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

ii
 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).

iii
 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 1

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 2

 Communication/Notification
Accessibility of Emergency Information

Populations to Consider Options to Consider

Individuals with sensory impairment
Hearing limitations 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
Visual limitations Braille
Large print
Disks
Audiocassettes
Audio-described videos
Individuals with speech limitations Sign language interpreters
TTYs/TTDs
Hearing carryover (HCO)
Telecommunications Relay Services (TRS)
Non-English speakers TV and radio
Information at churches, schools, clinics
Use of multiple languages
Coordination with ethnic media
communities
Existing community outreach workers
Individuals who are homeless 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 3

 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 audio-
described videos, videoconferences and PSAs.

Information compiled by EPOC’s Vulnerable Populations Workgroup 4

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 5

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 6

 Transportation/Evacuation
Persons with Limited Ability to Self-Evacuate

Populations to Consider Options to Consider

Individuals with mobility limitations 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
Congregate populations If it is necessary to evacuate, rather than
Jails/prisons shelter in place, the evacuation plan will
Detention centers need to address many issues, including but
Assisted living facilities not limited to:
Nursing homes Security during transport
Group homes Medical needs during transport
Shelters Staffing during transport
Hospitals Prior identification and preparation
of receiving facility
Medically compromised individuals Door-to-door service
Lift-equipped vehicle
Caregiver transportation
Life support equipment
Voluntary registry
Vehicle availability
Master list of drivers
Individuals with limited access to Establish transportation hubs with shuttle
transportation service to hubs
Pick up/drop off locations
Voluntary registry
Transit and school buses

Information compiled by EPOC’s Vulnerable Populations Workgroup 7

 Transportation/Evacuation
Persons with Limited Ability to Self-Evacuate

Considerations
The following “best practices” recommendations are from the National Consortium on
Human Services Transportation:

• 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 8

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 9

 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
Information compiled by EPOC’s Vulnerable Populations Workgroup
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
10
 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 11

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 non-
chemical 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 non-
controlled 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 12

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 13

 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&section=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 14

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 15