Hell on Wheels

By Joseph Straw
For the disabled and their advocates, the story of emergency management begins with a woman named Benilda Caixeta. An immigrant from Brazil paralyzed by muscular dystrophy, Caixeta was a prolific volunteer and leader among disability advocates in her adopted hometown of New Orleans. Her efforts were well known and resulted in a citation for her work from then-Louisiana Governor Kathleen Blanco in 2004.
As Hurricane Katrina bore down on the U.S. Gulf Coast late in August 2005, Caixeta, 51, contacted an accessible transportation provider and made arrangements for a ride to a shelter. That ride never arrived. When the storm hit the city on August 29, Caixeta called various government agencies and friends seeking help. Soon, the levee containing the Industrial Canal running alongside her Ninth Ward neighborhood failed. A week later, Caixeta’s wheelchair and her dead body were found floating inside her home.
The aftermath of Hurricane Katrina not only redefined the scope of catastrophe for which authorities must prepare, it laid bare the stark consequences when the concerns of those with special needs are not addressed. These populations include the disabled, the elderly, those without access to automobiles, and those outside the reach of basic crisis communications. Assisting them, experts say, requires inclusive planning, exhaustive outreach, and an informed approach to privacy and federal disability law.

Who’s Included
The first step toward ensuring accessible evacuations is defining special needs populations, says Barbara Citarella, RN, president of RBC Limited and a consultant to the Federal Emergency Management Agency (FEMA) on serving special needs populations. It’s a more inclusive category than one might assume.
FEMA, in its National Incident Management System Resource Center glossary, defines special needs populations as “those who have disabilities; who live in institutionalized settings; who are elderly; who are children; who are from diverse cultures; who have limited English proficiency; or who are non-English speaking; or who are transportation disadvantaged.”
Advocates and government agencies increasingly use the term “accessibility” and “functional needs” populations to refer to both the disabled and the broader special needs population.
After understanding who meets the definition of a special-needs population, the next step is assessment. That includes identifying who fits within that population in a given jurisdiction, where they are located, and what their specific needs are. This task is challenging, and it is a job that is never done, says Mark Sloan of Harris County (Texas) Homeland Security and Emergency Management, which serves the Houston region’s 4 million residents. “You never really check the box and say you’ve completed that,” Sloan says.
Who. Identifying the special-needs persons within a jurisdiction and reaching out to them as a part of the planning process is critical. This is done in part through partners and stakeholders, including government agencies, charities, and healthcare institutions. Emergency managers must also remember to reach out to independent individuals who may not be affiliated with any of these stakeholder groups.
Individuals. To access individuals unaffiliated with partner organizations, many states and jurisdictions have developed opt-in registries for residents who require assistance in evacuations. While some emergency management veterans argue that those voluntary registries are a waste of time and resources, others use them and say they work.
Richard Devylder, senior advisor for accessible transportation at the U.S. Department of Transportation and former special advisor to the secretary of the California Emergency Management Agency, is one of those who sees no value in the opt-in registries. Because they are completely voluntary, he notes, they can only accumulate data from members of the special needs population who are aware of them and who are willing to share data, directly or indirectly, with government agencies.
Once a registry is established and populated with data, agencies face the ongoing task of keeping it updated. As Mike Evans, deputy director of the Mobile County (Alabama) Emergency Management Agency notes, a database is “only as good as the data that’s in it,” and contact information and personal circumstances often change between the time a person registers and when disaster strikes.
Still, an opt-in registry may be better than nothing. In Texas, the state Transportation Assistance Registry is coordinated by the United Way of Texas. The public registers through the state’s free 211 information line, which is administered by the Texas Health and Human Services Commission. The United Way compiles the information provided and forwards it annually to emergency management agencies at the county level. To ensure timeliness and accuracy, county agencies follow up by marketing the registry and taking steps to confirm the data periodically with residents.
For example, Galveston County, Texas, which covers the Gulf Coast areas of the Bolivar Peninsula and Galveston Island, including the city of Galveston, has roughly 3,000 county residents who have opted in, explains County Emergency Management Coordinator Charlie Kelly. Once each year, Kelly’s office calls every phone number in the registry. It’s a labor-intensive process but the results show how important the effort is: some years, callers find that only 10 percent of the numbers registered are still current.
In advance of hurricane season each year, county officials hold a huge public gathering to get the word out. To encourage attendance, the event is held on the beach and billed as “fun for the whole family.” Among the attractions is an aerial rescue demonstration by the U.S. Coast Guard, says Kelly. Attendees are reminded to update data in the registry and to have neighbors and relatives with special needs do the same.
When an evacuation is ordered in Galveston County—usually a couple days before a major storm is scheduled to make landfall—the county calls everyone in the special-needs registry and instructs them to report to designated embarkation points from where they will be transported on state buses to inland shelters.
If they are disabled or cannot make it to the pick-up point themselves, an accessible county transit bus will pick them up. And if the resident has special medical needs, first responders will pick them up and transport them via ambulance. The process was activated prior to the arrival of Hurricane Ike in September 2008, and it worked as planned, Kelly says.
After hard lessons learned from Katrina, New Orleans established a similar registry in 2008 as part of its City Assisted Evacuation Program (CAEP). The program contributed to a largely successful evacuation in advance of Hurricane Gustav in August of the same year. CAEP registration data, for example, was used to select locations for 18 evacuation transportation hubs in the city before Gustav, says John Kiefer, a public administration professor at the University of New Orleans who studies the city’s handling of mass evacuations post-Katrina.
Gustav was not without its problems and lessons-learned, Kiefer says. For example, registration for CAEP, which city residents can do either online or by dialing 311, was initially steady, but surged enormously as Gustav approached. Government phone lines devoted to 311 and CAEP were overwhelmed, Kiefer says. Officials learned that the city needed to more aggressively market CAEP to residents, emphasizing that they shouldn’t wait until a storm was imminent to register.
Additionally, when the city’s first responders and volunteers from the region’s organization canvassed the city to round up CAEP registrants who lacked access to transportation, many declined to leave because they had elderly or disabled relatives elsewhere who either refused to leave or had not arranged for transportation. A potential solution Kiefer suggests is organizing CAEP registry data based not on individuals or even households, but on families.




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