phase three:

Phase Three:

Tools for Community Health Councils and Other Community-Based

Organizations To Provide Effective Emergency Response to People With

Disabilities

The Prepared Community

NMDOH Office of Health Emergency ManagementSanta Fe, NM 87505

Course Developers

Center for Development and Disability UNM School of Medicine

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

Module One

Review of Phases I and II of

The Prepared Community

Module One Learning Objectives

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

In this module, we’ll:

Module One: Review

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

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

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

Comprehensive Emergency Management

Module One: Review

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 emergencyto 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.”

The Emergency Response System

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.

How does the emergency response system work?

Module One: Review

All Response is Local, Continued

All response is local!

Module One: Review

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

Tools

Tools Developed in Phases I and II:

Tools for Effective Outreach

Community Profiles

Creating a Plan

Module One: Review

Module Two

Recent Federal Policy Changes Regarding Targeted Populations: News You Can

Use!

Module Two Learning Objectives

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.

In this module, we’ll:

Module Two: Federal Changes

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


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

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 AttackBiological 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

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.

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

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

The TCL


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


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”


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????????


Emergency Management Under Title II of the ADA

U.S. Department of Justice

Civil Rights DivisionDisability Rights

Section

Americans with Disabilities Act

ADA Checklist for Emergency Shelters

http://www.ada.gov/pcatoolkit/chap7shelterchk.htmModule Two: Federal Changes

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.

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 Three

What Are We Preparing For?

Implications for Communities

Module Three Learning Objectives

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.

By the end of this module, you’ll be able to:

Module Three: What Are We Preparing For?

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


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.


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.


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.


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.


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.


No H5N1 cases have been reported in North America or South America


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.


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.



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.

“Social Distancing”



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 .

“Sheltering in Place”



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].

The New Mexico Public Health Emergency Response Act – A Gubernatorial Declaration of a Public Health Emergency


Module Four

Tools You Can Use In Your Community

Module Four Learning Objectives

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

Topics

Personal Preparedness Planning

Resource Registries

Individual Registries

Tips for First Responders

Module Four: Tools

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

Resources

72hours.orghttp://www.72hours.org/index.html

PrepareNow.orghttp://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&re

directed=1&CFID=12437936&CFTOKEN=96203152

Module Four: Tools

http://www.72hours.org/index.html

http://www.preparenow.org/links.html

http://www.redcross.org/services/prepare/0,1082,0_239_,00.html

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

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


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


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

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.

Module Four: Tools

Don’t forget to “cycle” your stockpile materials!

Where Do We Start? Personal Responsibility

Module Four: Tools

Where Do We start? Organizational Responsibility

Module Four: Tools

A Template For Pre-Disaster Planning

Module Four: Toolshttp://www.ready.gov/america/_downloads/familyemergencyplan.pdf

Community Registries of Resources

Every community has many types of resources that can be used to respond to a disaster.

This includes such things as “stockpiles” of durable medical equipment such as wheelchairs or walkers, first aid supplies, oxygen refreshers, accessible or ramp vans, etc.

Even though they’re there, many people may not know about them.

It will be too late to collect information about them AFTER a disaster happens.

A critical task that is needed in your community is to develop a “registry” of these types of resources.

It should be shared with your local emergency manager when complete.

It should be updated periodically as resources permit. Module Four: Tools

Resource Registries: How?

Develop a simple form that can be used to collect information – place, organization, description of resources, contact information.

Enlist volunteers from community, civic, faith-based or fraternal organizations.

Divide up your community – perhaps by type of organization.

Give your volunteers lots of encouragement.

Make sure one or more people are responsible for compiling the information in one central location.

A simple program such as Excel can be used to enter and sort the information, but make sure hard copies of the latest version are always available!

Share it with your local emergency manager!

Module Four: Tools

Community Registries of People

There has been much debate over whether or how to collect information on people who need additional assistance in the event of an emergency.

Many communities have organized local, grass-roots efforts to ask people to voluntarily identify themselves and what needs they might have in the event of a disaster.

It will be too late to collect information about people who need assistance AFTER a disaster happens.

The registry should be shared with your local emergency manager when complete.

It should be updated periodically as resources permit.

Module Four: Tools

What Makes a “Good” Registry?

…Or, How To Create A Really BAD Registry!

Bad: Collect as much information as you possible can about every aspect of the person's needs and life.

Good: Focus on information that the first responder will need to get the person from their home or other location to a shelter, evacuation point,

etc.

Name

Location

Type(s) of disability

Medication – what and where is it?

Caregivers? If yes, contact information

Durable Medical Equipment? If yes, what and where is it?

Service animals? If yes, what kind, leash or harness, food

Other needs Module Four: Tools

What Makes a “Good” Registry?

Bad: the bigger the registry, the better!

Good: maintain registries that will be used on a local level.

Bad: create a registry that relies on technology.

Good: technology is great, but make sure there are always hard copies available of the latest version.

Bad: Wait until a disaster happens to let local emergency managers know that the registry exists.

Good: always coordinate your activities with the local emergency management community, particularly the county emergency manager.

Module Four: Tools

Sample Registry

Name Of I ndividual:

First Last Address:

Phone Numbers:

What should someone providing you with

help know about your disability?

Module Four: Tools

Sample Registry, Continued…

Do you want to be notified by someone with alerts or warnings if an emergency

happens? ❏ Yes ❏ No I f you checked “yes”, how do you want to be notified? Put a “1” next to the way you want to be notified first, a “2” next to the second way you want to be notified, etc. Method Order Special I nstructions Telephone In Person TTY Other:

I s there a neighbor, friend or relative who lives nearby who you want to be notified as well? I f so, what is their name, address and phone number?

Do you have a personal care assistant? ❏ Yes ❏ No I f you checked “yes”, please answer the following questions.

Will the assistant accompany you if an evacuation is ordered? ❏ Yes ❏ No

What is the name,

address, phone and hours of assistance of the personal care assistant?

Module Four: Tools


Will you need transportation assistance if there is an evacuation? ❏ Yes ❏ No I f you checked “yes”, what equipment will you need to take with you? Check all that apply: I tem Special I nstructions Wheelchair ❏ Walker or cane ❏ Crutches ❏ Oxygen system ❏ Hearing aid ❏ Other: ❏

Are there medications that you’ll need to take with you? ❏ Yes ❏ No I f you checked “yes”, what are they and where do you keep them? Medication Where I s I t? Refridgerated? ❏

❏

❏

❏

❏

❏

Module Four: Tools


Do you have a service animal? ❏ Yes ❏ No I f you checked “yes”, will he or she accompany you if an evacuation is ordered?

❏ Yes ❏ No

What is the name, address, phone and of the animal, and where is his or her food kept in your house?

Please return this form to:

Module Four: Tools

Tips for First Responders

Who is a “first responder?”

It can be anyone! in fact, we know that in the majority of disasters, citizens and survivors are often the first to look for and offer aid to others until the “official” emergency management system is in place.

There are some easy, simple tips to that will help first responders to work with people with a wide variety of disabilities.

Tips for First Responders was developed to be a quick, easy-to-use guide to give first responders the information they need when an emergency occurs.

Module Four: Tools

Module Four: Tools

Module Four: Tools

A Sample Tip Sheet

Module Five

Community Response: A Hypothetical Scenario

Module Five Learning Objectives

Review a scenario regarding pandemic influenza in your community;

Discuss how the emergency management system at the local, state and federal levels would respond to that scenario; and

Discuss how your community might react, including:


Module Five: Scenario

• keeping people apart,

• isolating people who become infected,

• ways to help people without using pharmaceuticals and

• taking care of people with disabilities in their homes, including family members and caregivers.

What We’ll Do

We’re going to present a scenario that might happen in your community.

After everyone has the opportunity to read through it, we’ll have a discussion about what steps you might take to help your community respond to and recover from the events that took place.

We’ll focus on several topics, including areas, including


Some Focus Areas for Discussion

Closure of schools and public events

Isolation and quarantine – social distancing and sheltering in place

Non-pharmaceutical interventions

Home care of people with disabilities, including family members and caregivers

How to ensure that children are sheltered and fed if their parents or caregivers become ill


For More Information

Joan Murphy (505) 476-8238

[email protected]

Anthony Cahill Elaine Brightwater (505) 272-2990 (505) 272-5815 [email protected] [email protected]

phase three:

Documents

community groups

community health councils

community outreachwhats

emergency module

effective emergency

communitybased organizations

prepared communitymodule

welfare of people