Fort Defiance Indian Hospital Board Inc., a is a tribally chartered, 501(c)(3) nonprofit and a PL 93-638 healthcare organization that operates and manages three facilities in the southeastern region of the Navajo Nation; Tsehootsooi Medical Center (TMC), Nahata? Dziil Health Center (NDHC) and the Nihi Dine?e Ba Wellness Center. TMC is located in Fort Defiance, Arizona and serves as the main facility providing emergency and outpatient services. FDIHB provides services to over 31,000 community members living in 16 of the 27 chapter communities including: Cornfields, Crystal, Fort Defiance, Ganado, Greasewood, Houck, Kinlichee, Klagetoh, Lupton, Nahata?Dziil (Sanders), Oak Springs, Red Lake, Sawmill, Saint Michaels, Steamboat, and Wide Ruins. The communities are located 10 to 63 miles from TMC, with Greasewood being the farthest outreaching community. The geographic area is designated as a ?Health Professional Shortage Area? by the Arizona Department of Health Services, signifying as having a shortage of dental, mental, and primary health care based on delivery of services, population-to-provider ratio, and availability of surrounding health care resources. It is also designated as an Arizona Medically Underserved Area (AzMUA) which is based on 14 weighted items such as poverty rate, transportation, low birth weight, prenatal care, unemployment, etc. On February 27, 2020, FDIHB mobilized the Incident Command System (ICS) Team to develop strategic plans in response to the Coronavirus pandemic. Following procedural guidance from the CDC (Interim infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 ? COVID-19 ? or Persons Under Investigation for COVID-19 in Healthcare Settings) and FEMA (National Incident Management System), a three tier activation system was created to safely test and treat patients and organize the flow of traffic throughout the hospital. Several areas at TMC were designated into
Yellow and Red Zones. Yellow zones require staff to wear gloves and surgical masks while Red zone areas require staff to wear full PPE. Red Zones include the Emergency Room, FastTrack/Observation, Adolescent Care Unit, Intensive Care Unit, Medical Surgical Unit, OB Ward, Imaging, Surgical, Podiatry, and Laboratory. Employees were trained on the proper use of PPEs to ensure the safety of each other and the patients. FDIHB employs a total of 1,030 non-clinical and clinical staff and 183 contract nurses and providers, as of May 1, 2020, approximately 88% have completed all four training modules. TMC received its first positive COVID-19 case on March 25, the same day the Navajo Nation Department of Health reported a total of 128 positive cases across the Navajo Nation. So far, FDIHB has had 121 positive COVID-19 patients in the FDIHB service area, having tested 837 community members. Preparing for a surge, TMC increased its bed space by 20, with the Adolescent Care Unit and Post-Anesthesia Care Unit (PACU) serving as Alternative Care Sites (ACS). FDIHB is requesting CDC funding to purchase much needed equipment, supplies, and system upgrades to efficiently manage the rising number of cases. This includes mobile x-ray machines to transport between ACS to accurately determine the severity of a condition in patients who tested positive for COVID-19 and are experiencing respiratory problems, vein finders and dopler ultrasound to increase efficiency during triage, a Vapotherm high flow machine to reduce the need for intubation of COVID-19 patients, wireless telemetry to monitor a patient's vital signs without the need for wires, a system upgrade to its mobile platform to enhance physician communication and an inventory upgrade to accurately track PPE supplies in real time across different departments. These items are crucial in helping FDIHB provide quality patient care to the community and ensure the safety of our healthcare providers.