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Disaster Preparedness and Response for Persons with Mobility Impairments: Results of the Nobody Left Behind Project

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Disaster 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., – PowerPoint PPT presentation

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Title: Disaster Preparedness and Response for Persons with Mobility Impairments: Results of the Nobody Left Behind Project


1
Disaster 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

2
Nobody 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

3
Persons 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.

4
Nobody 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

6
Katrina Federal Disaster Funds - 62.5 Billion
Washington Post, 9/9,2005
7
Cost to People with Disabilities
8
Cost 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

9
Nobody Left BehindResearch Activities Overview
  • Focus Area 1
  • County Programs, Policy, and Practice
  • Focus Area 2
  • Assessing Risk
  • Focus Area 3
  • Assurance and Policy Development

10
Focus 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.

11
Focus 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?

18
Nobody 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

19
Nobody 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?

20
Representative 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
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22
Summary Research Tables Corresponding to
Research Questions for Nobody Left Behind
23
Research 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
24
Research 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

25
Research Question 3Are sites able to assess
prevalence based upon adequate surveillance?
26
Table 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)
27
Research 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.

28
Research 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.

29
Table 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
30
Nobody 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

31
Nobody 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

32
Nobody 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

33
Nobody 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.

34
Nobody 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)

35
Nobody 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.

36
Nobody 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

38
Nobody 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.)

39
Nobody 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

40
Nobody 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.

41
Nobody 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.

42
Nobody 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

43
Current 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
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45
Consumer 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?

46
Consumer 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.

47
Consumer 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?)

48
Centers 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

49
Centers 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

50
Much 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.

52
Additional 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
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