Police officers, firefighters, paramedics, emergency medical technicians, doctors, nurses, and others in emergency response roles are regularly tasked with responding to emergencies and disaster sites and communicating with various people who have been involved in or witnessed an incident. However, some research has shown that there is “a gap in first responders’ ability to meet the functional and access needs of some people with disabilities.” To address this gap and be able to respond effectively and with respect, it is critical to understand the different types of needs and how various impairments can affect individuals with disabilities and access and functional needs (DAFN).
Differing Needs Within a Community
Emergency responders will encounter many individuals with DAFN, which are not restricted to any specific demographic groups. However, when responding to an emergency, functional needs are likely to be found in at-risk populations and situations, which include but are not limited to senior citizens, young children, impoverished or homeless persons, substance abuse cases, people with physical or mental disabilities, and those with cultural, geographic, or linguistical differences. At-risk populations are defined by the Centers for Disease Control and Prevention (CDC) as:
[I]ndividuals or groups whose needs are not fully addressed by traditional service providers or who feel they cannot comfortably or safely use the standard resources offered during preparedness, response, and recovery efforts.
In 2002, the Americans with Disabilities Act (ADA) defined an individual with a disability as “a person who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment.” However, in 2008, the ADA broadened the definition to include many other types of physical and mental impairments, which are currently defined as:
Any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more body systems, such as: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, immune, circulatory, hemic, lymphatic, skin, and endocrine; or
Any mental or psychological disorder such as intellectual disability, organic brain syndrome, emotional or mental illness, and specific learning disability.
Emergency responders must recognize the signs and ask the right questions in each scenario to identify and respond with sensitivity to people with potential hearing, mental, mobility, or environmental and chemical impairments. By understanding the potential needs associated with physical and mental impairments, responders will be better equipped to determine the appropriate actions and provide the highest level of care possible.
How Impairments Can Affect Daily Activities
Physical and mental disabilities are associated with a broad range of impairments. Following are general descriptions of the types of impairments that responders may encounter and how these impairments may affect daily activities. However, no assumptions should be made before discussing with and assessing each person’s individual abilities.
Vision impairments include various levels of visual ability: partially sighted, low vision, legally blind, and totally blind. As such, people with vision impairments may have difficulty reading, be unable to discern objects and colors, or have diminished depth perception. Some may also use assistive technologies or guide dogs to perform daily tasks.
Hearing impairments include partial or full loss of hearing in one or both ears and can affect the outer or middle ear (conductive) or the inner ear or hearing nerve (sensorineural). In addition to hearing loss, these impairments can affect a person’s balance and mobility. Some people with hearing impairments wear assistive devices (e.g., hearing aids), know sign language (American Sign Language is just one variation), and speak with some or no speech impediment.
Emergency preparedness and response professionals need to know how to respond to an emergency and how to meet the needs of everyone who may be affected.
Mobility impairments include different types of physical disabilities that “limit or prevent independent movement or full use of one or more body parts.” Regardless the cause (genetic, traumatic, neurological, disease- or age-related), ability to ambulate and perform routine tasks can vary significantly. Cognitive and neurological abilities could also be affected. Some people may use assistive equipment (e.g., wheelchair, crutches, cane, walker) or service dogs.
Mental impairments include neurological disorders, learning disabilities, and psychological or intellectual disabilities. These impairments may inhibit a person’s ability to learn, communicate, build relationships, or express or control behaviors, feelings, and emotions. Physical symptoms may also manifest. Some people may be able to use medications and other forms of therapy to manage certain symptoms.
Chemical and environmental impairments include hypersensitivity and severe reactions to various substances such as chemicals, smoke, latex, mold, foods, and other allergens. People with underlying health conditions like asthma could experience life-threatening effects.
When assisting anyone, with or without a known impairment, there are some general recommendations that responders should consider. The following action items will facilitate effective emergency response interaction under any circumstances. However, when one or more persons involved has an impairment or disability, not taking these actions could inhibit a responder’s ability to provide the immediate care and support needed. Following are just a few key recommendations, but many more tips for engaging persons with disabilities (including those specifically for first responders) are provided in the hyperlinked resources.
Identify yourself and why you are there.
Do not make any assumptions about a person’s abilities.
Remember that nobody has to divulge their disabilities but ask if there are any health issues that need to be addressed to better assist them.
Remain calm and provide reassurance throughout the interaction.
Always ask permission before attempting to touch or assist the person.
Provide frequent updates on the current situation and upcoming actions.
Ask if any assistance or any assistive devices are needed.
Be aware of any service animals, which are often dogs but could include other animals:
Know that service animals are working animals and not pets.
Do not pet or feed animals without the owner’s permission.
Do not distract working animals from their assistive tasks.
Do not separate the animal from the owner if evacuation is necessary.
Engaging People With Vision Impairments
Verbalize your actions and use visual descriptors.
Do not assume that people with vision impairments also have hearing impairments.
Let the person hold your arm or follow you if guidance is needed.
Describe obstacles such as doorways and steps and their orientation (e.g., stairs to your right).
Read any written information out loud.
Ensure adequate lighting conditions based on visual acuity.
Engaging People With Hearing Impairments
Establish eye contact and talk with the person rather than their family member or interpreter.
Do not speak with your back turned away from the person.
Use hand gestures and facial expressions to facilitate communication.
Offer to use written communication when oral communication is not understood.
Engaging People With Mobility Impairment
To respect their independence, ask the person if they need assistance and, if so, how to help them.
When talking with someone in a wheelchair for more than a few minutes, move down to their eye level.
Ask the person about their wheelchair or other equipment and ask permission before attempting to push or operate it.
When assisting someone with a walker or other assistive device, do not rush them – take breaks as needed.
Avoid the “fireman’s carry” on those who have severe limited mobility or preexisting spinal cord injury.
CERT team members assess victim actors, including a man who is deaf and in a wheelchair (Source: Joe Loong, June 30, 2013, CC BY-SA 2.0).
Engaging People With Mental Impairments
Use clear, concise, and respectful communication (one discussion topic at a time) – do not talk down to the person.
Explain processes and timeframes for what is happening or will occur.
Be reassuring, do not argue, and do not rush the person to respond.
Move to a quieter space if the person shows signs of agitation or stress.
Engaging People With Environmental Impairments
If smoke, odors, or spores that may be in the air, provide a means for the person to cover their nose and mouth to keep from inhaling anything harmful.
Check to make sure if they have any meds or epinephrin pen in case of any reactions.
Keep people with possible reactions clear from areas and “upwind” from smoke or odors.
More Education and Training to Close Response Gaps
Agencies and organizations that are tasked with incident management must create inclusive programs to address the needs of everyone within their communities. Agencies in Maryland created a toolkit using “a function-based approach to identify ways to meet the needs of a wide range of people that may be adversely affected by incidents.” Considerations are needed at each phase of an emergency: preparedness (external outreach, training and exercising, planning), response (shelter-in-place, evacuation support, emergency shelters), and recovery (post-incident external outreach, depart shelter and demobilize, and disaster recovery services). This toolkit contains the following resources to assist emergency preparedness professionals in developing their own DAFN programs:
Planning and legal considerations;
Description of the function-based framework – including communication, health and medical, maintaining independence, personal care assistance, and transportation;
Functional needs considerations worksheets;
Self-assessment checklist for creating inclusive emergency programs; and
Being able to identify and understand the needs of others and developing the skills to address these needs with sensitivity are crucial tools for any emergency preparedness and response professional. Emergency responders will encounter many scenarios that involve a person(s) with some form of disability or impairment. However, communicating effectively with everyone on scene involves interpersonal skills that may not be innate.
Learning how to communicate and interact with individuals with DAFN requires being able to identify functional needs, understanding how these needs may affect the person’s ability to perform routine tasks, and developing the skills to address these needs with sensitivity. Additional education and training on this topic would help agencies and individuals better serve their communities and close the emergency response gap for individuals with DAFN.
James Martin was the founder and executive director of the Maryland-based Accessible Resources for Independence (ARI), a 501(c)(3) organization that supports the disability community and, through a federal grant, also served as the Center for Independent Living for both Anne Arundel County and Howard County. In 1985, he was involved in an automobile collision that left him a functional quadriplegic and a member of the disability community. He served on the Commission for Disability Issues of Anne Arundel County as chair for the Legislative and Housing Committees. He also served as chairman of the Citizen Corps Council for Anne Arundel County and the City of Annapolis. As a member of and trainer for the Anne Arundel Community Emergency Response Team (CERT), he developed and taught a “Functional Needs” module for the local CERT training program and volunteered at the county emergency operations center, where he was a call-taker during snowstorms and hurricanes, including Irene and Sandy. He graduated from Anne Arundel Community College (AACC). He graduated in 1999 from the Architecture School of Mississippi State University with a Bachelor of Architecture degree. He later became an adjunct professor in the Architecture and Design Department at AACC.