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Emergency Preparedness

Earthquake was management by the seat of the pants and lots of luck (that element when opportunity meets up with preparation)— Elsa Ramirez Brisson, Nutrition Manager, Monterey County AAA, Salinas, CA.

Annually, natural disasters occur through floods, tornadoes, earthquakes, and hurricanes, and some may be serious enough that they are Presidentially declared. This declaration brings to bear the resources of the federal government in order to restore the public facilities of a community and to assist individuals in restoring their lives. During such declared disasters, the Administration on Aging will disburse special funds to those State Units on Aging affected. Many more disasters occur on a smaller scale that are not of such scope and, therefore, are ineligible for a federal response. This often leaves older persons dependent upon their own individual resources and capabilities, which are often inadequate.

Besides natural disasters on a small or large scale, incidents may occur at congregate nutrition sites and senior centers, at a participant’s home, at an agency’s office, on an agency operated van, etc. If a participant or staff member encounters a problem, staff must be ready to respond by calling for emergency assistance and/or providing on the spot remedial treatment whether it is first aid or the use of the Heimlich maneuver. Programs must have participant information on hand to contact family, caregivers, or their physician if there is a medical emergency. Program staff needs to know what to do when they find a home delivered meal participant lying on the floor unable to move. Equipment breakdowns also require alternate plans whether it means transferring food from a non-working refrigerator to one that works or providing an alternate menu that requires no cooking. Evacuation procedures must be in place and practiced regularly in the event of a fire or other emergency that requires evacuation. Programs need to have a plan in place to notify participants of emergency situations such as floods, tornados, ice storms, etc.

The on-going activities provided by the Aging Network serves as preparation for an appropriate emergency or disaster response. Currently, many States require Area Agencies on Aging (AAAs) to develop disaster preparedness plans that deal with the process of disaster response. A key element to the disaster response strategy is disaster advocacy and outreach. Typically, agencies will expand or develop new services in order to meet identified needs. One of the services that may be established is "Disaster Advocate and Outreach Services". Over the years, this service has been identified as the most critical service that can be provided by the Aging Network for older disaster victims.

State Units on Aging, AAAs, and Indian Tribal Organizations play critical roles in disaster response. State Units on Aging (SUAs) must facilitate the flow of information, provide technical assistance and maintain momentum in service delivery and development of funding to support the needs at the local level and older adults in the community effected. For example, the SUA must assure that the AAA know when shelters are going to be open and their locations so that AAA staff can be present to facilitate assistance for older adults. The SUA must coordinate the flow of information so that appropriate state organizations, including the State Emergency Management Agency and the Administration on Aging know the status of older victims and assistance needs. (From the Administration on Aging’s Emergency Preparedness Manual for the Aging Network, 1995)

At the local level, AAA and provider staff may be responsible to coordinate emergency procedures with their respective Emergency Management Office (EMO) and be included in their local EMO plan. This may mean keeping staff and participants informed of the nature of the disaster and response. Congregate dining centers and other facilities operated by an AAA or provider may become a temporary shelter and/or food preparation site serving people of all ages. Plans for such assistance should be in place that includes the facility’s capacity to become a shelter, the type of food items to be available (e.g., soups, sandwiches, and beverages), and the responsibilities of staff and volunteers. It is important to be familiar ahead of time with the agencies that provide financial or material assistance and their reimbursement and documentation requirements. These agencies include the SUA, the State agency that administers USDA commodities, the Red Cross, and others. Such required documentation may include a log of food and disposable items used, a record of the number of meals provided and to whom, a telephone log, and a list of workers and volunteers and their time involved in an emergency.

Individuals dealing with emergency situations must be sensitive to the needs and capabilities of older adults in the planning and provision of emergency services. It is a good practice for the State Unit on Aging, AAA, and local providers to work with their emergency response agencies in developing guidelines to best serve older adults. The Administration on Aging’s Emergency Preparedness Manual for the Aging Network includes a summary of special concerns of older adults and this is included later in the text.

To learn more about how nutrition service providers have prepared for emergencies, a “Quick Survey” on the subject was distributed to the Aging Network via the Center’s Listserve and distribution lists in December 2001. This survey was developed with assistance from Marla Bush in the Disaster Relief section and Jean Lloyd of the Administration on Aging. A total of 19 responses were received and a number of individuals offered to share their expertise and written documents. The survey below, is presented as a checklist of items that should be addressed by SUAs, AAAs, and/or local providers. The responses, indicated by percent, provides a snapshot of where programs have and have not developed procedures for a particular emergency situation. Use this checklist to determine your programs’ level of emergency preparedness.

1) Written procedures are in place: (n=19)

To contact staff (eg, telephone and cell numbers, phone tree) (100%)
For weather-related emergencies. (100%)
To determine program closings. (90%)
To notify participants of program closings (eg, radio, telephone). (90%)
For facility and equipment breakdowns. (75%)
When individuals are hurt or become ill. (63%)
With emergency service agencies to assist in meal delivery, rescue, or other matters. (53%)
When key personnel are absent (eg, cooks). (50%)
For threat of harm (eg, bomb threats). (16%)

2) Staff is trained: (n=18)

In dealing with participants who experience a sudden illness or are involved in an accident. (83%)
In fire/building evacuation emergency procedures. (78%)
To treat participants who are choking (eg, Heimlich Maneuver). (72%)

3) In an emergency, available are: (n=16)

Alternative food/catering services (eg, restaurants, schools, hospitals, etc.). (69%)
Supplies such as water, portable radios, batteries, flood lights and flashlights, first aid kits. (50%)
Generators to power refrigerators/freezers and/or alternative cooler space. (38%)
The nutrition program’s foodservices plan to provide food to the community (eg, emergency shelters, senior housing). (38%)

4) To assist older adults in an emergency situation: (n=19)

Participant files include emergency contact or caregiver designee information. (95%)
Participants are provided printed information about the types of foods and other necessities to have on hand for emergencies. (84%)
Participants are identified ahead of time if they will need special assistance. (74%)
Shelf-stable meal packages are provided to selected congregate participants for future use. (58%)
Shelf-stable meal packages are provided to selected homebound participants for future use. (58%)
Participants requiring shelf-stable meal packages for emergencies receive them regardless of their funding source. (58%)
Staff checks on a regular basis to ensure that participants that received shelf-stable food packages have them available (that the meal packages were not used). (32%)
Information to access health care in emergencies. (26%)
Relocation information. (11%)

The number of responses to the survey was limited. Only 10 of the 25 procedures on the checklist were in place by 75% or more of the respondents. This snapshot of general program preparedness indicates that there are still many areas that require attention by programs. A number of individuals have shared their policies, procedures, and other documents as requested in the survey and these are listed below. Other federal agencies and organizations that provide for emergency services are also listed.

Resources

Utah State Division of Aging Bonnie Athas, Program Specialist. Emergency procedures and guidelines are available. Each Center is responsible for tailoring emergency plans in response to chemical spills, power outage/other utility problems, storms, civil disturbances, earthquakes, fire, flood, nuclear problems, and bomb threats.

Johnson County Area Agency on Aging (Olathe, KS) Linda Netterville, Nutrition Program Manager. Policies and procedures for center and kitchen staff are available to respond to emergencies. These procedures include staff communications, participant notification, criteria for closing centers and home delivered meal services, and the provision of emergency meals.

Cortland County Area Agency on Aging (Cortland, NY) Joyce Maney, former Nutrition Project Director is also a trainer for emergency response. Policies and procedures for the agency are available to respond to emergencies or disasters/critical incidents in coordination with other emergency management agencies within the county and state. These procedures include several important categories: (1) preparing for emergencies, (2) response to alerts and general response to emergencies and shelter needs, and (3) recovery.

City of Duluth Parks & Recreation Department (Duluth, MN) Kathleen Larsen, Senior Program Director. Small posters indicating the radio stations and other media that announce the status of Meals on Wheels and Senior Center closings are available.

Rochester-Monroe County Chapter, American Red Cross A group of older adults who experienced a two-week power outage when a massive ice storm hit the Greater Rochester, New York, area worked with their local chapter of the Red Cross (who is also a caterer for the Visiting Nurse Service Meals on Wheels program) in preparing information to assist in preparing for emergencies. http://www.redcross.org/disaster/safety/seniors.html

Monterey County Area Agency on Aging Elsa Ramirez Brisson, MPH, RD, Nutrition Manager Monterey County was the site of more than 6 nationally declared disasters from 1989-2000. Each time the areas hit the worst were in our agricultural area and many migrant farm families were displaced. Ms. Brisson continues to be active in the response and training of Department of Social Services managers that work with the Red Cross to manage shelters and other needed services. She lives within walking distance of the largest shelter location and is bilingual/bicultural.

The Monterey County Nutrition Program is prepared to assist the community in a crisis. They know where some of the frailest older adults reside and have a network that can reach them. All central kitchens are on the A list for power and most have generator back-up.

“Just in Case Kits” is an on-going program for home delivered meals participants. Shelf stable meals are replenished each June or after use. The food packs are purchased from Sun Meadows Foods. The program also assisted the Red Cross with redesigning the "File of Life" or what used to be called the “Vile of Life.” It includes a leaflet in a pouch that sticks to the refrigerator with a magnet. The leaflet holds a person’s medication and health information. EMS personnel are trained to look on the refrigerator when arriving to assist someone especially a senior. http://www.aaamc.org

Links and descriptions of many projects funded by the Red Cross and provided by the aging network are available at www.prepare.org.

Council of Senior Centers and Services of New York City, Inc., Igal Jellinek, Executive Director, presented suggestions on emergency preparedness with particular reference to the September 11,2001 terrorist attack at the National Association of Nutrition and Aging Services Programs Conference (Salt Lake City, June, 2002).

Ensure staff backs up all its essential computer files on a regular basis and keep a copy in two different places.
Ensure that restaurants in the area are willing/able to provide emergency food.
Maintain a list of volunteers who are willing to help in an emergency.
Work with local law-enforcement and community-planning agencies to create a secure photo ID system for professional health care and senor service workers that will enable them access to your facility in an emergency.
Work with local officials to develop contingency plans for moving people (including those in wheelchairs), emergency supplies, and medication. Have seated canes and evacuation chairs available for those less mobile.
Develop a network of emergency pharmaceutical services that includes the means to both fill medications and get them to those who need them.
Upgrade communication systems (including trunks of phone lines and emergency response systems) and develop “redundancy” communication plans, including instructions on the use of emergency communications products and tools and back-up services. Staff should have cell phone numbers, two-way radios, etc., to communicate.
Contact clients and staff immediately and as continuously as possible: ensure that people do not feel isolated or abandoned and have the means to communicate with the outside.
Teach staff to remain flexible in terms of implementing emergency-preparedness plans, making sure to adopt to the nature and site of the disaster/emergency.
Understand that staff may feel a need to offer help and to be helped; offer group discussion sessions, and if possible, allow staff release time for volunteering.
Provide crisis counseling for older adults, caregivers, and staff. Older adults can be a resource as they lived through many wars which makes them more familiar with disasters and better to cope with the situation. Be aware and work with mental health services who may not be accustomed to working with older adults.
Be aware and provide for the needs of individuals who are visually impaired and/or deaf or who have other special needs. Maintain a list of who needs help in coops, apartment buildings, shelters, etc.
Ensure that individuals have adequate water and food on hand
Ensure that individuals have adequate shelter, toilet facilities.
Be prepared and make it an opportunity to connect with other agencies. Plan fund raising events for emergency supplies and equipment.
Ensure that an individual’s pet(s) is taken care as some individuals may refuse to leave without their pet.

JA Foodservice Corp Jackie Abbott, President, and Roger Whitfield, Vice President, presented suggestions on emergency meal services at the National Association of Nutrition and Aging Services Programs Conference (Salt Lake City, June, 2002).

Have at least 3 days worth of food on hand.
Food purveyors may provide freezer/cooler trucks for emergencies. Ask them for support and product discounts.
Kitchen may use dual power sources such as gas and electric. Determine value of having back-up generators or know where to lease one in an emergency.
Have Sterno on hand, coolers and blue ice, disposable pans and utensils. “Heater meals” heats itself and includes an entrée and vegetable ($3.25-3.75). Used primarily by truckers and campers.
A number of companies prepare and package shelf stable meals.
Ensure that your food supplier is prepared.
Include emergency plans in service contracts / RFP.

Administration on Aging Website has a dedicated section “Disaster Assistance Resources for Practitioners and the Aging Network,” that provides numerous resources and links to agencies involved in this effort. http://www.aoa.dhhs.gov/disaster/network/default.htm

Federal Emergency Management Agency FEMA advises on building codes and flood plain management, teaches people how to get through a disaster, helps equip local and state emergency preparedness, coordinates the federal response to a disaster, makes disaster assistance available to states, communities, businesses and individuals, trains emergency managers, supports the nation's fire service, and administers the national flood and crime insurance programs. http://www.fema.gov/

American Red Cross Provides numerous resources and advise on topics such as terrorism--preparing for the unexpected, power outages, family disaster planning, and special needs and concerns with additional information for older adults and people with special medical concerns that could hinder mobility during a disaster. http://www.redcross.org/services/disaster/beprepared/

US Department of Agriculture, Extension Disaster Education Network The EDEN links members from across the U.S. and various disciplines -- so they can use and share resources to reduce the impact of disasters. EDEN has resources covering food safety to field safety, physical and psychological needs, governmental process and community development. http://www.agctr.lsu.edu/eden/

Department of Health and Human Services: Office of Emergency Preparedness

OEP has the Departmental responsibility for managing and coordinating Federal health, medical, and health related social services and recovery to major emergencies and Federally declared disasters including: natural disasters, technological disasters, major transportation accidents, and terrorism. http://www.oep-ndms.dhhs.gov/

Department of Transportation - Office of Emergency Transportation The OET performs coordinated crisis management functions for multimodal transportation emergencies, including: natural disasters, technological incidents / accidents, labor strikes, security situations, such as domestic criminal acts or international terrorist acts, and national defense mobilization. http://www.rspa.dot.gov/oet/oet/

Small Business Administration Provides information on disaster recovery loans and grants and financial assistance for older disaster applicants. http://www.aoa.dhhs.gov/disaster/recovery.html

Center for Disease Control Provides public health emergency preparedness and response information. http://www.bt.cdc.gov/

Job Accommodation Network (JAN) Published Emergency Evacuation Procedures for Employees with Disabilities intended to provide an overview of emergency procedures for employees with disabilities. The Americans with Disabilities Act of 1990 (ADA) requires that employers, public services, and public accommodations and services operated by private entities modify their policies and procedures to include people with disabilities. Though individuals with disabilities may have specific needs and concerns, all employees will benefit from knowing workplace safety features and emergency procedures. Because some individuals with disabilities require a personal attendant or job coach, it is important that these individuals are also consulted. In addition, many workplaces contract with cleaning crews, security guards, and other services that may have employees with disabilities on staff. http://www.jan.wvu.edu/media/emergency.html

JAN's Searchable Online Accommodation Resource (SOAR) is available at http://www.jan.wvu.edu/soar and is designed to let users explore various accommodation options.

Summary of Special Concerns (From the Administration on Aging’s Emergency Preparedness Manual for the Aging Network, 1995)

SENSORY DEPRIVATION - Older persons' sense of smell, touch, vision and hearing may be less acute than that of the general population. A hearing loss may cause an older person not to hear what is said in a noisy environment or a diminished sense of smell may mean that he or she is more apt to eat spoiled food.

DELAYED RESPONSE SYNDROME - Older persons may not react to a situation as fast as younger persons. In disasters, this means that Disaster Application Centers may need to be kept open longer if older persons have not appeared. It also means they may not apply for benefits within specified time limits.

GENERATIONAL DIFFERENCES - Depending on when individuals were born, they share differing values and expectations. This becomes important in service delivery since what is acceptable to an 80 year old person may not be acceptable to a person 65 years of age.

CHRONIC ILLNESS AND MEDICATION USE - Higher percentages of older persons have arthritis. This may prevent an older person from standing in line. Medications may cause confusion in an older person or a greater susceptibility to problems such as dehydration. These and other similar problems may increase the difficulties in obtaining assistance.

MEMORY DISORDERS - Environmental factors or chronic diseases may affect the ability of older persons to remember information or to act appropriately.

TRANSFER TRAUMA - Frail older persons who are dislocated without use of proper procedures may suffer illness and even death.

MULTIPLE LOSS EFFECT - Many older persons have lost spouse, income, home, and/or physical capabilities. For some persons, these losses compound each other. Disasters sometimes provide a final blow making recovery particularly difficult for

older persons. This may also be reflected in an inappropriate attachment to specific items of property.

HYPER/HYPOTHERMIA VULNERABILITY - Older persons are often much more susceptible to the effects of heat or cold. This becomes more critical in disasters when furnaces and air conditioners may be unavailable or unserviceable.

CRIME VICTIMIZATION - Con artists target older persons, particularly after a disaster. Other targeting by criminals may also develop. These issues need to be addressed in shelters and in housing arrangements.

UNFAMILIARITY WITH BUREAUCRACY - Older persons often have not had any experience working through a bureaucratic system. This is especially true for older women who had a spouse who dealt with these areas.

LITERACY - Many older persons have lower educational levels than the general population. This may present difficulties in completion of applications or understanding directions.

LANGUAGE AND CULTURAL BARRIERS - Older persons may be limited in their command of the English language or may find their ability to understand instructions diminished by the stressful situation. The resulting failure in communication could easily be further confused by the presence of authoritarian figures, such as police officers, who may increase the apprehension and confusion in the mind of the older person. A number of seniors speak languages other than English, and there is a critical need to be sensitive to language and cultural differences. This could mean older persons in this category will need special assistance in applying for disaster benefits.

MOBILITY IMPAIRMENT OR LIMITATION - Older persons may not have the ability to use automobiles or have access to private or public transportation. This may limit the opportunity to go to the Disaster Application Center, obtain goods or water, or relocate when necessary. Older persons may have physical impairments which limit mobility.

WELFARE STIGMA - Many older persons will not use services that have the connotation of being "welfare." Older persons often have to be convinced that disaster services are available as a government service that their taxes have purchased. Older persons need to know that their receipt of assistance will not keep another, more impacted, person from receiving help.

MENTAL HEALTH STIGMA - Similar to welfare stigma, older persons often feel ashamed that they may experience mental health problems. These attitudes must be addressed individually if older persons are to receive mental health care.

LOSS OF INDEPENDENCE - Older persons may fear that they will lose their independence if they ask for assistance. The fear of being placed in a nursing home may be a barrier to accessing services.

Contributors

Jackie Abbott, President, and Roger Whitfield, Vice President, JA Foodservice Corp., 377 Riford, Benton Harbor, MI 49022 (616) 926-2800 or JLAbot@jrpack.com
Bonnie Athas, RD, Program Specialist, Division of Aging and Adult Services, 120 North 200 West, Suite #125, Salt Lake City, UT, 84103; (801) 538-3925 or bathas@hs.state.ut.us
Elsa Ramirez Brisson, MPH, RD, Nutrition Manager, Monterey County AAA, 1000 S. Main, Suite #211-A Salinas CA (831) 755-8495 or elsard@redshift.com
Igal Jellinek, Executive Director, Council of Senior Centers and Services of New York City, Inc., 49 West 45^th Street, 7^th Floor, New York, NY 10036; (212) 398-6565, ext. 225 or ijellinek@cscs-ny.org
Kathleen Larsen, Senior Program Director, City of Duluth Parks & Recreation Dept. 12 E. 4^th Street, Duluth, MN, 55805; (218) 723-3724 or klarsen@ci.duluth.mn.us
Joyce Maney, former Project Director, Cortland County AAA, 60 Central Ave., Cortland, NY 13045 (607) 753-5060
Linda Netterville, MA, RD, Nutrition Program Manager, Johnson County Nutrition Program, 11875 S. Sunset, Suite #200, Olathe, KS, 66061; (913) 447-8119 or linda.netterville@jocoks.com

References:

Emergency Preparedness Manual for the Aging Network. March, 1995 - Produced under the Direction of the US Administration on Aging, Fernando M. Torres-Gil, Assistant Secretary for Aging, the Kansas Department on Aging, Joanne Hurst, Secretary, Alicia Valadez Ors, Director. Accessed 4/30/02 at. http://192.168.10.130/disaster/manual/atitltoc.html

Compiled by Lester Rosenzweig, MS, RD, and staff of the National Policy and Resource Center on Nutrition and Aging, Florida International University, Miami, FL.
Contact: nutritionandaging@fiu.edu

This project is supported, in part, by a grant from the Administration on Aging,
Department of Health and Human Services (DHHS). Grantees undertaking projects under government
sponsorship are encouraged to express freely their findings and conclusions.
Points of view or opinions do not, therefore, reflect official DHHS policy.