Association of Maternal and Child Health Programs

Transcription

1 AMCHP Assciatin f Maternal and Child Health Prgrams State Emergency Planning and Preparedness Recmmendatins fr Maternal and Child Health Ppulatins Nvember 2007 Assciatin f Maternal and Child Health Prgrams th Street, NW, Suite 801, Washingtn, DC (202)

2 Assciatin f Maternal and Child Health Prgrams State Emergency Planning and Preparedness Recmmendatins fr Maternal and Child Health Ppulatins Nvember 2007 Cntents Emergency Management Prcess and Preparedness Overview Abut this Resurce Defining MCH Ppulatin Needs Emergency Preparedness Overview and Backgrund State MCH Staff in Emergency Preparedness Planning Recmmendatins t Imprve MCH Emergency Preparedness Natinal Recmmendatins Lcal, State, Territry and Jurisdictin Planning Emergency Planning Educatin Licensure Reciprcity Supplies Transprtatin and Evacuatin Shelters Pharmaceuticals and Hspitals Psychscial Needs Additinal Resurces Appendix A: State MCH Emergency Preparedness Survey Summary Appendix B: Wrkgrup Member List Appendix C: Type A Influenza Pandemic Plans fr Infant/Maternal Safety Appendix D: Disaster Preparedness fr Children and Yuth with Special Health Care Needs Appendix E: Reginal Survey, March 2006

3 Assciatin f Maternal and Child Health Prgrams Hurricanes Katrina and Rita, the pandemic flu threat, and increased cnsciusness f terrrism have heightened awareness f the need fr emergency preparedness within the maternal and child health (MCH) cmmunity. In respnse, the Assciatin f Maternal and Child Health Prgrams (AMCHP), supprted by the United States Department f Health and Human Services, Health Resurces Services Administratin, Maternal and Child Health Bureau, is addressing this vital issue. AMCHP aims t increase states capacity t engage in disaster preparedness t meet the needs f MCH ppulatins. While it is impssible t knw what kind f emergency may ccur r the magnitude r scpe f the disaster, it is pssible t engage in planning. Frtunately, a wealth f resurces exist describing hw t address many kinds f emergency situatins. Additinally, many prfessinal rganizatins have released recmmendatins n hw t wrk with special ppulatins during these emergency situatins. State- and cmmunity-level MCH staffs d nt need t recreate the preparedness wrk already dne natinally. Hwever, they will want t make sure that the needs f MCH ppulatins are adequately addressed within state planning and address any gaps that may exist. State MCH staffs are als challenged t educate the families and individuals they wrk with abut hw t prepare fr, respnd t and recver frm an emergency situatin. AMCHP s rle is t ensure MCH ppulatins needs are represented in discussins abut and recmmendatins relevant t emergency preparedness at the natinal and state levels. Abut this Resurce AMCHP develped this guide t ensure the needs f wmen and children are clearly addressed as part f state-wide emergency preparedness. The recmmendatins are based upn lessns learned and highlight imprtant steps t take t prtect the MCH cmmunity. Over time, AMCHP will build upn the infrmatin in this guide and prvide additinal resurces. AMCHP members can use this guide t clarify their rle in develping and participating in emergency preparedness plans and activities and t aid in advcating fr the needs f MCH ppulatins. It ffers a wealth f resurces and infrmatin fr review that prvide practical advice t meet the needs f MCH ppulatins befre, during and after an emergency. Mst recmmendatins are derived frm the real life experiences f MCH prgram staff wh have dealt with emergencies. MCH prfessinals can begin t address emergency preparedness by integrating activities frm this guide int their current systems and prcedures. Engaging in agency-specific planning and training are a first line f defense in preparing fr a pssible emergency. It is als vital t build relatinships, if they d nt already exist, with essential partners and thse grups that are mst vulnerable during an emergency. States are encuraged t cnsider these recmmendatins and use them t strengthen state-level emergency planning and preparedness activities. The priritizatin prcess used at the state and lcal level t allcate resurces and integrate the recmmendatins int preparedness and planning activities will vary. Hwever, this reprt shuld be used as a guide and resurce t assure that these special ppulatins needs are met. This guide was crss walked with the White Ribbn Alliance fr Safe Mtherhd's, Wmen and Infants Service Package (WISP) 1. The WISP ffers guidance t meet the health care needs f pregnant wmen, new mthers, fragile newbrns and infants during and after a disaster situatin. All sectins f this resurce guide brrwed frm WISP are ftnted. 1 Natinal Wrking Grup fr Wmen and Infant Needs in Emergencies in the United States. Wmen and Infants Service Package. April

4 Assciatin f Maternal and Child Health Prgrams Defining MCH Ppulatins Needs The fllwing infrmatin was develped by the New Yrk State Divisin f Family Health as part f their MCH Emergency Preparedness Plan. It prvides specific infrmatin abut the varius MCH grups and their specific needs during an emergency situatin. Wmen Pregnant wmen, nenates, infants and children have unique needs, particularly in times f disaster. Wmen experience greater rates f health cmplicatins assciated with pregnancy, including premature labr and births, lw birth weight infants, and nenatal and infant deaths. Apprximately 99 percent all births in the United States ccur in a hspital setting. In times f disaster, thse facilities may nt be available and/r accessible. Specially trained prfessinals and necessary supplies t prvide care fr this ppulatin may nt be available. Withut access t apprpriate supprts and emergency medical services in the antepartal, intrapartal and pstpartum perid, there is a pssibility f bth shrt-term and lng-term negative utcmes with increased mrtality and mrbidity. During an emergency, stress is increased tremendusly which can significantly impact pregnant wmen. This, in cnjunctin with a lack f prper nutritin and fluids, can result in premature labr and delivery if nt addressed. Pregnant wmen need access t skilled prfessinals fr prper assessment and methds fr hydratin (including intravenus hydratin) as well as tclytics as needed. Apprpriate supplies must be assembled int emergency kits t enhance prfessinals ability t assess maternal, fetal and nenatal status, prceed with apprpriate treatment measures, deliver infants as needed and prperly treat pstpartum wmen and nrmal and high-risk nenates. All newbrns must have access t a dry, clean, warm envirnment t prmte thermregulatin and access t medicatin, equipment, supplies and prfessinal expertise t address issues such as respiratry distress syndrme that may result frm prematurity. Medicatins and supplies must be readily available t treat pregnancy-related and chrnic health issues f pregnant wmen such as medicatins fr essential and pregnancy induced hypertensin, diabetes and pstpartum hemrrhage. Facilities must be available t perfrm emergency surgery as needed, such as emergency Cesarean Sectins and interventin fr pstpartum hemrrhage. The treatment f wmen and children can als be cmplicated by the lack f access t medical recrds and basic prvisins such as diapers, frmula, baby bttles and clthing. Staff with the ability t assist new mthers in breastfeeding is imperative since there may be little access t infant frmula. The stress f the disaster may be cmpunded by the separatin f mthers and nenates, infants and children. All measures must be taken t ensure whenever pssible that mthers and children are evacuated t the same lcatin r a methd is develped t prmte cmmunicatin s families are aware f where their family members are lcated and can be reunited as sn as reasnably pssible. Althugh the pririty f prfessinals will be immediate health care issues, mental health resurces are imperative fr wmen and children. Apprximately 1 ut f every 8 wmen experiences perinatal depressin, which is exacerbated tremendusly by a disaster. Wmen als need t have ready access t methds f birth cntrl. The availability f cndms is essential fr birth cntrl as well as prtectin f sexually transmitted infectins. Wmen and children may be especially vulnerable t sexual vilence during disasters where chas vertakes law and rder. Sexual vilence may becme mre prevalent, r wmen and children may be cerced int sex fr basic needs such as fd and safety. 3

5 Assciatin f Maternal and Child Health Prgrams Children Children have unique characteristics which make them mre vulnerable in an infectius, natural r man-made disaster. These vulnerabilities apply t all children, althugh children with special health care needs may als have specific cnditins which can place them mre at risk. Pediatric vulnerabilities have previusly been well described by the Illinis Emergency Medical Services fr Children s prject and are listed belw: Children are mre vulnerable t agents that act n the skin because their skin is thinner and have a larger surfacet-mass rati than adults. Children are particularly vulnerable t aerslized bilgical r chemical agents because they breathe mre times per minute than adults and wuld inhale larger dses f the substance in the same perid f time. Als, because sme such agents (e.g. sarin and chlrine) are heavier than air, they accumulate clse t the grund right in the breathing zne f children. Children are mre vulnerable t the effects f agents that prduce vmiting and/r diarrhea because they have less fluid reserve than adults and can becme dehydrated faster. Infants, tddlers and yung children d nt have the mtr skills t escape frm the site f a chemical, bilgical r ther terrrist incident. Children als lack cgnitive decisin-making skills t figure ut hw t flee danger r t fllw directins frm thers. Children have smaller circulating bld vlumes than adults s if treatment is nt immediate, relatively small amunts f bld/fluid lss can lead t irreversible shck r death. A child s cnditin can shift frm stable t life-threatening quite rapidly because he/she has less bld and fluid reserves, is mre sensitive t changes in bdy temperature, and has a faster metablism. Children and Yuth with Special Health Care Needs In additin t the vulnerabilities which all children may face during a disaster, children and yuth with special health care needs (CYSHCN) may als have cnditin-specific risks r be mre vulnerable because f the cmplexity f their cnditins. Parents f CYSHCN are their caregivers, ften prviding cmplex care invlving medicatins and medical devices such as insulin pumps, respiratry devices (nebulizers, xygen, ventilatrs), and parenteral devices. In the event f separatin frm their parents, ther trained persnnel will be needed t prvide this care. Children previusly cared fr in a hme setting may need a higher level f care if separated frm their parents/caregivers. Examples f CYSHCN at risk include, but are nt limited t, thse: with respiratry cnditins (asthma, cystic fibrsis, brnchpulmnary dysplasia) when expsed t aerslized bilgical r chemical agents r envirnmental cntaminants (smke, dust r ther particulate matter); with endcrine disrders when expsed t agents that prduce vmiting r diarrhea r in which dehydratin wuld place them at very high risk (cngenital adrenal hyperplasia); with metablic disrders r with severe fd allergies (phenylketnuria) requiring special frmula r diet; with neurlgical disrders whse baseline is difficult t assess withut caregiver s input; requiring medical devices, medical supplies r life-sustaining treatment (nebulizers, chest physitherapy vests, xygen, ventilatrs, dialysis); requiring medicatin (insulin, anti-epileptics, inhalers, Hemphilia factr) n a regular basis, withut which increased mrbidity and mrtality culd ccur; with muscul-skeletal disrders (cerebral palsy, muscular dystrphy) wh can nt mve independently r require assistance t ambulate; with cardiac cnditins whse exercise tlerance limits the endurance required fr walking/running during transprt/evacuatin; requiring tube r parenteral feedings by trained persnnel; with behaviral, emtinal r mental disrders whse cnditin may be exacerbated by separatin, transitin r anxiety; 4

6 Assciatin f Maternal and Child Health Prgrams with cmmunicatin disrders (hearing lss, nn-verbal r severe speech articulatin prblems); and, with an immuncmprmised state (cancer, HIV/AIDS) due t their medical cnditin r its treatment, when expsed t infectius agents. 5

7 Assciatin f Maternal and Child Health Prgrams Emergency Management Prcess and Preparedness Overview While great prgress has been made in emergency preparedness ver the last few years, gaps still exist. MCH staffs have expressed cncerns with hw well the needs f wmen, families and children are being met in recent emergency situatins. AMCHP members and funders requested that the assciatin explre and then begin meeting state MCH prgrams needs relevant t emergency preparedness. This sectin prvides an verview f disaster preparedness and sme key cncepts that need t be cnsidered. It als describes the pssible impact f emergencies n the different MCH ppulatins, and summarizes the needs and vulnerabilities f wmen and children, including thse with special heath care needs. Finally the sectin summarizes the needs that state MCH prgrams have identified, current effrts t enhance MCH preparedness effrts, and state accmplishments in integrating the needs f the MCH ppulatin int state plans. Backgrund: Emergency Preparedness The preventin f death and illness frm biterrrism and ther public health threats and emergencies is the primary gal f ur natin s public health preparedness effrt 2 accrding t the Assciatin f State and Territrial Health Officials (ASTHO). ASTHO reprts that state health agencies have made great prgress in recent years wrking tward a functinal, cmprehensive, all-hazards, public health preparedness system. The Centers fr Disease Cntrl and Preventin (CDC) ffers the fllwing encuraging facts abut states and cities receiving CDC emergency preparedness funds 3 : 100 percent reprt they have detailed public health respnse plans. This type f planning didn t exist befre percent f states reprt they have plans in place fr receiving and distributing Strategic Natinal Stckpile assets. 98 percent reprt having designated facilities t receive, stre and distribute cntents f the Strategic Natinal Stckpile. 100 percent reprt they have prtcls t activate their emergency respnse systems at all times. 98 percent reprt they have established Incident Cmmand Structures as recmmended in the Natinal Incident Management System. 98 percent reprt having crisis and risk cmmunicatin plans in place. Backgrund: Majr Disaster Prcesses Accrding t the U.S. Department f Hmeland Security, Federal Emergency Management Agency (FEMA), first respnse t a disaster is the jb f lcal gvernment's emergency services with help frm nearby municipalities, the state and vlunteer agencies. In a catastrphic disaster, and if the gvernr requests, federal resurces can be mbilized thrugh FEMA fr search and rescue, electrical pwer, fd, water, shelter, and ther basic human needs. It is the lng-term recvery phase f disaster which places the mst severe financial strain n a lcal r state gvernment. Damage t public facilities and infrastructure, ften nt insured, can verwhelm even a large city. A gvernr's request fr a majr disaster declaratin culd mean an infusin f federal funds, but the gvernr must als cmmit significant state funds and resurces fr recvery effrts. A majr disaster culd result frm a hurricane, earthquake, fld, trnad r majr fire which the president must determine warrants supplemental federal aid. The event must clearly be mre than state r lcal gvernments can 2 Assciatin f State and Territrial Healthy Officials. States f Preparedness: Health Agency Prgress Centers fr Disease Cntrl and Preventin. Makes Preparedness a Pririty. May 19,

8 Assciatin f Maternal and Child Health Prgrams handle alne. If declared, funding cmes frm the President's Disaster Relief Fund, which is managed by FEMA and disaster aid prgrams f ther participating federal agencies. A Presidential Majr Disaster Declaratin puts lngterm federal recvery prgrams int mtin, sme f which are matched by state prgrams and designed t help disaster victims, businesses and public entities. An Emergency Declaratin is mre limited in scpe and withut the lng-term federal recvery prgrams f a Majr Disaster Declaratin. Generally, federal assistance and funding are prvided t meet a specific emergency need r t help prevent a majr disaster frm ccurring. 7

9 Assciatin f Maternal and Child Health Prgrams State MCH Staff in Emergency Preparedness Planning While great prgress has been made in emergency preparedness ver the last few years, gaps still exist. MCH staff has expressed particular cncerns with hw well the needs f wmen, families and children are being met after the hurricanes in AMCHP members and funders requested that the assciatin explre and then begin meeting the needs f state MCH prgrams relevant t emergency preparedness. AMCHP began its effrts arund emergency preparedness in 2003 in respnse t member requests and feedback n their lack f invlvement in state and lcal planning. A fact sheet was then develped n the MCH Rle in Biterrrism Planning t prvide recmmendatins t states n key MCH and CSHCN issues t be addressed in their biterrrism plans. AMCHP then sught ut t gather infrmatin frm members regarding their needs via surveys, listening grups and discussins at reginal meetings. The gal was t identify hw MCH prgrams and issues were being addressed at the state level, and t wrk with members n shaping what rle MCH prgrams can and shuld play in state planning and preparedness. Several brad themes emerged frm the infrmatin gathering pprtunities: Planning is necessary. At this time, the needs f MCH ppulatins may nt be adequately addressed within existing disaster plans highlighting the need fr MCH staff t be actively engaged in planning effrts. Educating staff and MCH ppulatins abut these plans is necessary. Funding, training and ther resurces must be available t strengthen state MCH emergency preparedness planning and training. Partnership is essential. Inter-state agency wrking relatinships and cmmunity partner peratins need t be enhanced. A skilled wrkfrce is needed t ensure institutinal capacity and staff capability during emergencies. In late 2005 with supprt frm the Maternal and Child Health Bureau, AMCHP cnvened an MCH Emergency Preparedness Wrkgrup and charged it with develping resurces and guidance fr state MCH prgrams. MCH Preparedness Activities AMCHP queried members abut current MCH preparedness activities as part f regular reginal cmmunicatins in March Participants indicated a wide range f invlvement in disaster preparedness activities ranging frm nne r minimal t being an active participant. One regin discussed the challenges fr the Title V agency t be at the table with respect t emergency preparedness planning. This regin als emphasized the great need fr mre extensive, cgent training in emergency preparedness fr MCH leaders and staff. They als expressed cncern that MCH ppulatins unique issues were neither adequately understd nr addressed by thse with lead respnsibility fr emergency preparedness. Anther regin raised the cncern that MCH services may actually have been smewhat negatively impacted by emergency preparedness activities, due in part t cmpeting respnsibilities f the small health departments. The fllwing are examples f states and territries emergency preparedness accmplishments: Flrida s Emergency Medical Services fr Children Prgram has supprted the pediatric disaster management effrts including the distributin f: 5,000 Brselw Pediatric Antidtes fr chemical warfare tapes t hspital emergency departments, EMS prehspital prvider agencies, and EMS initial training centers; distributin f 100,000 JumpSTART/START mass-casualty incident triage algrithm cards; and, apprximately 260 cpies f the 8

10 Assciatin f Maternal and Child Health Prgrams "Decntaminatin fr Children" DVDs t emergency department and EMS initial training centers. In additin, a registering system fr special needs shelters fr the pediatric and yuth ppulatins has been established. Massachusetts is actively invlved in develping cntinuity f peratin plans fr every state agency and their respective prgrams. The MCH prgrams are invlved in this planning and have a staff persn fcused n special ppulatins, thus assuring the issues related t mthers, children and families are addressed. Missuri is actively invlved in planning and was enlisted t chair/participate in all aspects f care fr persns with special health care needs. In additin, a number f staff actively participated n planning cmmittees. Mntana's emergency preparedness imprved cnnectivity with lcal health departments and medical prviders thrugh the Health Alert Netwrk. This system greatly imprved the state s ability t quickly cntact prviders, including hspitals and health departments. Schls and child care centers were prvided with resurces and training t develp emergency plans fr thse settings. Puert Ric is experienced in dealing with natural disasters and has develped necessary plans and prtcl. The Lcal Emergency Preparedness plan was reviewed after a recent hurricane leading t an updated MCH Divisin Plan clearly defining rles in an emergency situatin. The plan includes steps t fllw, cntact infrmatin and the specific rle staff will have during a situatin. All central ffice persnnel have read the dcument, and it has been shared with reginal staff. Rhde Island s CSHCN prgram wrks with their state-911 n a Disability Registry and with Hasbr Children's Hspital n the Frequent Flyer prgram, an nline medical recrd fr children with cmplex special health care needs. Bth systems are linked int state and lcal emergency respnders. Texas CSHCN Prgram published a bilingual bklet titled, Emergency & Disaster Planning fr Children with Special Health Care Needs. The bklet cntains a bilingual emergency infrmatin frm fr children with special needs. The frm was develped by the American Academy f Pediatrics and adapted by the Texas Department f State Health Services. Utah, using the Healthy Child Care America grant, develped a health and safety training fr childcare prviders, which includes a sectin n emergency preparedness. West Virginia created a database t include children wh have medically cmplex cnditins and identified such individuals by name, address, medicatins, etc. This database has been shared with Emergency Management Services and transprt prviders, in the event f a crisis. A secnd phase f this effrt is being explred, which includes educating families. Wyming had cnsiderable fcus, funding and attentin paid t the imprvement f emergency preparedness plans, including increased technlgy capacity, staffing capacity and cmmunicatin systems. The system has been tested repeatedly t ensure adequate respnse if and when needed. Washingtn s MCH prgram is wrking with emergency preparedness staff t create a mdule t attach t the CHILD Prfile Immunizatin Registry that wuld track antibitics r vaccines given t individuals during an utbreak r emergency event. During the 2006 AMCHP Annual Cnference, the assciatin cnvened a grup f federal representatives and state MCH prfessinals t discuss disaster preparedness fr MCH prgrams and the cmmunities they serve. The challenges and lessns learned identified during this sessin were nted in the reprt, The Need fr an MCH Fcus in Emergency Plans. They include: Challenges Assciated with Emergency Preparedness The unique health issues f MCH ppulatins are neither adequately understd nr adequately addressed by thse with respnsibility fr emergency preparedness plans. Title V prgrams, specifically MCH and CSHCN directrs, are nt invlved with statewide disaster preparedness respnse planning teams. 9

11 Assciatin f Maternal and Child Health Prgrams There is a need fr an emergency preparedness curriculum and mre extensive training fr MCH leaders and staff. Barriers such as wrk settings, language, cmmunicatin issues and inter-state credentialing prevent an effective emergency respnse by the public health wrkfrce. Lessns Learned frm Recent Emergencies Public health preparedness and respnse wrks and saves lives, but needs strengthening. Similar preparedness gaps exist acrss the cuntry despite differences in states size, ppulatin and administrative rganizatin. The best plans invlve many partners. The private and nn-prfit sectrs must be included in public planning. MCH emplyees must participate in emergency preparedness exercise drills. Public health preparedness plans need t reflect the specific needs facing vulnerable MCH ppulatins, such as special evacuatin needs, medicatins, supprt, and thers. Maintaining a strng, centralized cmmand pst fr leadership, cmmunicatin crdinatin, and the fstering and sharing f resurces is necessary in a disaster. There is an increased need fr inter-agency and reginal cllabratin during a disaster. Strategic preparedness planning is expecting the unexpected. State MCH Emergency Preparedness Survey Summary Results An electrnic survey designed t identify the strengths and needs in MCH preparedness effrts was distributed in early summer 2006 t the MCH and CSHCN directrs f each state, territry and the District f Clumbia. Nearly 70 percent (35) f thse wh received the survey respnded. Fifteen MCH directrs, 13 CSHCN directrs, and seven peple wh held ther psitins respnded. Results included: Emergency Preparedness Effrts The majrity f respndents indicated that emergency preparedness was either a high r smewhat high pririty issue fr their MCH agency, with fur respndents indicating it was a lw pririty. When asked hw well MCH emergency preparedness needs are being addressed as part f larger statewide effrts; tw respndents indicated very with 26 respndents stating smewhat ; fur nt at all and three did nt knw. Rles When asked abut their rle in emergency preparedness within their state, nearly half f respndents indicated they had n frmal rle in emergency preparedness, but fifteen indicated that they were a member f a state-level emergency preparedness team. Awareness The majrity f respndents were either very familiar r smewhat familiar with the state s current MCH emergency plan, with fur peple being nt at all familiar. The MCH emergency preparedness plans that were in place were linked with r related t the statewide and lcal biterrrism and emergency preparedness plans. Cnstraints and Needs The majr cnstraints t effective MCH emergency preparedness plans were listed as staffing, budgets and persnnel expertise. Agencies were primarily addressing these needs by: invlving staff in planning effrts; building inter-agency relatinships; and, participating in preparedness exercises. If additinal funding were available, states wuld increase persnnel expertise in emergency preparedness; develp a planning cmmittee that includes MCH and CYSHCN and families; and, increase utreach educatinal prgrams. Skills and Training Needs The tp three preparedness skills r types f emergency preparedness training needed by MCH staff were: training staff in develping emergency preparedness plans; training n hw t address the needs f CYSHCN and their families; and, assessment f mental health and stress management. 10

12 Assciatin f Maternal and Child Health Prgrams Recmmendatins t Imprve MCH Emergency Preparedness The AMCHP MCH Emergency Preparedness Wrkgrup (see Appendix B) reviewed the needs and requests elicited in the 2006 annual cnference sessin and subsequent survey. Using this infrmatin the wrkgrup decided t develp a set f recmmendatins based upn the key emergency preparedness needs that emerged frm states. The grup began meeting in March 2006 under the leadership f Lynn Christiansen and Marilyn Kacica. Five wrkgrups were cnvened: 1. Pharmacy and Hspitals 2. Licensure Reciprcity 3. Transprtatin, Supplies, Evacuees and Shelters 4. Psychscial 5. Macr (prvided verall crdinatin and addressed the verarching issues) The wrkgrups met regularly by cnference call t shape the scpe and utcmes f the prject. They identified prminent MCH issues and develped relevant recmmendatins building upn existing resurces. AMPCHP held an Emergency Preparedness Summit in January 2007, attended by 54 AMCHP members and partners frm cllabrating rganizatins. Meeting participants reviewed and refined the recmmendatins frm the individual wrkgrups. The advice gleaned frm the Emergency Preparedness Summit was used t enhance the preliminary recmmendatins. In March 2007, the draft recmmendatins were presented at the AMCHP-MCH Emergency Preparedness Discussin Frum at the 2007 AMCHP Annual Cnference and cmments were slicited frm the audience. Recmmendatins included in this reprt address: Natinal Recmmendatins Lcal, State, Territry and Jurisdictin Planning Emergency Planning Educatin Licensure Reciprcity Supplies Transprtatin and Evacuatin Shelters Pharmaceuticals and Hspitals Psychscial Needs 11

13 Assciatin f Maternal and Child Health Prgrams Recmmendatins t Imprve MCH Emergency Preparedness: Natinal Planning Backgrund Emergency preparedness requires a multitude f partnerships at every level f gvernment and sciety. Funding, training and ther resurces in this area are primarily allcated at the natinal level. Similarities in states needs and cnsistent respnse effrts are ften best crdinated at the natinal level with state and cmmunity input. Lessns Learned frm Past Disasters Funding, training and ther resurces must be available t strengthen state MCH emergency preparedness planning and training. Planning is necessary. MCH ppulatins needs may nt be adequately addressed within existing disaster plans, thus MCH staff must be actively engaged in planning effrts. Similar preparedness gaps exist acrss the cuntry despite differences in states size, ppulatin and administrative rganizatin. The best plans invlve many partners. The private and nn-prfit sectrs must be included in planning. Partnership is essential, and intra-state agency wrking relatinships and cmmunity partner peratins need t be enhanced. A skilled wrkfrce is needed t ensure institutinal capacity and staff capability during emergencies. This includes training n the Incident Cmmand System (ICS). In the event f an emergency, the chain f cmmand frm the federal t lcal level is ften nt clear. Maintaining a strng, centralized cmmand pst fr leadership, cmmunicatin, crdinatin, and the fstering and sharing f resurces is necessary in a disaster. Recmmended Slutins Natinal Recmmendatins t HHS, HRSA, Maternal and Child Health Bureau and the Centers fr Disease Cntrl and Preventin Prvide funding and ther resurces t allw states t cntinue t prepare fr emergencies. Advcate fr the needs f MCH ppulatins in federal-level emergency planning. Cntinue t prvide training pprtunities t MCH staff abut emergency preparedness. Prvide funding fr additinal emergency preparedness infrastructure develpment and training fr MCH prfessinals. Prvide assurances that peple respnsible fr emergency preparedness at the federal, state and cmmunity levels are trained and able t perfrm their respnsibilities. Fund a calitin f rganizatins representing federal, state and lcal gvernments, nnprfit rganizatins, prfessinal grups, and thers t identify and plan fr the needs f MCH ppulatins as part f emergency preparedness activities. Supprt the establishment f a federally-spnsred MCH preparedness resurce center. Develp natinal regulatins r requirements regarding the Strategic Natinal Stckpile that ensure the needs f MCH ppulatins are met; ensure that pediatric dsages are addressed, plicy allws fr a 90 daysupply f medicatins, and reimbursement by public and private insurers is prvided. 12

14 Assciatin f Maternal and Child Health Prgrams Advcate fr the hiring f the Directr f At-Risk Individuals within the HHS Office f Preparedness and Respnse. Assist MCH agencies t develp partnerships arund preparedness with federal and natinal rganizatins that have a state-level presence. Recmmendatins t AMCHP Take actin t ensure the recmmendatins in this reprt are addressed. Engage in nging planning t identify and address the emergency preparedness needs f MCH prgrams at the natinal and state levels. Cnvene and maintain an verarching plicy-fcused grup, such as the macr grup, t ensure fllw-up and implementatin f these recmmendatins. Set up specific wrkgrups (e.g., a psychscial taskfrce that includes mental health prviders and families with disaster experience) t examine and suggest recmmendatins fr select issues. Advcate fr an emergency preparedness agenda that includes: new funding fr MCH staff t address emergency preparedness needs at the natinal, state and cmmunity levels; plicy and regulatry changes t meet the needs f MCH ppulatins; develpment f a brad-based calitin; and, ther tasks identified in this reprt. Wrk with Natinal Emergency Management Assciatin, ASTHO, the Natinal Gvernr s Assciatin and ther partners t encurage states t wrk thrugh the Emergency Management Assistance Cmpact (EMAC). Take actin t make the changes t barriers identified. Cntinue t identify the emergency preparedness plicy needs f members and wrk with Friends f Title V, an AMCHP-led calitin f rganizatins that share an interest in maternal and child health, t advcate fr the develpment and passage f needed legislatin and regulatins. Prvide the MCH perspective and advcate fr MCH ppulatins within natinal preparedness meetings, presentatins, discussins and planning. Actively participate with natinal gvernment and nn-prfit partners t address the needs f emergency preparedness. Identify and share best practices fr MCH emergency preparedness. Offer training sessins, hst cnference calls and cnnect members t ther rganizatins emergency preparedness educatin pprtunities. Prvide resurces n preparedness thrugh the website and newsletter and link members t emergency preparedness rganizatins. Prepare resurces n this subject such as plicy papers. Facilitate pprtunities fr members t participate in learning cmmunities r engage in sharing with thers invlved in this area. 13

15 Assciatin f Maternal and Child Health Prgrams Recmmendatins t Imprve MCH Emergency Preparedness: Lcal, State, Territry and Jurisdictin Planning Backgrund The natin s ability t respnd t emergencies such as natural disasters r acts f terrrism depends n the strength f the public health system. Withut sufficient funds and detailed plans, any such event will severely strain the entire public health system, decreasing ur ability t serve the mst vulnerable, such as children with special health care needs, the elderly, the disabled and the mentally ill. As states build emergency plans, they shuld include staff frm MCH and CSHCN prgrams. These public health leaders have the expertise t ensure the needs f wmen and children are met. In additin, cmmunity participatin is imprtant at all stages f any emergency t ensure the acceptability, apprpriateness and sustainability f maternal and infant services. Thrugh cmmunity participatin, essential infrmatin n the cultural, ecnmic, ethical, legal, linguistic and religius backgrunds f the ppulatins can be gathered t infrm emergency respnse plans fr key services and prgrams. It is especially imprtant t empwer wmen as part f this prcess t ensure that services are prvided t them. 4 Lessns Learned frm Past Disasters Public health preparedness and respnse wrks and saves lives, but needs strengthening. Planning is necessary. At this time, the needs f MCH ppulatins may nt be adequately addressed within existing disaster plans, thus MCH staff must be actively engaged in planning effrts. Title V prgrams, specifically MCH and CSHCN directrs, are nt always invlved with statewide disaster preparedness respnse planning. The unique health issues f MCH ppulatins are ften neither adequately understd nr adequately addressed by thse with respnsibility fr emergency preparedness plans. The best plans invlve many partners. The private and nn-prfit sectrs as well as cnsumers must be included in planning. Cmmunity partnerships are critical and shuld be established well befre an event takes place. Maintaining a strng, centralized cmmand pst fr leadership, cmmunicatin, crdinatin, and the fstering and sharing f resurces is necessary in a disaster. Recmmended Slutins Lcal Planning Befre the Event Gather infrmatin frm the cmmunity t identify: The best means f access t prviders by the cmmunity; Apprpriate sites fr prviding services; Training needs f care prviders and respnders; Available resurces; 4 Natinal Wrking Grup fr Wmen and Infant Needs in Emergencies in the United States. Wmen and Infants Service Package. April

16 Assciatin f Maternal and Child Health Prgrams Prper means f disseminating infrmatin t the cmmunity; and, Optins fr wmen if they are nt able t reach a birthing facility (e.g., a birth preparedness/cmplicatin readiness plan). Becme familiar with basic lcal and reginal health and vital statistics. Planning fr emergencies shuld take int accunt the expected numbers f births per unit time, ppulatin demgraphics, and infrmatin abut where births currently take place. 5 State, Territry and Jurisdictin Planning Befre the Event MCH leadership must be actively invlved in develping emergency preparedness plans emphasizing the health and safety needs f MCH ppulatins. MCH leadership s rle includes: Ensuring that health and psychscial needs f all wmen f reprductive age, especially pregnant wmen, new mthers, newbrns, infants, children and yuth are adequately met by incrprating the suggestins fund in this dcument. Implementing the recmmendatins develped by the Natinal Wrking Grup fr Wmen and Infant Needs in Emergencies, in the Wmen and Infants Services Package. Implementing the American Academy f Pediatrics recmmendatins fr children and disaster situatins. 6 Ensuring that the needs f the MCH ppulatin, including thse wh are hspitalized, are integrated int any existing hspital, cunty, reginal and statewide emergency preparedness plans. Addressing basic survival needs f MCH ppulatins in all state-level disaster preparedness plans t lessen the stress levels during an emergency and ensure that peple feel mre in cntrl and as safe as pssible. Fd, water, medicatins, security, transprtatin (buses), husing, etc., must be prvided t lessen the threat f emtinal reactins. Cnvening, if needed, prfessinals, gvernment, emergency preparedness and cmmunity t address the needs f children in child care r schls during a disaster situatin. Wrk with child care prviders and schls t strengthen their ability t manage a disaster situatin while children are at schl r in care. Preparing memrandums f understanding between relevant federal, state and lcal agencies clearly defining rles and respnsibilities in the prvisin f health and mental health care fr MCH ppulatins during times f crisis. Ensuring that first respnders are trained n hw t care fr pregnant wmen, infants, children and yuth, especially thse wh are high-risk and/r have special needs. Shelter wrkers and emergency health care prviders shuld als receive training t recgnize and address issues unique t MCH ppulatins. 5 Natinal Wrking Grup fr Wmen and Infant Needs in Emergencies in the United States. Wmen and Infants Service Package. April AAP resurces can be fund at 15

17 Assciatin f Maternal and Child Health Prgrams Establishing emergency tll-free public htlines fr MCH resurces and reprting within the Incident Cmmand Center structure. Supprt the develpment f a Natinal Incident Management System (NIMS) mdel fr MCH emergency preparedness that is relevant fr states, as well as U.S. territries and the District f Clumbia. State health department and MCH leadership, ther state agencies, lcal jurisdictins, and rganizatins playing majr rles in disaster planning, especially in the area f shelter peratins, agree upn a cmmn definitin and level f functin fr the special needs ppulatin. The fllwing definitin is cmmnly used within HRSA-funded prgrams addressing the needs f C(Y)SHCN: Children (and yuth) with special health care needs are thse wh have r are at increased risk fr a chrnic physical, develpmental, behaviral r emtinal cnditin and wh als require health and related services f a type r amunt beynd that required by children generally. Wrk cllabratively with families, prgrams, cmmunity rganizatins and prviders fr CYSHCN, including technlgically dependent hspitalized individuals, t ensure that the needs f this grup are met, particularly in the areas f planning, implementing and evacuating t emergency shelters. This includes: Implementing a vluntary database system develped fr emergency situatins fr CYSHCN t access their basic health infrmatin. Reviewing current systems used t identify and enrll children and yuth in the database. Include infrmatin abut transprtatin needs, enrllment in special needs shelters r hspitals, and ther vital infrmatin. Assuring that the database is regularly updated. Develping alternate system fr thse nt included in the system. Cnsidering the use f electrnic medical charts Facilitating the develpment f emergency readiness plans that includes cntinuus training drills fr cmmunities, prfessinals, families and registered/retired vlunteers wh will aid CYSHCN in an emergency. Plans shuld ensure that the fllwing are in place and have been supplied t the apprpriate cmmunity partners: Medical eligibility fr special needs shelter is determined and shelter registratin frms are cmpleted/updated by families. Children requiring evacuatin t a hspital (e.g., ventilatr dependent children) are identified. Children and families requiring special transprtatin t a shelter (e.g., ambulance, wheelchair, families withut surce f transprtatin in husehld, etc.) are identified. Sufficient quantities f supplies (medical, mats, water, xygen, fd, paper gds, generatrs, cellular phnes, satellite phnes, etc.) are requested. Health supprt and medical staffing plans are in place (e.g., children s hspitals, private prviders, cmmunity clinics, schl health teams, etc.). Nutritin service plans. Triage, treatment and/r apprpriate dispsitins f evacuees recmmendatins. Onsite transitin/discharge plans t hme r lng-term transitinal husing. Cntingency plans regarding cmmunicatins and ther essential lgistics. 16

18 Assciatin f Maternal and Child Health Prgrams Ensuring emergency readiness plans are updated and reviewed regularly and shared with families, staff and cmmunity partners. Ensuring nging training drills fr cmmunities, prfessinals, families and vlunteers wh will aid CYSHCN in an emergency are in place. Engage in a dialgue with media rganizatins abut the psychscial implicatin f the reprting f disaster situatins t MCH ppulatins, especially children. The media is a pwerful frce, bth psitive and negative, in cmmunicating and educating abut emergency events. Engage in planning s that statewide and lcal public health infrmatin systems and technlgies including web sites, database activities, and ther cmmunicatins and services remain available during an emergency. Fr example, ensure that access t states registries and databases are maintained during an emergency. State, Territry and Jurisdictin Planning: During the Event Rely n lcal Incident Cmmand System and the Natinal Incident Management System t carry ut preplanned activities. Have medical and psychscial experts n hand with critical incident training/crisis management training. State, Territry and Jurisdictin Planning: After the Event Rigrusly evaluate all aspects f the planning and implementatin prcess. Identify needed changes and address them in future planning. 17

19 Assciatin f Maternal and Child Health Prgrams Recmmendatins t Imprve MCH Emergency Preparedness: Emergency Planning Educatin Backgrund It is imprtant that MCH ppulatins and staff be aware f what t d in emergency situatins. All families assciated with MCH prgrams, especially thse wh have children with special needs shuld develp a family emergency preparedness plan. MCH staffs need t be knwledgeable abut state-level emergency preparedness plans and their rles in times f crisis. State-level MCH prgrams shuld cnsider what infrmatin is available and hw t best share it with vulnerable ppulatins. Staff can als identify and address any gaps in educatin materials. Lessns Learned frm Past Disasters Educate MCH staff and ppulatins abut emergency preparedness plans and activities, especially thse addressing MCH grups. Peple need t plan fr emergency situatins but d nt fr many reasns including lack f infrmatin. A skilled wrkfrce is needed t ensure institutinal capacity and staff capability during emergencies. MCH emplyees must participate in emergency preparedness exercise drills. There is a need fr an emergency preparedness curriculum and mre extensive training fr MCH leaders and staff. Recmmended Slutins Befre the Event Ensure that MCH ppulatins, especially thse that are mst vulnerable, have access t educatin and materials n preparing fr and cping with a disaster. This includes: Wrking with ther state and cmmunity partners t assure that state-based web and ther resurces are available in ne place that link MCH ppulatins t emergency preparedness infrmatin that is credible, helpful and will supprt vulnerable ppulatins during disasters. Mnitr and update materials regularly. Crdinating and participating in the develpment r enhancement f a web-based resurce directry fr the state by cunty that includes practical resurces in areas such as health, scial services, fd and clthing banks, mental health and where t g fr free resurces. Assisting families and individuals in preparing fr an emergency that includes: Assisting with the develpment f a family emergency preparedness plan that is ideally kept by bth the family and with the medical hme. Prviding planning tls r checklists with recmmendatins fr an at least tw-week emergency kit f necessary supplies needed t shelter in place r t evacuate Offering materials that address the needs f this ppulatin such as: psychscial needs; hw t care fr newbrns in shelter envirnments; child-specific infrmatin fr parents, teachers and thers wrking with children; etc. 18

20 Assciatin f Maternal and Child Health Prgrams Sharing infrmatin and resurces via hme visiting, clinic visits, case management services r ther pprtunities ffered by public health and ther cmmunity settings. When a disaster ccurs ensuring that pririty materials are distributed t families using pre-established mechanisms. Ensure that MCH staff has an understanding f disaster preparedness, is aware f state and MCH-specific plans, is trained fr emergency situatins, and participates in relevant trainings and exercises. Engage lcal and reginal ptential prviders bstetric/gyneclgists, certified nurse midwives, certified midwives, certified prfessinal midwives, labr and delivery nurses, emergency medical technicians, family practice physicians, nurse practitiners, physician assistants, emergency and first respnders, and dulas t: Educate and train hme-based delivery skills, services and equipment t institutin-based birth prviders. Acknwledge that they - the prviders named abve - may nt have experience prviding delivery skills with few resurces r medicatins, r wrking with wmen wh have expectatins f a medicated delivery. 7 7 Natinal Wrking Grup fr Wmen and Infant Needs in Emergencies in the United States. Wmen and Infants Service Package. April

21 Assciatin f Maternal and Child Health Prgrams Recmmendatins t Imprve MCH Emergency Preparedness: Licensure and Reciprcity Backgrund It is necessary fr states t have crdinated, cnsistent and rganized health care respnse n bth the state and federal level t ensure the health and welfare f MCH ppulatins at risk are prtected and served. Key t this effrt is the availability and deplyment f vlunteer health practitiners t meet the needs within public and private sectrs. The fllwing legislative activities were develped t assure there is an efficient system t prvide aid, advanced registratin and credentialing f clinicians, and the necessary legal envirnment recgnizing licensing privileges fr health practitiners n an interstate basis. The Emergency Management Assistance Cmpact (EMAC), established in 1996, is a natinal disaster-relief cmpact that prvides a mutual aid agreement and partnership between member states. T date, 50 states, the District f Clumbia, Puert Ric and the US Virgin Islands have enacted legislatin t becme members f EMAC. In 2007, Cngress passed legislatin fr the advance registratin and credentialing f clinicians needed in an emergency thrugh the Emergency System fr Advance Registratin f Vlunteer Health Prfessinals Plan (ESAR-VHP). Fllwing this in December 2007, the Pandemic and All-Hazards Preparedness Act (Public Law ) was passed t encurage participatin in ESAR-VHP by limiting awards t states nt participating beginning in fiscal year Underlying the successful deplyment and use f vlunteer health practitiners during emergencies is the need fr a legal envirnment that supprts these effrts. In respnse t this need, The Natinal Cnference f Cmmissiners n Unifrm State Laws put frth the Unifrm Emergency Vlunteer Health Practitiners Act (UEVHPA) 8. This new act wuld prvide unifrm legislative language t facilitate rganized respnse effrts amng vlunteer health practitiners. The UEVHPA wuld prvide fr: Applicatin f its cverage t declared states f emergency, disaster r public health emergency (r like terms at the state r lcal level); The cverage f vlunteer health practitiners wh are registered with ESAR-VHP, MRC, r ther similar systems; Prcedures t recgnize the valid and current licenses f vlunteer health practitiners in ther states fr the duratin f an emergency declaratin; Requirements fr vlunteer health practitiners t adhere t scpe f practice standards during the emergency (subject t mdificatins r restrictins); and, Reductin f the expsure f vlunteer health practitiners, r thse wh emply, deply r hst them, t significant disciplinary sanctins based n actins (r failures t act) during a declared emergency. 8 UNIFORM EMERGENCY VOLUNTEER HEALTH PRACTITIONERS ACT. Natinal Cnference f Cmmissins n Unifrm State Laws. July