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School preparedness crucial for safety of children, communities.

First in a series on public health preparedness in conjunction with APHA's National Public Health Week. The event, to be held April 2-8, has a theme of "Take the First Step! Preparedness and Public Health Threats: Addressing the Unique Needs of the Nation's Vulnerable Populations."

Almost 20 years ago, a strong downburst from a storm moving across Orange County, N.Y., slammed into East Coldenham Elementary School, collapsing a cafeteria wall and killing nine children as they ate lunch. Years later on the morning of Sept. 11, 2001, 9,000 schoolchildren were safely evacuated from the vicinity of the World Trade Center in New York City without a single casualty.

While few were prepared for the magnitude of Sept. 11, the East Coldenham Elementary tragedy had triggered a rededication to school preparedness in New York that not only contributed to the safe reunion of more than 1 million students with their loved ones after the terrorist attacks, but prepared schools for their essential role in the healing process. The 1989 disaster at East Coldenham Elementary was a wake-up call for communities and officials in New York and marked the beginning of the state's robust school preparedness efforts, according to Laura Sahr, emergency planning liaison in the New York State Education Department.

"Like many situations, it takes a real tragedy for things to change," Sahr told The Nation's Health.

Following the deaths at East Coldenham Elementary, New York developed regulations requiring all public schools to create multi-hazard emergency plans in coordination with county and local emergency officials, Sahr said, noting that the plans "dealt with anything and everything that could possibly happen." Today, all of New York's 700 public school districts--from large, urban districts with tens of thousands of students to small, rural towns that house kindergarten through high school in the same building--have emergency response plans and test their capabilities annually. Schools are also strongly encouraged to plan emergency drills in coordination with local first responders, as "the time to meet the fire chief is not when the building's on fire," Sahr said. Unfortunately, though, the degree to which New York schools have taken up preparedness efforts is not the norm across the nation, despite the fact that on any given weekday, schools are home to 53 million of the nation's most vulnerable residents.

A January 2006 study published in Pediatrics found "important deficiencies" in school emergency and disaster planning. While 57 percent of the 3,670 school superintendents surveyed nationwide said their school districts had a plan for the prevention of a terrorist or mass-casualty event, about 43 percent reported having no written prevention plan, the study found. Almost a quarter of those surveyed said their school districts' evacuation plan did not include specific details on children with special health care needs. And while almost every school had an evacuation plan, 30 percent of superintendents said an evacuation drill had never been conducted.

The study authors noted that the need for school-based emergency planning has long been recognized, but has usually revolved around natural disasters. It has only been in the past decade or so, with the wave of nationally publicized school shootings, that many schools have realized the need to address the possibility of a mass-casualty event happening inside a school. For example, in a review of the response to the Columbine school shootings in Littleton, Colo., officials found that local special weapons and tactics teams had never considered a school-based scenario before the student shooting occurred and had little knowledge of the school's layout, forcing them to depend on "hastily drawn sketches that were done on the scene," the

Pediatrics study reported.

"(Schools) should be a major and significant part of a community's crisis plan," said William Modzeleski, associate assistant deputy secretary of the U.S. Department of Education's Office of Safe and Drug-Free Schools. "About 100 percent of children between the ages of 5 and 17 are in schools ... so if you ignore schools, you're ignoring a significant population of the overall community."

While preparedness in the face of terrorism and natural disasters has seen increased scrutiny in the past few years, schools had been involved in basic emergency planning long before Sept. 11, Modzeleski told The Nation's Health. Still, research on what works in school-based crisis planning is "in its infancy," according to a 2003 Department of Education planning guide, which explains the four phases of crisis management: mitigation and prevention, preparedness, response and recovery. Modzeleski noted that the fourth phase--recovery--is especially essential. After a crisis, schools play a major part in returning a sense of normalcy not only to children, but to their parents as well. In fact, according to New York's Sahr, among the biggest questions on Sept. 11 was whether schools should open on Sept. 12. Throughout New York City, schools may be open from 7 a.m. to 10 p.m., representing a critical part of a neighborhood's infrastructure. So when schools close, the ripple effects can be felt throughout, said Gregory Thomas, MA, deputy director of planning and response in the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health.

"When schools close, it can create havoc for families both emotionally and economically," Thomas said.

Thomas helped author a 2004 report on how the New York City school system responded to the 2001 terrorist attacks and is also an advisor to the federal government on how schools can prepare for a possible flu pandemic. He said that many urban schools have no choice but to prepare for a crisis, noting that the New York City school system faces challenges every day, from water main breaks and subway disruptions to gas leaks and blackouts. Every school in the city has an emergency plan, though none had planned for a disaster such as that which occurred on Sept. 11, Thomas said. Still, the components of emergency training and New York's requirement that plans be updated yearly laid the foundation for school personnel to keep their students safe and to "think outside of the box when there was no box," he said.

And following the four phases of crisis management while encompassing an all-hazards approach is critical to good planning. To begin the process, Thomas said, school officials must assess the unique aspects of their student population as well as take stock of a school's surrounding environments and geographic location in a community. Issues can range from determining how many students have mobility issues to mapping out the proximity of businesses that could pose a danger--such as an explosion at a nearby gas station--to ensuring all of the school building's locks work properly. Ideally, such a hazards assessment should be carried out with the help of fellow community officials, such as firefighters and police officers.

"The challenge is making sure everyone is involved in creating the plan," Thomas said. "Also, the best plans are conducted with a full committee, from the school custodian to the principal. The whole staff has to be on board."

While preparedness planning can help protect schools from the effects of disaster as well as respond to threats such as school shootings, schools can also become the focal point in preventing the spread of more invisible threats, such as pandemic influenza. Studies have shown that vaccinating schoolchildren against seasonal flu can be key in curbing flu transmission rates. And although a vaccine against potential pandemic strains won't be immediately available if a flu pandemic is triggered, children and schools will play a large role in preventing its spread. Experts at the National Center for Disaster Preparedness noted that few schools have incorporated components into their emergency plans that address the presence of a deadly contagious disease, such as pandemic flu. Thomas, a member of a Department of Education and Centers for Disease Control and Prevention joint task force on schools and pandemic flu, said schools would be a center of attention for health officials trying to track and prevent pandemic flu, as schools would act as a sentinel for transmission trends throughout the larger community. At the federal level, Thomas said he and his colleagues are looking at the unintended consequences of pandemic flu school policies, such as the ripple effects of school closings on a community and ways to regain parents' confidence once it's safe for students to return to class.

"It's difficult to plan for something when you don't even know what it's going to look like," Thomas said.

But experts agree that starting early to implement tried-and-true public health prevention techniques will not only fight pandemic flu, but a host of other illnesses. Perhaps the easiest, most effective and least costly is promoting good hygiene and proper handwashing. According to the National Association of State Boards of Education, schools should at a minimum have handwashing policies for students and teachers, while policy-makers should consider expanding handwashing facilities in schools. Some school districts have already begun planning for a scenario such as pandemic flu. However monitoring and tracking general school preparedness progress is difficult, according to James Bogden, MPH, project director of the National Association of State Boards of Education's Safe and Healthy Schools Project. Local control is a guiding principle of the U.S. education system and therefore school preparedness plans can differ widely from district to district, he said. In addition, creating and exercising preparedness plans as well as training school personnel are among the many competing priorities schools must face every day, he noted.

"Schools are under unprecedented pressure to focus on academic achievement ... with punitive sanctions if you don't raise (testing) scores," said Bogden, a past chair of APHA's School Health and Education Services Section. "But there won't be any sanctions if you don't have an emergency plan in place. If you were a teacher, which would you focus on?"

Bogden said the U.S. Department of Education and CDC have produced "excellent" materials that guide schools through the planning process, but such materials have not been accompanied with dedicated federal funding or mandatory requirements for schools. Modzeleski at the Department of Education said that while every state has requirements for some school drills--such as fire drills--there are no preparedness requirements at the federal level. However, schools that receive funding from the federal Safe and Drug-Free Schools Program--known as Title IV funding--are required to develop a crisis plan.

"Preparedness is absolutely key--all you have to do is look at the lessons of Sept. 11 in New York City," Bogden said. "When's there an attack, an emergency of any kind, every adult with a child first thinks "is my child safe?'"

For more on school preparedness, visit <www.ncdp.mailman.columbia.edu/program_school.htm> or visit <www.nasbe.org/healthy_schools>. For more on National Public Health Week, visit <www.nphw.org>.
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Title Annotation:Planning ahead for health threats
Author:Krisberg, Kim
Publication:The Nation's Health
Geographic Code:1USA
Date:Mar 1, 2007
Words:1793
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