Public Health Emergency Preparedness
This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.
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Part I. Creation of a
School-Based, All-Hazards Emergency Response Plan: Overview, Background, and
More than seven years after the disaster of September 11,
2001, the U.S. remains relatively unprepared for a large-scale disaster
involving children. Despite important advances in our country's ability to
respond effectively to chemical, biological, or nuclear terrorism, there
continues to be inadequate development of pediatric protocols that could be
implemented by the local, State, and Federal agencies charged with preparation
and consequence management.
Emergency preparedness plans have evolved over recent years
to include not only intentional (terrorist) disasters but also unintentional
public health emergencies such as natural disasters (e.g., earthquakes or
floods; chemical incidents such as hazardous materials releases; and emerging infections
such as Severe Acute Respiratory Syndrome (SARS), West Nile virus, and pandemic
influenza). Under principles of dual functionality, emergency response plans must
now take the approach of creating response plans that integrate intentional and
Children differ from adults in many ways that are of great
importance in building public health emergency response plans. Their greater
susceptibilities result from differences in breathing rate, skin permeability,
innate immunity, fluid reserve, communication skills, and self-preservation
instincts. These differences and others require that disaster response plans be
modified for such a priority population.
Children also spend as much as 70-80 percent of their waking
hours away from their parents in school. Schools, therefore, have a vital role
in assuring that children are cared for and proper interventions are delivered
after a public health emergency. When this project was undertaken in 2004,
there was no national model for school-based public health preparedness. Consequently,
school districts across the Nation had rudimentary, fragmented, or non-existent
emergency preparedness programs. Since 2006, there has been a marked increase
in awareness of the vulnerability of schools and the challenging logistics involved
in protecting children in schools during unexpected events. However, there
continue to be obstacles for many school districts in creating a practical, comprehensive,
and practiced school-based emergency response plan. Among these obstacles are
evacuation, accommodations for children with special health care needs, and
inclusion of after-school programs in emergency response plans.
Under a contract from AHRQ, the Center for Biopreparedness
at Children's Hospital Boston conducted an analysis of emergency response plans
from school districts in Massachusetts, Florida, Wisconsin, Colorado, and California. Using these findings in conjunction with existing recommendations on the
development of school-based preparedness programs, we developed a template that
provides an overview, including "best practices" for school districts to use in
their development of a comprehensive emergency response plan. Finally, in
cooperation with the Brookline, Massachusetts, public schools, we designed a
roadmap for the development of school-based plans for each of the eight elementary
schools, high schools, preschools, and after-school programs in Brookline.
This monograph provides guidelines for use by school
districts of all sizes. Our goal in creating this monograph is to describe to
readers a practical approach to creating a school-based all-hazards emergency
response plan from the national literature in combination with "lessons
learned" in the field.
Sarita Chung, M.D.
Janice Danielson, M.Ed.
Michael Shannon, M.D., M.P.H.
Dr. Sarita Chung is a project scientist at the Center for
Biopreparedness at Children's Hospital, Boston, MA. She is a pediatric
emergency physician at Children's Hospital, Boston, MA, and Harvard Medical School.
Janice Danielson is an elementary school teacher with 25
years experience in kindergarten education. She currently serves as a
consultant in school-based emergency preparedness.
Dr. Michael Shannon is Director of the Center for
Biopreparedness at Children's Hospital, Boston, MA. He is Professor and Chief
emeritus of the Division of Emergency Medicine at Children's Hospital and Harvard Medical School.
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