Disaster Preparedness and Response for the Pediatric Healthcare Provider: How to Get Involved

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Disaster Preparedness and Response for the
Pediatric Healthcare ProviderHow to Get
Involved

• Lou Romig MD, FAAP, FACEP
• FL-5 DMAT, FL-7 SMRT

Photo courtesy of www.photolibrary.fema.gov
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Objectives

• Learn about the National Response Framework
• Learn about federal agencies involved in disaster
  planning and response
• Learn how to get involved in disaster planning
  and response

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Disasters are local events
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Federal Disaster Planning and Response
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National Response Framework

• All hazards response
• Local through federal levels
• Includes common terminology through NIMS
• Scalability
• Flexibility
• Adaptability

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www.fema.gov/nrf
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National Planning Scenarios

• Improvised Nuclear Device
• Aerosol Anthrax
• Pandemic Influenza
• Plague
• Blister Agent
• Toxic Industrial Chemicals
• Nerve Agent
• Chlorine Tank Explosion

• Major Earthquake
• Major Hurricane
• Radiological Dispersal Device
• Improvised Explosive Device
• Food Contamination
• Foreign Animal Disease
• Cyber Attack

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27 Federal Agencies plus the Red Cross
Local First Responders
County Executive
Disaster Occurs
Alert
Governor
Requests Aid From
FEMA Regional Director
Informs
Field Operations
THE National RESPONSE Framework
Declares Disaster
Advises
FEMA Director
Requests Assistance
Contacts
15 Emergency Support Functions (ESFs)
President
Declares Disaster
Provides
Sets Up
Emergency Response Team
Federal Coordinating Officer
Disaster Field
Office
Appoints
Joins
State Coordinating Officer
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National Response FrameworkEMERGENCY SUPPORT
FUNCTIONS
DOE
USDA
DOT
Energy
Agriculture Natural Resources
EPA
DHS
Transportation
Hazardous Materials
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11
1
Communication
10
2
Search and Rescue
ESF
9
Public Works (USACE)
3
FEMA
DOD
8
4
7
Health and Medical
5
6
Firefighting
HHS
USDA FS
Emergency Management
Logistics
Mass Care
GSA
FEMA
ARC
Opportunities for medical involvement
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National Response FrameworkEMERGENCY SUPPORT
FUNCTIONS

• ESF 13 Public Safety and Security (DOJ)
• ESF 14 Long-Term Community Recovery (FEMA)
• ESF 15 External Affairs (DHS)

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Michigan Emergency Management

• Emergency Management and Homeland Security
  Division (EMHSD) housed within Michigan State
  Police
• 8 ESFs
• 22 hazard-specific procedures sections
• http//www.michigan.gov/msp/0,1607,7-123-1593_3507
  ---,00.html

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National Response FrameworkEMERGENCY SUPPORT
FUNCTIONS
DOE
USDA
DOT
Energy
Agriculture Natural Resources
EPA
DHS
Transportation
Hazardous Materials
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11
1
Communication
10
2
Search and Rescue
ESF
9
Public Works (USACE)
3
FEMA
DOD
8
4
7
Health and Medical
5
6
Firefighting
HHS
USDA FS
Emergency Management
Logistics
Mass Care
GSA
FEMA
ARC
Opportunities for involvement
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Were from the Feds, and were here to help
ESF - 8
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Lead Agency for ESF-8
Office of the Assistant Secretary for
Preparedness and Response (ASPR)
Office of Preparedness and Emergency Operations
(OPEO)
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Roles of Emergency Support Function 8

• Assessment of Health and Medical Needs
• Health Surveillance
• Medical Care Personnel
• Health/Medical Equipment and Supplies
• Patient Evacuation
• In-Hospital Care
• Food/Drug/Medical Device Safety
• Worker Health/Safety

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Roles of Emergency Support Function 8

• Radiological, Chemical, and Biological Hazards
• Mental Health
• Public Health Information
• Vector Control
• Potable Water/Wastewater Solid Waste Disposal
• Victim Identification/Mortuary Services
• Veterinary Services

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• NDMS is a public/private sector partnership
• Federal partners - HHS, DOD, VA, DHS/FEMA

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NDMS Resource Teams

• DMATs Disaster Medical Assistance Teams
• DMORTs Disaster Mortuary Operations Teams
• NVRTs National Veterinary Response Team
• NNRTs National Nurse Response Team
• NPRTs National Pharmacy Response Team

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More later on joining a federal team
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So whos watching out for kids and families?
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• There is no agency charged with assuring the
  welfare of children and families during and after
  disasters.

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Federal agencies with advisory roles

• National Institute of Child Health and Human
  Development (NICHD)
• Based in the NIH
• Obstetric and Pediatric Section for Biodefense
  Activity
• Best Pharmaceuticals for Children Act of 2002 and
  2007
• Chemical, biological, radiological/nuclear
  weaponry

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Federal agencies with advisory roles

• Centers for Disease Control
• The Coordinating Office for Terrorism
  Preparedness Emergency Response (COTPER)
• Represented on most federal-level advisory
  committees, including those with
  family/pediatric focus
• Grant dollars

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www.emergency.cdc.gov
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Federal agencies with advisory roles

• National Biodefense Science Board
• Established under the Pandemic and All-Hazards
  Preparedness Act, 2007
• Guidance to HHS
• One voting member is pediatric emergency medicine
  specialist (Dr Daniel Fagbuyi)
• Working groups may have pediatric specialists

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Federal commissions with advisory roles

• National Advisory Committee on Children and
  Terrorism
• Public Health Security and Bioterrorism
  Preparedness and Response Act of 2002
• Established 2003 by Sen. Clinton
• 34 broad recommendations to the Secretary of HHS
  in 2004
• Included recommendation re federal disaster
  funding
• http//www.bt.cdc.gov/children/PDF/working/Recomme
  nd.pdf

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Federal commissions with advisory roles

• National Commission on Children and Disasters
• H.R. 3495 Kids in Disasters Well-being, Safety,
  and Health Act of 2007 (WiSH Act)
• Final report October 2010
• H.R. 5266 proposes continuance of the NCCD
• Focused on evaluating existing law and policy and
  incorporating lessons learned into new law and
  policy.

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Federal commissions with advisory roles NCCD

• 32 recommendations
• Development of a National Strategy for Children
  in Disasters
• Create a permanent focal point of responsibility
  and accountability for coordinating childrens
  disaster needs
• Prioritize children separately from at-risk
  populations
• http//www.childrenanddisasters.acf.hhs.gov

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Nongovernmental Agencies

• American Academy of Pediatrics
• National Center for Disaster Preparedness
• Save The Children

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http//www.aap.org/disasters/advisory-council.cfm

AAPs Disaster Preparedness Advisory Council
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AAP Website Children and Disasters
http//www.aap.org/disasters/
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http//www.ncdp.mailman.columbia.edu/index.html
National Center for Disaster Preparedness
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Save the Children Report (6/2009)

• http//www.savethechildren.org/atf/cf/7B9def2ebe-
  10ae-432c-9bd0-df91d2eba74a7D/disaster-decade-les
  sons.pdf

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Save the Children Michigan

• No policies recorded as being in place or under
  development for mandatory
• Evacuation plan for child care facilities
• Reunification plan for child care facilities
• Special needs of children in daycare
• K-12 written procedure for disaster planning

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The bottom line

• Significant engagement at federal/national level
• No oversight
• Little accountability

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Disaster preparedness must start at
home.If not us, who?
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Advocacy roles forpediatric and family disaster
preparedness
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Opportunities for Advocacy

• Hospitals
• Medical offices
• Home health care agencies
• EMS agencies
• Professional associations
• Michigan EMS for Children program (Dept of
  Community Health)

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Opportunities for Advocacy

• Local Emergency Management
• School system
• Individual schools/childcare facilities
• Homeowners associations
• Churches
• Civic organizations

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Service Opportunities Getting involved as a
disaster responder
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Getting involved as a disaster responder

• Responding outside of a disaster area
• Responding inside a disaster area
• Home
• Away

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Be a part of the system

• Pre-credentialing
• Resource-typing
• Training (including Incident Command/NIMS)
• Liability/ Workers comp coverage
• Support of family, coworkers and employers

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Response Networks

• Medical Reserve Corps
• ESAR-VHP
• Disaster Medical Assistance Teams
• Other opportunities for medical volunteers

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Medical Reserve Corps

• Part of US Citizen Corps
• Local initiatives with local/regional
  responsibilities
• Options to respond outside of local area (through
  state or federal activation)
• Medical and non-medical personnel
• Liability coverage varies

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Michigan Emergency Management Act 2009

• A responder who renders services during a state
  of disaster declared by the governor at the
  express or implied request of (a jurisdictional
  body) is considered an authorized disaster relief
  worker
• Not liable for an injury sustained by a person by
  reason of these services
• Does not apply if willful or gross negligence
• www.michigan.gov

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Medical Reserve Corps

• 938 MRC units (21 in Michigan), over 211,000
  volunteers
• Often housed within Public Health Departments
• Roles in public health initiatives and
  emergencies as well as disasters
• Often support Red Cross missions
• Usually deploy as individuals or in small groups

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www.medicalreservecorps.gov
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ESAR-VHP

• Emergency System for Advance Registration of
  Volunteer Health Professionals
• Federally subsidized, administered by state
  government
• Federal program within HHS/ASPR

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ESAR-VHP

• Not a response team or program
• Acts as advance registration and credentialing
  tool to facilitate use of medical volunteers on
  state and federal levels
• Personnel deployed via standardized
  resource-typing

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MRC/ESAR-VHP

• Oversight by DHHS/ASPR
• Standardize the volunteer process
• Replace previous volunteering through
  professional organizations
• Reduce freelance volunteering

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MRC/ESAR-VHP

• Volunteer, no penalties if unable to deploy
• Not paid when deployed. Expenses paid.
• No federal employment protection
• Liability/Workers comp covered by state law/regs
  unless federally deployed
• Additional training needed for federal deployment

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MRC/ESAR-VHPhttp//www.phe.gov/esarvhp
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Michigan Volunteer Registryhttps//www.mivolunte
erregistry.org/volunteermobilizer/
Office of Public Health Preparedness, MI Dept
of Community Health
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The NDMSandDHHS Disaster Medical Assistance
Teams
MI-1 DMAT Wayne, MI www.mi1dmat.org
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DMATs

• Oversight by DHHS/ASPR
• Deployed to domestic federally-declared disasters
  and national security events
• Deployed to Haiti earthquake, January 2010
• Volunteers become temporary federal employees
  when deployed
• Salary, per diem and other expenses paid while on
  deployment

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The Legalities

• Same employment protection as military reserves
• Deployment is voluntary for the individual
• An employer must let the employee deploy if they
  choose to respond
• Liability and Workers comp covered
• Medical licenses/certifications are fully
  transportable when deployed

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DMAT Missions

• Field emergency care facility
• Disaster shelter sick call/clinics
• Neighborhood outreach
• Fill in hospital and EMS staff
• Medical care for responders
• Medical standby for mass gatherings/NSEs
• Other federal missions (refugee health screening
  and care, Points of Distribution)

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FL5 DMAT photos
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Other NDMS Teams

• International Medical Surgical Response Teams (3)
• National Nurse Response Team
• National Pharmacy Response Team
• Disaster Mortuary Operations Response Teams
• National Veterinary Response Team

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NDMS Recruitment

• http//www.phe.gov/Preparedness/responders/ndms/Pa
  ges/ndmsrecruitment.aspx

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Other Medical Volunteer Opportunities

• American Red Cross
• http//www.redcross.org/en/volunteer
• AAP/JJ CHILDisaster Network
• http//www.aap.org/disaster
• Doctors without Borders
• www.doctorswithoutborders.org

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Michigan Volunteer Opportunitieshttp//www.childr
ensnational.org/EMSC/NationalActivities/DisasterAg
encies/Michigan.aspx
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Summary

• If we dont do our part, children and families
  may be overlooked
• Disasters are local
• Get involved before disaster strikes
• Theres a job that matches your desire to
  contribute

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Join us!

• louromig_at_bellsouth.net
• www.jumpstarttriage.com