Shrink the Pink Slice – Mass Care Infant/Toddler Feeding Concerns
As emergency managers, while we do not take an oath to “do no harm” like doctors do, I do believe we have an ethical responsibility to make things better for folks in disasters, not worse.
As emergency managers, while we do not take an oath to “do no harm” like doctors do, I do believe we have an ethical responsibility to make things better for folks in disasters, not worse: and this includes the most vulnerable of those adversely impacted – infants and toddlers.
If you are unfamiliar with the term “Pink Slice,” – it’s what you don’t know, you don’t know. It’s another way of describing a “Johari Window” – a social science model created by Joseph Luft and Harrington Ingham in 1955 (Johari is a combination of their first names: Joseph and Harry).
In my role as chair of the IAEM-USA's Children and Disasters Caucus, we were introduced to a registered nurse – Jennifer Hope Russell - who is getting her PhD and asked the Caucus for help with her dissertation research work. She is researching the disaster impacts on nursing mothers. In the back of my mind was baby formula, if someone had a challenge with breastfeeding. That would be a “reasonable accommodation”, right? Guess what: that’s not the right answer for a ton of reasons. Jenny is looking into how much - if any - support there is for breastfeeding in shelters, other disaster fixed feeding sites, etc. I thought this was an interesting question, and I believed I knew the answer, but it turns out I was wrong.
The significant – and long-term health impacting – concern that infants and toddlers are currently being redirected from breastfeeding/human milk to powdered infant formula, in many cases because of a lack of support for breastfeeding at disaster sites, was a Pink Slice for me.
I was under the impression that as part of the disability/access and functional needs (DAFN) support which must be provided in shelters under the 2010 Guidance on Planning for Integration of Functional Needs Support Services in General Population Shelters (FNSS) - from both the US Department of Justice and FEMA - that breastfeeding support was included as part of the durable medical equipment (DME), consumable medical supplies (CMS), and personal assistant service (PAS) guidance described therein. Unfortunately, none of those elements are listed or included. “Formula and baby food are indicated on the appendix for the one day’s worth of meals – in its own column for “infant”, and diapers are in the definition of CMS, but not any of the FNSS shopping lists. And while FEMA has recently updated the baby formula list to include a couple of other options on their Commonly Used Shelter Items catalog (better known as the CUSI), that catalog is still lacking in breastfeeding support equipment and other supplies. And most SLTTs use these guides for their own purchasing (before and during disasters) since they can be pretty sure they will be reimbursed under Stafford Act policies, for declared disasters. So far, we have not found any states, territories, or tribal nations who have built out the full protocols, procedures, training, equipment, supplies, etc. to really support this concern. As noted in the article, there is pending federal legislation on this issue to help alleviate this health risk.
So, if you know anything about me, I put my fingers to my keyboard and wrote an advocacy article - and invited Jenny to co-author it as well.
But that's not all.
While the article does more than just “admire the problem”, it does provide an outline for what could happen in SLTTs to effect positive changes. Through both the CEMIR and Barton Dunant, we are going to see if we can utilize our favorite POETE process for this concern, and actually build out the Plans, Organization (i.e. staffing needed), Equipment, Training, and some sample Exercise templates for the SLTTs to use. We are going to coordinate with the Colorado county we noted in our article, to use as a model (they have done a ton of work already on this issue, and their stuff can be duplicated elsewhere). I hope all of the SLTTs will all adopt some form of change to solve this problem. And we are going to give away this POETE framework at no cost for consulting with us. This is one of the key features of the CEMIR we hope to do on a regular basis: not only document emergency management intelligence needs but provide solutions as well.
Here's what I am doing – and I use a POETE process to create the POETE process we are building for the SLTTS to help solve their feeding health crises for infants/toddlers, during disasters:
Planning: We identified the problem – including gaps in logistical support at the federal, state/tribal/territorial, and local levels, wrote a starter advocacy piece, begun the engagement process with a few jurisdictions to start to build the formal POETE documentation, and are planning more articles. We are also assisting Jenny with her dissertation research – another feature of the CEMIR – melding practitioner expertise with academic needs and capabilities.
Organization: We firmly believe in the whole-community approach to solving this and other emergency management problems. While it may be government-mandated and even government-implemented, it does require support of the corporate world, volunteers, and non-governmental organizations before, during, and after disasters happen. In New Jersey, we are approaching the state through the NJVOAD. In Tennessee, this project will probably be initiated by a children’s hospital (and maybe that state’s milk bank – btw, New Jersey appears not to have a milk bank, so that will be another step in their process). Not sure what we will do with Colorado – which will be the third state. As noted in the article, success will require long-term support from lots of different folks: including the continuous and repeated training needed to support mothers who are breastfeeding in shelters. I am sure one goal for the SLTTs is to have this be a no-cost/low-cost solution – but that should never be a priority for EMs, in my opinion.
Equipment: While we don’t need any equipment (other than laptops, MS-Word, and the internet) to build this out, we are organizing the vendors and NGOs who would likely provide a nationwide capability to provide the CMS and DME to be delivered to shelters, fixed feeding sites, etc. We are going to structure the whole logistical supply-chain for this, probably through local retail stores within each SLTT. Basically, these items are available OTC and are in-stock now at your local Wal-Mart, Walgreens, CVS, Target, etc. I think this is the opportune time to pre-build kits, through NGO and Corporate philanthropic support for each SLTT to have a base supply on-hand. Figuring out temperature controls, storage, delivery, etc. is something to be worked out. The same is true for onsite (at the shelter, etc.) human milk storage. Refrigeration is mentioned in the FNSS guidelines, for medications (such as insulin), but it is not specifically noted to be used for safer storage of human milk. In other words, if you establish that the disaster health services office at a shelter needs a fridge, might as well be for human milk storage, too.
Training: That Colorado county has already done the yeoman’s work on developing PAS training for care assistance to support breastfeeding in disaster shelters, etc. What may be needed is the expansion of this training into other shelter roles (including supervision) such as feeding and dormitory management and probably into other NGO groups which may be involved in sheltering operations (such as the American Red Cross). Also needed will be the training for logistics for awareness and functioning of the supply-chain management associated with the movement and storage of human milk to the shelters.
Exercises: We are going to develop some compartmentalized and broad-scope table-top exercises for this concern, along the POETE model. Included, will be the preparedness-type “so where is your SLTT now, in terms of solving this problem?” one, which we all love to hate. These will be HSEEP-compliant, as are all of the exercises we design. I would love for a jurisdiction to run with this, and then involve the FEMA National Exercise Program folks to help us with the full “run of show” version needed for a ramp-up and down for a hurricane/wildfire notice scenario series.
Does this sound like something you would like to get involved in? We welcome anyone:
Who is a Mass Care and/or logistics SME and wants to help us with this project (remotely only, on a voluntary basis), or
Who is an EM who works directly with/for state, local, territorial and/or tribal governments and wants to start the discussion on reviewing their current ESF#6 plans, RSF health/social services plans, Community Lifeline needs, etc. towards updating them with our whole-community approach to solving infant/toddler feeding issues at shelters and other disaster sites.
Click below, if either is applicable for you. Thanks!
The CEMIR was at the IAEM-USA Region 2’s Conference at Stony Brook University on June 29, 2023. Mike Prasad presented “Introducing the Academic Concept of Emergency Management Intelligence” - more info can be found here.