Office of Operations
21st Century Operations Using 21st Century Technologies Evacuation of Special Needs Evacuees

Special needs evacuees, such as the elderly, medical patients, and people without transport, require special assistance during evacuations.

Elderly – The elderly have special needs.

As reported in the Final Report: An Assessment of Emergency Transportation Management for the Rural Elderly, “The elderly were very limited in their understanding of emergency preparedness and maybe vulnerable during disasters. They depended very heavily on others within their family and community to alert and get them to safety when disasters occurred. This dependence on family and the community does not suggest a lack of interest about emergency evacuation and safety in times of disaster. On the contrary, most of the respondents indicate a need for more information about emergency preparedness programs and how to get to safety in term[s] of [the] disaster.”

The assessment also suggests “the need for more technologies geared to increase communication, education and links between emergency management centers and the local communities. The study also suggests the need for emergency management centers to review their current strategies to assure that they can identify, locate and assist all special needs populations in times of disasters.”

The elderly may be reluctant to leave their homes, and experienced entities may encounter difficulties in evacuations: “The Red Cross is one of the largest organizations responsible for the evacuation of the special needs populations. In an article in which they discuss the problems in evacuating the elderly they noted the following: the elderly are usually reluctant to leave their homes, the elderly are reluctant to leave what is familiar to them and go to an unfamiliar place, often they have pets or animals that they do not wish to leave, in some cases they have objects or family keepsakes that they consider valuable and they do not wish to leave them behind, the elderly may not comprehend the danger and the need of immediate evacuation and the elderly may be reluctant to go with strangers.”

“Even though the Emergency Management Service workers are professionals, they still must deal with the suspicions of older people who would prefer to rely on a familiar face.”

“Another problem in transporting older citizens is that [there] may be physical or sensory impairments making it difficult for them to comprehend instructions or follow simple commands. Many may have medications or they may not remember where certain things are such as eyeglasses, canes, hearing aids, and dentures. They may also have hospital equipment that must be moved with them. Finally, there is the question of time. Professional Emergency Management Service workers may have to find the location of the person and then spend valuable time preparing them or convincing them to evacuate.”

“Professional Emergency Management Service workers may not be familiar with the person’s location and, getting to them may impose time and problems if they are off a secondary road. In the Milwaukee International Conference one of the ‘best practices’ models presented was the use of Geographic Information System (GIS) to locate areas in the delivery of certain services. The GIS can be used in other situations as well. Using the GIS during terrorist attacks was one of the ‘best practices’ presented at the conference.”

The 42nd Annual Conference of the Floodplain Management Authorities of New South Wales, Kempsey, Australia, presentation “Flood Warnings: Recent Lessons Learned and Developments Under Way” reported that elderly people may require assistance during flood evacuations: “Some people in a community are, of course, more vulnerable then others to the adverse effects of flooding. This is because certain social characteristics may impair a person’s ability to protect themselves from, or respond to, critical situations. Elderly people are often frail and unable to respond quickly without assistance. Some of them may also be socially isolated, resulting in them being unaware of evacuation warnings or unable to decide on a course of action.”

According to the Compendium: Graduate Student Papers on Advanced Surface Transportation Systems: Application of ITS Technology to Hurricane Evacuation Routes, during the hurricane evacuation in Galveston, Texas, “police cruise through assigned districts with public announcement systems to alert residents of an impending hurricane. Police are very familiar with their districts and even go door-to-door to alert the elderly and hard-of-hearing.”

Modeling Transit Issues Unique to Hurricane Evacuations: North Carolina’s Small Urban and Rural Areas recognized the special needs for the evacuation of the elderly: “The results of the completed work consist of modeling transit issues unique to hurricane evacuations in small urban and rural areas located in the state of North Carolina. Particular emphasis is placed on identifying transit options needed to assist underrepresented populations such as the elderly and disabled, who maybe, in some ways, captive without transportation means or limited in terms of evacuation means.”

The elderly may require communication regarding evacuations that is different from the general public due to age-related declines in perception. The 2004 Annual Hazards Research and Applications Workshop: Natural Hazards Center, University of Colorado, Boulder, presentation “Transportation and Evacuation Issues in Emergencies: S04-3,” reported: “Christopher Mayhorn of North Carolina State University spoke about the importance of designing risk communications that can be understood by the growing segment of elderly citizens. Age-related declines in perception and cognition raise issues that must be considered in the design and dissemination of warning messages. Vision and auditory difficulties suggest a need to avoid specific fonts, color shades, and frequencies, while cognitive declines require an emphasis on reducing distraction and not overtaxing working memory.”

Medical Patients – During an evacuation, medical patients may fear that they cannot reach a medical facility in time and may decide against evacuation. The article “Hurricane Floyd: Filled with Sound and Fury, Signifying—Traffic?” reported: “Shoulders of roadways became clogged with abandoned automobiles, some because they ran out of gas, others because of engine problems, and still others perhaps of sheer frustration. Hotels and shelters were forced to turn away hundred of evacuees. Rest stops became makeshift shelters where motorists spent the night. Reports surfaced of many simply giving up after several hours and returning to their homes. Medical patients, such as those needing kidney dialysis treatments, also turned back out of fear they would not reach a treatment facility in time. Complicating matters, service stations, restaurants and convenience stores boarded up and closed, leaving many without options for refueling or eating.”

After the 9/11 terrorist attack in New York City, medical patients were evacuated out of the city. As reported in Saving City Lifelines: Lessons Learned in the 9/11 Terrorist Attacks, “the New York City Health Department had to move and allocate patients to medical care facilities immediately after the 9/11 attack. Historically, New York City Transit has cooperated with the Health Department by providing buses to move patients, taking the moderately injured (“greens” or “walking wounded”) to medical facilities further from the event site so that nearby resources could be reserved for the more seriously injured.”

In addition, Saving City Lifelines reported: “Effective emergency medical response depends on participating agencies working together as closely as possible. This principle was important when self-dispatched patients, the walking wounded, showed up at the hospitals nearest the World Trade Center. Others went to New Jersey on the ferry, following an instinct to flee the danger and then seek medical attention. Walking wounded patients from the World Trade Center were reported to be as far away as Long Island, Connecticut, upstate New York, and Montreal, Canada. Many people used public transportation to get to medical facilities (after the terrorist attacks).”

Saving City Lifelines also reported: “Water assets augmented traditional transit for moving patients. More than 8,000 patients were decontaminated and treated by New Jersey Emergency Medical Services personnel and fire personnel at the Hoboken Ferry Terminal in New Jersey (after the terrorist attacks). Patients and evacuees arrived by small boats, yachts, tugboats, sightseeing boats, Coast Guard boats, and New York Police Department boats.”

Evacuations may be necessary at any facility, including nursing homes, hospitals, and jails. As reported in Transportation in Emergencies: An Often Neglected Story, “It’s not just public transit and school bus systems that have contingency plans. In the Toronto area, the ambulance authority has a plan for a hospital evacuation. As it is sending vehicles to assist the evacuating hospital, it is canvassing other hospitals to see how much bed space they have and how much room they have for specific types of patients. That allows it not only to move patients quickly but to get them to a facility that will look after their special needs.”

Nursing Homes/Rehabilitation Units of Hospitals – Evacuations of the elderly from either nursing homes and/or rehabilitative units of hospitals can be stressful and disruptive to residents. Evacuations of nursing homes and rehabilitation units of hospitals can differ in terms of an evacuation. Nursing homes, as reported in Elderly Populations in Disaster: Recounting Evacuation Processes from Two Skilled-Care Facilities in Central Florida, August 2004, took approximately 6 to 7 hours to complete with the residents being evacuated and relocated in groups along with the staff. On the other hand, the rehabilitation unit of a hospital took approximately 1 ½ days to complete due to the patients “special needs that prohibited the evacuation of all patients to the same place. Instead patients were evacuated to surrounding hospitals as beds with adequate levels of care were found for them.”

Nursing homes may not be included in community-wide disaster plans. As reported in Elderly Populations in Disaster: Recounting Evacuation Processes from Two Skilled-Care Facilities in Central Florida, August 2004, “nursing homes were able to support one another in an informal manner during disasters. In order to formalize these relationships, the authors encouraged the inclusion of nursing homes in community-wide disaster plans. The logistics of how to best protect the nursing home population during disasters must be understood in order to incorporate these facilities effectively into a community-wide plan.”

Offenders – The State of Florida has a new policy that bans sex offenders from being allowed into public hurricane shelters. As reported in the Orlando Sentinel article “Offenders Banned from Shelters,” “Hundreds of sex offenders being tracked by the state won’t be allowed into public hurricane shelters in Florida under a new policy that will allow them to ride out the storm in prisons instead. The policy was created to keep sex offenders and predators away from children in public shelters, Robby Cunningham, spokesman for the Department of Corrections, said Saturday. Sex offenders who choose to seek safety in a prison would be kept in areas such as visitor or meeting rooms, not with inmates, Cunningham said. ‘They are not incarcerated’ Cunningham said. ‘We don’t want them on the streets. We don’t want them violating their probation either.’”

People without Transport – People without transport have special needs. According to Transportation in Emergencies: An Often Neglected Story: “While most persons in Mississauga had their own vehicles and used them, some did not. To take care of them, police arranged for Mississauga Transit buses to follow its officers. The buses took those without their own transportation to Square One, a well-known shopping centre, where Red Cross had established a reception facility.”

The TR News article “Emergency Evacuation: Ensuring Safe and Efficient Transportation out of Endangered Areas” reported: “In New Orleans, for example, 25 to 30 percent of the population—more than one-quarter million people—are without access to personal transportation. In addition to people without vehicles, the indigent, the elderly, prisoners, the infirm, and tourists must be evacuated. Although most state emergency operation plans include these groups, many departments of transportation have not addressed the evacuation of low-mobility and special-needs populations.”

In addition as reported in the ITE Journal article “Planning for the Evacuation of New Orleans,” “In response to the need for a full evacuation, emergency-preparedness officials, in conjunction with local and state transportation and law-enforcement agencies, have developed a regional plan to evacuate the New Orleans metropolitan area in the event of a major hurricane. The New Orleans evacuation plan recognizes that while a total evacuation of the city may be required, an evacuation of only part of the population is practically possible. Of the 1.4 million inhabitants in the high-threat areas, it is assumed only approximately 60 percent of the population or about 850,000 people will want, or be able, to leave the city. The reasons for this are numerous. Although the primary reasons are a lack of access to transportation (it is estimated that about 200,000 to 300,000 people do not have access to reliable personal transportation), an unwillingness to leave homes and property (estimated to be at least 100,000 people) and a lack of outbound roadway capacity.”

As reported in the Victoria Transport Policy Institute paper “Lessons from Katrina: What a Major Disaster Can Teach Transportation Planners,” “This indicates that public officials were aware of and willing to accept significant risk to hundreds of thousands of residents unable to evacuate (during Hurricane Katrina) because they lacked transportation. The little effort that was made to assist non-drivers was careless and incompetent. According to accounts, public officials provided little guidance to people without personal vehicles, and when asked, they simply directed them to the Superdome (Renne, 2005), although it had insufficient water, food, medical care, and security. This led to a medical and humanitarian crisis.”

For low-mobility groups, busing is an option to transport evacuees. As reported in the National Review of Hurricane Evacuation Plans and Policies, “Busing is the most common mode of transportation for low-mobility groups. To transport people in busses, emergency management agencies have in the past contracted with local transit authorities, school districts, and tour operators, with varying levels of success.”

According to the Victoria Transport Policy Institute paper “Lessons from Katrina: What a Major Disaster Can Teach Transportation Planners,” “The New Orleans Regional Transit Authority had a policy for hurricane evacuations: drivers should evacuate buses and other agency vehicles with their families and transit-dependent residents, thereby protecting people and vehicles. There are unconfirmed stories that Amtrak offered use of a train for evacuation that was not accepted by local officials. But neither public buses nor trains were deployed to evacuate people out of the city. Residents who wanted to leave the area by public transport were expected to pay for commercial services, a major barrier to many low-income residents.”

According to National Review of Hurricane Evacuation Plans and Policies,people with low mobility are generally overlooked in state evacuation plans: “Evacuation of these low-mobility and special needs groups is an area that while included in most state emergency operation plans, has been largely unaddressed by departments of transportation. In practice, the responsibility for the evacuation of low mobility groups in facilities like prisons, hospitals, and schools is given to facility administrators.”

The San Francisco Chronicle article “Deadly Chlorine Gas Gone—But Fear Hangs Over Hard-Hit Town: Some Residents Warily Return Home After Train Wreck” reported: “Rhonda Smith described gazing out at emergency workers whizzing back and forth in safety suits (after the derailment), and waking her children to tell them she loved them. She had no car at her house and was waiting for somebody to stop by to ask if she was safe; no one came until more than 18 hours after the crash. ‘I don’t even know how to explain the feeling,’ she said.”

In New Orleans, the use of public transit was not implemented to transport evacuees without transport during 2004’s Hurricane Ivan. The Natural Hazards Observer article “What if Hurricane Ivan Had Not Missed New Orleans?” reported: “Residents who did not have personal transportation were unable to evacuate even if they wanted to. Approximately 120,000 residents do not have cars. A proposal made after the evacuation for Hurricane Georges to use public transit buses to assist in their evacuation out of the city was not implemented for Ivan.”

In addition, the article reported: “Emergency managers and representatives of nongovernmental disaster organizations, local universities, and faith-based organizations formed a working group to engage additional faith-based organizations in developing ride-sharing programs between congregation members with cars and those without.”

During Hurricane Katrina, buses also did not appear to be used to transport special needs evacuees. According to the Victoria Transport Policy Institute paper “Lessons from Katrina: What a Major Disaster Can Teach Transportation Planners,” “buses to transport residents to the Superdome reflected the emergency plans’ intent, and there were insufficient buses to evacuate everybody who needed assistance. The city had approximately 500 transit and school buses, a quarter of the estimated 2,000 buses needed to evacuate all residents needing transport. However, if given priority in traffic buses could have made multiple trips out of the city during the 48-hour evacuation period, and even evacuating 10,000 to 30,000 people would have reduced emergency shelter overcrowding. Many public buses were subsequently ruined by the flooding. Federal emergency officials also failed to deploy buses for evacuation as planned. A top Federal Emergency Management Agency staff described his surprise and frustration at the agency’s inadequate preparation before Katrina struck, despite his urgent warnings to agency executives. He says that at the time he wondered, ‘Where are the buses to get people out of there?’ The importance of buses for evacuation of the city became clear soon after the hurricane hit. On September 1 Mayor Nagin said on a local radio station, ‘I need 500 buses…This is a national disaster. Get every doggone Greyhound bus line in the country and get their asses moving to New Orleans.’”

The paper also reports: “This indicates that bus deployment was ad hoc, implemented by officials during the emergency without a detailed action plan. Such a plan would include the designation of certain staff as essential, meaning that they are expected to work during emergency situations. [New Orleans Regional Transit Authority] Transit agency staff would have an incentive to volunteer for such a role because they would be allowed to evacuate their own families.”

The City of New Orleans expects people without transportation to develop a support system for evacuation as seen during Hurricane Katrina. As reported in the Victoria Transport Policy Institute paper “Lessons from Katrina: What a Major Disaster Can Teach Transportation Planners,” “The City of New Orleans does provide a section on ‘Emergency Guide for Citizens with Disabilities’ in its Comprehensive Emergency Management Plan posted on the City’s Web site (New Orleans, 2005), but it contains little practical support, placing most of the responsibility for safety and evacuation on individuals. The Guide recommends that people with disabilities develop a ‘support system’ to provide help during disasters. The ‘General Evacuation Guidelines’ advises, ‘If you need a ride, try to go with a neighbor, friend, or relative,’ but provides no directions for people who lack neighbors, friends or relatives who have extra capacity in their evacuation vehicles, which is likely to be common in areas were poverty is concentrated.”

According to the paper, “From a transport planning perspective, the greatest mistake in New Orleans was the lack of a detailed action plan to dispatch buses for evacuating transit-dependent residents. Such a plan would include an inventory of all available buses and essential staff, and pre-established procedures to deploy buses when an evacuation order is announced. The plan should include designated collection locations, guidelines as to what each evacuee should bring with them, reliable communication networks, and roadway management to give buses and other service vehicles priority in traffic. Extra effort should be made to provide comfort to evacuees, for example, by having public officials and community volunteers accompany evacuation buses to provide physical and emotional support. Had such a plan been implemented more residents would have evacuated, lives would have been saved, unnecessary suffering avoided, and total costs reduced.”

Single Parents – Single parents also have special needs when evacuating their children. As reported in Transportation in Emergencies: An Often Neglected Story, “Single-parent families are often characterized by low adult-child ratios, which make evacuation more difficult. Census data have been used to identify areas within Grafton (evacuation of Mississauga, Canada) that have a high proportion of residents with these characteristics that translate into vulnerability. Maps of these areas can be used to help target particular areas for door knocking and for the provision of transport.”

February 7, 2006
Publication #FHWA–HOP-08-015