Improving Disaster Planning and Improving Disaster Planning and Response for Persons with Mobility Response for Persons with Mobility

Limitations – Early FindingsLimitations – Early Findings

Michael H. Fox, Sc.D., Glen W. White, Ph.D., Jennifer Michael H. Fox, Sc.D., Glen W. White, Ph.D., Jennifer Rowland, M.S.,P.T., Monika Suchowierska, Ph.D., Rowland, M.S.,P.T., Monika Suchowierska, Ph.D.,

Catherine Rooney, M.A.Catherine Rooney, M.A.

Research and Training Center on Full Participation in Research and Training Center on Full Participation in Independent Living at the University of KansasIndependent Living at the University of Kansas

American Public Health Association American Public Health Association November 18, 2003November 18, 2003

San Francisco, CaliforniaSan Francisco, California

Disaster Planning and DisabilityDisaster Planning and Disability

According to a November 2001 Harris According to a November 2001 Harris Poll commissioned by the National Poll commissioned by the National Organization on Disability: Organization on Disability:

58% of people with disabilities do not 58% of people with disabilities do not know whom to contact about know whom to contact about emergency plans in their community emergency plans in their community

61% of person with disabilities have 61% of person with disabilities have not made plans to quickly and safely not made plans to quickly and safely evacuate their homes; and evacuate their homes; and

Among those people with disabilities Among those people with disabilities employed full or part time, 50% say no employed full or part time, 50% say no plans have been made to safely plans have been made to safely evacuate their workplaceevacuate their workplace

All percentages in this poll were higher for people with disabilities than their non-disabled counterparts.

Disaster Planning and DisabilityDisaster Planning and Disability -National Attention Following 9/11 - -National Attention Following 9/11 -

After the 1993 WTC bombing, the After the 1993 WTC bombing, the local emergency management local emergency management office and the Associated Blind office and the Associated Blind worked with NYFD to develop a worked with NYFD to develop a comprehensive evacuation plan comprehensive evacuation plan and drill for their staff, most who and drill for their staff, most who have either low or no visionhave either low or no vision

On September 11, the entire staff On September 11, the entire staff calmly and safely evacuated their calmly and safely evacuated their building’s 9building’s 9thth floor, a success floor, a success they attribute directly to the they attribute directly to the customized planning and drillscustomized planning and drills

Source: N.O.D. Guide on the Special Needs of People with Disabilities.

The True Scope of the Issue The True Scope of the Issue

Nine of every ten presidential disaster declarations result Nine of every ten presidential disaster declarations result from natural phenomena in which from natural phenomena in which floodingflooding was a major was a major componentcomponent

Annually, the U.S. averages 100,000 Annually, the U.S. averages 100,000 thunderstorms thunderstorms Fires Fires in Southern California this fall caused at least 25 in Southern California this fall caused at least 25

deaths, destroyed 3,000 homes and left thousands deaths, destroyed 3,000 homes and left thousands homeless. Estimated cost so far is over $2 billion.homeless. Estimated cost so far is over $2 billion.

A A blizzardblizzard in March 1993 dumped record snows from in March 1993 dumped record snows from Alabama to New England, caused 170 deaths, left millions Alabama to New England, caused 170 deaths, left millions without power and resulted in $800 million in damages. without power and resulted in $800 million in damages.

Galveston Texas Galveston Texas hurricane hurricane in 1900 killed more than 6,000.in 1900 killed more than 6,000. Average of 22 “killerAverage of 22 “killer tornados tornados” each year. ” each year. Average of 13,000 Average of 13,000 earthquakesearthquakes of various magnitudes in of various magnitudes in

the U.S. each yearthe U.S. each year

Persons with Disabilities in the U.S.Persons with Disabilities in the U.S. The 50 million people with a self reported disability The 50 million people with a self reported disability

represent 19% of the 257 million people represent 19% of the 257 million people >> 5 in the civilian 5 in the civilian non-institutionalized U.S. population - non-institutionalized U.S. population - nearly one in fivenearly one in five

Within this population, Census 2000 found: Within this population, Census 2000 found: 9.3 million Americans with a sensory disability involving 9.3 million Americans with a sensory disability involving

sight or hearing. sight or hearing.

21.2 million with a condition limiting basic physical 21.2 million with a condition limiting basic physical activities, such as walking, climbing stairs, reaching, lifting, activities, such as walking, climbing stairs, reaching, lifting, or carrying.or carrying.

18.2 million of those 16 and older with a condition that 18.2 million of those 16 and older with a condition that

made it difficult to go outside the home. made it difficult to go outside the home.

Existing FEMA GuidelinesExisting FEMA Guidelines For persons with mobility impairments, existing For persons with mobility impairments, existing

Federal Emergency Management Agency (FEMA) Federal Emergency Management Agency (FEMA) guidelines are well-intentioned but impractical:guidelines are well-intentioned but impractical:

FEMA: Disaster Preparedness for People with Disabilities. FEMA: Disaster Preparedness for People with Disabilities. October, 1998October, 1998

– ““Show friends how to operate your wheelchair so that Show friends how to operate your wheelchair so that they can move you if necessary. Make sure friends they can move you if necessary. Make sure friends know the size of your wheelchair in case it has to be know the size of your wheelchair in case it has to be transported.”transported.”

– ““Find out the proper way to transfer or move someone in Find out the proper way to transfer or move someone in a wheelchair and what exit routes from buildings are a wheelchair and what exit routes from buildings are best.”best.”

– ““Mount a personal use fire extinguisher on an Mount a personal use fire extinguisher on an accessible place on each wheelchair.”accessible place on each wheelchair.”

National Business & Disability Council National Business & Disability Council Emergency Evacuation ChecklistEmergency Evacuation Checklisthttp://www.business-disability.com/Whats_New/eepc.asphttp://www.business-disability.com/Whats_New/eepc.asp

““Are all exit routes accessible as a means of Are all exit routes accessible as a means of egress in the event of an emergency?”egress in the event of an emergency?”

““Do you have a selection and follow up Do you have a selection and follow up process in place to designate process in place to designate buddies/monitors/fire wardens?”buddies/monitors/fire wardens?”

““Do you have procedures to follow if a Do you have procedures to follow if a buddy/monitor/warden is out of the office?”buddy/monitor/warden is out of the office?”

………………………………

MissionMission

To research, identify, and advance To research, identify, and advance person-environment centered person-environment centered strategies that encourage full strategies that encourage full participation in society among participation in society among persons with disabilities representing persons with disabilities representing diverse cultures, varying diverse cultures, varying socioeconomic strata, and emerging socioeconomic strata, and emerging populations.populations.

Using the Person-Environment ModelUsing the Person-Environment Model

A systematic line of A systematic line of research can be research can be conducted to plot conducted to plot person-environment person-environment factors and the resulting factors and the resulting trajectories of trajectories of disablement;disablement;

Person Factors

Environment F

actors

De

gre

e o

fD

isa

ble

me

nt

Patterns of person-Patterns of person-environment risk can be environment risk can be identified so that identified so that services to people with services to people with disabilities can be disabilities can be developed.developed.

Nobody Left BehindNobody Left BehindThe Nature of the ProblemThe Nature of the Problem

Typically, disaster preparedness and emergency response systems are designed for non-disabled persons, for which escape or rescue involves walking or running. These are not appropriate for assisting persons with mobility impairments.

In addition, many plans do not appear to specifically address the transition needs back to pre-disaster conditions that are required for persons with mobility impairments.

Nobody Left BehindNobody Left Behind

Three year grant, TS#-08040, awarded the KU Three year grant, TS#-08040, awarded the KU RTC/IL by the Association for Teachers of RTC/IL by the Association for Teachers of Preventive Medicine and the Centers for Disease Preventive Medicine and the Centers for Disease Control and Prevention Control and Prevention

http://rtcil.org/NLB_home.htmhttp://rtcil.org/NLB_home.htm Glen White, KU, P.I.Glen White, KU, P.I. Michael Fox, KUMC, Co-P.I. Michael Fox, KUMC, Co-P.I. October, 2002 – September, 2005October, 2002 – September, 2005 AIM: Understand county level disaster AIM: Understand county level disaster

preparedness and response around needs of preparedness and response around needs of persons with mobility impairmentspersons with mobility impairments

Nobody Left BehindNobody Left BehindFocus AreasFocus Areas

County Programs, Policies and PracticesCounty Programs, Policies and Practices

– Do counties experiencing recent disaster have Do counties experiencing recent disaster have preparedness and emergency response systems in preparedness and emergency response systems in place for persons with mobility impairments? place for persons with mobility impairments?

– Has the disaster affected how planning is done?Has the disaster affected how planning is done?

– Have persons with disabilities been included in the Have persons with disabilities been included in the planning process?planning process?

Nobody Left BehindNobody Left BehindFocus AreasFocus Areas

Assessing RiskAssessing Risk

– What surveillance takes place at county level? What surveillance takes place at county level?

– Do counties know how many persons with Do counties know how many persons with mobility impairments reside or work in their mobility impairments reside or work in their jurisdictions? jurisdictions?

– Among counties with adequate surveillance Among counties with adequate surveillance data, what are morbidity and mortality rates data, what are morbidity and mortality rates following disasters for persons with mobility following disasters for persons with mobility impairments and what factors appear to impairments and what factors appear to influence rates?influence rates?

Nobody Left BehindNobody Left BehindFocus AreasFocus Areas

Assurance and Policy DevelopmentAssurance and Policy Development

– What disaster management systems appear to be What disaster management systems appear to be most effective in reducing injury and death among most effective in reducing injury and death among persons with mobility impairments exposed to persons with mobility impairments exposed to disaster? disaster?

– How can exemplars of best practices be How can exemplars of best practices be incorporated into other county disaster plans?incorporated into other county disaster plans?

Nobody Left BehindNobody Left BehindMethodsMethods

1.1. Identify Federal Emergency Management Agency (FEMA) Identify Federal Emergency Management Agency (FEMA) declared disasters over the last five yearsdeclared disasters over the last five years

2.2. Select a random sample of 30 counties or equivalent units Select a random sample of 30 counties or equivalent units (i.e., boroughs, reservations, etc.) so that each of the ten (i.e., boroughs, reservations, etc.) so that each of the ten federal regions are representedfederal regions are represented

3.3. Expand our understanding of both county and disaster Expand our understanding of both county and disaster through existing datathrough existing data

4.4. Evaluate disaster plans in place at time of occurrence and Evaluate disaster plans in place at time of occurrence and more recently for actions targeting persons with mobility more recently for actions targeting persons with mobility disabilitiesdisabilities

5.5. With assistance of national advisory panel, identify best With assistance of national advisory panel, identify best practicespractices

Nobody Left BehindNobody Left BehindDisaster Sites in the StudyDisaster Sites in the Study

Town Hall MeetingTown Hall MeetingLawrence, Kansas Lawrence, Kansas

Headline, Lawrence Journal World, July 24, 2003:

Disaster safety for special-needs populations explored

May tornado raises questions about preparedness

Wednesday night, representatives of the Research & Training Center on Independent Living at KU met with about 20 (26, note) public safety and community service leaders to solicit and discuss safety measures.

Residents from the neighborhoods struck by the May tornado also were invited to the meeting at Raintree Montessori School, 4601 Clinton Parkway, but none showed up

"Regardless of whether you have a disability or not, you have to have a plan of what to do," said Paula Phillips, Douglas County Emergency Management director. "As a government, we can't prepare for you. There are more of you than there are of us."

Town Hall MeetingTown Hall MeetingLawrence, Kansas Lawrence, Kansas

Other Insight Gained – Personal responsibility

Keeping 2-3 day supply of medication Preparing for “worst case scenario”

– Community emergency shelter is accessible Role of Safe Rooms – new housing requirement?

– Most first responders consider EVERYONE they encounter in disaster as “disabled.” Need to inform first responders of persons with special needs

– Role of Independent Living Centers in education– Public warning systems are not intended for people

indoors

Nobody Left BehindNobody Left BehindWhere are we now?Where are we now?

Piloting the county surveyPiloting the county survey– Examples of questions:Examples of questions:

““Does your current emergency management plan Does your current emergency management plan have protocol to assist people with mobility have protocol to assist people with mobility impairments during an emergency?” (ICF definition impairments during an emergency?” (ICF definition of mobility impairments)of mobility impairments)

““To your knowledge, were people with mobility To your knowledge, were people with mobility impairments included in the process of developing impairments included in the process of developing these protocols?”these protocols?”

““If no written formal protocols exist to assist people If no written formal protocols exist to assist people with mobility impairments, to your knowledge what do with mobility impairments, to your knowledge what do emergency services personnel do to assist people emergency services personnel do to assist people with mobility impairments during an emergency?with mobility impairments during an emergency? “ “

Nobody Left BehindNobody Left BehindWhere are we now?Where are we now?

Piloting the county surveyPiloting the county survey– A few A few preliminarypreliminary findings from piloting the findings from piloting the

survey in 5 counties:survey in 5 counties: The Emergency Management Plan is a living The Emergency Management Plan is a living

document that undergoes constant changedocument that undergoes constant change The FEMA Emergency Planning and Special Needs The FEMA Emergency Planning and Special Needs

course (G197) offered through the Emergency course (G197) offered through the Emergency Management Institute appears useful in increasing Management Institute appears useful in increasing awareness at the county levelawareness at the county level

Surveillance efforts on identifying persons with Surveillance efforts on identifying persons with mobility impairments before or during disasters mobility impairments before or during disasters appear spotty appear spotty

Nobody Left BehindNobody Left BehindWhere are we now?Where are we now?

Expanding background of sample disaster Expanding background of sample disaster occurrences & beginning our surveyoccurrences & beginning our survey

Developing consumer/web-based query Developing consumer/web-based query form to document experiences of persons form to document experiences of persons with mobility impairments during disasters with mobility impairments during disasters nationwidenationwide

Meeting with advisory board members to Meeting with advisory board members to stay current with existing community needs stay current with existing community needs and national standardsand national standards

Nobody Left BehindNobody Left BehindWhere do we think this will lead?Where do we think this will lead?

Technology Technology AdaptationAdaptation– Understanding and Understanding and

use of new devices use of new devices that will improve that will improve escape, rescue and escape, rescue and survival for persons survival for persons with mobility with mobility impairmentsimpairments

Nobody Left BehindNobody Left BehindWhere do we think this will lead?Where do we think this will lead?

Improved SurveillanceImproved Surveillance– Better understanding at Better understanding at

the community level for the community level for the need to know how the need to know how many people are at risk many people are at risk in disasters who may in disasters who may have mobility have mobility impairmentsimpairments

0

10

20

30

40

50

60

70

80

90

1stQtr

2ndQtr

3rdQtr

4thQtr

East

West

North

Nobody Left BehindNobody Left BehindWhere do we think this will lead?Where do we think this will lead?

Environmental changesEnvironmental changes– Housing: safe rooms, slide Housing: safe rooms, slide

escapes, common shelters, escapes, common shelters, implementing ADA implementing ADA accessibility guidelines, accessibility guidelines, special needs awareness special needs awareness programs (SNAP)programs (SNAP)

– Workplace: space, lighting, Workplace: space, lighting, energy backup, employee energy backup, employee inputinput

– Community: participation in Community: participation in planning process by persons planning process by persons with disabilities with disabilities

Nobody Left BehindNobody Left BehindWhere do we think this will lead?Where do we think this will lead?

Enhanced Training and Enhanced Training and EducationEducation– First responders, First responders,

disaster managers, disaster managers, other county officialsother county officials

– Employers, employeesEmployers, employees– Persons with disabilitiesPersons with disabilities

Nobody Left BehindNobody Left BehindTimelines Timelines

Should be completed with data collection by Should be completed with data collection by June, 2004June, 2004

Best and emerging practices to be identified Best and emerging practices to be identified in conjunction with consumers and National in conjunction with consumers and National Advisory Group by early 2005Advisory Group by early 2005

Dissemination and national conference in Dissemination and national conference in summer, 2005summer, 2005