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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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Introduction of 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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Information Gathering, Findings

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" exercises.
  • 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 drills.
  • 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 emergency. 
  • 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 emergency planning.
  • Only two schools had conducted tabletop exercises to prepare for a large-scale crisis.

Interviews

School principals. Once 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 crisis.
  • 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.

Site Visits

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, emergency kit.
  • 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.
Sheltering-in plans
  • No school had created a sheltering-in-place plan for each building. However, potential sites identified included the school cafeteria, auditorium, or library.   
Lockdown plans
  • 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. 

Extended Day Programs

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.

Main findings:

  • 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 response.
  • 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

After-School Athletic Programs

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. 

Effective 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. 

Management 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 special populations.

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