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21st Century Operations Using 21st Century Technologies

Evacuating Populations With Special Needs

Routes to Effective Evacuation Planning Primer Series

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Chapter 3: Planning and Preparedness—Overview

Glossary Terms
Used in this Chapter:

Congregate Care Like-to-Like Sheltering

Cognitive Disabilities

Emergency Alert System (EAS)

Emergency Operations Centers (EOCs)

Emergency Support Functions (ESF)

General Population Shelters

Geographic Information System (GIS)

Hospitals

Mutual-Aid Agreements

Special Needs or Medical Needs Shelters or Units

Transfer Trauma

The best way to prevent injury and loss of life during an emergency evacuation is advance planning that prepares transportation agencies, EMAs, and the special needs population. Experience shows that without proper planning and community preparedness, disasters become even more chaotic and unnecessary loss of life and injuries result. In short, those with disabilities may face increased risk, higher death rates, and difficulty in evacuating without prior planning at both the household and agency levels. [16]

Transportation Needs

It is important to properly store, maintain, and document the number of buses being identified for emergency contingency purposes and to perform maintenance on and test the inactive fleet often. Some of the vehicles to be used for transportation in an evacuation may be owned by various public and non-profit agencies. If these vehicles are insufficient to meet the need, it may become necessary to contract for vehicles.

On a federal level, FEMA has committed to supporting state and local agencies with transportation resources for evacuation. According to USA Today on September 11, 2008, prior to the landfall of Hurricane Ike, Glenn Cannon, FEMA’s Assistant Administrator for Disaster Operations said “FEMA has contracts in place for trains, planes, and buses, in case local authorities order evacuations.” [17] It is important for communities to identify how many and what type of vehicles will need to be acquired through a contract, what agency holds that contract, what the requirements are to use the contract, what the specifications are for specialized equipment to support moving those with special needs, and how costs are accounted for and reimbursed under the contract. Local jurisdictions should work with local and state EMAs to ensure these requirements are included with the request for Presidential disaster declaration and/or coordinated with FEMA in advance to ensure rapid delivery of these transportation resources.

The Federal Transit Administration (FTA), through its report Disaster Response and Recovery Resources for Transit Agencies , recommends that a contingency fleet of vehicles be kept and maintained in case of emergency or disaster when feasible.

FTA, 2006, Disaster Response and Recovery Resource for Transit Agencies

The Federal Transit Administration (FTA) recognizes that “Transit’s unique role in facilitating the evacuation of people with special needs before and after an event needs to be coordinated and planned for in advance.” [18] Those who may require transportation assistance include:

  1. Individuals who can independently get to a pick-up (evacuation) point
  2. Individuals who live independently and require transportation from their location
  3. Individuals who live in a group setting (e.g., group home, assisted living center) that require transportation directly from their location
  4. Individuals in acute care/in-patient facilities
  5. Individuals with disabilities
  6. Individuals with limited English proficiency.

FTA recognizes that increased coordination (at both state and local Emergency Operations Centers [EOCs]) among Emergency Support Function (ESF)-1: Transportation, ESF-6: Mass Care, ESF-7 Logistics Management and Resource Support, and ESF-8: Health and Medical Services is necessary to ensure adequate, timely, and efficient transportation to and from individual residences, group homes, shelters, assisted living facilities, and hospitals. According to FTA, planners should be aware of the:

  • Need to coordinate the identification of individuals with specialized needs, their locations, and their requirements for transportation assistance (e.g., type of vehicle, language translation services) prior to an emergency event.
  • Need to coordinate the roles, responsibilities, and dispatching functions for paratransit services to evacuate individuals requiring transportation from their location. This includes the interface with human service transportation providers (e.g., Medicaid, aging).
  • Need to coordinate resumption of critical health care functions such as dialysis treatments and outpatient treatment. This may also include treating patients with limited English proficiency, so translators should be included in treatment plans.
  • Need to coordinate post-event efforts and manage special needs patients in shelter settings.
  • Requirements for transporting people with special needs:
    • Define roles of public transit agencies
    • Coordinate people with special needs lists with community transportation coordinators and ADA passengers
    • Pre-plan routes to serve people with special needs.

According to the TRB Special Report 294, “Transit has a unique role in evacuating the carless and special needs populations—such as the disabled, the elderly, and the medically homebound—in an emergency; but most local evacuation plans do not address the needs of these groups adequately.”

In 2008, the Transportation Research Board (TRB) released its Special Report 294, The Role of Transit in Emergency Evacuation, which “explores the role that transit systems can play in accommodating the evacuation, egress, and ingress of people to or from critical locations in an emergency.”

Challenges for Emergency Evacuation Planning and Preparedness

Several challenges exist when planning for the evacuation of people with disabilities. Planners should consider the following:  

  1. Recognize clearly that people with disabilities include diverse situations and conditions from mobility to sensory to cognitive disabilities. [19] Medical conditions must also be considered.
  2. Disabilities may be permanent or temporary, and the number of people with disabilities may vary over time. As many as one in every five people is expected to experience at least a temporary disability . [20] Moreover, the number of people with disabilities in the United States is expected to rise over the next 30 years. [21] As the number of people with disabilities and medical conditions increases, access and inclusion of them remains low and problematic, especially regarding disasters and emergency evacuations. Plans should be adjusted routinely to account for changes in the number of people and scope of evacuations of those with special requirements.
  3. An individual may experience multiple types of disabilities simultaneously such as a blind amputee who requires both a wheelchair and service animal.
  4. Other situations and conditions may interact including limited language abilities, age, poverty, [22] and cultural differences. For example, an elderly immigrant with a mobility limitation may speak only her native language, relying on a younger member of the family for translation. The older person would need to be transported with the family member acting as translator.
  5. Geographic location matters. Many people in urban areas rely on public transportation systems to move about or may use transportation provided by non-profit organizations, senior services, or city agencies. Seniors with disabilities who are low income represent a particularly vulnerable group.
  6. Few jurisdictions have staff familiar with disabilities in general, let alone evacuation planning. [23] Therefore, people from the disability community must be included in emergency evacuation planning and preparedness; they bring real perspectives, ideas, and experience to the planning process. This practice is clearly recommended by Executive Order 13347: Individuals with Disabilities in Emergencies.
  7. Many proposed solutions such as registries, buddy systems, and transportation inventories represent untested ideas that may carry as many risks and challenges as they do potential benefits. From a transportation perspective, it is important to consider whether there are enough resources to pick up individuals and possible caretakers/family members and transport them to the designated facility. Caretakers and family should never be separated during transportation, and agencies need to plan accordingly.

Identifying Special Needs Populations

The Oahu MPO in Honolulu, Hawaii, identifies the environmental justice and Title VI populations on the island of Oahu in the report Environmental Justice in the Oahu MPO Planning Process: Defining Environmental Justice Populations (2004).

A recommended starting point to plan for special needs population evacuations is to gather baseline data on the number and types of people with disabilities. [24] Using census data, information from social service and home health agencies and other supporting organizations can provide an initial snapshot for planning purposes. MPOs and state DOTs are required by law to address the needs of environmental justice and Title VI populations in their systems planning processes (23 CFR 450). As a result, they must document where these populations are located. The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (Sec 6001—Planning/ 23 USC 134 and 135; 23 CFR 450) contains requirements for transportation agencies in security.

Once the general number and type of disabilities is known, it may be possible to create a specialized registry that identifies the location of those at risk. Geographic Information Systems (GIS) can be used to create displays for planning purposes. However, such registries can be time-consuming and expensive, and individuals may be reluctant to self-disclose their conditions or other personal information. [25] Registries must be available to those who need to use them and not locked up during an event. [26] If registries are used, transportation agencies must be part of the team that develops and uses them during exercises and emergencies. Limited evidence to date suggests that registries must be specialized and linked to inventories of transportation assets. [27]  

Training

The Oklahoma Assistive Technology Program is specifically designed to provide critical information to first responders regarding evacuating people with disabilities.

Training staff to work with people with disabilities is important. Many first responders and emergency management and transportation personnel lack understanding of disabilities, including how to communicate with and/or physically move an individual in a wheelchair or with very specialized equipment. FEMA’s training course, Emergency Planning and Special Needs Populations (G-197), [28] addresses many of the concerns regarding people with disabilities and emergency management training. However, the G-197 course is not specific training for transportation agencies on evacuating people with disabilities; rather, it is an overview course that teaches participants how to include special needs populations in all phases of emergency management.

Transportation agencies must remain alert to training as it unfolds nationally and within the state and look for local training opportunities. For example, a transportation agency could have a local agency that works with visually impaired and blind populations train bus drivers or have bus drivers go to a state school or a nursing home to interact with staff and residents to gain experience in understanding people with dementia, mental retardation, etc. A starting point may be to bring representatives from the disability community together with transportation responders to discuss key issues and concerns. Including people with disabilities in emergency evacuation exercises and drills will provide valuable and practical information to transportation agencies.

Outreach

Transportation agencies can help disseminate information prior to an event and can encourage those at risk to prepare, thus reducing the numbers of persons requiring assistance during an evacuation.

Transportation agencies can participate in and support efforts to educate those at risk. FEMA and the American Red Cross (ARC), among others, recommend that persons with disabilities engage in self-education, personal planning, and preparedness. People with disabilities should develop a personal support network and an evacuation kit. People with disabilities will be motivated to evacuate when they believe that those assisting them are truly ready to meet their individual needs. [29] Furthermore, building trust between those at risk and those involved in evacuation is important. Individuals, particularly the elderly and those with serious health problems, are most likely to evacuate when they trust in the credibility of local officials. [30]

Early evacuation of those with special needs must be a priority. [31], [32] Failure to evacuate early may result in increased risk of death, delays due to clogged transportation arteries, and elongated evacuation times that may heighten transfer trauma and other conditions. Those who are left may very well die. [33] Consider the following:

  • Collaborate with community agencies engaged in emergency transportation planning. If an emergency transportation-planning group does not exist in your area, start one.
  • Schedule a meeting with the agencies engaged in emergency management in your community and ensure they understand what messages need to be delivered to the special needs populations in your community. It is important that the transportation agencies have clear messages that can be communicated to the general public and special needs populations. Assist those agencies in educating the public. Designate a few people to receive training in delivering emergency preparedness information.
  • Assist the EMAs in your community in distributing pamphlets, guides, and/or other materials (e.g., bus drivers can have emergency preparedness brochures on buses to distribute).
  • Participate in exercises and drills as well as regular community events. Offer transportation during non-disaster times, such as to state fairs or other local events so that familiarity increases, credibility builds, and people gain experience interacting with each other.
  • Negotiate a co-branding agreement wherein your agency is permitted to reprint other agencies’ materials with your transportation agency’s logo.
  • Remember not to always focus on the “needs” of the special needs populations in your community; remember their abilities as well. Emergency preparedness, response, and recovery begin at the individual level and assisting people to be prepared, where appropriate, will ultimately make your job easier when an incident occurs. This applies to transportation agencies as well as all agencies involved in emergency management and response.

Planning “With” versus Planning “For” People with Special Needs

Crowd of evacuees

Traffic moving slowly on a hazy day

Bridge destroyed by earthquake

Transportation agencies need to engage and plan with the disability and special needs community, especially with regard to emergency evacuation procedures and transportation. It is imperative that the planning process also include the disability community. The following is a checklist to ensure that special needs issues are integrated into emergency evacuation plans and other initiatives. Since some of these activities will be ongoing, it is important to establish the roles and responsibilities of each agency. There are a number of Web sites that can provide information about federal public involvement requirements and techniques. These are included in Annex 6 of this primer.  

  • Organize the initial emergency evacuation planning team. Hold a kick-off meeting and include American Sign Language (ASL) interpreters if requested, microphones for the hard of hearing, and other languages as needed. Make sure the meeting location is accessible. A transportation agency may want to work with the local EMA to co-host this kick-off meeting and offer to co-lead future meetings.
  • Establish ongoing meetings and reviews (get buy-in from the organizations to continually be a part of the planning and response process; this includes educational outreach into the disability and special needs community and responders).
  • Determine jurisdictional strategies, timelines, and community needs for evacuation in coordination with local EMAs and the disability community.
  • Identify and develop resources to address the information needs of special populations within your community. This might include examining existing Web sites, hotlines, brochures, flyers, Emergency Alert System (EAS), media outlets, volunteer groups, and communication technologies (e.g., pagers, calling systems).
  • Design multiple and redundant means to reach and communicate with the disability community and the local EMA.
  • Identify a variety of viable options in the plan and focus on abilities. The special needs community is very diverse. There is no “one quick fix” that will meet all of the needs of all of the members of special needs populations.
  • Coordinate with the disability community in establishing cross training for transportation personnel and the special needs population, especially in regard to the movement of people with mobility and medical needs. For example, a person with a physical disability can show a transportation staff member how to move him/her from the wheelchair to the transport vehicle with minimal complications. Likewise, transportation agencies can teach the disability community about organizing evacuation routes and the challenges they face. Together, transportation agencies and the disability community can come up with joint solutions.
  • Consider the needs of the medically fragile, who may be dependent upon their caregivers to plan for, manage, and provide appropriate transportation to various sites, such as shelters or points of distribution.
  • Reexamine, test, and update systems pertaining to emergency evacuation of people with disabilities and those with other unique disaster-related needs. Test these plans through emergency evacuation tabletops, exercises, and drills. Identify the types of vehicles needed to move people with mobility and medical needs and include those agencies at planning meetings as well as exercises and drills.
    • Inventory and develop mutual-aid agreements with other agencies, jurisdictions, private faith-based groups, state schools, and airport shuttle services to identify available transportation assets.
    • Cross-analyze the available vehicles with the registry of people needing assistance in evacuating and map it using GIS (if one exists). 
  • Provide a robust communication and education program specifically geared toward people with disabilities, seniors, and other individuals with specific needs.
  • Consider the following for emergency evacuation planning committees:
    • Foster open dialogue about emergency response and concerns of the special needs population.
    • Improve community awareness and appropriate response utilization and management.

After Hurricane Katrina, hundreds of people with disabilities were separated from critical equipment resulting in the need for those that moved and received evacuees to provide individual support and replace highly specialized and expensive equipment.

National Organization on Disability, 2005

Chapter 4 of this primer provides more specific information on communicating with special needs populations and the community in general.

Medical Needs

Movement of people with medical needs, particularly senior citizens, must be conducted carefully to avoid transfer trauma. [34] Transfer trauma occurs when those who are moved die as a result of the movement (see Chapter 6). Movement of those with DME may require additional time. After Hurricane Katrina, people with disabilities were forcibly separated from service animals, resulting in further challenges to their mobility and independence. In addition to compliance with the ADA, keeping people with their caretakers, DMEs, and service animals reduces the burden on the shelter (see Chapter 2).

Medical Support Personnel

Emergency evacuation planning for personnel must include both transportation staff and medical staff or caretakers. When transporting people with medical conditions, equipment and medicine will need to be transported along with the person.

As will be discussed in Chapter 6, it is imperative to transport medical personnel and/or caregivers with people with medical conditions. Staffing needs and ratios when transporting people with medical requirements during an evacuation are evaluated differently than a non-emergency movement because of the technical skill sets required to ensure adequate care. For example, people with medical needs will need a healthcare professional, such as a nurse or home health aid, who will be responsible for providing an advanced level of care to the person.

Transportation agencies must train their drivers and others in communication, interaction, lifting, and other tasks and should include those who can do this (e.g., advocacy organizations, community emergency response team members, and others) on board the vehicle to free up the driver.

When considering staffing recommendations for evacuations, establish standards for both medical personnel who will be transported with the person as well as people who are alone and may need assistance. Planners should keep in mind that personnel (caretakers, personal attendants, buddies, family, and friends) may be unable to get to the person’s home during an emergency, and transportation personnel should be aware of this and how to manage these types of contingencies (e.g., should the driver wait or move without the caretaker). Transportation agencies must be prepared to assist those with special needs to move themselves physically as well as move their equipment and service animals and the animal’s emergency kit. [35]

Planning groups may coordinate with neighboring jurisdictions and the state to obtain commitments for support.

Each jurisdiction, in conjunction with its planning committee, will need to make reasonable adjustments to its plans based on capacity and resources. Recognizing that adjustments will be made, good plans include ideal staffing levels as a goal. Many jurisdictions use established staffing models, which should be reviewed by the planning committee. However, most jurisdictions may not have adequate medical or transportation staff to meet the ideal staffing standards or needs. Commitments for support may be established in local or state mutual-aid agreements or jurisdictions may adjust mutual-aid agreements to address the supply of medical personnel. If staffing models are used, they should incorporate specific technical support (e.g., registered nurses, nurse practitioners, and medical doctors), the client-to-professional ratio, and the number of vehicle drivers required.

Transportation agencies also should work with local health authorities, DME suppliers, and other medical care personnel. Plans should address transportation staff shifts, especially if those with special support requirements are evacuated before the general population. Transportation staff should know protocols and be trained on: 

  • Moving people with medical conditions (including bedridden, oxygen-dependent, and those with respirators)
  • Assisting people with mobility limitations including quadriplegics, paraplegics, and stroke survivors
  • Asking for guidance from the person with special needs prior to touching, lifting, or otherwise moving an evacuee.

Shelters and the Role of Transportation Agencies

Prior to, during, or after a disaster, there is often a need to establish areas of safe refuge or shelters to temporarily house those who are displaced as a result of a disaster. It is essential, although not always common, to be prepared to shelter or provide safe refuge during an emergency or disaster to all individuals (including those with special needs) within a community who do not have an alternative such as friends and family. While the focus of this primer is not sheltering, the primer does provide an overview of some primary considerations. Transportation agencies participating in evacuation planning and operations must be aware of their jurisdiction’s sheltering plan and know which facilities will receive people with special needs during an emergency evacuation.

Transportation agencies move people to shelters, which are presumed to be safer, more secure locations. Shelters housing those with special requirements constitute specially designated locations. During disaster events, EMAs will identify functional shelters that may or may not conform to evacuation plans. Shelters often take the form of general population shelters, special/medical needs shelters or units, congregate care like-to-like shelters, andhospitals.

 

Pre-selected locations for those with special support requirements tend to be more common in areas that experience frequent events. More rural areas or areas that do not experience a widespread impact may not have pre-designated or sufficient numbers of special needs shelters.

The “No Household Pets” policy in general population shelters does not apply to service animals (see Chapter 7).

The special needs shelter may be a stand-alone shelter or a special needs unit within the general population shelter. By offering skilled medical staff, medical supplies, specialized equipment, and special dietary provisions, the special needs shelter will provide a higher level of care than at a general population shelter.

A person who receives 24-hour home health aid, has an IV drip, and is electrically dependent would be considered fragile, warranting preemptive evacuation to a hospital to receive high-level care.

Transportation agencies will be transporting their passengers to one or more of these facilities:

  • General Population Shelter: General population shelters support individuals who can independently support their own needs, including individuals who are with their own caregivers. General population shelters should be, but are not always, accessible for those with mobility disabilities (such as providing entrance ramps, accessible bathrooms, and passageways). If transportation agencies are moving people with disabilities to a general population shelter, contingency plans must be in place in the event the general population shelter is not accessible.
  • Special Needs or Medical Needs Shelters or Units:  Definitions for special needs or medical needs shelters or units can vary and depend on the resources available and whether jurisdictions have established such a shelter system. Transportation agencies and emergency evacuation planning committees must clearly understand the type of special needs shelter system that is in place in their local jurisdiction and the types of individuals that may be cared for at these shelters or units. All special needs shelters must be accessible. The level of care provided depends on the availability of resources within the jurisdiction or through its agreements with out-of-jurisdiction providers. The limits of the special needs shelters must be communicated clearly to the public and transportation agencies. Transportation agencies may aid in the operation of a special needs shelter by moving not only people with medical needs but equipment, medicine, and other resources between facilities.
  • Congregate Care Like-To-Like Sheltering:  This type of sheltering occurs when evacuees are moved from one CRCF to other CRCFs that provide an equal level of care. CRCFs and the recipient facilities should develop a plan to maximize resources and provide a continuum of care for those residents being moved between facilities. Transportation agencies should be aware that residential chain facilities are most likely to be able to do this; small, independent facilities may experience greater difficulty in securing site-to-site beds for patients and clients. As such, communities with smaller, independent facilities may need additional support and may not have destinations pre-arranged. Transportation agency staff should seek to become part of medical planning teams and to participate in exercises, drills, and other types of training. For additional information on CRCFs, see Chapter 6.
  • Hospitals:  Sheltering at hospitals should be reserved only for the most critical patients who require specialized, skilled care on a regular basis, often those whose condition is likely to deteriorate quickly during an emergency. Hospitals are required to have emergency plans in place. Transportation agency staff should seek to become part of medical planning teams and to participate in exercises, drills, and other types of training.

Transportation and Shelter Operations

In support of sheltering operations, transportation agencies should:

  • Be part of the planning process to pre-designate locations or keep an updated list of such locations.
  • Know whom to contact to verify that shelters are open and receiving evacuees.
  • Know the locations of general and special needs shelters and if they are open and receiving evacuees.
  • Confirm with the shelter manager that they will receive transported evacuees and that the shelter can provide accommodations for the evacuees.
  • Ensure that the transportation provider can provide requisite accommodations for evacuees on a given vehicle.
  • Inform evacuees of the location and assure them that the shelter is ready for their particular needs, including accommodating service animals, equipment, and support people.
  • Complete transport.

Regarding their role relating to shelters, transportation agencies should be familiar with local jurisdiction plans and should ask:

  • Has my agency coordinated with the local EMA and ARC regarding transportation to general and/or special needs shelters?
  • Has the transportation driver discussed shelter locations with those on board?  
  • Are the evacuees being prepared to move from the bus to the shelter?
  • What kinds of accommodations exist at the special needs shelters?
  • What categories of special needs evacuees can general needs shelters accommodate?
  • Does the special or general needs shelter know we are en route?
  • Has the special or general needs shelter been notified that our arrival is imminent and that they should stand by to assist us with offloading those needing special care?
  • Are people with medical conditions automatically being sent to a hospital or alternate care facility?

[16] McGuire et al., 2007.

[18] Federal Transit Administration, 2006, Disaster Response and Recovery Resource for Transit Agencies.

[19] National Organization on Disability, N.D.

[20] N.F.P.A., 2007.

[21] Schmid, R, “U.S. Must Prepare for Growing Disabled Population, Study Says,” Orlando Sentinel, April 25, 2007.

[22] It is important to note that income levels tend to be lower among those with disabilities, thus reducing the likelihood that they possess transportation and/or resources such as being able to purchase gasoline for an evacuation.

[23] Department of Homeland Security, 2006.

[24] McGuire et al., 2007.

[25] Metz et al, 2002.

[26] California Independent Living Council 2004.

[27] GAO, 2006.

[28] FEMA G-197, Emergency Planning and Special Needs Populations, is a course that was developed by emergency management and special needs specialists to show how to integrate special needs populations into all aspects of emergency management. The course can be accessed on the FEMA EMI Web site.

[29] Van Willigen et al., 2002.

[30] Rosenketter et al., 2007; Tierney, Lindell and Perry, 2001.

[31] Kirkpatrick et al., 2004.

[32] In terms of prioritized evacuations, check with local and/or state EMAs regarding protocols for evacuating people with disabilities and medical conditions. If no protocols are in place, transportation agencies may want to support local and state EMAs in working with special needs organizations to put protocols in place as well as provide traffic and other relevant analysis to EMAs for priority evacuation of special needs populations.

[33] McGuire et al., 2007.

[34] Fernandez et al., 2002.

[35] It is important to be aware that liability issues and work place safety issues may arise. In the planning phases, it is prudent to involve your agency’s general counsel in discussions of liability and workplace safety. By addressing these issues proactively in the planning process, before the disaster strikes, agencies are able to develop solutions in advance.