Emergency Planning & Preparedness for Special Needs/Vulnerable Populations

1.  Emergency Planning & Preparedness for Special Needs/Vulnerable Populations Amelia Muccio Director of Disaster Planning NEW JERSEY PRIMARY CARE ASSOCIATION

2. Learning Objectives • Discuss the definition of special needs/vulnerable populations • Explain what is currently being done to assist this population • Discuss emergency planning techniques for people with diabetes and asthma • Identify next steps for Community Health Centers

3. Disaster Exercise: ‘Be the Disaster’ Anticipate Crises • According to Webster's Dictionary, knowledge is “the fact or condition of knowing something with familiarity gained through experience or association.” • Therefore, one woman’s hindsight (experience) can be someone else’s knowledge. • We must incorporate emergency planning into our everyday routine without eliciting fear/panic/anxiety.

4. Your Mission: Create a Dog Tag“Aurora’s Tag” • ID tag on collar reads: • Aurora • 954.975.7550 (home/land line)

5. Is That Sufficient?

6. ID Needs More Information & Redundancy • Aurora Ferrigno-Muccio • Full Address • Mobile Number • Vet’s Number • While initial tag was adequate, it would not be helpful during a disaster.

7. Definition of Special Needs/Vulnerable • In disaster preparedness and response, the terms "vulnerable" or "special needs" populations are often used to characterize groups whose needs are not fully addressed by traditional service providers. • People who feel they cannot comfortably or safely access and use the standard resources offered in disaster preparedness, relief and recovery. • They include but are not limited to those who are physically or mentally disabled (blind, Deaf, hard-of-hearing, cognitive disorders, mobility limitations), limited or non-English speaking, geographically or culturally isolated, medically or chemically dependent, homeless, frail/elderly and children.

8. Who Are We Protecting? • Elderly • Disabled • High Dx Prevalence • Pregnant Women • Homeless • Children • Low SES • Minorities • Low Education Level • Non-English Speaking

9. First Problem:The Definition • No ‘one size fits all’ definition • Diversity within Special Needs/Vulnerable • Too narrow of a definition includes a chance of exclusion • Too broad of a definition will include everyone • Need definition that is balanced but will NOT leave anyone behind

10. Do We Know What ‘They’ Need?

11. Second Problem:The Diversity

12. Third Problem:Self-Classification • What if I do not consider myself “disabled,” “vulnerable” or “special needs?”

13. Rule of Thumb on Definition • During a disaster, who enters American Red Cross shelter population? • Hint: it is not you and I... • Common threads: • lack of social and fiscal safety net • Lack of freedom/mobility • Dependency!!!

14. The Special Needs/Vulnerable CommunityExample: Langa Settlement, South Africa • Similar populations • Patient demographic: • Underinsured & Uninsured • Stigmatized Poor • Socially Stressed • Migrant • High Disease Prevalence • Low Education Levels

15. Rebuilding Part of Langa Settlement after Massive Fire (1000+)

16. Langa Rebuilt in 1 Day ButOur Communities Need Much Longer • Lack of fiscal resources (savings) • Lack of safety nets (Renter’s Insurance) • Voiceless • The population FQHC’s serve will have difficulties recovering from a disaster. • Therefore, we must focus on prevention and preparedness.

17. What is Needed?Special Needs Registry 1. Advanced registration • State or County driven • Register online or by phone • Central database linked to Police, OEM, EMS, Etc. • ‘Just in Time’ registration • Assist those who did not pre-register Transportation Needed!!!!

18. Broward County, FloridaRegistration or Roundup • Elderly population • Advanced Special Needs Registry • EMS transports registered disabled to Hurricane Shelters • Police transport homeless and high-risk areas (mobile homes) • Some accuse County of dumping them (homeless cannot bring personal belongings and disabled transported with records)

19. New Jersey Special Needs Advisory Panel (NJSNAP) • NJSNAP identifies issues affecting members of New Jersey’s special needs population in their emergency preparedness, and issues affecting emergency management personnel as they prepare to assist individuals with special needs. • NJSNAP is also tasked with making recommendations, developing solutions, drafting proposed legislation, formulating memos of understanding, and devising programs to address identified issues as directed by NJOEM.

20. The Value of Partnerships • Diverse population requires diverse solutions • Must be a joint effort to take care of special needs/vulnerable populations • Multiple stakeholders across disaster continuum

21. Emergency Planning for Diabetes & Asthma

22. Real Life Implications: Hurricane Katrina • Of the more than 1,300+ people who died because of Hurricane Katrina, more than 70% were over age 60. • New Orleans has one of the largest diabetic populations in South • People fled without shoes • Medicare allows only one pair per year • Many patients with diabetes developed wounds (skin ulcers to limb amputations)

23. Special Needs/Vulnerable Populations • High risk of mortality/morbidity during disaster due to mobility, transportation, social network, and illness (O2 dependent) issues.

24. Hurricane Wilma, October 2005 Example #1 • No electricity • No working phone • No automobile • No generator • You are geographically isolated • Your family member enters into diabetic stupor • What do you do?

25. Hurricane Wilma, October 2005 Example #2 • No electricity • No working phone • No generator • No automobile • Pharmacies have been closed for 3 days • Family member runs out of asthma medication and is experiencing breathing distress • What do you do?

26. Diabetics & Asthmatics • Diabetics: • Disaster is major stressor and affects insulin levels • Mobility issues • Difficulty evacuating • Lack of medication • No storage for insulin • Wound care issues arise • Asthmatics: • Disaster affects respiratory system • Sensitive population, canaries in a coal mine • Lack of medication • Difficulty evacuating • Environmental pollutants post-disaster

27. Diabetics: Evacuation & Wound Care

28. Asthmatics: Environmental Exposure Post-Disaster

29. Know What Your CHC Can Offer • Assist hospitals with patient surge • Dispatch mobile vans into community • Function as Alternate Care Site for treatment of non-acute patients (walking wounded) • Serve as POD (Point of Distribution) for prophylaxis • Function as screening Center and provide disease surveillance • Serve existing patient population (vulnerable population) during event (stay open later)

30. Basic Emergency Planning:Disaster Needs Mimic Everyday Needs • Organizational agility • Plans, drills, and evaluations • Training and education • Staff protection and support • Communications and reporting • Supplies and equipment • Security • JCAHO and HRSA PIN*

31. M+P>R+RSuccessful Disaster Planning Equation • CHC’s are planning for events (pandemic, hurricane, power outage, outbreak, terrorism) that require highlevels of pre-disaster preparedness (prevention, and mitigation activities). • Disaster is reasonably expected and preparedness initiatives have been undertaken. • Examples of low levels of pre-disaster preparedness, economic depression and long-term civil war

32. Recommendation #1. Diabetics/Asthmatics Obtain Emergency Health Information Card/MedicTag • An emergency health information card & MedicTag communicates to rescuers what they need to know about patient if they find him/her unconscious or incoherent, or if they need to quickly help evacuate them. • An emergency health information card should contain information about medications, equipment, allergies and sensitivities, communication difficulties , preferred treatment, treatment-medical providers, and important contact people.

33. Recommendation #2: Diabetics/Asthmatics Obtain Additional Medication • Medication: It is best if your patients are able to maintain at least a 7 to 14 day supply of essential medications (insulin/inhalers) and keep this supply with them at all times. • If this is not possible, even maintaining a three day supply would be extremely helpful.

34. Recommendation #3: Diabetics/Asthmatics Establish a Personal Support Network—“Be a Good Neighbor” • Check on your elderly/disabled neighbors especially if they lack local family members • Know their family contact info • Keep in mind their limitations • Power failures in high rises have killed many elderly/disabled • They die of dehydration in their own homes b/c they could not walk down the stairs (phones were out)

35. Recommendation #4: FEMA Independent Study: IS-197.SP Special Needs Planning Considerations for Service/Support Providers • Course Objectives • Describe the impact of different types of hazards on special needs populations. • Describe challenges during the different phases of an emergency. • Explain how to develop emergency plans and work with emergency management and other local officials during the planning process for your local community. • CEUs: 0.4 • Course Length: 4.5 hours

36. Recommendation #5: Utilize CHC’s Waiting Room as Disaster Education Tool • Next to Cosmo and GQ, add disaster preparedness resources • Plenty of free/nominally priced brochures on emergency disaster planning, family disaster plans, go bags, emergency supplies kits, communication plans, special needs planning, shelter-in-place, and disaster coloring books for children

37. In Summary • Diversity prevents one single definition from being all inclusive • Advanced Special Needs Registries are needed • CHC’s populations need additional emergency planning considerations • Assist patients in incorporating emergency preparedness into their daily routine • Diabetics and Asthmatics need to have emergency supplies kits with medical documentation, extra medication, and medical supplies

38. Successful Emergency Preparedness:Plan. Drill. Revise.