As recent disasters have grimly illustrated, many more groups fall into this classification, such as the economically disadvantaged, non-English speakers and chronically ill citizens.
In the wake of Hurricane Katrina -- which offered a powerful example of how a large-scale disaster impacts vulnerable populations -- emergency management officials and others seek ways to better protect these citizens during a crisis.
Who Are You?
Health and Human Services Secretary Mike Leavitt and Department of Homeland Security Secretary Michael Chertoff cosponsored a conference in late June on Emergency Management and Disability and Aging Populations because improving emergency preparedness response and recovery for people with disabilities -- and for the nation's seniors -- is one of the top priorities for both departments, and for the entire field of emergency management, Chertoff said during the conference.
"The issues involved affect a large proportion of our population, and groups that are unfortunately sometimes overlooked in our society," Chertoff said at the conference. "As we look back on the impact of Katrina and Rita, we know a disproportionate number of the fatalities were people above the age of 65 and people with disabilities who were unable to evacuate quickly."
While it's true the elderly, people with disabilities and children are more likely to suffer in a disaster situation, they are often joined in their suffering by "regular" people who are barely scraping through life.
"There's a variety," said Barb Graff, director of Emergency Management for Seattle. "Some of those would be English-as-second-language, economically disadvantaged, limited mobility, elderly, physically disabled, cognitively impaired, those in need of assisted living, and medically fragile -- people who depend on ventilators, respirators, dialysis, folks for whom water or power would make a big difference, diabetics in need of an ongoing supply of insulin, or the increasing population of those with autoimmune deficiencies. And I'm sure I'm missing somebody in there, but those are kind of the primary categories we're looking at."
Anyone ill-prepared is vulnerable -- a scenario common to those on fixed incomes, said Fred Smith, managing director of HOPE Coalition America (HCA), a program of nonprofit relief organization Operation HOPE, which assists with predisaster preparation and post-disaster financial management issues.
Smith said people on fixed or low incomes can be among the most vulnerable in a disaster. "Depending on their geographic area, typically more of them are vulnerable, and that was certainly the situation in Katrina," he said. "Fixed-/low-income -- they typically do not have substantial savings, or any savings, to sustain them. If their normal lives are disrupted, they have little resources. The other vulnerability is they typically use public transportation and lack the capability to evacuate on their own."
Quantifying the Unknown
The criticism leveled at the government following Katrina was that it was unprepared to manage the response. It is likely much of the government's trouble in responding was due, at least partly, to the difficulty of identifying vulnerable citizens.
"It's hard to quantify who you haven't been in touch with if you don't know someone's there," Graff said. "We have a Human Services Department in the city that's very progressive in trying to reach out on a daily basis to meet the needs of the vulnerable population." And as long as people get into any kind of a system of support through the Human Services Department -- whether that's getting signed up for food stamps, case management services or programs for the elderly -- Graff's department has a way of knowing what their needs are and can plan for them.
"And once you get into a system or program, it's more likely we'll be able to take care of people's needs," Graff said. "The hard thing is to be able to research and quantify how many people are out there and not within the system yet."
Evolving privacy laws and other regulations make it difficult to locate citizens who may need help, said Ellis Stanley, Sr., general manager of the Los Angeles Emergency Preparedness Department. Early in his 32-year career, he said, it was relatively easy to obtain information on homebound individuals or the hearing impaired, for example.
"We could do programs in which we reached out and touched them," he said. "Now we have a different challenge with the privacy laws, and laws public health has to adhere to, or social services. It's harder now for us to get that."
Stanley advocates a rule change that would make it easier for first responders to get information on vulnerable citizens. Citizens currently must agree to release information -- an option many aren't even aware they have. Otherwise, the data is not available to the Emergency Preparedness Department.
"Right now most people don't know they can say, 'We want emergency management officials to have this information so they can plan and keep me in the process.' So I want people to have to physically opt out -- sign something saying, 'I don't want you all to have that information,' as opposed to it automatically means that emergency responders can't get it," Stanley said.
Stanley's department also is working on creating a new position -- a special needs emergency planner -- that will work in conjunction with the Department of Disability.
Everyone at the Table
According to Ana-Marie Jones, executive director of Collaborating Agencies Responding to Disasters (CARD), an organization working with community groups to coordinate disaster response for vulnerable citizens, part of the problem is the singular nature of the messages sent by those campaigning for disaster preparedness.
"The messages given out through government and traditional sources are very much written for American, healthy middle-class people," Jones said. Very little information is geared toward people who don't fall into that category, she said, adding that the whole idea of everyone in the country being told to buy kits, have a plan and get training is fine only for people who have money and access.
"But for anybody else, that message is pretty close to useless," Jones said. "It's the fact that we tend to put out a singular message -- just a single message -- saying, 'Do A-B-C,' without any true awareness about how different messages are interpreted by different populations. In disasters, this has huge implications."
The typical preparation message instructs citizens to have a supply of food, water, blankets, a battery-powered radio ... the same list we've seen a million times for countless different disaster scenarios. That message is echoed in government documents at every level, from federal agencies to schoolhouse clipboards.
But what does that preparation list mean to someone who is blind or in a wheelchair, or even a healthy person who is simply down on his luck? How do such people afford these preparations? How do the disabled and elderly get to the store for these supplies? Where do you turn for the information in the first place?
Jones believes community and faith groups are the answer.
"I'd focus on how we connect all the different community groups and faith organizations," she said, pointing to San Leandro, Calif., as an example of a community-based disaster response. Any nonprofit in San Leandro that receives city funds is considered part of the disaster response effort. "Those agencies actually take disaster training courses. They have disaster preparedness as part of their mindset. So they are active in doing things to make sure culturally competent services and messages are available for their constituent base."
Los Angeles' Stanley said the city has residents of every religious faith, and as Jones suggests, the Emergency Preparedness Department connects with vulnerable populations through those groups. "We work with those organizations to help them better understand what our needs are," he added, "so they can actually talk with their congregations and encourage them to sign up for programs like SNAP."
SNAP -- special needs awareness planning -- is an up-and-coming GIS platform Los Angeles emergency planners will be able to use to identify the vulnerable on a broader scale. Special needs residents can register online -- where they are, what needs they have -- which helps in planning.
"Say we're going to have to deal with a shelter in a particular area, if we've got so many people with motorized wheelchairs, we might need to make sure we have enough power there that they can charge those wheelchairs," Stanley said. "If we've got an area where we know we've got people on life support, it may necessitate us to do appropriate planning to address that in the planning process."
In Seattle, Graff said the Human Services Department, which does a wide variety of things on a daily basis to attend to the vulnerable population, is one way the city has taken vulnerable citizens into account.
"We do contract with a wide variety of nonprofit and social services agencies to try to meet people's needs on a daily basis," she said. "And again, as long as we know about them through a program relationship beforehand -- if we're serving a certain number of meals to the hungry, or shelter to the homeless, or mental health counseling services to those who need it beforehand -- we have a good idea that's going to be necessary during and after a disaster as well."
What Graff's department hasn't had the resources to do thus far is figure out who else is out there -- vulnerable citizens who aren't yet in the system. "So we're working right now with our local public health department, which has created an entire initiative and funded a position to help identify the needs of vulnerable populations in the city. We're partnering up. We've asked everyone who does public education on our behalf to work with that full-time position, that program, to help identify who, in what numbers, are our special needs population, and what can we do to help them."
One key to addressing vulnerable populations is bringing everyone to the table, Stanley and Graff both said.
"We need to be working with caregivers, case managers, the public health department, hospitals, home nursing services and folks like that to be able to say, 'How do we marshal all our resources so we're using them all in the best possible way?'" Graff said.
And Stanley said that ultimately, he wants to include planning for vulnerable populations in the exercise process, citing a training event where the Emergency Preparedness Department gathered 60 to 70 sign language interpreters. The idea is that when there's a disaster, they're already familiar with how to help. "When we have an emergency and we need people there who can sign, they've already been part of that planning process, part of that exercise process, and then incorporated into the response process."
Planning is just a necessary part of the process, Stanley said. "And we have to make sure we're not planning in isolation -- that we have the vulnerable population at the table, so they understand what roles and responsibilities they have, and equally important is their caregivers. The caregivers are the ones who become their first line of defense when an emergency comes because [they are] their first line of defense on a daily basis."
You can't wait to provide these kinds of services until after the disaster, Graff said. "So the more you do before the disaster on a daily basis to try to meet your vulnerable population's needs, the easier it's going to be to deal with that in case of a disaster."
