Northern Mariana Islands Emergency Management Structure

Homeland Security and Emergency Management: The CNMI Homeland Security and Emergency Management (HSEM), located within the Office of the Governor, is the emergency management agency for the territory. The CNMI Governor has direct authority over the CNMI HSEM which serves as the coordinating agency for all emergency management services, federal emergency management agencies, the private sector, and nongovernmental organizations.

The HSEM develops and maintains the CNMI All-Hazards Emergency Operations Plan, which establishes the shared framework for the CNMI’s response to and initial recovery from emergencies and disasters. CNMI agencies responsible for providing emergency assistance are organized into 18 functional groups, emergency support functions (ESF). Each ESF outlines responsibilities of state agencies and partners for emergency functions and provide additional detail on the response to specific types of issues and incidents.

The purpose of the CNMI All-Hazard Emergency Operations Plan (EOP) is to establish the CNMI Emergency Operations System which organizes the CNMI’s response to emergencies and disasters while providing for the safety and welfare of its people. It sets forth lines of authority, responsibilities and organizational relationships, and shows how all actions will be coordinated among the CNMI, its various Municipalities and the Federal Government. The EOP is designed as an “ALL HAZARDS” plan and applies to all hazards identified in the Hazard Identification Risk Assessment found in the CNMI State Standard Mitigation Plan (SSMP). The CNMI EOP defines operational structures to perform the following functions:

• Coordinate emergency management plans at the federal, state, and local government levels. Outlines the activation and coordination processes of the CNMI’s Emergency Operations Center (EOC) and associated functions. 
• Effectively utilize government (federal, state, and local), non-governmental organizations, and private sector resources through the response mission arena of emergency management. 
• Provide a system for the effective management of emergencies, including describing how people (unaccompanied minors, individuals with disabilities and others with access and functional needs, and individuals with limited English-speaking proficiency) and property are protected.

Public Health/Hospital Emergency Preparedness Program: The CHCC health department and hospital Emergency Disaster Plan (EDP) outlines how the health department and hospital will manage the impacts of an emergency and execute duties assigned by the CNMI EOP. The lead division for emergency management under the CHCC is the Public Health/Hospital Emergency Preparedness Program (PHHEPP) which is located under the office of the Chief Executive Officer. PHHEPP works to prevent, mitigate, plan for, respond to, and recover from natural and human-caused health emergencies and threats. The PHHEPP is also responsible for the coordination of the CNMI Medical Reserve Corps (MRC) that may provide volunteers to assist with emergency operations.

CHCC/Health Department Functions in the CNMI EOP: Within the CNMI EOP, the CHCC is the lead agency for the ESF8 functions, Health and Medical Services. In this role, the CHCC is responsible for coordinating, communicating and serving as the liaison with federal and response agencies concerning public health and medical emergencies. It leads the coordination and facilitation of public health support of individuals and communities under evacuation, quarantine, or isolation for incidents involving the release of chemical, biological, radiological, nuclear, and explosive materials; natural and man-made disasters; and major disease outbreaks. As the health department, the CHCC is responsible for public information and risk communication prior to, during, and following a public health or medical emergency to the CNMI EOC. Additionally, the CHCC is responsible for public health screening, testing, vaccination, treatment and other public health services during a public health medical emergency requiring the services. The CHCC serves in support capacity for the following ESFs: 2 (Communications), 5 (Information and Planning), 6 (Mass Care), 10 (Oil and Hazardous Materials Response), 11 (Agriculture and Natural Resources), 14 (Long-term Community Recovery), 16 (Volunteers and Donations), 17 (Cyber and Critical Infrastructure Security).

Maternal & Child Health (MCH): Both the CNMI EOP and the CHCC EDP have limited language that specifically addresses the needs of maternal and child health. There is also minimal language for those with access and functional needs, which can include pregnant women and children.

When an imminent or actual emergency occurs, the CNMI HSEM coordinates the CNMI’s response through the activation of the CNMI Emergency Operations Center (EOC). During an emergency, the CHCC establishes an emergency response structure to coordinate the CHCC’s activities using the Incident Command Structure Agency Operations Center (AOC). The PHHEPP is responsible for training staff to fulfill the leadership roles in the AOC for planning, operations, and logistics sections chiefs, as well as section staff. Staff of Population Health Services have been trained and served on emergency management leadership and support roles before and during the pandemic as part of the CHCC AOC.

The CNMI’s Title V Director has served as the AOC Operations Chief for Vaccinations with various Title V staff members supporting operations sections/functions, communications, and planning.

AMCHP Emergency Preparedness and Response Learning Collaborative (ALC): In 2021, the CNMI participated in the AMCHP Emergency Preparedness and Response Learning Collaborative opportunity to address emergency preparedness for the MCH population. CNMI participants included representatives from MCH Title V along with staff members from the CHCC PHHEPP.

Participation in the ALC resulted in the identification of action steps for strengthening MCH focused activities within the CHCC EDP and the EOP, including:

Strategy: Integrate MCH considerations into state/territory EPR Plan

 Activities:

• During the next 12 months, the MCH Director and the Public Health Emergency Program (PHEP) directors will meet at least one time to discuss EPR needs related to maternal and infant health.
• An MCH staff member will annually update the list of local and state/territory MCH partners, stakeholders and/or social networks to ensure that the contact information is accurate.
• An MCH staff member will ensure that state/territory EPR guidance for sheltering and other mass care needs address maternal and infant populations and the specific needs such as supplies and instructions for infant feeding and safe sleep.
• Annually the MCH program updates its roster of which MCH staff members are trained to assume leadership or other positions during a response if the hazard has a disproportionate effect on women of reproductive age and/or infants.

Strategy: Develop a plan to gather epidemiologic/surveillance data on women of reproductive age and infants to guide action

 Activities

• Two MCH or state/territory epidemiologists (or more) will estimate the number of pregnant women in a jurisdiction.
• During the next three years, the state/territory will assess emergency preparedness among postpartum women using the Pregnancy Risk Assessment Monitoring System (PRAMS) or a PRAMS-like survey.
• Within the next three years, the state/territory will assess emergency preparedness among MCH populations using selected disaster preparedness questions in the CNMI Hybrid Survey.
• At least one ALC team member assesses possible use of DRH Post-Disaster Health Indicators in emergency data collection tools for pregnant/postpartum/lactating women.

Title V Preparedness Efforts: The CNMI’s Title V Director worked collaboratively with the PHHEPP Planner in the development of the CNMI’s COVID-19 vaccination plan. The Title V Director was involved in CNMI-wide vaccination planning discussions including the identification and implementation of vaccination for priority populations, including: healthcare workers, first responder, teachers and childcare workers, the man’amko (elderly), and worked to expand population access in a phased approach as vaccine availability moved from limited to broad supply.

The Title V Director was significantly involved in the development of standard operating procedures which operationalized COVID-19 mass vaccination operations and that served as the framework for vaccine points of dispensing (PODs) during the initial and subsequent phases of the COVID-19 vaccination roll out. Additionally, working collaboratively with the CHCC AOC Communications team, the Title V Director worked collaboratively to lead the development of standard operating procedures, a vaccination registration data system framework, reporting metrics, and facilitated training to establish a CNMI COVID-19 vaccination call center as part of strategies to ensure information and access to vaccinations were communicated as widely and quickly as possible to the CNMI Population.

During the pandemic, Title V Programs provided leadership for their programs to develop policies and procedures in alignment with CDC and CHCC guidance, federal and local mandates, and the Governor’s executive orders. Adaptations to programs had to be implemented for the health and safety of staff, families, and the community.

Newborn Metabolic Screening- staff worked closely with the CNMI hospital nursery department, pediatricians and the CHCC laboratory to ensure that specimen collection prior to discharge for babies born. Staff monitored screening results to ensure that follow-up services were initiated timely to minimize risk for loss to follow-up. Additionally, what use to be a limited weekly window for collecting specimens at the nursery ward was modified to enable a 7-day specimen collection to further reduce the risk for loss to follow-up of babies born outside the specimen collection window.

Newborn Hearing Screening staff continued to work to ensure babies had a hearing screening before discharge after birth. The EHDI Program Coordinator worked closely with the hospital nursing staff to ensure that babies who were referred for follow-up or diagnostic audiological screening services were seen and not lost to follow-up. There were some challenges in conducting annual equipment calibration as off-island vendors were not able to enter the CNMI to calibrate the equipment due to travel quarantine protocols. The program had to negotiate loaner equipment and work to send equipment to the state of Oregon to complete annual equipment calibration requirements.

Home Visiting services were modified to tele-home visits, following guidance from HRSA and in compliance with the CNMI Governor’s executive orders. Home visitors continued to provide services and continue participant recruitment throughout the pandemic by utilizing video conferencing or phone access. Support was offered to families who did not have means to connect virtually by providing them prepaid cellular cards and mobile phone units to access weekly home visits. Emergency supplies were also made available to program participants, including infant diapers, wipes, disinfecting supplies, and grocery store vouchers for food.

WIC waivers were extended by the USDA, allowing the CNMI WIC Program and its clinic to provide all services remotely by phone, mail, and electronic correspondence. The CNMI WIC had fully implemented eWIC in 2018 which enable families to continue accessing food benefits via electronic transfer benefits (EBT) throughout the pandemic. The CNMI WIC worked with WIC enrolled vendors to implement the WIC-to-go services allowing WIC participants to purchase WIC approved products over the phone and to schedule pick up. The project aimed to cut shopping time and also minimize time spent in public places as part of social distancing measures.

Immunization services and activities focused on routine vaccinations continued throughout the pandemic. The CNMI Immunization program strengthened its outreach activities and worked closely with public and private schools to monitor vaccination rates and coordinate mobile vaccination activities to ensure that kids are kept up to date with routine vaccine recommendations.

Early Intervention Program is the CNMI’s IDEA Part C program. Services were modified to phone visits and/or videoconferencing via the Zoom platform.

Children with Special Healthcare Needs Program offered parent/peer support services through telephone and videoconferencing and gradually transitioned back to face to face services by the summer of 2021. Learning sessions and trainings for parents of CSHCN and service providers were conducted virtually through Zoom. Despite COVID-19, Shriner’s outreach clinics were successfully completed on Saipan twice in 2021.

Group Prenatal Care Group prenatal visits were suspended due to COVID-19 pandemic restrictions and social distancing requirements that made it difficult to coordinate face to face visits for groups of 8 to 10 women and their partners. Access to equipment and internet connection were challenges identified and made it difficult for group prenatal care to successfully transition to virtual sessions. Additionally, a virtual platform made it impossible for screenings and measurements to be conducted.

COVID-19 Lessons:  The COVID-19 pandemic identified gaps in planning and operations as well as resulted in the development of innovative strategies to address them. Timely and accurate information was a priority area identified to be able to effectively communicate information regarding COVID and to dispel misinformation about vaccinations through linguistically and culturally appropriate information.  Title V staff worked closely with medical providers to produce social media messaging and public awareness videos to promote information from trusted messengers on the benefits of vaccination. Social media posts and videos promoting vaccinations among pregnant and breastfeeding women, children and teens were developed and aired on the local cable news network as well as the local movie theater. A call center was established through telephone number (670) 682-SHOT [7468] as a centralized communication hub for community members to be able to speak to a live representative.

PRAMS & COVID-19: In 2021, the CNMI began the implementation of its PRAMS project and in 2022 was able to secure IRB approval of the survey protocol through a reliance agreement with the Hawaii Department of Health IRB. The CNMI PRAMS will be sampling 100% of all resident births in the territory and will begin sampling 2022 births. Included in the CNMIs PRAMS questionnaire are questions about experiences with prenatal care, delivery, postpartum care, infant care during the pandemic, and COVID-19 vaccinations.