Emergency Preparedness for Frail Elders
By David Surface

Effective preparation for older adults in emergency situations requires prioritizing tasks and planning for a variety of circumstances.

Of all the people who suffered in the wake of Hurricane Katrina, perhaps the hardest hit were older and infirm adults. Many older adults died in their homes as flood waters advanced, while many others considered safe within nursing homes suffered from dehydration and other medical problems. Still other elders relocated to the now-infamous evacuation site waited for days to receive the basic care and supplies they needed.

Far from being a unique, isolated event, the confusion and destruction wrought by Hurricane Katrina serve, for some experts, as a sign of things to come. The general aging of the population, combined with what many see as our increased vulnerability to natural disasters, set the stage for a future in which emergency/disaster preparedness for older adults is imperative.

Setting Priorities
A 2008 statement by the World Health Organization asserts that in a catastrophe or disaster, emergency management teams should make the support of older adults a primary goal. Two professionals working as advocates to improve emergency response to protect “the frail elderly” in disaster situations are Susan Smith, EdD, MSPH, of Indiana University, director of the Heartland OSHA Training Institute Education Center at Bloomington, and her colleague, Mary Jane Tremethick, PhD, RN, CHES, of Northern Michigan University.

Smith and Tremethick identify the frail elderly as adults over the age of 60 who are suffering from age-related physical and mental deterioration to such an extent that their ability to recognize and respond to a disaster may be compromised. Another factor affecting these older adults is that many of them also suffer from economic hardships and social isolation, further impacting their ability to deal with a disaster or emergency situation.

Tremethick emphasizes the importance of informal community networks in assuring the safety of older adults during a disaster or emergency. “I was in a very small rural community, and the person I was working with told me, ‘Our firemen know where every single older adult in our community lives.’” Tremethick recalls. “That was in a population of about 1,000 people. Can you imagine how difficult that would be in a large city?”

Smith points to the disproportionate number of deaths between older men and older women during the 1995 Chicago heat wave as an example of the importance of informal community networks in a disaster situation.

“In the Chicago heat wave, more elderly men died than elderly women,” Smith points out. “That’s because elderly men tended not to have the kind of social network that elderly women had.”

Partnering for Effectiveness
Both Smith and Tremethick agree that an interdisciplinary approach is the key to effective emergency/disaster preparedness. They advise institutions that care for elders, such as hospitals and nursing homes, to develop emergency plans that involve not only the personnel at the institution but also community emergency personnel.

“You also need to involve the emergency personnel in your community, the first responders,” says Tremethick. “Make sure they take part in fire drills and evacuations.”

Involving emergency personnel in drills gives first responders a firsthand look inside the facilities that may prove vital later. “It lets the emergency responders inside of these facilities,” says Tremethick, “so they can see what the specific challenges might be in the event of a real emergency.”

When engaged in emergency/disaster planning, institutions that serve older adults need to communicate not only with the emergency personnel in their communities but also, when possible, with other similar institutions. Smith highlights one important example: “During Hurricane Katrina, several nursing homes planned to use the same ambulance company in the event of an evacuation. That led to serious problems and did not provide adequate evacuation.”

Again, this illustrates how an interdisciplinary approach to emergency preparedness can help. “If you involve these first responders, such as ambulance companies, this is often where these issues come to light and can be dealt with,” says Smith.

Planning Ahead
Some plans for emergency evacuation call for “redundancy” in disaster planning and encourage facilities to implement what’s known as a “three-deep” philosophy in which they contract with multiple vendors for the provision of food, water, emergency power, and transportation.

According to Smith, for professionals involved in emergency planning for older and infirm adults, there are two important questions: “First,” Smith says, “Can you get them out if you have to? Number two, where do you put them if you have to get them out?”

Both Tremethick and Smith emphasize the importance of taking a wide-range, detailed view when making sure there are adequate provisions for elders at the evacuation site. “When it comes to the elderly and other high-risk populations,” says Smith, “you need to make sure you have everything you need ready and waiting at the other end of an evacuation.”

“Each older adult will have specific needs,” Tremethick says. “How are we going to meet their needs when they are off site? How do we make sure there are adequate personnel?”

Tremethick points out that emergency planners need to look beyond obvious necessities such as food and water. “You’re taking them to a place they’re not familiar with. How are you going to meet their needs when they’re there? Do you have an adequate emergency supply of medications, hearing aids, glasses?”

Smith also advises emergency planners to look beyond the obvious when stocking an evacuation site for older and infirm adults.

“In a recent evacuation of elderly people from New Orleans, there was a three-day delay before the handicapped toilets arrived at the shelter location,” Smith recalls. “You can have cots, but what about people who need assistance laying [sic] down and getting up? You can have chairs, but what about people who have trouble getting in and out of chairs that don’t have arms?”

While many states have emergency plans in place for the evacuation of their frail elderly, Smith is particularly impressed with the planning done in two states. “If you want to see really good evacuation planning, look at California and Florida,” Smith says, “Because when you have to deal with natural disasters a lot, you get good at it.”

— David Surface is a freelance writer and consultant in Brooklyn, NY.

The following are resources recommended by Smith and Tremethick for professionals engaged in emergency/disaster planning for older and infirm adults:

For the University of Tennessee Safety Center Ten-Point Checklist for Emergency Preparedness click here. 

The U.S. Department of Health and Human Services has a checklist specifically for health care facilities. To view, click here.
 
Access the Center for Disability Issues and Health Professions’ online evacuation preparedness guide for individuals with disabilities by clicking here.

The Florida Healthcare Association’s “National Criteria for Evacuation Decision-Making in Nursing Homes” is available here.