A public health emergency is a natural or human-made event that negatively affects the health of a population and creates the conditions for widespread illness or disability. Public health emergencies disrupt lives, families, and communities. They fall into three categories: natural disasters, such as hurricanes, tornadoes, wildfires, floods, and earthquakes; Emerging or significant outbreaks of diseases, such as Covid-19, Zika virus, Ebola, and pandemic influenza; and human-caused disasters, such as nuclear accidents, bioterrorist attacks, and war.

For any public health emergency, there are four cyclical and recurring phases of management: mitigation, preparedness, response, and recovery.

Mitigation: Actions taken to prevent and reduce the overall cause and impact of disasters including, but not limited to: constructing levees or other permanent barriers to control flooding, tying down buildings with ground anchors to withstand high winds, and buying insurance policies.

Preparedness: Planning, training, and education for disaster events that cannot be mitigated or prevented, such as participating in disaster drills and tabletop exercises, and developing preparedness plans for what to do in case of a disaster.

Response: Actions taken in the duration or immediate aftermath of a disaster, including implementing disaster response plans, addressing public health concerns such as disease spread and food contamination, and conducting search and rescue missions.

Recovery: Efforts occurring when regular operations and activities are re-established. The recovery period can often be prolonged and includes activities such as preventing or alleviating financial burden, rebuilding damage structures, and starting mitigation activities to lessen vulnerability during future disasters.

In this video clip (3:38), Dr. Wanda Barfield, Director of the Division of Reproductive Health at the CDC, addresses the importance of centering women of reproductive age – specifically pregnant and postpartum people, and infants – in emergency preparedness and response. She provides poignant examples of successes and unique challenges for these populations that surfaced during multiple types of recent emergencies.

Other reasons why we choose to center these populations include:

• Federal legislation identifies pregnant and postpartum women and infants as populations with special clinical considerations in public health emergencies;
• People who are pregnant or postpartum may experience higher rates of poor reproductive outcomes during and after disasters, such as miscarriages, premature deliveries, cases of intrauterine growth restriction (IUGR), low birth weight infants, sexual violence, and lack of access to contraception²;
• Pregnant, postpartum, and breastfeeding people and infants may be uniquely impacted by public health issues resulting from disasters, such as contaminated food and water sources²; and
• Focusing on the specific circumstances experienced by people who are pregnant and postpartum and infants contributes to an “all hazards approach” by ensuring that health and other systems have the capacity to address the broadest possible range of emergency needs. This includes preventing excess adverse outcomes and exacerbations of existing health disparities in pregnancy-related morbidity and mortality.

Disasters occur within a specific context based on a community’s geographic, cultural, demographic, political, and historical characteristics, which produce unique considerations for each¹.. They require tailored solutions. As an example, the Stafford Act requires FEMA assistance be delivered in an equitable manner without discrimination on the grounds of race, color, religion, nationality, sex, age, disability, language accessibility, or economic status. However, this cannot be done through a one-size-fits-all approach.

Executive Order 13985 (January 20, 2021) defines equity as “the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.”

Watch this video clip (2:30) that describes the critical need to apply equity frameworks across all phases of emergency management. This perspective is reinforced by federal entities, such as the Federal Emergency Management Agency (FEMA). Pages 9-13 of their strategic plan identifies opportunities to “instill equity as a foundation of emergency management,” such as:

• Understand the factors that affect a community’s resilience and vulnerability to disasters;
• Proactively and continuously engage state, local, tribal, and territorial partners, local community leaders, and other community representatives to gain insight into how programs can better serve them;
• Make space to invite and elevate diverse voices, and to foster mutual understanding and respect for [different] perspectives and experiences;
• Deliberately [define] what success looks like for each user of each program in a manner that can be consistently measures;
• Routinely evaluate programs and policies for disparities in outcomes; and
• Conduct ongoing equity-based evaluations across programs, as well as partner with external organizations experienced in this work.

WATCH:This video clip (4:47) connects gains in individual knowledge, skills, and abilities to collective emergency response capability. It references two federal guidance documents from the fields introduced above that learners are encouraged to explore in greater depth. Presenter: Mikayla Frye, Program Manager for Workforce Development and Capacity Building, AMCHP.

• Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health, 2018 Update (Centers for Disease Control and Prevention)
• Maternal and Child Health Leadership Competencies, Version 4.5 (Health Resources and Services Administration)

Watch the following video clips to learn about a few activities included in the checklist for Strategy #2. You can find the complete list of Checklist activities that support Strategy #2 in the Checklist document offered for download at the start of this course.

PHEP Capability	Activity	Presenter	Length	Selection Rationale	Play Video
Community Preparedness	S2-A1: During the last three years, has MCH published a report that describes demographic characteristics and locations of high-risk MCH populations who may be particularly vulnerable to effects of an emergency?	Marianne Zotti, DrPH, FAAN Emeritus	1:49	Factors associated with increased vulnerability also impact the ability to withstand and recover from disasters.
Community Preparedness	S2-A2: Have two or more MCH or jurisdiction epidemiologists estimated the number of pregnant women in a jurisdiction?	Marianne Zotti, DrPH, FAAN Emeritus	1:06	Estimates can provide the justification for specific planning and response efforts.
Community Preparedness	S2-A3: During the next three years, will your jurisdiction assess emergency preparedness among postpartum women using the Pregnancy Risk Assessment Monitoring System (PRAMS) or a PRAMS-like survey?	Marianne Zotti, DrPH, FAAN Emeritus	1:08	Most jurisdictions participate in PRAMS and can opt into the emergency preparedness module.
Public Health Surveillance and Epidemiological Investigation	S2-A5: After at least one emergency response in the last three years, have MCH leaders and/or responders identified facilitators and barriers to collecting timely, actionable data about salient conditions and outcomes among pregnant and postpartum women and infants?	Amy Moskovitz, MPH, CLC	0:43	Prompts critical thinking about what has/has not been collected in past emergencies and why, which can inform protocols moving forward.

Addressing maternal and infant health needs in planning for and responding to emergencies cannot be disconnected from the broader pursuit of equitable outcomes for all. This video clip (1:42) demonstrates how to apply an equity lens in implementing a specific capacity building activity (S2-A5). A primary takeaway is to recognize and address the structural limitations and unintentional biases in surveillance systems and practices. Presenter: Ben Kaufman, Associate Director for Workforce Development and Capacity Building, AMCHP.

Please select either (a) PRAMS or (b) the CDC Pregnancy Estimator tool to explore in more detail or choose to explore both if you are interested and time permits.

PRAMS

EXPLORE: On the PRAMS page of the CDC website, you can view the core and supplemental questionnaires, learn about methodology, see which jurisdictions participate, access released data, read success stories, and more.

WATCH: In this video clip (3:39), Penelope Strid, MPH, CDC epidemiologist, describes what PRAMS is and the eight-part preparedness question that is currently offered as standard. She briefly reviews how this was implemented and analyzed in two states, Hawaii and Tennessee, including how Hawaii stratified their analyses.

CDC Pregnancy Estimator Tool

EXPLORE: On the DRH EPR Tools and Resources page of the CDC website, you can scroll down to the “Pregnancy Estimator” section to find .pdf copies of a simulated example and point-in-time calculator form, as well as a geographic calculator (.xlsx) to generate estimates for your jurisdiction. There is also a brochure (link) that explains the tool in more detail.

WATCH: In this “Voices from the Field” video clip (0:43), Andrea Lenartz, MPH, former CSTE Applied Epidemiology Fellow for Maine shows how they use the Pregnancy Estimator Tool and other sources (e.g., Social Vulnerability Index) to visualize data they are asked to gather in S2-A1.

Watch the following video clips to learn about a few activities included in the checklist for Strategy #4. You can find the complete list of Checklist activities that support Strategy #4 in the Checklist document offered for download at the start of this course.

PHEP Capability	Activity	Presenter	Length	Selection Rationale	Play Video
Community Preparedness	S4-A2. Does the MCH Program annually review hospital protocols for discharging newborns and postpartum women after an emergency, including those who are displaced from their disaster-affected homes?	Marianne Zotti, DrPH, FAAN Emeritus	1:35	Critical for maternal morbidity and mortality prevention, with shared relevance for clinical and public health professionals.
Public Health Laboratory Testing	S4-A5. Does the MCH Program annually review and update contingency plans for newborn screening during and after emergencies?	Amy Moskovitz, MPH, CLC	1:59	Clear life and death implications for high-risk infants, as well as initiation and continuity of care for those with identified conditions.

Addressing maternal and infant health needs in planning for and responding to emergencies cannot be disconnected from the broader pursuit of equitable outcomes for all. This video clip (2:28) demonstrates how to apply an equity lens in implementing a specific capacity building activity (S4-A2). A primary takeaway is to be intentional about reaching out to hospitals serving communities that have been made more vulnerable (by structural racism, geographic isolation, etc.) to the impacts of public health emergencies; their experiences can inform discharge protocols that can ensure the safety of all people who are pregnant and postpartum and newborns. Presenter: Mikayla Frye, Program Manager for Workforce Development and Capacity Building, AMCHP.

Please select either (a) hospital protocols for discharging newborns and postpartum women or (b) contingency plans for newborn screening to explore in more detail or choose to explore both if you are interested and time permits.

Hospital protocols for discharging newborns and postpartum women

EXPLORE: On the Hospital Preparedness Program (HPP) page of the Administration for Strategic Preparedness and Response (ASPR) website, you can learn about how this program is rolled out across jurisdictions (scroll to “Core Member Spotlights”) and access related resources.

WATCH: This video clip (6:48) is excerpted from a presentation by Kay Daniels, MD, Clinical Professor of Obstetrics and Gynecology at Stanford University. She frames her interest and experience in hospital preparedness, discusses the multiple layers of acuity and needs among maternal and infant populations in hospitals, addresses challenges associated with emergency transfers, and uses a wildfire example to underscore the need for standard evacuation, transfer, and discharge protocols.

Contingency plans for newborn screening

EXPLORE: The CDC’s National Contingency Plan for Newborn Screening (CONPLAN) is a detailed document that captures the vast newborn screening network in eight key strategic objectives and identifies challenges that may disrupt time-sensitive processes during and in the aftermath of public health emergencies.

WATCH: This video clip (5:45) is excerpted from a presentation by Sabra Anckner, RN, MSN, Associate Director for Clinical and Community Collaboration, AMCHP. She frames her interest and experience in newborn blood spot screening, uses a hurricane example to describe the process and what is needed to ensure continuity of operations during a disaster, and shares critical considerations related to the transportation and delivery of samples, communications with hospitals, and follow up support for families of children with an identified special health care need.

Based on what you’ve learned, answer the following multiple-choice questions. When you click “submit,” you will see which of your responses were correct. For those questions you answered incorrectly, the correct answer will also be visibly indicated. For all questions, a brief statement justifying the correct answer will be provided.

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