There is a State of Alabama Emergency Operations Plan (EOP) and an ADPH-developed EOP. The ADPH EOP is reviewed every 2 years, or as needed, by the Center for Emergency Preparedness (CEP), the State Health Officer, and all ADPH bureau staff with emergency assignments within the EOP. ADPH’s EOP does not specifically include language to address the needs of the MCH population. However, it does provide the opportunity for special assistance requests from the CEP Social Work Coordinator to access resources for people who are considered vulnerable, underserved, disabled, or have special needs. CEP does recognize pregnant women and children as fitting into one of the above groups.

The State of Alabama EOP is written and managed by the Alabama Emergency Management Agency (AEMA). This publicly available document includes a letter of agreement in which it is described as an all-discipline, all-hazards plan that establishes a single, comprehensive framework for incident management. The letter also states that the Alabama EOP provides the structure and mechanisms for the coordination of state support to state, local, and tribal incident managers and for exercising direct state authorities and responsibilities. Furthermore, the EOP assists in reducing the vulnerability to all natural and man-made hazards; minimizing the damage and suffering caused by any disaster; and assisting in the response to and recovery from all-hazard incidents. The EOP was last updated in 2017 and changes must be submitted in writing, using an official EOP change request form. 

The state’s EOP does not specifically include language that addresses the needs of the MCH population. However, in the past when an emergency occurred that impacted women of childbearing age (i.e. Zika), the EOP leaders consulted with Title V MCH staff to create an appropriate response. Title V MCH staff provided a state action plan for ZIKA, led activities, participated in calls with the CDC, and directed actions to assist and monitor the health of pregnant women and infants, including the development of the Zika registry.

State agencies develop supporting EOPs in their Emergency Support Functions (ESFs). The ESFs are described by AEMA as providing the structure for coordinating state/federal interagency support for catastrophic and non-catastrophic events, disasters, or emergencies. The ESF structure includes mechanisms used to provide state support to counties and county-to-county support, both for declared disasters and emergencies under the Stafford Act and for non-Stafford Act incidents. An outline of the state agencies designated as ESFs in the Alabama EOP is as follows:

• ESF # 1 Transportation, AEMA
• ESF # 2 Communications, AEMA
• ESF # 3 Public Works and Engineering, Alabama Department of Transportation
• ESF # 4 Fire Fighting, Forestry Commission
• ESF # 5 Emergency Management, AEMA
• ESF # 6 Mass Care, Emergency Assistance, Housing and Human Services, DHR
• ESF # 7 Logistics Management and Resource Support, Alabama Department of Finance
• ESF # 8 Public Health and Medical Services, ADPH
• ESF # 9 Search and Rescue, AEMA
• ESF # 10 Oil and Hazardous Materials Response, Alabama Department of Emergency Management
• ESF # 11 Agriculture and Natural Resources, Alabama Department of Agriculture and Industries and Alabama Department of Conservation and Natural Resources
• ESF # 12 Energy, Alabama Department of Economic and Community Affairs
• ESF # 13 Public Safety and Security, Alabama Department of Public Safety
• ESF # 14 Long-Term Community Recovery, Office of the Governor
• ESF # 15 External Affairs, Office of the Governor

No Title V Program staff were involved or consulted in the planning and development of the Alabama EOP. Title V leadership is not included in the state’s emergency preparedness planning before a disaster; however, Title V staff are consulted in the response when pregnant women and children are impacted. Title V leadership is not currently a part of the Incident Management Structure (IMS); however, the Title V director was included in the past.

There were no gaps in emergency preparedness and/or surveillance data identified during the 2020 Title V MCH Needs Assessment. An exploration of those needs is a consideration for future annual MCH assessments. Following the last assessment, staff was immediately thrown into disaster response due to COVID-19. There has been no formal assessment of gaps in emergency preparedness and/or surveillance data to determine the state’s ability to adequately assess and respond to MCH population and program needs, but the lessons learned during the COVID-19 response have changed certain protocols in the event of a future disaster or PHE.

FHS division directors submit Continuity of Operations Plans (COOP) annually to allow services to continue to be provided in the event of emergencies and disasters in accordance with the ADPH EOP. In addition to providing personal contact information and technology needs for staff, ADPH COOPs serve to do the following:

• Identify the core functions of each division, including populations served 
• Keep lines of communication open with the FHS director and other ADPH administrators
• Provide operational guidance and supervision to FHS directors and managers
• Fulfill Incident Command System position functions and assists with pandemic response
• Coordinate communications with FHS directors and managers and other outside entities
• Identify emergency preparedness team assignments
• Establish protocols for the processing of critical procurements and payments (e.g. emergency PKU formula orders)

CRS

CRS plays a role in the state’s emergency structure through serving as a member of Alabama’s Functional and Access Needs in Disasters (FAND) Taskforce whose mission is to ensure equal access throughout all phases of emergency management. Through this partnership, CRS provides a voice for CYSHCN and their families in the development of emergency preparedness and response training. Graham Sisson, ADRS Deputy Attorney General and Director of the Governor’s Office on Disability, serves as the chair of FAND and was appointed to be the liaison with the Governor’s Mass Care Task Force (MCTF), which oversees the coordination of state-level planning and preparedness activities and FAND.

Members of FAND include agencies that serve individuals with functional and/or access needs during the preparedness, response, and recovery phases of a disaster. Examples of member constituencies are those who interact directly with people with disabilities including, but not limited to, health needs, mental health, sheltering, casework, and communications. Members include the Alabama Council for Developmental Disabilities and individuals with developmental disabilities. Task force members facilitate inclusive planning, preparedness, response, and recovery activities related to providing services to people with disabilities following a disaster. Activities include identifying resources, advocating to ensure effective communication for those with communicative barriers, ensuring persons with functional and accessible needs are involved in the planning process, and disaster-affected areas understand appropriate actions to accommodate persons with functional accessible needs.