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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the Project to Town Stakeholders
The Brookline Schools Readiness project began after an
initial meeting with the school Superintendent, Assistant Superintendent, and
School Medical Director. At that time, a verbal and written proposal to spend a
year in the Brookline schools, assessing them for emergency readiness and
providing a comprehensive emergency response plan, was presented. Following
this, additional meetings were held with:
- The Brookline School Committee.
- The crisis teams (principals, assistant principals, nurses) of each school.
- Town Safety Officers group (representatives form fire, police, EMS, Department of Public Works, Highway and Sanitation, Water and Sewer, and the Brookline Public Health Commissioner).
After these meetings, it became clear that there was inconsistent
communication around emergency preparedness between the school department and the
Safety Officers group. While town emergency responders, who had been meeting
regularly for many months, had created mitigation and response plans to most emergencies,
school administrators were uninformed; moreover, they were uncertain how
thoroughly the town's emergency responders had considered the particular needs
of each school. When the project proposal was presented to this group, there
was general agreement that more work was needed to coordinate communication and
effective response with schools in the event of a large-scale disaster.
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Survey Creation, Completion, and Analysis
Survey creation. In order to create an Emergency
Response Plan for Brookline Public Schools, recognizing that each school in the
system was unique, we began by conducting a series of written, anonymous, Likert-type
surveys of key personnel. Our goal was to determine the levels of understanding
and the perceived needs of the staff in each school. We designed three separate
surveys, obtaining information from three distinct school groups: the crisis
teams (including the principals), the school nurses, and the teaching staff. The
response rate for each of these groups ranged from 45-100 percent. We analyzed
the surveys according to staff position, school building, and, in the teacher
survey, by grade level (Appendix B: Needs Assessment Surveys).
Main survey findings:
- Crisis teams reported feeling generally confident and
competent to respond to crises. At the same time, they indicated a desire
for further training in emergency response.
- When analyzed by school, staff varied widely in their
familiarity with the town emergency response plan.
- All staff were better informed about evacuation/relocation
procedures than about lockdown or sheltering-in-place procedures.
- All staff believed it would be beneficial to regularly have
evacuation, lockdown, and shelter-in-place drills, particularly "tabletop"
- There was marked inconsistency in the amount of information
provided to parents (e.g., the school's relocation plan).
- Crisis teams, nurses, and teachers all felt relatively
comfortable talking to students about disaster preparedness; uniformly,
they felt more comfortable speaking with lower grade than upper grade students.
Personnel also were more comfortable discussing evacuation plans than
lockdown or shelter-in-place plans.
- All reported that there were a sufficient number of fire
- Mental health services were reportedly readily available
to the schools as needed.
- All crisis teams included the principal, assistant principal,
guidance counselor, psychologist, and nurse. Some also included the custodian,
office secretary, and building aide.
- The crisis teams for each school had their own
configurations with varying degrees of readiness to mobilize in an
- Most crisis teams did not have explicit assigned roles for
their members in the event of a major crisis.
- Only two schools had established an outdoor gathering area
for the crisis team in the event of an emergency evacuation.
- While the crisis team in most schools met on a regular
basis, the subject of their meetings generally related to daily incidents
involving individual students in need rather than global issues such as
- Only two schools had conducted tabletop exercises to
prepare for a large-scale crisis.
the surveys were completed and analyzed, we met with each school principal to
discuss our findings. We reviewed the results of the particular school survey
with each principal, informing him/her of the staff's readiness, knowledge, and
concerns regarding emergency preparedness. We inquired about issues related to
each specific school building and student body (e.g., number and type of
special needs students) (Appendix C: Interview Questions for Principals).
Main findings in school principal interviews:
- We found significant variation in the degree to which each
principal had considered emergency response in his/her building.
- All schools had created a crisis response team, though
some met regularly and had annual training, and others did not meet on a
regular basis and seemed inadequately prepared to respond effectively to a
- Teachers and other school personnel were not consistently
trained in emergency response or informed of the emergency plan.
- Parents were not consistently informed of the emergency
response plan, with many principals having a "need-to-know" approach,
keeping this information secret until disclosure became necessary.
Following the interview with each principal, we toured the
school complex with the custodian. The purpose of these site visits was to
identify potential security risks, obstacles to rapid egress, and potential
sheltering-in-place and lockdown spaces for each building. We evaluated the
ease of access to the building during the school day, the locations of all exits,
and the location of the boiler room and the school elevators.
Main findings during site visits:
Access to the school building
- There was a variable degree of building security and of
mechanisms for identification of staff and visitors in the building. One
of the elementary schools and the preschool building had developed a key
card system which allowed only official personnel to enter the building
after 8:30 and before 2:00.
- In some schools, administrators had trained staff on the
appropriate response if an unidentified person is found in the hallway.
Evacuation and relocation protocols
- All Brookline schools had an evacuation plan. Staff knew
paths of egress for individual classes.
- All schools had a relocation plan; however, these plans were
not known to all staff. Only one school had practiced its relocation plan.
- All of the school nurses had emergency supplies and
medications readily available for travel to an off-site location.
- Many schools did not have a complete, ready-to-go,
- Some schools did not have a sufficient number of
wheelchairs to match the number of students with mobility difficulties.
- In some schools, staff had created easily accessible
parent/student information to grab in the event of an evacuation.
- In one school, the staff was equipped with an emergency
kit for each classroom, including parent contact numbers, a class list,
and materials to keep children engaged.
- Schools with multiple relocation sites had the unsolved
challenge of dispatching a nurse or first-aid-trained staff member to each
site along with child-specific medications.
- No school had created a sheltering-in-place plan for each building.
However, potential sites identified included the school cafeteria,
auditorium, or library.
- Few schools had
lockdown plans in place; none had practiced their protocol.
- Many schools
had an inordinate number of rooms without locks, making it difficult to
identify lockdown sites.
We met with the directors of the Extended Day Programs from
all of the Brookline Elementary Schools. We discussed their current crisis
protocols and the effectiveness of their communication with each other, with
parents, and with school administrators. (Appendix D: Interview Questions for
Extended Day Directors Meeting/After-School Programs). One of the difficulties
that became immediately apparent was the isolation of after-school programs. Staff
reported there were no crisis response plans for events occurring when these
programs are in session. Additionally, we found that each school's after-school
program functioned independently of the others. Staff also reported a lack of central
oversight to these programs and the lack of coordinated planning with either
the school department or town emergency responders in the event of a crisis.
- In the after-school
programs, which included Extended Day, enrichment activities, athletics, homework
center, Brookline Music School, and After Hours U, there are more than 2,000
children in school buildings between the hours of 2:00 p.m. and 6:00 p.m.
- Apart from the
Extended Day Programs, it was unclear who was ultimately responsible for the
safety of children during these hours.
- It was unclear
whether all staff supervising children in these programs would know where to go
or what to do in an emergency.
- Extended Day
staff reported that there had been little communication between the school
principals, Brookline school administration, or town Emergency Response Team
and the Extended Day directors around issues of emergency preparedness and
- All of the
Extended Day Programs had staff trained in first aid and CPR.
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Unresolved Challenges in the Brookline Emergency Response Plan
In the Brookline Public Schools, there are approximately 1,500
athletes engaged in 3 sports seasons. An estimated 50 percent of the school
system's students participate in at least one sport. However, emergency
preparedness and response plans did not exist within the After-School Athletic
Programs. The designated emergency leader was the school system's licensed athletic trainer, who was present at many games and available by cell phone to all
coaches. In the event of an emergency in which the trainer is not available and
an emergency response is required, coaches are instructed to dial 911.
Liaison with Local Emergency Response Teams
School-based emergency response plans must be incorporated
into those of the local public health authorities and emergency response teams.
Although we had the opportunity to attend public health meetings and offer
opinions/advice on school plans, there were no regular meetings between school
authorities and the town. Moreover, although the Brookline Department of Public
Health had established a liaison with the Brookline schools, many BPS personnel
felt this relationship was ineffective.
of Special Populations
A comprehensive school-based emergency response plan must
take into account special populations, including:
- Technology dependent children (e.g., those requiring respiratory support).
- Physically disabled children (e.g., those who require crutches or wheelchairs for mobility).
- Children with severe developmental delays (e.g., autism).
We found that
none of the Brookline schools had planned effectively for the management of
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