Chapter 4: Communication Needs

Transportation agencies, their employees, and associated personnel may face considerable challenges in communicating with those in need of transportation assistance. With patience and, where possible, pre-planning, communication efforts can be enhanced. This chapter provides information for transportation personnel on how to better communicate with people who have limited English proficiency, who speak other languages, and who have a disability that affects communications.

Languages/Limited English Proficiency [36]

Depending on the location, languages may vary from primarily English to languages found on every continent. Transportation agencies should devise methods on how to communicate verbally, as well as using text and graphics. For those with limited literacy levels, spoken and written communications—in any language—will not work well. In these cases, “talking boards,” or other graphic tools that use pictures of key tasks (e.g., bathroom, food, location of pain) will be needed on each transportation vehicle. When patients experience cognitive impairments such as Alzheimer’s or other types of dementia, additional communication strategies may be necessary as described below. Accordingly, behaving in a calm, reassuring, and sincere manner may serve as the only means to convey intent. Training staff to communicate through a variety of means will build the confidence of the transportation staff in an evacuation.

Keeping patients and/or people with disabilities together with their ready kits/go bags, buddies, caretakers, equipment, service animals, and/or medical staff goes a long way toward making an evacuation successful. Making a considerable effort to keep them together with key resources will help all dimensions of the transportation process (movement, storage, communication) to flow far better.

Ideally, the pre-planning process will result in the identification of the ways in which transportation agencies can and will communicate with CRCFs and others before, during, and after an event. Communications are often the first thing to fail during an emergency due to a lack of resources (e.g., cell phones, walkie-talkies, radios), limited range, or disasters destroying communication lines (e.g., cell towers).

One of the most useful activities transportation agencies can undertake is an exercise. Conduct a transfer exercise with volunteers who can replicate the population to be transferred such as local people who speak various languages including sign language or who cannot hear. Practice various ways of communicating among vehicle, agencies, and facilities; with medical staff and caretakers on board the vehicle; and between transportation staff and patients. Conduct a thorough, honest, and intensive debriefing of the exercise to identify places where improvements can be made. 

• Work with local agencies and facilities to identify the range of languages and the possible number of people with limited English proficiency.
• Encourage the local planning committee(s) to identify the types of languages and whether or not the person can communicate with written or pictorial means.
• Devise a strategy to keep caretakers and service animals with the passenger.
• Develop written and pictorial illustrations of various words and phrases that may need to be used during the evacuation process. Develop these in the languages most likely to be needed based on the census taken during evacuation planning. Include copies on board all transportation vehicles and provide copies to each supervisor, driver, and other transportation staff. Focus on the following:
  • What is happening and why (e.g., there is a hurricane coming and we need to move you to safety)
  • The place where the person is being taken and the time it should take to get there
  • The kind of facility that they are being taken to and how they will be cared for
  • What has been done to prepare for their transport and arrival; this will reassure many patients and their caretakers.
• Create consistent, easily readable photo identification badges and shirts for the transportation staff: 
  • Color-code the shirts and/or badges to identify supervisors, drivers, and other key staff 
  • Give a printed handout in relevant languages and/or with illustrations to each evacuee.

Communicating with People with Disabilities

The National Organization on Disability’s (NOD’s) Emergency Preparedness Initiative identified three types of people who may require transportation assistance during emergencies—those with sensory, mobility, or cognitive disabilities. NOD and various etiquette guides recommend strategies for communicating with patients who fall into these categories. [37]

Sensory

People with sensory disabilities may experience varying levels of vision impairment or may be deaf or hard-of-hearing. Levels of functioning may vary from the blind who travel easily through urban areas or seniors with macular degeneration who have not acclimated to their declining vision. Working and communicating with persons who have sensory disabilities requires the transportation employee to practice sensitivity, respect, compassion, and patience. The agency may experience this in two types of settings—working with those with sensory disabilities to plan for transportation and transporting persons with sensory disabilities.

It is important that persons with sensory disabilities be brought into the planning process. Their insights may generate particularly appropriate ideas as they experience the condition on a daily basis. Accordingly, it is important to ensure that the planning process addresses their communication needs such as having materials provided in Braille where possible, allowing service animals to stay with the planning partner, and/or including a certified sign language interpreter.

Following the direction of Executive Order 13447, these key partners must be included if transportation of evacuees is to be as successful as possible. The lack of planning among agencies prior to a disaster often results in a more chaotic situation as well as miscommunication and lack of coordination during response. Partnering is critical to avoiding negative outcomes.

Transportation agency staff must be trained in working with those with sensory disabilities. Practical suggestions include:

• Speak in a normal tone of voice.
• Maintain eye contact even with those who are visually impaired.
• Consider having staff trim facial hair so that lips can be easily seen; do not cover the mouth with hands while talking.
• Do not turn away from a person who is deaf or hard-of-hearing; allow the person to observe you speaking.
• Try to decrease noise and other distractions.
• Have a variety of communication tools ready if possible—a sign language interpreter, a communication board or laminated list, and/or pen and paper.
• Always ask permission before touching someone, such as “may I assist you onto the bus, please?” Respect their response.
• Be polite and respectful, such as “would you help me by getting onto the bus now?”
• Orient a visually impaired individual to the transportation vehicle.
• Provide written or verbal instructions on what is going to happen during the transportation.
• Always explain what is going to happen next in stepwise, concrete terms.
• Offer to assist with the service animal’s needs such as food and water. Do not touch the service animal without asking permission first.
• Observe obstacles and barriers ahead of the person and call them out to the person (e.g., “there is a curb to step down first, then three steps up and a left turn onto the bus).”
• Provide alternatives and allow the person to make decisions; respect their independence.
• Verify that transportation and other agencies involved in communication understand and can communicate with each other (interoperability).
• Take communications equipment specific to the individual during the evacuation so that they are able to continue to communicate once reaching their destination.
• Smile and be reassuringly supportive.

Mobility

Mobility disabilities can range from people who experience difficulty moving; to those who use assistive devices such as canes, walkers, wheelchairs, or scooters; to those who may need to remain in beds or similar conveyances. It is absolutely imperative that people with mobility challenges remain with their equipment. Leaving equipment behind places a significant burden on the patient as well as on staff at the arrival facility. Similarly, service animals must be accommodated under the ADA and cannot be left behind. 

Transportation agencies will develop more effective transportation plans if they include people with mobility disabilities in the planning process. Agencies should ensure that the locations they select for meetings are accessible and that sufficient notice is provided so that those with a mobility disability can arrange to be at the meeting. Providing transportation to the meeting for such partners might prove beneficial and insightful. 

Working with people with mobility limitations requires many of the suggestions listed above, including speaking in a normal tone of voice; being respectful; touching only with permission; and providing written, pictorial, and/or verbal instructions in an appropriate language. In addition, agencies should train and exercise their personnel in greeting and communicating with individuals:

• Speak at eye level; if needed, sit down to communicate with those in wheelchairs.
• Provide options and ask for suggestions. Be open to the person’s suggestions as they have more experience with transportation.
• Maintain eye contact.
• Verify that you have understood and that the individual understands.
• Be patient, particularly if an individual also has difficulty speaking or may speak slowly. Verify that you have understood (e.g., “I believe you said that you would like me to place your walker next to you on the bus, is that correct?”).
• Tell the individual where you have placed their assistive device.
• Always ask for permission to touch a service animal; this animal is working and should not be distracted.
• Thank the person for their support and suggestions.

Cognitive

Cognitive disabilities can vary as much as sensory or mobility situations. Cognitive disabilities can be temporary such as the impact of a stroke or brain injury, as permanent as a cognitive development disability such as mental retardation, or as fluctuating as an individual going through early stages of Alzheimer’s or other types of dementia. Because of the diverse range, it can be challenging to communicate properly and appropriately at all times. Disasters and the trauma of transportation may also worsen some conditions, increasing stress and confusion and impairing communication abilities. Some strategies for enhancing communication include:

• Try to decrease noise and other distractions that may impair comprehension.
• Maintain eye contact.
• Be polite and reassuring.
• Speak slowly and carefully but in a normal tone of voice.
• Keep phrases simple and straightforward.
• If someone asks you to repeat something, do so.
• Listen carefully.
• Verify what you think you heard (e.g., “I believe you said that you would like for me to…”).
• Think of yourself as a partner in the communication process and work with the individual to confirm understanding. Include buddies, caretakers, and others as partners in the communication process but focus your attention on the individual with the cognitive disability. Do not ignore the person by communicating solely with the family member or friend.
• Provide written, verbal, and/or pictorial information about the transportation procedures.
• Do not assume that you should transfer individuals with cognitive disabilities to a special needs shelter or other such facility; verify with the individual, their facility, and/or their family member where they are to be transported. Likewise, do not transport a person with an apparent cognitive disability to a facility without the facility’s knowledge that an individual has arrived who may need special assistance.

CRCFs

To ensure continued communications between transportation agencies and CRCFs during evacuation, the following steps are recommended:

• Identify the types of communication resources available prior to an event:
  • If one type of communication system is the one to be used in most events (e.g., cell phones), develop a backup system.
  • Ensure that as many agencies and facilities as possible know the communications plan and use the same equipment.
  • If using a radio system, test to ensure that all agencies and facilities use the same channel and wavelength to avoid problems of interoperability (i.e., cannot communicate because equipment varies too much).
• Test the communication resources on a regular basis.
• Develop a phone-tree of key people to contact for transportation during an evacuation. This may include supervisors, medical staff, facility directors, and others.
  • Test these phone numbers on a regular basis to ensure that they have not changed and that the name of the person is still the same.
  • Conduct a communications drill at least once a year.
  • Before the onset of an event, or shortly before the start of something like hurricane season (June through November), check the system again.
  • In particular:
    • Identify, discuss, and explain the various terms used during transportation and within facilities to enhance comprehension during transportation. If a “code blue” (or similar system) is used to convey a particular type of emergency, ensure that all people participating in the evacuation understand what that means.
    • Ensure that drivers and other on-board staff know who to call along the route in an emergency. Pre-identify and test the numbers of hospitals, 9-1-1, and other EMS resources along the route.
• Upon arrival at the host facility, the transportation agency should communicate a safe arrival to the original CRCF and confirm successful transfer of patients to the new facility.
• After transfer, assess the communications equipment, as it may be needed for re-entry after the danger has passed:
  • Is it in working order? Do batteries need to be charged?
  • Do any repairs need to be made to the communications equipment?
  • Have any communications boards or other such materials been used? Do they need to be replaced or repaired?
  • Have you informed the host facility staff and transportation supervisors of where drivers and other transportation staff will be staying in case they are needed again?
• Do not underestimate the abilities of those with disabilities and their capacities to assist, respond to, and participate in their own transportation and communication needs.

Content: What Information Needs to be Communicated

Written, recorded, and arranged communications prepared in advance can be developed to distribute to evacuees. Develop a simple, straightforward information sheet at an age-appropriate reading level with graphics. Include blanks for shelter locations and other information that will be filled in just before or during the event. Agencies might partner with local or state EMAs and other agencies to produce pamphlets, brochures, Web site materials, posters, and other items (such as t-shirts, cups, maps, magnets, calendars, bags, and other useful materials) that communicate information needed by people with special needs. This information should address the following questions, and may be written in a Frequently Asked Questions (FAQ) format:

• Where is the transportation collection site closest to my home?
• How do I arrange for transportation from my home?
• What type of vehicle will be used for transportation? Can it accommodate my equipment, luggage, medical needs, and support person? How much can I bring?
• How far in advance do I need to arrange transportation?
• How do I get on a transportation registry? Is it handled confidentially? Does it guarantee that I will get transportation assistance? How does the registry work in my community?
• Where can I get further information about an upcoming evacuation in my language (including ASL)?
• Is this agency ready for my particular needs? Whom can I contact for further information? Do they speak my language at this number? Is there Text Telephone (TTY)?
• What transportation route will most likely be used?
• Where will I be taken? Are they ready for my needs? Can I contact the shelter in advance to let them know that I am coming? 
• Is the transportation staff trained in lifting me and in transporting my equipment?
• Can the transportation staff understand me? What can I do to increase my ability to communicate with the staff?
• Can the transportation vehicle take my service animal? Will the shelter accept my service animal? Do I need to do anything special to assist my service animal?
• Will I be allowed to get off the vehicle to use bathroom facilities?
• Is the transportation fleet organized sufficiently so that we will not run out of gas?
• How can I be sure that I will not be separated from my equipment or service animal?
• What happens if I have a medical emergency during transportation?
• Will there be medical facilities in or near the shelter location should I need them?
• If I am separated from my family, what should I do to be reunited?
• How do I get back home?
• Where can I find further information?

Public information is vital prior to an emergency evacuation. The local emergency evacuation planning committee should suggest recommendations regarding several issues from the evacuation and transportation perspective including how to work with local EMA and shelter officials to advertise the locations and accommodations provided by shelters and the role of transportation agencies in assisting people to reach shelters.

People with special needs are more likely to move to such locations if they believe that facilities are ready for them. Advance information and education can positively influence evacuation behavior and increase the willingness of those with special needs to use transportation services. Public service announcements that demonstrate people with special needs using such vehicles and entering shelters can increase public confidence in the credibility of what transportation agencies have to offer.

• Determine when to provide special needs shelter locations, either just prior to, during an emergency, or well in advance.

There are advantages and disadvantages that the planning committee and transportation agencies need to consider about the proper time to open special needs shelters. Jurisdictions handle this in different ways. Some announce both general shelters and special needs shelters well in advance, which allows individuals to make a plan and practice it to become more familiar with the location of their shelter. Others decide to only announce shelters during an evacuation or after an emergency has occurred, when a shelter can be confirmed to be safe and out of harm’s way. Transportation agencies must know, before the public, which shelters will be open, if special needs populations will be evacuated in advance of the general public, emergency evacuation routes, and where people with special needs will be sent. Shelters are usually designated by the local EMA but opened by the ARC. It is vital that transportation agencies have a good working relationship with representatives from both EMA and shelter operations staff.

• Ensure that you know where designated shelters are located per the local emergency management plan or how to learn if the plan has been altered in an event.
• Ensure that people with special needs know where and how they can be picked up and to which shelters they may be assigned.

Checklist

Communicating with a diverse set of passengers can be challenging, and no single driver, supervisor, or agency can have the full capacity to respond. However, capabilities can be enhanced through planning and preparing as much in advance as possible. Transportation agencies can:

• Work with the local EMA to be a part of a language bank for emergency times.
• Work with the EMA and others to pre-identify the languages used in the area including ASL.
• Involve local ethnic organizations in helping with translation at location pick-up points and during transport.
• Ask local instructors of foreign languages and their students to assist with interpretation.
• Contact area colleges and universities to integrate international students speaking foreign languages into communications during transport. It is important to make sure that they are properly trained, especially with any medical translations.
• Train staff in 50 of the most commonly used words in two to three of the most common local languages. In Oklahoma City, for example, all new police recruits are now required to learn basic Spanish.
• Work with the EMA and other agencies to identify the numbers of people and the types of disabilities that may influence communication choices.
• Write scripts to be released at the time of an evacuation for drivers and others to use with people who do not speak the local language or who may be deaf or hard of hearing.
• Purchase communication boards that simultaneously use signs/pictures and words in locally spoken languages.
• Involve people with special needs, social service and health organizations, and others with expertise in pre-writing and testing transportation messages that will be used before, during, and after an event.
• Increase interaction between transportation staff and those likely to need transportation including inviting people with special needs to planning sessions and to participate in training.
• Encourage transportation staff to go to events that increase their interaction and communication with people with special needs such as events held at a school for the deaf and/or blind, events held at a facility for people with cognitive disabilities (adult day care, state residential facility), and ethnic cultural festivals that use local languages and/or dialects.
• Encourage the agency to co-sponsor local events such as Disability Awareness Week and/or to reach out at the onset of tornado and hurricane seasons to people with special needs.
• Conduct training for transportation staff by involving people with special needs in developing the staff’s ability to hear, comprehend, and make themselves understood by those who they will seek to serve.
• Develop pre-recorded messages in the languages that are spoken.

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