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Ethics of Special Needs for School Nurses in a Public Health Emergency Laura M. Stough Center on Disability and Development Texas A&M University – PowerPoint PPT presentation

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Title: Ethics%20of%20Special%20Needs%20for%20School%20Nurses%20in%20a%20Public%20Health%20Emergency

Ethics of Special Needs for School Nurses in a
Public Health Emergency
  • Laura M. Stough
  • Center on Disability and Development
  • Texas AM University
  • 979-845-8257

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Photos credit the Associated Press
Photos from http//
A rescuer carries a young man who is unable to
walk to safety. - Retrieved from FEMA Photo
Library 2006.
Deaf section for Hurricane Katrina evacuees at
the Houston Astrodome. (Houston, TX., 9/10/2005
-- FEMA photo/Andrea Booher)
Tanisha Blevin, 5, holds the hand of fellow
Hurricane Katrina victim Nita LaGarde, 105, as
they are evacuated from the Convention Center in
New Orleans, La., Saturday, Sept. 3, 2005. (AP
Photo/Eric Gay )
Defining Disability
  • Mashaw and Reno (1996) document over 20
    definitions of disability used for purposes of
    entitlement to public or private income support
    programs, government services, or statistical

Census Bureau (2000)
  • A person with a disability has difficulty in
    performing functional tasks or daily living
    activities or meets other criteria, such as a
    learning or developmental disability. Persons
    with severe disabilities are defined as being
    completely unable to perform one or more of these
    tasks or activities, need personal assistance or
    have one of the severe conditions identified by
    the census.

Who are People with Disabilities?
Using traditional labels, people who have
  • Mobility impairments
  • Visual impairments
  • Hearing impaired or Deaf
  • Intellectual disabilities
  • Mental illness
  • Traumatic brain injury
  • Other health impairments

From left to right http//www.photolibrary.fema.g
Students with Disabilities
  • Pervasive developmental delay
  • Intellectual disabilities (mental retardation)
  • Autism
  • Speech impairments
  • Emotional disturbance/behavior disorders
  • Traumatic brain injury
  • Learning disabled
  • Deaf or hearing impaired
  • Blind or visually impaired
  • Other health impaired Hospitalized, asthma, ADHD

Statistics on Individuals with Disabilities
  • 12.6 of the working age population
  • 12 of the school-aged population
  • 16.7 of the total population
  • 21.3 (almost 250,000) of the residents of the
    New Orleans metropolitan area described
    themselves as disabled in the 2000 Census.

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Participants and Method
  • Survey of people New Orleans who were evacuated
    to the Astrodome and other large facilities in
    Houston about their reasons for not evacuating in
    anticipation of the hurricane.
  • Took place Sept. 10-12, 2005 among 680 randomly
    selected adult evacuees residing in Houston
  • Interviews were conducted face-to-face.

  • As part of survey results
  • - 35 responded that I did not have a car
    or a way to leave.
  • - 38 responded that I was physically unable
    to leave or I had to care for someone who was
    unable to leave.
  • (Survey of Hurricane Katrina Evacuees, Sept. 2005)

Research on Risk Factors
  • Individuals with mobility impairments
  • Those without transportation
  • People from lower SES groups
  • Non English speakers
  • Single heads of household

Post disaster vulnerability
  • PTSD
  • Alcoholism and substance abuse
  • Family violence
  • Secondary disabilities

Laws that Influence Disaster Response and Recovery
  • The Americans with Disabilities Act of 1990 (ADA)
    is the short title of United States Public Law
    101-336, signed into law on July 26, 1990 by
    President George H. W. Bush.
  • The ADA is a wide-ranging civil rights law that
    prohibits, under certain circumstances,
    discrimination based on disability.
  • It affords similar protections against
    discrimination to Americans with disabilities as
    the Civil Rights Act of 1964, which made
    discrimination based on race, religion, sex,
    national origin, and other characteristics

According to the ADA, who is considered to have a
  • Disability is defined as "a physical or mental
    impairment that substantially limits a major life

A Major Life Activity involves functions or
activities that are of central importance to
daily life such as
  • Caring for one's self
  • Performing manual tasks
  • Walking
  • Seeing hearing
  • Speaking
  • Breathing
  • Learning
  • Working

Chapter 7
  • Emergency Management
  • Under Title II of the ADA

Basics for Emergency Management
  • State and local governments must comply with
    Title II of the ADA in the emergency and
    disaster-related programs, services, and
    activities they provide
  • This requirement applies to programs, services,
    activities provided directly by state and local
    governments, as well as those provided through
    third parties, such as the American Red Cross,
    private nonprofit organizations, and religious

This includes
  1. Advance planning for emergencies and disasters
  2. Staging emergency simulations
  3. Alerting the public to emergencies and disasters
    and to available programs, services, and
  4. Community evacuation and transportation
  5. Emergency shelter programs
  6. Temporary lodging and housing
  7. Social services and emergency- and
    disaster-related benefit programs

This includes
  1. Emergency medical care and services
  2. Relocation programs, activities, and services
  3. Transition and transportation back to the
    community following an emergency or disaster
  4. Emergency and disaster recovery programs,
    services, and activities, and
  5. Remediation of damage caused by emergenicies and

Basics for Emergency Management
  • Emergency programs, services, activities, and
    facilities must be accessible to people with
    disabilities and generally,
  • May not use eligibility criteria that screen out
    or tend to screen out people with disabilities

Basics for Emergency Management
  • The ADA requires making reasonable modifications
    to policies, practices, and procedures when
    necessary to avoid discrimination again a person
    with a disability and,
  • taking the steps necessary to ensure effective
    communication with people with disabilities

Basics for Emergency Management
  • The ADA generally does NOT require state or local
    emergency management programs to take actions
    that would fundamentally alter the nature of a
    program, services, or activity or impose undue
    financial and administrative burdens.

The Stafford Act
  • The Robert T. Stafford Disaster Relief and
    Emergency Assistance Act (Stafford Act) is the
    law that authorizes Federal assistance when the
    President declares a State to be a disaster area.
  • Section 308 of the Stafford Act protects
    individuals from discrimination on the basis of
    their race, color, religion, nationality, sex,
    age, or economic status in all disaster
    assistance programs.
  • Section 309 of the Stafford Act applies these
    non-discrimination provisions to all private
    relief organizations participating in the
    response and recovery effort.

The Stafford Act
  • Sec. 689(a) requires the FEMA Administrator to
    develop guidelines to accommodate individuals
    with disabilities guidelines include the
    accessibility of, and communications and programs
    in, shelters, recovery centers, and other
    facilities and devices used in connection with
    disaster operations, including first aid
    stations, mass feeding areas, portable payphone
    stations, portable toilets, and temporary
  • Section 689(c) amends the Stafford Acts Federal
    Assistance to Individuals and Households program
    (408) to recognize that damage can render a home
    inaccessible to disabled persons, and thus,
    uninhabitable to them. Accordingly, temporary
    housing assistance can be provided to individuals
    with disabilities whose residence is rendered
    inaccessible as a result of a major disaster.
    Further, in locating readily fabricated
    dwellings, FEMA must now seek whenever
    practicable, sites that meet the physical
    accessibility requirements for individuals with

Equal Opportunities Act
  • FEMA and other federal or state agencies are
    equal opportunity employers.
  • FEMA will provide reasonable accommodations for
    employees and other individuals with
  • FEMA must serve all individuals equally,
    providing access to Agency programs and
    activities equal to the access provided to
    non-disabled persons.

Emergency Shelter Programs
  • Regardless of who operates a shelter, the ADA
    requires shelter operations to be conducting in a
    way that offers people with disabilities the same
    benefits provided to people without disabilities

Advance Planning
  • The most effective way for public health care
    workers to ensure that advance planning addresses
    the needs of people with disabilities is to
    involve community members with a wide variety of
    disabilities in the advance planning process.
  • Why?

  • Because individuals with disabilities will
    be able to identify the types of
    disability-related needs that community residents
    and visitors are likely to have during
    emergencies as well as some of the community
    resources that may be available to help meet
    those needs.

Eligibility Criteria
  • Two categories of shelters
  • Mass Care Shelters
  • Serve general populations
  • Special Needs/Medical Shelters
  • Provide heightened level of support
  • Considerations
  • Respect the right of IWD to make choices
  • IWD who have support needs can often be housed in
    mass care shelters

Texas Hurricane Sheltering Plan
  • Types of Medical Special Needs Persons
  • Level 0 Persons who have no medical needs, but
    require transportation assistance for evacuation.
  • Level 1 Persons dependent on others or in need
    of others for routine care (eating, walking,
    toileting, etc.) and children under 18 without
    adult supervision.
  • Level 2 Persons with physical or developmental
    disabilities such as blindness, significant
    hearing impairment, amputation, deaf/blind, and
    mental retardation.
  • Level 3 Persons requiring assistance with
    medical care administration, monitoring by a
    nurse, dependent on equipment (including
    dialysis),assistance with medications, and mental
    health disorders.
  • Level 4 Persons outside an institutional
    facility care setting who require extensive
    medical oversight (i.e. IV chemotherapy,
    ventilator, life support equipment, hospital bed
    and total care, morbidly obese).
  • Level 5 Persons in institutional settings such
    as hospitals

Texas Hurricane Sheltering Plan
  • Levels 1, 2 who can live independently or who
    have care givers accompanying them may be housed
    in a general population shelter. Facilities
    should provide nearby space for care givers,
    family members, and provide appropriate care for
    companion pets.
  • Level 3 and levels 1 and 2 without care giver
    support will be housed in a medical special needs
    shelter or in designated areas within a general
    population shelter. Facilities should include
    space for care givers, family members, and
    provide appropriate care for companion pets.
  • Level 4 will be housed in an acute care hospital
    or long-term care facility.
  • Level 5 will be a facility-to-facility transfer
    (i.e. hospital to hospital, long term care to
    long term care, assisted living to assisted
    living, etc.)

Supporting Children with Disabilities during and
post disaster
  • ADA requires people to be accommodated in the
    most integrated setting appropriate to their
  • Students should generally be housed with their
    families, friends and neighbors
  • Shelter operators may not make eligibility
    dependent on a childs ability to bring their own

  • Ensure that Special Needs and Medical Shelters
    have sufficient numbers of adequately trained
    medical staff/volunteers before placing students
  • Keep families or students with their caretakers
    together whenever possible, which will usually be
    in a general needs shelter

Triage of Care
  • Students with disabilities should receive same
    precedence of care as those without disabilities.
  • Students with disabilities living in the
    community predisaster may require more non
    medical supports.
  • Most students with disabilities will not need a
    medical special needs shelter.

Images retrieved from FEMA Photo Library 2007.
Effective Communication
  • Provide explanations to children of what is
  • Provide alternate format materials for students
    with disabilities (blind, low vision)
  • Ensure that audible information is accessible to
    students who are deaf/hard of hearing

  • Provide an effective way for children to stay
    with and receive durable medical equipment and
    medical supplies
  • If possible, provide refrigeration for meds
  • If electricity is available, give priority to
    those who use ventilators, suction devices, etc
  • Provide food options to those children with
    dietary restrictions
  • Provide emergency supplies that enable care for
    service animals

From left to right http//www.photolibrary.fema.g
http// http//www.photolibrary.fem
Post disaster
  • Reconnect children with their families
  • Make sure that services the child was receiving
    pre-disaster are reconnected post-disaster
  • Support the parents and caretakers as a form of
    supporting children

Remember your own family!
  • Create a disaster preparedness plan
  • Have back-up support for your own childcare needs
    so that you will be able to offer support to
    other children
  • Keep yourself healthy and do not work with
    disaster survivors if you are ill
  • Discuss with your family your role in disaster
    response and recovery and get their understanding
    and buy in

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Disaster Acronym Guide
  • Translations for Two Communities that Love
    Alphabet Soup

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Long Term Recovery from Hurricane Katrina
  • Funded by the National Center on Birth Defects
    and Developmental Disabilities through the
    Centers for Disease Control and Prevention
  • With support by the Association of University
    Centers on Disability

Photo by Kendall Kessel April 2006
Photo by Kendall Kessel April 2006
Contact Info
  • Center on Disability and Development at Texas AM
  • http//
  • Project REDD
  • http//