Phase Three:

1. The Prepared Community Phase Three: Tools for Community Health Councils and Other Community-Based Organizations To Provide Effective Emergency Response to People With Disabilities

2. Course Developers NMDOH Office of Health Emergency Management Santa Fe, NM 87505 Center for Development and Disability UNM School of Medicine

3. Our Agenda Today Module One: Review of Resources From Phases I and II of the Prepared Community Module Two: Recent Federal Policy Changes Regarding Targeted Populations Module Three: What Are We Preparing For? Implications For Communities Module Four: Tools You Can Use In Your Community Module Five: A Disaster Scenario Round Table Discussion Overview

4. Module One Review of Phases I and II of The Prepared Community

5. Module One Learning Objectives In this module, we’ll: • Review the purpose and role of The Prepared Community Training Program • Recall key concepts presented in Phases I and II of this training program • Define their relevance and how they can be applied in your community • Link them to material presented in Phase III Module One: Review

6. Topics • What is The Prepared Community? • Defining an Emergency • Defining Community Outreach • Reviewing the Emergency Response System • Co • “All Response is Local” • What is “Targeted Outreach?” • Tools Developed in Phases I and II Module One: Review

7. What Is The Prepared Community? • A three-part training and technical assistance program designed to give communities the knowledge and tools they need to better prepare to meet the challenges of future emergency situations • Focuses on populations within communities that may have greater functional or medical needs than the general population, including people with a wide range of physical and cognitive disabilities • Developed by the Office of Health Emergency Management of the New Mexico Department of Health with partners including the Center for Development and Disability at the University of New Mexico. • Community Health Councils are the primary target audience, although many other organizations are involved Module One: Review

8. Emergencies and Community Outreach What’s an “Emergency?” …a natural or man-made event that disrupts patterns of daily living, endangers the health and welfare of people in one or more communities, and causes community needs to surpass the capacity of the community to respond to those needs. What is “Community Outreach?” …reaching large numbers of people in your community in a short period of time before, during and after an emergency to help them prepare, link them to resources and help them recover from the impact of the emergency Module One: Review

9. Comprehensive Emergency Management Mitigation and Prevention: sustained action that reduces or eliminates long-term risk to people and property from natural hazards and their effects. Preparedness: governments, community groups, service providers, businesses, civic and volunteer groups take concrete steps to prepare for an emergency, including planning, training, gathering information or stockpiling. Response: initial actions in response to and emergency to prevent loss of life, injury or further damage if possible. Recovery: the longer-term process of returning people and communities to normal, including resuming patterns of daily life, restoring “social networks,” resumption of business and repair of property.” Module One: Review

10. The Emergency Response System How does the emergency response system work? • Response begins and ends at the local level. • If an incident exceeds local capacity to respond, other levels of government are asked to respond – e.g., the county or surrounding counties, state government and finally the federal government • A system called the “Incident Command System” is put in place. The system makes sure that everyone responding to the emergency works together and coordinates their activities, information is shared and resources are utilized efficiently. • One person is designated as the “Incident Commander.” This person has overall leadership and responsibility for the response to the emergency. Module One: Review

11. All Response is Local, Continued All response is local! Module One: Review

12. Key Elements of Phases I and II Who Might Need Targeted Outreach? ...before, during and after an incident, members of the population may have additional needs in one or more of the following functional areas: maintaining independence, communication, transportation, supervision or medical care. Examples include: Seniors People with physical or cognitive disabilities, such as people who are blind or deaf, people who have mobility limitations or use equipment such as wheelchairs, oxygen or assistive technology devices People who don’t have their own transportation People who don’t speak English Module One: Review

13. Tools Tools Developed in Phases I and II: Tools for Effective Outreach Community Profiles Creating a Plan Module One: Review

14. Module Two Recent Federal Policy Changes Regarding Targeted Populations: News You Can Use!

15. Module Two Learning Objectives In this module, we’ll: • Review key changes in recent federal law and policy about people with disabilities and disasters • Discuss the impact that these changes will have on what happens in the event of a disaster • Assess what these changes mean for your community when a disaster happens. Module Two: Federal Changes

16. Topics • The New National Response Plan, National Preparedness Guidelines and Target Capability On Functional And Medical Needs • 2006 Reauthorization Of The Homeland Security Appropriations Bill • Changes In The Role Of The American Red Cross In Mass Sheltering • Department of Justice Guidelines: ADA Best Practices Toolkit for State and Local Governments and Checklist for Emergency Shelters Module Two: Federal Changes

17. What Is the National Response Framework? • Issued by the Department of Homeland Security • Will replace the National Response Plan • A guide to how the nation conducts all-hazards incident response • Outlines specific roles for all levels of government and best practices for managing incidents ranging from purely local to large-scale natural disasters or terrorist attacks • It’s built on “flexible, scalable and adaptable” coordinating structures to align key roles and responsibilities • It begins with the principle that local jurisdictions are the starting point for planning and response. http://www.fema.gov/pdf/emergency/nrf/nrf-base.pdf Module Two: Federal Changes

18. What Are The National Preparedness Guidelines? • The National Preparedness Vision contains a set of concise core national preparedness goals. • Fifteen National Planning Scenarios form the basis for planning: • Nuclear Attack • Biological Attack (Aerosol Anthrax, Biological Disease Outbreak, Pandemic Influenza or Plague) • Chemical Attack (Blister Agent, Toxic Industrial Chemicals, Nerve Agent or Chlorine Tank Explosion) • Natural Disaster (Major Earthquake, Major Hurricane, Fires) • Radiological Attack (Radiological Dispersal Device) • Explosive Attack (Bombing Using Improvised Explosive Device) • (Food Contamination, Foreign Animal Disease (Foot and Mouth diseases) • Cyber Attack Module Two: Federal Changes

19. National Preparedness Guidelines, Continued • The Universal Task List is a menu of 1600 unique tasks that facilitate efforts to prevent, protect against, respond to and recover from the major events that are represented by the fifteen scenarios. • The Target Capabilities List defines 37 areas or tasks and contains things that state and local jurisdictions must be capable of doing. Module Two: Federal Changes

20. The TCL Respond Mission Area (cont) Firefighting Operations/Support WMD/Hazardous Material Response and Decontamination Explosive Device Response Operations Animal Health Emergency Support Environmental Health and Vector Control Citizen Protection: Evacuation and/or In-Place Protection Isolation and Quarantine Search and Rescue Emergency Public Information and Warning Triage and Pre-Hospital Treatment Medical Surge Medical Supplies Management and Distribution Mass Prophylaxis Mass Care (Sheltering, Feeding, and Related Services) Fatality Management Recover Mission Area Structural Damage Assessment and Mitigation Restoration of Lifelines Economic and Community Recovery Common Planning Interoperable Communications Prevent Mission Area Information Collection and Threat Detection Intelligence Fusion and Analysis Information Sharing and Collaboration Terrorism Investigation and Apprehension CBRNE Detection Protect Mission Area Risk Analysis Critical Infrastructure Protection Food and Agriculture Safety and Defense Public Health Epidemiological Investigation and Testing Citizen Preparedness and Participation Respond Mission Area On-Site Incident Management Emergency Operations Center Management Critical Resource Logistics and Distribution Volunteer Management and Donations Worker Health and Safety Public Safety and Security Response Module Two: Federal Changes

21. Functional And Medical Support Sheltering • Version 3 of the TCL will include a new Target Capability on “functional and medical support sheltering.” • Workgroup convened By the Department of Homeland Security and the Department of Health and Human Services • Representatives of Federal, State, Research and Advocacy Communities • The goal in the new TC is that “…the population requiring support accommodated in general shelters is maximized by meeting individual functional and medical support needs…. • Population requiring medication, consumable supplies or durable medical equipment • Population requiring functional support when an existing caregiver is not available • Population requiring medical support Module Two: Federal Changes

22. 2006 Reauthorization Of The Homeland Security Appropriations Bill • Mandates “…the inclusion of people with disabilities in every phase of emergency management activities at all levels of government.” • Creates a national Special Needs Coordinator reporting to the Secretary of Homeland Security • Creates a National Advisory Council • Durable medical equipment and service animals are considered “essential assistance” • Contains requirements for accessible temporary and replacement housing and states the need to “accommodate the housing needs of people with disabilities” Module Two: Federal Changes

23. Changes In The Role Of The American Red Cross in Mass Sheltering • The Red Cross was formerly designated by the Federal Government as a “primary agency” in providing mass shelters. • Problems occurred, included not being able to assign Federal assets & provision of long-term sheltering. • They are now designated as a “support agency.” • They are beginning a new program for people with functional needs, including a training program for all volunteers, an accessibility review of shelters and the creation of a stockpile of pre-positioned durable medical equipment. • Implications???????? Module Two: Federal Changes

24. Emergency Management Under Title II of the ADA • U.S. Department of JusticeCivil Rights DivisionDisability Rights Section • Americans with Disabilities Act • ADA Checklist for Emergency Shelters http://www.ada.gov/pcatoolkit/chap7shelterchk.htm Module Two: Federal Changes

25. Emergency Management Under Title II of the ADA, Continued • Emergency managers and shelter operators need to ensure that sheltering programs are accessible to people with disabilities, including individuals who use wheelchairs. • Local governments and shelter operators may not make eligibility for mass care shelters dependent on a person’s ability to bring his or her own personal care attendant. • The ADA generally requires emergency managers and shelter operators to make reasonable modifications to policies, practices, and procedures when necessary to avoid discrimination. Module Two: Federal Changes

26. Emergency Management Under Title II of the ADA, Continued • A reasonable modification must be made unless it would impose an undue financial and administrative burden. • This includes modifying “no pets” policies to incorporate service animals, use of kitchen facilities for people with medical conditions, and modifying sleeping arrangements to meet disability-related needs. Module Two: Federal Changes

27. Module Three What Are We Preparing For? Implications for Communities

28. Module Three Learning Objectives By the end of this module, you’ll be able to: • Examine what an “All-Hazards” approach to emergency management means; • Consider the assumptions that emergency managers make about preparing for, responding to and recovering from a disaster; • Define the very different assumptions made about one type of disaster - pandemic influenza; and • Review what these different assumptions mean for the phases of comprehensive emergency management – preparation and mitigation; response; and recovery in a pandemic influenza scenario. Module Three: What Are We Preparing For?

29. Topics • Planning for Disasters: Federal “Scenarios” • What is an “All Hazards” Approach to Emergency Management? • The Comprehensive Emergency Management System • Assumptions for Most Types of Disasters • How is Pandemic Influenza Different? • Assumptions for Pandemic Influenza • Responding to Pandemic Influenza Module Three: What Are We Preparing For?

30. An “All Hazards” Approach • An “all-hazards” approach to emergency management focuses on common elements of preparing for and responding to many types of disasters. • The goal of an “all-hazards” approach is the most effective and consistent response to any disaster or emergency that threatens citizens and communities. • It emphasizes cooperation and coordination among many levels of government, with those closest to the disaster being the “lynchpin” of efforts. • It emphasizes the involvement of numerous non-governmental agencies including the non-profit sector, voluntary organizations (the Red Cross) and the private sector. Module Three: What Are We Preparing For?

31. Assumptions For Most Types of Disasters • Some or many supports that people use to sustain themselves independently (electricity, water, heat, food sources) will be difficult or impossible to obtain for a period of time. • Some or many people will need to leave their homes to receive these services (shelters). • Some or many people will need to receive health services, ranging from minor (cleaning up cuts and scrapes to avoid infection) to major (acute medical care). • Some or many people will be unable to stay in place in their residences because of these factors, or because their residences are destroyed or threatened. All of these assumptions mean that some or all people in an area will leave or be removed from their homes and go to a central location. Module Three: What Are We Preparing For?

32. An Exception to Current Planning: Pandemic Influenza • Influenza: an illness caused by a highly contagious virus that spreads easily from one person to another • A pandemic occurs when there is a widespread or world wide outbreak of disease. • An influenza pandemic or “pandemic flu” is caused when a new virus appears that people have not been exposed to before. • Pandemic Influenza: an influenza epidemic occurring over a large geographic area that affects large numbers of people and may cross national and international boundaries, including sovereign tribal boundaries. Module Three: What Are We Preparing For?

33. Pandemic Influenza, Continued • The viruses that cause it may be able to change genetically and result in human-to-human transmission. • Because many or most people won’t have natural immunity in their bodies, it will spread quickly and result in large numbers of people becoming affected. • Three worldwide (pandemic) outbreaks in the 20th century - 1918, 1957, and 1968. • The Spanish Flu of 1918 killed 20-40 million people worldwide and 500,000 in the U.S. • If a pandemic influenza killed the same proportion of people today, the death toll would be between 1.2 billion and 2.4 billion people worldwide and 1 ½ million in the U.S. Module Three: What Are We Preparing For?

34. H5n1 Influenza (Avian) • Since 1997 H5N1 has occurred in a large number of birds • Started in Asian countries • Human infections have occurred • Has spread to European continent, Germany, France North Africa and Egypt • 58% mortality rate • Highest number of deaths-Indonesia • Avian Influenza is NOT a pandemic influenza human outbreak – yet. Module Three: What Are We Preparing For?

35. No H5N1 cases have been reported in North America or South America Module Three: What Are We Preparing For?

36. Assumptions for Pandemic Influenza • It will spread quickly. • It may overwhelm the healthcare system because large numbers of people will require care at the same time, resulting in shortages of people, equipment and space. • Pharmaceutical treatments may be non-existent for a period of time because the vaccine will have to be developed from the “new” virus. • Even after they are developed, they will be in short supply because of the widespread nature of the pandemic. • Healthcare workers and first responders may be at higher risk of exposure, making delivery of these services difficult or impossible. • Widespread illnesses in communities may mean that there will be shortages of people who provide services such as fire, police, utilities, municipal services and others. Module Three: What Are We Preparing For?

37. Assumptions for Pandemic Influenza, Continued • These services, as well as delivery of food, gasoline and other commerce may be significantly disrupted. • Depending on how widespread the pandemic is, assistance and resources from other levels of government may be limited or non-existent for a period of time. Module Three: What Are We Preparing For?

38. Responding to Pandemic Influenza “Social Distancing” • Voluntary or mandatory quarantine or isolation of people who become infected. • Voluntary or mandatory closure of schools, public transportation, shopping centers and malls, and public gatherings to reduce the risk of infection to non-infected people. • Voluntary or mandatory restrictions on travel. Module Three: What Are We Preparing For?

39. Responding to Pandemic Influenza “Sheltering in Place” • Chemical, biological, or radiological contaminants may be released accidentally or intentionally into the environment. • In response, people may be told to stay indoors for periods of time ranging from several hours to several days. • This precaution is designed to keep people safe. • This technique has been used successfully in many places around the world. • Pre-Planning on both the community and individual levels is essential . Module Three: What Are We Preparing For?

40. Responding to Pandemic Influenza The New Mexico Public Health Emergency Response Act – A Gubernatorial Declaration of a Public Health Emergency The Secretary of Health may “utilize, secure or evacuate health care facilities for public use” and “inspect, regulate, control, restrict or ration the allocation, sale, dispensing or distribution of health care supplies.” He or she may also … “isolate or quarantine a person as necessary during a public health emergency, using the procedures set forth in the Act;” “authorize…medical tests and examinations” and “…isolate or quarantine a person who refuses medical tests or examinations.” The State Medical Examiner may “…implement and enforce measures to provide for the safe disposal of human remains [including] embalming, burial, cremation, interment, disinterment, transportation and disposal…” To the extent possible, the religious, cultural, family and individual beliefs of a deceased [will be respected]. Module Three: What Are We Preparing For?

41. Module Four • Tools You Can Use In Your Community

42. Module Four Learning Objectives By the end of this module, you’ll be able to: • Become aware of and how to use four existing tools: personal preparedness plans, resource registries, individual registries and Tips for First Responders; • Understand how to implement one or more of these tools in your community; and • Discuss what they can do to help you, and what they can’t do. Module Four: Tools

43. Topics • Personal Preparedness Planning • Resource Registries • Individual Registries • Tips for First Responders Module Four: Tools

44. Personal Preparedness Planning • Our experience with many previous disasters reinforces the critical role of individuals being prepared. • We also know that very few people – with or without “special needs” – have made any preparations. As few as 7% of people in a recent poll said that they were prepared. • In all scenarios we’ve talked about, it might be several days or longer before vital services are restored. • People need to be encouraged to take responsibility for helping themselves in the hours, days and perhaps weeks after a disaster. • One of the critically important steps your community can take is to mount a campaign to motivate people to make a personal preparedness plan. Module Four: Tools

45. Resources 72hours.org http://www.72hours.org/index.html PrepareNow.org http://www.preparenow.org/links.html American Red Cross “Be Prepared Campaign” http://www.redcross.org/services/prepare/0,1082,0_239_,00.html Federal Emergency Management Agency “Are You Ready” Campaign http://www.fema.gov/areyouready/ National Organization on Disability “Prepare Yourself!” Campaign http://www.nod.org/index.cfm?fuseaction=page.viewPage&pageID=1430&nodeID=1&FeatureID=1625&redirected=1&CFID=12437936&CFTOKEN=96203152 Module Four: Tools

46. Resources, Continued Emergency Planning For People Who Use Assistive Technology Devices Powered By Electricity or Batteries http://www.jik.com/techartV4.doc Tips for People With Mobility Limitations from Los Angeles County http://www.cert-la.com/ESP/ESP-Disabilities-Guide-2006.pdf American Red Cross “Be Prepared Campaign” http://www.redcross.org/services/prepare/0,1082,0_239_,00.html Emergency Preparedness at Home for People With Disabilities http://www.disabilitypreparedness.org/Emer%20Prep%20at%20home%20rev%206-07-06.pdf Disaster Preparedness for Persons with Mobility Impairments  www.nobodyleftbehind2.org/ Module Four: Tools

47. Common Elements of Personal Planning • Individuals should be prepared to maintain themselves for a minimum of 72 hours (three days) without services (food stores, electricity, water, etc.) • Supplies of food and water • Change of clothes • Medications • Flashlight, portable radio, batteries Module Four: Tools

48. Common Elements of Personal Planning • Copies of prescriptions • Service information (e.g., Medicare or Medicaid cards, health insurance plan cards, social security card) • First Aid Kit • Food for service animals, if applicable • Information on durable medical equipment, if applicable • Contact information for family, caregivers, close friends who could help Module Four: Tools

49. Common Elements of Personal Planning • For disasters in which an evacuation might happen, these items should be placed in a “To-Go Kit” – a durable, lightweight container such as a duffle bag. • These items can be used at home in the event of a disaster that requires people to stay in their homes. Module Four: Tools

50. FEMA’S RECOMMENDATIONS • Three-day supply of non-perishable food. • Three-day supply of water - one gallon of water per person, per day. • Portable, battery-powered radio or television and extra batteries. • Flashlight and extra batteries. • First aid kit and manual. • Sanitation and hygiene items (moist towelettes and toilet paper). • Matches and waterproof container. • Whistle. • Extra clothing. • Kitchen accessories and cooking utensils, including a can opener. • Photocopies of credit and identification cards. • Cash and coins. • Special needs items, such as prescription medications, eye glasses, contact lens solutions, and hearing aid batteries. • Items for infants, such as formula, diapers, bottles, and pacifiers. • Other items to meet your unique family needs. Don’t forget to “cycle” your stockpile materials! Module Four: Tools