MDPH Emergency Preparedness and Response Plan

The MDPH mission is to prevent illness, injury, and premature death, to ensure access to high quality public health and health care services, and to promote wellness and health equity for all people in the Commonwealth. As a part of carrying out its mission, MDPH responds to public health and health care impacts resulting from a variety of incidents or events. There is a designated Office of Preparedness and Emergency Management (OPEM) and the MDPH All-Hazards Emergency Operations Plan (EOP) identifies the steps MDPH will take to respond to all types of incidents and events. The EOP establishes the framework for MDPH support for local and state response activities to mitigate or prevent public health emergencies; prepare staff, volunteers, and members of the public to respond and recover from an emergency; respond appropriately; and recover effectively and efficiently.

The EOP can be used in conjunction with the Comprehensive Emergency Management Plan (CEMP) managed by the Massachusetts Emergency Management Agency (MEMA). MDPH and MEMA collaborate and coordinate their response actions as indicated by the situation. MDPH’s EOP is typically reviewed annually and may also be modified following an exercise or real incident. Due to the demands of the COVID-19 response, the EOP was last updated in January 2019.

Since 2010, MDPH has worked with public health and health care stakeholders to identify and assess risks that may pose a particular threat to the public health and health care system in the

Commonwealth, looking at both the likelihood of occurrence and the severity of impact. While the rating of severity of risks varies across the Commonwealth, common hazards identified include natural disasters (e.g., earthquake, hurricanes, winter storms, floods, heat waves, pandemic influenza) and disasters that are human-generated (e.g., radiological emergencies, chemical threats, terrorism). In its planning assumptions, the EOP recognizes that some individuals and families will be more vulnerable to the threats associated with the incident or event and/or may have difficulty accessing the public health and medical services they require. The CDC’s Public Health Workbook to Define, Locate, and Reach Special, Vulnerable, and At-risk Populations in an Emergency identifies five categories that should be planned for during incidents or events:

• Economic Disadvantage (using poverty as a criterion may help reach a large number of people)
• Language and Literacy (includes people who have limited ability to read, speak, write or understand English or their native language)
• Medical Issues and/or Disability (Persons with any impairment that substantially limits a major life activity or physical, mental, cognitive, or sensory issues)
• Isolation (cultural, geographic, or social)
• Age (Older adults with chronic health issues or other impeding factors and infants and children 18 years or younger can also be at risk, particularly if they are separated from their parents or guardians)

Title V staff are not involved in the development of the EOP and do not have an explicit role in the state’s Incident Management Structure, though they do play an important role in supporting and participating in an emergency response, described further below. The following personnel and groups have critical pre-identified responsibilities in the Department’s readiness and response:

• MDPH Commissioner: As the lead health official for the Commonwealth, the Commissioner is responsible for directing the Department’s response in an emergency and may authorize activation of the EOP.
• The Commissioner’s Executive Team: responsible for strategic planning, policy, and leadership during an incident or event. In addition to the Commissioner, the team is comprised of the Associate Commissioner, Assistant Commissioners, Chief Operating Officer, Chief of Staff, General Counsel, Chief Financial Officer and Director of Diversity. The OPEM Director, Communications Director and Director of Government Affairs are consulted. The Commissioner’s Executive Team may also consult with other relevant Bureau or Office directors and may establish advisory groups of subject matter experts as needed.
• OPEM Director: The Director is responsible for overseeing planning and emergency preparedness for MDPH and may be delegated with authority by the Commissioner to coordinate a response within MDPH during an emergency and to activate the EOP.
• MDPH Offices and Bureaus: Organizational units throughout MDPH have response and/or recovery responsibilities during an emergency. Examples of Bureaus that may conduct specific response activities include, but are not limited to:
  • The Bureau of Infectious Disease and Laboratory Sciences (BIDLS) is responsible for tracking, responding to, and eliminating infectious diseases as well as performing laboratory tests to identify suspicious substances, food-, insect-, environmental-, and other pathogens, lead, and treatable disorders in newborns.
  • The Bureau of Environmental Health (BEH) is responsible for environmental health concerns and threats, including deployment of the Nuclear Incident Advisory Team for radiological emergencies, and the Rapid Response Team for food safety emergencies.
  • BIDLS and BEH each have on-call staff available 24/7 to respond to calls regarding possible emergencies.

Title V Role in Emergency Planning and Preparedness

Routine surveillance and data collection are a key component of the EOP. During normal operations, surveillance information may identify a hazard that would necessitate activation of the EOP and can also be used to inform decisions during a response. The Title V program has consistently played a role in surveillance and data collection during current and past emergencies. During the COVID-19 pandemic, Title V is supporting surveillance of those who get COVID-19 in pregnancy and follow-up of infants exposed prenatally to COVID-19; this surveillance effort is through the CDC's Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET), a surveillance system to rapidly identify the impact of emerging health threats to pregnant people and their infants. This effort leverages the flexibility of the existing active Birth Defects Monitoring Program (BDMP) in Massachusetts and strong collaboration between BDMP and BIDLS, building upon previous work to enhance the system to monitor outcomes for pregnant women with Zika infection.

In the past, BDMP conducted surveillance of Zika-associated birth defects and assists in surveillance of pregnant women with lab evidence of Zika infection and their infants. BDMP also supported Zika-affected families that relocated primarily from Puerto Rico in the aftermath of Hurricane Maria to ensure a continuum of public health surveillance, care, and access to services.

In addition to its role in data collection and surveillance, the BFHN Office of Family Initiatives also collaborates with Emergency Medical Services for Children to support pediatric disaster preparedness, such as developing portable packets for families to easily transport their children’s emergency information. The OFI Director serves on the Emergency Medical Services for Children Advisory Board.

The Division for Children and Youth with Special Health Needs (DCYSHN) has worked with OPEM, MassHealth, and the Office of the Child Advocate to establish policies and practices related to emergency care planning and coverage for families of children with medical complexity in the event that a parent becomes incapacitated or hospitalized due to COVID-19. Through this collaboration, dedicated web pages and resources were created, DCYSHN investigated emergency volunteer public health assistance, and the needs of CYSHN and their families during natural disasters and pandemics were included in MDPH promotional campaigns for the annual Emergency Preparedness Awareness Month.

More information about the ways in which Title V is currently responding to the COVID-19 pandemic can be found in the Overview of the State.

Future Title V Plans

Based on ongoing Title V program needs assessment efforts and lessons learned from current and previous emergency responses, gaps related to communications and real-time data were identified, which could impact Massachusetts’ ability to adequately assess and respond to MCH population and program needs in a future public health emergency. Therefore, in April 2021, BFHN submitted an application for HRSA/MCHB’s Emerging Issues in Maternal and Child (HRSA-21-080) funding to support the Massachusetts Maternal Child Health Emergency Response Project.

In the wake of the COVID-19 pandemic and racial reckoning over the past year, public health emergencies are likely to have inequitable effects on communities with large numbers of Black, Indigenous, People of Color (BIPOC) and Latinx, immigrants, people fearful of government, families of children and youth with special health needs, families experiencing housing instability, families experiencing job insecurity or underemployment, families affected by mental illness, and families affected by substance use.  The goal of the MCH Emergency Response Project is to develop an Emergency Preparedness and Response Roadmap in partnership with statewide and community stakeholders to guide an effective and equitable response to future public health emergencies affecting MCH populations. This will be achieved by establishing a state-community work group, including families, to 1) develop a bi-directional communication structure and plan between MDPH and communities, and 2) inform the development of processes and protocols to integrate real time surveillance and program data to provide timely information to community leaders and identify MCH families most affected by a public health emergency.

The proposed project incorporates what the Federal Emergency Management Agency (FEMA) refers to as a “Whole Community” approach”[1] to emergency preparedness. This approach is well-suited to the Massachusetts MCH population, and embodies three key principles: 1) understand and meet the actual needs of the whole community, 2) engage and empower all parts of the community, and 3) strengthen what works well in communities on a daily basis. Through this approach, existing structures and relationships that are present in the daily lives of individuals, families, businesses and organizations before an incident occurs can be leveraged and empowered to act effectively during and after a disaster. MDPH will also add to this approach explicitly addressing racism, centering the voices of families, and incorporating a healing centered approach to mitigate the effects of community and individual trauma.

The proposed project will take advantage of a new sense of urgency – within MDPH, among statewide and community providers, and among residents themselves, about improving Massachusetts’ response to the next public health emergency and new ideas and insights that can be tapped to create a more robust roadmap for preparedness and response.

[1] Federal Emergency Management Agency, A Whole Community Approach to Emergency Management: Principles, Themes and Pathways for Action (2011), https://www.fema.gov/sites/default/files/2020-07/whole_community_dec2011__2.pdf.