Emergency Preparedness for Older People By Nora O’Brien, M.A. Within 24 hours following the 9/11 terrorist attacks, animal advocates were on the scene rescuing pets, yet abandoned older and disabled people waited Issue Brief for up to seven days for an ad hoc medical team to rescue them. January-February 2003 Introduction Following the attacks on the World Trade Center on September 11, 2001, older people and persons with disabilities living near the disaster area were trapped for days before being rescued. In response, the International Longevity Center-USA contacted local and citywide organizations that serve older people to find out how they had dealt with the emergency and to discover what resources were available to aid vulnerable sectors of the city in the event of a future emergency. Not surprisingly, agencies with well thought-out emergency plans that held regular training drills were better equipped to handle large-scale emergencies than those that had not prepared. However, planning was only part of the solution. Hundreds of disabled and aging persons were not known to these organizations; workers were looking only for people who had been in contact with their agency and were on a list. Isolated individuals and those who had had no contact with a service agency were not in the network. The breakdown of telecommunications and the inability of workers other than emergency personnel to gain access to the area near the disaster exacerbated the situation. In the months following the 9/11 attacks, interviews with representatives from emergency organizations, including the Federal Emergency Management Agency (FEMA), the American Red Cross, the Office of Emergency Management for the City of New York, the police and fire departments, as well as representatives of citywide organizations that assist older and disabled people, revealed four significant shortcomings. In brief, New York City’s system for providing emergency assistance to its most vulnerable populations lacked: 1. Appropriate emergency management for older and disabled persons 2. Citywide coordinated community services 3. A system to identify and locate older and disabled people 4. Pertinent public information before and after emergencies. The information gained from these interviews formed the basis for a coordinated plan of action that utilizes emergency and social service networks to provide International Longevity rapid and comprehensive assistance. Although this disaster plan was Center–USA developed to meet the needs of vulnerable New Yorkers, it is our hope that it can be used in cities around the country for any type of emergency. Acknowledgment:The ILC-USA would like to thank the New York Times September 11th Neediest Cases Fund for its generous grant to undertake this project, the ILC Board of Directors for its support and direction, and all the organizations who participated in the interviews for this project. = Page 1 = Critical Issues in Emergency Preparedness older and disabled people living near Ground Zero. Breakdown of all communications For seven days or more following the attacks, older The destruction of the World Trade Center affected and disabled people were still unidentified and telephones, cell phones, e-mail, television, and neglected in the surrounding residential buildings. radio throughout the city. Mail and newspaper Representatives from FEMA and the Red Cross delivery was halted below 14th Street, and virtually said that there were no formal plans to reach out no information was disseminated regarding public to these populations in the emergency situation that transportation changes. Persons who were vision existed in the aftermath of the attacks. They had impaired or unable to read English were especially to respond in an ad hoc fashion; for example, impacted, contributing to their confusion and anxiety. FEMA set up an emergency phone line to provide Recommendation: A backup communications referrals for older people, and the Red Cross system to update and disseminate emergency created a search-and-rescue medical team for information. buildings near Ground Zero. Recommendation: All emergency organizations Access for essential services should have a formal plan to assist special- Service personnel lacked access to older and frail needs populations. residents living in the “frozen area.” Essential services, such as meals for the homebound and Coordinated community services home health care, were not delivered because staff There was no citywide emergency plan that coordi- had no official authorization to carry out their nated community services on behalf of vulnerable responsibilities. Emergency workers believed the people following the disaster. Although community buildings had all been evacuated, but disabled service agencies that serve older and disabled people people who were unable to leave their apartments did their best to provide care for their clientele were left behind with no electricity (and therefore following 9/11, there was no coordination to ensure no television, radio, lights, elevators, refrigerators, that comprehensive care was available to everyone etc.), no running water, and no information about who needed it. Hundreds of people unknown to what was happening and what they should do. organizations were neglected for days. Some agencies Home health aides were unable to check on did not know where or how to get volunteers whether or not their patients had been rescued. while other agencies were flooded with calls from They were denied access because they lacked potential volunteers who had to be turned away. identification showing that they were service If there had been a central office coordinating the professionals. In one such instance an aide could supply and demand of volunteers, agencies would not reach her quadriplegic patient. The patient have been better able to meet their clients’ needs. was alone for three days until an ad hoc Red Cross In creating a coordinated citywide emergency plan, team of medical professionals searched the one organization could take the lead in building a building and found the critically ill resident. consortium of representatives of agencies that serve Recommendation: A system to identify older and disabled populations. This consortium community service providers and permit them could devise a system in which agencies would pool to enter a disaster area in order to provide their resources. The lead organization would critical assistance and information to older appoint a contact person to serve as the liaison to and disabled people. FEMA, the Red Cross, the Area Agency on Aging, Appropriate emergency planning for the Salvation Army, the police and fire departments, older and disabled people and other emergency organizations. Emergency organizations, such as FEMA and the Recommendation: Create a citywide emergency American Red Cross, were not prepared to assist plan for older and disabled people. 2 Emergency Preparedness for Older People = Page 2 = System to identify and locate older needs. In the aftermath of 9/11, people did not and disabled people know whom to call for assistance, and there was Currently, there is no effective way to identify much confusion over identifying and accessing vulnerable people who are not connected to a telephone numbers of organizations that could help community service agency; the fire department has older and disabled people. Some organizations a system, but it is not updated in a timely fashion. received hundreds of calls and acted as emergency The plight of the old and disabled who were referral sources, directing callers to appropriate abandoned for three days in buildings that had been agencies. An official emergency telephone hotline evacuated highlights the need to develop a system for older and disabled people should be developed. to assist emergency teams in pinpointing sites that It could be housed in one or two of the consortium house a high percentage of vulnerable people. organizations and, during an emergency, staffed By knowing ahead of time that certain areas have by members of the consortium. a high density of frail people, emergency personnel Since most people think of emergency services only will be prepared to comb the buildings in search when they are faced with an actual crisis, it would of those in need. be useful to disseminate, through media and other A lead organization, or several organizations working channels, information that is easily accessed in an together, could use easily obtainable information, emergency. The telephone hotline numbers should sources such as census reports and city demographics be included, as well as agencies that the aged and to map out neighborhoods with a high concentra- the disabled rely on for transportation, meals, tion of older and disabled people. Organizations home care, medical and mental health care, medical that deliver citywide services could also be equipment, prescriptions, and financial aid. This enlisted to provide support. On a more local level, information could be distributed as a public service community boards and other neighborhood several times a year through newspapers, mailings, organizations could be encouraged to work with and brochures in doctors’ offices. local vendors, landlords, co-op boards, and houses Recommendation: Disseminate information on of worship to assist in establishing the location of public services and emergency planning several buildings that house people who need special times a year. assistance. Additionally, neighborhood community Geriatric mental health care service programs could be identified and their There is a shortage of mental health practitioners personnel and volunteers trained to work experienced in working with older clients and a collaboratively with emergency personnel to help lack of general knowledge about how mental health locate people and provide assistance. This type problems are manifested in older people. With of coordinated response system would be overseen better awareness of the symptoms, practitioners can by the lead liaison agency. intervene more quickly and appropriately. Recommendation: Develop a city map highlighting Recommendation: Develop and enhance neighborhoods with a high concentration geriatric mental health care. of older people, as well as more detailed neighborhood maps. System to provide emergency prescription refills Inability to refill their prescription medications Public information before and after attacks was a critical problem for older people. Local Information before, during, and following an pharmacies were closed, doctors’ offices were difficult emergency is crucial to ensure that everyone remains to reach, and older people could not physically safe, that all receive necessary services, and that get to other pharmacies to pick up their medications. they know the appropriate contacts for their special Several organizations used an ad hoc approach. 3 Emergency Preparedness for Older People = Page 3 = Recommendation: Develop a universal system A citywide emergency hotline providing referrals of providing medication or prescription refills on and information on services for people with special an emergency basis. needs would help minimize duplication and confusion. Each organization would develop its own list of services and provide volunteers to assist A Comprehensive Citywide Plan in answering the phones. Based on exhaustive investigations and interviews, the following approach to emergency management One central registry for volunteers would provide a was developed: more effective use of their service. One citywide center would collect information on volunteers An Emergency Planning Committee and match them with the needs of organizations A consortium of organizations specializing in and special subpopulations among the vulnerable, special-needs populations, such as clients who are such as immigrant neighborhoods with aged, physically or mentally disabled, or vision and/or limited English fluency. hearing impaired, would form a coalition to devise a strategy to meet their clients’ needs in an emergency. Existing community coalitions, including The committee would recommend that such a community boards, interagency councils, houses strategy be adopted by the emergency organizations of worship, and neighborhood organizations, and included in their overall emergency plans. One could help disseminate telephone numbers and committee member would be appointed liaison information on emergency services to older people to the organizations and would work with them to and disabled residents, elected officials, local mobilize community services where needed during leaders, neighbors, and vendors. an emergency. The committee would oversee the Public Agencies and development of the following: Community-based Organizations A map of neighborhoods with high concentrations Each agency should have its own comprehensive of people with special needs would identify specific emergency plan that will ensure the safety of and areas within the city that have a high percentage provide services to its staff and clients. The of older and disabled people who may be in need of plan should be available to all staff at all times. special assistance. If possible, buildings that house Additionally, there should be regularly scheduled large numbers of such individuals could be identified. training on the plan with special emphasis on preparing new staff. The plan should include: A map of community service providers by neighborhood would be created. By working at > Emergency contact information for all staff, the neighborhood level and preparing in advance, especially executive officers and other key personnel, community service providers could mobilize to accessible to all staff provide crucial services to the most vulnerable > Emergency contact information for all clients in their constituency. > A system for providing medical and mental health services for staff and clients A comprehensive database of frail older people > An audit of risk factors to limit exposure to risk, with addresses and contact information could be which is usually required by insurance companies derived from existing client lists, census data, > An off-site listing of office hardware and software and through voluntary reporting. This would assist > A list of ID numbers and vendors of in identifying people who are not affiliated with any office equipment organization and who are at special risk during > Insurance on key employees an emergency. At the neighborhood level, tenant > Insurance on business interruption services and neighborhood organizations could help identify vulnerable people. 4 Emergency Preparedness for Older People = Page 4 = > An identification program (e.g., badges) for There should also be a public information campaign employees and volunteers to alert older and disabled people and their > A backup location for employees to meet and caregivers about services that are available to them carry out essential activities if access to offices and what organizations to contact for information is restricted and assistance. This will help them to plan for > A backup communication system for employees comprehensive care year round and in the years ahead. > A redundant data system that allows multiple Finally, a campaign to inform people on how to ways to access client information if the main office prepare for and react to bioterrorism would is inaccessible help alleviate much of the misinformation and > Good relationships with local organizations, subsequent anxiety. stores, and vendors who can provide essential items in an emergency, such as food, water, and clothing. Conclusion Since the population of older people is growing A National Educational Campaign throughout the United States, it would be appropriate An educational campaign to help people prepare to develop plans of action in the event of a disaster— for all types of emergencies would enable vulnerable be it a terrorist attack, flood, hurricane, tornado, people and their caregivers to feel more in control or snowstorm—for older people as well as for other and less anxious. Federal, state, and local organiza- vulnerable populations who need special assistance. tions could conduct an educational campaign Planning ahead will minimize the potential for older and disabled people and their caregivers neglect that can result in trauma or death. In order about emergency preparedness and how to help to reach out to vulnerable populations, emergency themselves during a disaster. organizations could work with a local representative Part of the educational campaign could include familiar with community service agencies instructions about the following: mobilized to assist in search and care. By including a comprehensive citywide plan that utilizes existing > Each person should keep an emergency box public agencies, community-based organizations, that includes a transistor radio, flashlight, batteries, special-needs services in the emergency a blanket, a three-day supply of medications, plans of the police and fire departments, FEMA, nonperishable food, water, cash, and if possible, the American Red Cross, and the offices a cell phone. of emergency management, we can ensure that > Each person should keep a list of important all citizens will receive appropriate and timely care. phone numbers handy, such as family members, doctors, and pharmacists. This report is intended to serve as a conceptual > Each person should keep a list of all prescriptions. model for universal use in emergency preparedness > Each person should provide a contact-information for older and disabled people. list of friends, neighbors, agencies they frequent (senior centers), doctors, caregivers, helpers, Nora O’Brien, M.A., is the director of partnerships and local vendors (neighborhood deli, coffee shop) at the ILC-USA. who know them to her/his family and friends to serve as a backup to help locate and contact the older person during emergencies. 5 Emergency Preparedness for Older People = Page 5 = Board of Directors ILC Issue Briefs Laurance S. Rockefeller, Clinical Trials and Older Persons:The Need for Greater Representation Honorary Chair Old and Poor in New York City Kenneth I. Berns, M.D., Ph.D. Robert N. Butler, M.D. The Digital Opportunity Investment Trust (DO IT): Mary Carswell Using Information Technology to Prepare for an Older America Christine K. Cassel, M.D. Preparing for an Aging Nation:The Need for Academic Geriatricians Everette E. Dennis, Ph.D. Susan W. Dryfoos Lifelong Learning in Norway: An Experiment in Progress Lloyd Frank Old and Poor in America Annie Glenn Senator John Glenn Social Security: Investment in Family Protection Lawrence K. Grossman Raymond L. Handlan Robert D. Hormats Tasneem Ismailji, M.D. Rose Kleiner (1925-2001) Linda P. Lambert Max Link, Ph.D., Chair William C. Martin Albert L. Siu, M.D., M.S.P.H. Evelyn Stefansson Nef Joseph E. Smith Catharine R. Stimpson, Ph.D. James H. Stone William D. Zabel, Esq. International Longevity Center–USA Mel Zuckerman 60 East 86th Street John F. Zweig New York, NY 10028 212 288 1468 Tel ILC International Centers 212 288 3132 Fax Directors www.ilcusa.org Shigeo Morioka An Affiliate of Mount Sinai School of Medicine ILC–Japan Françoise Forette, M.D. ILC–France Baroness Sally Greengross ILC–United Kingdom The International Longevity Center-USA (ILC-USA) is a nonprofit, nonpartisan Rosy Pereyra Ariza, M.D. research, education, and policy organization concerned with longevity and ILC–Dominican Republic population aging. Copyright © 2003 International Longevity Center-USA, Ltd. All rights reserved. IB08–2003 = Page 6 =