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EPI Guide for Emergency Managers, Planners & Responders
The Emergency Preparedness Initiative Guide for Emergency Managers, Planners & Responders is available in both text and PDF formats. The text version of the EPI Guide appears below; the PDF version can be viewed and printed using Adobe Acrobat Reader. If you already have Adobe Acrobat Reader installed, just click on the link below to download the document. If not, then first click on the Abobe icon below to download your free version of Acrobat Reader.
EPI Guide for Emergency Managers, Planners & Responders: PDF Version (147K)
The National Organization on Disability encourages the use of this Guide and permits the reproduction of it in whole or in part so long as credit is properly given to The National Organization on Disability's Emergency Preparedness Initiative Guide on the Special Needs of People with Disabilities.
Emergency management professionals may receive up to three free copies of the Guide. Other requests may include charges for shipping and handling. Requests should be made to epi@nod.org or by fax to (202) 530-0727.
FOREWORD
The tragic attacks of September 11, 2001 changed our way of life. All Americans were awakened to the terrorist threat that will remain in our consciousness. The National Organization on Disability immediately formed a task force comprising U.S. Government officials, disability community leaders and disaster relief groups to identify the special needs of people with disabilities during emergencies and to recommend action. America's disability community includes 54 million men, women and children, many with physical disabilities that impact their hearing, vision and mobility, and others with mental and emotional disabilities.
The Task Force also recognized that special preparedness efforts are just as necessary for the many thousands of other natural and man-made disasters in the United States, including floods, tornadoes, hurricanes, earthquakes, fires, explosions, and transportation catastrophes. In all these emergencies, those with disabilities are especially vulnerable. Our Harris Survey research found that people with disabilities are less prepared and, correspondingly, more anxious than our non-disabled counterparts.
The Task Force effort led to N.O.D.'s Emergency Preparedness Initiative. Its purpose is to ensure that people with disabilities are included in emergency preparedness planning and response at all levels of our society. We appreciate the cooperation of the U.S. Government and the many emergency preparedness officials in states and communities throughout the country who have sought guidance and information. We are also grateful to many other leaders and citizens who have provided encouragement and support for the development of this guide for emergency managers, planners and responders.
People with disabilities, whose very lives depend on thorough planning for emergencies, must be involved in this planning. We urge officials at all levels to recognize the innate resourcefulness, ingenuity and determination gained through the daily challenges of disability that can help the community at large and enhance the effectiveness of emergency operations.
We thank you, the nation's emergency professionals on the front lines of homeland security and disaster preparedness, for including us and working with us toward an America that is safe for all.
Alan A. Reich
President
National Organization on Disability
THE NATIONAL ORGANIZATION ON DISABILITY'S EMERGENCY PREPAREDNESS INITIATIVE
The National Organization on Disability (N.O.D.) launched its Emergency Preparedness Initiative in the wake of the September 11th terrorist attacks. N.O.D. recognized that people with disabilities have a great stake in the effectiveness of public programs aimed at preparing for and responding to all types of disasters.
The Emergency Preparedness Initiative has two main objectives. The first is to make sure that the special needs of people with disabilities are adequately addressed prior to an emergency in order to minimize the adverse impact on them and their communities. This enables emergency responders to make informed decisions for the best use of available resources during emergencies. The second is to ensure that people with disabilities are included in the emergency planning process at all levels of government and the private sector so they can offer their insights, knowledge, and resourcefulness. People with disabilities can contribute greatly to the effectiveness of local emergency management planning.
About This Guide
This Guide highlights key disability concerns to those officials and experts responsible for emergency planning in their communities, and assists them in developing plans that will take into account the needs and insights of people with disabilities before, during and after emergencies. It also is designed to help emergency managers, planners, and responders make the best use of resources to include all citizens of the community in emergency preparedness plans. This Guide is neither a comprehensive emergency preparedness document nor a special needs plan in itself. Rather, it is intended to summarize issues that are critical to the needs of people with disabilities who live in communities all across America - issues that, if thoughtfully considered ahead of time, will make emergency management efforts easier and more effective when disaster arrives.
In this Guide are steps that every emergency preparedness manager can consider in ensuring that the needs and situations of people with disabilities are taken into account in all four phases of emergency management: mitigation, preparedness, response, and recovery. N.O.D. encourages every jurisdiction to develop and customize a plan for its own community in light of the area's specific hazards, its unique population, and its resources available for emergencies.
This document does not propose costly and time-consuming new initiatives, or an entirely separate set of emergency procedures for people with disabilities. It is a call to make sure that the interests of people with disabilities are made a full and enduring part of emergency preparedness efforts - and that community members with disabilities have just as much opportunity as citizens without disabilities to prepare for and survive an emergency.
THE EXPERIENCE OF DISASTER
Natural Disaster: Grand Forks, 1997
People with disabilities must be given priority during a disaster's initial recovery phase to avoid further trauma or interruption of established services.
During the recovery phase of the 1997 flood and fire in Grand Forks, North Dakota, emergency service workers found they needed to pay special attention to people with disabilities in impacted areas to minimize further distress.
One man who used a wheelchair and lived independently was flooded out of his accessible home. After the waters receded, the home needed major repairs and cleanup. The man was offered temporary accessible housing, but it was 250 miles away and would have removed him from his support network. Local emergency planners responded and involved a Volunteer Organizations Active in Disaster (VOAD) member group, which arranged for accelerated, professional repairs and cleanup of his home.
The man was able to return to his accessible home without a prolonged disruption. Emergency planners can often reduce the duration and extent of trauma for people with disabilities. Individuals, their families and their support networks all benefit from a rapid return to their familiar patterns.
Technological Disaster: San Francisco, 2001
Planners must look beyond individuals to support and care networks.
During the rolling blackouts in California during the summer of 2001, the San Francisco Office of Emergency Services (OES) worked with utility companies to be certain that persons relying on life-sustaining electrical equipment were notified in advance by the power authority of a regional energy reduction. This is standard planning everywhere for power concerns and for customers with critical needs.
The San Francisco OES identified potential problems and worked with the local VOAD to address them. These volunteer groups augmented emergency staff and made calls to alert home-based care provider groups and Meals-on-Wheels of upcoming energy reductions. While groups such as Meals-on-Wheels are not considered critical customers, they serve many home-restricted persons who have disabilities, medical conditions, and/or are elderly. The telephone calls enabled the providers to make proper arrangements in advance and either change their cooking schedules or switch to cold meals so no client went without food.
Man-Made Disaster: New York and the Pentagon, 2001
People have survived disasters because of effective emergency planning.
While tremendous destruction and loss of life occurred as a result of the terrorist attacks in New York and Washington, D.C. on September 11, 2001, some individuals with disabilities survived these attacks because of plans that had been made in advance.
After the 1993 World Trade Center bombing, at the suggestion of the local emergency management office, The Associated Blind (a local service provider for low- and no-vision clients) worked with the New York City Fire Department to develop a building evacuation plan and drill for their staff, most of whom have limited or no vision. The Associated Blind wanted a plan for their staff members covering the range of problems that could occur during a disaster. On September 11, their efforts paid off. The entire staff calmly and safely evacuated their building's 9th floor, a success they attribute directly to the customized advance planning and drills.
Also on September 11, a wheelchair user who worked on the 68th floor of the World Trade Center was safely carried from the building, thanks to a specialized chair purchased after the 1993 bombing. A Port Authority of New York and New Jersey employee escaped from the 70th floor because his prosthetic leg allowed him to keep pace with non-disabled workers on the emergency stairs - and, he says, because of experience gained in the building's frequent fire drills since 1993.
During the attack on the Pentagon, equipment previously installed to help employees and visitors with low or no vision to evacuate the facility in the event of an emergency made it possible for dozens of sighted individuals to flee the smoke-filled corridors as well.
A NATION UNPREPARED: N.O.D./HARRIS SURVEY FINDINGS
Americans are not well prepared for emergencies. An N.O.D./ Harris Poll survey commissioned in November 2001 discovered that 58 percent of people with disabilities did not know whom to contact about emergency plans in their community. Some 61 percent had not made plans to quickly and safely evacuate their homes. And among those who were employed, 50 percent said that no plans had been made to safely evacuate their workplaces. All of these percentages were higher than for people without disabilities.
The survey also found that people with disabilities were far more anxious about their personal safety. Eighteen percent of those with disabilities were extremely or very anxious, compared with just eight percent of the non-disabled population. Another 44 percent of people with disabilities were at least somewhat anxious.
These statistics should improve over time with continued emphasis on preparedness for all people, along with a focus on the special needs of those with disabilities.
PREPARING FOR EMERGENCIES: WORKING WITH THE DISABILITY COMMUNITY
Who are People with Disabilities?
According to the U.S. Census Bureau, 54 million Americans - about one-fifth of the U.S. population - have a disability. That is an astonishing number. Take the population of any community and divide by five. The result approximates the number of residents with disabilities in that community. Of course, some communities will have a larger or smaller proportion of citizens with disabilities, but few vary markedly from this calculation.
It is helpful to set forth a few basic statistics:
- Nearly four million people require the assistance of another person for daily life activities such as getting dressed, eating and bathing (Source: U.S. Census)
- More than eight million Americans have limited vision; 130,000 are totally blind (American Foundation for the Blind).
- 28 million Americans have hearing loss; 500,000 are completely deaf (National Association of the Deaf).
- There are 1.5 million wheelchair users. An additional four million people require mobility aids such as canes and walkers (U.S. Census).
- More than seven million people have mental retardation (U.S. Department of Health and Human Services).
- Many individuals have more than one disability.
Figures like these reflect the range of issues that need to be taken into account in developing and carrying out emergency plans. For instance, mobility limitations may make it difficult to climb up and down stairs or to move quickly over long distances. Vision impairments might impede the reading of signs or the traversing of unfamiliar or altered terrain. Hearing limitations could prevent one from following warnings or instructions. And a variety of mental disabilities might impair an individual's ability to appreciate or respond to an emergency.
Valuable as they are, statistics give emergency planners only a superficial impression of the impact of disability during an emergency. What is more important is the experience of disability, which raises such questions as:
- What is it like to be a person with a disability during and after an emergency?
- Can one hear or understand the warnings?
- Can one quickly exit a home or workplace?
- Can one move about the community after escaping?
- Are there special necessary or even vital daily items (medicines, power supplies, medical devices) that are not likely to be available in emergency shelters?
- Are basic services like restrooms and showers available and accessible to people with disabilities?
These questions are not always easy to answer. That is why it is imperative to analyze the various needs and form meaningful partnerships with the disability community.
PARTNERSHIP WITH THE DISABILITY COMMUNITY: OPPORTUNITIES AND BENEFITS
Involving and listening to people with disabilities assures the best insights for addressing their needs. Emergency planners should:
- Identify those in the community who might have special needs before, during and after a disaster or emergency. Doing so ahead of time results in an improved emergency plan, a better determination of resource needs, and more informed actions and decisions.
- Customize awareness and preparedness messages and materials for specific groups of people, thereby increasing the ability of these individuals to plan and survive in the event of an emergency. Such preparedness allows appropriate allocation of critical personnel, equipment and assets during the response period, and reduces 911 call volume.
- Educate citizens with disabilities about realistic expectations of service during and after an emergency even while demonstrating a serious commitment to their special needs. Such education results in a more cooperative relationship with local authorities and enhances their appreciation of the concerns of people with disabilities. It also leads to improved response by the entire community.
- Learn and gain from the knowledge, experiences, and non-traditional resources the disability community can bring to a partnership effort with emergency professionals. By utilizing and embracing members of the disability community as partners in the planning process, emergency personnel often discover creative solutions before they are needed during an emergency. These solutions may benefit not only the disability community but the general population.
- Work with institutional and industry-specific groups that are not typically considered to be emergency service resources but that can offer valuable and timely support to emergency professionals. Identifying and marshalling these groups ahead of time leads to a better-prepared service community that is able to take on responsibilities during an emergency. It also leads to a unified team able to quickly assess and communicate service gaps during an emergency, and to a host of additional equipment, materials, and skilled personnel.
HOW TO INVOLVE PEOPLE WITH DISABILITIES IN PLANNING
The most effective way to view emergencies through the eyes of people with disabilities is to involve community members with disabilities in the planning and preparation process.
It is important to realize that people with disabilities, even more than other demographic segments of the population, are not a homogeneous group. Individuals with disabilities have differing capabilities, opinions, needs, and circumstances, and no one individual or organization speaks for all people with disabilities. That said, there are a number of organizations in most communities that make a sincere effort both to represent the interests of their constituencies and to work with government and civic officials to ensure that people with and without disabilities work harmoniously on issues of common concern. The three categories of representation are government organizations, institutional partners and advocacy groups.
Government Organizations
Usually, the best place to start in selecting and involving disability representatives is the disability agency or task force within the Governor's office, the Mayor's office, or the county government. Typically, officials in these organizations can assist in identifying a cross-section of disability representatives within a locality.
Other government entities that may be helpful include:
- the Department of Health and/or Mental Health,
- the Department of Aging,
- the Department of Veterans Affairs, and
- the local Americans with Disabilities Act (ADA) Coordinator.
Institutional Participants
Beyond government organizations, examples of institutional participants are:
- Representatives from the home-based care industry, such as the local Visiting Nurse Service and the Home Health Aides Association, among others;
- Residential healthcare facilities, such as nursing homes, skilled care homes, and assisted living facilities;
- The local dialysis treatment network; and
- The ambulette industry.
Advocacy Groups
It is important to include representatives from advocacy groups in the disability community such as:
- The local Independent Living Center,
- Local groups serving specific and general disability populations (e.g., people who are blind, deaf, or have limited mobility or cognitive disabilities), and
- Individuals with disabilities who, though not affiliated with a group, are known to emergency professionals and who are willing to participate in the planning efforts.
What is most important in this process is to select a range of people in terms of both affiliation and disability. Involving people with all major types of disabilities, including sensory, physical, mental and cognitive disabilities, helps to ensure the most complete picture possible of the effect of disasters on people with disabilities.
It is important to understand the local demographics of disability (e.g., large concentrations of citizens with disabilities and senior housing communities). Most people with disabilities live and work independently and are dispersed among the population. A community's emergency planning needs, and the types of people required in the planning process, will be partly determined by such demographics.
A broadly based working group will be able to assist emergency management planners in anticipating the true impact of disaster on people with disabilities. This leads to a more detailed, compre-hensive, and thoughtful response plan for any community.
KNOW YOUR COMMUNITY MEMBERS
Before serving people with disabilities in a community, one must know whom to serve. Some people with disabilities will not require special assistance during an emergency, because they are able to care for themselves. Therefore, while some 20 percent of the total population have a disability, the national planning average used by emergency management offices, according to an informal survey, is notably lower at 10 to 13 percent. This figure acknowledges the self-support capabilities of many people with disabilities while still taking into account those who need help in an emergency. With so many community residents having some sort of disability, planning for emergencies and their aftermath can be a demanding job. It is helpful to:
- First, identify the concentrations of people with disabilities who live in the community. This includes large-scale senior housing developments, residential care facilities, and perhaps schools with large populations of students with disabilities.
- Second, work with local disability organizations to identify clusters of people with disabilities who either live or work in the community. For example, a certain apartment complex may house large numbers of residents with disabilities, even if it is not a disability facility per se. Some employers may hire many people with disabilities. Local disability organizations may help by providing membership rosters.
- Finally, consider developing a Special Needs Registry for the jurisdiction if one does not yet exist, whereby people meeting specified criteria voluntarily list themselves, making the local emergency authority aware of their presence. Some jurisdictions employ this registry only as a means of pre-emergency outreach. Others use it to alert citizens of impending emergencies. Still others rely upon it to assist in evacuations or provide emergency services such as transportation or health care during a disaster. If the community does not currently possess such a registry, creating one should be seriously considered since it can be an extremely useful tool.
If it is decided that a special needs registry will be developed or an existing registry relied upon, there are several issues to take into account:
- If the registry system is developed, will it be approved or mandated by the local authorities?
- Are funding, equipment, and staff available to maintain such a registry? More importantly, are there resources to continually update it once it is created? An out-of-date registry is of less use during a crisis; it may even consume critical resources when emergency responders look for people who no longer live or work where the registry says they do.
- What will be the criteria for inclusion in the registry?
- Who will review applications for inclusion and make eligibility determinations?
- What expectations will be placed on individuals with disabilities once they are listed?
- What allowances and accommodations will be made for people who are temporarily disabled, including those in long-term rehabilitation, recovering from a serious illness or hospitalized?
- What safeguards will be put in place to protect registrants' privacy and the confidential information they provide? When, how and with whom can this information be shared?
Recognize that no matter how comprehensive a registry may be, not all people with disabilities will register. Some people may not wish to identify as having a disability. Others may not view their disability as creating a special need. Still others may not think to register until after they feel the impact of a disaster. Some, despite the most concerted outreach efforts, may not be aware of the registry. Therefore any registry should be considered only as a guide in an emergency, and not as a definitive or exhaustive list.
COMMUNICATION IS THE KEY
Communication is the lifeline of emergency management. This is especially true for people with disabilities, many of whom are unemployed, socially isolated, or in other ways less connected to society than their non-disabled counterparts. Fortunately, most emergency communication can be undertaken at minimal cost, and most disability-targeted communication can be implemented as a simple adjunct to more general strategies.
Communication with members of the disability community must be viewed differently depending on the point at which it is initiated. This can be done:
- Well before an event, as part of a preparedness outreach effort;
- Prior to an event, as an emergency warning or notification;
- During an event, as emergency information and instruction; or
- Following the event, as recovery information.
The medium used to reach people may change at different points in the timeline. In addition, the technology employed may vary, and the amount of labor required to complete the task may change. In general, however, there are some important considerations to keep in mind when directing communication on one's own or in
partnership with the media:
- Television stations must be responsible to all viewers and not run a text message "crawl" across a television screen in any area reserved for closed captioning as this will make both sets of messages unintelligible for deaf or hard of hearing viewers.
- Camera operators and editors need to include the sign language interpreter in the picture if one is interpreting next to the official spokesperson presenting emergency information.
- Those setting up emergency hotlines during an event should include TTY/TDD (text telephone, also known as telecommunication device for the deaf) numbers when available, or the instruction "TTY callers use relay." Make sure the same information is provided by the official spokesperson and is used on television and radio.
- Frequently repeat the most essential emergency information in a simple message format those with cognitive disabilities can follow.
- When posting information on a website, make sure the website is accessible (see details on web accessibility in the "Tools and Resources" section of this guide).
- Provide information in alternate formats (e.g. Braille, cassette, large font, etc.) whenever possible ahead of time based on the needs of the population.
Another Communication Tool: A Disability Phone Tree
A phone tree patterned after existing internal notification and call-down systems is a particularly effective way to reach members of the disability community. It must of course be tested regularly. In addition, through a "reverse tree," members of the disability community can alert emergency professionals to issues of which they may not be aware. An effective and well-designed phone tree thus can multiply outreach and response capabilities while minimizing the number of staff needed to activate the tree at any time.
Community emergency managers should be responsible for initiating communication to the top-level contact persons on each branch of a phone tree. These "branch managers" might be the administrators of residential care facilities; officials at utility companies who maintain lists of life-sustaining equipment customers; staff members of disability organizations; senior housing complex managers; or even government officials providing oversight or regulation of such areas. These officials may already oversee a registry of their own residents, members, constituents or clients. They, along with backup designees, would be responsible for developing and maintaining the smaller branches of their registries and for providing labor, accurate lists, and their own tools (such as the activation of a page message or reverse TTY for some segments of the community) in the event of an emergency.
With a well-designed phone tree system in place, a consistent message is communicated, and members of the disability community have the opportunity to identify any emergency service gaps that may exist. However, even with the best-organized phone tree, it is very important - as well as being standard practice in emergency communication - to identify backup communication measures and not just to rely on telephone or fax capability. E-mail and secure access to web sites have emerged as viable options.
EVACUATION PLANNING FOR PEOPLE WITH DISABILITIES
Not all disasters require residents to flee their homes or businesses. However, the need for escape or rapid exit is common enough that it should be explicitly addressed as part of emergency planning efforts. Such planning can be a lifesaver. Experience demonstrates that people who are aware of evacuation procedures and who engage in escape drills are more successful in fleeing buildings than are those who are unfamiliar with the procedures. This brochure cannot fully cover all the aspects of this complex process (more detailed links are in the section on Tools and Resources, Page 25), but it highlights several that should be considered.
There are several types of facilities and structures where special consideration is required in connection with the evacuation of people with disabilities.
Buildings, Residential Facilities and Other Tall or Large Structures with Relatively Permanent Residents
As part of emergency planning efforts, it is important to work with the administrators of these facilities to ensure that each structure has a workable evacuation plan in place, and that the administrators undertake regular drills so residents or employees within their structures are familiar with these plans. These drills, of course, should pay ade
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