A.  DIRECTIONS TO AREA HOSPITALS

APPALACHIAN REGIONAL HOSPITAL, MIDDLESBORO, KY (606 573 8100)
Travel west on 58 to Cumberland Gap, follow signs to Middlesboro via tunnel to 1st traffic light.  Turn left on Cumberland Avenue and go through downtown, staying on Cumberland.  Hospital is on the right, approximately 4 miles

BRISTOL REGIONAL MEDICAL CENTER, BRISTOL, VA (423 968 1121)
From Lee County, travel south on US 23 to Exit 55 in Kingsport (11W or Stone Drive).  Turn left on Stone Drive, traveling toward Bristol.  Go across I-81 (by passing Knoxville/Roanoke exits), turn right at first traffic light onto Medical Park Blvd.  Hospital is on the right.

HOLSTON VALLEY MEDICAL CENTER, KINGSPORT, TN  (423 224 4000)
From Lee County, travel south on US 23 to Exit 55 in Kingsport (11W or Stone Drive).  Turn left on Stone Drive, turn right at 5th red light on Clinchfield, turn left on Ravine, hospital is on the left.

INDIAN PATH HOSPITAL, KINGSPORT, TN (423 378 7500)
From Lee County, travel south on US 23 to Exit 55 in Kingsport (11W or Stone Drive).  Turn left on Stone Drive, go to Rt. 93 and turn left (north), hospital is on the left.

JOHNSON CITY MEDICAL CENTER, JOHNSON CITY, TN  (423 461 6111)
From Lee County, travel south on US 23 Johnson City exit at Kingsport (I-181 south).  Approximately 16 miles take Exit 36, State of Franklin.  Turn right on State of Franklin, stay on road for approximately 2 miles, hospital is on the left.

LEE REGIONAL MEDICAL CENTER, PENNINGTON GAP (276 546 1440)
Go to Pennington Gap on Alt 58, located in west end of town, located on north side of Alt. 58.

LONESOME PINE COMMUNITY HOSPITAL, BIG STONE GAP, VA  (276 523 3111)
Travel east on Alt 50 to Big Stone, going through town (no turns at any traffic lights).  Turn right on First Avenue to reach the hospital which is located on the east side of town.

NORTON COMMUNITY HOSPITAL, NORTON, VA  (276 679 9600)
From Lee County, travel to Highway 23 and go north to first Norton exit.  At end of ramp turn left on 12th Street, go to first traffic light, turn left onto 11th Street, and proceed to 2nd traffic light.  Turn left on Park Avenue and then right on 15th Street which takes you to the hospital parking lot.

St. MARY�S HOSPITAL, NORTON VA  (276 679 9100)
From Lee County, travel to Highway 23 and go north to second Norton exit.  Turn left on 58, then turn right on Park Avenue N.E.  Turn left on 3rd Street and follow signs to hospital.
 

B.  TERRORISM
 

GENERAL INFORMATION

The terrorist attacks in September 2001 have brought to light the need for school crisis management plans to include strategies to protect students and staff in the event of subsequent attacks. Two key variables in responding to a terrorist attack are the nature of the terrorist threat and how much warning time there is available. In all cases of terrorist threat school officials should establish and maintain close communication with local public safety officials.
 

TYPES OF TERRORIST ATTACKS

The Federal Bureau of Investigation (FBI) categorizes terrorism in the United States as one of two types�domestic terrorism or international terrorism.
    1.    Domestic Terrorism:  Involves groups or individuals whose terrorist activities are directed at elements of our government or population without foreign
            direction.
    2.    International Terrorism:  Involves groups or individuals whose terrorist activities are foreign-based and/or directed by countries or groups outside the United
            States or whose activities transcend national boundaries.

According to the Federal Emergency Management Administration (FEMA), the weapons of mass destruction (WMD) likely to be used by terrorists fall into four categories: 1) conventional, 2) chemical, 3) biological, and 4) nuclear. Specific guidelines for schools have not yet been developed; however, some preliminary considerations are set forth below:

Conventional Weapons:  Conventional weapons include bombs and other explosive devices.  The goal is to place students and staff in a protected space and or to increase the distance from the blast area. Possibilities include
· Moving to basement rooms, if possible.
· Move to interior hallways, away from windows, closing doors to exterior rooms.
· Students/staff assume �duck and cover� position.
· Shut off gas utilities.
· If school buildings themselves be targeted, evacuation to other schools or community paces such as community centers or churches should be considered.
· Release students to their parents / other authorized persons in accordance with emergency release procedures.

Chemical Weapons:  Chemical agents are poisonous gases, liquids or solids that have toxic effects on people, animals or plants. Most chemical agents cause serious injuries or death.  The goal is to limit exposure to contaminated air.
· In the absence of gas masks which are not available in sufficient quantity and  present other practical problems, get all students into buildings, close all windows and doors, and shut off heat, ventilation, and air conditioning (HVAC) systems.
· Ground level spaces are preferable to basement areas because vapors may settle and become trapped in basements.
· Decisions to evacuate should be based on reliable information from public safety officials about the location of the chemical release and the direction and speed of winds carrying the agent toward or away from the school.
· If students are released to parents, procedures to minimize the penetration of airborne substances must be employed.

Biological Weapons:  Biological agents are organisms or toxins that have illness-producing effects on people, livestock and crops. They can be dispersed as aerosols or airborne particles.  Biological weapons present a particular challenge because symptoms may not present for days or weeks following exposure. Schools must rely on medical expertise in the development of procedures for responding to biological attack. Consider the following:
· If an attack is identified while it is occurring, schools should get students into buildings, close all doors and windows, and shut down HVAC systems. Just as with chemical weapons, the goal is to prevent or reduce exposure to the substance.
· Release students to their parents / other authorized persons in accordance with emergency release procedures.
· Because many biological weapons are contagious, school will likely be closed after an attack, pending clearance by medical authorities.

Nuclear Weapons:  Just as with conventional weapons, the goal is to place students and staff in a protected space and/or to increase the distance from the  blast area. Such weapons present a threat of not only blast effect but also exposure to radiation. Possibilities include
· Moving to basement rooms, if possible.
· Move to interior hallways, away from windows, closing doors to exterior rooms.
· Students/staff assume �duck and cover� position.
· Shut off gas utilities.
· Release students to their parents / other authorized persons in accordance with emergency release procedures.

Guidelines for Bio-Hazard Threats:  Follow procedures established by your local emergency responders (fire departments, police, SEMA, HAZMAT, etc.) Implement the following procedures if any of your schools receive any kind of bio-hazard threat (including anthrax and chemical agents) or if your schools has a bio-hazard emergency.
· Should you receive such a threat or have an actual bio-hazard emergency, immediately call 911 or report the threat; call the appropriate contact person in your school district.
· The persons immediately exposed to the potential agent MUST remain where they are. They should try to avoid inhaling or touching the substance.
· Try to contain the substance in the package in which it cam. Don�t attempt to clean any spilled contents. Cover the spilled contents and the package or letter with anything handy�trash can, cardboard box, paper, etc.
· Proceed with lock-down procedures. Use a code and explain that information will be forthcoming. Try to dispel alarm and panic by keeping information basic. All staff/students should remain in their respective areas until notified otherwise.
· Do not evacuate students outside or send them home until the emergency  responders have done their investigation.
· If it is necessary to move or evacuate students and staff to a different location, the HAZMAT team or other emergency responder will provide instructions to administrators as to how it will be done. If students and staff are moved/evacuated, remind staff to take their grade books, purses, and seating charts.
· Administration must inform the custodial/maintenance staff to shut down the heating and air handling units in the affected area.
· Keep the faculty, staff and students as informed as necessary. Work with emergency personnel who will provide the necessary and accurate information.
· Debrief students and staff after the incident.

Related Reading:  Guide for All-Hazard, Emergency Operations Planning, State and Local Guide. Chapter 6 -- Terrorism. Federal Emergency Management Administration (FEMA). (2001). Available online at www.fema.gov.

Lessons Learned from September 11 and Recommendations:  To gain a better understanding of actions taken in response to September 11, the U.S. Department of Education has met with educators, students, teachers, administrators, law enforcement officials, medical experts and mental health professionals from around the country. These meetings were very productive, and the following items were determined to be critical elements to ensuring successful crisis management.
· We strongly urge schools to have a plan for dealing with crisis, including crises such as school shootings, suicides, and major accidents, as well as large-scale disasters, such as the events of September 11, that have significant impact on schools throughout the country. We recommend that every school review its school safety plan to ensure that it is comprehensive and addresses a wide range of crisis situations. Schools that do not have a school safety plan should implement a plan immediately. Some suggestions regarding issues that should be addressed in a school safety plan are included at the end of this document.
· Effective school safety plans are developed with input from, and support of, a variety of public and private agencies, including agencies representing law enforcement, fire departments, emergency services, victim services, and agencies responsible for homeland security. To be effective, school safety plans must communicate goals and assignments clearly and be updated regularly to remain relevant over time. Whether schools are reviewing existing plans or developing new ones, they should seek to include agencies with relevant expertise that may not have routinely partnered with schools.
· Developing a comprehensive school safety plan is only part of the task. Schools should conduct practice drills on a regular basis, and the results of practice activities should be reviewed to determine if revisions are needed. Practices can be incorporated within regularly scheduled safety activities, such as fire drills. Schools are encouraged to maintain contact with agencies that respond to crises, such as local law enforcement and fire departments, emergency preparedness agencies, and the National Guard, to ensure schools are included in any community-wide emergency preparedness drills.
· During a crisis, there is no guarantee that normal chains of communication, command, and control will work as intended. Communications between schools and central headquarters can be disrupted, delayed, or otherwise impeded during a crisis. School-level administrators cannot be certain that information, guidance, or orders will be available, and they must have the skills and confidence to respond to any crisis situation they might face. School administrators are encouraged to consider several options for overcoming communication difficulties. First, they may want to  delegate decision-making authority to building-level principals during times of crisis. School district officials should work closely with law enforcement officials and other emergency service agencies in advance of a crisis situation to ensure that clear lines of authority are established and well known. Finally, we encourage officials to work with experts in the telecommunications field to understand what communication links are likely to be affected in certain circumstances, and explore back-up systems or plans, including �low-tech� or nontraditional communications strategies.
· Accurate and timely information on a crisis needs to be provided to students, family members, and faculty when appropriate. Absent such information, rumors and false information are likely to spread, which can cause additional problems for school and law enforcement officials. Therefore, school districts should develop a detailed procedure for providing accurate and timely information to students, parents, and faculty.
· School policies that address typical problems may not provide adequate guidance regarding some situations faced by schools in recent years. Policies need to be reviewed to make sure they address a wide range of situations. We encourage school districts to review policies related to the possession of cell phones, terror hoaxes, and assessment of threats against schools, students, and faculty. We believe all threats made against students, faculty, and school property must be taken seriously and handled appropriately. We also encourage schools to work with parents, faculty and students to develop strategies for publicizing the serious consequences associated with making threats.
· School safety plans must address issues beyond safety, and consider the health and mental health needs of students, faculty, and parents that result from a crisis. Crises such as the ones experienced at Columbine and on September 11 affect students, faculty, and parents, to varying degrees, in every school district. When addressing health and mental health issues, school safety plans should recognize that some students, faculty, and parents might need these health-related services for long periods of time. We recommend that every school safety plan include a section that deals with recovery issues, including the health and mental health needs of students, faculty, and parents.
· Almost every community has access to the health and mental health services that can address the needs of those affected by crisis, but many school districts have not developed linkages with the organizations that can provide these services, and as a result, these services are not immediately available in time of crisis. We encourage school districts to initiate conversations with local health and mental health providers and develop �memoranda of understanding� to delineate roles and responsibilities in times of crisis.
· Schools experiencing major crises invariably receive an outpouring of support from potential volunteers who want to help. However, few districts have a plan in place to screen volunteers to make sure they are qualified and suitable to provide services in schools. We recommend that school safety plans include a process for screening persons who volunteer to assist during a crisis. Schools may want to consider having a cadre of experts and other service providers prescreened, so they can participate in  emergency response activities without any delay.
· Only a few school districts have staff members who are adequately trained to deal with the results of a crisis such as a school shooting or the events of September 11. We encourage every district to designate and train a person, or group, to act as lead official(s) for response to crisis situations.
· Students are sometimes further traumatized by actions taken, often with the best intentions, by teachers, faculty, and parents. Constantly retelling or re-showing portrayals of violent events can have a traumatic effect on students. School districts are encouraged to work with mental health service providers, teachers, and parent groups to establish guidelines for activities that respect the developmental capacity of students.

Additional Considerations for School Safety Plans in Response to September 11:  Schools need to develop comprehensive school safety plans that address the variety of crises they might face. While many schools and school districts have revised school plans to address shootings such as the tragedy at Columbine High School, the terrorist attacks in New York City and Virginia raise concerns that may not be addressed in current plans. The information below identifies specific concerns and suggests possible approaches to addressing them.
· Evacuation: A major crisis may require several schools to be evacuated simultaneously. Because school plans frequently call for students to be evacuated to other schools in the district, alternate evacuation sites and routes should be identified. This will necessitate coordination of safety plans for individual schools with district-wide plans. Special plans are also necessary to address the threat or suspicion of bio-terrorism. In these situations, evacuation procedures must ensure that cross-contamination does not occur.
· Attendance: In a major crisis, schools may need to quickly account for students. A plan for collecting and maintaining accurate attendance figures throughout the school day is necessary to provide data for this process. Schools should remember that attendance records should be stored in locations that are readily accessible to teachers, administrators, emergency service workers, and law enforcement officials.
· Information for Parents: Parents expect schools to provide quick and accurate information regarding the location and status of their children. Schools should establish procedures for making such notifications and should regularly share those procedures with parents. A major crisis impacting an entire community may also require evacuation of parents or other caregivers from their homes or places of employment. As a result, school safety plans need to address alternatives for communicating with parents. This scenario also requires schools to examine procedures for releasing students to parents or other caregivers. If parents or other designated individuals cannot reach their students, or if students cannot be transported to their homes, schools should have a plan to respond appropriately.
· Transportation: Alternate strategies for transporting students during evacuations and/or to their homes must be considered. During a large-scale crisis, usual methods for transporting students may not be available. Further, schools located in some sites such as military bases may be closed to the public, thus alternatives for transporting those students would be necessary.
· Lead Official: Every school site should have one person designated �lead official,� who is well-trained, well-acquainted with all aspects of the school safety plan, and has the authority to take charge during a crisis. In addition to the lead official, schools should have a deputy or assistant lead official in case the lead official is not available in a time of crisis. Lead officials should meet regularly with law enforcement and other emergency responders to clearly define the roles and responsibilities for everyone involved.
 

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