Disaster Preparedness for Persons with Developmental Disabilities

1. Disaster Preparedness for Persons with Developmental Disabilities Tim O’Malley M.Ed., R.N. Community Health Liaison 216.931.7452 omalley.timothy@CuyahogaBDD.org

2. OBJECTIVES TODAY: • Disaster Prep and Individuals with DD • Overview of the Cuyahoga County Board of Developmental Disabilities • Disaster Planning • Sheltering and Evacuation Considerations • Community Resources • Future Directions

3. Background and History • The 2009 H1N1 influenza pandemic and Hurricane Katrina highlighted the importance of communities being prepared for potential threats and the consequences that occur when a community is ill prepared. • Consumers with intellectual and neuro-developmental disabilities are subject to the same issues as all of us. • Recommendations for preventive health care are the same for individuals with Intellectual Developmental Disability (IDD) as they are for all of us.

4. Pandemic • In 1968, the influenza pandemic killed more than 700,00 people worldwide, and estimated 34,000 of those in the United States. • The Pandemic of 1918 killed more than 50 million people worldwide and an estimated 675,000 people in the U.S.

5. Pandemic • Public health experts worldwide continue to watch and make plans to deal with the potential of a pandemic in the form of avian flu. • While no current pandemic exists, the potential for one exists. Person-to-person spread causing serious illness, sweeping across the country and world in a very short time.

6. Disasters • Cuyahoga County is vulnerable to many hazards, all of which have the potential to disrupt the community, cause damage and create mass casualties. • The jurisdictions within Cuyahoga County have robust response and recovery capabilities.

7. Potential Hazards • Nuclear Power Incident • Drought • Power Failure • Cyber Attack • Winter Storm • Temperature Extremes • (CBRNE) • Floods • Tornado/High Winds • Utility Failure • Earthquake • Civil Disorder • Infectious Disease Outbreak • Hazardous Materials Spill

8. Emergency Action Levels • Cuyahoga County, in cooperation with state and federal agencies, has established emergency action levels that describe a progressive order of escalation for managing an emergency.

9. Historical Perspective • A common problem emerging from 9/11 and the Katrina disasters is that there is little available empirical data on the safe and efficient evacuation of persons with disabilities in an emergency. In times of a disaster or possible terrorist attack, emergency plans often place persons with a disability at risk for bad outcomes.

10. Historical Information • Cuyahoga County serves a large number of consumers with IDD (9000 individuals). • Individuals have varying levels of intellectual and physical capabilities • Variety of living environments, some are with family, paid providers, nursing homes, group homes and some live independently within the community.

11. Emergency Response Systems • Emergency response systems and emergency preparedness plans are, for the most part, designed for persons where escape or rescue involves walking, running, driving, seeing, hearing and quickly responding to directions.

12. Profile of Cuyahoga County • In Cuyahoga County and its 6 adjoining counties (Lorain, Lake, Medina, Geauga, Summit, Portage) it is estimated that 286.757 individuals 5 years of age and older have at least one disability. • The data above underline the importance to consider persons with a disability when developing emergency evacuation plans.

13. Planning Assumptions • Disasters differ in character by magnitude, severity, duration, onset, area affected and frequency. • A disaster may impact multiple jurisdictions within Cuyahoga County with casualties, property loss, disruption of normal services and damage to economic, physical and social infrastructures.

14. Planning Assumptions • Disaster events will be managed independently until multiple response agencies become essential or resources are exhausted. • Effective disaster preparedness requires ongoing public awareness and education to ensure citizens will take appropriate action.

15. Terminology • Within the emergency management field the term S/N “special needs” is defined in a multiple ways. Often important segments of the diverse group are overlooked. (i.e. people with hidden disabilities, people with serious mental illness, people with intellectual and cognitive disabilities, people with a variety of visual, hearing and mobility limitations.

16. Functional Needs Approach • According to The U.S. Department of Homeland Security, people with functional needs may have difficulty maintaining independence, understanding communication, arranging transportation, and keeping adequate supervision or medical care. Under this definition, a significant portion of Cuyahoga County citizens have functional needs.

17. Cuyahoga County Emergency Operations PlanSupport Agencies • Have the authority and/or capability to support the primary agency in accomplishing the Emergency Support Function, (ESF) mission and tasks. Board of DD is considered a Support Agency.

18. Service and Support Administrator (SSA) • Also called a service coordinator or case manager – works with individuals and providers of services. For families who have a member with a disability, the SA should provide the family with the resources and support the family needs that are essential to their well-being as well as monitor progress.

19. Support Administrator Duties • Single point of accountability and knowledge of the individual’s needs and their family’s circumstances • Offer solutions to complex issues • Resource regarding background information, social and medical issues that will impact care during an emergency

20. Considerations for people with disabilities • Those with disabilities or other special needs often have unique needs that require more detailed planning in the event of a disaster. • Learn what to do in case of power outages and personal injuries. Know how to connect and start a back-up power supply for essential medical equipment.

21. National Organization on Disability Brochure

22. Who does what and when? • Self- responsibility • Shared responsibility • First responder actions/considerations

23. “Self-Responsibility” • Develop a backup plan. Inform caregivers, friends, family, neighbors or others who might be able to help during an emergency. • Stock up on food, water, and any necessary prescription medications, medical supplies or equipment. Have enough to last at least one week.

24. Prepare Yourself For An Emergency

25. “Self-Responsibility” • Make a list of emergency contact information and keep it handy. • Keep a charged battery at home. It can power electric wheelchairs and other motorized medical equipment if there is an electricity outage. • Learn about alternate transportation routes.

26. “Shared Responsibility” • Understand the responsibilities and limitations of a “first responder” (for example, members of your local fire department or law enforcement office) during an emergency. • Critical employee families have different needs during an emergency than other families. At least one of the family’s primary caregivers will be away.

27. Shared Responsibility • If you use a personal care attendant obtained from an agency, check to see if the agency has special provisions for emergencies (e.g., providing services at another location should an evacuation be ordered). • If you live in an apartment, ask the management to identify and mark accessible exits and access to shelters.

28. First Responders • Get to know your local community and the make-up of the population. • State of Ohio has 88 counties, each with a Board of Developmental Disabilities. • Reach out and visit and get to know the staff and consumers. Introduce yourself!

29. Emergencies, Special needs Shelters and Children/Adults with Technology Dependencies… • E-mail relating stories in the aftermath of Hurricane Ike in Galveston, Texas. From the perspective of an MD who operates a special needs clinic in Houston, Texas. • Realistically – What can and cannot be done to assist is both heartbreaking and inspiring.

30. Cuyahoga County Board of DD Website • www.CuyahogaBDD.org • Links to other Board of DD websites • General Disability information • Local Resources and Contacts

31. Cuyahoga County Board of DD • Emergencies during normal work hours (8:00 am – 4:30 pm, Monday – Friday, except holidays) (216.241.8230) • After-hours on-call (AHOC) system for those seeking assistance in case of a crisis or emergency. (Monday – Friday 4:30 pm – 8:00 am, all day Saturday/Sunday and Holidays) (216.694.7077)

32. County Board of DD“How can we help prepare?” • Board of DD is currently working with the Red Cross on the development of procedures for “Sheltering” • Provide education to our consumers about preparing for emergencies - • Shelter-In-Place, Ready Now, Go Bags • Ready When the Time Comes and • Just in Time Training

35. Emergency Management “Be Prepared” Kit • Readiness Checklist: Emergency Plan for Home (Blue) • Shelter Checklist: Be Prepared to Go to a Shelter (Green) • Yellow Checklist: Important People and Papers (Yellow)

36. Plan Ahead for Emergencies • Emergency management has three phases; planning, response and recovery. • People with disabilities have the right to participate in all phases, in planning for, responding to, and recovery from emergencies. • You have responsibility in planning ahead for an emergency because you and the people who assist you know your needs.

37. An ADA Guide for Local Governments • “Making Community Emergency Preparedness and Response Programs Accessible to People with Disabilities” • U.S. Department of Justice – Civil Rights Division, Disability Rights Section

38. Considerations • If you use an electric wheelchair or scooter, have a manual wheelchair for backup. • Teach those who may need to assist you in an emergency how to operate necessary equipment. • Store backup equipment at your neighbor’s home, school or your workplace. • Have a back-up plan

39. Promising Practices • The following are examples of innovative and promising practices/programs geared towards addressing gaps in emergency management and planning for at-risk individuals. • Examples taken from National Council on Disability’s (NCD) “Effective Emergency Management: Making Improvements for Communities & People with Disabilities”

40. Planning • Special Needs Tool Kit for pandemic flu and mapping. The tool kit provides detailed instructions on how to assess the needs of the elderly, people with disabilities, non-English-speaking people and people living in congregate settings. • Kansas Association of Local Health Departments (2007)

41. Planning • Course “Ready, Willing and Able” • Created online course to train hospital staff, health care workers, emergency personnel, Medical Reserve Corps and other workers to assist people with disabilities during disaster events. • Other Disability courses are also available online at: www.train.org

42. Registries • Registries have emerged as a possible means to identify and conduct planning for citizens with needs for transportation, evacuation and other kinds of assistance. • 2008 New Jersey’s Office of Emergency management launched a “Register Ready” effort to sign up people with disabilities who may need help during an emergency.

43. Current Collaboration between CCBDD and Red Cross - Sheltering • Dedicated “Special Needs” Shelters • A place where medical, behavioral and social considerations can receive appropriate attention. • Maintain same goals of safety, shelter and early reunification

44. Board of DD/Red Cross Special Needs Shelter • Able to accommodate individual with disability and their caregiver • Plan for specific resources and training of volunteer staff • Quiet space addressing specific needs, mobility, feeding, transfers, toileting/bathing and communication needs

45. Screening Questionnaire • In an emergency, could this individual remain in their residence up to 72 hours? • Is the individual “LIFE DEPENDENT” on electricity? • Has the Power Company and Fire Department been notified in the event of an emergency? • Is there a back-up generator for ventilator/oxygen dependent individual?

46. Screening Questionnaire • Is there a visible sign on the door or in a window indicating there is oxygen in the home? • If the patient is tube fed, has the caregiver been instructed on gravity tube feeds? • Current list of medications with ready access? • Building management aware of people with disabilities that might prioritize care in the event of an emergency?

47. Using Community Based Organizations • Health and Human Service Information • Cuyahoga County “Call 211” • Ashtabula: 440.997.5957 • Geauga: 440.285.3194 • Lake: 440.953.5465 • Lorain: 800.275.6106 • Medina: 888.330.4211

48. Faith Based Organizations • The church staff and congregation can learn how to deal with special needs emergencies on the church campus. • Church can develop a way of emergency communication with persons who must shelter-in-place. • Church can assist parents of children, youth or adults with special needs to prepare for a community emergency.

49. Online Resources/Information • An ADA Guide for Local Governments – Making Community Emergency Programs Accessible to People with Disabilities • www.ada.gov/emergencypreguide.htm • Conference on Emergency Preparedness for People with Disabilities • www.nod.org • NOD’s Emergency Preparedness Initiative Guide • www.nod.org

50. Conclusion • Questions • Suggestions/Comments • Opportunities for Improvement/Collaboration