Hell on Wheels

By Joseph Straw


Another part of the process is to engage with and educate the general population, a task that carries unique demands and challenges in the case of special needs populations. Here, as in the planning process, it’s important to leverage relationships with those organizations already serving the affected groups.
Sloan explains that his office directly engages stakeholders, such as the region’s home healthcare providers and device vendors. Those organizations can help the authorities by directly educating their patients and clients about individual preparedness and about what they can do and what they should expect when evacuation is necessary, he says. Another effective option is inclusion of emergency services literature with meals-on-wheels deliveries, experts say.
In New Orleans, government agencies faced the challenge of accessing and educating populations with limited access to news media, high illiteracy rates, and widespread skepticism about the motives of government and outsiders. Kiefer recalls the rumors within the city’s poor communities—shared by community activists testifying before Congress—that the city’s levees had been bombed to destroy poor neighborhoods and force out or even kill their residents.
The solution, Kiefer says, is “working through established trusted agents.” One example is Operation Brother’s Keeper, a program that predates Hurricane Katrina. Coordinated by the Southeast Louisiana Chapter of the American Red Cross, the program focuses on faith-based organizations in the city and region as agents for preparedness. Program staff and volunteers train faith-based organizations in disaster readiness and response, help them conduct emergency preparedness assessments of their own organizations, and recruit members to serve as volunteers in preparedness and response.
In diverse regions such as the Gulf Coast, where communities speak languages ranging from French dialects and Spanish to Cambodian and Vietnamese, communications must target residents in their native languages and through their own cultural organizations as well. Emergency managers can also use online social media to help get the word out.
The ideal practical solution to the challenge of identifying special needs populations would be a “database of databases” that aggregates volunteer registries, government social services rolls and private provider databases. This, however, is not feasible, given the privacy and data security implications of collecting data on people’s health and social welfare. In particular, private database “owners” fear—perhaps incorrectly—that they could be charged with violation of 1996’s Health Insurance Portability and Accountability Act (HIPAA), which carries heavy penalties for unauthorized sharing of confidential patient information.
The concerns have hampered special needs programs like the one in Arlington County, Virginia. That effort sought to combine social services databases for use in emergencies by transit agencies, specifically Specialized Transit for Arlington Residents, or STAR, the county’s service for mass transit accessibility, says Steve Yaffe, transit services manager for the Transportation Division of Arlington’s Department of Environmental Services. County social service agencies told program developers that they would not share data on residents for fear of violating privacy laws. That, combined with a dispute over intellectual property rights from the program between the federal grant agency and its software developer, doomed the effort, he explains.
Armstrong, of Kern County, California, relates similar experiences when seeking to leverage existing data about special-needs communities. When you ask for information, he says, “Everyone will say, ‘HIPAA’ and tell you ‘I can’t talk to you about that.’”
Kern County and a partner agency arrived at a workaround in one emergency, Armstrong says. In that case, a moderate power outage threatened residents who relied on electricity for household medical devices. By law, California’s PG&E had to have a database of those residents. During the outage, Kern County called the utility and requested data, including addresses, for customers that were at risk without power.
PG&E declined due to privacy concerns. The utility did, however, offer to call each at-risk customer affected by the outage, ask if they needed medical assistance, and provide those people’s addresses to the county. PG&E made the calls, found that fortunately none of its customers were in distress, and power was promptly restored.
While well-intentioned, PG&E’s handling of the situation was too restrictive, and its protection of the database in that case was not required by the law, Citarella of RBC says. HIPAA explicitly allows sharing of patient information during emergencies and responses, and perhaps more important, generally allows sharing of information “that’s needed for the care and treatment of the patient,” she says. “If you’re trying to evacuate someone in an emergency, that’s care and treatment of the patient.”
The utility’s handling of the situation illustrates the need for more education in HIPAA, Citarella says. Every stakeholder in emergency management should be trained in the fundamentals of HIPAA and when it’s legal to share information. Training exercises must emphasize critical thinking, she says, because in an emergency, imminent safety risks supersede regulatory compliance concerns.
Armstrong, meanwhile, proposes a separate solution that might also facilitate sharing in emergencies: legal waiver forms that when signed by the citizen, explicitly allow for sharing of personal information only in the event of an emergency, avoiding the privacy risks of routine access.
Nothing can bring back Banilda Caixida or ease the pain of loss of those who knew her. But combined efforts to apply the lessons learned from her tragedy, it is hoped, will help to prevent similar situations from occurring in the future.

Joseph Straw is an assistant editor at Security Management.
@ Read FEMA Documents Including the fnss guidance and various ada compliance guides via “Beyond Print."




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