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Disaster Preparedness and Response for the Pediatric
Healthcare Provider:How to Get Involved
Lou Romig MD, FAAP, FACEPFL-5 DMAT, FL-7 SMRT
Photo courtesy of www.photolibrary.fema.gov
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
Disasters are local events
Federal Disaster Planning and Response
National Response Framework
• All hazards response• Local through federal
levels• Includes common
terminology through NIMS
• Scalability• Flexibility• Adaptability
www.fema.gov/nrf
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
THE NationalTHE National
RESPONSERESPONSEFrameworkFramework
THE NationalTHE National
RESPONSERESPONSEFrameworkFramework
DisasterOccurs
LocalFirst
Responders
LocalFirst
RespondersCounty
Executive
CountyExecutiveAlert
RequestsAid From
GovernorGovernor
FEMARegionalDirector
FEMARegionalDirector
Informs
FEMADirector
FEMADirector
Advises
PresidentPresident
Contacts
DeclaresDisaster
DeclaresDisaster
RequestsAssistance
EmergencyResponse
Team
EmergencyResponse
Team
15Emergency
SupportFunctions
(ESFs)
15Emergency
SupportFunctions
(ESFs)Provides
FederalCoordinating
Officer
FederalCoordinating
Officer
StateCoordinating
Officer
StateCoordinating
Officer
Appoints
Sets Up
Joins
Field Operations
Disaster Field Office
27 Federal Agencies plus the Red Cross
National Response FrameworkEMERGENCY SUPPORT FUNCTIONS
ESF
12 12
3
4567
8
9
1011
HHS
GSA
FEMA
ARCFEMA
USDA& FS
DOD
DOTDOE
DHS
USDA
EPA
Health andMedical
Search and Rescue
HazardousMaterials
Agriculture& NaturalResources
Energy
Tran
spor
tatio
n
Communication
Public Works (USACE)
Firefighting
Emergency Management
Mass CareLogistics
Opportunities for medical involvement
National Response FrameworkEMERGENCY SUPPORT FUNCTIONS
ESF 13: Public Safety and Security (DOJ)
ESF 14: Long-Term Community Recovery (FEMA)
ESF 15: External Affairs (DHS)
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
National Response FrameworkEMERGENCY SUPPORT FUNCTIONS
ESF
12 12
3
4567
8
9
1011
HHS
GSA
FEMA
ARCFEMA
USDA& FS
DOD
DOTDOE
DHS
USDA
EPA
Health andMedical
Search and Rescue
HazardousMaterials
Agriculture& NaturalResources
Energy
Tran
spor
tatio
n
Communication
Public Works (USACE)
Firefighting
Emergency Management
Mass CareLogistics
Opportunities for involvement
We’re from the Feds, and we’re here to help…
ESF - 8
Lead Agency for ESF-8
Office of the Assistant Secretary for Preparedness
and Response (ASPR)
Office of Preparedness and Emergency Operations (OPEO)
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
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
NDMS is a public/private sector partnership
Federal partners - HHS, DOD, VA, DHS/FEMA
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
More later on joining a federal team
So who’s watching out for kids and families?
There is no agency charged with assuring the welfare of children and families during and after disasters.
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
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
www.emergency.cdc.gov
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
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/Recommend.pdf
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.
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 children’s disaster needs
Prioritize children separately from “at-risk” populations
http://www.childrenanddisasters.acf.hhs.gov
Nongovernmental Agencies
American Academy of Pediatrics
National Center for Disaster Preparedness
Save The Children
http://www.aap.org/disasters/advisory-council.cfm
AAP’s Disaster Preparedness Advisory Council
AAP Website: Children and Disasters http://www.aap.org/disasters/
http://www.ncdp.mailman.columbia.edu/index.html
National Center for Disaster Preparedness
Save the Children Report (6/2009)
http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/disaster-decade-lessons.pdf
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
The bottom line:
Significant engagement at federal/national level
No oversight
Little accountability
Disaster preparedness must start at home.
If not us, who?
Advocacy roles for
pediatric and family disaster preparedness
Opportunities for Advocacy
Hospitals
Medical offices
Home health care agencies
EMS agencies
Professional associations
Michigan EMS for Children program (Dept of Community Health)
Opportunities for Advocacy
Local Emergency Management
School system
Individual schools/childcare facilities
Homeowners’ associations
Churches
Civic organizations
Service Opportunities:
Getting involved as a
disaster responder
Getting involved as a disaster responder
Responding outside of a disaster area
Responding inside a disaster area Home Away
Be a part of the system
Pre-credentialing
Resource-typing
Training (including Incident Command/NIMS)
Liability/ Worker’s comp coverage
Support of family, coworkers and employers
Response Networks
Medical Reserve Corps
ESAR-VHP
Disaster Medical Assistance Teams
Other opportunities for medical volunteers
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
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
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
www.medicalreservecorps.gov
ESAR-VHP
Emergency System for Advance Registration of Volunteer Health Professionals
Federally subsidized, administered by state government
Federal program within HHS/ASPR
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
MRC/ESAR-VHP
Oversight by DHHS/ASPR
Standardize the volunteer process
Replace previous volunteering through professional organizations
Reduce freelance volunteering
MRC/ESAR-VHP
Volunteer, no penalties if unable to deploy
Not paid when deployed. Expenses paid.
No federal employment protection
Liability/Worker’s comp covered by state law/regs unless federally deployed
Additional training needed for federal deployment
MRC/ESAR-VHPhttp://www.phe.gov/esarvhp
The NDMSand
DHHS Disaster Medical Assistance Teams
MI-1 DMATWayne, MI
www.mi1dmat.org
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
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 Worker’s comp covered Medical licenses/certifications are fully
transportable when deployed
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)
FL5 DMAT photos
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
http://www.phe.gov/Preparedness/responders/ndms/Pages/ndmsrecruitment.aspx
NDMS Recruitment
Other Medical Volunteer Opportunities
American Red Cross http://www.redcross.org/en/volunteer
AAP/J&J CHILDisaster Network http://www.aap.org/disaster
Doctors without Borders www.doctorswithoutborders.org
Michigan Volunteer Opportunitieshttp://www.childrensnational.org/EMSC/NationalActivities/
DisasterAgencies/Michigan.aspx
Summary
If we don’t do our part, children and families may be overlooked
Disasters are local
Get involved before disaster strikes
There’s a job that matches your desire to contribute
