Title: Disaster%20Preparedness%20and%20Response%20for%20Persons%20with%20Mobility%20Impairments:%20Results%20of%20the%20Nobody%20Left%20Behind%20Project
1Disaster Preparedness and Response for Persons
with Mobility Impairments Results of the Nobody
Left Behind Project
- Michael H. Fox, Sc.D., Glen W. White, Ph.D.,
- Catherine Rooney, M.A., Jennifer Rowland, Ph.D.,
P.T. - Research and Training Center on Independent
- Living at the University of Kansas
- Governors Public Health Conference
- Wichita, Kansas
- April 11, 2006
2Nobody Left Behind
- http//www.nobodyleftbehind2.org
- Three year grant, TS-08040, awarded the KU
RTC/IL by the Association for Teachers of
Preventive Medicine and the Centers for Disease
Control and Prevention - Glen White, Ph.D., KU, P.I.
- Michael Fox, Sc.D., KUMC, Co-P.I.
- October, 2002 September, 2005
- AIM To understand county level disaster
preparedness and response around needs of persons
with mobility impairments
3Persons with Disabilities in the U.S.
- 50 million people with a self reported disability
represent 19 of the 257 million people gt age 5
in the civilian non-institutionalized U.S.
population - Within this population, Census 2000 found
- 9.3 million Americans with a sensory disability
involving sight or hearing. - 21.2 million with a condition limiting basic
physical activities, such as walking, climbing
stairs, reaching, lifting, or carrying. -
- 18.2 million of those 16 and older with a
condition that made it difficult to go outside
the home.
4Nobody Left BehindThe Nature of the Problem
- Typically, disaster preparedness and emergency
response systems are designed for non-disabled
persons, for whom escape or rescue involves
walking or running. - 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.
5 The True Scope of the Issue
- 90 of presidential declared disasters result
from natural phenomena in which flooding was a
major component - Annually, the U.S. averages 100,000 thunderstorms
- Galveston Texas hurricane in 1900 killed more
than 6,000. Death toll from Katrina still
unknown, but exceeds 2,000. - Average of 22 killer tornados each year.
- About 13,000 earthquakes of various magnitudes in
the U.S. each year
6Katrina Federal Disaster Funds - 62.5 Billion
Washington Post, 9/9,2005
7Cost to People with Disabilities
8Cost to People with Disabilities
- Special Needs Assessment 4 Katrina (SNAKE Teams)
National Organization on Disability (NOD) - Recommendations
- Disability and aging organizations involved in
the Katrina response effort report their budgets
are depleted. - No use or under-use of disability and aging
organizations - Need for participation of disability groups in
planning process - Emergency information needs to be in accessible
format
9Nobody Left BehindResearch Activities Overview
- Focus Area 1
- County Programs, Policy, and Practice
- Focus Area 2
- Assessing Risk
- Focus Area 3
- Assurance and Policy Development
10Focus Area 1 COUNTY PROGRAMS, POLICY, AND
PRACTICE
- Objective
- To determine whether counties that have
experienced a disaster during 1998 - 2003 have
systems of workplace, home, and community
disaster preparedness and emergency response in
place for residents with mobility impairments.
11Focus Area 1 COUNTY PROGRAMS, POLICY, AND
PRACTICE
- Research Questions
- Have disasters facilitated changes in disaster
preparedness and emergency response policies and
practices for persons with mobility impairments?
If so, how? - Has the disaster preparedness and emergency
response planning process included community
stakeholders representing people with
disabilities? If so, what has been their
involvement? With what outcomes?
12 Focus Area 2 ASSESSING RISK
- Objective
- To evaluate surveillance systems in place at the
county level that can identify morbidity and
mortality frequency and prevalence for persons
with mobility impairments exposed to a disaster
13 Focus Area 2 ASSESSING RISK
- Research Questions
- Are counties able to assess prevalence of persons
with mobility impairments who reside or work in
their jurisdictions and are at risk of disaster
exposure (calculating the denominator)?
14 Focus Area 2 ASSESSING RISK
- Research Questions (continued)
- Are counties able to determine how many persons
with mobility impairments are affected by
disasters? - Among counties that have surveillance systems in
place, what are prevalence rates of disaster
exposure for persons with mobility impairments,
and what factors appear to influence these
rates?
15 Focus Area 3 ASSURANCE AND POLICY DEVELOPMENT
- Objective
- To recommend modifications to county disaster
coordinating agencies to address the health,
safety, and survival needs of people with
mobility impairments
16 Focus Area 3 ASSURANCE AND POLICY DEVELOPMENT
-
- Research Questions
- What surveillance systems appear most effective
in assessing risk for people with mobility
impairments exposed to disasters? - How can counties use surveillance systems to
better manage their risk for persons with
mobility impairments?
17 Focus Area 3 ASSURANCE AND POLICY DEVELOPMENT
- Research Questions (continued)
- What county policies, practices, or programs are
exemplars of best practices that can be emulated
by counties around the U.S.? - How can these policies, practices, and programs
be incorporated in county disaster plans?
18Nobody Left Behind- Methods
- Identify Federal Emergency Management Agency
(FEMA) declared disasters between 1998 - 2003 - Select a random sample of 30 counties or
equivalent units (i.e., boroughs, reservations,
etc.) across each of the ten federal regions - Interview these county emergency managers
- Evaluate their disaster plans in place at time of
occurrence and more recently for actions
targeting persons with mobility disabilities - With assistance of national advisory panel,
identify best practices - Administer on-line consumer survey
19Nobody Left BehindMethodsWhat did we ask?
- Examples of survey questions
- Does your current emergency management plan have
a protocol to assist people with mobility
impairments during an emergency? - To your knowledge, were people with mobility
impairments included in the process of developing
these protocols? - If no written formal protocols exist to assist
people with mobility impairments, to your
knowledge what do emergency services personnel do
to assist people with mobility impairments during
an emergency?
20Representative County Selection
- Selection of state level disaster occurrences so
that each of the ten federal regions is
represented - REGION I Connecticut, Maine, Massachusetts,
New Hampshire, - Rhode Island, Vermont.
- REGION II New York, New Jersey, Puerto Rico,
Virgin Islands. - REGION III Delaware, Maryland, Pennsylvania,
Virginia, West - Virginia, District of
Columbia. - REGION IV Alabama, Florida, Georgia, Kentucky,
Mississippi, - North Carolina, South
Carolina, Tennessee. - REGION V Illinois, Indiana, Michigan,
Minnesota, Ohio, - Wisconsin.
- REGION VI Arkansas, Louisiana, New Mexico,
Oklahoma, Texas. - REGION VII Iowa, Kansas, Missouri, Nebraska.
- REGION VIII Colorado, Montana, North Dakota,
South Dakota, - Utah, Wyoming.
- REGION IX Arizona, California, Hawaii, Nevada.
- REGION X Alaska, Oregon, Washington, Idaho.
21(No Transcript)
22Summary Research Tables Corresponding to
Research Questions for Nobody Left Behind
23Research Questions 1 Have disasters facilitated
change for people with mobility impairments?
- Table 1. Reasons for Modifying County Disaster
Plans - Using Chi-squared tests, none of these 2x2
relationships are statistically significant
N30 Revisions prompted by disaster? Revisions prompted by disaster? Revisions prompted by people with disabilities? Revisions prompted by people with disabilities? Revisions prompted by federal mandates? Revisions prompted by federal mandates? Revisions prompted by other concerns? Revisions prompted by other concerns?
County disaster plan revised since disaster? Yes No Yes No Yes No Yes No
Yes (n29) 27.6 72.4 6.9 93.1 58.6 41.4 6.9 93.1
No (n1) 0.0 100 0.0 100 0.0 100 0.0 100
24Research Questions 2 Were people with
disabilities included in the planning process?
- Four of the six best practice sites had people
with disabilities included in the process. This
question was only answered for six counties
engaged in the planning process (Question 14) - Of the total survey only 4 out of 30 sites (13)
had people with disabilities included in the
disaster planning process
25Research Question 3Are sites able to assess
prevalence based upon adequate surveillance?
26Table 2. Reported Surveillance of Counties Experiencing Disasters Counties Counties Frequencies Frequencies Data Validity
Measure Category Count
people with mobility impairments in county 13 lt 75 4(13) Database-5 Census-3 Estimate-5 Good Fair Poor
people with mobility impairments in county 13 300-400 2 (7) Database-5 Census-3 Estimate-5 Good Fair Poor
people with mobility impairments in county 13 3,000-10,000 6(20) Database-5 Census-3 Estimate-5 Good Fair Poor
people with mobility impairments in county 13 gt10,000 1(3) Database-5 Census-3 Estimate-5 Good Fair Poor
persons injured in disaster 30 30 None 27(90)
persons injured in disaster 30 30 lt100 1(3)
persons injured in disaster 30 30 100-300 1(3)
persons injured in disaster 30 30 10,000 1(3)
persons killed in disaster 30 30 None 26(87)
persons killed in disaster 30 30 1-5 3(10)
persons killed in disaster 30 30 2,749 1(3)
persons with mobility impairments killed 30 30 None 28(93)
persons with mobility impairments killed 30 30 1 1(3)
persons with mobility impairments killed 30 30 Unknown 1(3)
persons with mobility impairments rescued 30 30 None 17(57)
persons with mobility impairments rescued 30 30 2-15 4(13)
persons with mobility impairments rescued 30 30 25-100 4(13)
persons with mobility impairments rescued 30 30 gt100 5(16)
persons with mobility impairments rescued 30 30 Unknown 1(3)
27Research Questions 4 5 Were surveillance
systems in place that allowed estimates of
prevalence of people with mobility impairments at
risk in a disaster?
- No way to determine prevalence rates based upon
surveillance systems in place. - However, we may want to test this further with
our site in Coffey County. Where there are
accurate voluntary data registries, this measure
could be possible.
28Research Question 6 Surveillance systems that
appear most effective possible best
practices.
- Six counties identified as possible best
practices (out of 30) based upon two criteria - Having in place guidelines for persons with
disabilities and - Identifying operating procedures in place that
follow the guidelines - Best practice sites included the following
counties/jurisdictions Dubuque County, Iowa
Brooklyn-New York City, New York Coffey County,
Iowa Maricopa County, Arizona Norton City,
Virginia Lincoln County, Nebraska.
29Table 3. Differences Between Disaster County
Sites Identified as Best Practices and All Other
Sites All mean differences were tested using
ANOVA and Mann-Whitney for between group
differences.
Disaster County Characteristic Best Practice Site (6) Other Disaster Site (24) Significance, p-value
Mean Total Population 571,266 217,711 .285
Area in square miles 2,248 2,436 .932
Persons per square miles 205 1,783 .575
urban area 67 58 .721
White 91 76 .097
Median household income 36,577 38,914 .568
above median income 33 29 .849
below poverty 13 14 .610
with Center for Independent Living 50 63 .429
persons with physical disability gt 5 8.4 9.7 .392
people with disabilities 5-64 years old 5.1 7.2 .141
people with disabilities gt64 years old 29.1 30.7 .551
t with employee who took FEMA course 17 42 .271
knowing how many people with disabilities live within district 100 29 .001
30Nobody Left BehindWhat did we find out?
- Findings - Emergency Managers
- People with disabilities either were not
represented or had minimal representation in the
emergency planning process - The G197 FEMA Emergency Planning and Special
Needs course pertaining to people with
disabilities appears useful in increasing county
awareness, though only 27 of county emergency
managers reported completing it - Only 20 of the emergency managers reported
having specific guidelines in place to assist
people with mobility impairments during
emergencies
31Nobody Left BehindWhat did we find out?
- Findings - Emergency Managers
- Surveillance efforts to identify persons with
mobility impairments are weak - 57 of county managers did not know how many
persons with mobility limitations lived within
their jurisdiction - Of those who claimed to know, most gave broad
estimates based on unreliable sources - 27 of counties used Census or self-reported
registries to identify this figure more
accurately
32Nobody Left BehindWhat did we find out?
- Findings- Emergency Managers
- 20 of emergency managers reported having
specific guidelines in place to assist people
with mobility impairments during emergencies - Among 24 (80) of jurisdictions that did not
- 38 (9) identified transportation accommodations
that they have in place - 17 (4) identified accessible shelters and other
educational programs that sought to reach out in
some way to persons with disabilities
33Nobody Left BehindWhere are we now?
- Findings of Emergency Managers
- Among jurisdictions not having specific details
or guidelines in place, all (24) told us that
they were important to have - Every persons life is important.
- I have never seen a publication that would
address many of these impairments. - We have it, just not in our particular
plancovered in council on aging and human
resource protocols. - Its a fact of life. They are out there, they
need assistance, and youve got to address it.
34Nobody Left BehindWhat did we find out?
- Findings - Emergency Managers
- 97 (29) of disaster management plans had been
revised since the time of the county disaster we
asked about - But among these, only 2 (7) revised their plans
owing to disability related concerns - Other reasons driving revisions of plans
- Annual review (72)
- Federal mandates (59)
- State mandates (24)
- Disaster (28)
- Other factors (34)
35Nobody Left Behind - Findings
- Among jurisdictions not having specific
guidelines in place (24), 5 (21) told us they
were planning to develop them. 19 (79) told us
they were not. Reasons why not - If need is brought to our attention, we will
accommodate - We are trying to focus on special needs as a
whole - It is covered in other plans
- We dont need to be any more specific than we
already are.. - Confidentiality issues limited local
authority - We are overwhelmed with the demands of Homeland
Security - My office is only staffed by one volunteer.
36Nobody Left Behind Findings
- Sites reporting no specific guidelines stated the
following resources were needed to develop them - 67 financial resources
- 33 knowledgeable and trained personnel
- 17 greater education for the public
- 25 a FEMA/State/or County mandate
- Among reporting sites, who told us they were
planning to develop the guidelines - One told us the idea originated with our
interview, another started with discussions of
the needs of non-English speaking residents, one
mentioned particular advocate associated with
university
37- Consumer Survey
- Do you have a personal disaster experience to
share? - We want to hear from persons with mobility
limitations who have experienced a disaster. - Please complete our on-line survey at
-
- http//www.nobodyleftbehind2.org
-
- Click on Consumer Survey
38Nobody Left BehindConsumer Survey Findings
- There are inaccessible escape routes
- Few people know how to use the adaptive escape
chairs for wheelchair users - There was no accessible transportation after
the disaster event to get around in the
community - Very slow response in helping citizens with
disabilities return to their homes (e.g.,
rebuilding ramps, moving debris, etc.)
39Nobody Left BehindConsumer Survey Findings
- Shelters, including bathrooms, were not
accessible for wheelchair users - During extended power outages, persons were
unable to use assistive equipment and medical
devices - Power outages disabled elevators, forcing persons
with mobility limitations to be dependent upon
neighbors or emergency workers
40Nobody Left BehindConsumer Survey Findings
- It is really difficult to get the utility
company to understand power is a need, if
disabled. - I ambulate with forearm crutches and my leg
stamina is limited. As a social service provider
in NYC, I am in tall buildings often and one in
particular had an evacuation drill. There were
no plans or equipment to assist me. They told me
to ignore the drill. I felt very vulnerable
because I attend regular work meetings in this
building.
41Nobody Left BehindConsumer Survey Findings
- I have juvenile rheumatoid arthritis and use a
wheel chair. We had a bomb threat at work, which
was very scary. Everyone evacuated, but I was
still left on the 3rd floor by the stairwell for
the firefighters to come get me. But, no one
came. Finally, I just struggled and I used pure
fear to get myself down the stairs and outside.
It was scary just to realize that there are not
really any procedures in place to help someone
like me in an emergency.
42Nobody Left BehindNew Directions
- Received 162,000 funding from the National
Institute on Disability and Rehabilitation
Research to conduct research on two tasks - Identify barriers and gaps that Centers for
Independent Living personnel have experienced
concerning people with disabilities in the
recently affected hurricane areas and relocation
centers - Identify barriers and gaps that emergency
personnel have experienced concerning people with
disabilities in the recently affected hurricane
areas and relocation centers
43Current Research
- Early February, 2006
- Visited with CIL staff and consumers from
Southern Mississippi and visited Katrina affected
areas in Gulfport and Biloxi - Late February, 2006
- Visited with CIL staff and consumers from
Southern Louisiana conducting interviews in Baton
Rouge and visiting Katrina affected areas around
New Orleans (e.g., 9th Ward, Arabi, St. Bernard
Parrish) - March, 2006
- Visited with CIL staff in Alabama
44(No Transcript)
45Consumer Reports
- Fear
- Dense darkness
- Safety (looters)
- Unknown (where to go? What to do? When can I go
back, if ever?) - What will my life be like now?
46Consumer Reports
- Resignation
- The system is broken and will not help me.
- There is nothing I can control or do.
- I have invested my whole life in my home and now
it is gone.
47Consumer Reports
- Anger
- FEMA stands for F Every Mississippian Again.
- The response of authorities at all levels was too
little too late. - When we stayed with family after the disaster
there was lots of tension (When you going to
leave?)
48Centers for Independent Living Reports
Question MS CILs S. LA CILs
Anyone with DP training at your CILs? No Yes, limited
Before Katrina, did your CIL have a plan to provide services in the event of a disaster? No Yes, limited
Did your Center have an informal or formal relationship with first-responders before Katrina? No No
How many PEOPLE WITH DISABILITIES from your county had to relocate following Katrina? Thou-sands 35 K
49Centers for Independent Living Reports
Question MS CILs S. LA CILs
What were your CILs most significant accomplishments during the shelter and recovery phase? Finding consumers getting well over 100,000 of equipment to consumers Continuing to provide services post-Katrina
Based on your Katrina experience how can CILs be more effective in helping pwd in future disasters? Train, train, train for DP both staff and consumers work more closely with DP specialists Locate, evacuate, pre-assess, move to CIL-contr. shelter
50Much remains to be done
- People with disabilities must be treated as a
separate group with separate needs and not
combined with special needs. Such designations
only widen disparities. - The overwhelming response of people with
disabilities affected by Katrina is that they
dont want to be forgotten - Exemplary disaster preparedness and emergency
response procedures and annexes need to be
developed and used to help get people with
disabilities out of harms way
51- Mission to promote emergency preparedness
inclusion, research, education, awareness and - planning for people with disabilities at the
local, state, and national level through a
variety of means. - The Consortium consists
- of the American Association on Health and
Disability (AAHD), the University of Kansas
Research and Training Center on Independent
Living, and the University of New Mexico Center
for Development and Disability.
52Additional Sources of Information
- www.nobodyleftbehind2.org
Findings submitted to Journal of Disability
Policy Studies in response to Call for Papers
Disaster Preparation and Emergency Response for
People with Disabilities Research, Policy and
Practice