Bridging Systems: Health Care and Public Health Collaborate on Emergency Preparedness in North Dakota

March 31, 2026 | Maggie Nilz, Tim Wiedrich

Strong collaboration between public health agencies and health care systems is essential to preparing for and responding to emerging health threats. From supply chain disruptions to large-scale public health emergencies, coordinated planning helps ensure health care facilities have the resources they need to continue serving their communities. ASTHO sat down with Tim Wiedrich, Director of Public Health Preparedness (DPHP) for North Dakota, to discuss how the state’s medical cache and cross-sector partnerships strengthen health care readiness and support response efforts across a largely rural state.

Can you briefly describe your role as DPHP and how it interfaces with health care partners in your jurisdiction?

As DPHP in North Dakota, my role focuses on building systems that allow health care and public health partners to respond to emergencies in a coordinated way. From the beginning, our approach has been to establish a statewide public-private partnership that brings together health care, public health, emergency management, and other stakeholders. Over time, we have worked to create uniform processes that allow these partners to be on the same page during incidents. The goal is to ensure that when an emergency occurs, operations — such as logistics, transportation, and supply distribution — are already aligned across sectors. This allows us to respond more efficiently.

How have you built buy-in across public health and health care sectors?

Buy-in has largely come through relationship building and collaborative planning. Early on, we brought together around 150 stakeholders for a strategic planning process focused on designing a statewide preparedness system. That collaboration continues today through strong partnerships with the North Dakota Hospital Association, North Dakota Long Term Care Association, EMS agencies, local public health units, pharmacies, the state board of pharmacy, and others. Their input has helped shape how the system operates and ensures it meets real operational needs across the health care sector.

Because North Dakota is a rural and frontier state, we recognized that larger models used in other states would not necessarily work here. Our partners helped us design a system that addresses those unique challenges, particularly around supply distribution and access to resources in smaller communities.

What structures are essential to making such efforts successful?

A key element of our model is the state medical cache, which has evolved into a major statewide resource supported by approximately 80,000 square feet of climate-controlled and secured warehouse space and four full-time staff. The cache is available to public health agencies and health care entities across the state. Importantly, access does not require a state or federally declared emergency. An organization simply needs to demonstrate a need that cannot be met through its normal supply chains. This approach allows the cache to function not just as an emergency stockpile but as a resilience tool for the health care system.

What challenges have you encountered and how did you address them?

One of the biggest challenges is planning for supply needs in a system that often relies on just-in-time supply chains. In an emergency, those systems can quickly become strained or disrupted. Another challenge relates to the rural and geographically dispersed nature of North Dakota. Many communities are small and far apart, which makes supply distribution and infrastructure support more difficult.

To address this, we focused heavily on preplanning and infrastructure support. The cache includes equipment that helps medical facilities maintain operations during disasters — such as generators, electrical distribution systems, trailer-based heaters, and snow-removal equipment. These resources can prevent hospital evacuations and stabilize health care infrastructure during emergencies. We also had to confront practical issues such as product expiration. Through our state risk-management processes, we determined that in certain situations, maintaining expired medical materials that remain viable is better than having no supplies available during a crisis.

What outcomes or improvements have you seen because of this work?

The medical cache has allowed North Dakota to support health care facilities during both large-scale emergencies and smaller operational disruptions. For example, during the COVID-19 pandemic, the cache contained 1.9 million medical masks, which helped meet health care needs as national supply chains were severely strained. More recently, a health care center lost access to a pharmaceutical supplier, which would have forced them to cancel surgeries. Through the cache’s purchasing power and transportation system, we secured and delivered the needed supplies so the facility could continue operating. These examples demonstrate how the cache supports everyday health care continuity, not just disaster response.

How has this collaboration changed the way your jurisdiction approaches disaster preparedness today?

The collaboration has shifted preparedness from a theoretical planning exercise to an operational reality. The cache now includes a wide range of assets, such as:

• Durable medical equipment, including ventilators, oxygen concentrators, suction devices, and gas cylinders.
• Medical surge beds and portable procedure beds.
• Disposable medical supplies such as pharmaceuticals, syringes, and bandages.
• Transportation assets, including 30 vehicles and about 40 trailers.

If fully activated, the transportation and patient movement assets contained in the cache, along with memorandums of agreement with state medical providers such as EMS services and long-term care facilities, could support transporting approximately 2,000 patients. The system also includes incident command vehicles and trailers, as well as support services such as mobile shower facilities and food services for response staff, patients, and long-term care residents. Overall, this has created an integrated and operationally ready preparedness system.

How do hospitals and health care centers participate in stockpile planning and decision-making?

Hospitals and health care partners are involved through ongoing collaboration with organizations such as the North Dakota Hospital Association and other health care groups. Their input helps shape which resources should be maintained in the cache and how they are distributed. Because health care partners are directly involved in planning discussions, the system reflects real operational needs across hospitals, long-term care facilities, EMS services, pharmacies, and others.

What strategies have helped align public health and health care priorities around inventory, storage, and distribution?

Our strategy is to ensure that the system is accessible and practical for health care providers. Under our model, health care entities can request supplies from the cache when normal supply chains fail and then replace what they’ve used once those supplies are available through the normal supply chain. Additionally, the cost of operating durable equipment is paid by the requester for things like fuel consumption, but there is no cost for using the equipment itself. This model allows the cache to remain sustainable while still supporting health care partners when needed.

The transportation network is another critical element. The system can move supplies directly from the cache to a facility or coordinate transfers between hospitals using the statewide transportation network.

How does this model account for rural or geographically dispersed facilities?

The medical cache can deploy supplies and equipment rapidly across the state using its transportation fleet. In urgent situations — such as a hospital needing a ventilator in the middle of the night — the cache can dispatch a courier to deliver the equipment directly.

The system can also coordinate transfers between hospitals if another facility has available equipment. Additionally, the cache helps manage vaccine and pharmaceutical distribution in situations where products are packaged in quantities impractical for smaller communities. The state can receive and repackage supplies in ways that better serve rural facilities.

North Dakota is also exploring ways to strengthen preparedness across other states in our region through shared stockpile capabilities. The idea is to leverage existing authorities, such as the Emergency Management Assistance Compact, to allow states to share resources without creating entirely new governance structures.

Under this model, North Dakota serves as a central hub for certain assets and other states can request resources if they have the infrastructure to use them. We utilize a dashboard system that allows partners to view available resources, submit electronic requests, and track orders in real time. The goal is to create a network where strong state systems collaborate and coordinate investments, improving preparedness across the region.

What advice would you give to other states or territories interested in implementing a similar approach?

The most important step is to start by defining the problem you are trying to solve. Our biggest challenge was rurality and frontier conditions. Extreme heat, winter storms, flooding, drought, and other natural hazards pose significant challenges, especially given the state’s sparse population and vast geographic area. Once we clearly define the problem, we collaboratively design and implement a strategy to address it. For us, the key is to approach this strategically as a single statewide system built on a public-private partnership. The focus is developing a system that can effectively respond to catastrophic emergencies while also supporting day-to-day incidents and meeting operational needs.

Our approach is guided by three strategic pillars for building the statewide system:

1. Uniform response processes across the state.
2. Availability of trained personnel ready to respond when needed.
3. Access to medical materials and equipment is maintained within a centralized state cache.

Another key lesson is to learn from others and adopt good ideas that work, but tailor them to your environment. Strong relationships are also critical. Partners need to be involved in planning, but they should not feel burdened by the process.

Finally, the state needs to maintain leadership, remain fundamentally connected to preparedness planning, and lead the response. That leadership helps ensure coordination across sectors and keeps the system aligned with the state’s broader strategy.