In order to alleviate suffering and aid citizens whose personal resources are exceeded by the effects of a disaster or emergency, government at all levels must provide public and private resources to cope with any emergency. To employ those resources in an organized, effective manner requires a consistent approach, well-defined and practiced procedures, and organizational structures. The Pennsylvania Emergency Management Agency (PEMA) is responsible for preparing and maintaining PA’s written Commonwealth Emergency Operations Plan (CEOP) and other required contingency plans to provide for Commonwealth and local disaster emergency management responsibilities. The CEOP is reviewed and updated every two years, or sooner if required. The CEOP outlines procedures and organizational structures and assigns responsibilities to accomplish the mission of helping the citizens of Pennsylvania. It is an operational, not an administrative plan. The responsibilities and coordination structures outlined in the CEOP align as closely as possible with day-to-day responsibilities, but their accomplishment during a disaster emergency must be coordinated. For the CEOP to work, the tasks and procedures outlined in the plan must be practiced and exercised.

At the federal level, the National Response Framework (NRF) aligns federal coordination structures, capabilities, and resources into a unified, all-discipline, and all-hazards approach to incident response and the National Incident Management System (NIMS). The CEOP aligns with the NRF and incorporate the principles of NIMS. The continual refinement of plans and procedures and the mandated use of NIMS will accommodate situational changes and promote preparedness for all kinds of emergency situations.

The CEOP is designed to assist state-level leaders and emergency management personnel in handling all phases of emergency management during a human-caused or natural disaster. All-hazards emergency management acknowledges that most disasters and emergencies are best managed as a cycle consisting of five phases: prevention, preparedness, response, recovery, and mitigation. The CEOP concentrates primarily on the response and recovery phases of that cycle, while mitigation, prevention, and preparedness responsibilities are included in an Appendix. All-hazards emergency management also acknowledges that there are common emergency functional responses. To address these commonalities, the plan contains fifteen functional annexes, each addressing an Emergency Support Function (ESF). The basic plan and the ESF annexes provide all-hazards emergency operations policies and guidance to state agencies. The CEOP assigns responsibility for the accomplishment of the ESFs to appropriate agencies of state government.

The CEOP is organized into three sections. The first is the Basic Plan, which prescribes general principles and responsibilities. The second is a set of fifteen ESF Annexes, which provide for the accomplishment of specific functions. The third is a set of Appendices, which provide amplifying information for users of the plan. The guidance contained in the CEOP is intentionally general in nature. Each department or agency mentioned in the plan has developed implementing instructions to ensure accomplishment of those responsibilities assigned in the plan. In those cases where the assigned responsibilities require a plan of their own, a separate, stand-alone plan was developed. The Table of Contents of the CEOP refers to these as “related plans” and divides them into two groups: incident (hazard)-specific plans and support plans (such as Volunteer Management). While the PEMA will coordinate and track the currency of related plans, the agency that is responsible for writing and maintaining the plan is listed.

This CEOP outlines the organization of emergency response assets at all levels of government in Pennsylvania, and the approach that will be used to respond to disasters and emergencies of all types. It further prescribes procedures and coordination structures for state-level response, which includes field forces and support by state agencies to local and county responders. This plan delegates responsibilities to the various state agencies and prescribes coordination structures that will ensure optimum efficiency in the application of limited state assets. The ultimate objective of all emergency response is to minimize the negative consequences of any disaster or emergency situation in the state. This is best accomplished by orchestrating state activities during prevention, preparedness, response, recovery, and mitigation from disasters and emergencies. Each department or agency developed internal operating procedures or implementing instructions to ensure that responsibilities assigned in the CEOP are executed.

Each of Pennsylvania’s 67 counties is required, in accordance with the provisions of the Commonwealth of Pennsylvania Emergency Management Services Code or Title 35, Pa. C.S.A. Section 7503 (1), to prepare, maintain, and keep current an emergency operations plan for the prevention and minimization of injury and damage caused by disaster, prompt, and effective response to disaster and disaster emergency relief and recovery in consonance with the CEOP.

The CEOP does not specifically consider the needs of the MCH population, which includes at-risk and medically vulnerable women, infants, and children. Instead, the agencies responsible for serving the MCH and other vulnerable populations are encouraged to consider the needs to the populations in their plans. Title V program staff were not involved in the planning and development of the CEOP, nor is Title V leadership included in the Incident Management Structure. However, Title V leadership is included in the DOH management structure and is consulted when emergencies impact MCH populations. Additionally, Title V staff are asked to review frequently asked questions documents, factsheets, and other pertinent disaster/emergency response communications related to MCH populations before they are published. When appropriate, Title V leadership may be called upon to participate in emergency preparedness planning and training exercises when warranted.

Furthermore, the Bureau of Family Health (BFH), as Pennsylvania’s Title V program, has a Continuity of Operations Plan (COOP) used to ensure BFH can maintain operations during an emergency or disaster. The COOP is a web-based system allowing each Bureau within the Pennsylvania Department of Health (DOH) to develop their own plan, which in turn is a part of the Commonwealth’s COOP overseen by PEMA. Title V program staff are not directly involved in the overarching planning and development of the Commonwealth COOP; however, BFH has direct control over its own COOP and Title V program staff are involved in identifying essential functions as well as identifying how to maintain essential functions during an emergency. As part of the DOH Executive staff, the Title V Director is involved in DOH COOP planning. The BFH COOP is reviewed every three months and updated as necessary.

The BFH COOP plan specifically addresses all programming within the BFH, including programming for at risk and medically vulnerable women, infants, and children. Where programs are funded locally via Title V, staff work closely with vendors to ensure they also have a COOP and can continue to serve at-risk and medically vulnerable populations during an emergency.

Overall, there were no gaps identified during the Title V needs assessment related to emergency planning. The COVID-19 pandemic did force Title V staff and programs to function in a new way. Historically the BFH COOP was based primarily on having an alternative location for staff to physically be present. The pandemic and subsequent quarantine forced staff to work out of their homes and found little to no loss of operations and in some ways modernized practices. This adds another tool to the BFH COOP which was not previously considered a widespread option. Additionally, many of the community-based Title V programs were able to continue to provide some level of service virtually throughout the COVID-19 pandemic, though service numbers were impacted. Due to the nature of the pandemic, PA, like many other states, saw disruptions to prevention and primary care for maternal and child health populations. In future, more consideration may be given to public messaging about the importance of continuing routine care during extended emergencies and addressing concerns about safety when seeking care. The COVID-19 pandemic did reveal the need for better collection of demographic information with surveillance data and, subsequently, DOH has worked with submitters to improve the collection and reporting of demographic information and thereby improve DOH’s ability to assess and address disparities.

All Commonwealth staff are provided annual training on emergency preparedness. In order to test effectiveness, drills are provided by PEMA periodically to ensure that the CEOP and COOPs are maintained, updated, and functional. PEMA also provides periodic trainings and updates to the emergency preparedness coordinators in each department. These trainings are attended by the emergency preparedness coordinator for the Bureau of Family Health.

Title V continues to look for opportunities to participate in the development of emergency preparedness and response training, communication plans, and tools/strategies to enhance statewide preparedness for MCH populations. The Title V program oversees many of the statewide MCH public health programs in PA, such as newborn screening, Title V home visiting, Child Death Review, and Maternal Mortality Review, and includes these programs in its preparedness planning. Additionally, Title V leadership coordinates plans with other public health programs within DOH, such as WIC, as appropriate and utilizes regularly scheduled meetings with agency partners to identify additional opportunities for coordination. The Title V program will continue to seek opportunities to strengthen statewide preparedness planning to address potential short- and long-term impacts of disasters and emerging threats on the MCH population.