Emergency Preparedness for Children with Special Needs * Script

Emergency Preparedness for Children with Special Needs * Script Introduction Welcome to Emergency Preparedness for Children with Special Needs. This 2-hour course is part of a series of online trainings designed to help you, as child care providers and directors, to gain a better understanding of how to create an inclusive child care environment for infants and toddlers. One of the most important features of any child care program is the extent to which the program and its staff are able to create a healthy and safe environment for all children. Part of creating such an environment is being prepared for unexpected emergencies. The way we respond in an emergency situation, whether positive or negative, usually depends on how well prepared we are beforehand. It is especially important to be prepared in child care settings that enroll infants and toddlers with disabilities because these children may be physically or developmentally unable to protect themselves. Child care facilities that have an emergency plan in place and practice it on a regular basis are better able to protect the children in their care. The purpose of this course is to provide the basic guidelines necessary to develop a disaster preparedness plan for child care facilities that currently enroll or, at some point in the future will enroll, infants and toddlers with special needs. Learning Objectives By the time you have completed this course, you should be able to: Identify various types of emergencies that can potentially affect your community, Develop and practice an emergency evacuation and relocation plan, taking into consideration the special needs of children with disabilities, Develop and document communication and notification procedures, Assemble two emergency supply kits: one for sheltering in place and another for evacuating, Describe roles and responsibilities of child care staff members in the event of an emergency, Develop a recovery plan, and Be better prepared to handle medical emergencies. Definition of Inclusion In a joint effort to create a national definition of inclusion, the National Association for the Education of Young Children and the Division of Early Childhood recently released a position paper describing the key features of inclusive child care. In that paper, the authors describe inclusion in this way: Early childhood inclusion embodies the values, policies, and practices 1

that support the right of every infant and young child and his or her family, regardless of ability, to participate in a broad range of activities and contexts as full members of families, communities, and society. The desired results of inclusive experiences for children with and without disabilities and their families include a sense of belonging and membership, positive social relationships and friendships, and development and learning to reach their full potential. As previously noted, creating a healthy and safe environment for all children is a hallmark of inclusive child care. While we might not ever be able to fully anticipate every emergency that could arise when caring for children, being prepared for emergencies should be a top priority for child care providers working in home- and center-based facilities. Young children are particularly at risk when confronted with disasters because they often do not have the capacity to make judgments and decisions on their own that will ensure their safety. Children with special needs are especially vulnerable and will require special adult attention when disasters strike. For example, children with impaired mobility will need assistance during evacuations. Children with special health care needs may have essential equipment or medications that must accompany them. It is critical that the disaster preparedness plan [which we will discuss later in this course] have special provisions, including the assignment of staff, to assist these children in the event of an emergency (California Childcare Health Program, p. 2). Identify Different Types of Disasters Let s begin by taking a look at some of the various types of disasters that could potentially affect child care programs. All locations are vulnerable to some form of disaster. Before developing an emergency plan, it s a good idea to become familiar with the types of threats that can potentially affect your area. Different types of disasters sometimes require specific action, and understanding the nature of different events is a vital part of the planning process. Disasters come in many different forms. There are natural disasters such as hurricanes, floods, wildfires, tornadoes, thunderstorms, winter storms, extreme heat, and droughts. There are industrial disasters such as hazardous materials incidents or nuclear plant emergencies. There are health emergencies such as flu pandemics. Unfortunately, there are also intentional acts of violence or terrorism that can impact child care settings. Being able to cope effectively with such disasters depends on how well a child care facility and its staff are prepared. The likelihood of facing a particular disaster depends on several factors including geographic location, proximity to power plants and other facilities that produce or store hazardous materials, weather conditions, and so forth. Activity #1 Identify Disasters Using the handout Identify Disasters, take a few moments to list and analyze potential disasters that may affect your particular area. Think about how prone your area is to weather occurrences like tornados, hurricanes, blizzards, and wildfires. Also include any risks in your area from chemical plants, military bases, and major highways. As we discuss emergency preparedness, refer to this list and make notes about what specific steps are required to be prepared for such disasters. 2

Should You Stay or Go? The first priority during an emergency or disaster situation is to ensure the safety of the children by deciding whether to stay put or leave the facility. Depending on the type of emergency at hand, different types of actions may be required to keep children of all abilities and ages safe from harm. Each child care facility should have an emergency evacuation and relocation plan in place as required by the Texas Department of Family and Protective Services Child Care Licensing division, or your state s child care regulatory agency. This plan is designed to ensure the safety of children during a fire, severe weather, or other emergency situation that requires evacuation or relocation. It should be routinely practiced at different times during the hours of operation. Sheltering-in-place means remaining safely indoors to protect yourself and others from pending danger. There are many different ways to shelter-in-place depending on the situation. For example, during a tornado warning, you should retreat to a room located underground or the innermost, window-free room inside of your facility. During a chemical release, it is recommended that shelter be taken in a room above ground level. As you can see from these two examples, different emergencies require different forms of action. If an emergency arises that requires sheltering-in-place, local emergency management officials will alert radio and television stations with specific instructions on how to follow through, which will then be broadcast to the public. Shelter-in-Place Emergency Being prepared for a shelter-in-place emergency involves having a plan in place before the unexpected happens. Consider the following suggestions: Each room should be in an interior part of the building, have few or no windows, and have adequate space for everyone to sit, including infants in carriers or on blankets, Select several rooms, if necessary, to avoid overcrowding, particularly when caring for children in wheelchairs or who have portable medical equipment like oxygen tanks, Shelter rooms should be equipped with a land-line telephone that is hard wired to the wall. Cell phones should be kept on hand, but keep in mind that they might not work due to heavy call traffic or damage to service towers, Each shelter room should be equipped with a walkie-talkie so communication can take place between groups, Designate one person to answer incoming calls from concerned parents, and Each shelter room should contain an emergency supply kit to accommodate the number of children who will be in that room. During a shelter-in-place emergency: Close the child care facility, Listen to a television or radio for sheltering instructions from your local emergency management team, 3

Bring children and staff indoors, and report to the shelter room or rooms, If there are visitors in the center, invite them to stay, Locate your disaster supply kit, and make sure it is in each shelter room, Change the voicemail greeting to indicate that you are closed and the children will remain in the building until authorities announce that it is safe to leave, Close and lock all windows, doors, and other openings to the outside, Instruct the person who is familiar with the building s mechanical systems to turn off all fans, air conditioning, and heating systems, Once everyone is in the shelter room, lock the doors and windows. If necessary, seal vents, windows, and doors with the plastic sheeting and duct tape found in your disaster supply kit, Account for all children and staff in the room. Keep a written log of all names, Listen for an official announcement from emergency management personnel via radio or television. They will let you know when it is safe to leave or if it is necessary to evacuate the building, and Conduct activities with children to keep them calm. These activities should be developed ahead of time. Activity #2: Infant/Toddler Activities Let s think about specific activities you can prepare for the infants and toddlers in your care. While preschoolers and school-aged children can be occupied with books and art projects, it may take a little more planning for children under three years of age. Take a couple of minutes to list items that you would include in your program s emergency supply kit. How did you do? Some items that may help soothe infants include pacifiers, rattles, soft stuffed animals, and battery-operated music or light toys. For toddlers, consider pop-up books, jumbo crayons and paper, musical instruments, and puppets. Evacuation In some cases, such as a fire or flood, evacuation may be necessary. Evacuate immediately if told to do so by authorities. They will not ask you to leave unless they determine that lives are in danger. Decide on a meeting place directly outside of the child care facility where children and staff will gather to make sure that everyone has exited safely, Select a remote location for emergencies that render your primary meeting place unsafe, and, Post both locations outside of all entrances and exits, and ensure that both destinations are known by all employees, caregivers, volunteers, parents and licensing agents. Keep in mind that evacuating immobile children can present challenges. Caregivers pushing infants in cribs and children in wheelchairs may have a difficult time traveling through grassy surfaces and may cause a delay in evacuation time. If possible, choose an evacuation location with a route that is comprised of primarily concrete or asphalt surfaces. 4

Before an evacuation drill is ever implemented, you must have a detailed plan in place. This written and posted plan should include roles and responsibilities and what supplies and materials are needed. Here are some suggestions for creating your evacuation plan: List the conditions that might require your center to evacuate, Document a clear chain of command, including specifically designating: o Who will authorize the evacuation, o Who will assist with relocating the children to a safe area, and o Who will keep a log of all children and staff in attendance during the evacuation, Establish a set of procedures for assisting the children in your program with disabilities, Post the evacuation plan in each room of the facility, Appoint a member of the staff to shut down critical operations while the evacuation is underway, and Inform your local emergency management office and child care licensing representative of your evacuation plan. While your evacuation is in progress, here are some actions that should be considered when escorting the children to safety: Listen to local radio or television stations for evacuation instructions, Evacuate your facility immediately if instructed to do so by emergency management authorities, Take along your disaster supply kit, set of portable emergency records, and a copy of your emergency evacuation plan, and Post the evacuation notice on your front door. This notice will let others know your emergency evacuation location. Later in the training, we will discuss specific ways to communicate with parents once you have safely evacuated your facility. However, if you are safely able to notify parents, local authorities, and media outlets before or as you are evacuating, provide the information listed on your posted evacuation notice. If you are unable to safely notify any outside contacts, ensure that 911 or your local emergency agency has been notified, particularly if you have a child who will need more intensive and individualized care in your evacuation location. This notification will help local authorities prioritize their response teams and times. For reference, please refer to the handout entitled Communication Checklist Worksheet. Emergency Records In the event of an emergency, one of the first priorities is to gather items that are life-saving and irreplaceable, as well as crucial for contacting parents. These include child information records, emergency medical consent forms, medication administration orders, and local emergency contact information. Assemble a portable set of emergency records, and designate a staff member to be in charge of the records during an evacuation. The emergency records should be stored in a portable file container so they are safe from damage, easy to locate, and ready to be transported in case of an evacuation. Update information on a regular basis or as needed. 5

Transportation During an Emergency In rare cases, an emergency may require vehicular transportation, particularly if you have a child in your care who may require more advanced medical attention. As you are creating your emergency preparedness plan, decide who will be responsible for transporting the child or children, and the type of transportation that will be used. Some options may include, but are not limited to: A school van, A transportation service, Vehicles owned by staff members, and A vehicle that can accommodate a wheelchair or other medical equipment, as needed. Keep in mind that any vehicle used to transport young children must meet all safety requirements, including car seats, seat belts, and licensed drivers. During an evacuation, keep a record of crucial information including names and duties of assigned staff. The handout Evacuation/Transportation Checklist for Child-Care Facilities provides space to document this information. As we list the items in this sample checklist, jot down the information you already know, and circle any areas that need to be addressed. Name and address of your child care facility, Cell phone number of responsible person, Total number of children at the center, Total number of staff at the center, Name and address of evacuation site, Name of contact person at evacuation site, Phone number at evacuation site, and Number of children and staff gathered at evacuation site, If any children are transported by vehicle, include the: Name of the person or persons responsible for transportation of children, Number of children and staff transported by vehicle, Make, model, and license plate of vehicles used to transport, Name and phone number of transportation provider (if used), Number of vehicles dispatched to evacuation site, and Time the vehicles departed for evacuation site. Appoint one person to be in charge of this documentation throughout the evacuation. If at all possible, this person should be someone who is not directly supervising children, such as the director or a regular volunteer. This will ensure that all children and staff are counted in an efficient and accurate manner. 6

Remember to bring medications, supplies, and emergency records. Several portable emergency supply kits should be kept on hand along with the set of portable emergency records. We ll discuss these supply kits a little later in our training. Post the Plan! Post the emergency evacuation and relocation plan in each room of the facility. The plan and diagram must show the following: A floor plan of your child care facility, Two exit paths from each room, unless a room opens directly to the outdoors at ground level, The designated locations outside of the child care facility where all caregivers and children meet to ensure everyone has exited the center safely, and The designated location or locations inside the child care center where all caregivers and children take shelter from threatening weather. For more information regarding evacuation and relocation in the state of Texas, please visit the Texas Department of Family and Protective Services website on your screen: http://www.dfps.state.tx.us/child_care/about_child_care_licensing/. You can also access the Child Care Minimum Standards directly by visiting the website that is also listed on your screen: http://www.dfps.state.tx.us/child_care/child_care_standards_and_regulations/default.asp If your center is outside the state of Texas, please refer to your state s child care licensing requirements regarding emergency preparedness. Emergency Supplies Gathering supplies before an emergency situation arises is an essential part of disaster planning. Supplies such as food and water may not be readily accessible after an incident occurs. Assembling a disaster supply kit beforehand will not only provide the basic necessities needed to sustain life, but it will also reduce some of the stress associated with surviving a disaster. Two different types of supply kits should be assembled for the child care setting. The first kit should be assembled for each group of children, and the second kit should be prepared for the entire program. Ask yourself a few questions. Do most of your children s families live near the child care facility? Do some of them commute long distances? If you answer yes to the first question, then start by stocking enough supplies to last one day. If you have several families who work and live far away, you may need to prepare for at least an overnight stay. By asking these questions, you will be able to determine the quantity of supplies needed for your center. Determine where to store emergency supplies. Every group of children in care should have an emergency supply kit to accommodate each child s needs, and there should be a reserve of 7

supplies for the entire facility. Classroom kits can be stored in new trash barrels with wheels or wheeled suitcases for easy transportation. Supplies reserved for the entire facility can be stored inside of a locked closet or kitchen pantry. The supplies should be inspected and refreshed as needed every six months. Examine the kit for expired food and outdated batteries, and replace as necessary. Now that we ve talked about the storage container we need, let s look at what we need to put in it. Keep in mind that this list contains suggested items. Think about the needs of the children in your program, the resources available near your home or facility, and the staff (if any, outside of you) that will most likely be on hand. Some items to consider for your kit include: A first aid kit, Blankets, Blank roster sheets, Child emergency information cards, Pens and paper, A whistle, Child activities, including small toys, Duct tape and plastic sheeting, Scissors, Sealed drinking water and paper cups, Formula and bottles, including breast milk properly labeled and administered, Non-perishable food items, including snack packs and nut-free granola bars, Toileting supplies, including wipes and diapers, Hand sanitizer, A portable radio, preferably a radio specially designed for emergencies, A flashlight, A walkie-talkie, and Extra batteries for all battery-operated devices. Refer to the handout Portable Emergency Supplies List for a printable version of this list. If your child care facility has several classrooms, a cache of emergency supplies should be kept in case of an emergency that requires extended sheltering-in-place. Here are some items to consider for the facility-wide kit. One gallon of water per person per day times three days, with small paper cups, Non-perishable, age-appropriate food items, including: o Ready-to-drink formula, o Canned foods with expiration dates and easy-to-open lids, o Grains, including cereals and crackers, and o Foods for children with special dietary needs, Extra bottles and liners, 8

A generator or battery backup for all electrical medical equipment, Copies of prescriptions for medical equipment, supplies, and medications, Manual wheelchair, if needed, Compresses: 2 for each child, Bandages, multi-sized Splints, Sealed containers of water for flushing wounds, Hydrogen peroxide, Liquid soap, Extra hand sanitizer, Tweezers, One box of latex gloves, Extra blankets, One portable toileting kit, including additional diapers, underwear, toilet paper, wipes, plastic bags with ties, and One small tool kit. For a printable version of this list refer to the handout Emergency Supplies List for the Entire Facility. Planning for Children with Special Needs Preparing for an emergency for a child with special needs should begin at the time of enrollment and continue throughout the year. The Centers for Disease Control and Prevention suggest discussing and documenting the following areas of care with parents to best prepare for emergency situations: Daily plan of care, Medical equipment, Allergy information, including food and medication allergies, type of reaction, and what to do if the child has a reaction, Surgical history, Diagnoses by body system, List of doctors with contact information, Medical equipment providers, The family s assigned pharmacy contact information, Medications and supplies including stock numbers and basic descriptions of products for comparable substitutions, and Insurance information. For more information, visit the CDC s website about emergency preparedness for children with special needs. This website is listed on your screen. http://blogs.cdc.gov/publichealthmatters/2013/07/emergency-preparedness-for-families-withspecial-needs/. 9

In addition, talk with parents about specific actions that need to be taken for their child in case of an emergency evacuation. For example, if their child has a sensory integration diagnosis or sensitivity, what should be done to minimize stress? Headphones worn during fire alarms, favorite stuffed animals or blankets, and social stories created to walk through the steps of disaster drills can help. For children who regularly use specialized equipment or devices, make sure the child s physician or specialist has provided a specific set of instructions in case of emergency. Discuss this list with parents to ensure the child is protected both at home and at the child care facility in case a disaster occurs. The American Academy of Pediatrics has a form that parents can ask their child s healthcare provider to complete. You can go to the website on your screen to print the form: http://www2.aap.org/advocacy/blankform.pdf. Develop a Recovery Plan It may not be safe to return to the child care facility after an incident, especially if you were ordered to evacuate. Once local authorities give permission to return to your area, the director or administrator must decide whether or not it is safe to allow children back inside the building. Some hazards to be watchful for after a disaster are: Carbon monoxide, Other hazardous chemicals, Mold and mildew, Polluted water and sewage, Infectious diseases, Insects and reptiles, and Unstable structures. In the instance of an extreme disaster, such as a fire or flood, you may need to contact your local fire department or hire a professional contractor to inspect the facility. They can help determine if structural damage was sustained during the incident and provide suggestions on what needs to be fixed before the facility can become operational. Communicating with Parents During recovery, parents should be notified of the status of the child care program. To keep parents informed of important issues during recovery, you can: Make contact by telephone or cell phone, Have a prerecorded voicemail option that includes the address and phone number of your evacuation site and a statement that the children are being cared for by trained staff, Send email updates to parents via smartphones, and Provide information to local media. 10

Staff Training Your goal should be to develop and maintain a successful emergency management plan. It will require that all staff members complete a training session, as well as remain updated on any changes that might occur in the plan. Before planning a training session, ask yourself the following questions: Who will attend the training? Who will conduct the training? What type of activities will be carried out during the training? How many times during the year are the trainings offered? How will the training session be reviewed and evaluated based on the needs of the children enrolled? Choose appropriate training activities that will meet the needs of the staff members. Some possible activities include: Orientation: This is a required training for all new hires and volunteers that includes your emergency preparedness plan, provides an opportunity to answer questions, and includes a pre- and post-test, Ongoing Trainings: These sessions are held several times throughout the year to keep employees up-to-date on new information and changes, Tabletop Exercise: This type of session provides an opportunity for select administrators, staff members, parents, and volunteers to assemble as an emergency management committee and discuss their roles and responsibilities in an emergency situation. It is beneficial to hold this type of exercise before conducting a more extensive and time-consuming drill, Walk-through Drill: During this session, the emergency management committee members will actually carry out their assigned duties during an assigned time. This drill provides an excellent time to identify problem areas and make necessary changes. Finally, and most importantly, the Evacuation Drill: This required drill must occur every three months and involves acting out a real evacuation with all of the adults and children in your center. The purpose is to test the procedures for accounting for all people who evacuate the building and to identify and correct any obstacles that might hinder a speedy evacuation, such as unprepared staff members or confusing procedures. In Texas, child care programs are required to conduct monthly fire drills, and practice severe weather drills every three months. If you have children with special needs in your program, it is recommended that you practice these drills even more often. While you may not want to sound your fire alarm more than once a month, you can simulate the sound with an alarm recording or vocal prompt to help a child with a sensory integration disorder practice what to do during evacuation outside of the loudness and busyness of the scheduled drills. For a child with a vision or hearing impairment, one-on-one practice of exit routes can help calm anxiety during drills or actual evacuations. 11

Emergency management training for employees should address: The types of threats and hazards that might affect your area and the protective actions that can be taken, The chain of command and roles and responsibilities of employees, The protocol for notification, warning, and communications, Procedures for locating parents in an emergency, Shelter-in-place, evacuation, and accountability procedures, Location and use of emergency supply kits, portable emergency records, and other emergency equipment, Emergency shutdown procedures for electricity, gas, water, and computers, and Specific procedures for children with disabilities including communication, transportation, and mobility. An effective emergency management plan is one that is shared, updated, and frequently practiced by all staff members, children, parents, and volunteers. All employees in a child care setting must know what their specific roles and responsibilities are during a crisis situation. Undetermined leadership and unassigned duties can result in total chaos during an emergency, which can lead to a very dangerous situation for everyone involved. One way to avoid confusion is to designate the emergency-related duties to specific staff. A back-up person should be assigned for each task on the list in case the person originally assigned to the duty is unavailable. Keep a list posted at the front desk or entrance and inside each classroom and common area. Make sure that parents are continually updated on this information. Children with disabilities have needs that may be different from other children. Be sure to designate staff members who are trained to assist with the care of these children along with specific duties that need to be carried out. Remember that additional practice outside of normal trainings and drills is recommended to address any questions or identify needs. Emergency Support Function is a term used by emergency management professionals. It simply refers to the necessary duties and functions that must be performed during an emergency situation. Many of the functions that are executed during an emergency response are common to most emergency situations. Therefore, it makes sense to organize your plan according to the support function rather than repeating the same set of instructions for every single type of disaster. Emergency Response Plan Flip Chart Activity #3 Emergency Response Plan Flip Chart A great way to prepare for an emergency is to create an Emergency Response Plan Flip Chart. This chart contains descriptions of the most common emergency support functions during an emergency situation. These functions will most likely be executed no matter what type of disaster or emergency has occurred. To create the flip chart: Print the handout Emergency Response Plan Flip Chart, 12

Fill out the sections that apply to your center, then Fold or cut along the dotted line of each section and staple together to form a flip chart. Laminate each plan if possible, and keep a blank copy of the document in a file so that you can easily make changes as needed. Please keep in mind that this template was designed as a guide for you to get started. We encourage you to make changes to satisfy the needs of your child care facility. Some disasters can be life threatening and may require the assistance of skilled medical professionals to help save lives. However, access to a doctor or nurse during a disaster might be delayed for hours or even days. Child care facilities should obtain certification for CPR and pediatric first aid for all employees counted in the child/caregiver ratio. Other involved adults including volunteers, food handlers, specialists, and administrative staff should also obtain CPR and first aid certification in case child care providers are involved in caring for other children. Conclusion During this course, we have addressed various types of emergencies that may require shelteringin-place or evacuation. We have discussed emergency evacuation and relocation plans, and we have explored how to specifically plan for emergencies when caring for children with special needs. We have identified how to assemble emergency supply kits, both for small groups of children and for the entire program. We have also talked about how to assign roles and responsibilities and why this is important for effective emergency preparedness, particularly for children with special needs. Here are the major messages we would like you to take home from this training: Some events, like tornado warnings, require sheltering-in-place, while others, like fires, require evacuation. Caregivers should be able to identify potential disasters and know if they should stay or go, During emergencies, staff members should have a clear chain of command including who is responsible for what action or actions, Emergency records, including child information cards and medication administration orders, should be kept in portable containers for easy transport during an evacuation, All components of an emergency supply kit should be compiled before an emergency, and caregivers should examine and update the kits frequently, Children with special needs may need additional preparation and planning for evacuation drills to reduce evacuation times, stress, and confusion, and Staff should be trained on all components of an emergency preparedness plan during orientation and throughout the year. Thank you for your participation in this course, and for your desire to provide quality inclusive care for all children. 13

* This module was adapted from Emergency Preparedness for Child Care Providers, written and produced by the Texas A&M AgriLife Extension Service. This course was developed and produced by the Texas A&M AgriLife Extension Service of the Texas A&M University System in cooperation with the Texas Department of Family and Protective Services, Child Care Licensing Division, and using funds provided by the Texas Workforce Commission. 14