Planning considerations for persons with access and functional needs in a disaster—Part 2: Evacuation and sheltering
Keywords:disasters, at-risk populations, special healthcare needs, vulnerable populations, evacuation and sheltering
Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when dealing with these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed, and what recommendations can be made in order to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for not only this unique group but also all of the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.
Smith DA, Swacina PJ: The disaster evacuation or shelter-inplace decision: Who will decide? J Am Med Dir Assoc. 2017; 18: 646-647.
Mori H, Sugawara Y, Obuchi SP, et al.: Evacuation decision making and expanded roles of adult daycare services in the Great East Japan earthquake: Qualitative analysis using semi-structured interviews. J Public Health Manag Prac. 2018; 24(2): 129-136.
Fitzgerald J, Wollner SB, Adalja AA, et al.: After Fukushima: Managing the consequences of a radiological disaster. Biosecur Bioterror. 2012; 10: 228-236.
Dosa DM, Hyer K, Brown LM, et al.: The controversy inherent in managing frail nursing home residents during complex hurricane emergencies. J Am Med Dir Assoc. 2008; 9(8): 599-604.
Sorenson JH, Shumpert BL, Vogt BM: Planning for protective action decision making: Evacuate or shelter in-in-place. J Hazard Mater. 2004; A109: 1-11.
Dostal PJ: Vulnerability of urban homebound older adults in disasters: A survey of evacuation preparedness. Disaster Med Public Health Prep. 2015; 9(9): 301-306.
Langan JC, Palmer JL: Listening to and learning from older adult Hurricane Katrina survivors. Public Health Nurs. 2012; 29(2): 126-135.
Perry C, Pulley W, Paugh J, et al.: Why some ignore public health disaster warnings. J Healthc Prot Manage. 2013; 29(1): 20-26.
Adelman DS, Legg TJ: Caring for older adults with dementia when disaster strikes. J Gerontol Nurs. 2010; 36(8): 13-17.
Claver M, Dobalian A, Fickel JJ, et al.: Comprehensive care for vulnerable elderly veterans during disasters. Arch Gerontol Geriatr. 2013; 56: 205-213.
Dosa DM, Hyer K, Thomas K, et al.: To evacuate or shelter in place: Implications of universal hurricane evacuation policies on nursing home residents. J Am Med Dir Assoc. 2012; 13: 190e1-190e7.
Johnson HL, Ling CG, McBee EC: Multidisciplinary care for the elderly in disasters: An integrative review. Prehosp Disaster Med. 2015; 30(1): 72-79.
Dosa DM, Grossman N, Wetle T, et al.: To evacuate or not to evacuate: Lessons learned from Louisiana nursing home administrators following Hurricanes Katrina and Rita. J Am Med Dir Assoc. 2007; 8(3): 142-149.
Kawano T, Hasegawa K, Hiroko W, et al.: Infectious disease frequency among evacuees at shelters after the Great Eastern Japan Earthquake and tsunami: A retrospective study. Disaster Med Public Health Prep. 2014; 8(1): 58-64.
Kawano T, Tsugawa Y, Nishiyama K, et al.: Shelter crowding and increased incidence of acute respiratory infection in evacuees following the Great Eastern Japan Earthquake and tsunami. Epidemiol Infect. 2016; 144(4): 787-795.
Henderson TL, Robert KA, Kamo Y: Older adults’ responses to Hurricane Katrina. J Appl GerontolTechnol. 2010; 29(1): 48-69.
Associated Press. The latest: Over 100 reported missing in California wildfire. ABC News. Available at http://abcnews.go.com/Lifestyle/wireStory/latest-fires-force-evacuations-northern-california-50367266. Accessed November 12, 2018.
Hogan TP, Holmes SA, Rapacki LM, et al.: Disaster preparedness and response practices among providers from the Veterans Health Administration and Veterans with spinal cord injuries and/or disorders. J Spinal Cord Med. 2011; 34(4): 353-361.
Tanigawa K, Hosoi Y, Iwasaki Y, et al.: Loss of life after evacuation: Lessons learned from the Fukushima accident. Lancet. 2012; 379(9819): 889-891.
Horswell C, Hegstrom E: Exodus weighs heavily in death toll: 107. Evacuation: Lessons come at a high cost: 107 lives. Houston Chronicle. September 29, 2005. Available at http://www.chron.com/news/hurricanes/article/Exodus-weighs-heavily-in-deathtoll-107-1502590.php. Accessed November 12, 2018.
Associated Press: Bus carrying 24 elderly evacuees burns; 24 dead. Fire engulfs vehicle carrying seniors from Houston-area nursing home. NBCNews.com. September 24, 2005. Available at http://www.nbcnews.com/id/9449949/ns/us_news-katrina_the_long_road_back/t/bus-carrying-elderly-evacuees-burns-dead/#.W-MtbRqouJA. Accessed November 12, 2018.
Blanchard G, Dosa D: A comparison of the nursing home evacuation experience between hurricanes Katrina (2005) and Gustav (2008). J Am Med Dir Assoc. 2009; 10: 639-643.
Greenough PG, Lappi MD, Hsu EB, et al.: Burden of disease and health status among Hurricane Katrina-displaced persons in shelters: A population-based cluster sample. Ann Emerg Med. 2008; 51(4): 426-432.
Rios L, Cullen T: A disaster medical assistance team operates a hurricane evacuation shelter with U.S. public health service support. Prev Chronic Dis. 2006; 3(2): 1-3.
Hasegawa A, Ohira T, Maeda M, et al.: Emergency responses and health consequences after the Fukushima accident: Evacuation and relocation. Clin Oncol. 2016; 28: 237-244.
Bagaria J, Heggie C, Abrahams J, et al.: Evacuation and sheltering of hospitals in emergencies: A review of international experience. Prehosp Disaster Med. 2009; 24(5): 461-467.
Deal BJ, Fountain RA, Russell-Broaddus CA, et al.: Challenges and opportunities of nursing care in special needs shelters. Disaster Manag Response. 2006; 4(4): 100-105.
Jenkins JL, McCarthy M, Kelen G, et al.: Changes needed in the care for sheltered persons: A multistate analysis from Hurricane Katrina. Am J Disaster Med. 2009; 4(2): 101-106.
Bame SI, Parker K, Lee JY, et al.: Monitoring unmet needs using 2-1-1 during natural disasters. Am J Prev Med. 2012; 43(6S5): S435-S442.
Arrieta MI, Foreman RD, Crook ED, et al.: Providing continuity of care for chronic diseases in the aftermath of Katrina: From field experience to policy recommendations. Disaster Med Public Health Prep. 2009; 3(3): 174-182.
Brodie M, Weltzen E, Altman D, et al.: Experiences of Hurricane Katrina evacuees in Houston shelters: Implications for future planning. Am J Public Health. 2006; 96: 1402-1408.
Veenema TG, Rains AB, Casey-Lockyer M, et al.: Quality of healthcare services provided in disaster shelters: An integrative literature review. Int Emerg Nurs. 2015; 23: 225-231.
Caillouet LP, Paul PJ, Sabatier SM, et al.: Eye of the storm: Analysis of shelter treatment records of evacuees to Acadiana from Hurricanes Katrina and Rita. Am J Disaster Med. 2012; 7(4): 253-271.
Cloyd E, Dyer CB: Catastrophic events and older adults. Crit Care Nurs Clin N Am. 2010; 22: 501-513.
Sloand E, Killion C, Gary FA, et al.: Barriers and facilitators to engaging communities in gender-based violence prevention following a natural disaster. J Health Care Poor Underserved. 2015; 26(4): 1377-1390.
Nara M, Ueda S, Acki M, et al.: The clinical utility of makeshift beds in disaster shelters. Disaster Med Public Health Prep. 2013; 7: 573-577.
Ichiseki H: Features of disaster-related deaths after the Great East Japan Earthquake. Lancet. 2013; 381: 204.
Nomura S, Gilmour S, Tsubokura M, et al.: Mortality risk amongst nursing home residents evacuated after the Fukushima nuclear accident: A retrospective cohort study. PLOS One. 2013; 8(3): 1-9.
Willoughby M, Kipsaina C, Ferrah N, et al.: Mortality in nursing homes following emergency evacuation: A systematic review. J Am Med Dir Assoc. 2017; 18: 654-670.
Castro C, Persson D, Bergstrom N, et al.: Surviving the storms: Emergency preparedness in Texas nursing facilities and assisted living facilities. J Gerontol Nurs. 208; 34(8): 9-16.
Dworkin DA, Brown JW, Gonzalez MH: Barriers to outpatient respiratory therapy among adult residents of emergency shelters. Ann Intern Med. 2012; 157(9): 679-670.
Parmar P, Arii M, Kayden S: Learning from Japan: Strengthening US emergency care and disaster response. Health Aff. 2013; 32(12): 2172-2178.
Nick GA, Savoia E, Elqura L, et al.: Emergency preparedness for vulnerable populations: People with special health-care needs. Public Health Rep. 2009; 124: 338-343.
Stephens KM, Khan AS, Olivares D, et al.: All-Hazards Preparedness Guide. Atlanta, GA: Centers for Disease Control, Office of Public Health Preparedness and Response. September 14, 2013. Available at https://www.cdc.gov/phpr/documents/ahpg_final_march_2013.pdf. Accessed November 12, 2018.
Homeland Security News and Information, National Terror Alert Response Center: Shelter in place: Know how, know where. Available at http://www.nationalterroralert.com/shelterinplace/. Accessed November 12, 2018.
Kailes JL, Enders A: Moving beyond “special needs.” A function- based framework for emergency management and planning. J Disabil Policy Stud. 2007; 17(4): 230-237.
McGuire LC, Ford ES, Okoro CA: Natural disasters and older US adults with disabilities: Implications for evacuation. Disasters. 2007; 31(10): 49-56.
Laditka SB, Laditka JN, Xirasagar S, et al.: Providing shelter to nursing home evacuees in disasters: Lessons from Hurricane Katrina. Am J Public Health. 2008; 98(7): 1288-1293.
Chavez N, Sanchez R, Hanna J: California fires: New evacuations ordered for Santa Rosa. CNN. October 14, 2017. Available at http://www.cnn.com/2017/10/14/us/california-fires-updates/index.html. Accessed November 12, 2018.
Yan H, Almasy S, McKirdy E: Puerto Rico governor: Still time to get to shelters before Hurricane Maria. CNN. September 20, 2017. Available at http://www.cnn.com/2017/09/19/americas/hurricanemaria-caribbean-islands/index.html. Accessed November 12, 2018.
Downey EL, Andress K, Schultz CH: Initial management of hospital evacuations caused by Hurricane Rita: A systematic investigation. Prehosp Disaster Med. 2013; 28(3): 257-263.
Laditka SB, Laditka JN, Cornman CB, et al.: Resilience and challenges among staff of Gulf Coast nursing homes sheltering frail evacuees following Hurricane Katrina, 2005: Implications for planning and training. Prehosp Disaster Med. 2009; 24(1): 54-62.
Narayan C: Apocalyptic devastation in Puerto Rico, and little help in sight. CNN. September 26, 2017. Available at http://www.cnn.com/2017/09/25/us/hurricane-maria-puerto-rico/index.html. Accessed November 12, 2018.
Resnick B, Barclay E: What every American needs to know about Puerto Rico’s hurricane disaster. Vox. October 16, 2017. Available at https://www.vox.com/science-and-health/2017/9/26/16365994/hurricane-maria-2017-puerto-rico-san-juan-humanitarian-disasterelectricty-fuel-flights-facts. Accessed November 12, 2018.
Pitt County, NC: Medical shelter information. Available at https://www.pittcoumtync.gov/208/Medical-ShelteriInformation. Accessed November 12, 2018.
BBC News: Why was Houston not evacuated before Hurricane Harvey? BBC News. August 29, 2018. Available at https://www.bbc.com/news/world-us-canada-41085438. Accessed November 12, 2018.
Wrightman JM, Dick WH: Winter storms and hazards. In Koenig KL, Schultz CH (eds.): Koenig and Schultz’s Disaster Medicine. Chapter 40. Cambridge, UK: Cambridge University Press, 2016: 670-691.
MDC: When disaster strikes - Promising practices. Individuals with mobility challenges. Available at www.fema.gov/newsrelease/2004/11/23fema-and-state-provide-housing-thousands-displaced-hurricane-victims.. Accessed November 12, 2018.
FEMA and state provide housing to thousands of displaced hurricane victims. November 23, 2004. Release number: 1539-288. Accessed November 28, 2018.
Department of Homeland Security/Federal, Emergency Management Agency: Emergency support function # 6 – Mass Care, emergency assistance, housing, and human services annex. Available at https://www.fema.gov/pdf/emergency/nrf/nrf-esf-06.pdf. Accessed November 12, 2018.
ADA Best Practices Tool Kit for State and Local Governments: Chapter 7 addendum 2: The ADA and emergency shelters: Access for all in emergencies and disasters. Available at https://www.ada.gov/pcatoolkit/chap7shelterprog.htm. Accessed November 12, 2018.
Gostin LO, Hanfling D, Arnold DT, et al.: Committee on guidance for establishing standards of care for use in disaster situations. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Washington, DC: Institute of Medicine of the National Academies, 2012. Available at https://www.nap.edu/read/13351/chapter/1#vi. Accessed November 12, 2018.
Fannin A, Brannen DE, Howell M, et al.: Using functional needs and personal care assistance rather than disability status during chronic care triage in community mass care. Disaster Med Public Health Prep. 2015; 9: 265-274.
Office of Emergency Management State of New Jersey: Specialized shelter planning template. Available at http://www.state.nj.us/njoem/plan/pdf/spec-shelter-planning-template.pdf. Accessed October 5, 2017.
Americans with Disabilities Act: ADA checklist for emergency shelters. Washington, DC: US Department of Justice, Civil Rights Division, Disability Rights Division, 2010. Available at https://www.ada.gov/pcatoolkit/chap7shelterchk.htm. Accessed November 12, 2018.
Americans with Disabilities Act: An ADA guide for local governments. Making community emergency preparedness and response programs accessible to people with disabilities. Available at https://www.ada.gov/emergencyprepguide.htm. Accessed November 12, 2018.
Mace SE, Doyle C, Fuchs S, et al.: Pediatric patients in a disaster: Part of the all-hazard, comprehensive approach to disaster management. Am J Disaster Med. 2012; 7(2): 111-125.
Bradenburg MA, Watkins SM, Brandenburg KL, et al.: Operation child-ID: Reunifying children with their legal guardians after Hurricane Katrina. Disasters. 2007; 31(3): 277-287.
Mace SE, Sharieff G, Bern A, et al.: Pediatric issues in disaster management, Part 3: Special health care needs patients and mental health issues. Am J Disaster Med. 2010; 5(5): 261-274.
National Center for Missing and Exploited Children (NCMEC): Available at http://www.missingkids.com/home. Accessed November 12, 2018.
Patton-Levine JK, Vest JR, Valkadez AM: Caregivers and families in medical special needs shelters: An experience during Hurricane Rita. Am J Disaster Med. 2007; 2: 81-86.
Currier M, King DS, Wofford MR, et al.: A Katrina experience: Lessons learned. Am J Med. 2006; 119: 986-992.
Teramoto C, Nagata S, Okamoto R, et al.: Identifying residents’ health issues six weeks after the Great East Japan Earthquake. Public Health Nurs. 2015; 32(6): 654-661.
Maja-Schultz T, Swain B: Disabled adults in adult care facilities facing disasters in New York City: An aggregate assessment. Care Manag J. 2012; 13(2): 67-74.
Anderson AH, Cohen AJ, Kutner NG, et al.: Missed dialysis sessions and hospitalizations in hemodialysis patients after Hurricane Katrina. Kidney Int. 2009; 75: 1202-1208.
Larkin H: Louisiana’s second chance. Hosp Health Netw. 2007; 81(2): 54-56, 58, 60.
Downey EL, Andress K, Schultz CH: External factors impacting hospital evacuations caused by Hurricane Rita: The role of situational awareness. Prehosp Disaster Med. 2013; 28(3): 264-271.
Madamala K, Campbell CR, Hsu CR, et al.: Characteristics of physician relocation following Hurricane Katrina. Disaster Med Public Health Prep. 2007; 1(1): 21-26.
Yee EL, Palacio H, Atmar RL, et al.: Widespread outbreak of norovirus gastroenteritis among evacuees of Hurricane Katrina residing in a large “megashelter” in Houston, Texas: Lessons learned for prevention. Clin Infect Dis. 2007; 44(8): 1032-1039.
Suzuki M, Uwano C, Ohrui T, et al.: Shelter-acquired pneumonia after a catastrophic earthquake in Japan. J Am Geriatr Soc. 2011; 59(10): 1968-1970.
North CS, King RV, Fowler RL, et al.: Delivery of mental health care in a large disaster shelter. Disaster Med Public Health Prep. 2015; 9: 423-429.
North CS, Pfefferbaum B: Mental health response to community disasters: A systematic review. JAMA. 2013; 310(5): 507-518.
West JC, Schreiber MD, Benedek D, et al.: Disaster behavioral health. In Koenig KL, Schultz CH (eds.): Koenig and Schultz’s Disaster Medicine Comprehensive Principles and Practice. 2nd ed. Chapter 9. Cambridge, UK: Cambridge University Press, 2016: 124-136.
Castelluci M: Addressing mental health is vital long after tragedy strikes. Modern healthcare. October 7, 2017. Available at http://www.modernhealthcare.com/article/20171007/NEWS/171009931. Accessed November 12, 2018.
Levin A: Florida psychiatrists respond to Orlando nightclub shooting. Psychiatric News. June 24, 2016. Available at https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016. Accessed November 28, 2018.
Camalot T: Saturday 29, 2018 Las vegs Sun. Oct 1 shooting shined a spotlight on our strained MH system. Available at https://lasvegassun.com/news/2018/sep/29/oct-1-shooting-shined-a-s[otlighton-our-strained/. Accessed November 12, 2018.
American College of Emergency Physicians: Boarding of admitted and intensive care patients in the emergency department. Available at https://www.acep.org/patient-care/policy-statements/boarding-of-admitted-and-intensive-care-patients-in-the-emergencydepartment/#sm.00001vnszrag6wem9x40d7mjuj81w. Accessed September 14, 2018.
American College of Emergency Physicians: Crowding. Available at https://www.acep.org/patient-care/policy-statements/crowding/#sm. 00001vnszrag6wem9x40d7mjuj81w. Accessed November 12, 2018.
American College of Emergency Physicians: Health care system surge capacity recognition, preparedness, and response. Available at https://www.acep.org/search/?searchtext=health%20care%20system%20surge%20capacity%20recognition,%20preparedness,%20and%20response#sm.00001vnszrag6wem9x40d7mjuj81w. Accessed November 12, 2018.
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