1. Ethics of Special Needs for School Nurses in a Public Health Emergency
Laura M. Stough
Center on Disability and Development
Texas A&M University

3. Photos credit the Associated Press

4. http://www. gov. state. la. us/index. cfm

6. Photos from: http://www.nod.org/katrinaphotos/katrina9.jpg

7. A rescuer carries a young man who is unable to walk to safety.
- Retrieved from FEMA Photo Library 2006.

8. Deaf section for Hurricane Katrina evacuees at the Houston Astrodome
Deaf section for Hurricane Katrina evacuees at the Houston Astrodome. (Houston, TX., 9/10/ FEMA photo/Andrea Booher)

9. Tanisha Blevin, 5, holds the hand of fellow Hurricane Katrina victim Nita LaGarde, 105, as they are evacuated from the Convention Center in New Orleans, La., Saturday, Sept. 3, (AP Photo/Eric Gay )

10. Defining Disability
Mashaw and Reno (1996) document over 20 definitions of disability used for purposes of entitlement to public or private income support programs, government services, or statistical analysis

11. Census Bureau (2000)
A person with a disability has difficulty in performing functional tasks or daily living activities or meets other criteria, such as a learning or developmental disability. Persons with severe disabilities are defined as being completely unable to perform one or more of these tasks or activities, need personal assistance or have one of the severe conditions identified by the census.

12. Who are People with Disabilities?

13. Using traditional labels, people who have…
Mobility impairments
Visual impairments
Hearing impaired or Deaf
Intellectual disabilities
Mental illness
Traumatic brain injury
Other health impairments

14. From left to right: http://www. photolibrary. fema

15. Students with Disabilities
Pervasive developmental delay
Intellectual disabilities (mental retardation)
Autism
Speech impairments
Emotional disturbance/behavior disorders
Traumatic brain injury
Learning disabled
Deaf or hearing impaired
Blind or visually impaired
Other health impaired: Hospitalized, asthma, ADHD

16. Statistics on Individuals with Disabilities
12.6% of the working age population
12% of the school-aged population
16.7% of the total population
21.3% (almost 250,000) of the residents of the New Orleans metropolitan area described themselves as disabled in the 2000 Census.

19. Participants and Method
Survey of people New Orleans who were evacuated to the Astrodome and other large facilities in Houston about their reasons for not evacuating in anticipation of the hurricane.
Took place Sept , 2005 among 680 randomly selected adult evacuees residing in Houston shelters.
Interviews were conducted face-to-face.

20. As part of survey results…
- 35% responded that: “I did not have a car or a way to leave.”
- 38% responded that: “I was physically unable to leave” or “I had to care for someone who was unable to leave.”
(Survey of Hurricane Katrina Evacuees, Sept. 2005)

21. Research on Risk Factors
Individuals with mobility impairments
Those without transportation
People from lower SES groups
Non English speakers
Single heads of household

22. Post disaster vulnerability
PTSD
Alcoholism and substance abuse
Family violence
Secondary disabilities

23. Laws that Influence Disaster Response and Recovery

24. The ADA
The Americans with Disabilities Act of 1990 (ADA) is the short title of United States Public Law , signed into law on July 26, 1990 by President George H. W. Bush.
The ADA is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability.
It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964, which made discrimination based on race, religion, sex, national origin, and other characteristics illegal.

25. According to the ADA, who is considered to have a disability?
Disability is defined as "a physical or mental impairment that substantially limits a major life activity."

26. A “Major Life Activity” involves functions or activities that are of central importance to daily life such as:
Caring for one's self
Performing manual tasks
Walking
Seeing hearing
Speaking
Breathing
Learning
Working

27. Emergency Management Under Title II of the ADA
Chapter 7
Emergency Management
Under Title II of the ADA

28. Basics for Emergency Management
State and local governments must comply with Title II of the ADA in the emergency and disaster-related programs, services, and activities they provide
This requirement applies to programs, services, activities provided directly by state and local governments, as well as those provided through third parties, such as the American Red Cross, private nonprofit organizations, and religious entities

29. This includes… Advance planning for emergencies and disasters
Staging emergency simulations
Alerting the public to emergencies and disasters and to available programs, services, and activities
Community evacuation and transportation
Emergency shelter programs
Temporary lodging and housing
Social services and emergency- and disaster-related benefit programs

30. This includes… Emergency medical care and services
Relocation programs, activities, and services
Transition and transportation back to the community following an emergency or disaster
Emergency and disaster recovery programs, services, and activities, and
Remediation of damage caused by emergenicies and disasters

31. Basics for Emergency Management
Emergency programs, services, activities, and facilities must be accessible to people with disabilities and generally,
May not use eligibility criteria that screen out or tend to screen out people with disabilities

32. Basics for Emergency Management
The ADA requires making reasonable modifications to policies, practices, and procedures when necessary to avoid discrimination again a person with a disability and,
taking the steps necessary to ensure effective communication with people with disabilities

33. Basics for Emergency Management
The ADA generally does NOT require state or local emergency management programs to take actions that would fundamentally alter the nature of a program, services, or activity or impose undue financial and administrative burdens.

34. The Stafford Act
The Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) is the law that authorizes Federal assistance when the President declares a State to be a disaster area.
Section 308 of the Stafford Act protects individuals from discrimination on the basis of their race, color, religion, nationality, sex, age, or economic status in all disaster assistance programs.
Section 309 of the Stafford Act applies these non-discrimination provisions to all private relief organizations participating in the response and recovery effort.

35. The Stafford Act
Sec. 689(a) requires the FEMA Administrator to “develop guidelines to accommodate individuals with disabilities… guidelines include ‘the accessibility of, and communications and programs in, shelters, recovery centers, and other facilities; and devices used in connection with disaster operations, including first aid stations, mass feeding areas, portable payphone stations, portable toilets, and temporary housing.’
Section 689(c) amends the Stafford Act’s Federal Assistance to Individuals and Households program (§408) to recognize that damage can render a home inaccessible to disabled persons, and thus, uninhabitable to them. Accordingly, temporary housing assistance can be provided to individuals with disabilities whose residence is rendered “inaccessible” as a result of a major disaster. Further, in locating readily fabricated dwellings, FEMA must now seek whenever practicable, sites that – “[meet] the physical accessibility requirements for individuals with disabilities.”

36. Equal Opportunities Act
FEMA and other federal or state agencies are equal opportunity employers.
FEMA will provide reasonable accommodations for employees and other individuals with disabilities.
FEMA must serve all individuals equally, providing access to Agency programs and activities equal to the access provided to non-disabled persons.

37. Emergency Shelter Programs
Regardless of who operates a shelter, the ADA requires shelter operations to be conducting in a way that offers people with disabilities the same benefits provided to people without disabilities

38. Advance Planning
The most effective way for public health care workers to ensure that advance planning addresses the needs of people with disabilities is to involve community members with a wide variety of disabilities in the advance planning process.
Why?

39. Because individuals with disabilities will be able to identify the types of disability-related needs that community residents and visitors are likely to have during emergencies as well as some of the community resources that may be available to help meet those needs.

40. Eligibility Criteria Two categories of shelters Considerations
Mass Care Shelters
Serve general populations
Special Needs/Medical Shelters
Provide heightened level of support
Considerations
Respect the right of IWD to make choices
IWD who have support needs can often be housed in mass care shelters

41. Texas’ Hurricane Sheltering Plan
Types of Medical Special Needs Persons
Level 0: Persons who have no medical needs, but require transportation assistance for evacuation.
Level 1: Persons dependent on others or in need of others for routine care (eating, walking, toileting, etc.) and children under 18 without adult supervision.
Level 2: Persons with physical or developmental disabilities such as blindness, significant hearing impairment, amputation, deaf/blind, and mental retardation.
Level 3: Persons requiring assistance with medical care administration, monitoring by a nurse, dependent on equipment (including dialysis),assistance with medications, and mental health disorders.
Level 4: Persons outside an institutional facility care setting who require extensive medical oversight (i.e. IV chemotherapy, ventilator, life support equipment, hospital bed and total care, morbidly obese).
Level 5: Persons in institutional settings such as hospitals

42. Texas’ Hurricane Sheltering Plan
Levels 1, 2 who can live independently or who have care givers accompanying them may be housed in a general population shelter. Facilities should provide nearby space for care givers, family members, and provide appropriate care for companion pets.
Level 3 and levels 1 and 2 without care giver support will be housed in a medical special needs shelter or in designated areas within a general population shelter. Facilities should include space for care givers, family members, and provide appropriate care for companion pets.
Level 4 will be housed in an acute care hospital or long-term care facility.
Level 5 will be a facility-to-facility transfer (i.e. hospital to hospital, long term care to long term care, assisted living to assisted living, etc.)

43. Supporting Children with Disabilities during and post disaster

44. Eligibility
ADA requires people to be accommodated in the most integrated setting appropriate to their needs
Students should generally be housed with their families, friends and neighbors
Shelter operators may not make eligibility dependent on a child’s ability to bring their own attendant

45. Eligibility
Ensure that Special Needs and Medical Shelters have sufficient numbers of adequately trained medical staff/volunteers before placing students
Keep families or students with their caretakers together whenever possible, which will usually be in a general needs shelter

46. Triage of Care
Students with disabilities should receive same precedence of care as those without disabilities.
Students with disabilities living in the community predisaster may require more non medical supports.
Most students with disabilities will not need a medical special needs shelter.

47. Images retrieved from FEMA Photo Library 2007.

48. Effective Communication
Provide explanations to children of what is occurring.
Provide alternate format materials for students with disabilities (blind, low vision)
Ensure that audible information is accessible to students who are deaf/hard of hearing

49. Supplies
Provide an effective way for children to stay with and receive durable medical equipment and medical supplies
If possible, provide refrigeration for meds
If electricity is available, give priority to those who use ventilators, suction devices, etc
Provide food options to those children with dietary restrictions
Provide emergency supplies that enable care for service animals

50. From left to right: http://www. photolibrary. fema

51. Post disaster Reconnect children with their families
Make sure that services the child was receiving pre-disaster are reconnected post-disaster
Support the parents and caretakers as a form of supporting children

52. Remember your own family!
Create a disaster preparedness plan
Have back-up support for your own childcare needs so that you will be able to offer support to other children
Keep yourself healthy and do not work with disaster survivors if you are ill
Discuss with your family your role in disaster response and recovery and get their understanding and “buy in”

54. Disaster Acronym Guide:
Translations for Two Communities that Love Alphabet Soup

56. Long Term Recovery from Hurricane Katrina
Funded by the National Center on Birth Defects and Developmental Disabilities through the Centers for Disease Control and Prevention
With support by the Association of University Centers on Disability

57. Photo by Kendall Kessel; April 2006

58. Photo by Kendall Kessel; April 2006

59. Contact Info
Center on Disability and Development at Texas A&M University
Project REDD