National Association of Perinatal Social Workers CEU Module #1 Lisa Baker, Ph.D., L.C.S.W. Department of Social Work University of Alabama at Birmingham LRBaker@uab.edu Objectives What is a disaster? Effects on families Disasters and children Preparedness Recommendations Preparing families with infants What is a Disaster? An event that exceeds the capabilities of the response – need exceeds resources Loss of life, property and livelihood Alters lives of individuals, families and communities Creates hazardous conditions that exceed ability to endure and succeed Types of disasters Natural Tornados Hurricanes Earthquakes Floods Tsunamis Landslides Wildfires Volcanic explosions Pandemic Flu Man-made Bombings Arson Mass shootings Terrorism Nuclear emergencies Chemical emergencies Mass food & water contamination All-hazards Approach All-hazards Collection of man-made & natural events that have the capacity to cause multiple casualties All-hazards Preparedness Comprehensive preparedness required to manage the casualties resulting from all possible hazards Potential impacts of disaster Immediate needs Communication/information Water, food, shelter Access to resources Transportation Electricity/power/gas Health Care Acute issues/ injuries Exacerbation of chronic illness Long term needs Rebuilding/relocating Infrastructure Financial/economic Psychosocial Health, well-being, complicated loss issues Mental health Time frame of impact can range from hours/days to months/years Psychosocial aspects Mental Health Needs PTSD, Depression, Anxiety Substance abuse Special concern about vulnerable populations Elderly Low income Chronic health care and mental health needs Children C-MIST (Kailes & Enders) Communication, Medical, Independence, Supervision, Transportation Displaced persons after Katrina Decrease in household income Increase in mental health problems Transportation issues Including school and children’s health care Children in disasters Children Major determinants affecting susceptibility Degree of exposure to event Parental response to event Pre-existing Mental health illnesses Age Separation from parents Mitigating factors Early support & intervention Return to normalcy, especially school Key issues include School readiness Reunification Perinatal Health Evidence that disasters impact maternal mental health and some perinatal health outcomes Low birth weight Preterm delivery Maternal depression Anxiety Post traumatic stress Children & Disasters Special challenges Dependent Physically and emotionally Non-communicative Increased anxiety More vulnerable to exposures Especially biological, chemical and radiological/nuclear agents Unable to provide information in a crisis Often separated from caregiver Special health concerns of women and infants Disruption in clean water supply for drinking and bathing Inadequate access to safe food Exposure to environmental toxins Crowded shelter conditions Disruptions of public health and clinical care infrastructure Increase in psychosocial stressors Callaghan, et. Al. (2007). Health concerns of women and infants in times of natural disasters: Lessons learned from Hurricane Katrina. Maternal Child Health Journal, 11 Children with Healthcare Needs 20% of households May include Home Ventilator or other electrical device Wheelchairs/equipment Chronic daily meds Parents not always able to provide correct information 47% of caregivers bringing child to specialty care clinic were unable to provide correct diagnosis (in non-crisis situation) 29% were unable to provide correct medication list Carracio et. Al (1998) Children with Special Healthcare Needs Present a challenge to EMS, non- children’s hospitals Can place undue burden on medical needs shelters Med refill – most common request in shelters Loss of power in home Basic supplies Current level of preparedness Campaigns primarily mass media – education based 3 Steps Be informed Have a plan Have a kit Less than 1/3 public has basic emergency plan Nat’l Ctr. Of Disaster Preparedness at Columbia Univ. Majority of Americans are unprepared for a major disaster Citizen Preparedness Survey Database Report (Dept. Homeland Security, 2007) Growing research base on level of preparedness Reasons why people are not prepared Lack of resources Incomplete knowledge about what to do Competing priorities Especially with complicated care Impediments Barriers Lack of Transportation Caring for Pets Life How do the spare flashlight batteries end up in the Game boy? Steps to Personal Preparedness (Red Cross, FEMA, AAP) Most common recommendations Get informed Make a Plan Assemble a Kit Maintain the Plan 3-day rule Get Informed 1. Community Hazards 2. Community disaster plans 3. Hurricanes Tornados wildfires Response plans evacuation plans shelters Community warning systems Make a Plan Meet with family members Choose “out-of-town” contact Designate a meeting place Complete a Family Communication Plan Plan escape routes Plan for those with special needs Emergency Information Form for Children with Special Needs Plan for pets Prepare for different disasters Especially critical when dealing with children Assemble a Kit General Kit Water & food First aid supplies Medications Radio Small tools Clothing Personal items Copies of ID and important papers Insurance, passports, driver’s license Money Store in large. waterproof container Children Age-related supplies Diapers, wipes, bottles, powdered formula Activities Coloring books, crayons Extra “transition” objects Blankets Stuffed animals Copies of Guardianship related documents Current photos of children Emergency Information Form for Children with Special Health Care Needs 6 Key Elements for Every Disaster Plan 1. 2. 3. 4. 5. 6. Designated shelters for pregnant women & families Basic supplies & equipment for pregnancy women and infants A plan to provide prenatal and well baby care A plan to provide for access to safe environments for delivery A plan to keep families together or reconnect families with infants Specialized educational materials March of Dimes Preparedness considerations for evacuated pregnant women and infants Ascertain pregnancy status as part of intake Make pregnancy tests available Consider contraceptive needs Promote continuation of breastfeeding (more on this later!) Recognize effects of exposures and provide information Determine feasibility of establishing a pregnancy registry to track outcomes Equip DMAT and other response teams with capacity for managing pregnant and lactating women and their infants Callaghan, et. Al. (2007). Health concerns of women and infants in times of natural disasters: Lessons learned from Hurricane Katrina. Maternal Child Health Journal, 11 Infant Feeding post disaster Breastfeeding advantages Milk is nutritionally perfect (even in cases of maternal malnourishment) Readily available Protective against infectious diseases and respiratory illnesses Always correct temp – can prevent hypothermia Hormone release in mother provides stress relief – calming for mother and infant Formula Disadvantages • May not be available • May require brand switch • Errors in prep may occur • Water may be contaminated • Limited or no method of sterilization for bottles & nipples • Limited electricity to cold store opened formula American Academy of Pediatrics Ways to support breastfeeding mothers Keep families together Provide supportive environment Assure mothers that human milk provides adequate nutrition in absence of safe complementary foods Encourage re-initiation of breastfeeding if previously stopped Recommend ready-to-feed formula if breastfeeding not possible Pregnant women and families with infants Before a Disaster Complete general preparedness guidelines In addition: Let healthcare provider know where you will be List all prescriptions and prenatal vitamins Take extras when available Get copy of prenatal records Give other providers contact numbers Any special services or programs During a Disaster Bring any prescriptions when evacuating Keep copy of prenatal records with you Get out and walk every 1-2 hours if driving Wear comfortable shoes Pack snacks Pack maternity clothes Use car seats and helmets for infants and young children If evacuated Keep informed Try to eat throughout the day Do not eat spoiled or questionable food Listen to and follow public announcements Drink bottled water or treated water Recognize symptoms of labor Take measures to reduce stress as much as possible Post-disaster Potential dangers Flood water in streets and buildings Could be contaminated Avoid contact/ wash after contact Toxic exposures Contact health provider if concerned Returning home Bacteria and mold Hard physical work Electrical shocks General safety issues Care Providers Provide support for mothers and families Protect, Promote and Support Protect families Create safe zones where families can stay together Promote breastfeeding Support breastfeeding and alternative feeding Provide lactation consultants Private spaces Provide multi-lingual materials Take home message Preparedness saves lives Special considerations for pregnant women and newborns Research base is growing Promote family-centered care during mass critical care incidents Medical setting is great for preparedness activities Have the discussion Recent Recommendations for Perinatal Populations: Pregnant Women and Infants American Academy of Pediatrics March of Dimes Academy of Breastfeeding Medicine American College of Nurse-Midwives Centers for Disease Control American Red Cross Be Prepared!!