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State Emergency Planning and Preparedness Recommendations for Maternal and Child Health Populations
Hurricanes Katrina and Rita, the pandemic flu threat, and increased consciousness of terrorism have heightened awareness of the need for emergency preparedness within the maternal and child health (MCH) community. In response, the Association of Maternal and Child Health Programs (AMCHP), supported by the United States Department of Health and Human Services, Health Resources Services Administration, Maternal and Child Health Bureau, is addressing this vital issue. AMCHP aims to increase states’ capacity to engage in disaster preparedness to meet the needs of MCH populations.
While it is impossible to know what kind of emergency may occur or the magnitude or scope of the disaster, it is possible to engage in planning. Fortunately, a wealth of resources exist describing the how to address many kinds of emergency situations. Additionally, many professional organizations have released recommendations on how to work with special populations during these emergency situations. State- and community-level MCH staffs do not need to recreate the preparedness work already done nationally. However, they will want to make sure that the needs of MCH populations are adequately addressed within state planning and address any gaps that may exist. State MCH staffs are also challenged to educate the families and individuals they work with about how to prepare for, respond to and recover from an emergency situation. AMCHP’s role is to ensure MCH populations’ needs are represented in discussions about and recommendations relevant to emergency preparedness at the national and state levels.
About this Resource
AMCHP developed this online guide to ensure the needs of women and children are clearly addressed as part of state-wide emergency preparedness. The recommendations are based upon lessons learned and highlight important steps to take to protect the MCH community. Over time, AMCHP will build upon the information in this guide and provide additional resources.
AMCHP members can use this guide to clarify their role in developing and participating in emergency preparedness plans and activities and to aid in advocating for the needs of this population. It offers a wealth of resources and information for review that provide practical advice to meet the needs of MCH populations before, during and after and emergency. Most recommendations are derived from the real life experiences of MCH program staff who have dealt with emergencies.
MCH professionals can begin to address emergency preparedness by integrating activities from this guide into their current systems and procedures. Engaging in agency-specific planning and training are a first line defense in preparing for a possible emergency. It is also vital to build relationships, if they do not already exist, with those groups that are essential partners or most vulnerable during an emergency.
States are encouraged to consider these recommendations and use them to strengthen state-level emergency planning and preparedness activities. The prioritization process used at the state and local level to allocate resources and integrate the recommendations into preparedness and planning activities will vary. However, this report should be used as a guide and resource to assure that these special populations’ needs are met.
This guide was crosswalked with the White Ribbon Alliance for Safe Motherhood's, Women and Infants Service Package (WISP). The WISP offers guidance to meet the health care needs of pregnant women, new mothers, fragile newborns and infants during and after a disaster situation. All sections of this online resource guide that are in green font are from the WISP and there is a direct link to this resource when cross linked
Defining MCH Populations’ Needs
The following information was developed by the New York State Division of Family Health as part of their MCH Emergency Preparedness Plan. It provides specific information about the various MCH groups and their specific needs during an emergency situation.
Women | Children | Children and Youth with Special Health Care Needs
Women
Pregnant women, neonates, infants and children have unique needs, particularly in times of disaster. Women experience greater rates of health complications associated with pregnancy, including premature labor and births, low birthweight infants, and neonatal and infant deaths. Approximately 99 percent all births in the United States occur in a hospital setting. In times of disaster, those facilities may not be available and/or accessible. Specially trained professionals and necessary supplies to provide care for this population may not be available. Without access to appropriate supports and emergency medical services in the antepartal, intrapartal and postpartum period, there is a possibility of both short-term and long-term negative outcomes with increased mortality and morbidity.
During an emergency, stress is increased tremendously which can significantly impact pregnant women. This, in conjunction with a lack of proper nutrition and fluids, can result in premature labor and delivery if not addressed. Pregnant women need access to skilled professionals for proper assessment and methods for hydration (including intravenous hydration) as well as tocolytics as needed. Appropriate supplies must be assembled into emergency kits to enhance professionals’ ability to assess maternal, fetal and neonatal status, proceed with appropriate treatment measures, deliver infants as needed and properly treat postpartum women and normal and high-risk neonates. All newborns must have access to a dry, clean, warm environment to promote thermoregulation and access to medication, equipments, supplies and professional expertise to address issues such as respiratory distress syndrome that may result form prematurity. Medications and supplies must be readily available to treat pregnancy-related and chronic health issues of pregnant women such as medications for essential and pregnancy induced hypertension, diabetes and postpartum hemorrhage.
Facilities must be available to perform emergency surgery as needed, such as emergency Cesarean Sections and intervention for postpartum hemorrhage. The treatment of women and children can also be complicated by the lack of access to medical records and basic provisions such as diapers, formula, baby bottles and clothing. Staff with the ability to assist new mothers in breastfeeding is imperative since there may be little access to infant formula.
The stress of the disaster may be compounded by the separation of mothers and neonates, infants and children. All measures must be taken to ensure whenever possible that mothers and children are evacuated to the same location or a method is developed to promote communication so families are aware of where their family members are located and are reunited as soon as reasonably possible.
Although a priority of professionals will be immediate health care issues, mental health resources are imperative for women and children. Approximately 1 out of every 8 women experiences perinatal depression, which is exacerbated tremendously by a disaster.
Women also need to have ready access to methods of birth control. The availability of condoms is essential for birth control as well as protection of sexually transmitted infections. Women and children may be especially vulnerable to sexual violence during disasters where chaos overtakes law and order. Sexual violence may become more prevalent, or women and children may be coerced into sex for basic needs such as food and safety.
The public health impact of disasters, especially in times when appropriate resources are not available, will have significant short-term as well as long-term impact.
Children
Children have unique characteristics which make them more vulnerable in an infectious, natural or man-made disaster. These vulnerabilities apply to all children, although children with special health care needs may also have specific conditions which can place them more at risk. Pediatric vulnerabilities have previously been well described by the Illinois Emergency Medical Services for Children’s project and are listed below:
- Children are more vulnerable to agents that act on the skin because their skin is thinner and have a larger surface-to-mass ratio than adults.
- Children are particularly vulnerable to aerosolized biological or chemical agents because they breathe more times per minute than adults and would inhale larger doses of the substance in the same period of time. Also, because some such agents (e.g. sarin and chlorine) are heavier than air, they accumulate close to the ground – right in the breathing zone of children.
- Children are more vulnerable to the effects of agents that produce vomiting and/or diarrhea because they have less fluid reserve than adults and can become dehydrated faster.
- Infants, toddlers and young children do not have the motor skills to escape from the site of a chemical, biological or other terrorist incident. Children also lack cognitive decision-making skills to figure out how to flee danger or to follow directions from others.
- Children have smaller circulating blood volumes than adults so if treatment is not immediate, relatively small amounts of blood/fluid loss can lead to irreversible shock or death.
- A child’s condition can shift from stable to life-threatening quite rapidly because he/she has less blood and fluid reserves, is more sensitive to changes in body temperature, and has a faster metabolism.
Children and Youth with Special Health Care Needs
In addition to the vulnerabilities which all children may face during a disaster, children and youth with special health care needs (CYSHCN) may also have condition-specific risks or be more vulnerable because of the complexity of their conditions.
Parents of CYSHCN are their caregivers, often providing complex care involving medications and medical devices such as insulin pumps, respiratory devices (nebulizers, oxygen, ventilators), and parenteral devices. In the event of separation from their parents, other trained personnel will be needed to provide this care. Children previously cared for in a home setting may need a higher level of care if separated from their parents/caregivers. Examples of CYSHCN at risk include, but are not limited to, those:
- with respiratory conditions (asthma, cystic fibrosis, bronchopulmonary dysplasia) when exposed to aerosolized biological or chemical agents or environmental contaminants (smoke, dust or other particulate matter);
- with endocrine disorders when exposed to agents that produce vomiting or diarrhea or in which dehydration would place them at very high risk (congenital adrenal hyperplasia);
- with metabolic disorders or with severe food allergies (phenylketonuria) requiring special formula or diet;
- with neurological disorders whose baseline is difficult to assess without caregiver’s input;
- requiring medical devices, medical supplies or life-sustaining treatment (nebulizers, chest physiotherapy vests, oxygen, ventilators, dialysis);
- requiring medication (insulin, anti-epileptics, inhalers, Hemophilia factor) on a regular basis, without which increased morbidity and mortality could occur;
- with musculo-skeletal disorders (cerebral palsy, muscular dystrophy) who can not move independently or require assistance to ambulate;
- with cardiac conditions whose exercise tolerance limits the endurance required for walking/running during transport/evacuation;
- requiring tube or parenteral feedings by trained personnel;
- with behavioral, emotional or mental disorders whose condition may be exacerbated by separation, transition or anxiety;
- with communication disorders (hearing loss, non-verbal or severe speech articulation problems); and,
- with an immunocompromised state (cancer, HIV/AIDS) due to their medical condition or its treatment, when exposed to infectious agents.
Last Updated
November 2, 2007
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