Archive for September, 2016
Arcan Cetin suspected of killing 4 women and a man Friday night at the Cascade Mall in Burlington, Washington.
Sunday, September 25th, 2016Tropical Storm 20W: Megi heading towards Taiwan and the south China coast
Saturday, September 24th, 2016
Active Shooter: A man armed with long gun entered a Macy’s store at a mall in Washington state, killing 4 women and vanishing into the night
Saturday, September 24th, 2016
Saudi Arabia reports five additional cases of Middle East Respiratory Syndrome
Friday, September 23rd, 2016Details of the cases
- A 55-year-old, national, male, living in Arar city, Northern Border region. He developed symptoms on 3 September and was admitted to hospital on 8 September. The patient, who has no comorbidities, tested positive for MERS-CoV on 10 September. The case also reports contact with camels and consumption of their raw milk in the 14 days prior to onset of symptoms. Currently, he is in stable condition admitted to a negative pressure isolation room on a ward. The Ministry of Agriculture was informed and investigation of camels is ongoing.
- A 65-year-old, national, male, living in Riyadh city, Riyadh region. He developed symptoms on 29 August and was admitted to hospital on 4 September. The patient, who has comorbidities, tested positive for MERS-CoV on 5 September. He has a history of contact with camels in the 14 days prior to the onset of symptoms. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward. Ministry of Agriculture was informed and investigation of camels is ongoing.
- A 40-year-old, non-national, male, living in Hofouf city, Al Ahssa region. He developed symptoms on 15 August and was admitted to hospital on 28 August. The patient, who has comorbidities, tested positive for MERS-CoV on 30 August. He works in a camel market and has history of contact with camels and consumption of their raw milk in the 14 days prior to onset of symptoms. Currently the patient is in critical condition admitted to the ICU on mechanical ventilation. Ministry of Agriculture was informed and investigation of camels is ongoing.
- A 69-year-old, national, male, living in Taif city, Taif region. He developed symptoms on 21 August and was admitted to hospital on 24 August. The patient, who has comorbidities, tested positive for MERS-CoV on 25 August. Investigation of history of exposure to the known risk factor in the 14 days prior to onset of symptoms is ongoing. Currently the patient is in stable condition admitted to a negative pressure isolation room on a ward.
- A 43-year-old, national, male living in Hriymala city, Riyadh region. He developed symptoms on 12 August but tested negative for MERS-CoV on 13 August. Due to persistence of symptoms, he was admitted to hospital on 17 August and tested positive for MERS-CoV on 21 August. The patient has no co-morbidities. He is a household contact of a previously reported case (see DON posted 16 September, case no.2). He has no other history of exposure to the known risk factors in the 14 days prior to the onset of symptoms. Currently the patient is in stable condition admitted to a negative pressure isolation room on ward.
A government investigation of lab incidents involving incomplete pathogen activation at US high-containment labs since 2003 turned up 11 events that weren’t reported and identified problems with identifying and tracking such instances.
Friday, September 23rd, 2016
A boat reportedly carrying 600 migrants capsized off the Egyptian coast near Kafr al-Sheikh. Around 150 have been rescued and authorities have retrieved 42 bodies so far.
Thursday, September 22nd, 2016
School District Crisis Preparedness, Response, and Recovery Plans — United States, 2012
Thursday, September 22nd, 2016KidSchoolDisasterPrep: MMWR Document
Weekly / September 16, 2016 / 65(36);949–953
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 (1–3). 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 (2–4). 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 (1–3). 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.
References
- 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
- 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.
- Council on School Health. Disaster planning for schools. Pediatrics 2008;122:895–901. CrossRef PubMed
- 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
- 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
- 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
- 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
- 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
- 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.
TABLE 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.
TABLE 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.
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.