EVACUATION PLANS OF FULL TIME WHEELCHAIR USERS WITH SPINAL CORD INJURIES

N A T H A N H O G A B O O M

D E P A R T M E N T O F R E H A B I L I T A T I O N S C I E N C E A N D T E C H N O L O G Y

U N I V E R S I T Y O F P I T T S B U R G H

H U M A N E N G I N E E R I N G R E S E A R C H L A B O R A T O R I E S

V A P I T T S B U R G H H E A LT H C A R E S Y S T E M

CO-AUTHORSMichelle Oyster HERL University of Pittsburgh PM&R

Melissa Riggins University of Arkansas for Medical Sciences

Michael Boninger HERL University of Pittsburgh PM&R

BACKGROUN

D

Natural disasters are becoming more common1

Hurricane KatrinaHaitian Earthquake

Recent efforts to improve preparedness2

People with disabilitiesLarge percentage with locomotive and/or functional impairments3

Problematic during evacuation4

~273,000 people with SCI5

Mobility limitations that could make it difficult to evacuate effectively

McClure, et al.6

487 full-time wheelchair users (WCUs) with SCIWhether or not they felt they could safely evacuate

64% had plans from home, 31% from towns/cities

PURPOSE & HYPOTHESIS

How effective were their plans?

What was missing from their plans? Identifying missing elements will provide information on how preparedness in this population can be improved

Hypothesis:Evacuation plans would be missing critical elements Indicates previous study6 overestimated preparedness of people with SCI

METHODS

Participated in McClure, et al.6

University of Pittsburgh Model Center on SCI Wheelchair users at least 1 year post SCI

Phone interview and transcription No warning – simulate emergency situation Open- and closed-ended questions about evacuation plans

Open: detailed evacuation plans from each location Closed: frequency of practice, human/technology assistance,

levels/stories in building

10 criteria for optimal plans derived from preparedness checklists

Scoring system applied to transcriptions Each plan given a score 0 – 10

Critical Elements derived from Emergency Preparedness Publications7-9

Escape routes (exits, building stories, distance to travel)

Personal Support Network communication – Before

Personal Support Network communication – After

Supplies/supply kit

Transportation

Assistance needed (human or technology)

Meeting place/temporary shelter

Vital records and documents

Ability to give clear, concise, and detailed directions to emergency personnel

Practice plan

DERIVED FROM FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA)7, AMERICAN RED CROSS (ARC)8, CENTER FOR DISABILITY ISSUES AND THE

HEALTH PROFESSIONS (CDIHP)9 EMERGENCY PREPAREDNESS PUBLICATIONS

RESULTS

47 participants selectedData from 20 usedNo difference in groups

20 with plans from home, 10 from towns/cities

All who reported a town plan had a home plan

Those with high scores in one had high scores in the other

r = .882, p = .001

Black: home plansGrey: town/city plans

MEDIAN OF 3 CRITERIA MENTIONED IN BOTH LOCATIONS

LIFTING DEVICES WERE THE MOST COMMONLY USED AT

Black: home plansGrey: town/city plans

DISCUSSIO

N

Evacuation plans missing critical elements

From homes: Most participants mapped escape route, defined assistance, and

gave clear and concise directions Fewer mentioned personal support network communication,

supplies, or vital records/documents

From towns/cities: Similar to home plans Most mentioned accessible transportation Few able to give clear and concise directions or had practiced plans

Forethought being put into evacuation preparedness

Critical elements are being omitted

WHAT NEXT?Consult evacuation preparedness literature: FEMA7, ARC8, CDIHP9

Report of the Online Forum on Disabled and other Vulnerable People in Natural Disasters – World Bank Disability & Development Team10

Importance of personal support network communication Network of friends, family, neighbors, co-workers, etc. People who will plan before and help during an evacuation One of the first steps in creating a plan Recommended one for every location where a lot of time is spent

School, work, home, etc. At least 3 members7-9

WHAT NEXT?

Assistive Technology Necessary in the planning process Lifting devices needed if individual cannot lift him or herself

independently Accessible vehicles or transportation Able to give directions on AT use to emergency personnel

Educational efforts targeting people with disabilities, their personal support networks, and emergency personnel

Fill gaps in evacuation plans Proper use of vital AT

MORE INFORMATION

Evacuation preparedness in full-time wheelchair users with spinal cord injury. Journal of Spinal Cord Medicine 2013;36(4):290-295.

NSH15@pitt.edu

REFERENCES1. Guha-Sapir D, Vos F, Below R, Ponserre S. Annual Disaster Statistical Review 2010: The Numbers and Trends. Brussels:CRED;

2011. p. 12-3.

2. Nelson C, Lurie N, Wasserman J, Zakowsi S. Conceptualizing and defining public health emergency preparedness. Am J Public Health 2007;97(S1):S29-S11.

3. StatsRRTC. Annual disability statistics compendium: 2010 [document on the Internet]. 2010 [updated 2010; cited 2013 Oct 14]. Available from http://disabilitycompendium.org/pdf/Compendium2010.pdf

4. Bethel JW, Foreman AN, Burke SC. Disaster preparedness among medically vulnerable populations. Am J Prev Med 2011;40(2):139-43.

5. National Spinal Cord Injury Statistical Center. Spinal cord injury facts and figures at a glance. J Spinal Cord Med 2013;36(2):170-171.

6. McClure LA, Boninger ML, Oyster ML, Roach MJ, Nagy J, Nemunaitis G. Emergency evacuation readiness of full-time wheelchair users with spinal cord injury. Arch Phys Med Rehabil;92(3):491-498.

7. FEMA. Preparing for disaster for people with disabilities and other special needs [document on the Internet]. 2004 [updated 2004; cited 2013 Oct 14]. Available from http://www.fema.gov/library/viewRecord.do?id=1442.

8. American Red Cross. Disaster preparedness for people with disabilities [document on the Internet]. 2006 [updated 2006; cited 2013 Oct 14]. Available from http://www.redcross.org/museum/prepare_org/disabilities/disability.pdf

9. Center for Disability Issues and the Health Professions. Emergency evacuation preparedness: Taking responsibility for your safety, a guide for people with disabilities and other activity limitations [document on the Internet]. 2002 [updated 2002; cited 2013 Oct 14]. Available from: http://www.cdihp.org/evacuation/emergency_evacuation.pdf.

10. World Bank Disability & Development Team. Report of the online forum on disabled and other vulnerable people in natural disasters. 2006 May 22-June 9; online discussion. Published December 2006 [document on the Internet]. Available from http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALPROTECTION/EXTDISABILITY/0,,contentMDK:20922979~pagePK:210058~piPK:210062~theSitePK:282699,00.html.