Understanding, Motivating
and Supporting Evacuation
with 
Special Needs Populations 


Brenda D. Phillips, Ph.D. 

Center for the Study of Disasters & Extreme Events 

Oklahoma State University 


Overview of The Presentation 


• 
Populations at Risk 
• 
Warnings 
• 
Evacuation 
• 
A Practical Approach 
• 
Individual, household, 
community and agency 
strategies 

What do we know about special needsand disaster evacuation? 

• 
We aren’t adequately prepared (DHS June 2006) 
• 
Lack staff expertise, time, funding 
• 
Perception is important. 
• 
Individual responsibility is a possibility – but not for all. 
• 
Public education and outreach works, in part because it 
makes those who feel vulnerable more likely to take 
action. 
• 
Disasters may be just another challenge among many. 
• 
Sources: VanWilligen et al 2002; Rahini 1993. 

CA Wildfires 2003 

(2003 State Independent Living Council) 


• 
Multiple counties; 730,000 acres burned; 22 deaths; 200 
injuries; 36,000 homes destroyed. 
• 
Prepare: few emergency bags; lack of a fire-safe perimeter. 
• 
Notify: difficulty getting the warning in rural areas with rapid 
onset; TV and radio signals not available; poor directions. 
• 
Evacuate: little transportation, lack of family, MARTA blocked 
by police; registry locked up. 
• 
Shelter: not ADA compliant, service animals not allowed, no 
sign language interpretation. 

Nursing Homes (GAO, Post Katrina) 


• 
“If hospital and nursing home administratorsdecide to evacuate, they face the challenge ofsecuring sufficient and appropriate transportationto move their patients or residents.” 
• 
“According to hospital and nursing homeadministrators, their contractors providingtransportation would be unlikely to provide themwith vehicles during a major disaster becauselocal demand for transportation would exceedsupply.” 

Can the federal government help? 


• 
“While NDMS supports the evacuation of patients 
in need of hospital care, the program was not 
designed nor is currently configured to move 
nursing home residents.” 
• 
Translation: you better develop your own plans, 
procedures and mutual aid agreements including 
transportation, transfers, and beds. 
• 
RED ALERT: watch the Federal Highway Administration 
website for new guidance coming out soon. 

Warning people to evacuate 


(Mileti 1999) 

1. Hearing the warning 
2. Believe that it is credible 
3. Confirm that a threat exists 
4. Does the warning pertain to me? 
5. Determine if protective action needed 
6. Is protective action feasible? 
7. Determine what action to take 

1. Hearing the Warning 

Situation Report: 


• 
“There’s a hole in the weather warning system.” 
• 
Dr. Vincent Wood, Norman National Weather Service 
• 
“America’s current public warning and emergency 
communication systems get a failing grade from 
deaf, hard of hearing, late-deafened, and deaf-
blind individuals.” 
-Deaf and Hard of Hearing Consumer Advocacy Network 2004. 


Persons that are 
deaf or hard-of-hearing 

• 
FCC policies & implementation. 
• 
Have you tried CC? 
• 
Pagers….but technology costs $. 
• 
Sources: Vincent Wood and Robert Weisman, 2004.; Consumer Action 
Network; National Organization on Disabilities. 

Technology is not enough. 


“It is not just a matter of knowing sign language. It 
takes years of training to become an interpreter 
who can work with a group like this, and it takes 
an understanding of the deaf culture to be 
effective.” 

Gallaudet University graduate student assisting FEMA post-
impact. 


Being deaf during Katrina 


• 
“We had to invent a whole new vocabulary.” 
• 
Issues 
• 
English is a second language. 
• 
Levels of communication vary. 
• 
Deaf from birth? Is it age related? 
• 
Deaf/blind? 
• 
Cost of technologies. 
• 
TV meteorologists. 
• 
Scrolls obscure closed-captioning. 
• 
But the Deaf & Blind Community also stepped up. 

Is text messaging a solution? 


• 
Text messaging is age-related 
• 
Literacy levels vary 
• 
Doesn’t work for people with visual limitations 
• 
Income means you may not be able to afford 
some messaging systems 
• 
Text messaging is problematic 
• 
Multiple, overlapping redundant systems are more 
effective 

Deaf Communications: Katrina 


• 
Technologies that were used: 
• 
Sidekicker pagers. 
• 
Text messaging worked with cells oneweek after. 
• 
Email, web sites, newspapers. 
• 
Note the potential bias, though! 
• 
Age, income “compound.” 
• 
There is no technological panacea. 

2. Is it credible? 
• 
How credible are you? 
• 
“Caring…concern…trustworthy…honest, altruistic,
objective.” 
• 
Cultural credibility filters: 
• 
“Mexican Americans reported obtaining proportionately moreinformation through social networks than either African 
Americans or whites.” 
• 
This is likely to be a process for Hispanic elderly. 
• 
Tierney, Lindell and Perry, Facing the Unexpected, p. 31. 

Relationships matter 


• 
Broadmoor, Victoria, Australia 
• 
New immigrant population 
• 
Fires among senior citizens (from Turkey) of cultural origin 
• 
Firefighters learned Turkish 
• 
Worked with local Islamic center and migrant organization 
• 
Went on the radio, gave presentations 
• 
Result: fewer fires 
• 
Because the firefighters built credibility 

3. Does a threat exist? 
• 
People will confirm the threat through social 
networks. 
• 
So, how are you going to use social 
networks to facilitate evacuation? 

Reducing confirmation time. 


• 
Gender matters. Research shows that: 
• 
Women are more likely to believe warnings. 
• 
Women are more likely to warn others. 
• 
Women are more likely to want to evacuate. 
• 
Women appear more likely to gather the family. 
• 
So….engage women in the community,
facilitate their leadership! 

4. Does it pertain to me? 
• 
To decide, I’ll ask: 
• 
What are others doing? How does this compare to my 
previous experiences? Are others like me heeding the 
warning? 
• 
Social Comparison Theory 
• 
Translation: it’s not just the physical cues of the 
storm….it’s the social cues too. 
• 
Tell neighbors and family to help you warn those at risk. 
• 
Get the Media to help you with this. 

5. Do I need to act? 

How do the elderly respond toevacuation messages? 

• 
They may lack critical resources 
to evacuate: health, 
transportation, knowledge. 
• 
When warned, they do respond. 
• 
When not reached, their death 
and injury rates are much higher. 
• 
As many as 70% of theKatrina fatalities were 65. 
• 
Sources: Hutton 1976; Lindell and Perry 
1997; Fernandez et al. 2002. 

Seniors/Katrina


(GAO 18 May 2006) 

“The elderly are more likely to be representedamong the transportation disadvantaged becausethey are more likely, compared with the generalpopulation, to have a disability, have a low income,
or choose not to drive.” 


The Elderly and Katrina 


• 
Long-time homeowners. 
• 
No Cars. Fear of Highway. 
• 
Camille, Betsy were the 
benchmark. 
• 
Uniting the Family: 
• 
“We finally left Sunday 
morning.” 
• 
Race/ethnicity/income 

Elderly issues related to evacuation 

• 
Sensory deprivation, delayed response, transfer trauma,
nutrition. 
• 
Social support systems may not last during a prolonged
evacuation. 
• 
Cultural issues matter. 
• 
Asian Americans especially likely to under-use services. 
• 
Native American elders may have additional issues. 
• 
Sources: www.aoa.gov; Poulshock and Cohen 1975; Kilijanek and Drabek 1979; 
Eldar 1992). 

Frail Elderly 


• 
Frail Elderly: 
• 
“Access to dialysis and other critical services are related to 
transportation.” 
• 
“In many cases, frail elderly are dropped-off at shelters and 
nursing homes without care instructions or medical records.” 
(Fernandez et al. 2002). 
• 
Coordination among agencies and organizations with resources is 
crucial. 
• 
Are all the players at the table for this? 

6. What can I do about it? 
• 
I don’t have transportation 
• 
Can I get there? I don’t know the route? 
• 
Is the shelter ready for my needs? 
• 
I live alone, I’m isolated. 
• 
A particular problem for the elderly, especially men. 
• 
I have a specific issue: 
• 
“Sight-impaired or blind persons…rely on memory as anavigation device; imagine trying to evacuate a buildingthat is in a state of disarray.” (Imperiale 1991). 
• 
Imagine going somewhere you have never been.
Would you go? Is it better to stay here? 

Mobility issues and Katrina 


• 
Separated from your wheelchair. 
• 
Specific for the disability. 
• 
Retrieval issues. 
• 
Separated from your service animal. 
• 
Separated from your family. 
• 
We need to keep people together. 
• 
We need to keep people with their resources. 
• 
Have we trained our evacuation staff for this? 

Do Buddy Systems Work? 


• 
Individual with disability is often “one deep.
• 
What if that one person is out of town? 
• 
They are less likely to evacuate. 
• 
They may need backup persons and plans. 
• 
VanWilligen et al. 

What about my pet/service animal? 


• 
People, especially theelderly, will refuse toevacuate without pets. 
• 
They are family. 
• 
Service animals crucial. 
• 
So….plan for pets, educatethe public and partner withpet care providers. 
• 
Treat service animals 
separately from pets. 
• 
(“Layla” and “Nickel” Photos courtesy of Cassie Miller, 
Oklahoma State University) 

7. Take Action 
• 
Tornado warnings may be received 7-15minutes before impact. 
• 
Seven steps = people die. 
• 
We need to motivate, support, educate
people to spur them through the steps. 
• 
They will go through the steps. 
• 
We need to jump start every step. 
• 
This is a never-ending process. 

Practical strategies 


• 
Individuals 
• 
Agencies 
• 
Households 
• 
Community organizations 

Individuals 


• 
Emergency bags (preparenow.org). 
• 
Checklists and GuideCards (eadassociates.com) 
• 
Buddy Systems: fire research suggests: 
• 
Minimum one buddy for a visibility or hearing issue; minimum two for a mobility 
issue. 
• 
Don’t forget backups. 
• 
Train buddies carefully; Involve individual with disability in training for lifts and 
transfers. 
• 
Call down lists/phone “trees” 
• 
Branch managers (advocacy organizations) connected to clients. 
• 
Neighborhood Watches. 
• 
Sources: Rahimi 1994; www.preparenow.org; Fernandez et al. 2002; T.R.A.C. LA; Upper Pinellas County Red Cross, Tampa,
FL: GAO 2006; National Research Council Canada). 

Emergency Bags (http://www.preparenow.org/eqtips.html) 

• 
Health card 
• 
Instructions on how to be helped 
• 
Key docs: SSN, will, bank # (sealed bag with copy toout of state friend). 
• 
Medications for 7-14 days. 
• 
Flashlight. 
• 
Signaling device (whistle). 
• 
Dark glasses, folding cane 
• 
Battery operated radio and extra batteries. 
• 
Store where reachable. 

Buddies (www.preparenow.org) 


• 
Who really needs them? Self-
assessment quiz at
www.preparenow.org/eqtips.html 

• 
Three persons at work, home plus out of 
state support. 
• 
Keys, emergency supplies, documents. 
• 
Communication system during event. 
• 
How will you alert buddies/IWD? 

Visual Impairments 


• 
Reluctant to leave familiar surroundings 
• 
May require assistance with orientation and 
navigation 
• 
Personal preparedness (AFB, ACB) 
• 
Personal Support (NOD) 
• 
Free course: 
• 
www.afb.org, Safety in the Home 

Partners! 



Executive Order 13347 


• 
Recommendations: 
• 
“increase the rate of 
participation of people withdisabilities in emergencyplanning…preparedness,
response and recoverydrills and exercises” 
• 
“ensure that 
Telecommunications 
personnel and captionerscan travel to an from their 
designated facilities to 
provide continuity ofservices.” 

Protect and Empower 


• 
“I wanted to provide 
public education and 
increase awareness so 
the hearing impaired 
could take an active role 
in enhancing their own 
level of safety.” 
• 
Jim Davis, EM 
Coordinator, Pittsylvania 
County VA. 

CERT and Deaf Citizens 


• 
“As much as 
possible, disabled 
persons must be 
prepared to enact 
self-help procedures 
after disaster.” 
• 
(Parr 1987) 

Agencies 



I don’t know enough…
… 


• 
www.nod.org, downloadable brochures specific to 
disasters and disabilities 
• 
A free service of the Office of Disability 
Employment Policy, U.S. Department of Labor 
• 
http://www.jan.wvu.edu/media/atoz.htm 
• 
Specific, downloable fact sheets to every possible 
disability and how you might accommodate and negotiate. 
• 
Specific to the workplace, but insightful. 

Communication: 


don’t rely on one single strategy 

• 
Use social networks, partneringorganizations 
• 
Multiple media, redundant 
messages 
• 
Train the media 
• 
Diverse strategies for diverseaudiences 
• 
Cognitive, sensory, mobilitydisabilities 
• 
Seniors: who do they listen toand trust? 
• 
Do you like brochures? 
• 
Magnets, public serviceannouncements, cups, kits, t-
shirts with maps! 
• 
Tool banks, stockpiles of supplies 
• 
“You have to sell it 
like coca-cola. You 
have to be 
unrelenting.” 
• 
Dr. Dennis Mileti,
Rebuilding New OrleansConference, September25, 2006 


Deaf and Hard of Hearing Consumer
Advocacy Network 2004 


• 
Ask. Pull people in early in the process. 
• 
Provide interpreters, text messaging. 
• 
Use Amber Alert. 
• 
Keep local organizations and individualsinformed. 
• 
Work with the NWS, cable services, ISP 
including wireless. 
• 
Install technologies. 

Registries…..or not? 


• 
Time & Staff Cost 
• 
Format 
• 
Access 
• 
Invasion of privacy 
• 
Difficult to keep up 
• 
Link to transportationinventories; cross-agencyplanning and coordination 
• 
Needs to be partnered 
• 
Fire department 
• 
Red Cross 
• 
Senior Networks 
• 
Disability advocates 
• 
Health agencies 
“Some may construe suchan identification scheme 
as an invasion of privacyand contrary to trueindependence.” (Jones1987). 


Service Animals (NOD) 


• 
ADA does not require identification, license ortraining. 
• 
If someone tells you it is a service animal it is,
including for emotional and psychological comfort. 
• 
You can’t exclude them unless they are a threat. 
• 
What you can do: 
• 
Help people plan. 
• 
Develop “animal support network.” 
• 
Vets, shelters, humane society, foster homes. 
• 
Create “pet friendly shelters.” 

$$$$$ Show me the money $$$$


• 
Local fundraisers 
• 
civic groups, university clubs, faith based 
• 
Foundations 
• 
Private, corporate (Gates Foundation…..) 
• 
Universities 
• 
Federal programs 
• 
Partner with other agencies in your state 

The Community 


“Emergency managers should focus on leveragingthe services provided by existing organizations,
sensitize them to disaster issues, and encouragethem to incorporate disaster-planning principlesinto their operations.” (Fernandez et al. 2002) 


Who are your partners? 


• 
Fire department 
• 
Home health organizations 
• 
Physicians 
• 
Red Cross 
• 
School systems 
• 
Social service providers 
• 
Advocacy organizations 
• 
Veterinary schools, Humane Society 
• 
Department of Transportation (primary 
federal agency to be responsibility formass evacuations). 
• 
Disability Support & Advocacy 
Agencies. 
• 
Administration on Aging network. 
• 
Health Departments….and so many 
more. 
• 
“Have staff 
members 
sensitized and 
educated by arepresentativefrom a local 
IndependentLiving Center.”
(Imperiale 1991) 


Congregations Who Care--Prepare 

• 
Four steps: 
• 
Coordination with others 
• 
Community education programs 
• 
Training the congregation 
• 
Personal planning encouragement 
• 
Specific initiatives for disabilities 
• 
www.nod.org/congregationsprepare 

Contingency plans for city employees 

• 
“During the 1995 Chicago heat wave, many 
elderly did not travel to shelters and aid 
distribution centers…during subsequent 
heat waves, city workers were dispatched 
to knock on the doors of the elderly to 
deliver food and water and provide 
transportation to the cooling shelters.” 
(Fernandez et al. 2002). 


Identify high risk locations (nursing homes) 


(GAO, Post-Katrina) 

• 
Independent nursing homes most at risk 
• 
What worked during Katrina: 
• 
Clear articulation of plans with EMA, school 
boards and transit agencies. 
• 
Voluntary registry with specialized categories. 
• 
Involvement of social service providers. 
• 
Formal agreements over liability and
reimbursement. 
• 
Exercises. 

Transportation solutions during Katrina:
they came from the community! 

• 
Pre-existing citizen networks. 
• 
Community outreach activities 
• 
Neighborhood watch networks. 
• 
Home health organizations. 
• 
Physicians. 
• 
Red Cross. 
• 
Source: GAO Study 

Transportation Inventory & Networks 


• 
Identify available transportation options. 
• 
Inventory by type x disability. 
• 
Identify availability vehicles, drives. 
• 
Locate proximity to those at risk. 
• 
Consider GIS mapping. 
• 
Develop agreements. 
• 
Pre-draft liability and reimbursement. 
• 
Contingency plan. 
• 
Practice, practice, practice. 

Build disaster resilient organizations 

• 
Are there plans in place at work for your 
employees? (NOD 2005) 
• 
2001 50% PWD said no 
• 
2003 27& PWD said no 
• 
2005 34% PWD said no 
• 
Mandate evacuation plans for employees 
with disabilities. 

Exercises and drills 


• 
“makes a potential disaster very real to residents 
and community responders” (Snyder 1991). 
• 
People change their behavior when they practice 
that behavior. 
• 
Make it realistic. 
• 
Involve those at risk. 
• 
Involve your partners. 

Opportunities for Outreach 


• 
Specific Dates 
• 
Tornado Awareness Week 
• 
EM Month 
• 
Disaster Day 
• 
April 19 
• 
September 11 
• 
Hurricane Katrina 
• 
Think outside disasters 
• 
Cinco de Mayo 
• 
Hispanic Awareness Month 
• 
Ethnic Festival Events 
• 
Disability Awareness Week 
• 
Grandparents’ Day 
• 
Music festivals