Evacuation - Medical

People with chronic medical conditions often need help managing their disease, syndrome, or disorder. Caregivers may provide assistance; but in an emergency, people with chronic conditions can lose equipment, medicine, or care support that they need. Planners should consider these medical needs ¹ when creating disaster plans.

Preparedness
Response
Recovery
Mitigation
Additional Resources

Preparedness

Work with care facilities. People who need daily medical care and support may not know where to get help during and after an event. There are facilities and groups in the community that provide these services every day. To help people with disabilities, planners can:

Make a registry of care facilities in the area.
Hold education and outreach events to help people find nearby resources.
Work with care facilities to create Continuity of Operations Plans (COOP) so they can continue providing services after a disaster. Include ways for facilities to communicate so that they can coordinate care.
Work with facilities to develop ways to protect and maintain record-keeping systems.
Work with grant-making bodies to make sure that hospitals and primary health care facilities have enough funding for planning.

Make sure medication is available. People with medical needs may require basic medications for daily living or to relieve pain. They might need medication to help them stay independent and carry out daily activities. Planners can:

Develop a list of essential supplies to keep on hand. This might include common medicines to relieve pain, fever and inflammation (such as aspirin and ice, if possible); oxygen; and insulin. Identify ways to fund and store key medications or supplies.
Work with Federal, State, local, and private insurance providers to develop ways to pay for storing basic medications or supplies.

Find supplies of durable medical equipment. People with disabilities may require durable medical equipment (DME), such as hospital beds, wheelchairs, and walkers. Identify sources for this equipment in the community before an event.

Keep a list of equipment in your area. Give this information to people with disabilities and their care providers. Include the type of equipment available, location, cost, and whom to contact to get the equipment.
Create links between community groups and equipment suppliers. Encourage suppliers to loan extra equipment during and after an event.
Help community efforts to collect and arrange for DME to be stored and available for loan.

Document important medical and legal information. Everyone shares in the responsibility to plan and prepare for disasters. Planners should ask everyone to record important medical and legal information. Planners should also suggest how to store the information. This information will come in handy if someone cannot communicate these facts for themselves. Suggest that people create the following:

Emergency Contact card. Include the names of family or friends living both in and out of the local area. Responders will use this information to contact a person's support network, if necessary.
Health Information card. Record vital health needs, such as adaptive equipment, blood type, allergies, sensitivities, Social Security Number, immunization dates, and contact information.
Legal documents. Make extra copies of wills, living wills, deeds, and medical, property, or casualty insurance information.

People with disabilities may need to keep other information. Planners can recommend several actions.

For people with chronic disabilities:
- Attach written instructions to all equipment.
- Make sure equipment has a back-up power source. Determine how long the power source will last.
- Keep oxygen tanks in a safe and secure place.
For people with physical impairments:
- Learn how to operate a back-up power supply or generator for essential medical equipment.
- Store back-up equipment, such as a manual wheelchair, at alternate locations. Consider your home, neighbor's house, school, or workplace.
- Report any hygiene support needs, including showering, defecating, or urinating
For people with sensory impairments:
- Keep important equipment and assistive devices in a common and accessible location. For example, secure hearing aid or eyeglasses in a container by the bedside using Velcro.

Response

Make sure equipment is accessible. During an event, someone with medical needs may not have access to support equipment. Planners can encourage their community to do the following:

Ask home care providers how to care for special health needs
Consider ways to provide for medical needs if electricity, supplies, or trained personnel are unavailable
Network with resources such as Area Agencies on Aging (AAAs) and local Red Cross Chapters

Train emergency managers and responders. It is important to have enough supplies to support the needs of various disabilities. It is also important to train personnel to use equipment that they might use during an event. Train responders how to interact with people with disabilities before an event. The training should focus on allowing people to maintain independence and dignity. Training should also include stress management and mental health issues. If possible, include mental health staff in a training and response plan.

Develop a system to shelter people with disabilities. In some communities, there are people with medical needs who will need professional support. Planners may consider creating a tiered sheltering system to support these needs. This system could send people with medical support needs to a shelter with trained providers. Planners should train shelter staff to provide blood pressure monitoring and basic first aid. Additionally, plans should allow family or friends to stay at special needs shelters. Family or friends may serve as caregivers during the event and reduce the demand placed on shelter staff.

Identify needs and issues that evacuees may have before they enter a shelter. A series of questions may help find assistance, make referrals, and provide long-term care. Consider using a questionnaire to triage the needs of people who enter shelters, such as the American Red Cross Initial Intake and Assessment Tool found at http://www.medicalreservecorps.gov/File/MRC_Resources/ARC_HHS_Assessment_Tool_May07.pdf (PDF - 23 KB). Evacuees who enter regular shelters without medical support may get sick or their chronic conditions may get worse.

Consider using the START rapid triage system that was used successfully after Hurricane Katrina. See http://www.start-triage.com/ for more information.
Conduct a one-on-one clinical examination of evacuees. The process takes time but helps maintain people's health
After people with disabilities are examined, continue to monitor them for potential problems
Make sure that the shelter has acute and chronic care personnel that can manage the needs of both the individual and population, where necessary.

Include health promotion in sheltering plans. Share information on the following items within the shelter:

Disease prevention strategies
Special health conditions and care routines
Contact information for key health providers
Medication information
Information on alternate sources of life-sustaining care

Recovery

People with medical needs may need services and financial support to recover from an event. Planners can:

Find disaster relief services ahead of time. Work with the Federal government to make sure there is enough money for services. This is particularly important for any required long-term medical service.
Find ways to help maintain benefits and services when disaster assistance is not enough. For example, develop partnerships or other ways to replace DME. Partner with local agencies so that people with disabilities may contact service clubs for the equipment they need.

Mitigation

After an event, planners should draft an after action report to note lessons learned. The report should record the events and response that occurred. The report should include information on what support or equipment people required. The report should assess if needs were met during the disaster. The report should also include ways to revise and improve plans. If the response did not support the medical needs of people with disabilities, planners should work to improve plans.

Additional Resources

Are You Ready? A Guide to Citizen Preparedness, FEMA

FEMA's guide helps people and their families plan for disasters by providing a step-by-step outline to create a disaster supply kit. The FEMA guide also includes information for emergency planning for people with disabilities, how to locate and evacuate to a shelter, and suggestions for planning for family pets.

Access this document at http://www.citizencorps.gov/ready/cc_pubs.shtm
Disaster Mitigation and Persons with Disabilities, Independent Living Research Utilization

This webcast emphasizes the need for people with disabilities to stockpile medications before an emergency. The webcast notes any policy and payment limitations that may make stockpiling difficult for some.

Access this document at http://www.ilru.org/html/training/webcasts/archive/2003/08-27-PB.html
Disaster Mitigation for Persons with Disabilities: Fostering a New Dialogue, Peter David Blanck: The Annenberg Washington Program

This report advocates training for responders in the use of 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/
Disaster Preparedness and People with Disabilities or Special Health Care Needs, Iowa's Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT)

This article in Iowa's Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) Care for Kids Newsletter lists tips for preparing for a disaster, such as creating a disaster plan, setting up a support network, and educating members of the network about the disaster plan.

Access this document at http://www.iowaepsdt.org/EPSDTNews/2002/win02/disaster.htm
Earthquake Tips for People with Disabilities, June Isaacson Kailes

Guidance includes 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, how to keep important equipment and assistive devices, and practicing assertive communication skills.

Access this document at http://www.preparenow.org/eqtips.html
Emergency Evacuation Preparedness: Taking Responsibility For Your Safety, A Guide For People with Disabilities and Other Activity Limitations, Center for Disability Issues and the Health Professions (CDIHP)

The information contained in this guide is focused on helping people with disabilities prepare for large or small-scale emergencies. People with disabilities are urged to take responsibility for their own safety during emergencies and evacuations and work effectively with first responders.

Access this document at http://www.cdihp.org/evacuation/toc.html
Emergency Preparedness for People with Disabilities, City of Los Angeles Department on Disability

This guide lists supplies that are helpful to have on hand before a disaster and provides special information for people with visual, mobility, and hearing disabilities, in addition to owners of service animals.

Access this document at http://www.ci.la.ca.us/dod/handbook.pdf (PDF - 809 KB)
Emergency Tip Sheets for People with Disabilities, Independent Living Resource Center of San Francisco

The 10 sheets offer tips for people with cognitive or psychiatric disabilities, communication problems, medical concerns, and help with service animals or pets. The information describes what can be done before, during and after disasters for individuals with each category of impairment. The document also includes a checklist for people to use to help get prepared.

Access these documents at http://www.prepare.org/disabilities/disabilities.htm
How to Develop a Disaster Action Plan for Older, Distant Relatives, Jane Irene Kelly

This guidance offers ten steps to help prepare older family members for a disaster. People with physical, sensory, chronic, behavioral, or cognitive disabilities may find this information useful.

Access this document at http://www.aarp.org/bulletin/yourlife/Articles/0505_sidebar_11.html
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 making medical equipment and personnel trained in its use readily available following a disaster.

Access this document at http://katrinadisability.info/NCD.html
Natural Disaster Public Service Announcements (PSAs) and Podcasts, Centers for Disease Control and Prevention

CDC PSAs and Podcasts provide timely messages about what you can do to protect yourself and your family during a natural disaster. Messages are provided in script, audio, video, ASL, and podcast formats.

Access these documents at: http://emergency.cdc.gov/disasters/psa/
Preparing for Disaster for People with Disabilities and other Special Needs, FEMA

This booklet is designed to help those with special needs, as well as their family/friends/caretakers, prepare for various emergencies. Check-lists of general items, strategies, potential problem areas, and solutions to consider are offered.

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 limitations prepare an emergency plan. Included is a list of suggested disaster supplies, 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 Shelter, Putnam County, FL Department of Emergency Services

This page provides 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 helpful to shelter in a location with trained staff.

Access this document at http://putnam-fl.com/brd/PCPS/PSN%20Shelters.htm
Report on Special Needs Assessment for Katrina Evacuees (SNAKE) Project, National Organization on Disability (NOD)

Often during an emergency evacuation, the conditions of those disabilities worsen due to either an over-emphasis of medicinal intervention or an under-utilization of specialized and trained caregivers. By providing special needs populations with proper care and equipment, they do not need to be shuffled to hospitals and nursing facilities. Effectively training disaster workers would allow them to identify evacuee limitations and to mitigate deterioration through appropriate supervision and evacuee placement.

Access this document at http://www.nod.org/Resources/PDFs/katrina_snake_report.pdf (PDF - 126 KB)
Tips for Creating an Emergency Health Information Card, June Isaacson Kailes

An Emergency Health Information Card communicates to rescuers what they need to know if they find a person with disabilities unconscious or incoherent or need to help evacuate the person quickly. This document details what a card should contain, and gives examples and recommends where to keep copies.

Access this document at http://www.preparenow.org/tipcrd.html

Notes

¹ The definition for medical needs is currently being worked by a multi-agency work group. At present, the definition for seriously ill includes the casualty status of a person whose illness or injury is classified by medical authority to be of such severity that life is imminently endangered. (back)