The welfare and safety of Ohio citizens is severely threatened during disasters. The goal of emergency management is to ensure that in disaster response, mitigation, preparedness, and recovery actions, the State effectively functions so that public welfare and safety is preserved and restored. The Ohio Emergency Operations Plan (Ohio EOP) is an integral element of the State’s emergency management response effort. State agencies in Ohio cooperate with the Ohio Department of Public Safety, through the Ohio Emergency Management Agency (Ohio EMA), in an ongoing planning process for the Ohio EOP.

The Ohio EOP establishes a comprehensive framework through which State of Ohio agencies and other designated non-state agencies assist local jurisdictions to respond to and recover from disasters that affect the health, safety, and welfare of the citizens of Ohio. The Ohio EOP follows the Emergency Support Function structure as outlined in the U.S. Department of Homeland Security's National Response Framework and incorporates the National Incident Management System. The Ohio EOP is available electronically at the Ohio EMA website at https://ema.ohio.gov/EOP_Overview.aspx. Ohio’s EOP is reviewed and updated on a four-year schedule with 25% updated each year due to the large number of documents that comprise the entire state EOP. The Ohio Department of Health, including the Title V MCH program, supports the update and development of tabs within the Ohio EOP.

In addition, Ohio Department of Health’s (ODH) Bureau of Health Preparedness (BHP) provides direction, support, and coordination in preventing, preparing for, and responding to events that threaten the public’s health. ODH takes a whole community approach to preparedness and response. Whole-community planning and response means considering the whole community as our baseline to ensure that everyone is being effectively served. A plan/response is effective when it serves the most vulnerable members of the community. ODH engages representatives of populations with access and functional needs, including subject matter experts within the MCH program. “Access and Functional Needs” replaces the old terminology of “special needs,” to better operationalize the myriad needs individuals may have during emergencies. Access and functional needs include anything that may make it more difficult– or even impossible– to access, without accommodations, the resources, support, and interventions available during an emergency.

ODH utilizes the CMIST framework to address access and functional needs in emergency plans and responses. The CMIST framework defines the components of access and functional needs:

• Communication – Refers to limitations in both receiving and providing information (e.g., only speaking a language other than English, not being able to read or write well, or being unable to speak).
• Maintaining Health – Refers to needs associated with managing health conditions that require observation or ongoing treatment (e.g., requiring dialysis or administered oxygen, needing IV therapy or tube feeding, relying on power-dependent equipment to sustain life, or needing medication to maintain optimal levels of health).
• Independence – Maintaining independence is the goal of CMIST.
• Safety and Support – Addresses individuals who may have lost the support of assistants, attendants, family, or friends; or may be unable to cope in new or strange environments (e.g., people with Alzheimer’s or individuals who experience stressors beyond their ability to cope, people who function adequately in a familiar environment but become disoriented in an unfamiliar environment, children who are unaccompanied, or people who are incarcerated).
• Transportation – Refers to needs related to travel (e.g., not having a vehicle or driver’s license, needing specialized transportation, or being unable to navigate existing transportation options).

In addition, ODH champions person-first language and appropriate terminology to engage individuals with access and functional needs. This initiative was rolled out statewide, and all Local Health Departments (LHDs) have adopted the use of appropriate, person-first language.

Emergency planning and preparedness intersects Incident Engagements, Planning Support, and Preparedness Training.

Incident Engagement

The MCH program has a key role in incident response. MCH has provided subject matter experts (SMEs) and supported outreach to impacted populations over a variety of incidents, including, COVID-19, Zika, Ebola, water shortages, and power outages. MCH leadership and other MCH staff are incorporated in ODH’s Incident Management Structure in Planning and Operations sections depending on the event’s needs. During the Zika response, MCH championed interventions to engage pregnant women, women intending to be pregnant, and their partners. Outreach was conducted through a variety of avenues, including WIC and STD clinics. MCH also supported the pregnancy registry, followed-up with impacted families, and ongoing surveillance of birth defects potentially related to Zika. Engaging male partners was an often-overlooked aspect of this response and highlighting this would be important to demonstrate the community-wide perspective that protecting unborn children involves both men and women, not just expectant mothers.

Throughout the COVID-19 pandemic MCH has been integral to ODH’s response. During the COVID-19 outbreak, nearly 50 BMCFH staff contributed to the state’s response. Specifically, BMCFH staff were assigned full-time or volunteered part-time for Ohio’s COVID-19 call centers, participated on state workgroups to develop guidance for sectors operating safely, participated in the Minority Health Strike Force, led the data team responsible for creating the Ohio Public Health Advisory System, and provided support for the state’s population study of coronavirus infection. Staff not involved in the COVID-19 response assumed additional duties to continue non-COVID-19 operations. Early during the COVID-19 pandemic, MCH developed a survey of local partners regarding needed supports for continued operations, including supports for alternate services to accommodate suspension of face-to-face services. MCH routinely developed and updated guidance for locals to ensure safety during COVID-19. In addition, as discussed in other sections of the application, multiple MCH data and surveillance activities have also been modified or expanded to collect data to understand the impacts of COVID-19 and inform planning and response.

Other incidents MCH prepares to engage for include water shortages and power outages. Due to aging infrastructure and environmental hazards, Ohio experiences water shortages. During these shortages, the MCH program identifies the number of impacted WIC recipients and supports messaging through the local health department. This engagement ensures vulnerable families can access supplemental water resources. Accessing water resources could take several forms: ensuring responders serve vulnerable populations, especially women and children who cannot afford to purchase bottled water or who cannot travel to where water is being distributed; making populations aware of the impacts to the water system and available support; and communicating guidance about formula and cooking for families with children.

Ohio also experiences power outages that can have cascading impacts on private water systems and population health, especially during extreme heat or cold. As with water shortages, MCH supports outreach and guidance to ensure impacted families can navigate resources and impacts. Support could include sharing guidance on food safety in home, especially after extended power outages, sharing guidance on generator safety in the home, and support replacement of food for WIC participants.

Planning Support

The MCH program has critical roles in plan development. The MCH program supports updates and development of the Ohio EOP, ODH response plans, and ODH emergency response procedures.

The Ohio EOP is reviewed and updated on a four-year schedule with 25% updated each year due to the large number of documents that comprise the entire state EOP. The Ohio EMA manages the Ohio EOP and coordinates the review and update process. When a section of the Ohio EOP is scheduled for review, the Ohio EMA sends ODH BHP the related documents and the BHP emergency response unit coordinates review within ODH. The review process within ODH includes sharing of the documents with all points of contact and a meeting to discuss proposed revisions. Ohio EMA collates all revisions from the primary and support agencies in the EOP and sends a finalized draft to all state agencies involved for executive signature. The MCH program is included in this process to support the updates of existing and development of new tabs within the Ohio EOP. Review of state EOP documents was suspended in early 2020 due to the COVID-19 response. In spring of 2021 Ohio EMA reached out to ODH BHP to discuss resumption of the review process. Because many staff are still involved in the COVID-19 response, the timeline for revision and completion of review is still being determined. At this time anticipated sections that might be reviewed in 2021 include: ESF #8 Public Health and Medical Services base plan, ESF 8 Tab F Medical Surge Plan, ESF #8 Mass Fatality Incident Response Plan, and ESF #13 Tab B Ohio Medical Countermeasures Security Plan.

MCH also advocates for the needs of women and children in ODH response plans, including the ODH Emergency Response Plan (ERP)- Basic Plan, ODH Pandemic Influenza Response Annex, and ODH Continuity of Operations (COOP) Plan. The ODH ERP is reviewed annually but changes can be made at any time if information from either exercise or real-world event After Action Reports/ Improvement Plans show a need.

Within ODH response plans, MCH supports the refinement and execution of the following response procedures:

• Incident Size-up: defines the process for determining activation of the response plan, setting objectives, and identifying key partners to engage.
• CMIST Size-up: identifies the access and functional needs in the impacted area and strategies to serving the whole community
• CMIST Profile: Defines the key CMIST demographic info for the State of Ohio; each county in the state has their own CMIST profile
• Internal SME Contact List: Defines the key personnel who would be called on to support response efforts, based on incident needs.
• Communicating with and about: Describes person-first language and identifies appropriate terminology for various types of access and functional needs
• Water Shortage: defines the response steps taken by ODH to support local response to water shortages

Specific MCH considerations in the ODH Pandemic Influenza Response Annex include: leveraging the school nurse program during pandemics, including the school nurse reporting database for absences and closures due to illness; supporting outreach strategies to vaccinate women and children during a pandemic; pregnant women, infants and children with related medical needs are in Tier 1 of vaccination priorities; and supporting the provision of guidance through established channels programmatically and with LHDs.

Within the ODH COOP, MCH has two essential functions identified to ensures that these functions will continue without interruption, even during the direst circumstances. The two identified essential functions are Bicillin provision for Syphilis treatment and the Metabolic Formula program within the Children with Medical Handicaps program.

In late 2020, MCH and BHP jointly participated in AMCHP’s Action Learning Collaborative (ALC) to better integrate considerations of the MCH population into ODH’s planning and response functions. The ALC provided a structured process to identify areas for improvement while balancing the ease of implementing improvement strategies and the anticipated impact of the improvement strategies. To improve collaboration, BMCFH and BHP leadership have begun meeting quarterly to discuss shared issues. BMCFH has shared information about Title V, bureau programs, and MCH population considerations to educate BHP staff. In turn, BHP presented on public health emergency preparedness during Preparedness Month (September ‘21) at the BMCFH Learning Session to educate BMCFH staff. BMCFH staff have also been working with BHP to update the COOP and are planning for a comprehensive review of the EOP to recommend areas where considerations for the MCH population could be added. During the COVID-19 response, BMCFH leadership received the daily Situation Report, call center script updates, and an invitation to a daily department leadership briefing call. BMCFH was invited to participate in an interview that will contribute to the ODH COVID-19 After Action Report. One gap that has been identified is that while MCH staff are often pulled to serve in Incident Command roles there is not a designated MCH role in ICS. This means that while MCH is technically represented, often MCH perspectives are not requested, and so MCH population needs may not be fully assessed and addressed. BHP and BMCFH are committed to continuing to enhance our partnership to better serve MCH populations.

Other outgrowths of the Action Learning Collaborative include staff from BMCFH were trained to assist with pushing messages through the public health emergency communication system; staff from BMCFH participated on a small workgroup with staff in Preparedness to work on emergency preparedness for Ohioans with special needs; and in the last year, the chiefs of the bureau of MCFH and Health Preparedness now report to the same up chain manager, facilitating closer collaboration.

Preparedness Training

ODH facilitates trainings to support health preparedness. Trainings are made available through webinars and/or integrated into grant requirements (* = Previous PHEP grant requirement and ongoing recommended training; ** = Identified in PHEP grant as a recommended training):

• 20 Things Every School Nurse Should Know about Preparedness
• CMIST Introduction Webinar*
• Disability Training for Emergency Planners: Serving People with Disabilities* (available on Ohio Train)
• Emergency Response for People Who Have Access and Functional Needs. (http://terrorism.spcollege.edu/SPAWARAFN/guide.html)**
• IS-368: Including People with Disabilities & Others with Access & Functional Needs in Disaster Operations**
• L197: Integrating Access and Functional Needs into Emergency Planning**

During the COVID-19 pandemic additional trainings were provided across numerous topics and through numerous programs to support MCH populations and professionals serving these populations.