Disaster Preparedness and Response for the Pediatric Healthcare Provider: How to Get Involved Lou Romig MD, FAAP, FACEP FL-5 DMAT, FL-7 SMRT Photo courtesy.

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

Join us!

[email protected]

www.jumpstarttriage.com