The homeless are either a public and annoying distraction, or almost invisible, depending on the personal views of their fellow citizens. According to a report – Foreclosure to Homelessness: The Forgotten Victims of the Subprime Crisis – issued by the National Coalition for the Homeless, 61 percent of the U.S. communities that provided input for the report saw an increase in homelessness during the past year. Moreover, the total number of homeless individuals throughout the country, according to estimates developed by the National Law Center on Homelessness and Poverty, is now between 700,000 and two million people.
There are several distinguishing aspects of homelessness that make the nation’s “undomiciled” population both a special case and a significant challenge to emergency planners. With homelessness now apparently increasing, that challenge must therefore be given greater attention in the emergency-planning process.
The first step in meeting that challenge is determining how to reach and communicate with the homeless population. Fixed-address strategies – such as the use of direct mailings and/or reverse 9-1-1 calls – are not usually effective. Moreover, the “traditional” media (newspapers and the nation’s television and radio networks) do not fully penetrate the homeless community. Some local “congregation points” – e.g., specific buildings and other locations such as shelters, outreach centers, and health clinics focusing on the needs of the homeless – where members of the undomiciled community tend to go in times of emergency do exist, but they do not reach all of the nation’s homeless.
Nonetheless, emergency planners in some communities are taking the steps needed to set up lines of communications with or close to these facilities and congregation points so that important information that normally would be disseminated to the general public through the media –and/or by direct communications during an actual emergency – can reach the homeless community as well.
Some of these locations may be effectively used in mounting an actual response to such an emergency. Many communities have plans in place, for example, to carry out a mass vaccination program; those plans usually include the designation, ahead of time, of specific locations where the vaccinations would be administered. Large shelters and other easy-to-reach congregation points obviously could fulfill that role during a real emergency.
Fixed Addresses, Root Causes, Social Services
Many other well known “locations” – such as public parks, the more or less open spaces under bridges, and deserted buildings – often represent a notional “fixed address” for many of the nation’s homeless, but no phone or mail service is available in those generic locations. Emergency medical services (EMS) staff, however, often know about these locations through their interactions with patients, or by personal observation. Actual person-to-person contact may be the only way to communicate with the homeless people living in such locations.
Another challenge facing the nation’s emergency planners is presented by the variety of the root causes of homelessness. Some citizens have simply fallen on hard times (because of the credit and housing problems, for example, that have developed in recent years), but there is a large subset of the homeless population suffering from other difficult problems – e.g., psychiatric problems of various types, including post-traumatic stress disorder (PTSD), and/or substance abuse – that affect their interactions with others. Whatever the cause, their views of the rest of society range from wariness to outright paranoia, making the use of well-intended “outreach” programs a difficult proposition at best.
The homeless present an even more formidable challenge for social workers who provide life-sustaining services. Most of the nation’s social-services agencies have worked long and hard to build personal relationships within the homeless community, and usually have a certain degree of credibility with at least some members of that community. Participation of these agencies both in planning and in execution of the emergency plans developed is critical, not only because such agencies can contribute valuable insights in the planning process but also because they have a foot in both worlds and therefore may be the only means available to serve as a bridge between society at large and the homeless community.
Prior Service and Other Considerations
According to the National Coalition for Homeless Veterans, almost one fourth (23 percent) of America’s homeless are veterans of the nation’s armed services. For emergency planning purposes, this means that VA (Veterans Administration) social-services and medical facilities are among the best and most diversified resources likely to be available in future times of disaster.
The lack of healthful food, adequate medical care, and the facilities needed for routine hygiene – as well as the enormous emotional difficulties many homeless people experience in choosing between: (a) the close-quarters living space provided by the shelter community; and (b) living outdoors in all types of weather – put the homeless community at an increased risk for naturally occurring diseases. Not incidentally, these same conditions make the nation’s homeless community an ideal target for bioterrorists seeking to spread diseases quickly and easily throughout the entire country.
There are those who see the homeless primarily as a problem, but homeless people are also American citizens, and members of the local community. As such, they are deserving not only of respect but also of equal treatment under the law – as well as, perhaps, an extra dose of compassion and attention in times of disaster affecting all U.S. citizens.
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.