Global & Disaster Medicine

Archive for the ‘Documents’ Category

Tourism vs. Child Protection: A Compilation of Good Practices

15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices

Copyright © 2014, World Tourism Organization (UNWTO)
15 Years of the UNWTO World Tourism Network on Child Protection: A Compilation of Good Practices
Published by the World Tourism Organization (UNWTO) First printing: February 2014 All rights reserved.

 


4th case of Yellow Fever reported in Europeans who had recently traveled to South America in the past 8 months.

Yellow Fever in Europe

A travel-associated case of yellow fever has been reported by the Netherlands in March 2017 after travel to Suriname. During the past eight months, four travel-associated cases of yellow fever have been identified among EU travellers returning from South America. This represents a significant increase on four travel-associated cases of yellow fever among EU travellers during the last 27 years (1999 to July 2016).

Brazil has been experiencing a yellow fever outbreak since January 2017 and travel recommendations have been updated accordingly [1,2]. Therefore, EU travellers travelling to areas at risk of yellow fever in South America should be informed of the potential exposure to yellow fever virus and an individual risk benefit analysis should be conducted during pre-travel medical consultation. The ongoing yellow fever outbreak in Brazil should be carefully monitored, as the establishment of an urban cycle of yellow fever would have the potential to rapidly affect a significant number of people. The risk of introduction and further transmission of the yellow fever virus in the EU is currently considered very low.

Advice to travellers EU citizens who travel to, or live in areas where there is evidence of periodic or persistent yellow fever virus transmission, especially those in outbreak-affected regions, are advised to:

• Be aware of the risk of yellow fever in endemic areas throughout South America, including recently affected States in Brazil. WHO publishes a list of countries, territories and areas with yellow fever vaccination requirements and recommendations [1-3].

• Check vaccination status and get vaccinated if necessary. Vaccination against yellow fever is recommended from nine months of age for people visiting or living in yellow fever risk areas. An individual risk benefit analysis should be conducted prior to vaccination, taking into account the period, destination, duration of travel and the likelihood of exposure to mosquitoes (e.g. rural areas, forests) as  well as individual risk factors for adverse events following yellow fever vaccination.

• Take measures to prevent mosquito bites indoors and outdoors, especially between sunrise and sunset when Aedes and sylvatic yellow fever mosquito vectors are most active [4]. These measures include: − the use of mosquito repellent in accordance with the instructions indicated on the product label; − wearing long-sleeved shirts and long trousers; − sleeping or resting in screened/air-conditioned rooms, or using mosquito nets at night and during the day.

Advice to health professionals: Physicians, health professionals and travel health clinics should be provided with or have access to regularly updated information about areas with ongoing yellow fever transmission and should consider yellow fever in the differential diagnoses for illnesses in relation to travellers returning from affected areas.  To reduce the risk of adverse events following immunisation, healthcare practitioners should be aware of contraindications and comply with the manufacturers’ precautionary advice before administering yellow fever vaccine [5].

	Map: South America showing areas at risk for Yellow Fever Transmision in Columbia, Venezuela, Guyana, Suriname, French Guiana, Brazil, Paraguay, and parts of Ecuador, Peru, Bolivia, Argentina, and Uruguay


WHO: Don’t pollute my future! The impact of the environment on children’s health

WHO

Don’t pollute my future! The impact of the environment on children’s health

Cover: Don’t pollute my future! The impact of the environment on children’s health

Background

In 2015, 5.9 million children under age five died. The major causes of child deaths globally are pneumonia, prematurity, intrapartum-related complications, neonatal sepsis, congenital anomalies, diarrhoea, injuries and malaria. Most of these diseases and conditions are at least partially caused by the environment. It was estimated in 2012 that 26% of childhood deaths and 25% of the total disease burden in children under five could be prevented through the reduction of environmental risks such as air pollution, unsafe water, sanitation and inadequate hygiene or chemicals.

Children are especially vulnerable to environmental threats due to their developing organs and immune systems, smaller bodies and airways. Harmful exposures can start as early as in utero. Furthermore, breastfeeding can be an important source of exposure to certain chemicals in infants; this should, however, not discourage breastfeeding which carries numerous positive health and developmental effects (4). Proportionate to their size, children ingest more food, drink more water and breathe more air than adults. Additionally, certain modes of behaviour, such as putting hands and objects into the mouth and playing outdoors can increase children’s exposure to environmental contaminants.

 


WHO: Inheriting a sustainable world: Atlas on children’s health and the environment

WHO

Overview

More than a decade after WHO published Inheriting the world: The atlas of children’s health and the environment in 2004, this new publication presents the continuing and emerging challenges to children’s environmental health.

This new edition is not simply an update but a more detailed review; we take into account changes in the major environmental hazards to children’s health over the last 13 years, due to increasing urbanization, industrialization, globalization and climate change, as well as efforts in the health sector to reduce children’s environmental exposures. Inheriting a sustainable world? Atlas on children’s health and the environment aligns with the Global Strategy for Women’s, Children’s and Adolescents’ Health, launched in 2015, in stressing that every child deserves the opportunity to thrive, in safe and healthy settings.

This book seeks to promote the importance of creating sustainable environments and reducing the exposure of children to modifiable environmental hazards. The wide scope of the SDGs offers a framework within which to work and improve the lives of all children. To this end, we encourage further data collection and tracking of progress on the SDGs, to show the current range of global environmental hazards to children’s health and identify necessary action to ensure that no one is left behind.


Report of the Independent International Commission of Inquiry on the Syrian Arab Republic

Report of the Independent International Commission of Inquiry on the Syrian Arab Republic

The Independent International Commission of Inquiry on the Syrian Arab Republic was established on 22 August 2011 by the Human Rights Council through resolution S-17/1 adopted at its 17th special session with a mandate to investigate all alleged violations of international human rights law since March 2011 in the Syrian Arab Republic.

The Commission was also tasked to establish the facts and circumstances that may amount to such violations and of the crimes perpetrated and, where possible, to identify those responsible with a view of ensuring that perpetrators of violations, including those that may constitute crimes against humanity, are held accountable.

UN

Aleppo aerial campaign deliberately targeted hospitals and humanitarian convoy amounting to war crimes, while armed groups’ indiscriminate shelling terrorised civilians – UN Commission

Independent International Commission of Inquiry on the Syrian Arab Republic

Arabic

GENEVA (1 March 2017) – The brutal tactics used by the parties to the conflict in Syria as they engaged in the decisive battle for Aleppo city between July and December 2016 resulted in unparalleled suffering for  Syrian men, women and children and amount to war crimes, according to a UN report released today.

In their report based on 291 interviews, including with residents of Aleppo city, and the review of satellite imagery, photographs, videos and medical records, the Independent International Commission of Inquiry on the Syrian Arab Republic documents daily Syrian and Russian airstrikes against eastern Aleppo over several months which steadily destroyed vital civilian infrastructure resulting in disastrous consequences for the civilian population.

By using brutal siege tactics reminiscent of medieval warfare to force surrender, Government forces and their allies prevented the civilian population of eastern Aleppo city from accessing food and basic supplies while relentless airstrikes pounded the city for months, deliberately targeting hospitals and clinics, killing and maiming civilians, and reducing eastern Aleppo to rubble, the report states.

By late November 2016 when pro-Government forces on the ground took control over eastern Aleppo, no functioning hospitals or other medical facilities remained. The intentional targeting of these medical facilities amounts to war crimes, the Commission concludes.

In the report, mandated by the Human Rights Council at its 25th special session in October 2016, the three-person Commission also notes how armed groups indiscriminately shelled civilian-inhabited areas of western Aleppo city with improvised weapons, causing many civilian casualties. A number of these attacks were carried out without a clear military target and had no other purpose than to terrorise the civilian population.

“The violence in Aleppo documented in our report should focus the international community on the continued, cynical disregard for the laws of war by the warring parties in Syria. The deliberate targeting of civilians has resulted in the immense loss of human life, including hundreds of children”, said Commission Chair Paulo Pinheiro.

In one of the most horrific attacks investigated by the Commission, Syrian Air Force deliberately targeted a United Nations/Syrian Arab Red Crescent humanitarian convoy in Orum al-Kubra, Aleppo countryside. The attack killed 14 aid workers, destroyed 17 trucks carrying aid supplies, and led to the suspension of all humanitarian aid in the Syrian Arab Republic, further aggravating the unspeakable suffering of Syrian civilians.

“Under no circumstances can humanitarian aid workers be targeted. A deliberate attack against them such as the one that took place in Orum al-Kubra amounts to war crimes and those responsible must be held accountable for their actions”, said Commissioner Carla del Ponte.

The repeated bombardments, which also destroyed schools, orphanages, markets, and residential homes, effectively made civilian life impossible and precipitated surrender. The report further stresses that Syrian aircraft used chlorine – a chemical agent prohibited under international law – against the civilian population of eastern Aleppo, causing significant physical and psychological harm to hundreds of civilians.

As it became clear that eastern Aleppo would be taken by pro-Government forces, all parties continued to commit brutal and widespread violations, the report states. In some districts, armed groups shot at civilians to prevent them from leaving, effectively using them as human shields. Pro-government forces on the ground, composed mostly of Syrian and foreign militias, executed hors de combat fighters and perceived opposition supporters, including family members of fighters. Others were arrested and their whereabouts remain unknown.

The report also notes that the eastern Aleppo evacuation agreement forced thousands of civilians – despite a lack of military necessity or deference to the choice of affected individuals – to move to Government-controlled western Aleppo whilst others were taken to Idlib where they are once more living under bombardments. In line with the precedents of Moadamyia and Darayya, this agreement confirms the regrettable trend whereby parties to the conflict in Syria use civilian populations as bargaining chips for political purposes.

“Some of these agreements amount to forced displacement. It is imperative that the parties refrain from similar future agreements and provide the conditions for the safe return of those who wish to go back to their homes in eastern Aleppo”, said Commissioner Karen AbuZayd.

Background
The Independent International Commission of Inquiry on the Syrian Arab Republic, which comprises Mr. Paulo Sérgio Pinheiro (Chair), Ms. Carla Del Ponte, and Ms. Karen Koning AbuZayd has been mandated by the United Nations Human Rights Council to investigate and record all violations of international law since March 2011 in the Syrian Arab Republic.

The full report and supporting documentation can be found on the Human Rights Council web page dedicated to the Independent International Commission of Inquiry on the Syrian Arab Republic: http://www.ohchr.org/EN/HRBodies/HRC/IICISyria/Pages/IndependentInternationalCommission.aspx

The report is scheduled to be presented on 14 March during an interactive dialogue at the 34th session of the Human Rights Council.

– See more at: http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=21256&LangID=E#sthash.l48EGFJw.dpuf

 


Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014

litchii-encephalopathy_lancet-2017

NY Times

comment-litchi


SOFA Score: What it is and How to Use it in Triage

aspr-tracie-sofa-score-fact-sheet_1-5-17

“….Though SOFA was developed for sepsis research and has been validated in additional settings, there is concern that it does not accurately predict mortality when used for patients with isolated respiratory failure as demonstrated during the 2009 H1N1 pandemic. …”


Hospital fires (2012-2014)

US Fire Administration

Hospital-Fires_2012-2014

Data snapshot: Hospital fires (2012-2014)

For each year from 2012 to 2014, an estimated 5,700 medical facility fires were reported to fire departments in the United States. Nearly a fifth of those (1,100 fires) were in hospitals. It is estimated that these fires caused fewer than five deaths, 25 injuries and $5 million in property loss per year. 1Download this snapshot PDF 406 KB

Loss measures for hospitals and all other medical facility fires (three-year average, 2012-2014)

The average number of fatalities per 1,000 hospital fires was lower than the same measure for all other medical facility fires. In addition, the number of injuries was also lower than that of other medical facilities. 2

Loss measure Hospital fires All other medical facility fires
Loss measure

Fatalities/1,000 fires
Hospital fires0.4 All other medical facility fires0.6
Loss measure

Injuries/1,000 fires
Hospital fires17.3 All other medical facility fires19.6
Loss measure

Dollar loss/fire
Hospital fires$6,030 All other medical facility fires$11,290

Hospital fires by incident type (2012-2014)

The majority of hospital fires were fires that were confined to cooking pots (60 percent). Confined fires are smaller fires that rarely result in death, serious injury or large content losses. 3 Fires in trash bins, incinerators or compactors composed 10 percent of hospital fires, while 3 percent were fuel burner or chimney fires.

 

Nonconfined fires, generally larger structure fires, made up 27 percent of hospital fires. Source: NFIRS 5.0.

Confined fires: 73.0%
Nonconfined fires: 27.0%
Confined fires
Property type: 73.0%

Leading confined fire types

  • Cooking vessel: 60.4%
  • Trash, incinerator or compactor: 9.8%
  • Fuel burner or chimney: 2.9%

Hospital fires by time of alarm (2012-2014)

Hospital fires occurred most frequently from 8 a.m. to 6 p.m., accounting for 60 percent of the fires. The fires peaked between the hour of noon and 1 p.m. This period of high fire incidence coincides with lunchtime meal preparations, as cooking is the leading cause of hospital fires. Source: NFIRS 5.0.

 

Causes of hospital fires (2012-2014)

The leading causes of all hospital fires were:

  • Cooking (68 percent)
  • Electrical malfunction (6 percent)
  • Heating (5 percent)

Source: NFIRS 5.0.

Cooking: 68.5%
Electrical malfunction:6.1%
Heating: 5.0%
Intentional: 3.9%
All other causes: 16.5%

Note: Percentages are adjusted for those fires with unknown values of cause. Ten percent of hospital fires had unknown values of cause.

While cooking was the leading reported cause of hospital fires overall, it only accounted for 6 percent of all nonconfined hospital fires. Nonconfined fires are larger, more serious fires.

The leading causes of nonconfined hospital fires were:

  • Electrical malfunction (22 percent)
  • Appliances (13 percent)
  • Intentional actions (12 percent)
  • Other equipment (11 percent)

Extent of fire spread in hospital fires (2012-2014)

Eighty-four percent of all hospital fires were limited to the object of origin. Only 3 percent extended beyond the room of origin. Source: NFIRS 5.0.

Limited to object of origin 83.7%

Limited to room of origin 13.1%

Limited to floor of origin 1.7%

Limited to building of origin 1.4%

Beyond building of origin 0.0%

83.7% Limited to object of origin

13.1% Limited to room of origin

1.7% Limited to floor of origin

1.4% Limited to building of origin

0.0% Beyond building of origin

Note: Total percentages do not add up to 100 percent due to rounding.

For more information on hospitals, including patient experience and quality of care data, please visit: Medicare.gov.

Sources: NFIRS 5.0 and the National Fire Protection Association.

Notes:

  1. Medical facilities are defined by Property Use codes 311 to 343. Hospitals are defined by Property Use code 331. Fires are defined as a subset of nonresidential building fires in NFIRS by using Incident Types 111 to 123 (excluding Incident Type 112). For Incident Types 113 to 118, the Structure Type is 1, 2 or null, and for Incident Types 111 and 120 to 123, the Structure Type is 1 or 2. Aid Types 3 (mutual aid given) and 4 (automatic aid given) were excluded to avoid double counting of incidents. Estimates of fires are rounded to the nearest 100, deaths to the nearest five, injuries to the nearest 25, and dollar loss to the nearest million dollars.
  2. The average loss measures computed from the NFIRS data alone in the table differ from the average loss measures computed from national estimates. Average loss for fatalities and injuries is computed per 1,000 fires. Average dollar loss is computed per fire and rounded to the nearest $10. The 2012 and 2013 dollar-loss values were adjusted to 2014 dollars.
  3. In NFIRS, confined fires are defined by Incident Types 113 to 118.

Chagas disease fears along the Texas-Mexico border

TX-Mexico Border_PLOS-11-2016

Garcia MN, O’Day S, Fisher-Hoch S, Gorchakov R, Patino R, Feria Arroyo TP, et al. (2016) One Health Interactions of Chagas Disease Vectors, Canid Hosts, and Human Residents along the Texas-Mexico Border. PLoS Negl Trop Dis 10(11): e0005074. doi:10.1371/journal.pntd.0005074

Background
Chagas disease (Trypanosoma cruzi infection) is the leading cause of non-ischemic dilated cardiomyopathy in Latin America. Texas, particularly the southern region, has compounding factors that could contribute to T. cruzi transmission; however, epidemiologic studies are lacking. The aim of this study was to ascertain the prevalence of T. cruzi in three different mammalian species (coyotes, stray domestic dogs, and humans) and vectors (Triatoma species) to understand the burden of Chagas disease among sylvatic, peridomestic, and domestic cycles.
Methodology/Principal Findings
To determine prevalence of infection, we tested sera from coyotes, stray domestic dogs housed in public shelters, and residents participating in related research studies and found 8%, 3.8%, and 0.36% positive for T. cruzi, respectively. PCR was used to determine the prevalence of T. cruzi DNA in vectors collected in peridomestic locations in the region, with 56.5% testing positive for the parasite, further confirming risk of transmission in the region.
Conclusions/Significance
Our findings contribute to the growing body of evidence for autochthonous Chagas disease transmission in south Texas. Considering this region has a population of 1.3 million, and up to 30% of T. cruzi infected individuals developing severe cardiac disease, it is imperative that we identify high risk groups for surveillance and treatment purposes.


School District Crisis Preparedness, Response, and Recovery Plans — United States, 2012

CDC-MMWR

KidSchoolDisasterPrep:  MMWR Document

Brenda Silverman, PhD1; Brenda Chen, MBBS1; Nancy Brener, PhD2; Judy Kruger, PhD1; Nevin Krishna, MS, MPH1; Paul Renard Jr, MS1; Sandra Romero-Steiner, PhD3; Rachel Nonkin Avchen, PhD1

Summary

What is already known about this topic?Children represent nearly one fourth of the U.S. population, have unique vulnerabilities, and might be in a school setting, separated from families, when a disaster occurs. The U.S. Department of Education recommends that schools develop and exercise crisis preparedness plans in collaboration with community partners.

What is added by this report?Data from the 2012 School Health Policies and Practices Study indicated that 79.9% of school districts required schools to have a comprehensive plan that includes provisions for students and staff members with special needs, whereas 67.8% to 69.3% of districts required plans that addressed family reunification procedures, procedures for responding to pandemic influenza or other infectious disease outbreaks, and provision of mental health services for students, faculty, and staff members, after a crisis. On average, urban districts required schools to include more of the four selected topics in their plans than nonurban districts. Across all districts, >90% collaborated on plans with staff members from individual schools within the district, local fire departments, and local law enforcement agencies.

What are the implications for public health practice?The deficiencies found in some census regions show a need to strengthen school district–based disaster preparedness planning. These deficiencies need to be addressed to meet the four Healthy People 2020 preparedness objectives (PREP-5).

The unique characteristics of children dictate the need for school-based all-hazards response plans during natural disasters, emerging infectious diseases, and terrorism (13). Schools are a critical community institution serving a vulnerable population that must be accounted for in public health preparedness plans; prepared schools are adopting policies and plans for crisis preparedness, response, and recovery (24). The importance of having such plans in place is underscored by the development of a new Healthy People 2020 objective (PREP-5) to “increase the percentage of school districts that require schools to include specific topics in their crisis preparedness, response, and recovery plans” (5). Because decisions about such plans are usually made at the school district level, it is important to examine district-level policies and practices. Although previous reports have provided national estimates of the percentage of districts with policies and practices in place (6), these estimates have not been analyzed by U.S. Census region* and urbanicity. Using data from the 2012 School Health Policies and Practices Study (SHPPS), this report examines policies and practices related to school district preparedness, response, and recovery. In general, districts in the Midwest were less likely to require schools to include specific topics in their crisis preparedness plans than districts in the Northeast and South. Urban districts tended to be more likely than nonurban districts to require specific topics in school preparedness plans. Southern districts tended to be more likely than districts in other regions to engage with partners when developing plans. No differences in district collaboration (with the exception of local fire department engagement) were observed by level of urbanicity. School-based preparedness planning needs to be coordinated with interdisciplinary community partners to achieve Healthy People 2020 PREP-5 objectives for this vulnerable population.

SHPPS is a national survey conducted every 6 years by CDC to assess school health policies and practices at state, district, school, and classroom levels. This report uses school district–level data from the 2012 survey (6). A two-stage sample design was used to generate a nationally representative sample of public school districts in the United States. Seven district-level questionnaires (each assessing different aspects of school policies and practices) were administered in each sampled district; this report provides results from the healthy and safe school environment questionnaire. Respondents were asked whether their school district required schools to have a comprehensive plan to address crisis preparedness, response, and recovery that included four specific topics identified in PREP-5: family reunification procedures, procedures for responding to pandemic influenza or other infectious disease outbreaks, provisions for students and staff members with special needs, and provision of mental health services for students and staff members after a crisis. Respondents also were asked whether the district collaborated with specified categories of partners (e.g., local fire department or local mental health or social services agency) in developing crisis preparedness plans.

A single respondent identified by the district as the most knowledgeable on the topic responded to each questionnaire module. During October 2011–August 2012, respondents completed questionnaires via a secure data collection website or paper-based questionnaires. Among eligible districts, 697 (66.5%) completed the healthy and safe school environment questionnaire. Additional data regarding SHPPS methods are available online (6). Data were weighted to provide national estimates and analyzed using statistical software that accounted for the complex sample design. School districts were categorized by geographic location into one of the four U.S. Census regions (Midwest, Northeast, South, and West) and by level of urbanicity (urban or nonurban). Prevalence estimates and 95% confidence intervals were computed for all point estimates. Significant differences were evaluated by census region and urbanicity by t-test, with significance set at p<0.05.

District requirements for school plans varied by specific topic and region, ranging from 87.8% in the South for provisions for students and staff members with special needs to 57.9% in the Midwest for procedures for responding to pandemic influenza or other infectious disease outbreaks (Table 1). Overall, 79.9% of school districts required provisions for students and staff members with special needs; 67.8% required plans that addressed family reunification procedures, 69.0% required procedures for responding to pandemic influenza or other infectious disease outbreaks, and 69.3% required plans for provision of mental health services for students, faculty, and staff members after a crisis. For all four of the topics, the percentage of school districts requiring schools to address the topic was lowest in the Midwest.

By urbanicity, on average, urban districts required schools to include more of the four topics in their preparedness plans than did nonurban districts (3.1 versus 2.7 specific topics, p<0.05). Urban districts also were significantly (p<0.05) more likely than nonurban districts to require schools to include family reunification, provisions for students and staff members with special needs, and provision of mental health services in their plans (Table 1).

Analysis of responses regarding district collaboration with community partners found differences in practices for preparedness planning by census region, although only one significant difference was found by urbanicity (Table 2). Across all districts, >90% worked with 1) staff members from individual schools within the district, 2) local fire departments, and 3) local law enforcement agencies. In contrast, 16.6% of districts (range = 12.0%–20.8%) worked with a local public transportation department§ (Table 2).


Discussion

Children represent approximately one fourth of the U.S. population and are separated from their caregivers while attending school. They have unique physiological, psychological, and developmental attributes that make them at heightened risk during disasters (13). Particular challenges for school-based preparedness are planning for children with special needs (e.g., disabilities or functional or medical needs), chronic conditions, or limited English proficiency (1,2,4,7). Effective readiness can be hampered by compartmentalized planning that overlooks the unique vulnerabilities of children in and following public health disasters (8). Broader community participation in school-based disaster planning can ensure that relevant stakeholders have a common framework and understanding to support response and recovery following a disaster.

Although SHPPS found that more than two thirds of districts require schools to include specified topics in their crisis plans, these requirements do not necessarily exist at the state level. A 2014 National Report Card evaluated state-level standards for preparedness planning for children and found that only 29 states met the basic standards for safety of children during an event (9). However, the National Report Card focused primarily on disaster planning standards for children in child care facilities with only one standard specific to K-12. A state level approach to disaster preparedness planning is needed for both child care facilities and schools.

The findings in this report are subject to at least three limitations. First, the “yes or no” responses do not provide insight into the relevance of the specific topics in the preparedness plan or whether plans were exercised or evaluated to identify areas for improvement. Second, SHPPS data are collected every 6 years, and the most recent district data are from 2012. It is possible that some districts have updated their policies and practices related to preparedness since the data were collected. Finally, SHPPS data are self-reported and as such there might be opportunity for misclassification because of respondent interpretation of a particular question.

The U.S. Department of Education’s Practical Information on Crisis Planning: a Guide for Schools and Communities recommends that school crisis plans be developed in partnership with other community stakeholders (4). In this report, percentages of districts collaborating with school staff members and law enforcement, fire department, and emergency medical services were high across all census regions and levels of urbanicity, although other partnerships need improvement. The American Academy of Pediatrics suggests that additional efforts are needed to address deficiencies in partner engagement for school disaster planning and to address the unique vulnerabilities of children (3). School-based and community-based preparedness planning, training, exercises, and drills to improve emergency response, recovery, and overall community resilience are needed (7).

National and district-specific information on school crisis preparedness planning is required to identify and address critical gaps in preparedness, response, and recovery policies and plans for children. Findings from this report can strengthen school and community preparedness through multi-organizational, transdisciplinary partnerships engaged in preparedness planning (7). Disaster planning is a shared responsibility (2). The Children and Youth Task Force, Office of Human Services Emergency Preparedness and Response, is promoting a coordinated planning approach involving governmental and nongovernmental organizations and health care providers to improve outcomes and minimize the consequences of disasters on this vulnerable population (7).


Acknowledgments

Tim McManus, MS, Denise Bradford, MS, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.



Corresponding author: Brenda Silverman, bsilverman@cdc.gov, 404-639-4342.


1Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC; 2Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 3Office of Science and Public Health Practice, Office of Public Health Preparedness and Response, CDC.


References

  1. Bartenfeld MT, Peacock G, Griese SE. Public health emergency planning for children in chemical, biological, radiological, and nuclear (CBRN) disasters. Biosecur Bioterror 2014;12:201–7. CrossRef PubMed
  2. National Commission on Children and Disasters. 2010 report to the president and Congress. AHRQ Publication No. 10-M037. Rockville, MD: Agency for Healthcare Research and Quality; 2010.
  3. Council on School Health. Disaster planning for schools. Pediatrics 2008;122:895–901. CrossRef PubMed
  4. US Department of Education, Office of Safe and Drug-free Schools. Practical information on crisis planning: a guide for schools and communities, 2007. Washington, DC: US Department of Education; 2007. http://www2.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf
  5. US Department of Health and Human Services. Healthy people 2020. Washington, DC: US Department of Health and Human Services; 2016. https://www.healthypeople.gov/2020/topics-objectives/topic/preparedness/objectives
  6. CDC. Results from the School Health Policies and Practices Study 2012. Atlanta, GA: US Department of Health and Human Services, CDC; 2013. http://www.cdc.gov/healthyyouth/shpps/2012/pdf/shpps-results_2012.pdf
  7. US Administration for Children & Families, Office of Human Services Emergency Preparedness and Response. Children and Youth Task Force in Disasters: guidelines for development. 2013. http://www.acf.hhs.gov/sites/default/files/ohsepr/childrens_task_force_development_web_0.pdf
  8. Hinton CF, Griese SE, Anderson MR, et al. CDC grand rounds: addressing preparedness challenges for children in public health emergencies. MMWR Morb Mortal Wkly Rep 2015;64:972–4. CrossRef PubMed
  9. Save the Children. 2014 national report card on protecting children in disasters. Fairfield, CT: Save the Children; 2014. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SC-2014_disasterreport.pdf


* https://www.census.gov/geo/reference/gtc/gtc_census_divreg.html.

http://www.census.gov/geo/reference/urban-rural.html.

§ Sixty two percent of districts did not have public transportation departments.


Return to your place in the textTABLE 1. Percentage of school districts that require schools to have a comprehensive plan to address crisis preparedness, response, and recovery* that includes specific topics, by U.S. Census region and urbanicity — School Health Policies and Practices Study, United States, 2012
Specific topic Census region % (95% CI) Urbanicity % (95% CI) Total % (95% CI)
Midwest Northeast South West Urban Nonurban
Family reunification procedures 60.2§ (52.8–67.3) 72.0 (62.3–80.0) 71.6 (63.7–78.4) 73.6** (63.1–82.1) 78.0†† (71.5–83.4) 61.5 (55.8–66.8) 67.8 (63.5–71.9)
Procedures for responding to pandemic influenza or other infectious disease outbreaks 57.9§ (50.2–65.3) 75.2 (67.7–81.5) 79.4 (72.5–84.9) 68.5 (56.3–78.6) 72.9 (66.1–78.8) 66.5 (60.6–71.8) 69.0 (64.7–73.1)
Provisions for students and staff members with special needs 72.2§ (64.3–79.0) 87.6 (80.9–92.1) 87.8§§ (82.4–91.7) 73.0¶¶ (63.9–80.5) 85.8†† (80.6–89.7) 76.3 (70.8–81.1) 79.9 (76.0–83.3)
Provision of mental health services for students, faculty, and staff members after a crisis occurred*** 60.1§ (52.7–67.1) 80.4 (72.6–86.4) 72.7 (65.7–78.6) 71.6 (60.7–80.4) 77.1†† (70.6–82.5) 64.4 (59.0–69.4) 69.3 (65.2–73.2)

Abbreviation: CI = confidence interval.
* In the event of a natural disaster or other emergency or crisis situation.
https://www.census.gov/geo/reference/gtc/gtc_census_divreg.html.
§ Significant difference (p<0.05) between Midwest and South districts.
Significant difference (p<0.05) between Northeast and Midwest districts.
** Significant difference (p<0.05) between West and Midwest districts.
†† Significant difference (p<0.05) between urban and nonurban districts.
§§ Significant difference (p<0.05) between South and West districts.
¶¶ Significant difference (p<0.05) between West and Northeast districts.
*** For example, to treat post-traumatic stress disorder.

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Return to your place in the textTABLE 2. Percentage of school districts that collaborated with school or community partners to develop preparedness, response, and recovery plans,* by planning partner type, U.S. Census region, and urbanicity — School Health Policies and Practices Study, United States, 2012
Partners engaged Census region % (95% CI) Urbanicity % (95% CI) Total§ % (95% CI)
Midwest Northeast South West Urban Nonurban
Staff members from individual schools within district 93.0 (88.3–95.9) 97.4 (92.3–99.1) 96.9 (92.7–98.7) 95.7 (87.6–98.6) 97.1 (94.0–98.6) 94.3 (91.1–96.5) 95.4 (93.2–96.9)
Students or their families 33.5 (27.4–40.1) 47.0** (36.7–57.6) 50.9 (43.5–58.2) 43.8 (34.2–53.8) 42.8 (36.2–49.8) 43.0 (39.9–48.3) 42.8 (38.7–46.9)
Local fire department 90.9 (86.2–94.1) 95.8 (90.3–98.2) 91.7 (86.4–95.0) 89.3 (80.8–94.4) 94.7†† (90.8–97.0) 90.1 (86.6–92.7) 91.9 (89.4–93.9)
Local law enforcement agency 93.8 (89.4–96.5) 100**, §§ (100–100) 94.0 (89.0–96.8) 91.7¶¶ (83.1–96.1) 96.7 (93.5–98.3) 93.7 (90.4–95.9) 94.8 (92.6–96.4)
Local emergency medical services 80.0 (73.6–85.2) 86.0 (78.4–91.2) 87.4 (81.0–91.9) 75.6 (63.2–84.8) 82.3 (76.0–87.2) 83.2 (78.6–86.9) 82.8 (79.2–85.9)
Local public transportation department 12.0 (8.1–17.4) 20.6 (13.4–30.4) 20.8 (15.5–27.4) 13.7 (8.2–22.1) 20.7 (15.4–27.2) 14.0 (10.7–18.2) 16.6 (13.7–20.0)
Local health department 62.4 (55.4–69.1) 69.1 (58.9–77.8) 69.1 (61.5–75.7) 60.9 (49.5–71.3) 68.9 (61.9–75.2) 63.5 (58.1–68.7) 65.6 (61.3–69.6)
Local mental health or social services agency 41.0 (34.5–47.9) 51.8 (43.3–60.2) 48.5 (40.7–56.4) 46.1 (34.3–58.4) 49.9 (43.1–56.7) 43.8 (38.4–49.3) 46.1 (41.9–50.4)
Local hospital 39.7 (32.5–47.3) 36.7§§ (27.6–46.8) 50.3*** (42.4–58.2) 32.1 (23.3–42.3) 42.8 (35.7–50.1) 40.1 (34.8–45.7) 41.2 (36.9–45.6)
Local homeland security office or emergency management agency 36.9 (29.8–44.6) 51.6** (41.9–61.3) 58.0*** (49.6–66.0) 29.4¶¶ (20.7–39.8) 49.2 (42.2–56.2) 41.8 (36.0–47.9) 45.1 (40.6–49.7)
Other community members 61.4 (54.5–67.9) 70.8 (61.6–78.5) 76.7*** (69.0–83.0) 58.6 (47.6–68.9) 66.1 (59.5–72.2) 67.7 (62.2–72.7) 67.4 (63.2–71.3)

Abbreviation: CI = confidence interval.
*Among districts that had a preparedness plan or required schools to have a plan.
https://www.census.gov/geo/reference/gtc/gtc_census_divreg.html.
§Total refers to the total number of districts that responded to the evaluated question on the healthy and safe school environment module. Districts with missing data were not included in the denominator.
Significant difference (p<0.05) between Midwest and South districts.
** Significant difference (p<0.05) between Northeast and Midwest districts.
†† Significant difference (p<0.05) between urban and nonurban districts.
§§ Significant difference (p<0.05) between Northeast and South districts.
¶¶ Significant difference (p<0.05) between West and Northeast districts.
*** Significant difference (p<0.05) between South and West districts.

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Suggested citation for this article: Silverman B, Chen B, Brener N, et al. School District Crisis Preparedness, Response, and Recovery Plans — United States, 2012. MMWR Morb Mortal Wkly Rep 2016;65:949–953. DOI: http://dx.doi.org/10.15585/mmwr.mm6536a2.


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