Crises and emergencies can occur at any time, but it may seem as though they happen at the worst possible moment. The ability to respond quickly and competently to any situation will greatly increase the chances of positive outcomes. By planning ahead and putting in place appropriate policies, these problems may be handled with less stress and confusion.

Written policies and procedures, accompanied by training for all staff, are essential. All staff should know what to do and where to go in an emergency situation, whether that emergency involves an injured child or adult; evacuation of the home or center for a fire or chemical spill; or realizing that during a field trip, a child is missing from your sight.

Responding appropriately means preparing adequately through training, practice, and access to necessary information. Here are examples of information that childcare programs should have readily available at all times.

Emergency Information Files

Certain critical information should be gathered on all children and staff and organized in an easy-to-use file. Because information often changes, data on each child should be regularly updated. Examples of critical information include:

• Accurate and current contact names and telephone numbers. Stress the importance of this information, and the need for confidentiality, when orienting new or substitute staff.

In certain types of emergencies, such as evacuation due to fire or flood, you may not have time to gather these separate files. It is a good idea to keep either a copy or a second original of this information in an easily-accessible, portable file that can be located quickly when needed. Make sure to request more than one contact name and number for each child and staff member in the program.

• Names and telephone numbers of medical providers, preferred hospitals.
• Copies of current insurance or Medicaid cards.
• Parent/guardian signatures authorizing emergency care.
• Information on allergies or chronic health conditions.

Remember that confidentiality should always be respected, so emergency information should not be posted openly. Some programs require that this information be maintained in the child's file (or the personnel file for staff). Only staff with a "need to know" should have access to these files. Place this "to go" file where it is inaccessible to visitors, but easily accessible to staff, such as locked in the front drawer of a file cabinet by the door.

Information identifying children or staff with serious allergies (to milk or peanuts, for example) or medical conditions such as asthma or diabetes should be shared with caregivers and other appropriate staff, such as bus drivers or food service managers. Attach simple care plans outlining specific steps to follow if a crisis occurs and maintain this information in a file that is identifiable but not openly posted. Parents should be confident that this information is shared only on a "need-to-know" basis. Remember to take this file on field trips.

Safe Exit Guidelines

A safe exit during an emergency relies on clear, practiced policies. Post a simple map near each exit with arrows showing the path to use when evacuating the area in the event of fire and indicate both primary and secondary escape routes. Windstorms (tornado, hurricane) may require evacuation to another, more secure location or building; post a second map showing evacuation routes to designated areas where staff and children can safely wait for the "all clear" signal. Plan who will give that signal and how.

Have a planned response if violence threatens. Consider a code word or phrase such as "Groundhog Day" or "Birthday Party"that will alert staff that a threat is present without alarming the children. Practice proper responses, such as seeking cover or locking doors. Train all staff, including substitutes and volunteers, in this response. If you are a single family provider, plan a response such as calling 911, or having neighbors aware of a signal prepared for a distress call, such as an outside light. Some telephones have a large emergency button that is automatically programmed to dial 911 or other emergency help numbers when you push it.

Whether your site is home-based or center-based, evacuation and shelter procedures must be clearly identified and regularly practiced. Document practices, including type and date. State childcare licensing laws and Head Start Performance Standards offer guidance in mandated emergency procedures.

Community Emergency Resources

Post emergency phone numbers, resources, and other information in a highly visible place, such as near the door. Emergency telephone numbers and program addresses also should be posted by the telephone. Check state and local licensing requirements, Head Start Performance Standards, and/or accreditation criteria to determine the information required to be posted.

Examples of appropriate information include:

• Location of the nearest phone; keep the area around the phone or intercom clear so that the equipment is easily accessible.
• Emergency assistance numbers, such as 911, sheriff, fire department, and the poison control center.
• Address of the childcare program, name of caregiver, and classroom number (if applicable). Remember, a substitute caregiver or volunteer unfamiliar with the program might be making the telephone call and will need this information.
• Location of fire extinguishers.
• Location of the first aid kit.
• Basic first aid information, including management of dental emergencies, choking responses, and CPR procedures. (See resource section for examples)
• Child abuse hotline numbers.

Properly trained staff should administer care. Remember to track expiration dates of CPR and other certifications to ensure updated skills. Substitute staff who provide care also should maintain these skills.

Nothing helps prepare for an emergency more than practice. Plan drills during arrival and dismissal times, mealtime, naptime, and even outside playtime. Have someone block usual exits to test backup routes. Remember to practice evacuating from vehicles, as well as from the classroom.

Planning, preparing, and practice can help alleviate panic and let childcare programs appropriately respond to problems as they occur.

By Janie Sailors RN, Health Specialist Region IV Head Start Quality Improvement Centers, Western Kentucky University, Bowling Green, KY

Resources

Childcare guidelines including emergency preparation material can be found in Caring for Our Children; National Health and Safety Performance Standards by calling the American Academy of Pediatrics, 800-433-9016.

The text can be found on the National Resource Center for Health and Safety Performance Standards web site: nrc.uchsc.edu.