Events of recent years have highlighted the importance of planning and preparing for the continuity of healthcare services in the event of any type of emergency or disaster. Providing healthcare services
to the migrant farmworker population poses a host of challenges to service providers under the best of circumstances--challenges such as isolated rural work and home locations, group housing, mobility, limited English proficiency, cultural factors, transportation, documentation status, and poverty. The significance of these factors is undoubtedly magnified under emergency circumstances. Migrant health centers tend to work with limited staff and budgets to provide services and may find it difficult to
imagine how they could stretch themselves to respond to a crisis. Indeed, even the task of developing an
Emergency Management Plan (EMP) is proving to be difficult for many of those who are engaged in the process.

Clinicians can serve a role in helping patients to avoid disruption of their healthcare needs in an emergency by discussing safety and other prevention measures with them. In particular, those whose well-being is dependent on medications or medical equipment should be encouraged to have a personal emergency plan with important contact information and options for securing needed supplies and care.

For health centers, planning for the ability to continue critical health care services under emergency conditions is challenging, since emergencies are by their very nature unpredictable. An appropriate response will vary depending on the duration, scope, severity and nature of the emergency.

Clinicians are routinely trained to manage medical emergencies by establishing clearly defined roles and functions for the members of the healthcare team, using triage systems, establishing a safe and efficient care environment, reassuring patients through clear communication, and providing treatment swiftly and according to urgency and degree of need. These same principles and skills need to be utilized in emergency or disaster settings and require planning and practice to function effectively in a time of need. Protocols which focus on the ability to prioritize needs and to be able to function with
limited human and material resources must be developed and adequate time for training and drills must be allocated.

Critical issues for clinicians to consider include:

• The need to establish back-up systems for energy generation, documentation, communication and other clinical operations
• Identification and location of high risk patients such as those with disabilities, chronic illnesses, and those who are culturally, linguistically and geographically isolated
• Inclusion of outreach staff and promotores in planning—they can be critical partners in preparing, educating, locating and transporting patients in need
• Training of staff on clinical aspects of possible emergencies relevant to the migrant population or the geographic setting such as pesticide exposure, weather-related emergencies and disease epidemics
  Collaboration with other service providers in planning for continuity of services and clinical supplies
• The need to advocate for an immigrant population that may be fearful of accessing needed services in an emergency
  While there are a growing number of resources for both clinicians and administrators to assist in
  providing services in an emergency situation, there are few resources directed at the unique needs of migrant farmworkers.

The Migrant Clinicians Network, Farmworker Justice and Migrant Health Promotion have collaborated to begin to produce some of those resources, which include:

• Linguistically and culturally appropriate avian flu fact sheets for patients,
• A webcast to assist MHCs in emergency planning (archived at www.cdnetwork.org),
• A promotora curriculum “Emergencies and Natural Disasters” at 
  Relevant tools, protocols and sample emergency plans posted on the MCN website at www.migrantclinician.org/clearinghouse,and
• Health Network, a bridge case management system to assist with continuity of care for
  mobile patients (www.migrantclinician.org/healthnetwork)

For additional technical assistance in planning for the clinical aspects of emergency preparedness, please contact the Migrant Clinicians Network at 512-327-2017.

Candace Kugel, CRNP, CNM
Director of Performance Improvement
Migrant Clinicians Network