ADA Audio Conference

Good day ladies and gentlemen and welcome to "Prepare for the Unexpected: Emergency Preparedness/Evacuation for People with Disabilities" at this time all participants are in a listen only mode. Later we will open it up for question and answer session and instructions will follow at that time. If anyone should require audio assistance during the conference please press star then zero to reach an operator. I would now turn the call over to Robin Jones.

Great. Good morning and good afternoon wherever you might be connecting from today. Welcome to the program on disaster preparedness and I am happy to have everyone with us and hopefully this session will meet your needs and answer questions or give you new information or whatever your particular interest in this program might be.

This is the second of our series of programs this year that focuses on the issues that are particularly of interest to Title II entities. As many of you know we are a program that is offered monthly. And it is a program offered through the National Network of ADA Centers also referred to as DBTACs in various regions of the country. There are ten of us nationally.

The ADA audio conference session for this month is again focused on emergency preparedness and in a minute I will introduce our speaker and turn things over to him. Just as a reminder before we get going today people are joining us from a variety of different mediums. Some people are using the telephone other people are using the streaming audio on the internet and we have individuals who are joining us utilizing real time captioning on the internet. As a new feature or enhanced feature of the program we are also projecting the slides that are provided the power point presentation that was provided by our Speaker and the instructions on how you would have been able to connect to that were included in your instructions for this session so if you are someone interested in following along visually looking at the power point slides please follow those directions.

You all should also have a copy of the Speaker’s power point presentation which was also distributed as part of the materials for this session as well as some additional resource information that the speaker provided us. So hopefully everyone has been able to access that information. Once the Speaker begins today he will indicate when he is ready to take questions from people. At that time people can ask or submit any questions relevant to the information and our Speaker will make every effort to respond to your questions. And, the Operator will provide information to all of us at the time when it is ready for being able to take questions. So just bear with the process and we will get your questions.

So without further ado, I am going to go ahead and introduce our Speaker today and get us moving along on the session so that we will have plenty of time. I am very pleased to have Carl Cameron, Ph.D. join us today for our particular session, for this particular session. And he is with an organization that is known as Inclusive Preparedness Center it was formerly called the Center for Disabilities and Special Needs and Preparedness and he might be able to give a word or two or give some information if anyone is interested in the name change but Carl is the President of that organization. He is a nationally known research and training professional in the area of employment and community integration of people with disabilities. And he has been recognized as a program developer, researcher, teacher, author and presenter throughout the United States and he is actually calling us from Canada today because he is in Canada today working with them on some partnerships and collaboration around these issues of preparedness, as well. So it is an international, I guess, as well as United States at this point.

He is a media and training expert and an experienced producer of satellite video teleconference, videotape training and interactive video productions. Since September 11th of 2001, much of his work has been focused on developing training and technical assistance programs and materials for planners, first responders and persons with disabilities and other needs groups to improve overall preparedness for terrorist attacks and other disasters. Under his leadership the Center has been designated as a national training partner for the Department of Homeland Security, a multiple grantee under the Urban Area Security Initiative and, a recipient of People Who are Making a Difference award from the Environmental Protection Agency. Just on a professional note for Dr. Cameron, he earned his doctorate in special educations statistics and communications from the University of Florida and has been a faculty member of the University of Missouri, George Washington University, University of Maryland and most recently at George Mason University in Fairfax, Virginia. He has designed an education programs for the Department of Defense Education Agency and has provided expertise to a wide variety of research organizations.

So I think just that descriptor alone is a mouthful but tells us a lot about our Speaker and speaks to his expertise and I think again we will all get a lot out of our session today. So without further ado Carl, I am going to go ahead and turn it over to you.

Thank you, Robin, I really appreciate that introduction. And I am always kind of amazed when I hear you describe and trying to see is that really me. But in this case I hope most of those things are valuable to you as we go through the sessions this afternoon. As Robin indicated I am calling from Toronto, where I am working with the Canadian Red Cross and the and the March of Dimes Canada and we have just announced a new collaboration between the United States and Canada called Inclusive Emergency Preparedness Canada and one of the things we are doing is trying to strengthen the relationship between the two countries but also to strengthen within each country their ability to look at issues related to emergency preparedness.

So I am going to start this afternoon by just talking a little bit about the way in general in terms the way a lot of emergency preparedness activities have begun and then we will get into some very specific areas in terms of looking at the kinds of planning that need to be done, and the kinds of issues that come up depending on you as an individual, your family, organizations and we will talk about planning at all of those levels. As we go through the next few minutes I will try to stop every few minutes or so and take some questions so we don't get to the point of everybody gets tired by the end of the presentation and forgets to ask the question they really wanted to ask.

So I will try to indicate when that happens and you can understand that the technical people will take care of that for us. If you want to look at your slides I will try to indicate for you on each of the slides when I am going to make the change and you can kind of follow along as best you can. So if you are ready to go, let's go to the first, the next slide.

And I think it probably sets up in this particular and for those of you who don't have the slides in front of you, let me read them, some of this to you so you will get a sense. There is a statement that says in a very dramatic fashion, natural and man made disasters remind us that a major segment of a population are very vulnerable and we still have a great deal to do to make sure those needs are addressed to the maximum extent possible. And by way of introduction of myself, I got started in this area as indicated from the introduction, I was, I had been involved for many, many years in disability education of various areas and a lot, probably most of the time spent in terms of employment and individual self determination issues.

And I was actually approached a number of years ago by the Environmental Protection Agency and some of the folks there who were talking about some piece of legislation that EPA had which was called Community Right to Know. And this piece of legislation, national federal piece of legislation, still in existence says that communities around the country who are near chemical plants or chemical installations, the communities have a right to know what is in those chemical plants and what would be the worst case scenario, assuming that there was an accidental disaster.

So I got involved because people were saying, well, you know it is pretty easy. We just have to go out to the community and provide that information. And I started to ask the question, well how do you provide it? To whom do you provide it? Who do you think is actually able to get this information and process it and do you understand that you have a heterogeneous population out there and not everybody deals with information in the same way. Well, that all kind of started from that point and just continued to develop as we started to see that in fact most of emergency preparedness was not really being addressed in the populations that we were concerned about.

So if you turn to the next slide, I think it, somewhat after those year we started to see some of the events that we are all terribly familiar with now in terms of the 9/11 incidents and the previous one in the Trade Towers and then of course, Katrina over the past few years and a whole lot of other natural disasters have taken place fairly recently where we are really looking at some of those issues of those individuals who are sheltering, sheltering at home, evacuating and then returning home. And we will talk about those aspects as we go through.

We know that particularly when we heard the reports from Katrina and the Gulf Coast disasters that so many of the things that happened that were so horrible could have been easily handled and mitigated had there been some planning going on with the, with individuals, with families, particularly with service providers, and with the emergency management agencies themselves. So all of a sudden we are seeing that there is a little bit different focus in terms of emergency preparedness. And it is not about rescue and it is not about the emergency management agencies. But it is about all of us. And in terms of how we deal with the potential disasters over the actual disasters that take place.

Well, excuse me again. If you turn your slides to the next slide, there are three or four slides that I have just tried to share with you to just show you some pictures of some of the efforts that went on at the Gulf Coast and some of these may be familiar some may not. But the first picture shows an individual being rescued on the top of an air mattress with his wheelchair and his belongings and being pulled along by another person right outside the Superdome down in New Orleans. And really understanding that that was most of the rescue that took place was done by volunteers or family or people who waded through a lot of this muck and water to rescue other people.

The second slide then shows a whole lot of individuals, mostly elderly, in wheelchairs, all lined up from buses waiting to go -- excuse me, waiting to go on aircraft, and sitting out in the sun kind of waiting when it looks like there is a great deal of need for that kind of evacuation but not necessarily the resources to do that. In the next slide we are seeing an individual who has, who is being evacuated by helicopter and who needs to be evacuated from a hospital bed. And the final picture is a -- if I can get my slides to go, the final picture is showing individual rescue from a boat. And again volunteers helping individual, in this case an elderly woman, to make sure that you know that she is rescued. And in the middle of all of the flooding that went on. So what did we learn from all of this? We learned a number of things that really have pointed us in some directions that as individuals and organizations we really need to focus on.

If you will turn your slide to the next slide, I have kind of listed there some things that we learn from all of those events that help kind of shape the policy and shape the planning that is currently going on. One of the first things we learned was that, you know that there was a tremendous loss of identification and records. The fact that so many people were evacuated without much of anything. But certainly where we had individuals who had service records. Who were -- medical records who were in badly need of having services provided in which they needed a kind of support service that needed to have some history with it. Most of those things were gone. And the identification in many cases of people was extremely difficult simply because again the records, the kind of identification, personal identification was gone. Many cases the kinds of medical information people needed were gone. Very difficult time in that and other recent natural disasters in terms of getting medications and access to Medicaid and Medicare. A lot of times those forms which are required, those identifications that are required, were not there. It is also a very interesting phenomenon that the events surrounding Katrina happened very close to the end of the month. And in fact those people who were on month-to-month medications were finding that they were within the last few days of their medication. And had no backup in terms of a long term ability for those medications.

The other thing we saw was incredible loss of durable medical equipment during that time. There was a group who gathered out of actually it was coordinated out of Washington D.C. to look at being able to supply some of that durable medical equipment to the Gulf Coast and I know one time there was a shipment of 1500 manual wheelchairs that went to the Gulf Coast simply because all of those people who had both manual and power chairs were rescued and none of their durable medical equipment was taken with them so lots of that medical equipment had to be replaced and reorganized in order for that to happen. One of the real tragedies I think that happened out of Katrina was the service provider agencies lost their constituents and their staff.

For instance I was down not too long ago and I talked with some agencies who still have not been able to locate those individuals for whom they provided service and the people who provided the service, they are gone, they have been relocated. And there is no real trace or record where those individuals are. Some of you may know that a number of those organizations went out of business as a result of the inability to plan ahead and to have a plan for getting back into business. Plus the loss of income that happened when those organizations were actually not able to bill for services for some period of time.

Tremendous problem, there was the report, a state report that came out from the National Organization of Disability talked about the rejection from shelters and the inability of individuals to get placed in congregate or mass care shelters because of their disability. Some horror stories that went around with that in terms of inability to have any place to go and stayed on buses for long periods of time. Stories about care providers and individuals who were together but were separated simply on the basis of the transportation needs and moved along.

Some of the good things that did happen, and they weren't all bad but certainly one of the things was the rest of the disability community at large was really helpful in terms of relocating a large number of people to other communities around the country and also being able to donate materials, donate services that really made a difference in terms of the number of people who did get supported during this time.

It might be a good point just to stop right here and see if there are any comments or questions from the group related to what we talked about so far. And then we will kind of move on.

Ladies and gentlemen if you have a question at this time please press the star and the 1 key on your touch tone telephone. If your question has been answered and you wish to remove yourself from the queue please press the pound key. Again if you have a question, press the star and the 1 key. We do have a question.

I have a question about durable medical equipment. I wanted to know how hard it was for people to get who use their wheelchairs replaced and things like that. Is it a loss then? Did you hear that?

Yes, I heard the question. The question was if everyone else did not hear it was, how hard was it for people to get their durable medical equipment replaced? And that certainly varied by the source of the funding for that. But there was a great deal of time went by for most people before that replacement actually took place. Because obviously there had to be refitting, reordering, rebuilding, and resupplying for individuals. So in many cases, it took months for that to happen.

There appear to be no further questions.

Okay then we are going to go ahead and move ahead in the slide presentation and just talk real briefly about definition of vulnerable populations and part of this I think is really talking about terminology that is being used more and more. For a long time you know we have heard and still hear terminology about special needs. And the, there are various opinions about whether they like that terminology. I have yet to find probably a terminology that everybody likes. But I think it is probably what is really happening in terms of both the national scene as well as individual preferences and organizational preferences that we talk more and more about people who are vulnerable during a disaster as a focus as opposed to talking specifically about disability and special needs. And I am sure for as many people as we have out in the audience probably everybody has an opinion about that.

But you are going to see vulnerable populations I believe used more and more even to the point if you go to the next slide, you see that that terminology is being used in the National Response Framework. And in terms of looking at both one, a functional definition and trying to broaden this out into terms of some individuals who maybe wouldn't normally be considered in that group but let me read that to you so you have it, which is from the National Response Framework. Individuals who before, during or after an incident may have additional needs in one or more of the following functional areas: maintaining independence, communication, transportation, supervision and medical care and this includes those individuals we usually have identified as those who have disabilities, those who live in institutionalized settings, those who are elderly, those who are from diverse cultures, those with limited English proficiency or non-English speaking, children and transportation disadvantaged. And I think probably that if you look at some of these and say, gee, that is certainly different than what I have been thinking about. But for example children, we have been doing a lot of work with organizations that provide day care programs, preschool programs. And talking about the vulnerability of a population of preschool-aged children who are at a facility in where they are being supported by one or two staff during the day. And their parents are across town working and they tend to be very vulnerable in terms of where they are going to go, how are they going to be sheltered, and how are they going to be reunited with their family members.

A lot of talk about transportation disadvantage, as well and talking about people who do not have cars basically. You know we are talking about people for who public transportation is spotty. Personal transportation may not be a reality. And the importance of you know in many cases an evacuation projects and programs that sort of infer that everybody has a car and as a result everybody could jump in their car and evacuate when in fact that is not true in many, many cases and there has been limited planning in some of those areas.

So just kind of summarize on some of these things, what are the issues for people with disabilities and other special needs? This is the next slide. And I think we can talk about some of these areas that probably will be familiar to most of you. But certainly the areas which we need to focus in on. Communication that happens during a disaster or pre, or the warnings of a disaster and how that communication takes place. Most of the time that communication has been single facetted, television, radio as being primary focus of that communication. But as we know that is not sufficient. And that there is different options and needs to be looked at in terms of that communication.

We are now seeing even more so the communities who have some kind of an alert system.

Carl, have we lost you? Hello, Carl.

His line is still connected.

Carl? Hello, Carl?

Can you hear me?

Yeah, we did lose you there. So okay. Can you test it again? Hello? Carl?

I am having problems here. Hello?

Hello, Carl, are you there?

I am here. Can you hear me?

Yes, we can hear you. Sorry about that. I don't know what happened there. I think it is on your end but.

I will try not to move or something.

Okay.

Can you tell me where we lost?

I think it was at the end of your last question is where we lost. Were you done with the response to that question?

Yes, oh, quite some time ago.

Okay.

I am sorry.

So are we ready for another question then?

Yeah, I understood there were no more questions.

Okay. All right. I got caught up in your sound problem. Why don't we go ahead then again if there aren't any additional questions at the time and have you proceed.

Okay. I will assume that we are on the slide that talks about defining vulnerable populations which should be the next slide in the sequence for everyone. Talking about vulnerable populations, as a little bit different terminology than a lot of folks are maybe used to. In terms of hearing terms like people with disabilities and special needs. That special needs term which is used very often within the emergency management arena more and more we are seeing being replaced by talking about vulnerable populations. And so the slide says is a definition we use within our organization which is people who because of their special needs cannot shelter in place, evacuate, maintain or recover during or following a disaster without additional and often specialized assistance from others.

So that is kind of the shorthand version, if you go to the next slide you can see a definition of special needs from the National Response Framework. Now for many of you, you know there has been a national response plan in place for a few years. Preceded by the Federal response plan. But a little over a year ago then there was an introduction of a National Response Framework. And one of the things that was valuable to this was that it did in fact include for the first time references to special populations and individuals who may be vulnerable. And also has been utilizing a more functional definition of the people that need that assistance and I will read that slide to you because some of you may not have that option.

I am coming through okay? Can you hear me?

Yes, you are fine.

Yeah, okay. Thank you. The definition says individuals who before, during and after an incident may have additional needs in one or more of the following functional areas: maintaining independence, communication, transportation, supervision and medical care. Including those groups that we normally may associate in terms of special needs populations, those who have disabilities, those who live in institutionalized settings, the elderly, those who are from diverse cultures who may have limited English proficiency or no English speaking ability. Populations of children and individuals who are transportation disadvantaged. Now I think most of those are self explanatory. But the last couple are really helpful. One is that those who are children, when you think about in this country there are large numbers of children who are separated from their families daily and go to preschool programs and early elementary school grades who are in fairly large groups and supervised by a small number of people. And those people who are separated by their families. Their families may be at work or other places around the community and so they become very vulnerable because of their location during that time.

We are also talking about people who are transportation disadvantaged. Individuals who don't have cars basically. And I think one of the things we kind of make an assumption about emergency management agencies. We really assume that a lot of the evacuation plans that they are working on really focus on the fact that everybody can jump in their car and evacuate. And we know that that is not true. And we know for a large segment of the population they need public transportation or alternate transportation in order if there is an evacuation or an order to evacuate. So this is the group of people we are talking about. And this is the focus what we think about when we talk about vulnerable populations.

The next slide is, talks about the issues for people with disabilities and other special needs. What do people think about, we have done a great deal of research over the last few years and asked people about what are those issues that they think are most important in terms of disaster preparedness. And what we have is a list of a few items which I think you can see that probably focus on the issue today.

One is communication. When we talk about communication, we are really talking about individuals getting warning information, understanding the situation. Getting directions about where to go. And what that really means in terms of the proper information. We know from lots of experience that people need communication a variety of ways. And that doesn't always happen. One of the things that has been happening is a lot of individual warnings and notification devices within communities that allow you to get that information by cell phone, by pager, over the telephone, various ways which allow you to get information in a variety of ways. And so with the idea that because you get information from different sources, that you will be able to get that information appropriately.

One of the things we don't think about very often I think is the second item which is comprehension. That just because people get information doesn't necessarily mean that everyone understands what to do with that information. A lot of times the information that comes across is somewhat garbled, somewhat in detail. I know I have looked at a whole lot of pieces of information come out during disasters and they go on and on in talking about the disaster but they never give a clear direction as to what to do. And for some people that is a very difficult process of trying to cipher out all of the details and information. The emergency warning systems, whether it is internal in your house or whether it is in the community, they are continually being looked at and tried to reorganize in terms of what the best possible way is to make sure you get information. Do you need visual signals in your house? Do you need auditory signals? Is there a way that they are still even talking about continually having sirens and air raid sirens pretty much like hurricane warnings or tornado warnings that happen in the Midwest so there is a lot of work being done right now to find out the best way to make sure people get warned appropriately.

Probably the big area that we really want to talk about, too, is the assistance that is necessary in order to do three or four things which are really key. One is shelter in place. In terms of what do people need to do in order to do that. Most of you are probably aware that we have just gone to level 6 of the World Health Organization's focus on the pandemic. And there is a great deal of information that suggests that pandemic is going to reappear particularly as we get into the flu season maybe in an altered form. And that great numbers of people maybe in fact having to isolate themselves while not traditionally the thought of sheltering in place. It is staying in place and it is trying to keep people from spreading germs. But shelter in place I always tell people that you know 99% of the time when there is a disaster, the best possible option is going to be to shelter in place. If you can't shelter in place that 1% of the time which is going to be very serious and very life threatening, then you know that issue of getting out and evacuating becomes the second most important process here in terms of how do you get there, what do you use? Where do you go? And when do you go? And all of that information continually is being looked at in terms of the communities which provide that information.

One of the things that goes on in my community I suspect it is pretty much everywhere else is trying to identify evacuation routes. Trying to focus on where people go. How they get out of this city? I live in Washington D.C. and the first thing that happens is the bridges are clogged and people go nowhere so it is some very, very tough issues in terms of getting people to evacuate from anywhere. The third area which is extremely important is support in the mass care shelters and a lot of work is being done in a lot of the communities in terms of making sure mass care shelters are accessible. And I guess I would really like to talk about that for just a second because one of the things that we know that is very important is that people with disabilities for the most part should be able to go to mass care shelters and be accommodated appropriately. That is not always the same information you hear depending on who you talk to. But there is no real reason for an individual with a disability who does not have a medical need not to be accommodated in a mass care shelter or what is called a congregate shelter. So that kind of information is really crucial in terms of making sure all of our shelters are accessible as possible. You know, in kind of an analogous to that is also the issue of pets and service animals who need to be sheltered there in those mass care shelters, as well and a lot of work is being done in those areas.

The fourth thing that is not consistent around the country and that is special medical needs shelters and the ability of a community to put up a medical shelter for those who need medical assistance but may not need hospitalization. With the understanding that if there is a disaster, those hospitals may be in fact focusing on acute care for those who are injured and that special medical needs shelters for ongoing medical needs may be handled by special medical shelters. And so at one time they were called special needs medical shelters but I think you are seeing more and more the terminology to really focus in on the fact that they are medical, different, because they are providing medical services.

Finally in that area is recovery and the support for people who once the disaster is over need that support of going back to, going back to home. To be able to resume their everyday lives. And you know that for some people who have spent a great deal of time being self sufficient and focusing on their lifestyle, all of a sudden go back to a situation where most of that is gone and they have to recover and provide and find the agencies that will help them recover and help them rebuild.

The last thing I would just like to suggest is that over and over I see this issue that there is always some assumption that in disaster preparation, emergency preparedness, is that people with disabilities are really thought of as people who need assistance. But many people out there in the communities are also saying, I am a person with a disability but I can help in the process. And we have seen that through community emergency response teams and others that really have focused on getting people with disabilities to participate -- whoa. Are you there?

Yeah, we are here. We are here.

Okay. I just heard this big thunderstorm.

Oh, no it must be on your side or something. Not on ours.

Very strange. But anyway, it is probably a good point to stop and see if there are any comments or questions again that people may have in terms of where we are so far.

Carl, I have a question that was submitted through our online system for people who are on streaming audio and that was someone asking whether or not there was any activity in New Orleans related to continuity of operations planning by community agencies or government prior to the hurricane?

Well the answer -- the short answer to that is yes and no. For some agencies there was a bit of planning, a great deal of planning going on, and other agencies not so much.

I dealt with an agency down there that plans and actually practices evacuating their entire operation twice a year. And by evacuation that means they take their entire constituency. And they break up into teams and take those people to an inland location. Weekend, have kind of a weekend retreat. But they practice very successfully in terms of transporting and supporting.

On the other hand you know that there are lots of organizations there. And I, probably more than certainly should have been who didn't in fact have any kind of coup planning going on at all or continuity of operations planning to get back into business and those are the ones that were probably the first to fail. And then some people who were planning also had only partial plans or had some very strange -- I guess the one that always comes to my mind is organizations who told me and told other people that they had -- they were okay with their transportation, evacuation transportation because they had a transportation provider. And they talked to them and they have agreed or even have a contract that they would provide that service. Well that same transportation company then also had contracts with a number of other organizations to do the same thing. And you can imagine what happened is that the first person there got the service and the rest of the people there thought they had transportation but didn't. So there is a variety of that coup plan. I guarantee there is more coup planning going on now than there was before.

Great. Thank you. And Operator can you give some instructions and we will see if we have any questions from those on the telephone.

Again, ladies and gentlemen, if you have a question please press star 1. The first question.

Hi, yes, can everyone hear me okay?

Yes, we can.

Okay. Great. I just had a question. As you were talking and just thinking about this outside of the session, I was just curious, it seems like in with regard to evacuation in the case of an emergency facilities like hospitals, nursing homes and other agencies, they are pretty much covered as far as having a plan on what to do, at least now it seems like most people may seem to have some idea what they should do as far as evacuations but what about people with disabilities who reside in residential -- more so apartment buildings? I know I would think fire department, police would be trained to help but what about big apartment buildings, are they trained to be able to help with evacuation or who would they contact for such a huge evacuation?

That is a really excellent point. And one of the things at IPC that we spent a great deal of time is looking at individual preparation, as well. Because more and more as you know people live independently, live in the community, live in situations where they in fact you know must be taking more and more control of what happens during a disaster.

Uh-huh, yeah.

And so what is happening is that there is a number of training programs. We have one which we call the personal preparedness planner. And it is kind of an interesting process where we have created a non-reading -- practically non-reading version of a planning guide and it looks, I call it chutes and ladders because it kind of looks like a board game in terms of going through the various steps that are necessary to be personally prepared and then there is a companion guide with that that is provided for an assistant or friend or family member so that they can kind of go through that planning together.

One of the things we were successful with was using it with Meals-On-Wheels so people who were getting Meals-On-Wheels would actually get a copy of the planner and then every time there was a delivery or every periodically that service provider would work with them saying, well, how are you coming? Did you buy that water you were going to get for sheltering in place? Or did you talk to your friends about what would happen during the disaster and be able to come? Because we know from all of the research and history is that you can tell people what to do. But the most important part is to make sure they actually do things and do the planning. Just like you know as an organization it is one thing to say we should do it. It is another thing to actually do it and practice it. I hope that helps.

It does, thank you.

Next question?

Next question. Go ahead.

Hi.

Hi. I have got a person here who has a question. It seems to me that under the definition of vulnerable populations prisoners would be included in that. I was wondering if that is the case? And also are measures taken to sort of incorporate in these special needs populations, these shelters into the general area or do vulnerable populations tend to be segregated by themselves and not cared for.

That is a really good question and there is really a lot of controversy still going on related to that, because in one case you know I am a proponent as I think many people are that people who are most vulnerable should be supported along with their peers in a congregate shelter. And I think that there is probably a very mixed reaction that some people do that. Other people say, well, we have got to put people who are deaf together because of the communication issue. Or we have got to you know provide -- if they needed some special services and to provide segregated settings for that. In many cases they have separate places in shelters for those who need a different kind of bedding. There are lots of people for whom the normal cot is not sufficient. And so there is some planning for individuals, segments of the shelter which have support, different kinds of bedding different kinds of areas, even larger areas, which would accommodate a personal care attendant or an animal or service animal of some kind. So there is some differences.

I think what I hear is you getting to maybe one of the points I think is really, really hard. And that is you know in a congregate shelter, what about people who may be dangerous to others or themselves. But probably mostly to, you know to others. And should those people be allowed into a shelter? How are you going to identify that? Some real thorny issues that I think if I had the answer I would probably be rich. But I think those are issues that are still to be decided and are still out there.

Thank you.

Next question, please.

The next question.

Go ahead.

Hi.

Hi. Yes, I would like, I also consider dialysis patient in stage renal disease vulnerable population. And I would like to know was there some protocol in place or how did they respond to the patients that needed to be dialysized?

When you say they, are you speaking about a particular incident or just in general?

The actual patient that needs to be dialysized.

Uh-huh. Well, one of the things that I have worked with is some states in which they have identified locations that could provide dialysis during an emergency and have the equipment and support to be able to do that. And kind of centralize that with the understanding that maybe not all of the dialysis centers would be open. It is a big issue, because one it increases the amount of transportation and time and transportation. But I know that sometimes they are included in special medical shelters. Sometimes they may even be unique in terms of just providing that service to those individuals.

Okay. Okay. Thank you.

Uh-huh.

At this time I am showing no further questions. Again, if you have a question please press star 1.

Do you want to go ahead and go on?

Yeah, why don't we go ahead. I am going to go through a couple of areas in terms of sheltering in place and talking a little bit about evacuation. But then what I really want -- seeing as though we have about a half hour left I really want to focus on what some service providers and organizations can do in the planning process so I am going to go fairly quickly through this and so we can get into the planning process here.

There are a lot of issues with sheltering in place. One of those things as you can see on the slide is that many individuals can secure their own facility, their own house if they are trying to shelter in place. And you know we had that incident a while ago where the head of FEMA said well everybody should have duct tape and be ready to duct tape their house and there was a big guffaw about that and a lot of concern about it.

But things like that that may be something you could use to secure your own location may be difficult for a lot of people to do or may just not happen. The food and water storage continues to be a real issue for people because the replacement issue and trying to get those supplies in at all and then to try to keep them rotated become some real issues that continue to be worked at. And there are very logical models for doing that in terms of you know a regular rotation cycle that would be able to make sure things are in place.

The one thing I would just like to add to all of that is that there is a lot of concern about food and water storage but water is a good example. Water they say we can probably keep for a couple of years. But I guarantee if it was kept for three or four years, it may not, it may taste a little like plastic, but you know it is still usable and drinkable. And so one of the things I always say about preparedness is you are not going on a camping trip or vacation, you know. You are preparing for something to survive for a period of time. But just some logical structural things you can do at home make a big difference.

The big thing that we find, too, is that the issues with sheltering in place, whether the issues for sheltering in place whether it is an organization or an individual living at home that once a routine has been established for those individuals, it may be very difficult to get to change that. No I want to go out because it is time to go to work. Or you know there is a routine that has been established. And we know that that routine once it is disrupted may cause and elicit a whole lot of negative behaviors that we didn't really see when the routine was kept fairly standard.

Some of the things that happened to some of those houses when things are closed up and when things are -- for instance if there was a chemical release and you are instructed to try to keep your house as closed as possible the addition of respiratory problems that may come as a result of a defined space.

One of the things that we change to evacuation to look at some of those issues, we want to continue to look at is in terms of the critical care items that need to go with people. It is one thing as you saw in those pictures if you look at the slides early on. It is one thing to get people out but it is also important to get some things that may be crucial to those people's existence. For instance, durable medical equipment, having enough medication to last for long enough in order to be able to survive until you can get additional medications, special diet materials, special communication devices. All those things may be really crucial in terms of -- excuse me, they may be real crucial in terms of getting out and going with evacuation.

One of the things that we have seen with a lot of group homes and other congregate living places is individuals putting together go kits which they keep. I have seen some where they keep them in plastic trash cans and they put all of those things in there. Keep that for all of the people that may be going with them. Make sure all of these things are there. Medications will continue to be an issue. Mainly because of the way medications are dispensed in this country and the fact that you know there is - it is very difficult to stockpile any kinds of medications particularly those that may be riskier, so that you know there can be a few places for that. There are some models being tried out in terms of being able to get an additional month's supply and then you continually use the oldest month first. That hasn't been real successful in the public financing program. But sometimes a whole lot of programs may get samples. And while I can't really recommend it, I suspect that in some cases people are also getting some out of date medications that might in some cases be all right.

Big thing that -- excuse me, the big thing that is really going to really make a difference in terms of evacuation is the people who don't think about communicating where they are going, what is going to happen to them, and how for people to get in touch with them once they evacuate. In some cases people can't communicate and can't provide that information, but to find a way to make sure. I mean it might be as simple as leaving a note on the refrigerator saying I have gone with the rescuers and they are going to go to a certain shelter. Or it may be much more complicated than that.

If you will change to the next slide, talk a little bit about planning for disasters by service providers and advocacy organizations. And I think of all of the things we do, this is probably where we spend most of our time. And it is looking at the organizational planning that goes into creating a plan. We actually don't even use the term creating a plan. We talk about planning. Because it really is planning. It is not -- its end goal is not the development of a written plan although some things call for that. But it is really about making sure you take -- develop the planning and incorporate that into your day-to-day operations of an organization.

The next slide talks about readiness versus preparedness. And I think -- excuse me, the only thing that -- I think the real point I want to make here is that emergency preparedness personnel talk a lot about preparedness and they really talk about it as preparedness of the emergency professionals. And they really spend a lot of time talking about how they are all going to provide that rescue, if you will, that support. And that is an important part of this process. But what we are really talking about here is community readiness. The organization putting in their routines and then taking action and included in that action is crucial which is the practice of these particular activities to make sure that you can do it. They always say planning is only as good as the practice. And I think you are going to see if you have ever done any kind of an exercise or a plan that no matter what you plan for, it doesn't look like that when you try to carry it out.

On the next slide everyone, I have done, I have put together this readiness cycle and this is the materials at that we use as a basis for our planning documents. And there is really these segments which talk about one getting your leadership involved in this process. Selecting a readiness coordinator within your organization. Establish a working group. And assess the current state of readiness.

We have a template which we use which has identified 71 indicators of readiness for an organization and that becomes the first assessment, self assessment for organizations to look at and see how ready they are for a disaster. The second step is to go through readiness improvement actions meaning the ones that are most important first. Nobody can go through that process and do everything that probably needs to be done after they do an assessment but to really look at why are you -- where are you at most in danger and what are those things that really needs to be done. Maybe in some case it is even getting you some low hanging fruit that would allow you to get things done without a great of expenditures of money because money is hard to come by.

The identification meet the needs of the people you serve first and then secondly the staff of your organization you all know that if the staff isn't there you don't have an organization because we are all providing services. And it is all human services. And that some of the scenarios we talk about are during a disaster nobody shows up for work. We talk -- do we look at some of the pandemic scenarios going on right now that show that may be 50% of the workforce will be ill. And if that happens, you know that most of your programs can't even operate. So there needs to be some real decisions made about what you need in order to survive. What things have to take place, what other things can be put off or discontinued until the disaster is over.

I think if there is anything that I want to reinforce by this is that again that none of this is any good unless you try it, you train staff in order to do it and then you try it out. The training and the education part all involves one -- what we usually call exercises where you do a drill exercise practice and then learn from that and change this environment. Finally as you know it always comes up, people say and depending on what state you live in you may have a requirement in order to continue to do your service to be able to have a written plan. So there is a documentation component of that which kind of completes this circle in terms of what you need to do in terms of analysis then the mitigation to have a real disaster plan.

I think I will stop here again and I do apologize for my coughing. I don't know. All of a sudden I started talking and all I can do is cough. So I will take some questions now and see if there is any.

Sure. Carl, I have a question for you that was submitted through one of our other systems here. The question is: Are there chutes or ladders or specific equipment that would be available for others to use with people with disabilities? You know this person is using the term consumers. But I know there are many pieces of equipment obviously the evac chairs and things of that nature but what would you recommend for people who were looking at equipment or things of that nature you know or other sources. What do you have to say about that particular issue? There is a lot of talk about people using different types of equipment that are untrained. What would you have to say about that?

Well, I agree there is lots of equipment out there and lots of people ready to sell you some equipment many of which is very good and very useful. I think if we would use a little common sense and start to think about the way we get equipment for the other parts of our program. It that it makes some sense of you in terms of what really is needed. Getting the individual involved and helping to try to make that decision. Most of these companies will give you an opportunity to try it out. See if it works. Some of these things look really, really cool in the magazine but if you try to go downstairs with a stair climbing device or a sledge, it makes a big difference depending on the person you are dealing with.

Person, individuals who are very large it creates some really big issues in terms of a sled for going down stairs or evacuation. There is some really wild and exotic equipment that you saw after 9/11 they were talking about a big plastic chute that could go down many stories and it kind of looked like the Chinese finger handcuffs and you kind of slide down and it slows your dissent all the way down many stories. It doesn't look to me like most of those things have a very practical life span but when you are talking about evacuation chairs, evacuation sleds, my office, for instance, we have a number of people who have -- use power chairs in various ways and one of the things we know is we can get them down out of the building with a manual chair because we tried it and it works.

So you know I mean I think there is -- I think that equipment is available. You can go -- you can go online and see hundreds of companies that have material. I think the probably the question is trying to pick the right one but I would also encourage people to be sensible about that.

Okay. Great. Thank you. Any questions from the online - I am sorry, from the telephone?

I do have a question.

Go ahead.

I am here for my son, who has cerebral palsy. I have heard a lot of your speaking here since I have been here talking about the medical issues and things of that nature, one thing I haven't heard is the issue of security. We remember Katrina the horror stories that come out when they all went into the football stadium and some of the horrible things that happened to men and to women when they went into rest rooms but we know in natural disasters the criminal element is still going to work and is very fluent in what they do because that is what they do. You talked about the pandemic situation the situation of the police department. What if half of them had the pandemic flu or whatever it was and you didn't have the police, you didn’t have the security. The situation that they have talked a lot about on TV about the possibility of this electronic device that could be detonated over the United States that could shut down all the electrical systems where nothing electrical would work at all, who is going to provide the security or would we have to go back to a neighborhood watch where the neighborhoods would have to step up as they do now and neighborhoods where the crime is really bad and watch out for one another. Somehow, some way we have got to be able to do this ourselves and quit waiting for the government to pick up our backs and carry us on down the road. Thank you.

I think just in a quick response, I think you are bringing up a lot of issues that people think about, and are trying to deal with. Let me just for instance one thing that I think is always important to remember is that during Katrina, the reports coming out of New Orleans were horror stories of rapes and murders and et cetera in the Dome and you know in hindsight when all of it was all looked at, reviewed, there was not one major incident that they could point to in the Dome during that disaster. There was no, there was no rape. There was no killing. There was no none of those things which I heard myself on the radio so I guess in some respects we have to be a little bit careful because during a disaster there is lots of reports and everybody has a little bit different take on what is going on.

But it doesn't negate your concern that those security issues whether it is a shelter whether it is a security issue in terms of evacuations or whether it is you know the issues of just in general the breakdown of law and order are things that are probably not the total discussion here today but certainly involved in what we do. Because we have people who are vulnerable and they may be vulnerable in terms of not having the appropriate protection.

I don't know if that answers your question. But at least it is something to consider.

Okay. Thank you. I have got another question here online about what about someone with a service animal there has been lots of horror stories about them being left behind in New Orleans. I know you addressed a little bit about the service animals but are you seeing that the organizations you are working with are getting a better understanding of the whole issue of allowing people to be evacuated with their service animals and then also providing the appropriate sheltering that would be inclusive of service animals. Is that mindset changing?

That definitely has changed over a period of time. An what we are seeing now is not only is there general acceptable that service animals can be in the shelters, can stay on the job as much as necessary that there be additional locations for them to be housed when they are not in service. Because another thing has focused on this and that is the fact that almost everywhere in this country now any shelter that is opened up will have a facility for pets.

And I am not trying to equate service animals and pets. But the fact that they are considering animals, that there is food, you know, there is water, those things that animals need in order to survive, you know, will be taken care of. The reality in New Orleans was horrible for a lot of pets but there were a lot who ran away, there were a lot who got caught in the water. And there were lots of people down there trying to rescue animals for a long period of time and in some cases they were able to do that and in some cases not.

Okay. Great. Thank you. Are there questions from the phone?

The next question.

Hi, I am in North Carolina. How can disability support groups work with local and regional EMS to be more prepared? It is a two part question. Also are there local medical centers we should cooperate with?

All right. Let me see if I can take that first one, I don't know of any location where EMS would not more than welcome you know people from support organizations and individuals to try to work with them in terms of the planning process. There is a lot of planning to do. And there is a lot of areas in which the emergency management services are trying to deal with on a regular basis. And I think that I also find that what we find and that is we work with a lot of agencies who have banded together with other like agencies and other service providers to start the planning and develop them themselves. And so we find service providers from agencies which are exercising themselves, then they get together with some of the other service providers in their community and exercise together. Then the next step is that they start bring in emergency management and looking at a community wide exercises. So I think the opportunities are there to be able to do that. And I think that if you just -- if you read and look at the literature and the news, you are finding more and more interest in making sure that people who are most vulnerable are included in all segments of that planning.

Thank you.

Thank you. I have an online question here. Do you find a lack of communication between community service providers and emergency planners at the local and regional level? I think specifically service providers of people with disabilities.

The answer is yes. And I think that there has been a lot of positive change in terms of that direction. But I also think that there is still a lot of disconnect in terms of being able to really start the planning together and a cooperative planning.

One of the things that I think it is always important to remember is that the responsibilities put on them -- the responders in a community is huge. And I think there is not one responder that I have ever met who has said, I don't want to be in that role of helping people, that is why I signed up to be a responder was so that I could help people.

I think the reality of what we have to realize is they can't do it all. And they cannot in fact be everywhere during a disaster. We know if your house is on fire or you have a safety issue and you call 911, somebody is going to come and work with you. If it is 10,000 homes in your area, that is a very different situation. No one is coming for a period of time. And so that is why this -- whether it is your provider organization, your community, your support group, whatever it is to be able to start that planning and make sure you are as prepared as possible until some time that those people can get to you, if necessary.

Okay. Great. Thank you. Questions from the telephone?

The next question.

Hi.

That's okay. We will take everybody.

Hi, I haven't heard anything discussed on psychiatric or mental health disorders so if there is a protocol.

I think the question was that they have not heard anything specifically talked about in regards to working with people with psychiatric disabilities and protocols for those kinds of issues, is that correct?

Yes.

It is hard to hear so I am trying to see if I can help everyone hear the question.

It is another one of those areas where a lot of work is being started now. I don't know that you are seeing a great deal of work in all parts of the country. I just finished working with all of the -- with all of the mental health facilities in one state in terms of planning statewide and trying to provide those services.

And you know there are a lot of - there is a lot of questions. There is the questions that come up about forensic units. And you know what is the security issues that go on with individuals who are incarcerated and being mentally ill at the same time. And there is -- but in terms of that whole issue of individuals for whom the change in routine is going to be very difficult, I think that is something that every one of the support organizations that support people should be involved in. Because they are the experts. You go to emergency management agencies. And there they have certainly have very little experience in that area. But are really looking to the organizations that already understand the issues of mental behavioral issues and variable to be able to utilize that information to make the best decisions.

Okay. I know you have some more material to cover here and we are getting down towards the bottom of the hour. So I don't know if you want to go on at this point. And what you additionally need for the rest of your presentation at this point.

All right. I think that what I really was about to do, was going to do was try to take that diagram that I had talked about, this community disaster readiness cycle the planning for organizations and delve down more in detail.

There is a couple of things I would like to say that I think would be helpful. I understand from Robin that at the last slide for those of you who have slides has information about contact my organization. And looking for additional information, there is a couple of things that I think really -- may be really helpful there. One is the planner that we talked about is there for you to be able to look at in more detail. And get an idea of how you might go about that as a service provider organizations and do it for yourself. The whole intent is that you could do that without having people come in and do it for you or with you but a lot of people are already in the process of doing this planning. And this is just a way to be able to kind of make sure you are covering as many bases as possible.

Also on the web site that is listed there is a planner that I talked about which is an individual planner. Get an idea what it looks like and that it has as indicated before relatively low reading level, very straightforward. We have used it with all populations. And everybody likes it because it is understandable and very straightforward. That web site is www.inclusivepreparedness.org. That is inclusivepreparedness.org and there is a lot of other reference material there that might be really helpful in terms of finding additional resources for you and your organization.

Are there any other questions still out there?

I am sure there probably are. Operator, can you give us an idea?

Again if you have a question please press star 1.

Okay, I have a question from online. When a government entity mandates a mandatory evacuation, do they have any additional responsibilities or anything or specific responsibilities again when there is a mandatory evacuation to ensure that people with disabilities or those who lack transportation receive the assistance including cost of transportation, food, lodging, paying for that versus the person with a disability of paying for that. Is there anything that would be a difference between a mandatory evacuation versus a voluntary evacuation in that regard, as well?

Well, first of all, if it is an evacuation and even if it is a voluntary one, all of those that information, if you are going to a shelter, food is never charged or none of the resources that come from a shelter are charged to anyone. Those are all done by governmental agencies, providing the supports. Sometimes that is operated through a church organization. The Red Cross, and there is others. But these are no cost supports.

The other thing that is important to know that in the event of a disaster and once a disaster is declared by the government then you will also going to have the option for immediate financial support in order to exist over the short term and usually they are talking about FEMA payments. Also you know that FEMA provides housing for individuals who have lost their housing and finally we have got this resolve that there is such a thing as accessible housing and they need to make sure that there are units that are accessible, as well. And I think finally that point is -- has been taken care of, I hope. But generally there is not any requirement once you are evacuated to a shelter that isn't being provided by one of the agencies that do that support.

Okay. Thank you. Well, we are almost at the bottom of the hour. Are there any additional questions from anyone on the telephone at this point?

I am showing no questions.

Okay. Great. Well obviously there is a lot of information. And again people should have the slides that were provided by our Speaker. He said -- identified that the last few slides that we didn't go one by one by one on were basically just a reiteration of the overall chart that appeared on his power point slide. So for those of you that think we missed some information, he was just a further drilldown of that information which he did talk about. So just wanted to clarify that.

I want to thank Carl for your time for connecting with us internationally today from Toronto and good luck with your efforts and things up in that particular area. For all of you that have joined us today, again I want to thank you for participating in the program. You have the contact information for the Inclusive Preparedness Center if you would like to follow up with them, getting additional resources as well as information on this particular topic.

I want to invite everybody to look at the future sessions and whether or not you have interest in them. Our July 2009 session will be our annual update from federal agencies including the Equal Employment Opportunity Commission and the US Department of Justice. I anticipate just from what is buzzing around out there that we will hear some more definitive information from both EEOC and DOJ about the release of some recent of some regulations related to some activities they have been going on ADA Amendments Act as well as the pending Title II and Title III regulations, so stay tuned and join us on July 19th for that particular session.

I also want to draw your attention to, if you are not familiar with the other programs that are offered which includes, the legal webinar series that we have. Our June 30th 2009 is going to be a litigation update on Title III case law. If you have never looked at that program or aren't familiar with it, if you go to www.ada-audio.org website and choose the 2008-2009 Legal Webinar Series link, you will find the schedule for the legal webinars and again that is a June 30th session that is a 90 minute session that is running from 1 to 2:30 p.m. Central Standard time. So we invite you to explore that and join us, as well. So a couple of opportunities coming up.

The session today has been recorded. And an archive of this session will be available within the next ten business days on the ada-audio.org website. If there is information you want to go back to or you want to listen again or for others too. So again thank you very much for our Speaker. Thank you very much to our participants and I hope everyone has a good rest of their day. Thank you very much.

Thank you.

Ladies and gentlemen, that does conclude the conference for today. Again thank you for your participation. You may all disconnect.