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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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Recommendations

Development of a Comprehensive, District-Wide, School-Based All-Hazards Emergency Response Plan 

All school-based emergency response plans should be based on the four phases of emergency management: mitigation, preparedness, response, and recovery.

  1. Mitigation comprises actions that reduce or eliminate long-term risk to people and property from disasters, such as addressing the safety and integrity of school buildings, security, and culture and climate of schools to prevent violence.
  2. Preparedness focuses on planning for natural disaster or terrorist events and involves understanding the local community emergency plans and developing evacuation protocols prior to any event.
  3. Response is the actual steps taken to save lives and prevent further damage during a crisis.
  4. Recovery entails methods to restore the learning and teaching environment after a crisis.

These are not four separate, distinct phases; instead all phases create the groundwork for a continuous process where the results of each phase help the next phase build a stronger emergency response plan.

While this document focuses on the mitigation and preparedness phases, a clear understanding of all the phases is needed to coordinate an effective, robust, and comprehensive emergency response plan.

The recommendations below are based on the practical experience of developing an all-hazards school emergency plan for a school district and are designed to provide a template rather than a specific action plan. What is most important in the development of school emergency plans is the understanding that a "one size fits all" plan will not serve every school equally; individual schools should instead adapt these guidelines for their own needs.

Laying the Groundwork

Fundamentals: support from leadership. Creation of a comprehensive school-based emergency response plan requires approval, commitment, and support from the highest levels of school leadership; the process must take a top-down approach. Key leaders in undertaking the project include: (a) the district superintendent, (b) the school committee, and (c) the local or regional public emergency response team (police, fire, and emergency medical services [EMS]). Inclusion of the latter is essential in establishing liaison with the group that is charged with consequence management. Communication with response teams also assures that emergency plans created by the school do not conflict with efforts already underway. 

Planning team composition. The team creating the district-wide school plan should include, at a minimum, at least one representative from each of the following: school administrators, school principals, guidance counselors or school psychologists, teachers, nurses, secretarial staff, custodial staff, and parents. At least one member of the team or a consultant should have experience in emergency management and the development of emergency response plans.

Each school crisis team should also be invited to participate in planning for their individual schools. The school crisis team is typically composed of staff members who are trained to recognize and respond to different types of crises that can arise at school.

Specific Steps to Create a School Plan

Step 1. Plan regular meetings. The team creating the plan should schedule regular meetings with school leaders, school committee leaders, town safety officers, and public health authorities.

Step 2.  Perform a needs assessment. Schools should conduct surveys to evaluate the knowledge, opinions, and needs of their school as perceived by the school staff (Appendix B. Needs Assessment Surveys).

Step 3.  Conduct a structured interview with each school principal. The planning team should survey all principals using an instrument that permits a streamlined interview, identifies the specific needs of each school building, outlines structural vulnerabilities, and recognizes the needs of special populations (Appendix C. Principal Interview Questions).

Step 4.  Conduct a site survey of every school in the district. Knowledgeable members of the planning team should conduct a careful walkthrough of each school in order to:

  • learn its structural nuances.
  • identify any obstacles to a comprehensive plan.
  • evaluate (or identify) lockdown and sheltering-in sites.
  • evaluate nearby hazards such as chemical industries or nuclear power plants.

Step 5. Create and plan education and training modules for the school staff. The planning team should provide specific training modules on key aspects of emergency response and pediatrics, including specific training and tabletop exercises. Tabletop disaster exercises are moderator-guided classroom exercises in emergency response. These exercises can help familiarize staff with general response procedures and resolve perceived logistics challenges. Such training is often available from local, State, or Federal emergency response programs  (Appendix E. Tabletop Exercise Resources).

Step 6.  Create two documents—an all-hazards Emergency Response Manual and a school-specific Emergency Response Handbook. It is essential that two documents are created and the information within is practical and easily accessible.

All-Hazards Emergency Response Manual. Using the information obtained from the needs assessment surveys and borrowing from existing emergency response plans (both within the school district and from outside districts), the planning team should construct a comprehensive, easily accessed, and easy-to-use manual. This all-hazards response manual, which specifies appropriate responses to particular emergencies, is a permanent document. Information provided in this manual should include:

  • Articles and documents on general crisis management guidelines and checklists for crisis readiness.
  • Forms that can be used to document various kinds of crises.
  • Various scenarios for "tabletop" exercises.
  • Articles related to trauma and grief in children.

If the manual is placed on the Internet, a paper copy should also be available in case the Web is not accessible.

School-Specific Emergency Response Handbook. Using information gained from school-specific surveys and site walkthroughs, the planning team, in conjunction with the school crisis team, should create a school-specific handbook with guidelines for the individual school and its staff. This document will have information and checklists that may change with each school year. Preferably, this handbook is unbound, in a three ring binder, so that pages can be inserted and removed as necessary. For quick access, the manual should be clearly indexed and specific to the roles of the various people who need to respond quickly and effectively. A vertical "flip format" with tabs identifying the plan for each type of crisis and specific job descriptions for teachers, principals/crisis management, nurses, and administration can be used. Information provided in the school-specific handbook should include:

  • A comprehensive form delineating various aspects of preparedness, reviewed annually by the school principal. There should be spaces for the names of those personnel responsible for particular duties and lists of supplies needed in an emergency. (Appendix F. Annual School Emergency Preparedness Summary Form).
  • Protocols for evacuation, lockdown, and sheltering-in-place.
  • A document that details building-specific accommodations.
  • A map of individual school buildings.
  • Contact numbers for town emergency responders and local support resources.

Step 7.  Create a timeline for accomplishing each of the above tasks. The timeline for creating an Emergency Response plan can be highly variable, although a reasonable goal is completion in one academic year. Implementation may take longer, depending on the degree of changes needed, available budget, and approval of all recommendations.

Step 8. Inform parents of the plan. Each school should have a series of parent-teacher meetings, informing the parents of the plan and providing them opportunities to ask questions, raise concerns, clarify information, and offer input.

Step 9. Implement the plan. As plan implementation begins, conduct staff meetings to inform staff members of the plan details. The entire staff must know where they can access key information about specific emergencies, their individual responsibilities, the names and roles of crisis team members, and the lockdown and sheltering-in-place sites.

Step 10.  Conduct practice drills. Conduct practice drills, particularly those that would require deployment of evacuation, lockdown, or sheltering-in-place procedures. Consider using tabletop disaster drills. Afterwards, encourage practice drills in conjunction with local emergency response teams to evaluate practicality and effectiveness of emergency response plans.

Step 11.  Re-evaluate the plan annually, and revise if necessary. At the beginning of each school year, the crisis team of each school should review the plan and revise if necessary, based on any significant changes in staffing, school structure, or student body.

Implementation of a School-Based Emergency Response Plan

Building security and safety. The steps essential to creating a safe and secure school environment are:

  • Assure that access to school buildings is limited during the school day; a swipe-card or code key system is a practical means of building security.
  • All adults in the building should be identified. All visitors should check in at the office and wear a visible visitor pass.
  • Doors to the boiler room should always be locked.
  • Each school should have a building site map with exits and HVAC/utility shut-offs clearly marked.
  • Schools may be located near industry, including petroleum distilleries, manufacturing facilities, landfills, or power plants. In such cases, special arrangements must be made since a release from any of these sites may require immediate evacuation or, if evacuation is not possible, sheltering-in-place. In the case of proximity to nuclear power plants, current guidelines call for potassium iodide to be stockpiled at the school (AAP Committee on Environmental Health, 2003).

Preparation for large-scale emergencies. The following represent key steps in preparing school personnel for responding effectively to large-scale emergencies:

  • The school central office administrators, principals, and local emergency responders should meet annually to update disaster preparedness and response plans.
  • A mechanism for emergency communication should be established between each school and the school district and town emergency responders (e.g., preprogrammed cell phones with group page capability, group e-mail through Internet, or another type of mass notification system). Redundant means of communication should be in place in the event the primary means of communication, such as cell phones, are not available.
  • Crisis team members at each school should be completely aware of their specific responsibilities after a disaster of any type. Each crisis team should establish a command post, or meeting place, in the event of an emergency evacuation. Each member of the crisis team should have access to a walkie-talkie or cell phone, which is programmed with the numbers of all the crisis team members. Crisis team members should also have ongoing training in mental health with special recognition of the vulnerabilities of children post event and be prepared to provide ongoing counseling or mental health referral.
  • Some schools use a code when using the public address (PA) system to inform staff of emergencies requiring lockdown or shelter-in-place. We recommend instead a straightforward announcement of an emergency over the PA system. If the PA system is missing in some parts of the school complex, plans should be made for alternate means of rapid communication among staff.
  • Children with special health care needs, including technology dependent children, physically disabled children, and children with developmental delays, will require specialized plans that should include a means of rapid evacuation of physically disabled children from upper floors without use of elevators (which may be disabled or unavailable), efficient shepherding and evacuation of children with autism or other disorders of communication, and access to medication for children with chronic medical needs (e.g., asthma, diabetes).
  • Preschools, alternative high school sites, and extended-day or other after-school programs should be included in all disaster planning.
  • All schools should have an emergency kit readily available for immediate evacuation. This kit should contain the evacuation plan, a first aid kit, student medical alert lists, the personnel directory, a student directory, the daily attendance list, camera, flashlight, spare batteries, student emergency contact forms, teacher schedule list, and the emergency response manual.
  • All classroom teachers should have an emergency folder, including contact numbers and emergency medical information that is easily accessible for immediate evacuation. They should also have a bag with distraction activities (e.g., coloring books) in the event of a prolonged relocation. Substitute-teacher folders should include all emergency protocols for that classroom.

Evacuation, relocation, sheltering-in-place, and lockdown. While virtually all schools have simple evacuation plans, activated for situations including fire, suspicious packages, a bomb threat, or a nearby hazardous material spill, few have comprehensive emergency response plans that include protocols for temporary relocation, sheltering-in-place, and lockdown. Each of these four key aspects of school-based emergency response should be well established, as outlined below. Additionally, there should be annual drills of each plan to assure that everyone in the building knows where to go and what to do. These drills can be done with staff only or with staff and students.   

Evacuation. Each school should have a map of the surrounding area indicating a safe zone for evacuation. Such plans should be created with the assistance of local emergency response teams since they are likely to be key participants in a school evacuation. Plans for evacuation in inclement weather should be included. Evacuation during adverse weather conditions can be extremely difficult for a number of reasons:

  • A rapid school evacuation does not permit students to obtain their coats (in upper grades, these coats may be in their homeroom or locker).
  • During periods of active weather (e.g., snow, hail, or rain), students may become endangered by outdoor conditions.
  • Snow removal efforts may produce barriers to rapid evacuation.

Rapid, efficient evacuation also requires that each school have a sufficient number of wheelchairs for children with mobility difficulties. Finally, when an emergency evacuation is required, the school fire alarm should be used to ensure that all staff and students in the building can hear the notice. (Go to Part II for a detailed protocol with job descriptions during an evacuation.)

Relocation. Relocation plans must be created in order to house students after events in which the school cannot be immediately reoccupied. Relocation sites can include neighboring churches, theaters, or auditoriums. Such sites should be identified and designated in advance; parents should be informed of the sites so that they will know where to find their children. As an alternative to fixed relocation sites, school buses or similar vehicles can be used to temporarily keep students warm and secure. Relocation protocols should also include plans to bring student medications from the nurse's office, along with emergency evacuation materials. There should be an annual relocation practice drill so that all personnel are familiar with the walking route, the relocation site, and the specific area to which each grade level will go. This can be done with staff only, or with staff and students. (Go to Part II for a detailed protocol with job descriptions during a relocation event.)

For schools that rely on the transport of students by parent or school bus because of the school's distance from homes or public transport, relocation plans may include the use of school buses rather than simply walking to the relocation site. Reliance on bus fleets presents two challenges that can impact on effective evacuation/relocation:

  • There must be a means of rapidly mobilizing the school bus fleet, bringing it to the site within minutes.
  • The school bus fleet must be large enough to transport all students at once rather than sequentially.

Sheltering-in-place. When threats to school children occur outdoors, complete evacuation may not be safe, for example, after the sudden release of a chlorine gas cloud. In such cases, there must be well-established plans for sheltering-in-place. The sheltering-in-place site should have the following features:

  • It is ideally located as far into the center of the school as possible, away from windows.
  • Where possible, it should be a large, single room (this facilitates communication and serves to "nest" students).
  • The sheltering-in-place site should ideally have heating, ventilation, and air conditioning (HVAC) units that can be turned off and/or vents that can be closed.
  • The school alarm for sheltering-in-place should be distinct from the evacuation (fire) alarm.

Go to Part II for a detailed protocol with job descriptions during a shelter-in-place event.

Lockdown. Another form of school disaster, which has been witnessed multiple times over the last decade, is a threat within the school. This can take the form of an angry parent, a terrorist, or a sniper. In such cases, students are best protected by a school lockdown, in which locks and barricades are used. Rooms with doors that can be locked form the best lockdown site. If students are in a classroom that can't be locked when a lockdown situation occurs, they should either be moved to an area which can be locked, or barricades should be placed at the classroom door. Mechanisms for communication with outdoor emergency response teams should also be created; these may consist of signals that can be broadcast from the classroom window or cell phone/walkie-talkie communication with the central office or emergency response. (Go to Part II for a detailed protocol with job descriptions during a lockdown event.)

Communication. Communication remains the foundation of effective disaster response but also the component most likely to fail. One method of preventing such a failure is to ensure the use of the same vocabulary during all emergencies. The Incident Command System (ICS) is a management system used to organize emergency response and offers a common language. ICS permits a scalable response to an emergency (incident) of any magnitude and provides a common framework within which people can work together. ICS is used by all levels of government—Federal, State, and local—and by many private-sector and nongovernmental organizations.

In creating an effective school emergency response plan, the following elements are essential for within-school communication

  • Every school should be certain that its PA system is audible in every section of the school, or that alternate means of communication are created for those rooms not having a PA system.
  • Schools should adopt a policy around student use of cell phones during emergencies. While most schools have a strict policy of no cell phone use during school, cell phones can be an effective means of communicating with parents during a school crisis. On the other hand, indiscriminate cell phone use during disasters can be deleterious by distracting students from important messages by school staff or by increasing student anxiety via unfiltered and inaccurate reporting. Rational but strict guidelines should therefore be established.
  • A communication system and protocol should be provided to any school-based extended day or athletic program. Because the school's central office is likely to be closed, the emergency response protocol may require direct communication with local emergency response groups.

The following features are necessary for effective out-of-school communication:  

  • Each school should be equipped with at least two working walkie-talkies or radio phones for the principal and the custodian. These phones should be preprogrammed to contact the central office and town emergency responders after an emergency.
  • Each school secretary should have an easily accessed, current list of all parent phone numbers, including cell phone numbers.
  • In order to adapt to increasing use of parent cell phone numbers as the emergency contact, the school/school district parent database must have three telephone number fields (home, work, cell phone).
  • Every school must develop a means of rapid communication with parents. A parent-based "telephone tree" is one simple, inexpensive means of creating such a communication network; voice mail or call forwarding systems are also useful options. Innovative Web-based communication systems and even automated "dialout" systems, which can communicate with hundreds of parents quickly, are extremely valuable.
  • The principal should have a protocol for communicating with parents during or after a crisis. This could include creation of a communication command center or designation of a school spokesperson.
  • There should be a designee to brief the media. Statements should be written in advance and then modified as events unfold.

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