Evacuation - Maintaining Functional Independence

Based on the 2005 American Community Survey, there are 7.5 million people in the U.S. that need assistance to carry out daily activities. This may include getting dressed, eating, and bathing. Nearly 11.3 million people find it difficult to leave the home alone. Many have a physical or mental condition that prevents them from doing so.

People use a variety of supports to assist their daily activities. These supports can range from durable medical equipment, like wheelchairs and walkers, to the aid of another person. In an emergency, these people may lose the aid they need to function independently. Without support, their conditions may worsen. Emergency planners should include ways to support these individuals in their plans.

Preparedness
Response
Recovery
Mitigation
Additional Resources

Preparedness

A community may have a wide variety of supportive needs to plan for. In order to account for these needs, planners should reach out to individuals and organizations well before an event occurs.

Encourage people to report their needs. If someone needs assistance with daily activities, encourage them to make their needs known. Needs might include (but are not limited to):

Assistance with errands or personal care
Personal care equipment
Adaptive feeding devices
Specially-equipped vehicles
Mobility aids
Service animals/pets and ancillary needs for pets, such as food or medications
Electricity-dependent equipment (suggest that they also register with their local utility company)

The emergency planner has limited resources to provide for these needs. However, he or she may able to refer people to organizations that can provide assistance or support. Planners should partner with organizations before an event, and include their resources in the community plan. Consider creating a registry or referral service to help people find support for their needs.

Encourage people to prepare themselves to support their specific needs. Federal guidance recommends that people keep supplies on hand to support themselves for up to 72 hours. It also suggests that people with disabilities keep a First Aid kit and develop a support network.

Planners should encourage everyone to learn what resources are available to them and from where. This may be especially important for people with disabilities. Local government service agencies and non-profits may provide this support.
Service organizations will know the communities they serve. Planners can work with providers to communicate the need to be prepared. By tapping into this knowledge and expertise, planners can ensure that this message reaches the target audience and is understood.

Response

Train responders and volunteers to help people with disabilities. Responders, care providers, and community members can help those with disabilities. It is important that they know how to assist others and communicate in an emergency.

If one knows how to get out of a building ahead of time, he or she is more likely to be able to evacuate independently. Planners can work with building managers and others to review building and community evacuation plans. Plans and paths should be explained clearly to everyone. This is especially important for those who are blind or deaf and may need alternate ways to access plan information.
In all cases, a trained helper can ease the trauma of an evacuation. For a blind person all that is necessary is to say, "May I take your arm?" For someone with a mobility impairment, special equipment like an evacuation chair may help them move out of the building quickly. In this case, it is helpful for users to learn how and when to use these tools. Planners can ensure emergency responders or volunteers are trained how and where to assist people with such impairments.

Plan to accommodate equipment and service animals. There is a wide variety of tools people with disabilities use to support their needs. Planners should be aware of ways in which an emergency may affect needed equipment and animals, and include supports in the plan. Consider the following:

Security lights and flashlights may be useful for people with limited vision. Be cautious about strobe lights, as some individuals can seizure from exposure.
Warning signals may create interference for those who wear hearing aids. For some, this may take away their ability to hear as normal. Others with significant hearing impairments may not hear warnings at all. Planners can assist these populations in making special arrangements to receive warnings.
Plans should include ways to evacuate individuals with any equipment they use. This will allow people who use wheelchairs, canes, etc. to maintain independence as soon as they reach safety.
Chemicals and toxins may harm service animals or damage equipment, including medical devices. Protect and treat all equipment properly so that safe areas do not become contaminated.

Case Study: In 1997, the New York City Office of Emergency Management conducted a drill called the Interagency Chemical Exercise (I.C.E.). The drill involved disability issues to present first responders with a realistic situation. It also proved to be a chance to educate response agencies on how to improve systems. The evaluators found that wheelchairs, glasses, and canes were not properly decontaminated. Additionally, service animals were not handled properly. As a result, the cold zone (safe area) was contaminated because assistive devices, like wheelchairs, were not managed properly. If this happened in a real event, it could have caused serious harm to the community, people with disabilities, and responders alike.

Lesson Learned:State emergency planners should create protocols to decontaminate support equipment and animals. Share these with community planners and responders.

Create shelter plans that include supports for people with disabilities. When planning for shelters, consider the following:

In a shelter, people who rely on assistive devices should not be separated from their equipment. This may cause someone who is normally self-sufficient to become dependent if he or she cannot use their equipment. Planners should work with advocates and persons with disabilities to educate emergency management and shelter staff. Topics can include the variety and use of assistive devices like scooters, wheelchairs, walkers canes, crutches, or communication devices.
Medical devices may stop working or become lost in a disaster or evacuation. Develop partnerships to create resources for durable medical equipment replacement. Additionally, make provisions to adequately disinfect/clean all durable medical equipment to preclude infections such as MRSA.
Create or modify policies to ensure service animals can remain with their owners at shelters. Consider ways to transport, feed, and shelter the animals.
Ensure caregivers remain with their clients. Since they already have a working relationship, caregivers will be better able to understand their clients' needs and how to address them.

Recovery

Once the emergency is resolved and people are able to return to home, planners may need to address several issues:

People who rely on medical devices or equipment may need new supplies when they return to their homes. Planners and emergency managers can assist this process by working with care providers and funding agencies. These partners can help speed payment for equipment or devices can help maintain functional independence.
If a caregiver has not remained with his/her client, consider ways to connect the person with someone who can provide assistance. Work with care facilities, churches, charities, and other community services to provide sources of support. By identifying these sources ahead of time, people will have quick access to recovery services.

Mitigation

Following a disaster, planners should draft an after action report (AAR). The AAR may include information on what kinds of activities or support equipment 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 allow individuals to maintain or regain functional independence, consider ways to improve the plan.

Additional Resources

10 Ways to Help Katrina Survivors, Information on Disability for Empowerment, Advocacy, and Support (IDEAS)

This website provides tips and resources for individuals to help others in the wake of Katrina, including federal disaster assistance hotlines and links. These tips include contacting disability organizations, and providing supplies.

Access this document at http://katrinadisability.info/agencies.html#10
2005 American Community Survey: Disability Characteristics, U.S. Census Bureau

This U.S. Census Bureau survey provides 2005 data on estimates of demographic, social, and economic characteristics of people, households and housing units.

Access this document at http://factfinder.census.gov/servlet/STTable?_bm=y&-qr_name=ACS_2005_EST_G00_S1801&-geo_id=01000US&-ds_name=ACS_2005_EST_G00_&-_lang=en&-format=&-CONTEXT=st.
Are You Ready? A Guide to Citizen Preparedness, FEMA

This document helps individuals prepare themselves and their families for disasters. It provides a step-by-step outline on how to prepare a disaster supply kit, emergency planning for people with disabilities, how to locate and evacuate to a shelter, and even contingency planning for family pets.

Access this document at http://www.citizencorps.gov/ready/cc_pubs.shtm
Basic Tips in Emergency Preparedness for Seniors and People with Disabilities, Bay Area Emergency Preparedness Coalition For Seniors and People with Disabilities

This website lists tips for before, during, and after a disaster including what supplies to have on hand, how to prepare one's house for disaster, and evacuation needs.

Access this document at http://www.preparenow.org/ba-eprep.html
Disaster Mitigation and Persons with Disabilities, Independent Living Research Utilization

This web cast emphasizes the need for individuals with disabilities to stockpile enough supplies to maintain independence for up to 72 hours, should an evacuation become necessary. Additionally, individuals should learn about support resources in neighboring communities.

Access this document at http://www.ilru.org/html/training/webcasts/archive/2003/08-27-PB.html
Emergency Planning for People with Hearing Loss, Help for Hearing Loss

This collection of articles provided by Help for Hearing Loss includes topics such as emergency preparedness for people with hearing loss, as well as people with various disabilities.

Access this document at http://www.hearinglossweb.com/Issues/EmergPlan/emerg_plan.htm#ok
Emergency Tip sheets for People with Disabilities and Medical Concerns, Independent Living Resource Center of San Francisco

This website lists general tips of what people with disabilities and medical concerns can do before, during, and after disasters.

Access this document at http://www.prepare.org/disabilities/disabilities.htm
Emergency Tip Sheets for People with Visual Disabilities, Independent Living Resource Center of San Francisco

This tip sheet advised people with visual disabilities on what to do before, during, and after disasters.

Access this document at http://www.ilrcsf.org/resources/Visual.pdf (PDF - 30 KB)
Incorporating Special Needs Populations into Emergency Planning and Exercises, Davis, E and J. Mincin

This study provides case studies of exercises in New York City and the Pentagon. Through exercises, cities learned that existing plans did not address decontamination of supportive equipment and guide animals.

Access this document at http://www.nobodyleftbehind2.org/findings/davis_mincin.shtml
National Council on Disability on Hurricane Katrina Affected Areas September 7, 2005, National Council on Disability

This letter calls for service and procedural changes in the wake of Hurricane Katrina, particularly with regards to obtaining 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 provides information on identifying/locating those in a community with disabilities/special needs, how responders can assist various categories of disabilities, esp. 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, and 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)
Preparing for Emergencies: A Checklist for People with Mobility Problems, FEMA

This checklist will help people with mobility problems start preparing an emergency plan. Included is a listing of a suggested disaster supplies kit, as well as information on an escape plan, a home hazard hunt, evacuation, and fire safety.

Access this document at http://www.montgomerycountymd.gov/Content/homelandsecurity/preparedness/mobilitychecklist.pdf (PDF - 124 KB)
Special Needs Planning Considerations for Services and Support Providers, FEMA

This is a training module for providers of emergency services to incorporate individuals with special needs into their planning.

Access this document at http://training.fema.gov/EMIWeb/IS/IS197SP.asp