Report on Exemplary and Best Practices in
Preparedness and Emergency Response
For People with Disabilities
White, Principal Investigator
H. Fox, Co-Investigator
Rooney, Project Coordinator
and Training Center on Independent Living
University of Kansas
March 15, 2007
Nobody Left Behind (NLB): Disaster Preparedness for
Persons with Mobility Impairments research study determined the readiness of emergency management sites across the United States
to assist persons with mobility impairments during disasters.
This research was under the direction of Glen W. White, Principle
Investigator, and Michael H. Fox,
Co-Investigator, at the University of Kansas,
Research and Training
Center on Independent
Living (RTC/IL). Thirty randomly selected sites that had experienced a Federal
Emergency Management Agency (FEMA) declared disaster during 1998-2003 were the focus
of the research. Emergency managers at each site were surveyed by telephone and
their local emergency plans were reviewed. Experts in disaster preparedness and
response and/or people with
disabilities assisted in the project as advisors.
component of the NLB project was to identify exemplary polices, practices, and
programs in emergency management designed to assist persons with mobility
limitations. The identified exemplary situations are the basis of this white
paper. With the support of policy
makers in emergency management and disabilities, these practices can serve as
catalysts for change, which may be emulated
by other counties, cities, parishes, or
Emergency Management Practices
with the emergency managers helped determine whether guidelines were in local
emergency plans to assist persons with mobility impairments. Six
sites out of 30 self identified that their local emergency management plan
included such guidelines. Among these 6
sites, there was a 50/50 split between urban and rural locations. Two of these
6 sites included a nuclear facility plant in their jurisdiction which indicates
additional responsibilities as well as financial resources to address these
distinguishes these six sites as exceptional compared to the other sites in the
study is the cumulative effect of policies and practices that they employed. Thus,
these sites took a comprehensive approach to addressing the needs of persons
with disabilities, including mobility impairments.
1 illustrates the six emergency management practices that the sites identified
to assist persons with disabilities, including mobility impairments. These management
practices included having guidelines and the inclusion of the disability
community in planning. Each of the sites
had at least three out of six emergency management practices, making for a more
extensive approach to assisting persons with disabilities than the other sites.
Emergency Management Practices Including
the Needs of Persons
with Mobility Impairments and the
Corresponding Number and
Percentage of the Six Exemplary Sites
with these Practices
Emergency Management Practices
Number of the 6 Sites with Practice
Guidelines to assist persons with mobility
Surveillance identification of persons with mobility
Consumer outreach for
persons with mobility impairments.
Customer service delivery in transportation,
sheltering, problem solving, etc. as related to the needs of persons with
Education and training about the disability community
and their needs in disaster preparedness and response.
Inclusion of persons with
the local planning process, and/or
in training drills of responders.
Specific consumer services delivery
Administering and maintaining a surveillance system, usually a
self-identified registry system of
persons needing assistance during a disaster or
accessible transportation vehicles
and guidelines to evacuate persons with disabilities needing assistance;
3. Establishing a so called special medical
needs shelter; and
4. Conducting training and exercises on
evacuation of persons with disabilities.
the sites that did not consider their plan as having guidelines to assist
persons with mobility impairments, several also administered registries,
identified accessible transportation,
evacuated persons with disabilities, established shelters, or conducted training and/or
exercises on evacuation of persons with disabilities. Yet,
the norm was to have a few policies aimed
at addressing one specific disability and issue. For
example, it was common to have policies on communication or
warning alternatives for the hearing
impaired. However, the remaining assistance needs of persons with disabilities,
including persons with mobility impairments, were missing from the plans or practices.
of Persons with Disabilities
figures on Table 1 on page 4 show that only half of the exemplary sites reported having training in assistance needs of persons
with disabilities. These findings support
previous NLB recommendations on the need for
better educated emergency management personnel regarding disabilities and
It is a must that active representation across disabilities
be included at the planning table, not just service providers or advocates for
the elderly. Persons with disabilities have much to contribute
to emergency management efforts, as
shown by the preparedness tip sheets developed for
and by persons with mobility impairments in Attachments 1 and 2. From personal
experiences, these preparedness tips were formulated
from responses to an online survey conducted by the NLB project. Inclusion of persons with disabilities in
emergency management can lead to more
effective preparedness for
individuals and the community.
resource to assist managers in this area is a white paper commissioned by the
NLB study called, “Why and How to Include
People with Disabilities in Your Emergency Planning Process,” by June I.
Kailes. This paper
can be found on the www.nobodyleftbehind2.org
website under findings.
and organizations that could help
get emergency managers in touch with qualified persons with disabilities to
serve on planning committees are Governor’s
Offices on Disabilities, the Statewide Independent Living Council (SILC), and local
or regional centers for independent living (CILs). Resource directories for
the SILC and CILs by state can be found on http://www.ilru.org/html/publications/directory/index.html.
30 sites randomly selected for the
NLB project and other sites, as recommended by advisors
and consultants, were investigated by the researchers with an eye for exemplary policies, practices, or programs to assist persons with mobility
impairments. Four such cases were
identified. Two exemplary practices were
from sites that had also self-identified in the NLB study as having guidelines in
their local plans to assist persons with mobility impairments. The researchers termed these exemplary policies,
practices, and programs as “emerging best practices.”
emerging best practices are in: 1) comprehensive planning for persons with disabilities in the local emergency
management plan 2) comprehensive planning tool using surveillance and consumer
education; and 3) day to day surveillance and consumer education outreach.
Comprehensive planning in local emergency management plans. The
optimal approach to comprehensive planning is an extensive set of guidelines in
the local emergency plan to address the needs of persons with disabilities. One site did just this by creating an “Appendix
on Persons with Disabilities” to the Annex on Direction and Control in their
local emergency management plan. Attachment
3 of this report is that Appendix
with slight modifications in formatting
and to remove the identity of the site. Attachment 4 is the corresponding self-registry form
for persons with disabilities.
provisions of the Appendix take a multi-disability approach (sensory, physical, and emotional/mental), set minimum
training and reception care requirements, seek inclusion of persons with
disabilities, and place responsibilities on persons with disabilities and other
responders in participation with preparedness and the plan. Attachment 4 is the
self registry form that corresponds with the first directive that persons
with disabilities make their needs known and prepare themselves for potential emergencies. The Appendix on Persons
with Disabilities can be used as a model with minor
adjustments to fit many local systems.
It is an excellent starting point to bridge gaps in assistance measures
for persons with disabilities, while
providing for more knowledgeable and confident emergency management
teams to address these needs.
component of this Appendix is it utilizing persons with disabilities in the
training exercise. For those
managers considering providing training and exercises that include persons with
disabilities an excellent resource is: Incorporating Special Needs Populations into Emergency
Planning and Exercises" by E. Davis
and J. Mincin (2005, June). This
paper can be found on www.noodyleftbehind2.org
Comprehensive planning tool using surveillance and
the NLB study, it was discovered that one site was utilizing a best practice,
field-developed, surveillance and consumer education model. It brings the
health field and emergency management together to map the assistance needs of a
community to best design non-medical and medical assistance. This planning tool
relies on consumer education and participation. Survey questionnaires are
included in the consumer education packet or
online at a website. The questionnaires allow for
the intake of assistance information
such as physical location, medical needs, medication, mobility, and medical
history. The consumer packets are
distributed by mail, Meals on Wheels, Area Agencies on Aging, and home health
agencies in this Texas
model. Recently, distribution has occurred through churches
utilizing the Faith-Based nursing program (Parish Nurses). Using the provided database
software to map the various types of assistance needs and locations, planners
can determine the placement of shelters, staffing, and medical equipment and
Moss, RN, MSN, at the Lamar University Department of Nursing created this tool
for local adoption and it is called “The
Disaster Preparedness Planning for
the Special Needs Population." (See Attachment 5 for
website to obtain the database software, special needs assessment survey,
survey questionnaires, and consumer education packet.) Existing shelters
developed through this model were tested under the conditions of Florida
hurricanes and Hurricane Rita. This tool is being used by several
emergency managers in Texas, Louisiana,
In 2006, the State of Texas went live with a
modified version of this database model, through the 2-1-1 program, in order
to establish the State of Texas
consumer and surveillance outreach. One site in
the NLB study stood out with its “accumulative effect of several policies and
practices” aimed at meeting the needs of specific individuals with
disabilities. Good management, a workable
self-identifying registry, consumer education, and adequate resources were a part
of the success of this operation as well.
The emergency manager took the consumer and surveillance outreach
program designed for the part of the
county that encompassed a 10 mile radius of the nuclear power plant and
expanded it to cover the entire county. The
end result translated into excellence in meeting the individual assistance
needs of persons with various disabilities across this rural county.
Some 20 years ago, the emergency
management and nuclear industry used a calendar as a means to provide the
public with safety and evacuation routes in case of a nuclear power or other emergency. This site has found that
changing the theme of the calendar with local attractions, photos or other points of interest each year on the
calendar has kept the attention of the public.
It has become the best tool to have safety information
readily available to the public. Along with the calendar, each household in the
county gets a postage paid registration card. This card is to be filled out if
anyone in the household requires assistance during disasters. Knowing these
individual needs and residencies helped the emergency manager create an
environment to meet those needs. For
example, when the emergency management office was relocating, it built in the
capacity to serve as a special medical needs shelter and the entrance and
bathrooms of the building were made accessible.
emergency manager also has built upon small community scale of knowing one
another and responding. For example, volunteers have been recruited from the
county road and bridge staff to go to the homes of persons in the rural countryside
who need assistance with evacuation or
to receive warnings.
office also has adequate staffing and financial support
due to the tax revenue generated from the local nuclear power plant. Otherwise, the staff for
an office that size would have been a part-time manager rather than three
full-time staff persons. The nuclear
power plant money pays for the
calendars, inserts, and mailings, The county pays for
the registry, and this information
is shared with 911. One staff person maintains the registry and interagency
exchange of information.
Resources for Guidelines
emergency managers in the NLB study who did not include people with
disabilities in their local emergency management plan said to create such
guidelines, such as the Appendix on Person with Disabilities ( Attachment 3), requires
one or more
Table 2 illustrates the resources
identified by the emergency managers as needed to develop guidelines to assist
persons with disabilities. A majority
required additional funding while other resources included trained personnel, a
mandate, and additional public education efforts.
Resources Needed to Develop
Guidelines in Local Emergency
Management Plans on the
Needs of Persons with Disabilities and
the Percentage of these Managers
Needing Specific Resources
____________________________ ______ ________________
Resources Needed to Percentage of Managers Needing
Guidelines Resource to Develop Guidelines__
and Trained Personnel
FEMA, State, or County Mandate 25%
Public Education Efforts 17% ____________________________ _____
More attention is required in local emergency
management systems to effectively address the needs of persons with mobility
impairments and other disabilities. An emerging best practice is to create an
extensive approach to addressing the needs of persons with disabilities by developing
an Appendix on Persons with Disabilities in the local emergency management plan
(see Attachment 3 for Appendix
example). Another emerging best practice is a workable
database design for mapping local
and state consumer medical and non-medical assistance needs for the planning of special medical needs shelters. (See
Attachment 5 for this model.) Other
factors that contributed to best
practices included proactive management, effective consumer education, and
adequate resources. Each of the exemplary and best practices scenarios can be
used as models and, with minor
adjustments, fit many local systems. Their scopes can also be expanded to
address other gaps in services or
policies. Regardless of which direction an emergency management offices takes,
it is important to encourage the
inclusion of persons with disabilities. A majority of the emergency managers without guidelines
stated they required additional funding, trained personnel, a mandate, and
additional public education efforts.
changes are also needed to get emergency management and response
personnel educated in
disability sensitivity and specific disability related needs that encompass the
broad spectrum of disabilities (sensory,
physical and emotional/ cognitive). Prevention saves lives, so additional
emphasis and resources need to go towards distribution of existing disability
related preparedness information to
the disability community as well as the creation of new materials.
infrastructure of local emergency management offices needs to be strengthened.
This may include the resources for
emergency managers to receive and offer training dealing with persons with
disabilities and their emergency management needs, create surveillance
resources for identification of
persons with disabilities, offer outreach materials for
preparedness for persons with
disabilities, and seek their input into the emergency management process.
Previous NLB research findings indicated there is limited attention by
emergency managers on taking courses regarding persons with disabilities. This
may be in part due to past policy decisions, particularly within FEMA, to focus
the original required training and
operational structure of emergency planning and response on the needs of the
general population. Thus, learning about and planning for
the needs of the so called “special needs populations,” which includes persons
with disabilities, becomes optional. Given this mind set, it is evident from
the interviews of the emergency managers that the managers are interested and
committed to providing quality services to all constituents in their service
areas. It is recommended that persons with disabilities be taken out of the
category of special needs populations. By doing this, persons with disabilities
would automatically be included in the overall training components for emergency management. However, additional
continuing training options should be encouraged and promoted by policy makers as
no one course to date is a true model training program.
resource on the topic of appropriate terminology in the field is from a white
paper commission by the NLB project: Disaster Services and “Special Needs”: Term
of Art or Meaningless Term?”
by June I. Kailes. This paper can be found on www.noodyleftbehind2.org under
the purposes of developing a full scale resource guide, the size of the NLB
sample was too small to obtain more
than a few examples of exemplary and emerging best practices. Another approach designed specifically to
collect and systematically review possible best practices is recommended. In addition, very few local emergency
management plans were submitted to the researchers for
review since the documents were frequently revised, security reasons, and
because of the hassle of reproducing the document. Thus, the researchers had to rely on the self
identification from the managers about having guidelines to meet persons with
mobility impairments. It became evident during
the interviews that some type of checklist on possible policies and practices
constituting assisting persons with mobility impairments would be helpful.
Without this list, emergency managers had to decide on their own what
constitutes addressing needs. So, what one manager thought was not a specific
policy or practice another might
have thought it was such as special medical needs shelters.
media coverage of the plight of the disabled, elderly, and poor from the aftermath of Hurricane Katrina in New Orleans is making
policy makers’ examine the system that failed. Attention is now being given to
the assistance required of special needs populations which currently encompasses
disabilities. The time is right to
re-examine the mind set of the past and to address shortcoming
in the field as a whole.
Who best can direct the changes other then
emergency managers with exemplary practices.
Taking research and placing it into practice is the next challenge to
advance practices in the field. As the
saying goes “An ounce of prevention is worth
a pound of cure.” Each of the emerging
best practices presented in this white paper are a separate ounce of
prevention. They can be modified to meet specific local needs and be
implemented with support from policy
makers in emergency management and disabilities community.
This report was created by the Research and Training Center
on Independent Living and does not necessarily reflect the views of the funder or the University
of Kansas. Any use of the
contents of this report should be
followed by this citation: The Research
and Training Center on Independent Living, The University of Kansas (2007,
March), Nobody Left Behind: Briefing
Paper: Objective Three, Part 2 Focus Area: Report
on Exemplary and Best Practices in Disaster Preparedness and Response for People with Disabilities. Lawrence, KS:
Nobody Left Behind staff. For more
information, refer to www.nobodyleftbehind2.org
and Best Practices
Planning in Local Emergency
Appendix on Persons with
I. The following considerations must be addressed in order to integrate matters relating to persons with
disabilities into all planning and procedural activities.
Active participation by persons with disabilities
in the identification process is required in order
to provide effective assistance.
Persons with disabilities must take responsibility
for registering with emergency
response agencies, making their needs known, and preparing themselves for potential emergencies to the maximum extent
possible within their means.
B. Systems to provide alert or
warning include, but are not limited to:
2.Commercial radio Emergency Alert System
3.Media Alert through Department of Public
4.Telecommunication devices for hearing/speech impaired persons (TT).
5.Standard warning systems such as sirens,
klaxons, and public address loudspeaker systems.
6.House-to-house notification by law enforcement, fire, or
other emergency response personnel.
8.Basic emergency sign language for persons who are deaf or
C. Training and exercises involving
evacuation of persons with disabilities should emphasize:
How to address and relate to persons with
How to guide persons with visual impairments.
Emergency sign language and finger spelling.
How to handle mentally impaired individuals in an
The use of specialized mobility equipment.
Moving individuals who use a breathing apparatus or other life-sustaining equipment.
How to move/transfer the bedridden and frail elderly.
8. Safe handling procedures for individuals who use a wheelchair or other
9. The importance of taking medications and other items along
with the evacuee.
10. Characteristics of an emergency call from
persons with disabilities.
11. How to rescue persons with disabilities from
para-transit vans and buses.
D. Reception and care centers for use by persons with disabilities must be
identified as such.
The unique requirements of
such facilities include:
Accessible rest rooms with 60" x 60" or larger stalls.
Emergency electric generator
and other equipment.
6. Facilities for
accommodating service animals for
persons with disabilities.
E. Specific Tasks
County Department of Emergency Management
a. Assist agencies without emergency plans to
develop such plans.
b. Conduct or
participate in seminars or workshops for
staffs of agencies that serve persons with disabilities to provide information relating to emergency response alerts,
warnings, sheltering, evacuation procedures, and other related matters.
c. Install a TT device for speech/hearing impaired persons in the EOC
and train the staff in its use.
Participate in emergency preparedness planning, as
required, for agencies representing or providing services to persons with disabilities.
Assist in the notification, warning, and evacuation
of persons with disabilities.
Communicate with hearing impaired individuals at
the Sheriff's communications center.
American Red Cross Chapter
Identify and designate reception and care
facilities capable of accommodating persons with disabilities.
Provide emergency vehicles and drivers to transport disabled evacuees to reception and care centers.
Persons with Disabilities
Be aware of individual warning, evacuation, and
Register with the local emergency services organization if special warning procedures,
evacuation assistance, and/or
special shelter facilities are needed (See Appendix 2 of this report).
Maintain stocks of supplies, equipment, and
medications which may be required for
a minimum of three days in a shelter.
d. Be aware of county warning procedures, evacuation
plans, and shelter.
Self-Registry Form that
Corresponds with Attachment
of this form is voluntary.
requested on this form is needed to
assist emergency response agencies and their personnel in the event of an
emergency to locate, warn and, if necessary, evacuate persons with
will be held in strict confidence and will be disclosed only to authorized members of the (name of the city or town goes here) emergency response organization as described in the (name of the
city or town goes here)
Emergency Operations Plan.
When the form
is completed, mail it to the (name of the city or
town goes here) or phone (name
of the city or town phone number
goes here) and a member of the (city or
town) emergency response organization
will pick it up at your residence.
Date of Birth
Flashing Light or
Other Visual Method
who can provide assistance:______________________________
Type of Disability
and Best Practices
Planning Tool uses Surveillance
Preparedness Planning for
the Special Needs
This planning and
educational tool is provided by Patti Moss, Lamar University,
Department of Nursing and retired Sgt. Robert Smith,
police department and emergency management. It can be found at www.disaster-research.us
and the website contains:
(also available on CD).
3. Survey questionnaires.
a. Non-medical for
b. Special needs evacuation form
to gather planning information.
4. Consumer education packet.
PowerPoint on background and use of the tool.