A case for inclusion of disability training for first responders

By Katherine Forgaard-Pullen

Abstract

It is critically important to include training for emergency first responders on the topic of disabilities management in a disaster including disabilities awareness, major disability categories and the necessity of effective communications with disabled persons. It is too easy for able bodied people to assume capability without awareness of disability needs, damaging people’s dignity and creating trauma that, with simple adaptations, could be avoided. Learning the basics regarding the major categories of physical, sensory, cognitive, psychiatric and hidden disabilities will help first responders meet all citizens’ needs effectively and efficiently. An inability to communicate with a disabled person could have catastrophic consequences for the individual, a group and/or the response team; adaptations in communication can be learned and each responder unit should examine their plans to include specific training to meet these needs. Trained to meet disabled citizens’ needs in an emergency, first responders will maintain safety for all through heightened awareness, knowledge of possible adaptations and be confident in communicating with people no matter their special needs.

Introduction

“If there is one immediate benefit that came out of the events of September 2001, it may be the understanding, … that in disaster situations, nobody, regardless of their physical or mental condition, should be left behind.”  (Fox, White, Rooney, and Rowland)

Convincing municipal planners to include training for first responders specifically in disabilities and responses to people with disabilities is vital to achieve good outcomes for citizens with accessibility challenges.

Many municipalities, counties, regions and provinces rely on the excellent publications available from various senior planning departments but do not demonstrate more than lip service to implementation strategies in the field.  Claiming budgetary restraints and personnel limitations, training in responses suitable for persons with disabilities is placed lower on the priority list.  The attitudinal barriers implied in these choices at the planning tables are the most difficult barriers disabled people face.  Putting disability training on the agenda for first responders is the ethical and appropriate choice for all planners to make.

Awareness of Disability

Assumptions of “Able-ness” are made in a cultural context that includes stereotypes and misinformation.  Ask a disabled person about what average citizens expect from them and the answers range from amusing to offensive.  Blind people are asked if their sense of smell improves; deaf people are often spoken to in exaggeratedly slow ways as though their lip reading skills are ‘retarded’; people with handicapped parking permits who do not use mobility aids are harassed for not appearing to need the special parking spots.  In an emergency, these kinds of faux-pas become deadly errors.  Many visually impaired people do not utilise a cane; deaf people may well live alone and not be aware of the sirens or loud hailers, cognitively impaired people can hide as a response to stress or strangers.  Our choices during planning can alleviate or mitigate some of these situations, but our first responders are still likely to encounter people who require a different sort of assistance to be safe during the emergency.

Dignity as a human right is enshrined in the United Nations Universal Declaration of Human Rights, and disability is a protected category in the Canadian Charter of Rights and Freedoms.  It is also a pretty easily accepted concept for all of us.  The problem occurs when another person’s dignity requires an additional or different set of tasks or responses to ensure it.  All major emergencies hold a possibility that some people will suffer extended harm beyond the measurable losses of the event itself – injuries that do not heal.  Injuries to dignity are very slow to heal, and for some, create intense suffering.  These can be prevented.

Adaptations as tools and skills to preserve life and maintain safety and dignity are possible, available and teachable.  Many are simple, such as recognition of the need to explain what you are doing while you are doing it to a visually impaired person.  Some take more time, which is precious during an emergency, such as writing information for deaf people.  Strategies for this need to be developed in the planning process.  First responders are by nature able to learn the proper procedures and take pride in delivering first class services.  This type of training is just another set of tools and skills for their professional tool kit.

Major Disability Categories and relevant information

Physical disabilities are one of the most obvious groups of disabilities.  Each person will have some remaining abilities; many have mechanical items required for living.  Pain is a likely companion.  Many people who are severely disabled fear unskilled handling.

Sensory disabilities primarily include visual impairment /blindness and hard of hearing/deafness.  (Other sensory deficits such as loss of feeling, taste, or smell are either concurrent with other physical problems, or do not affect individuals in ways that impact participation in mainstream life.) Blindness and deafness of any degree can co-occur.

Cognitive disabilities include intellectual delay (historically known as developmental handicaps or ‘retardation’), brain injury, strokes and dementias.  All of these conditions affect the person’s ability to understand or communicate information.  All people become confused when too much information is given too quickly.  For people with cognitive impairment confusion leads to fear, and fear becomes troubled behaviour.

Psychiatric disabilities range from mild to severe, and stress can be a trigger for symptoms to escalate.  Most people who live with psychiatric disabilities manage their lives independently.

Hidden disabilities can include some of the conditions listed above, but extend to individuals living with health conditions that require access to medications or medical supplies.

Communication

“The evidence is clear that the more you (communicate in advance) the better the messages will be listened to, perceived, comprehended, and that an appropriate behavioural response to the message will result”

Dr. Robert Chandler, Centre for Communication and Business, Pepperdine University.

The places to communicate in advance regarding disabilities and emergency responses in a disaster are a) in planning and preparation, b) with the disability communities and individuals, c) with service providers to the people with disabilities, and d) in training opportunities for first responders. Consequences of ineffective communication can be dire.  There are multiple points of communication, and thus many potential points of failure.

Even if the messaging has been flawlessly designed, it is still not likely to get through…unless it has been planted…in the subconscious long in advance”. (Parker, 2008)

Picture1The body of Ethel Freeman, in wheelchair, and another body lie covered outside an entrance to the Convention Center where thousands waited to be evacuated from hurricane-ravaged New Orleans on Sept. 2, 2004. Although rescued by first responders, there were inadequate resources and poorly trained personnel at the receiving centres for the many frail and disabled residents of New Orleans after Hurricane Katrina.

The goal of increasing training for first responders in disabilities issues is to decrease dire outcomes for persons with disabilities. No family or community should face the sorrow that Herbert Freeman Jr. felt when after the rescue, his 90 year old mother died of exhaustion and thirst waiting in a line up for appropriate care at the receiving centre.  Both the planning and the communication failed this family.

Adaptations for communication to citizens during the disaster events themselves can be learned ahead of time, practiced ahead of time and teams can problem solve during the event as needed.  There are some basic principles, and there are some specifics that are dependent on the disability and the barrier faced.  For example, it is important that responders remember that nearly all disabled people are able to participate in their own rescue.  Most disabled persons have intact abilities as well as their health condition.  Speaking and communicating appropriately to the individual allows the responder to include the citizen as a member of their own rescue team – the one with the most knowledge about their needs.  Another example is learning the universal symbols for varying health conditions.  If the municipality encourages the use of display cards during emergencies, the ability of the responders to adjust their activity will be enhanced…if the responder is familiar with the symbols displayed.

Common Symbols used in Disability Communication

 Picture1 Picture1
 Picture1  Picture1

Communication about disability needs in planning stages includes utilizing the excellent resources provided by Emergency Management Ontario (see the end of the article for web links), National Fire Protection Association’s Emergency Evacuation Planning Guide [For] People with Disabilities, and so on. These essential resources must then be enveloped into the overall plan itself.  Planning and Preparation principles in emergency planning acknowledge that plans must be communicated to the community and the citizens, and that citizens, institutions and businesses must undertake their own emergency planning initiatives.  Communicating the existence of resources appropriate for individuals living with disabilities to the citizens, disability communities and those who provide services to people living with disabilities is an essential component of the planning process.  These resources must be made available in as many modalities through as many varied sources and technologies as possible, with respect to the demographics of the community for whom the plan is prepared.Picture1

Identifying training needs

Demographics are a good place to start the identification process.  The disability rates in Ontario rose approximately 2% from 2001 to 2006 for an overall estimation of 15.4% of the population. So it is inevitable that first responders will engage with persons with disabilities.  What may not be as well understood is that most people with disabilities live in their own homes, and thus the municipality cannot rely solely on institutions or agencies to assist with emergency responses to the majority of disabled citizens.

Current resources for responder training in adaptive responses for people living with disabilities need to be inventoried. This includes a snapshot of the first responder awareness levels, community networks, resource and training personnel, and funding sources for additional training needed.

Consulting Disabled communities directly is a resource that is underutilized at best.  When response exercises are designed and implemented, are the disability communities directly involved?

 

Giving first responders direct contact and experience with assisting individuals with disabling conditions is a much more effective learning technique than many hours spent with lecturers and seminars.  Including citizens with disabilities in the planning committees, rather than or in addition to their service providers allows for an enhanced awareness and the most effective deterrent to assumptions of ‘ableness’.  One of Dr. Robert Chandler’s statements (Parker, pg. 8) about communication with businesses can be paraphrased to describe communication with disability communities:  “One doesn’t communicate to disability communities.  One communicates to people within the community – representatives, stakeholders or affirmative actors in that business.

Summary

It is not hard to imagine how it must feel to be left behind in your wheelchair while others evacuate to safety, use public transportation, and access shelters or other forms of temporary housing during disasters. Without meaningful changes, persons with mobility impairments or other disabilities will continue to risk their lives, safety, and independence needlessly due to a lack of, or inadequacies in, preparedness and response measures. There is no reason for another 20 years of consumer reports reminding us of this discrimination.”  (Rooney, and White)

References

Daniels, R. Steven. “Revitalizing Emergency Management after Katrina: A Recent Survey of Emergency Managers Urges Improved Response, Planning, and Leadership and a Reinvigorated FEMA-The Federal Government Has Responded by Making Most of the Recommended Changes.” The Public Manager 36.3 (2007): 16+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5023708621>.

Elliott, Robert. “Masters of Disaster.” Security Management Jan. 2006: 86+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5013467471>.

Enders, Alexandra, and Zachary Brandt. “Using Geographic Information System Technology to Improve Emergency Management and Disaster Response for People with Disabilities.” Journal of Disability Policy Studies 17.4 (2007): 223+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5020654617>.

Ernst, Robert A. “Emergency Response: Worst-Case Scenario.” Occupational Hazards Sept. 2006: 35+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5017454647>.

Fox, Michael H., Glen W. White, Catherine Rooney, and Jennifer L. Rowland. “Disaster Preparedness and Response for Persons with Mobility Impairments: Results from the University of Kansas Nobody Left Behind Study.” Journal of Disability Policy Studies 17.4 (2007): 196+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5020654605>.

Getha-Taylor, Heather. “Collaborative Governance Lessons from Katrina: Federal Executives Involved in the Response Effort Reveal Four Key Lessons That Illuminate Both the Challenge and Opportunity of Working Together in Emergency Management.” The Public Manager 36.3 (2007): 7+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5023708617>.

Gips, Michael A. “Preparing Places of Refuge: Problems with the Louisiana Superdome Raise Questions about How Evacuation Sites Are Chosen.” Security Management Oct. 2005: 22. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5011262024>.

Kailes, June Isaacson, and Alexandra Enders. “Moving beyond “Special Needs”: A Function-Based Framework for Emergency Management and Planning.” Journal of Disability Policy Studies 17.4 (2007): 230+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5020654622>.

Kitteringham, Glen. “Disaster Response and Recovery.” Security Management July 2007: 93. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5023866074>.

Meyer, Matthew. “Do You Know Where Your Workers Are? A Key Step in an Effective Life-Safety Plan Is Ensuring That Critical Workplace Data Are Up to Date and Easily Available during an Emergency.” Security Management July 2003: 65+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5002546272>.

Minter, Stephen G. “Not If, but When: Emergency Response Experts Urge Companies to Get Prepared for Disaster.” Occupational Hazards Nov. 2001: 54+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5002431030>.

Parker, K. “Firing of the Right Message.’ Disaster Management Canada.  Spring 2008. Vol 2. Issue 1.

Rooney, Catherine, and Glen W. White. “Consumer Perspective: Narrative Analysis of a Disaster Preparedness and Emergency Response Survey from Persons with Mobility Impairments.” Journal of Disability Policy Studies 17.4 (2007): 206+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5020603077>.

Rowland, Jennifer L., Glen W. White, Michael H. Fox, and Catherine Rooney. “Emergency Response Training Practices for People with Disabilities: Analysis of Some Current Practices and Recommendations for Future Training Programs.” Journal of Disability Policy Studies 17.4 (2007): 216+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5020654612>.

Tucker, Patrick. “Rethinking Emergency Housing: Hurricane Katrina Left a Number of Unanswered Questions in Its Wake, Such as How Best to House People after a Disaster.” The Futurist Nov.-Dec. 2006: 68+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5017885736>.

Wettig, Terry L. “Emergency Planning.” Security Management June 2007: 118+. Questia. 11 May 2008 <http://www.questia.com/PM.qst?a=o&d=5023837289>.

Emergency Management Ontario Weblinks

http://www.mcss.gov.on.ca/mcss/english/pillars/accessibilityOntario/business/wel_cus_disability.htm

http://www.emergencymanagementontario.ca/stellent/idcplg/webdav/Contribution%20Folders/emo/documents/Disability%20Guide_Eng.pdf

http://www.phac-aspc.gc.ca/chn-rcs/ld-vi-eng.php?rd=disability_incapacite_eng

Katherine Forgaard-Pullen is an emergency management consultant. She is a graduate of the Northern Alberta Institute of Technology’s (NAIT) Emergency Management Diploma Program and a former Canadian public servant with Transportation Safety Board of Canada.