First Responder Training — BFFC

Welcome

What every first responder needs to know

This training covers North Carolina law, how to respond when someone complains about a breastfeeding parent, and what to do when a lactating parent or formula-dependent infant needs your help in a micro-emergency or large-scale disaster.

It takes about 8 minutes. When you finish, you will receive a digital certificate of completion to share with your department.

~95%

Of infant deaths in emergencies caused by contaminated water & unsanitary conditions

0–2 mo

Formula-dependent infants at this age are most vulnerable in any emergency

#1

Guilford County's rank for infant mortality disparity among NC's five largest counties

Why this matters in Guilford County: Black babies in Guilford County are far more likely to die in their first year of life than white babies — and that gap has not meaningfully changed in 30 years. First responders interact with families every day. The knowledge in this training can make a real difference.

Module 1 of 5 — The Law

North Carolina law protects breastfeeding in public

Five BFFC Breastfeeding Welcome signs — Lactancia Bienvenida — art by L. Jámal Walton, installed in Durham parks

N.C. Gen. Stat. § 14-190.9 (1993) — Public Breastfeeding

"A woman may breastfeed in any public or private location where she is otherwise authorized to be, irrespective of whether the nipple of the mother's breast is uncovered during or incidental to the breastfeeding."

A breastfeeding parent is not in violation of indecent exposure laws. There is no requirement to cover up, move, or stop. This applies in parks, restaurants, stores, libraries, government buildings, and every other public space.

The PUMP Act — Federal Law (effective April 2023)

Employers — including the City of Greensboro and Guilford County — must provide a private space that is not a bathroom and reasonable break time for any employee who needs to express milk, for up to one year after birth. This applies to owned and leased buildings. A supervisor joking that a colleague "has gone home to feed her baby again" can create a hostile work environment under the PUMP Act — that is a legal liability for the city.

When someone complains — do this

Go to the person who complained

Explain breastfeeding is legally protected under NC § 14-190.9

Offer to help them relocate if they are uncomfortable

Support the breastfeeding parent

Never do this

Ask the parent to cover up or move

Side with the person complaining

Treat the breastfeeding parent as the problem

Threaten citation or removal

Key principle: The parent exercising their legal right is not the subject of the call. The call is about someone who is uncomfortable. Those are two different people — respond accordingly.

Module 2 of 5 — Micro-emergencies

Any call involving a family with an infant matters

A car accident, a domestic call, a welfare check, a mental health crisis — any of these can involve a lactating parent and an infant. What you do in the first minutes has real consequences for both of them.

Rule 1 — Keep parents and babies together. Separation disrupts feeding, causes distress to both parent and infant, and can compromise milk supply. An infant that cannot be fed by their parent is at immediate nutritional and emotional risk. Reunite them as quickly as safety allows. Ask: "Is your baby being fed? Do they need to be brought to you?"

Rule 2 — Formula-dependent infants ages 0–2 months are the most vulnerable. Formula requires clean water, a clean container, and a heat source. Any formula or pasteurized milk left out must be discarded after 2 hours — it grows bacteria and yeast and becomes dangerous. Breastmilk is safe at room temperature for up to 6 hours. Nutrition directly from the breast is always the safest option.

Rule 3 — Stress inhibits letdown, not milk supply. A stressed parent can still make milk. Stress affects their ability to release it. A calm, private space helps letdown occur. Infants sense parental stress and will nurse more, cry more, and be fussier — that is a stress response, not a feeding problem. A blanket in the back of a patrol car can be enough.

Rule 1: The Prime Directive — Keep parents and babies together

Scenario A — Parent separated from infant at scene

A lactating parent is at a scene and their infant is with another person or in the vehicle. The infant is unharmed.

Reunite parent and infant as quickly as safety allows. Ask: "Is your baby being fed? Do they need to be brought to you?"

Scenario B — Parent in distress, infant unfed

Parent is upset or in shock and says she cannot breastfeed right now because she is too stressed and her milk won't come.

Reassure her: "Stress affects how easily milk flows, not whether you have it. Let's find somewhere quieter." Create a private, calm space. Even a blanket in the back of a patrol car works.

Scenario C — Formula-dependent infant, no clean water or supplies

The family has powdered formula but no access to clean water, or the formula has been out in an open container for over 2 hours.

Discard the open formula. Contact WIC or an infant feeding specialist. If the parent can breastfeed at all — even partially — encourage it. If formula is unavoidable, ready-to-feed sterile 59 ml / 2 fl oz bottles are the only safe option — already sterile, no water or preparation needed.

Scenario D — Family needs to clean infant feeding supplies

A family needs to wash bottles, cups, or feeding supplies. Only a high-occupancy public restroom is available — not safe for washing baby feeding equipment.

Direct them to a clean sink that is not a public restroom. Ideal supplies: plain unscented bleach (no thickener or fragrance), dish soap, bottle brush, a washbasin, and a way to air dry. If no clean sink is available, single-use disposable cups are safer — use a clean one each time rather than rewashing in potentially contaminated water.

Module 3 of 5 — Large-scale emergencies

Build the relationship before the emergency

BFFC SAFE Team Helene response — food distribution lines, indoor distribution center, specialists walking trails, formula supplies

When Hurricane Helene struck Western NC on September 27, 2024, Asheville's breastfeeding coalition had been building relationships with first responders since 2019. When everything was covered in mud and sewage, those relationships made all the difference.

376

Volunteers mobilized within 7 days of Helene's landfall

1,436

Families served across Western NC

7,000

Rapid infant needs assessments completed over ~6 months of ongoing response

~95%

Of infant deaths in emergencies result from contaminated water & unsanitary conditions

"The infant feeding specialists walked trails, stood in line at food distribution centers, checked formula expiration dates, and conducted rapid needs assessments on families. The first responders carried the kits — on ATVs, by helicopter, lifted by fire wires — getting supplies to families where roads no longer existed. They kept us safe. We knew each other's names and phone numbers before any of that happened. We had had the conversation during blue-skies time." — Love Anderson, CEO, Breastfeeding Family Friendly Communities

WUNC Public Radio · Due South · Nov 25, 2024

"Local organization responds to infant feeding needs in Western NC" →

For department / county leadership

Make this work official in your agency

If you're a chief, captain, EM director, or county leader, here's how to formalize infant feeding in emergencies for your jurisdiction.

SAFE Team · PDF

County Policy Adoption Toolkit →

Model EOP annex language and implementation guide

SAFE Team · Word

Sample IYCF-E County Policy Template →

Editable policy template ready for adoption

SAFE Team · Interactive

IYCF-E Readiness Self-Assessment →

9-question audit for emergency managers

Infant feeding safety in any emergency — safest to least safe

Help families move as high up this list as conditions allow.

1

Direct breastfeeding / chestfeeding

Always safest. No supplies needed. Temperature-regulated. Provides antibodies. If expressed, safe at room temperature for up to 6 hours.

2

Expressed human milk from the parent

Safe if stored correctly. Without refrigeration, use within 6 hours. Assess carefully with spotty power.

3

Pasteurized donor milk — labeled, still frozen

Safe if from a milk bank or known community source. Do not use if thawed and refrozen.

4

Ready-to-feed sterile formula — 59 ml / 2 fl oz bottles with sterile nipple

The only safe formula option in emergencies. Already sterile. No water, no mixing, no preparation needed. Use when formula cannot be avoided.

5

Powdered formula — only with verified clean water

Not sterile. Requires clean water, a clean container, and preparation. High contamination risk. Last resort. Discard if out 2+ hours.

!

Avoid — homemade formula · concentrated formula without clean water · unsolicited donations of unknown origin or storage history

Nutritionally inadequate or cannot be prepared safely without clean water. Discard formula in open, damaged, or flood-exposed containers.

Module 4 of 5 — Knowledge check

Answer all four questions to continue

Select the best answer for each scenario. You'll see immediate feedback and the correct answer if you miss one.

Module 5 of 5 — Commitment & certificate

Check each commitment, then receive your certificate

I know that NC § 14-190.9 protects breastfeeding in any public or private location. When someone complains, I will support the breastfeeding parent and direct my response to the person who is uncomfortable.

I will make every effort to keep lactating parents with their infants during any emergency response.

I know that stress inhibits letdown but not milk supply. I will help create a calm, private space when possible so a lactating parent can feed their infant.

I know formula out for 2+ hours must be discarded. Breastmilk is safe up to 6 hours at room temperature. In emergencies, ready-to-feed sterile 59 ml / 2 fl oz bottles are the only safe formula option.

I will not distribute powdered formula when clean water is unavailable, and I will not hand out unsolicited formula donations without first assessing whether a family actually needs them.

I will direct families needing to clean infant feeding supplies to a clean sink — not a public restroom — and connect them to Every Baby Guilford or BFFC for further support.