1. Improving Disaster Planning and Response for Persons with Mobility Limitations – Early Findings Improving Disaster Planning and Response for Persons with Mobility Limitations – Early Findings Michael H. Fox, Sc.D., Glen W. White, Ph.D., Jennifer Rowland, M.S.,P.T., Monika Suchowierska, Ph.D., Catherine Rooney, M.A. Research and Training Center on Full Participation in Independent Living at the University of Kansas American Public Health Association November 18, 2003 San Francisco, California

2. Disaster Planning and Disability According to a November 2001 Harris Poll commissioned by the National Organization on Disability:  58% of people with disabilities do not know whom to contact about emergency plans in their community  61% of person with disabilities have not made plans to quickly and safely evacuate their homes; and  Among those people with disabilities employed full or part time, 50% say no plans have been made to safely evacuate their workplace All percentages in this poll were higher for people with disabilities than their non-disabled counterparts.

3. Disaster Planning and Disability -National Attention Following 9/11 - After the 1993 WTC bombing, the local emergency management office and the Associated Blind worked with NYFD to develop a comprehensive evacuation plan and drill for their staff, most who have either low or no vision On September 11, the entire staff calmly and safely evacuated their building’s 9 th floor, a success they attribute directly to the customized planning and drills Source: N.O.D. Guide on the Special Needs of People with Disabilities.

4. The True Scope of the Issue The True Scope of the Issue  Nine of every ten presidential disaster declarations result from natural phenomena in which flooding was a major component  Annually, the U.S. averages 100,000 thunderstorms  Fires in Southern California this fall caused at least 25 deaths, destroyed 3,000 homes and left thousands homeless. Estimated cost so far is over $2 billion.  A blizzard in March 1993 dumped record snows from Alabama to New England, caused 170 deaths, left millions without power and resulted in $800 million in damages.  Galveston Texas hurricane in 1900 killed more than 6,000.  Average of 22 “killer tornados” each year.  Average of 13,000 earthquakes of various magnitudes in the U.S. each year

5. Persons with Disabilities in the U.S.  The 50 million people with a self reported disability represent 19% of the 257 million people > 5 in the civilian non-institutionalized U.S. population - nearly one in five 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.

6. Existing FEMA Guidelines  For persons with mobility impairments, existing Federal Emergency Management Agency (FEMA) guidelines are well-intentioned but impractical: FEMA: Disaster Preparedness for People with Disabilities. October, 1998 –“Show friends how to operate your wheelchair so that they can move you if necessary. Make sure friends know the size of your wheelchair in case it has to be transported.” –“Find out the proper way to transfer or move someone in a wheelchair and what exit routes from buildings are best.” –“Mount a personal use fire extinguisher on an accessible place on each wheelchair.”

7. National Business & Disability Council Emergency Evacuation Checklist http://www.business-disability.com/Whats_New/eepc.asp  “Are all exit routes accessible as a means of egress in the event of an emergency?”  “Do you have a selection and follow up process in place to designate buddies/monitors/fire wardens?”  “Do you have procedures to follow if a buddy/monitor/warden is out of the office?”  ………………

8. Mission Mission  To research, identify, and advance person-environment centered strategies that encourage full participation in society among persons with disabilities representing diverse cultures, varying socioeconomic strata, and emerging populations.

9. Using the Person-Environment Model  A systematic line of research can be conducted to plot person-environment factors and the resulting trajectories of disablement; Person Factors Environment Factors Degree of Disablement   Patterns of person- environment risk can be identified so that services to people with disabilities can be developed.

10. Nobody Left Behind The Nature of the Problem Typically, disaster preparedness and emergency response systems are designed for non- disabled persons, for which escape or rescue involves walking or running. These are not appropriate for assisting persons with mobility impairments. 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.

11. Nobody Left Behind  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  http://rtcil.org/NLB_home.htm http://rtcil.org/NLB_home.htm  Glen White, KU, P.I. Michael Fox, KUMC, Co-P.I. Michael Fox, KUMC, Co-P.I.  October, 2002 – September, 2005  AIM: Understand county level disaster preparedness and response around needs of persons with mobility impairments

12. Nobody Left Behind Focus Areas  County Programs, Policies and Practices –Do counties experiencing recent disaster have preparedness and emergency response systems in place for persons with mobility impairments? –Has the disaster affected how planning is done? –Have persons with disabilities been included in the planning process?

13. Nobody Left Behind Focus Areas  Assessing Risk –What surveillance takes place at county level? –Do counties know how many persons with mobility impairments reside or work in their jurisdictions? –Among counties with adequate surveillance data, what are morbidity and mortality rates following disasters for persons with mobility impairments and what factors appear to influence rates?

14. Nobody Left Behind Focus Areas  Assurance and Policy Development –What disaster management systems appear to be most effective in reducing injury and death among persons with mobility impairments exposed to disaster? –How can exemplars of best practices be incorporated into other county disaster plans?

15. Nobody Left Behind Methods 1.Identify Federal Emergency Management Agency (FEMA) declared disasters over the last five years 2.Select a random sample of 30 counties or equivalent units (i.e., boroughs, reservations, etc.) so that each of the ten federal regions are represented 3.Expand our understanding of both county and disaster through existing data 4.Evaluate disaster plans in place at time of occurrence and more recently for actions targeting persons with mobility disabilities 5.With assistance of national advisory panel, identify best practices

16. Nobody Left Behind Disaster Sites in the Study

17. Town Hall Meeting Lawrence, Kansas Headline, Lawrence Journal World, July 24, 2003: Disaster safety for special-needs populations explored May tornado raises questions about preparedness Wednesday night, representatives of the Research & Training Center on Independent Living at KU met with about 20 (26, note) public safety and community service leaders to solicit and discuss safety measures. Residents from the neighborhoods struck by the May tornado also were invited to the meeting at Raintree Montessori School, 4601 Clinton Parkway, but none showed up "Regardless of whether you have a disability or not, you have to have a plan of what to do," said Paula Phillips, Douglas County Emergency Management director. "As a government, we can't prepare for you. There are more of you than there are of us."

18. Town Hall Meeting Lawrence, Kansas   Other Insight Gained – –Personal responsibility   Keeping 2-3 day supply of medication   Preparing for “worst case scenario” – –Community emergency shelter is accessible   Role of Safe Rooms – new housing requirement? – –Most first responders consider EVERYONE they encounter in disaster as “disabled.”   Need to inform first responders of persons with special needs – –Role of Independent Living Centers in education – –Public warning systems are not intended for people indoors

19. Nobody Left Behind Where are we now?  Piloting the county survey –Examples of questions:  “Does your current emergency management plan have protocol to assist people with mobility impairments during an emergency?” (ICF definition of mobility impairments)  “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. Nobody Left Behind Where are we now?  Piloting the county survey –A few preliminary findings from piloting the survey in 5 counties:  The Emergency Management Plan is a living document that undergoes constant change  The FEMA Emergency Planning and Special Needs course (G197) offered through the Emergency Management Institute appears useful in increasing awareness at the county level  Surveillance efforts on identifying persons with mobility impairments before or during disasters appear spotty

21. Nobody Left Behind Where are we now?  Expanding background of sample disaster occurrences & beginning our survey  Developing consumer/web-based query form to document experiences of persons with mobility impairments during disasters nationwide  Meeting with advisory board members to stay current with existing community needs and national standards

22. Nobody Left Behind Where do we think this will lead? Technology Adaptation –Understanding and use of new devices that will improve escape, rescue and survival for persons with mobility impairments

23. Nobody Left Behind Where do we think this will lead? Improved Surveillance –Better understanding at the community level for the need to know how many people are at risk in disasters who may have mobility impairments

24. Nobody Left Behind Where do we think this will lead? Environmental changes –Housing: safe rooms, slide escapes, common shelters, implementing ADA accessibility guidelines, special needs awareness programs (SNAP) –Workplace: space, lighting, energy backup, employee input –Community: participation in planning process by persons with disabilities

25. Nobody Left Behind Where do we think this will lead? Enhanced Training and Education –First responders, disaster managers, other county officials –Employers, employees –Persons with disabilities

26. Nobody Left Behind Timelines  Should be completed with data collection by June, 2004  Best and emerging practices to be identified in conjunction with consumers and National Advisory Group by early 2005  Dissemination and national conference in summer, 2005