Hawaii Emergency Management Structure

Statewide: The Hawaii Emergency Management Agency (HI-EMA), located in the state Department of Defense, is the emergency management agency for the State of Hawaii. The Governor has direct authority over HI-EMA, which coordinates all county emergency management agencies, federal emergency management agencies, state departments, the private sector, and nongovernmental organizations.

HI-OEP: HI-EMA develops and maintains the State of Hawaii Emergency Operations Plan (HI-EOP), an all-hazards plan that establishes the shared framework for the state's response to an initial recovery from emergencies and disasters. State agencies responsible for providing emergency assistance are organized into 16 functional groups, state emergency support functions (SESF). Each SESF outlines responsibilities of state agencies and partners for emergency functions and provides additional detail on the response to specific types of issues and incidents.

The last HI-EOP basic plan was completed in 2022. By statute, the HI-EOP is updated every two years.

State Departments: Additionally, each state department has an EOP to address how each department will manage the impacts of an emergency on its operations and execute duties assigned by the HI-EOP.

Counties: Each county develops its own EOPs that are consistent with the HI-EOP and provide guidance on the utilization, direction, control, and coordination of local resources during emergency operations and address the mechanism for requesting and integrating state support when local resources are not sufficient.

Department of Health (DOH): Within DOH, the lead for emergency management is the Office of Public Health Preparedness (OPHP), located directly under the Director of Health. OPHP works to prevent, mitigate, plan for, respond to, and recover from natural and human-caused health emergencies and threats.

DOH EOP: In the HI-EOP, DOH has a lead role for SESF 8, Public Health and Medical, and ESF 10, Oil and HAZMAT, response. During a response, SESF representatives work with HI-EMA and other state, county, and federal agencies to manage the incident.

COOP: OPHP is coordinating the update of the Department’s Continuity of Operations Plan (COOP), in which each division or office indicates its Mission Essential Functions and Essential Support Activities. The Family Health Services Division is updating its information and has already identified the Newborn Metabolic Screening Function and WIC Formula Distribution as Mission Essential Functions. September 2023 is the target timeframe for completion of the Department’s COOP.

Maternal Child Health (MCH): Both the HI-EOP and HI-DOH have limited language that addresses the needs of maternal and child health. There is also minimal language for those with access and functional needs, including pregnant women and children. In the situational analysis, HI-EOP does acknowledge specific populations that are particularly vulnerable to the impacts of emergencies, including individuals with disabilities or access and functional needs and people with limited English proficiency:

• Individuals with disabilities and others with functional and access needs must be considered in emergency planning. Approximately 11% of Hawaii’s population has a disability. Nearly 50% of residents over the age of 75 are disabled.
• Approximately 26% of residents speak languages other than English at home and 18% of the population is foreign-born.

Incident Management Structure (IMS)

HI-EMA: When an imminent or actual emergency threatens the state, HI-EMA coordinates the state's response by activating the State Emergency Operations Center (SEOC) and State Emergency Response Team. The Title V Director serves as the DOH ESF-8 (Public Health & Medical) liaison to the SEOC before and during the pandemic.

DOH: During an emergency, DOH establishes an emergency response structure to coordinate DOH’s activities using the national IMS guidance – Department Operations Center (DOC). OPHP trains DOH staff to fulfill leadership roles in the DOC for planning, operations, and logistics section chiefs and section staff. Family Health Services Division (FHSD) members have been trained on and served in emergency management leadership roles before and during the pandemic as Section Chiefs in the DOC.

The Hawaii Title V Director has served as the DOC Planning Section Chief, while FHSD’s Administrative Officer has served as DOC Logistics Section Chief during the COVID-19 response.

Hurricane Season Preparedness

In Hawaii, Hurricane season is from June 1 through November. The season begins with major forecasts by the national weather service and a major emergency preparation informational campaign from June through August. Forecasters warn of above-average hurricane season for 2023.

OPHP produced hurricane preparedness PSAs in 2022. One featured a mother with her young children discussing the importance of preparing for emergencies and building an emergency kit. In 2022, these PSAs were shown statewide on TV and digital media during hurricane season. For the 2023 hurricane, the audio from the PSAs is airing on numerous statewide radio stations and digital media.

Building Resilience in Children

OPHP partnered with a local children’s theatre group to promote resilience to its audience through one of its plays and in one of its television segments. The message described simple actions children can take when faced with adversity. These actions can be used for everyday challenges or during times of emergency. The play, The Pa’akai We Bring, was performed statewide to public audiences (of families) and thousands of elementary and middle school students as a school-sponsored activity. The television segment was broadcast several times on local networks during prime viewing hours.

COVID-19 After Action Review

OPHP continues to assess the DOH response to the COVID-19 pandemic. Several draft documents have been produced that focus on different timeframes within the three-year response.

Staff from across the department who were actively involved in the response were invited to participate in surveys, interviews, and meetings to discuss timelines, actions taken, and areas of improvement (AOI). Partners and community stakeholders were also included in this assessment process.

Red Hill Water Crisis

Approximately 10,000 households on Oahu were impacted by the contamination of drinking water from the Navy’s underground storage tanks, which was identified in November 2021. The DOH’s public FAQ document included a response for pregnant women exposed to contaminated drinking water based on what was known then.

The Department of Health’s WIC program supported its affected clients by allowing a change from powered or concentrated formulas to ready-to-drink formula, as well as providing advice on how to increase milk supply for lactating mothers.

The DOH and the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR) conducted a follow-up survey in September 2022 to learn more about the experience of people affected by the petroleum contamination in the U.S. Navy’s Joint Base Pearl Harbor-Hickam drinking water system.

DOH continues to oversee the Navy’s long-term drinking water monitoring plan, which requires two years of monitoring of homes, schools, childcare facilities, and other buildings on the Navy water system.

Title V Preparedness Efforts

The Hawaii Title V Director participated in developing the state COVID vaccination plan and served as the liaison for the early childhood/childcare providers to ensure priority vaccination status was given to this sector. He also provided regular communication updates during the pandemic to members of the early childhood community through the State Early Learning Board, a public-private governing board tasked with formulating statewide policy relating to early learning. FHSD programs and services helped share information with its constituents, providers, and families, as applicable, on both testing and vaccinations.

During the pandemic, Title V programs provided leadership for to develop policies and procedures in alignment with CDC and DOH guidance, federal and state mandates, and the Governor's emergency proclamation orders. Adaptations to programs had to be considered for the health and safety of staff, families, and communities.

Title V direct service programs were able to shift from in-person to remote service provision during the large-scale shutdown of businesses/services. Where possible, programs expanded capability to conduct online preventive assessments and screenings. Newborn metabolic and hearing programs worked closely with hospitals, midwives, and families to maintain high rates of screening and follow-up services. Early Intervention Services acquired an online development screening program to ensure evaluations could be completed remotely and promptly. Most Title V programs have returned to offering in-person services in FY 2022 but maintain remote/telephonic options, given several COVID variant surges.

OPHS/Title V collaboration

The Hawaii Title V program has a history of collaboration with OPHS. OPHS provides updates for this Title V narrative every year. In 2019, Hawaii participated in an AMCHP Emergency Preparedness and Response Learning Collaborative (ALC) opportunity to address the maternal and infant health population. The Hawaii team included representatives from the Title V CSHN Branch, OPHP, DOH Planning Office, and Hawaii State Medicaid agency. Relationships from the ALC help support ongoing information sharing and project collaboration when opportunities arise.

PRAMS Emergency Preparedness Data

In 2016, Hawaii was one of the first states to include an eight-part, pre-tested, standardized disaster preparedness question that measured family preparedness behaviors on the PRAMS questionnaire. The eight preparedness behaviors can be generalized into three categories: having plans, having copies of important documents, and having emergency supplies. A CDC Division of Reproductive Health intern analyzed the data for an Emergency Preparedness Summit and completed an unpublished manuscript. The results found Hawaii mothers were relatively well aware and prepared for emergencies, with 79.3% reporting at least one preparedness behavior. The high rate was attributed to the state’s experience enduring severe hurricanes and the annual state hurricane season educational campaigns.

Updated PRAMS for 2019-2020 with disaster preparedness question and shared with OPHP.