Emergency Vp Toolkit Best Practices Compilation

EMERGENCY PREPAREDNESS FOR VULNERABLE POPULATIONS BEST PRACTICES COMPILATION July 2008

Information Compiled by the Vulnerable Populations Workgroup Emergency Preparedness Oversight Council

EMERGENCY PREPAREDNESS FOR VULNERABLE POPULATIONS BEST PRACTICES COMPILATION Table of Contents

Topic

Page Number

Preface……………………………………………………………………………….iii Emergency Planning, Functional Approach…………………………………………1 Communication/Notification, Accessibility of Emergency Information…………….3 Communication/Notification, Descriptions and Considerations…………………….4 Transportation/Evacuation, Persons with Limited Ability to Self-Evacuate………...7 Transportation/Evacuation, Considerations………………………………………….8 Sheltering/Mass Care, Individuals in need of Enhanced Shelter Services………….10 Sheltering/Mass Care, Considerations………………………………………………11 Listing of Resource Documents……………………………………………………..14

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Preface The challenges faced during emergencies and disasters by individuals with special needs must be addressed in every phase of emergency preparedness. The information in this document is provided to support the efforts of local jurisdictions in addressing these issues. The information has been compiled from a wide variety of public, private, and advocacy organization Web sites and documents. Information has also been gathered from both “best practices” and “lessons learned” testimony, articles, and documents. A list of major resource documents, including the documents mentioned below, is included. A primary emergency preparedness resource is the State Emergency Response and Recovery Plan (SERRP). The SERRP defines state agency roles and responsibilities and provides the structure and mechanisms for effective coordination among federal, state, county, and tribal authorities, the private sector, and nongovernmental organizations (NGOs). The SERRP also identifies state, county/local, voluntary, and private organizations involved in performing disaster recovery operation activities and describes their respective roles and responsibilities. An additional planning tool is the Public Health Workbook to Define, Locate and Reach Special, Vulnerable, and At-Risk Populations in an Emergency, Centers for Disease Control and Prevention (CDC).

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Emergency Planning Functional Approach for Special Needs, Disabled and Vulnerable Populations Background Experts, such as the Centers for Disease Control and Prevention (CDC) and an International Seminar on Vulnerable Populations, acknowledge that enormous variability exists in defining special needs, disabled and vulnerable populations. Depending primarily upon the perspective or the focus of the group compiling the information, there are long and exhaustive lists, relatively short lists with broad categories, broad definitions without specifics, lists of individuals with special needs, lists of individuals with disabilities, and lists of individuals who are considered vulnerable. While planners across the country are taking different approaches to identifying this population, planning in most cases has not moved significantly beyond the stage of compiling the lists. As noted, the creation of lists of individuals with limitations, either broadly or narrowly defined, is the most commonly used approach to emergency planning for these populations. However, a review of planning efforts by governmental entities and other organizations indicates that there is no agreement on what categories should be used or on which individuals should be included. More importantly, the creation of such a list is not necessarily helpful in moving the planning process forward. It might be more productive to focus attention on critical emergency planning areas and to identify individuals who, for any reason, would need enhanced services in that specific area and begin planning to provide those enhanced services. Functional Approach to Emergency Planning for These Populations The individuals within these populations are not a homogeneous group. The extraordinary diversity that exists among these individuals is generally not acknowledged in planning efforts. For example, “the elderly” are included on almost all “special needs” lists, when the only thing these individuals have in common is age. Many elderly individuals live independently and function quite well. Their possible need for enhanced services during an emergency would be related to a specific limitation, not to their age. Further, the limitation might necessitate enhanced services in one area, such as mobility assistance, but not in other areas such as communication. A functional approach to planning acknowledges and addresses the individual differences among people with limitations and supports focused and results-oriented planning efforts by grouping individuals who will require enhanced services within each critical area of emergency planning and response. Planners can thus immediately begin to address the provision of the required enhanced services.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Examples of the Functional Approach to Planning The following are examples of three critical areas in emergency planning, with examples of individuals whose specific limitations will require planning for enhanced services in that area of emergency response.

Communication/Notification: Accessibility of Emergency Information • Individuals with sensory impairments (hearing and visual limitations) • Individuals with speech limitations • Non-English speakers • Individuals who are homeless Transportation/Evacuation: Persons with limited ability to self-evacuate • Individuals with mobility limitations • Congregate populations • Medically compromised individuals • Individuals with limited access to transportation Sheltering/Mass Care: Individuals in need of enhanced shelter services • Individuals in need of medical care management (not hospitalization) • Individuals dependent on others or in need of assistance from others for routine care • Individuals with sensory impairment • Unaccompanied children The following sections include possible options for planning to meet these needs; these matrices and accompanying documents contain additional planning information.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Communication/Notification Accessibility of Emergency Information

Populations to Consider Individuals with sensory impairment Hearing limitations

Visual limitations

Individuals with speech limitations

Non-English speakers

Individuals who are homeless

Options to Consider TTYs/TTDs Amplified phones Listening systems Sign language interpreters Captioning (open/closed) PSAs Emergency e-mail Wireless network alerts AZ 2-1-1 Telecommunications Relay Services (TRS) Voice carryover (VCO) Electronic messaging Cell phone/text messaging Braille Large print Disks Audiocassettes Audio-described videos Sign language interpreters TTYs/TTDs Hearing carryover (HCO) Telecommunications Relay Services (TRS) TV and radio Information at churches, schools, clinics Use of multiple languages Coordination with ethnic media communities Existing community outreach workers Information at shelters, food banks, bus stations and libraries Radio and TV Loudspeakers on police cars Existing community outreach workers

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Communication/Notification Accessibility of Emergency Information Descriptions and Considerations Descriptions A TTY, also referred to as TTD, is a device that is used in conjunction with a telephone to communicate with persons who are deaf, who are hard of hearing, or who have speech impairments, by typing and reading text. To communicate by TTY, a person types his or her conversation, which is read on a TTY display by the person who receives the call. VCO is voice carryover. VCO is a communication hybrid of TTY and voice. Many persons who become deaf or hard of hearing later in life prefer to speak rather than type. VCO allows a person with hearing loss to speak directly to the person who receives the call and read the response that is typed back. HCO is hearing carryover. People with speech impairments who are not deaf or hard of hearing often prefer HCO. HCO allows them to type their words on a TTY to the person who receives the call and hear that person’s spoken response through their handset. Telecommunications Relay Services (TRS) is a unified, nation-wide telecommunications system for persons with hearing and speech disabilities. TRS is a telephone transmission service that uses a relay operator or communications assistant to relay calls. The third-party communications assistant enables callers with hearing and speech disabilities who use TTYs and other technologies, and callers who use voice telephones, to communicate with each other. Closed captions are visual text displays that are hidden in the video signal and must be accessed through a remote control, on-screen menu, or a special decoder. Open captions are an integral part of the television picture, like subtitles in a movie. Open captions cannot be turned off. Considerations Communication access enables effective communication with individuals who are deaf or blind or who have speech, vision or hearing limitations. It includes the use of written materials available in alternative formats (e.g., Braille, large print, disks, audio cassettes), and hearing-assistive technologies such as amplified phones, TTYs and listening systems. Communication access also involves the use of auxiliary aids and services such as sign language interpreters (multiple languages), CART (communication access real-time translation) readers, people to assist with completing paperwork, and people to take notes. In addition, it includes accessible media such as web sites, captioned and audiodescribed videos, videoconferences and PSAs. Information compiled by EPOC’s Vulnerable Populations Workgroup

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FCC rules require broadcasters and cable operators to make local emergency information accessible to persons who are deaf or hard of hearing, and to persons who are blind or have visual limitations. This means that emergency information must be provided both aurally and in a visual format. • In the case of persons who are deaf or hard of hearing, emergency information that is provided in the audio portion of programming must be provided either using closed captioning or other methods of visual presentation, such as open captioning, crawls or scrolls that appear on the screen. Emergency information provided by means other than closed captioning should not block any closed captioning, and closed captioning should not block any emergency information provided by means other than closed captioning (e.g., currently, scrolling messages often block captions). • In the case of persons with visual limitations, emergency information that is provided in the video portion of a regularly scheduled newscast or a newscast that interrupts regular programming must be made accessible. This requires the aural description of emergency information in the main audio. If the emergency information is being provided in the video portion of programming that is not a regularly scheduled newscast or a newscast that interrupts regularly programming, this information must be accompanied by an aural tone. The tone alerts persons with visual limitations to tune to another source, such as a radio, for emergency information. • Emergency information provided visually and aurally must include critical details regarding the emergency and how to respond. Emergency preparedness information often is not available in accessible formats (e.g., Braille, large print, disks, audiocassettes, and accessible media, including web sites). Emergency information in accessible formats does not always provide critical details such as specific details on the areas that will be affected by the emergency, evacuation orders, detailed descriptions of areas to be evacuated, specific evacuation routes, approved shelters or the way to take shelter in one’s residence, road closures and how to obtain relief assistance (e.g., call the number on your screen). For deaf individuals who sign, the only language they speak is American Sign Language (ASL). This language does not translate directly to English. Therefore, captions at the bottom of a TV screen or messages written by a TTD operator may not be clearly understood. The best way to communicate with signers during an emergency is to have someone on the TV screen translating messages into sign language. TV stations should have a plan to secure emergency ASL interpreters for on-camera emergency duty. There are frequent advances in accessible telecommunications. CapTel, for example, works like other telephones, except that users can read a captioned version of their conversations on the text screen of their phone. Captions appear almost simultaneously with the spoken work, allowing users access to what is said, either by hearing it or by reading. Some personal computers, pagers, cell phones and PDAs can caption the spoken word. Information compiled by EPOC’s Vulnerable Populations Workgroup

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The inability to use TTYs (teletypewriters), amplified phones, and other equipment dependent on electricity should be considered. Users of hearing aids and cochlear implants sometimes experience compatibility and interference problems when using cell phones, making the availability of land lines an issue under some circumstances. Using a combination of communication techniques is more effective than relying on one method alone. Emergency information should be presented both audibly and visually. Consistent, unique, specific tones, music and voice tags such as “this is a special report” should precede emergency information. Emergency e-mail and wireless network alerts are viewed as helpful by individuals who are deaf or hard of hearing, but information is sometimes spotty or incomplete. In addition, some information is truncated when sent to various devices. In addition to posting important information on the screen (e.g., phone numbers), TV stations should also announce the information slowly and repeat it frequently for individuals with visual limitations. PDF documents containing emergency information should be posted in alternative accessible formats. Special populations living in institutions, group homes, or other residential facilities will likely not need special communications; staff working in such facilities generally know best how to communicate with the individuals residing in the facility and will do so in the event of an emergency. Although the literature on preparedness suggests that people who are homeless will resist warnings from those in uniform, a study in Colorado involving focus groups with individuals who are homeless indicated that they want the police to be the ones to alert them to danger. The focus groups suggested using loudspeakers mounted on police cars to spread emergency alerts. Not only are individuals who are homeless open to dealing with the police in an emergency, but they also believe that officers will know where to locate them to provide essential information. The Telecommunications Service Priority (TSP) program was created in 1988 as the regulatory framework to guide telecommunications carriers in repairing or providing new telecommunications services in the event of a disaster. As a general matter, users may make a request that the particular telecommunications services upon which they rely receive a priority assignment. These requests are directed to the Office of Priority Telecommunications of DHS’ national communications system.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Transportation/Evacuation Persons with Limited Ability to Self-Evacuate

Populations to Consider Individuals with mobility limitations

Congregate populations Jails/prisons Detention centers Assisted living facilities Nursing homes Group homes Shelters Hospitals Medically compromised individuals

Individuals with limited access to transportation

Options to Consider Pick up/drop off locations Door-to-door service Lift-equipped vehicle Wheelchair securement capability Liability coverage Service animals Voluntary registry Vehicle availability Use of lift-equipped school or transit buses Master list of drivers If it is necessary to evacuate, rather than shelter in place, the evacuation plan will need to address many issues, including but not limited to: Security during transport Medical needs during transport Staffing during transport Prior identification and preparation of receiving facility Door-to-door service Lift-equipped vehicle Caregiver transportation Life support equipment Voluntary registry Vehicle availability Master list of drivers Establish transportation hubs with shuttle service to hubs Pick up/drop off locations Voluntary registry Transit and school buses

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Transportation/Evacuation Persons with Limited Ability to Self-Evacuate Considerations The following “best practices” recommendations are from the National Consortium on Human Services Transportation: • • • • • •

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Clarify rules and regulations at local, state, and federal levels of government that might otherwise impede effective and efficient mobility for people who are transportation dependent; Develop voluntary registries of persons who identify themselves as requiring transportation assistance during an emergency, including the specific nature of their transportation need; Utilize existing 211/511 human service telephone information systems (where available) to relay information to these populations during an emergency; Establish chains of responsibility to eliminate confusion as to who holds what responsibility once an emergency plan is enacted; Secure agreements on where and when vehicles might be staged and stored during emergency situations, which vehicles are accessible, and specific plans for the transport of persons in need of transportation assistance; Build interagency and mutual aid agreements during the planning process that establish resources such as the shared use of accessible vehicles, fuel, scheduling and dispatching data, and the identification of those individuals requiring assistance; Develop funding agreements in advance to allow services to be deployed immediately during an emergency event.

Secure agreements to provide fuel and enter into cooperative agreements with other community services that also need a reliable fuel supply, such as police and fire departments, to increase the likelihood of an undisrupted fuel supply. Establish formal agreements that alleviate legal liability and reimbursement concerns when securing transportation resources to assist in evacuation. With vendor transportation contracts, ensure that the contracts, if not exclusive, are at least not conflicting relative to availability and the appropriate mix of vehicles for the anticipated demand. Information on how, when, and where transportation services will be provided during emergencies should be well known within the community before an emergency occurs. Use a variety of media and accessible formats. Determine a point of contact to address questions from the public.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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A roster should be prepared and maintained by the emergency vehicle operator. In addition to tracking the individuals who are evacuated, the roster can be used after the emergency for billing purposes. Transportation providers must be prepared to accommodate and transport service animals that may accompany some individuals.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Sheltering/Mass Care Individuals in need of Enhanced Shelter Services

Populations to Consider Individuals in need of medical care management (not hospitalization), examples include: monitoring by a nurse; assistance with medications; dependent on electrical equipment

Individuals dependent on others or in need of assistance from others for routine care Individuals with sensory impairment Unaccompanied children

Options to Consider Medical needs shelters or designated, discrete areas of mass shelters Availability of medical/nursing oversight Oxygen supply and equipment Architectural accessibility Portable lifts Cots same height as wheelchairs Sufficient refrigeration capacity/back-up coolers Emergency power generation Prior identification and preparation of receiving shelter Remain with family/caregiver in shelter Specified area of shelter (voluntary) Provide support and respite for caregivers Identification wristbands if necessary Accessible communications Accommodation for service animals Designated, discrete areas of mass shelters Continuous supervision Counselors with child welfare experience Establish links with state/community agencies serving children and National Center for Missing and Exploited Children Identify, train and maintain a list of volunteers/utilize existing volunteer agencies

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Sheltering/Mass Care Individuals in need of Enhanced Shelter Services Considerations GAO testimony before the U.S. Senate Special Committee on Aging (2006): • Although state and local governments can order evacuations, health care facilities can be exempt from these orders. Facility administrators are usually responsible for deciding whether or not to evacuate. Administrators indicated to GAO that they generally see evacuation as a last resort. • If the administrators decide not to evacuate, to shelter-in-place, they are challenged with the responsibility of ensuring that the facility has sufficient resources to provide care during the disaster and its aftermath. • If administrators decide to evacuate, they are likely to be faced with insufficient transportation resources for their population and a lack of receiving facilities. • The National Disaster Medical System (NDMS) is a federal program that supplements state and local emergency response capabilities. NDMS is neither designed nor configured to move nursing home residents. NDMS does not have agreements with nursing homes that could receive evacuated nursing home residents. In contrast, NDMS does have such agreements with participating hospitals. Adult residential care homes, assisted living facilities and other similar health care settings may shelter-in-place. However, facility managers should be encouraged to have back-up plans in place to alert officials and others when conditions limit or constrain their sheltering-in-place plans or unfolding events force them to take alternative actions. Individuals with special needs may choose to or need to shelter-in-place during emergencies. They should be encouraged to make this fact known to emergency officials, and a process for doing so should be available and publicized. Unless they reside in facilities, individuals with cognitive, mental or emotional issues are the least likely to be recognized as having special needs without self-identifying. One issue often overlooked in planning is the need to maintain shelter security for specific populations, e.g., women with protection orders, children at risk from sexual predators. By federal law (ADA), individuals with disabilities have the right to be accompanied by their assistance animals in all places of public accommodation, including emergency shelters. A person who is accompanied by an assistance animal is not required to show proof that the animal is an assistance animal. Individuals with service animals should be placed close to a shelter exit.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Ensure that a reasonable number of emergency shelters have back-up generators and a way to keep medications refrigerated. These shelters should be made available on a priority basis to people whose disabilities require access to electricity and refrigeration. Notify the public regarding the location of these shelters. Public phone stations need power sockets nearby to supply power to portable TTY/TDDs used by individuals with speech or hearing impairments. Writing tablets and pencils should be available for use by individuals with hearing impairments; do not assume that everyone reads and writes in English. Identify and widely publicize to the public, including individuals with disabilities and the organizations that serve them, the locations of the most accessible emergency shelters. At the accessible entrance to a shelter, have signage providing information about features of the shelter if it is less than fully accessible. Ensure that the approach to outdoor lavatories is accessible, and provide at least one nonchemical toilet for individuals with chemical sensitivities. Be prepared to repair or replace durable medical equipment, e.g., tires on wheelchairs. Establish contact with local agencies that supply personal care attendants, such as independent living centers. Allow individuals to stay in cars or other vehicles in parking lots or other areas near the shelter as necessary, and provide services in these areas. This could be necessary if the shelter is not accessible, or for some individuals who are unable to tolerate the environment of a mass shelter. Individuals in hospitals and long-term care facilities are evacuated to like facilities rather than to shelters. Some persons with mental disorders (along with family members) may need to be placed in an area where they can receive enhanced services and support or be monitored as necessary. Shelters may need to obtain, store, control and dispense both controlled and noncontrolled medications. The Connecticut State Office of Protection and Advocacy for Persons with Disabilities advocates the following approach: Each municipality should establish a shelter enhancement team made up of the local Emergency Management Director, the local American Red Cross Chapter, and local advocacy groups or individuals who can speak to access-related issues. This group should work together and develop a realistic plan for

Information compiled by EPOC’s Vulnerable Populations Workgroup

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establishing universally accessible sheltering within their community. The local group should assess its facilities and develop strategies for making each facility more accessible. Local teams should then prioritize needed improvements and coordinate improvement projects.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Resource Documents Access for 9-1-1 and Telephone Emergency Services, U.S. Department of Justice, Civil Rights Division, Disability Rights Section, available at http://www.usdoj.gov/crt/ada/911ta.htm Accessibility of Emergency Video Programming To Persons With Hearing And Visual Disabilities, FCC Consumer Facts, available at http://www.fcc.gov/cgb/consumerfacts/emergencyvideo.html Accommodating People With Disabilities In Disasters: A Reference Guide To Federal Law, FEMA, available at www.fema.gov/oer/reference/ ADA Best Practices Tool Kit for State and Local Governments, U.S. Department of Justice, Civil Rights Division, Disability Rights Section, available at http://www.ada.gov/pcatoolkit/toolkitmain.htm. An ADA Guide for Local Governments, Making Community Emergency Preparedness and Response Programs Accessible to People with Disabilities, U.S. Department of Justice, Civil Rights Division, available at www.usdoj.gov/crt/ada/emergencyprepguide.htm. AZ Department of Health Services, Demographics and Effective Risk Communication Research Report, available at www.azdhs.gov/phs/edc/edrp/. Best Practices Model: Including the Needs of People with Disabilities, Seniors, and Individuals with Chronic Mental Illness in Emergency Preparedness and Planning, New Mexico Governor’s Commission on Disability, web site currently under construction (Feb. 2008), but will again be available at http://gcd.state.nm.us/emergency.htm. Communicating During Emergencies, Federal Communications Commission (FCC) Consumer Facts, available at http://www.fcc.gov/cgb/consumerfacts/emergencies.html. Emergency Preparedness and Emergency Communication Access, Deaf and Hard of Hearing Consumer Advocacy Network, available at www.nvrc.org/content.aspx?page=5138§ion=5. Guide on the Special Needs of People with Disabilities for Emergency Managers, Planners and Responders, National Organization on Disability, available at www.dola.state.co.us/dem/publications/Guide_on_Special_Needs_People.pdf. Individuals with Disabilities in Emergency Preparedness, U.S. Department of Homeland Security, Office for Civil Rights and Civil Liberties, 2005 Annual Report, available at http://www.dhs.gov/disabilitypreparednessICC.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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Personal Communications Technology for Emergencies (listing of web sites providing information), available at http://www.disabilitypreparedness.gov/ppp/pcte.htm. Populations with Special Needs, Oak Ridge National Laboratory, available through Google at Oak Ridge National Laboratory ORNL/TM-2006/559. Public Health Workbook to Define, Locate and Reach Special, Vulnerable, and At-Risk Populations in an Emergency (working draft that may not be cited or quoted), Centers for Disease Control and Prevention, available at www.bt.cdc.gov/workbook. State Emergency Response and Recovery Plan (SERRP), posted on the Arizona Division of Emergency Management web site, www.dem.state.az.us/. Strategies in Emergency Preparedness for Transportation-Dependent Populations, National Consortium on Human Services Transportation, available at www.dotcr.ost.dot.gov/Documents/Emergency/Emergency%20Preparedness%20Strategy %20Paper.doc. The Current State of Transportation for People with Disabilities in the United States, National Council on Disability, available at www.ncd.gov/newsroom/publications/2005/current_state.htm. Transportation and Emergency Preparedness Checklist, National Consortium on the Coordination of Human Service Transportation, www.dotcr.ost.dot.gov/Documents/Emergency/Emergency%20Checklist.doc.

Information compiled by EPOC’s Vulnerable Populations Workgroup

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