and effectiveness was examined. While the physicians were actively discussing the importance of diet and fitness with their patients, time limitations prevented adequate follow up. Many patients expressed bewilderment at the amount of different diet information available via the popular press. Patients requested basic, simple guidelines to help them start meeting their weight loss goals. Handouts currently available at the clinic are from the American Heart Association, and while quite comprehensive were described as “confusing” and “overwhelming.” The final phase of this project thus involved the creation of a short, simple handout that outlined suggested dietary modifications for weight loss. Impact of Surgery on Lower Umpqua Hospital, Part II: Provision of Obstetrical Services, a Community Needs Assessment Project Date: 11/4/2002 Following an era of business success, growth of faculty, and outstanding service, Lower Umpqua Hospital is now searching to hire a general surgeon. A prior study examined the economic impact of surgery at the Lower Umpqua Hospital (Melvin, 2001). In this project, we assess the community impact of services provided by surgery. In particular, the Lower Umpqua Hospital has recently announced it will not provide routine obstetrical care (Vail, 2002). The Dunes Family Health Care also announced it will not provide third trimester prenatal care (Law, 2002). Community demographic and socio-economic climate, and health care services currently provided are described. A needs assessment describes the current market share, community vital statistics, and economic implications. Finally, the impact of cessation of services is addressed in terms of community reaction, a call for community response, and case-scenarios. Alternative Healthcare in Florence, Oregon Project Date: 9/23/2002 Florence is a retirement community of about 7300 people, with many low income residents. There are a surprising number of alternative healthcare options in such a small and not wealthy town. This study sought to uncover the reasons behind the use of alternative healthcare in this population. Primary care providers at the only hospital in town were questioned about their practices surrounding alternative healthcare and their patients. Four commonly recommended herbs were glucosamine sulfate for joint pain/arthritis, red yeast rice for hyperlipidemia, saw palmetto for BPH and St. John's wort for depression. Their motive behind recommending these aligned with patients reasons for using them. The majority use supplements because they are significantly cheaper than prescription medications without precription coverage from insurance. Some use the supplements because their primary care provider suggested them, others to match their philosophy of life and healthcare. Several patients with chronic pain issues use alternative healthcare providers such as the acupuncturist, acupressurist or naturopath for treatment of a condition for which there are not good answers. These alternatives are important to the people of Florence as another option, be it to compensate for lack of insurance coverage or to match with their belief system. More research and information is needed, desired and on its way due to funding from NIH of several well designed trials. Herbal and Complementary Medicine Use in a Native American Community Project Date: 9/23/2002 BACKGROUND: Although the use of complementary medicine is known to be extensive in the general American population, the role of alternative treatment in this Native American community has not been described. OBJECTIVE: To determine the prevalence of use of complementary medicine, reason for use, how the patient first learned of the complementary treatments, sources of reliable information on alternative therapies used by the patient, and whether or not they had previously been asked about unconventional treatment by clinic personnel. METHOD: Cross-sectional interview of 21 patients seen in an Indian Health Service ambulatory care clinic. Herbal and alternative treatments were compared to prescription medications obtained by chart review to identify any interactions. RESULTS: Fifty-seven percent of individuals interviewed had used herbal medications or alternative treatment modalities at least once in their lifetime. Patients were likely to continue using herbal and alternative treatments if their initial treatment was felt to be effective, even if later treatments proved to be ineffectual. Herbal and complementary medicine ws used most often for health promotion, family and tribal tradition, and religious practice, as well as chronic conditions such as low back pain, migraine headaches, diabetes mellitus, and depression. Family and tribal traditions was found to be the most common source for first-time patient exposure to herbal and alternative therapies, followed by internet, friends, media advertising, and employers. Nearly half (48%) of all patients would look first to their family physician for reliable information on herbal and complementary treatments. While over half of clinic patients interviewed reported using herbal or alternative treatments sometime in their lifetime, only 5% had ever previously been asked about herbal and complementary medicine use by personnel in the clinic. CONCLUSION: Use of unconventional treatments is common among patients in this Native American community. Patients demonstrate a willingness to discuss use of herbal and complementary therapy and have an expectation that their medical providers will be knowledgeable about these treatment options. Unconventional treatment use is not related to patient dissatisfaction with conventional medicine and patients perceive no conflict between these different health system beliefs. Community-acquired pneumonia Project Date: 9/23/2002 Community-acquired pneumonia (CAP) is a common reason for admission to the hospital. All patients admitted to the Blue Mountain Hospital in John Day, OR with a diagnosis of pneumonia for a one year period (September 1, 2001 to August 31, 2002) were identified and their charts reviewed. In addition to basic demographic data, diagnostic studies and antibiotic therapy used were identified. These data were compared to the current existing recommendations for diagnosis and treatment of CAP. The results of this comparison were then distributed to all of the physicians in John Day to help them to continue to make informed decisions regarding the diagnosis and treatment of CAP. Conversations and Perspectives on Attention Deficit Disorders in Grant County, Oregon. Project Date: 8/12/2002 The goal of this community project was to examine the perceptions, detection and diagnosis, and tratment and managment of attention deficit disorders, with (ADHD) or without hyperactivity (ADD), in a small rural community such as John Day, Oregon, and within the surrounding country. Conversations with three professionals intimately involved with the diagnosis and/or management of AD(H)D and a member of a family dealing with ADHD were held and recorded on mircocassette, and the contents were then transcribed. From these conversations, it appears that the unique blue-collar, small-town environment of John Day serves to discourage the rampant use of medication in the treatment of AD(H)D, despite universal agreement among the four interviewees concerning its effectiveness. However, nearly all endorse an increasing prevalence of acceptance of attention deficit disorders as legitimate and treatable illness amongst the local populace. Although resources are limited in such a sparsely populated region, community networks involving local physicians, the Mental Health Service, and the local school districts offer ample aid for those dealing with AD(H)D. While gaps still exist in terms of coverage and communication among the players and with those affected by AD(H)D, it appears that there is adequate coordination and comprehensiveness to successfully manage the great majority of young persons suffering from disorders of attention. Emergency Need Occupational Injuries in a Rural Town Setting: John Day, Oregon Project Date: 7/1/2002 Work place injuries continue to be a major concern in many blue-collar industries across the United States. In rural Northeastern Oregon these blue-collar industries are the predominant basis of the economy and thus on-the-job injuries are of major importance. This study was designed to evaluate which industries have the most on-the-job injuries that require emergency room treatment in and around the town of John Day, OR. The design was observation of Blue Mountain Hospital Emergency Department visits during a six-week clinical rotation with a local physician, as well as an extensive medical records compilation for the past year of all emergency room visits classified as on-the-job injuries. In this study, it was found that many injuries occurred as a result of inexperience in high turnover positions and seasonal, long work hour positions that led to intense physical activity without proper equipment and training. Of those injuries that were preventable in nature, lack of equipment such as proper gloves and boots as well as lack of training in operation of heavy equipment led to most injuries. Therefore, the most important conclusion of this project was that although these industries carry much inherent danger, better training and equipment could significantly reduce the number of work related injuries in John Day. A Glimpse into Curanderismo in Nyssa, Oregon Project Date: 3/25/2002 Few studies have been done to explore the extent to which these factors actually play in determining the trends of Hispanic patients toward utilizing health care. This project attempts to obtain a glimpse of what role folk medicine plays in the health access of the Hispanic population in Nyssa, Oregon. Specifically, the project attempts to determine the services provided by the town curandera, obtain a sense of utilization and perception within the community, and initiate a bridging of the gap between allopathic providers and traditional Mexican healers. In light of the above mentioned statistics regarding Hispanics in the United States and the increased Hispanic population in Nyssa, knowledge of the community's cultural beliefs and traditions can serve to improve patient care by attempting to understand the community members' perceptions of illness and health care. Coding Practices in a Rural Oregon Health Clinic: An audit report on acute care visits. Project Date: 3/25/2002 This study is intended to elucidate the general coding practices for an acute evaluation and management (E/M) encounter at a rural pediatric clinic. It entails the external audit of progress notes for acute E/M encounters during the first few weeks of one of the busiest months of the year for acute pediatric care, and will identify any flaws in the coding practices for such encounters. The basis for this study is to provide valuable feedback on coding practices and whether those practices are in compliance with established rules and guidelines set up by the Health Care Financing Administration (HCFA). The practice of over-coding or under-coding will be specifically addressed, and suggestions will be made about possible changes in documenting habits that more accurately reflect a fair and equitable assessment of the level of care provided for an acute E/M encounter. EMS in Harney County: Benefits of Transition from a City-run, Volunteer Fire Department Based Program to a Hospital-owned Program with Paid Personnel Project Date: 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. Assessment Of The Signs And Symptoms Of Acute Myocardial Infarction Of The Elderly In The Emergency Setting In Reedsport, Oregon. Project Date: 1/2/2002 The purpose of this study was to examine elderly patients who presented to the emergency department (ED) in Reedsport, Oregon for symptoms of acute myocardial infarction (AMI). The objective was to determine what diagnoses were ultimately found for these persons, and then to determine if the presenting signs and symptoms of the elderly with a discharge diagnosis of myocardial infarction (MI) were representative of the national average. The ultimate goal was to determine whether the elderly with AMI are being underdiagnosed in Reedsport, and, if so, can improvements be made to diagnose them? A case review was done of approximately one year's prior time of all persons greater than 70 years of age presenting to the emergency room (ER) with symptoms of AMI. These cases were reviewed for chief complaint, associated symptoms, electrocardiogram (ECG), cardiac markers (Troponin-I, CK-MB, and myoglobin), and other various findings. It was found that 9% of subjects selected were ultimately diagnosed with an AMI. 35% had other cardiac problems (13% related to angina and 22% related to non-ischemic etiologies), and 56% had diagnoses unrelated to cardiac origin. The ECGs, cardiac marker findings, and other studies are described. It is thought that due to limitations in specificity and sensitivity of the ECG and cardiac markers, but moreover, the prevalence of atypical presentations of AMI in the elderly, that it is possible that a number of MIs in the elderly are not being diagnosed in Reedsport. Recommendations for improvement are given. Help for the Homeless? An exploration of the Assistance Programs Available to the Homeless Population of Salem, Oregon. Project Date: 5/6/2002 Conducted in the community of Salem, Oregon from May to June of 2002, this project sought to explore the needs of the city's homeless population in order to determine if adequate assistance programs are currently in place. Initial interviews with homeless individuals seeking medical treatment were followed by an attempt at characterizing the demographics of this position. Utilizing this initial data, a survey was prepared, and distributed to homeless individuals, that sought to identify which needs were not being satisfactorily met by Salem-area assistance program currently in place. Each agency was contacted and a description of the provided services was obtained, with emphasis on theconcerns raised by survey responders. It was then possible to compare the perceived needs of the homeless population with the services in place to address them. In general, the homeless of Salem, Oregon are pleased with the assistance they receive, but are not very aware of all the programs and agencies available. Further, there is limited communication between these various agencies, and each assistance program is not fully aware of the others in the community. To address this weakness, a current Salem-area resource guide, detailing the services offered to the homeless, was prepared and distributed to local agecies so that a more coordinated effort can be achieved. Establishment of a Coumadin Clinic in Philomath, Oregon. Project Date: 11/5/2001 Warfarin is a commonly prescribed anticoagulant medication with a narrow therapeutic range. Patients on chronic warfarin therapy must have frequent blood tests to monitor the effects of the medication. Traditional warfarin monitoring requires a monthly venipuncture and a follow-up phone call from the physician to make medication adjustments. Anticoagulation clinics (Coumadin clinics) are increasing in popularity and provide instant blood test results and dosage adjustments with a drop of blood out of the fingertip. Philomath Family Medicine manages the anticoagulation for 45 patients on chronic warfarin therapy and will be opening a Coumadin clinic in January, 2002. The majority of patients surveyed indicate that they are interested in utilizing the services of a Coumadin clinic. Harney County Health News "Patient Education Newsletter" Project Date: 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. Bioterrorism Response Plan For Grant County. Project Date: 9/ 24/2001 Since September 11th, 2001, the number one thing that seems to be on everyone's mind is terrorism. Based on the definition of terrorism, acts committed with the purpose of terrorizing a population, the terrorist who committed the atrocities in New York and Washington were successful. Since the attacks, America has been scrambling to develop ways to prevent and respond to future terrorist activities. Of highest interest is toxic terrorism, which is the use of nuclear, biological or chemical warfare to create terror. By their very nature, nuclear and chemical warfare results in illness minutes to hours after the attack in persons close to the location of weapon release. Because of this, the first responders would be firefighters, police and emergency rescue workers, who would cordon off the area, decontaminate patients, and administer antidotes. However, in the case of biological terrorism, the effects of the biological attack may not be known for days to weeks and in persons widely dispersed from the site of release. Affected persons would present with an undiagnosed illness to clinics or emergency departments. Physicians would then have to recognize that the patient is affected by an unusual illness and treat with vaccines and antibiotics, making primary care physicians the method of surveillance for an unknown biological terrorist attack. While attending the American Academy of Family Physician Annual Congress in October of this year (2001), I noticed that the physicians in attendance were keenly aware that they would need to be vigilant in monitoring for signs of a biological attack, and that they were unprepared. It was noted in a recent Family Practice News that American physicians are not trained to recognize the signs and symptoms of agents that are likely to be used in an attack. What training that is available is geared to police officers and firefighters. The other concern is that once a physician has identified a patient, who is possibly affected by a terrorist agent, what do they do next. With this in mind, I returned to John Day with the idea that I would develop a bioterrorist response plan for Grant County. A Newly Opened Urgent Care Walk-in Clinic in Lebanon, Oregon: Improving Access or Providing a Safety Net. Project Date: 8/13/2001 Access to routine health care can be difficult in some rural communities for several reasons, these include a shortage of primary care physicians, lack of a facility, lack of insurance, etc. As a result, patients have to use Emergency Departments for care that is not emergent. To provide a more affordable alternative, Lebanon Community Hospital opened an Urgent Care within the hospital. This study is a cross-sectional study to assess the patient population that is using a rural Urgent Care. The results of this study indicate that this particular Urgent Care is being used for its intended purpose of improving access for patients who are unable to be seen by a PCP. Although there is a segment of the population who do not have a PCP or insurance, the Urgent Care is providing an alternative to the more expensive emergency department visit. Firefighter Injuries And The Impact On The Emergency Department And Physicians In Harney County Project Date: 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%. Back to subject search page or search by preceptor site