Public Health Emergency Preparedness
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11. Evacuation
Recommendation 11.1: Congress and Federal agencies should provide sufficient funding to develop and deploy a national information sharing capability to quickly and effectively
reunite displaced children with their families, guardians, and caregivers when separated
by a disaster.
- DHS should lead the development of a nationwide information technology capability to collect, share, and search data from any patient and evacuee tracking or family reunification system.
- DHS should support the development of voluntary consensus-driven standards for data collection and data sharing through a joint Federal, non-Federal, and private sector process.
- Government agencies should ensure the collection of appropriate data on evacuated children, particularly unaccompanied minors.
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Families may become separated during the chaos of a disaster, especially when it necessitates evacuation. A no-notice disaster occurring while children are in schools, afterschool programs, and child care facilities increases the likelihood that children will be separated from parents and guardians. Hurricanes Katrina and Rita demonstrated the consequences of a large-scale evacuation, as more than 5,000 children became separated from their families.377 More than 34,000 calls were placed to a special hotline that the National Center for Missing and Exploited Children established after the storms and it took 6 months for the last child to be reunited with their family.378 The longer a child is separated from parents and loved ones, the more he or she is at risk for physical injuries, abuse, abduction, and emotional trauma.379
The inability to track the movement and location of evacuated persons was a major factor
delaying family reunification after Hurricanes Katrina and Rita.380 Limitations in tracking
patients evacuated on various Federal, State, and private-sector aircraft were also identified.381
In subsequent years, a number of States have developed or purchased systems for tracking
evacuees.382 States also have the option of using the National Mass Evacuation Tracking
System (NMETS), a State-based system developed and released by the Federal Emergency
Management Agency (FEMA) on June 1, 2010. NMETS is offered in three versions: a manual
paper-based system, a low-tech computer database and an advanced technology system.383
State-based systems, however, have limited ability to track people who cross State lines,
especially if the information is stored and used within the person's originating State only
and interstate agreements to share information are not in place. After Hurricane Katrina,
evacuated households, many of which relocated out of State, moved an average of 3.5 times
over a 6-month period.384
In addition to evacuee tracking systems, tools were developed within the public and private
sectors to reunite family and friends displaced by disasters. Congress authorized the
creation of the National Emergency Child Locator Center385 and the National Emergency
Family Registry and Locator System386 within the Post-Katrina Emergency Management
Reform Act.387 Other prominent reunification tools have been created by the American Red
Cross, Google, and the National Library of Medicine.388
The development of these various evacuee tracking systems and family reunification tools is
encouraging; however, the absence of an overarching information technology capability
that allows these systems to share data on displaced persons nationally remains a significant
gap. The Commission recommends that Congress and relevant Federal agencies, including
the Department of Homeland Security (DHS), the Department of Health and Human
Services (HHS), and the Department of Defense (DoD) provide the necessary funding to
develop a national information sharing capability that addresses the significant challenge of
quickly and effectively reuniting displaced children with their families, guardians, and
caregivers when separated by a disaster. The Commission recognizes that the development
of the infrastructure for a national information sharing capability with appropriate standards,
guidelines, and protocols would require significant funding over multiple years, but believes
this investment is necessary and supports current efforts to address this significant gap.
The Commission recommends that DHS, as the Federal coordinating agency for Mass
Evacuation,389 lead the development of a nationwide information technology capability to
collect, share, and search data from any patient and evacuee tracking or family reunification
system. HHS and DoD should also have a major role in developing this capability, as they
utilize a patient tracking system for patients evacuated by the HHS National Disaster
Medical System.390
In its Interim Report, the Commission examined the Agency for Healthcare Research and
Quality's (AHRQ) Recommendations for a National Mass Patient and Evacuee Movement,
Regulating, and Tracking System.391 According to the AHRQ report, the system would
provide the capability to link existing Federal, State, tribal, local, community, and private
systems that track the location and health status of patients and evacuees at health care
facilities, disaster shelters, and other locations where patients and evacuees gather during
an evacuation.392 Since the Interim Report, efforts to advance the creation of this system
have progressed.393 DoD and AHRQ drafted a statement of work (SOW) reflecting Federal
requirements, which establishes a task-oriented approach allowing for incremental creation
of the system as funds become available. A multi-agency memorandum of understanding394
is being finalized to establish policy for the national system, perform legal and regulatory
reviews, examine existing tracking and regulating systems, and complete the SOW with
Federal, State, tribal, local, and private industry representatives. In the next phase, the DoD
project will look to bring together an interagency Executive Oversight Committee and one or
more working groups to address the issues surrounding the creation of this platform.
Additionally, the DHS Science & Technology Directorate awarded a contract to address the
creation of Extensible Markup Language (XML)-based standards that will enable the
exchange of information between legacy systems, through a "system of systems" approach.395
The Commission supports the objectives of the AHRQ recommendations and is encouraged
by the recent progress on this initiative.
The Commission recommends that DHS direct an accrediting body, such as the American
National Standards Institute (ANSI),396 to convene a panel of interested public and private
parties to address the collection and sharing of information on evacuees. Federal, State,
local, and private-sector entities would identify existing voluntary consensus standards or
help accelerate their development should no suitable standards be identified.397 Common
standards and protocols on privacy policies are needed to address the disclosure, access,
activation, use, and storage of information on evacuees, as well as "a threshold level of
confidentiality" that stakeholders agree to meet.398
Challenges and concerns regarding national data collection and sharing arose during
discussions at the Commission's February 2010 Long-Term Disaster Recovery Workshop.399
Participants questioned what information should be collected; who should have access to
this information and how it can be used; and how this system will balance the critical need
to share personally identifiable information (PII) while adhering to privacy and
confidentiality laws and regulations, such as the Privacy Act,400 the Health Insurance
Portability and Accountability Act (HIPAA) Privacy Rule,401 and the Family Educational
Rights and Privacy Act (FERPA).402 Questions remain about whether sharing PII during an
emergency for the purpose of evacuee tracking is explicitly prohibited by privacy laws or
limited by interpretations of laws. The Commission recognizes the importance of ensuring
privacy and confidentiality of personal information, and in certain cases, strengthened
privacy regulations are needed during disasters to protect children. Yet, information such as
the location of unaccompanied minors can speed family reunification and should be shared
with appropriate agencies and organizations when it is clearly in the best interest of a child.
The Commission recommends that evacuee tracking systems utilized by all levels of
government collect appropriate data on evacuated children, particularly unaccompanied
minors. A 2006 White House report called on DHS and the Department of Transportation to
evaluate State and local evacuation plans and singled out unaccompanied minors as one
subgroup that must be addressed in those plans.403 In response to suggestions from the
Commission during NMETS development, FEMA improved NMETS's ability to track children
by adding an "unaccompanied minor" check box and additional information fields to each
of the versions of NMETS.404 Simultaneously, processes and procedures must be in place to
allow youth, parents, and legal guardians to review information that is collected about them
and that may be disclosed, and allow them to approve or amend their information.405
Recommendation 11.2: Disaster plans at all levels of government must specifically address the evacuation and transportation needs of children with disabilities and chronic health needs, in coordination with child congregate care facilities such as schools, child care, and health care facilities.
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Following Hurricanes Katrina and Rita, a 2006 Government Accountability Office report on
the evacuation of vulnerable populations due to disasters found increased efforts in some
States and localities to address the evacuation needs of "transportation-disadvantaged"
populations, including persons with disabilities, but also found that many disaster plans
were still lacking in this area.406 Results from a 2007 University of Kansas survey of 30
FEMA-declared disaster sites found that 57 percent of county emergency managers did not
know how many persons with mobility limitations lived within their jurisdiction.407 While
attention to the unique needs of children in disaster planning is increasing, more attention is
necessary on evacuation planning for children with disabilities and chronic health needs.408
The Commission recommends that DHS/FEMA and relevant Federal and non-Federal agencies
fully address the needs of children with disabilities and chronic health needs in evacuation
and transportation plans. A 2009 report from the National Council on Disability stressed that
evacuating persons with disabilities is more time- and resource-intensive compared to persons
without disabilities; therefore, local pre-event evacuation planning is crucial.409 Planning that
addresses the evacuation of populations with disabilities or chronic health needs must also
consider children's unique developmental characteristics and dependency needs, such as: the
need to keep children with their guardians, family members and/or caregivers; medication,
medical equipment, and service animals; and appropriate messaging and risk communication
about how to evacuate and the risks of not evacuating. Individuals and families with
disabilities and chronic health needs must be included in the emergency planning process,
alongside emergency management agencies, State and local education agencies,
transportation providers, and non-governmental organizations.410 In addition, many children
spend a significant amount of time in schools and child care, and some reside in group homes
or juvenile justice facilities; therefore, planning for the evacuation of children with disabilities
and chronic health needs should be required for these child congregate care settings and
conducted in coordination with emergency managers.411,412
Transportation assets, particularly vehicles with accessible features for children with
disabilities, must also be identified and organized in advance of a disaster.413,414 School
buses and public transportation have been suggested as possible resources for mass
evacuation during a disaster.415 A report by the Western Transportation Institute found that 92
percent of total possible passenger seats within 24 Gulf Coast counties and parishes were
on school buses.416 However, school buses are not always air-conditioned, and most lack
wheelchair tie-downs and spaces for accommodating wheelchairs.417 The report
recommended that additional research be conducted on identifying and providing
transportation for children following a disaster, with an emphasis on multi-agency planning,
especially with child care facilities, schools, hospitals, emergency management agencies,
and law enforcement agencies.418
According to the U.S. Department of Education, more than 6.6 million children ages three
to 21 have a diagnosed disability, representing 13.4 percent of total public school
enrollment.419 FEMA's Comprehensive Planning Guide 301 includes specific guidance for
planning for the evacuation of schools and addressing the unique needs of students with
disabilities.420 The guide suggests that school-based plans should ensure the participation of
students and staff with disabilities in the event of an evacuation, lockdown, or shelter-inplace.
In addition, it recommends that all school-based plans address a wide variety of
disabilities, including visual, hearing, mobility, cognitive, and emotional.421 These plans must
ensure that evacuation vehicles and evacuation sites are accessible to students and staff
with disabilities, and address reunification of students with their families and guardians after
evacuation.422 Pursuant to the Individuals with Disabilities Education Act, schools are
required to provide transportation that accommodates students with disabilities.423 As part of
the Individualized Education Plans (IEP) mandated for students with disabilities, schools
should include plans for evacuating and providing appropriate transportation for these
students.424 A planning tool from the National Fire Protection Association includes a
checklist addressing issues regarding safe evacuation of students with disabilities that can be
included with each student's IEP.425
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