Evacuation - Supervision

Many people need help with activities of daily living. Family members or paid caregivers are likely to provide this support. People who need help may have Alzheimer's disease, psychiatric conditions like schizophrenia or depression, or other mental disabilities. Children and the elderly also may need supervision. In an emergency or disaster, they may lose the support of their caregiver. Planners need to include caregivers at all stages of planning. This way, a proper response to people needing supervision help is more likely.

• Preparedness
• Response
• Recovery
• Mitigation
• Additional Resources

Preparedness

There may be people in a community who rely on supervision or support. In order to maintain these supports, planners should reach out to people and service groups well before an event occurs.

Create partnerships with community groups. There may be community groups that provide supervision to those who need it. Planners should connect with these groups before an event. Planners should also consider how a group's services could help the planning process.

• For example: The Alzheimer's Association Safe Return program can help a person with Alzheimer's disease if he or she wanders off and becomes lost. Planners should ask people with Alzheimer's to register in the Safe Return Program. Registration may include personal contact information, medicines required, and doctor information. Moreover, planners should contact groups like Safe Return to find available resources before an event.

Educate the community. Being prepared is very important. Planners should ask citizens to:

• Build an emergency kit. See ready.gov for more information on what to include.
• Set up a support network in case the caregiver is absent during an event.
• Make sure that the support network knows the following information about the person: medical history, medications, and physician information.
• Make sure that extra medications are easy to reach.

Case Study: In 1997, the New York City Office of Emergency Management held an urban terrorism drill called the Interagency Chemical Exercise (I.C.E.). The drill included disability issues to give first responders a realistic situation. The goal was to teach response agencies how to improve plans. The drill showed that there was no way to identify victims. If people who need supervision are not identified, it will be hard to notify next of kin or care providers. This could delay important decisions like medical care and transport. Lesson Learned:Planners should develop a system to identify and track victims who need supervision.

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Response

When planning for evacuation, planners need to remember that many people with supervision needs may not be comfortable with emergencies. For example, people with dementia may have more stress and confusion due to a change of location. Strange noises and activities may also cause stress and confusion. Plans should try to limit stress and confusion.

Include caregivers in plans. Caregivers should evacuate with individuals they assist to ease any stress caused by change in location(s). When planning, make sure there is room for caregivers in specialized vehicles and destinations. Planners should also:

• Share information about safe places that can meet special needs.
• Make sure to target caregivers in communications plans.
• Ask caregivers to notify others (e.g., friends, family, medical personnel) when they move locations. Caregivers should give their contact information when possible.
• Train first responders how to help people who need supervision. People and groups that provide this care can give helpful input in support training.
• Tell responders about the different facilities available to meet people's needs so they can triage or refer as needed.

Case Study: In shelters set up after Hurricane Katrina, people with psychiatric needs often faced poor conditions and prejudicial treatment. Shelters were crowded, noisy, chaotic, confusing, and in some cases violent. Shelter conditions were unsafe for people with psychosis, anxiety, or depression. Many people with psychiatric disabilities were turned away from shelters. Others were put behind physical barriers to segregate them from the general population. Most special needs shelters were set up to help those with medical and physical disabilities, but not those with psychiatric needs. Many who were turned away from shelters ended up living on the streets with no services. Others were dumped into jails, emergency rooms, nursing homes, or mental institutions. Lesson Learned:Include mental health professionals and other volunteers in shelter planning. This will ensure that people needing supervision have adequate support. Work with the American Red Cross when planning for shelters.

Plan for shelter resources. Many general shelters may not be able to handle the needs of people who rely on supervision. Caregivers or family members may be able to provide direct support for these persons at a shelter. Planners need to include caregivers or the support of other volunteers in shelter plans.

• Assure that caregivers can stay with their family member or client.
• Include volunteers in planning to help those who may have been separated from their caregivers.
• People with mental or emotional conditions may have unstable behavior. Include ways to provide security for these persons and others at the shelter.
• Provide for mental health support in shelters. People with chronic psychiatric problems may need more help than the general population. Some individuals also may need professional help in addressing post traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social phobia, major depression, schizophrenia, etc.
• The safety of disaster victims is a chief concern for all disaster service providers. Health services and mental health service personnel working in supervisory capacities are encouraged to make referrals to other locations that may provide appropriate levels of care as necessary.

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Recovery

Ideally, caregivers can help those in need of supervision return home after an event. However, caregivers may not always be available to help. Planning should include ways to request and help shelter workers in contacting someone's next of kin. In addition, planners may help provide support until temporary arrangements can be made.

Help with victim tracking. Like the many people, those with supervision needs may become disoriented and get lost. Planners should work with community groups to set up a system to track victims who may have become disoriented. Planners can help create call-in centers or computerized tracking systems. These systems will help reconnect people with their support networks and speed recovery.

Provide mental health support. Provide access to mental health support after an event. The extra stress of an event and a change in routine may worsen an individual's condition. Look for ways to provide long-term crisis counseling, particularly to people with chronic mental health needs and others who have suffered mental health issues resulting from the emergency or disaster.

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Mitigation

After an event, planners should draft after action reports (AAR). The AAR includes information on what support people required and if their needs were met during the disaster. The report may also include lessons learned to revise and improve plans. If the plan did not provide adequate supervision for people, consider ways to improve the plan. The report should include feedback from caregivers and people with supervision needs.

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Additional Resources

• Caring for Someone with Dementia in a Disaster, FEMA
  
  This website provides useful tips for caregivers of people with Alzheimer's or other forms of dementia. The website also lists useful items to keep in an emergency kit.
  
  Access this document at: http://www.fema.gov/plan/prepare/dementia.shtm
  
  
• Disaster Mitigation and Persons with Disabilities, Peter Blanck, et. al.
  
  This web cast emphasizes the need for people with disabilities to store enough supplies to maintain independence for up to 72 hours, should an evacuation become necessary. Additionally, people should learn about support resources in communities nearby.
  
  Access this document at: http://www.ilru.org/html/training/webcasts/handouts/2003/08-27-PB/Transcript.txt
  
  
• Disaster Mitigation for Persons with Disabilities: Fostering a New Dialogue, Peter David Blanck This report advocates training for responders in using medical support equipment. It also suggests that the emergency response community should reach out to volunteer organizations to provide similar training.
  
  Access this document at: http://www.annenberg.northwestern.edu/pubs/disada/
  
  
• Earthquake Tips for People with Disabilities, June Isaacson Kailes
  
  Recommendations include: establishing a personal support network; conducting an "Ability Self-Assessment"; collecting supplies to keep at all times; collecting disability-related supplies for emergency kits; maintaining a seven-day supply of essential medications; keeping important equipment and assistive devices in consistent, convenient and secured places; and practicing assertiveness skills.
  
  Access this document at: http://www.preparenow.org/eqtips.html
  
  
• Emergency Tipsheets for People with Disabilities and Medical Concerns, Independent Living Resource Center of San Francisco
  
  The 10 sheets offer tips for people with: cognitive disabilities, communication disabilities, disabilities and medical concerns, environmental or chemical sensitivities, hearing impairments, life-support systems, mobility concerns, psychiatric disabilities, visual disabilities, and service animals or pets. The sheets lists information by category on what people can do before, during and after disasters. The document also includes a checklist for people to use to prepare.
  
  Access this document at: http://www.prepare.org/disabilities/disabilities.htm
  
  
• Essential Plan Elements for External Disaster Plans in California Long Term Care Facilities, California Hospital Association
  
  This document makes a number of recommendations for long term care facilities including addressing transportation, sheltering in the facility, and evacuation plans.
  
  Access this document at: http://www.calhealth.org/public/press/Article%5C107%5CEssentialElementsforExternalDisasterPlans.pdf (PDF - 32 KB)
  
  
• How to Develop a Disaster Action Plan for Older, Distant Relatives, Jane Irene Kelly
  
  This document lists ten steps on how to prepare older family members for a disaster.
  
  Access this document at: http://www.aarp.org/bulletin/yourlife/Articles/0505_sidebar_11.html
  
  
• Last Invited In, Forced to be Last Out, Illinois Assistive Technology Project
  
  This article discusses evacuation methods and devices for people with disabilities.
  
  Access this document at http://www.iltech.org/erevac.asp
  
  
• National Capital Region Disability Preparedness Initiative
  
  The National Capital Region has developed an initiative to implement a series of activities that will enhance ongoing UASI emergency planning in the National Capital Region. The activities incorporate preparedness planning for people with disabilities and other special needs.
  
  Access this document at: http://www.disabilitypreparedness-ncr.net/
  
  
• National Council on Disability on Hurricane Katrina Affected Areas September 7, 2005
  
  This letter calls for service and procedural changes in the wake of Hurricane Katrina. The letter recommends getting durable medical equipment from non-traditional sources.
  
  Access this document at: http://katrinadisability.info/NCD.html
  
  
• Orientation Manual for First Responders on the Evacuation of Persons with Disabilities, FEMA
  
  This manual has information on identifying/locating those in a community with disabilities/special needs. The manual also notes how responders can help people with various categories of disabilities, especially carrying techniques for categories of disabilities.
  
  Access this document at: http://www.usfa.dhs.gov/downloads/pdf/publications/FA-235-508.pdf (PDF - 910 KB)
  
  
• Preparing for Disaster for People with Disabilities and other Special Needs, FEMA
  
  This booklet is designed to help those with disabilities, as well as their family/friends/caretakers, prepare for various emergencies. The booklet includes check-lists of items, strategies, potential problem areas, and solutions to consider.
  
  Access this document at: http://www.fema.gov/pdf/library/pfd_all.pdf (PDF - 731 KB)
  
  
• Saving Lives: Including People with Disabilities in Emergency Planning, National Council on Disability
  
  This report, produced by the National Council on Disability (NCD), provides recommendations to the Federal Government regarding the inclusion of people with disabilities in emergency preparedness, disaster relief, and homeland security programs.
  
  Access this document at: http://www.ncd.gov/newsroom/publications/2005/saving_lives.htm
  
  
• Special Needs Shelter, Putnam County, Florida
  
  This page provides a list of evacuation guidelines for people with disabilities. Notably, it suggests designating separate "general population" and "special needs" shelters. People in need of medical support may find it beneficial to shelter in a location with training staff who may support basic medical needs.
  
  Access this document at: http://putnam-fl.com/brd/PCPS/PSN%20Shelters.htm
  
  
• The Needs of People with Psychiatric Disabilities During and After Hurricanes Katrina and Rita, Position Paper and Recommendations, National Council on Disability
  
  This paper researches the experiences of people with psychiatric disabilities during and after Hurricanes Katrina and Rita. It summarizes the major findings and makes general recommendations, as well as specific recommendations for emergency management officials and policymakers at federal, state, and local levels.
  
  Access this document at: http://www.ncd.gov/newsroom/publications/2006/peopleneeds.htm#executive

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