ODDC- Emergency Preparedness

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TITLE:Emergency Preparedness from the Lifespan Conference

Speakers: Elizabeth Davis, J.D., Ed.M, - Managing Director for Emergency Management and Special Needs Consultant; Lou Romig. M.D., Pediatric Emergency Medicine, Miami Children’s Hospital, South Florida Regional Disaster Medical Assistance Team; Goldie Dersh, Ph.D., ACSW-Director of Mental Health and Mental Retardation Services; and Steven Christianson, D.O., M.M., Medical Director, Visiting Nurse Service of New York (Katherine Cargill-Willis 4/27/04)

Impact on the Care of Children with Disabilities and Their Families:

There are approximately 10 million children with special health care needs (CSHCN) in the U.S. and a million more family members who care for them.
Families with children who have CSHCN and disabilities need to be better prepared for some types of emergencies than other families, especially disaster situations.
A Medical Home, an integrated team approach to both acute and chronic pediatric care, can be applied to enhance emergency preparedness and planning efforts by and for families of children with health challenges and disabilities. Because CSHCN may have unusual resource requirements, such as the need for medical gases, electricity to power critical technology, constant skilled or mobility assistance, all partners in their Medical Home must be prepared and plan for situations when the resources might not be readily available. The children’s chronic and acute care providers, equipment and supply companies, school and daycare staff and community emergency management agencies should facilitate emergency planning, but all the partners should have their disaster plans. Medical Home partners include:
Child and family;
Primary medical care providers;
Special care providers;
Suppliers;
Schools/daycare centers; and
Community emergency planners

Family considerations include:

Preparation for daily emergencies;
Risk assessment and advance planning;
Family unification;
Evacuation;
Home safety and survival; and
Advocacy and communication

Healthcare providers’ roles:

Assist family with planning;
Have their own disaster plans for continuation of services;
Advocate for payer recognition of disaster issues; and
Advocate for and participate in community disaster preparedness

Community planners’ roles:

Recognize the importance of supporting families;
Plan for children with special needs in community shelters;
Partner with community’s CHSCN families and agencies; and
Require focused, integrated disaster planning by all local facilities where CSHCN can be found

The research priorities should be on the:

Existing awareness of families of CSHCN regarding the importance of risk directed disaster planning;
Existing awareness of primary and specialty care providers of their role in family disaster planning for their patients with special needs;
Analysis of current special needs disaster shelter plans with regard to their preparedness for children with special needs and their families;
Event-based data collection and analysis of specific resource availability before, during and after community-wide disasters; and
Impact of disasters on the provision of resource and funding by public and private healthcare funding agencies.

Mental Health Impact on Persons with Disabilities: On 9/11, millions of Americans and hundreds of millions of others around the world viewed horrifying images of death and destruction. With ongoing threats of new attacks, the continuing war on terrorism and the war with Iraq, disaster planning is essential for almost everybody. For people more susceptible to stress, crisis-counseling and mental health services are necessary to restore, to recover, and to build coping systems that are both resilient and flexible. A wide range of feelings, thoughts and behaviors are normal reactions to trauma. Characteristics of Post Traumatic Stress Disorder (PTSD) include:
- Intrusive re-experience
- Emotional constrictions
- Heighten arousal
Anxiety, especially when it is disaster-based fear, is common and is usually accompanied by fears of recurrence and concerns about safety. The strength and resilience of a person’s pre-disaster coping system is a critical factor when determining the vulnerability to PTSD and/or mental disorder such as anxiety and depression.

For people who acquire a disability, there is often an emotional experience of loss of part of the self. Grieving for a loss in one’s life can cause grieving for other losses and can lead to re-traumatization over an already profound loss.

People with disabilities may underestimate their ability to learn new skills and overestimate their limitations resulting in learned helplessness. This situation is exacerbated in a disaster situation. Conversely, learning new skills to cope effectively with a disaster increases a person’s mastery of his environment and promotes psychological well being.

Stress can also be increased by fears that special services, supplies, transportation systems and institutional services will be disrupted. The development of preparedness plans that include providers and caregivers, are important for people with disabilities to ensure critical needs are addressed, alternative systems planned and priorities established for restoring services.

Five research questions concerning people with disabilities need to be asked:
- Is PTSD more prevalent?
- Is there a greater anxiety and depression during periods of high alert?
- If treatment is provided to work through traumatic loss, does this improve chance to cope with future disaster situations?
- Is psychological stress reduced by preparatory drills of evacuation and disaster preparedness in various setting such as work, community setting and home?
- Is psychological stress reduced by emergency preparedness guidelines and training of caregivers?
The Role of Home-Based Care During Emergencies: The homecare industry has the characteristics that make it an important community health care resource, capable of caring for the special needs population and coordinating with hospitals for emergency planning. If properly trained, homecare professionals could be an important part of public health community emergency preparedness programs, including terrorism related activities.

There are 636,060 heath care professionals;
85% of these people are hands-on;
153,230 nurses;
28,420 therapists and 6,390 social workers;
189,990 Home Health aides; and
Home care agencies currently arrange for or provide all disciplines including skilled nursing, O.T., P.T., speech, social work, and home health aides.

With appropriate training, home care professionals could provide the following services in emergencies:

Public health education at the community level;
Community surveillance and reporting because they are already in every zip code and most blocks in country;
Quarantine and care management in the home;
Vaccination, health screening, medication distribution, and health care at public health clinics and emergency shelter sites.

Research questions are:

How can home care agencies be brought more effectively into national and local surveillance programs?
What are the training needs to enable home care workers to more effectively participate in emergency and disaster planning?
What are the barriers that need to be removed so public health agencies can better incorporate homecare agencies in community emergency and disaster planning, including terrorism related activities.
How can homecare agencies work collaboratively together and more effectively with hospitals and other community health resources for comprehensive community disaster and emergency planning?
What are the resources, training, public health coordination and legal issues that need to be overcome to implement home based quarantine through home care agencies?

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