III.E.2.b.iv MCH Emergency Planning and Preparedness

Role of the Title V program in the state’s emergency structure 

Rhode Island’s MCH program is actively engaged in RIDOH’s emergency preparedness and response planning activities. RIDOH maintains a written emergency operations plan (EOP) that is reviewed and updated every three years. Included in the EOP is an Access and Functional Needs Reference Guide, which focuses on populations with special considerations, including at-risk and medically vulnerable womxn, infants, and children. The EOP was developed and is updated with input and feedback from the Executive Leadership Team and Health Policy & Leadership group, which includes the MCH Director.  
 

Participation in emergency preparedness planning activities 

Training, communication plans, and tools: MCH and CYSHCN staff are subject matter experts who provide guidance and best practice resources to support training and communications to enhance statewide preparedness for addressing potential short- and long-term impacts of disasters and emerging threats on the MCH population. During the response to COVID-19, MCH and CYSHCN staff developed a toolkit for the COVID unit to share with first responders and the Rhode Island National Guard. CYSHCN program staff also partner with the staff in RIDOH’s Center for Emergency Preparedness and Response who conduct the continued development, maintenance, and promotion of the Rhode Island Special Needs Registry (RISNER) to link staff conducting outreach on RISNER to partners conducting CYSHCN initiatives. 

Data assessment and surveillance: Through ongoing Title V program needs assessment efforts and lessons learned from previous emergency responses, Rhode Island has identified two primary gaps in emergency preparedness and/or surveillance data that could impact the State’s ability to adequately assess and respond to MCH population and program needs in a future disaster or public health emergency: 1) accessibility for residents with physical limitations and 2) language access including  languages other than English and American Sign Language. To address these concerns in the response to COVID-19, RIDOH staff provided technical assistance to vaccination clinics and testing sites about meeting ADA compliance and implementing CLAS standards around language access. 

Coordination with other RIDOH Programs: MCH coordinates with RIDOH’s Emergency Medical Services for Children (EMSC) program, which is designed to expand and improve state EMS systems that respond to and care for children in emergencies involving trauma or critical care. Over the years, EMSC has been an integral component of Rhode Island’s Maternal and Child Health Policy Team. Recent engagement has focused on increasing pediatric emergency care coordination, improving EMS practitioner pediatric skills and education, and encouraging family-centered care. Staff from both MCH and the Center for Emergency Preparedness and Response work closely with staff in RIDOH’s Office of Immunization to ensure there is a strong network of providers to support childhood, adult, and emergency vaccination capability. As demonstrated in the response to COVID-19, integration with the team within in the Center for Health Data Analysis who support the Rhode Island Child and Adult Immunization Registry (RICAIR) is essential to access near real-time information on vaccination in an emergency that helps drive policy decisions.  

AMCHP Building Emergency Preparedness and Response (EPR) Capacity for Maternal and Infant Health Action Learning Collaborative: RIDOH was selected to participate in the 2019-2020 AMCHP EPR Action Learning Collaborative cohort. The intent was to facilitate a closer working relationship between RIDOH’s Center for Emergency Preparedness and Response (CEPR) and the MCH Program and to take a more proactive approach to responding to the unique needs of MCH populations including pregnant women, families, and CYSHCN during emergencies by ensuring MCH is more fully integrated into RIDOH’s and the State’s emergency response plans. While the work within the cohort had a strong start, the COVID-19 pandemic started and a few months after the work began, putting a pause on the work.  

Past Emergencies with Significant MCH Integration 

•       Newport gas outage: In January 2019, the City of Newport experienced a week-long gas outage impacting most of the municipality, during the coldest period of the year. Impacts to parents and children included the closure of daycares and schools, the displacement of families from their homes, and raised significant questions on what evidence-based or other best practices could be given to support families trying to keep children warm in circumstances that conflict with standardized guidance (e.g., co-sleeping, wrapping babies in extra blankets).  

•       Zika Virus Task Force: RIDOH’s response to Zika virus included the implementation of a multidisciplinary Task Force, which is a precursor to the activation of RIDOH’s Incident Command System (ICS) according to its Emergency Operations Plan (EOP). This Task Force included partners typically involved in infectious disease response, but also included MCH public health professionals, clinicians, and organizations. The Task Force worked closely to develop plans to support the healthcare community caring for pregnant women with a travel history to areas with active Zika virus transmission, ensuring that messaging was readily available via traditional, social, and new media mechanisms in multiple modalities and languages The Task Force also developed a robust birth defects registry and tracking mechanism for all infants born to women with exposure to Zika virus.  

•       Ebola Response: While RIDOH worked with all hospitals and healthcare partners who provide care to patients across their lifespans, as well as State and local law enforcement, fire, EMS, and emergency management agencies statewide to ensure the best preparedness and response posture should an individual develop Ebola Virus Disease while in Rhode Island, RIDOH is especially proud of the work that it completed with its two assessment hospitals: one, a level-1 trauma center that also has a children’s unit, and the other, a specialty hospital for women and newborns. While these hospitals were working to develop their internal capabilities to receive and isolate a person under investigation for Ebola Virus Disease and care for the patient until an Ebola diagnosis could be confirmed or ruled out, they were also developing best practices related to the care of a birthing woman and her baby or a child-parent dyad when one or both might be suspected of having Ebola Virus Disease. 

In alignment with the Hospital Preparedness Program, the Rhode Island Department of Health’s Center for Emergency Preparedness and Response and the Healthcare Coalition of Rhode Island (HCRI, Rhode Island’s healthcare emergency preparedness and response coalition) finalized the Pediatric Surge Annex of HCRI’s Response Plan, the product of a collaborative effort between HCRI and RIDOH’s Center for Emergency Preparedness and Response to advance planning within Rhode Island’s healthcare system related to the management of medical surge involving a high volume of pediatric patients. As part of this effort, HCRI engaged a pediatrician from Rhode Island Hospitals’ Hasbro Children’s Unit to serve as the Coalition’s Pediatric Surge Clinical Advisor, to provide subject-matter expertise to HCRI and its members related to the management of pediatric patients. This physician also works closely with RIDOH’s MCH and EMSC teams.

In May of 2022, RIDOH and HCRI conducted a tabletop exercise to validate the Pediatric Surge Annex. Involving elements of a mass burn incident, the exercise included participants from RIDOH, hospitals (including Rhode Island’s Level 1 Pediatric Trauma Center), emergency management, and emergency medical services. The exercise sparked valuable discussions related to pediatric care capabilities and capacity in the State and led to the identification of several post-exercise activities to pursue, including training opportunities and pediatric-specific resources and supplies. 

As RIDOH and HCRI continue their collaborative efforts to enhance the healthcare system’s emergency preparedness and response capabilities, considerations related to the management of pediatric patients will remain a focus and will be incorporated into future training and exercise opportunities. 

Upcoming Year Plans:

In early 2023, staff from the MCH program and RIDOH’s Center for Emergency Preparedness and Response began convening to discuss an MCH-specific response reference guide, modeled after HHS’s Maternal-Child Health Emergency Planning Toolkit. Throughout the project period, work to build this reference guide will be ongoing. MCH and emergency preparedness tools and training will be shared and, as future plans, training, and exercises are developed, MCH partners will be consulted to ensure appropriate MCH integration. 

By June 30, 2024, the Healthcare Coalition of Rhode Island will develop and exercise the Chemical Emergency Surge Annex to its Response Plan. Both the plan and the exercise will incorporate response considerations for pregnant people, infants, and children. MCH partners will be consulted to provide input to the plan and exercise. As part of the follow-up from a previous pediatric burn surge exercise, the Healthcare Coalition of Rhode Island and the Rhode Island Emergency Management Agency will be hosting the DHS/FEMA-funded course, Pediatric Disaster Response and Emergency Preparedness, in December 2023.