Disaster response and people experiencing homelessness: Addressing challenges of a population with limited resources


  • Bryan Wexler, MD, MPH
  • Mary-Elise Smith, MD, MA




disaster planning, emergency preparedness, homelessness, vulnerable population


In this article the authors provide an overview of some issues that inhibit disaster planning and response for people experiencing homelessness and discuss the planning process conducted for this population in Worcester, MA. People experiencing homelessness face numerous challenges in preparing for disasters both natural and human caused. Similarly, providers attempting to aid these individuals must recognize and overcome various factors that hamper efforts to provide assistance. People experiencing homelessness lack the general resources many in the United States take for granted, including food, shelter, communication methods, and transportation. The population also has an increased prevalence of medical and psychiatric conditions. These factors amplify the typical difficulties in preparedness, communication, sheltering, and training for disasters. With these principles in mind, the authors reviewed the literature for best practices, identified potential stakeholders, and developed an annex to help address organization and delivery of care to those experiencing homelessness during a disaster.

Author Biographies

Bryan Wexler, MD, MPH

Director, Section of Disaster Medicine, WellSpan, York Hospital; Assistant Clinical Professor, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Mary-Elise Smith, MD, MA

Associate Professor, Emergency Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts.



Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009, 42 USC 11301 (2012).

Homeless emergency assistance and rapid transition to housing: Defining “homelessness.” Fed Regist. 2011; 76: 75994, 75995.

Federal Emergency Management Agency: Interim emergency management planning guide for special needs populations, version 1.0. August, 2008. Available at http://www.fema.gov/pdf/media/2008/301.pdf. Accessed May 2, 2015.

The United States Census Bureau: Profile of General Population and Housing Characteristics: 2010 Demographic Profile Data: Worcester City, US Census Bureau, American Factfinder. Available at http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml. Accessed May 2, 2015.

Worcester County Point In Time Count: Central Massachusetts Housing Alliance. January 25, 2012. Available at http://www.cmhaonline.org/documents/point_in_time/2012/2012_Worcester%20County_Point%20in%20Time%20Survey.pdf. Accessed May 2, 2015.

Edgington S: Disaster Planning for People Experiencing Homelessness. Nashville: National Health Care for the Homeless Council, 2009.

Paasche-Orlow MK, Taylor HA, Brancati FL: Readability standards for informed-consent forms as compared with actual readability. N Engl J Med. 2003; 348: 721-726.

Daniels RJ, Kunreuther H: On Risk And Disaster: Lessons From Hurricane Katrina. Philadelphia: University of Pennsylvania Press, 2006.

National Alliance on Mental Illness (NAMI): Mental Illness: Facts and Numbers. Available at http://www2.nami.org/factsheets/mentalillness_factsheet.pdf. Accessed May 2, 2015.

National Health Care for the Homeless Council: Homelessness and family trauma: The case for early intervention. Healing Hands. 2003; 7(2): 1-3.

Health Care for the Homeless Clinicians’ Network: Meeting the challenges of comorbid mental illness & substance-related disorders. Healing Hands. 2009; 13(1): 1-6.

Speier T: Introduction to crisis counseling programs and services to persons with serious and persistent mental illness. In Responding to the Needs of People with Serious and Persistent Mental Illness in Times of Major Disaster. DHHS Publication No. SMA 96-3077. Washington, DC: US Government Printing Office, 1996.

DeWolfe DJ: Crisis counseling services for disaster survivors with mental illness. In Responding to the Needs of People with Serious and Persistent Mental Illness in Times of Major Disaster. DHHS Publication No. SMA 96-3077. Washington, DC: US Government Printing Office, 1996.

Federal Emergency Management Agency: Guidance on planning for integration of functional needs support services in general population shelters. November 2010. Available at http://www.fema.gov/pdf/about/odic/fnss_guidance.pdf. Accessed May 2, 2015.

National Alliance to End Homelessness: Homelessness counts: Changes in homelessness from 2005-2007. Available at http://www.endhomelessness.org/content/article/detail/2158. Accessed May 2, 2015.

Wineman NV, Braun BI, Barbera JA, et al.: Assessing the integration of health center and community emergency preparedness and response planning. Disaster Med Public Health Prep. 2007; 1(2): 96-105.



How to Cite

Wexler, MD, MPH, B., and M.-E. Smith, MD, MA. “Disaster Response and People Experiencing Homelessness: Addressing Challenges of a Population With Limited Resources”. Journal of Emergency Management, vol. 13, no. 3, May 2015, pp. 195-00, doi:10.5055/jem.2015.0233.