When catastrophic events occur, providing emergency medical services to people with special needs, such as the elderly or those with mobility impairments, can be a formidable challenge for even the most seasoned responders. To help ensure a state of readiness, EMS systems must plan well in advance and coordinate in ways that they may find atypical.
In the context of emergency management, “special needs” refers to people with medical conditions, physical or intellectual disabilities, and those with limited language proficiency who may require particular assistance when planning for or responding to critical incidents. They are persons or groups with access or functional needs.
Chemical, biological, radiological, nuclear or explosive (CBRNE) events present extraordinary challenges to people with special needs, and thus to the medical responders who seek to assist them. To overcome the challenges, EMS personnel should strive to familiarize themselves with their jurisdiction’s special needs populations and apply an all-hazards approach to preparedness activities.
More than any other disaster, Hurricane Katrina shed light on the importance of taking extra precautions in support of people with special needs. In the hurricane’s aftermath, EMS resources were severely strained and in some cases destroyed. Responders struggled to locate and evacuate survivors with the most critical needs, even though the storm was forecast days before it made landfall in Louisiana. The circumstances surrounding the storm and relative lack of planning have become a lesson learned for the emergency management community, prompting authorities nationwide to take another look at their preparations as they relate to people with special needs.
Although natural disasters are often preceded by a warning, chances are there will be no advance notice of a CBRNE event. Federal, state and local governments move to deploy assets to devastated communities immediately. Depending on the extent of the disaster and logistics, however, some resources may not arrive for up to 72 hours after the event, underscoring the importance of prior planning and coordination in support of special needs populations.
Pre-Positioning Resources & Mutual Aid
Pre-positioning resources and developing mutual-aid agreements with neighboring jurisdictions are among the most effective ways to increase response capacity with an eye toward people with special needs.
Mutual-aid agreements must address personnel, vehicles, medical supplies and equipment. The very process of putting them in writing will help EMS systems forge relationships and focus on the life-sustaining assets required by the most vulnerable.
Locating People with Special Needs
Some local emergency management offices maintain registers of people with access and functional needs to help find and provide aid to them quickly in a disaster. If a jurisdiction has no register, EMS systems should map, as extensively as possible, the whereabouts of people with special needs.
The mapping could incorporate, for instance, assisted living facilities that serve older adults, group homes for people with chronic disabilities, and high density neighborhoods that have large numbers of non-English speaking persons, who will likely have trouble understanding and following emergency alerts and news broadcast instructions communicated in English.
Municipalities that use computer-aided dispatch systems may be able to mine the underlying database to identify the locations of some persons with special needs. Ultimately, though, no EMS system can account for all such persons in a given community, in part because people change residences and routinely cross jurisdictional borders just to get to and from work.
Once the maps showing the locations of special needs populations are ready, EMS systems should distribute print and electronic versions to their personnel. Update print versions annually and electronic versions more frequently as appropriate.
The diversity of possible CBRNE events and the inability to know their magnitude ahead of time make it impossible to provide one-size-fits-all guidance, such as whether to evacuate or shelter in place. Even so, EMS systems should take an all-hazards approach, which entails three basic steps: Assess Needs, Prepare Supplies and Make a Plan.
Each person’s abilities and needs are unique. That being the case, all individuals or their caregivers must assess their own situation and plan accordingly. EMS systems should encourage and support such preparedness consistent with their own missions and because it will reduce the strain on EMS resources should a critical incident occur.
In the wake of a CBRNE event, people with special needs require the same basic supplies as anyone else, such as several days of food and drinking water, a first aid kit, a radio, a dust mask to help filter contaminated air, and a whistle to signal for help.
But they may also need medications or equipment that could be hard to access if pharmacies and clinical facilities are closed or inaccessible. People with asthma and chronic obstructive pulmonary disease (COPD) may need supplemental oxygen. Those on dialysis may need sterile solution and catheters. Others may need backup batteries for a hearing aid or wheelchair. Still others may need extra water and pet food for a service animal.
EMS personnel should coordinate with the home health care providers in their community as they play a vital role in helping people with access and functional needs. These providers know what their patients require in the way of supplies and continuity of care. In addition, home health care providers make excellent partners when planning post-event wellness checks and possible evacuation and tracking. Home healthcare providers can also help their patients to become listed on the local register of people with special needs.
Finally, EMS systems should assess their own needs with respect to equipment, training and exercising and fill any identified gaps to strengthen their ability to aid the most vulnerable.
The Federal Emergency Management Agency (FEMA) recommends preparing two kits of emergency supplies. The first kit should contain everything one needs to shelter in place for at least three days because help may not arrive for up to 72 hours following an event. The second kit should be a lightweight, smaller version that can be carried if it becomes necessary to leave home.
Beyond the basic supplies, medications and equipment, people should have readily available copies of their prescriptions as well as dosage or treatment information; copies of their medical insurance, Medicare or Medicaid cards; instructions on how to operate any equipment or life-saving devices that they rely on; and emergency contact numbers.
Make a Plan
FEMA cautions that people probably will not have access to everyday conveniences following a disaster and encourages those with special needs to think through the details of their daily lives.
Individuals who routinely rely on others should make a list of those people and how they will contact them should a disaster strike. Developing a personal support network is essential. People with special needs should identify family, friends and others and ask them to be part of the network. These assisting persons should know all aspects of the personal emergency plan and have a copy of it, along with keys to the person with special needs’ home and information and training for operating any life-saving equipment. The network should include at least one person in another area who would not likely be affected by the same emergency.
FEMA also advises people to develop a family communications plan as families may not be together when a disaster occurs. Families may benefit from a plan that instructs each person to call or e-mail the same friend or relative in an emergency. It may be easier to make a long-distance call than to call across town, so an out-of-town contact, not in the impacted area, may be a good way to communicate among separated family members.
Emergency plans also must address evacuation versus shelter-in-place and what actions people should take during either contingency.
Shelter-in-place plans must address how one can safely shelter alone or with others. There may be times when it is necessary to stay put and create a barrier to guard against potentially contaminated air outside. This process is called “sealing a room,” and it may be prudent to take this type of action if one sees debris in the air or authorities say the air is heavily contaminated. In addition, knowing which shelters take working animals and can handle a person’s specialized needs, such as ventilator support or oxygen, will greatly facilitate the transfer of care during a disaster.
Evacuation plans should include several possible destinations in different directions so that one has options in an emergency. People with special needs should ask about evacuation plans at the places where they spend most of their time, such as work or school. They also should consider the modes of transportation they use and what alternatives could serve as back-ups, especially if handicap accessible transportation is required. Evacuation plans also should include additional travel time if needed.
Finally, EMS systems must encourage people to stay informed by paying attention to news broadcasts and emergency alerts. Knowing what might happen and adhering to local authorities’ guidance ultimately can save lives.
For more information on types of disasters and how people with special needs should prepare for them, visit www.ready.gov.
Laurence M. Raine, Dr.P.H., M.S., is an emergency medical services training specialist at the Office of Health Affairs, Department of Homeland Security, where he has served for the past six years. He is responsible for the development of training and education coordination in support of pre-hospital care within DHS. During the Vietnam War, Dr. Raine was a corpsman at the United States Naval Medical Center in Bethesda, Md.
Lt. Cmdr. Joseph W. Morris is a physician assistant with the U.S. Public Health Service Commissioned Corps, and a programs analyst at the Office of Health Affairs, Department of Homeland Security. He has more than three decades of experience in the pre-hospital, emergency and military arenas. Among his accomplishments, he is a Distinguished Fellow of the American Academy of Physician Assistants, a Fellow of the American Academy of Experts in Traumatic Stress, and holds a Certificate of Added Qualifications in Emergency Medicine from the American Academy of Physician Assistants.