Emergency Preparedness: Lessons for All from Sept. 11 Attack
Kleyman, Paul, Aging Today
"The image that sticks in my mind from my interviews is that of older people with walkers, canes and human assistance struggling over debris-laden roads to get out of the area," Nora O'Brien recalled about her work following the terrorist attacks of Sept. 11, 2001. She continued, "Social workers told me how difficult and frightening it was to help these frail older people walk farther north from the towers. They moved very slowly and had to take frequent breaks, sitting, in order to catch their breath to move on. Imagine how scary it must have been."
O'Brien, director of partnerships at the International Longevity Center-USA (ILC-USA) in New York City, presented her study, "Emergency Preparedness for Older People," at the 2003 Joint Conference of the National Council on the Aging and the American Society on Aging in Chicago in March. Released as an "Issue Brief" on the organization's website at www.ilcusa.org, the report distills lessons learned by agencies serving elders following the tragedy-lessons that service organizations can apply anywhere to disasters of any type, including floods, tornados or earthquakes.
ANIMALS BEFORE ELDERS
O'Brien began contacting agencies in the aftermath of the Sept. 11 incident after a local foundation called ILC-USA to express concern about how well agencies were able to reach out to older people following the destruction. She discovered that "within 24 hours, the animal advocacy groups were on the scene rescuing pets from evacuated buildings. However, it took from three to more than seven days for people to think about the older people who were left behind in evacuated buildings." In many cases, older and frailer people who were not connected to the better-organized service groups were stranded without food, water or their medications, because elevators were out of commission and they were unable to walk down stairs. In other cases, police barred home health aides who didn't have the official identification carried by emergency-response personnel from entering buildings in areas near the World Trade Towers. Furthermore, the breakdown in communications and transportation meant that older people and their families were unable to reach one another.
"One of the biggest issues," O'Brien said, "was volunteering. A lot of volunteers had no place to go; there was no central office to send out volunteers and the Red Cross was turning them away" when other organizations needed helping hands.
According to O'Brien, her initial findings showed that "the agencies responded the best they could; however, there was no interagency coordination." The fragmented organizational response left many elders to "fall through the cracks, especially those who were not known to any organization." She also discovered that the Federal Emergency Management Administration and private service organizations, such as the Red Cross, had no plans to meet the special needs of elders or people with disabilities. O'Brien, whose study was funded by The New York Times Company Foundation, noted that these agencies responded enthusiastically to her "Issue Brief" and are beginning to organize a plan.
O'Brien recommended that communities form interagency groups to coordinate services and resources, and she recommended that communities with high concentrations of older residents organize leadership consortiums. In New York City, she said, "these neighborhoods act as little villages, and I found that the tighter the villages were, the better they were able to respond to the neighbors that were there."
EAST SIDE NETWORK
A key finding, according to O'Brien, was that agencies that had reacted most successfully to the emergency "had very strong leaders, who had foresight to put together a plan." These organizations had developed a list of emergency numbers accessible to their staff members, clients and clients' family members. These agencies also had backup headquarters, and-in preparation for the year 2000 (Y2K) computer crisis that never materialized-they backed up their computer data in remote locations. While developing her report, O'Brien worked with one of these neighborhood groups, the East Side Emergency Preparedness Network for Older People, some leaders of which joined O'Brien at the conference session to describe their efforts.
The network's facilitator, Stephanie A. Raneri, executive director of the Isaac H. Tuttle Fund, said that when O'Brien described her research on developing emergency preparedness plans, she declared, "We're doing that!" She explained that soon following the Sept. 11 tragedy, she and executives from five service organizations formed the emergency-preparedness network not so much to prepare for another terrorist attack, but to be ready for snow emergencies and electricity emergencies. "It was a wonderful opportunity to focus us" on the power of a collective approach, she said. The organizations began examining the services they provide in consulation with the agencies' frontline service personnel and looking at what our capacity was whom we needed to serve and who are the most vulnerable people in the population of elders."
One reason the groups were able to get so soon the Sept. 11 attacks, said Rebecca Mushkin, director of older services at the Lennox Hill Neighborhood House, is that they "had a history in our community of working together." For examples groups in the area had formed a consortium to deal withcases of elder abuse. Still, she said, after Sept. 11, "we realized we were not as prepared as we needed to be." The group had compiled a list of high-risk elders in case services were shut down because of Y2K problems, but "that was not really up to date," she said "We did not have a plan; we were totally taken by surprise."
The new emergency preparedness consortium set about updating prioritizing the list they had established according to a simple color code. The most at-risk clients-those needing continuous attention-were coded red. The atrisk people included, for example, amputees and those who might be confused or who were dependent on 24-hour care.
SIMPLE COLOR CODE
"A yellow-code client," Mushkin explained, "is somebody who is somewhat independent on oxygen or a nebulizer. Someone would need us to check in on them." The East Side network has notified the local utility that in the event of a power failure, "Mr. Smith at such address needs oxygen, so they would go to the home of that person and give him portable oxygen or bring him to the nearest hospital." Green-code include those who "could probably go a day or two without any kind of support or help," Mushkin said. The consortium asigned clients to a geographic grid, in order to identify them quicky and deliver assistance to them efficiently.
In coordinating staff and services, the group has developed a complete list of each organization's staff members, including such information as office, home and cell phone numbers, for example. They documented how to get into each client's building in an emergency, and whether it has a doorman or buzzer or is a walk-up apartment house. They inventoried available transportation, such as vans operated by agencies, determined how they can cover each other's needs. In service is closed down, others in the area will be prepared to step in to feed those clients. They also secured cooperation from restaurants and supermarkets, which agreed to provide emergency food supplies if needed-for instance, "if the bridges and tunnels are closed down," Mushkin said.
Susan Siroto, program director for search and Care Inc., based in New York, discussed the consortium's efforts to reconcile variability in the protocols, payments methods and operations of participating agencies. In addition, the groups examined the clinical skills needed by care managers and other staff to sensitively broach the topic of emergency preparedness with cliets in reassuring ways and without creating undue anxiety among clients resistant to discussing potential disasters.
One work-in-progress aspect of the East Side network, Siroto said, is the agencies' effort to develop consent forms that each allow each agency to share a client's health information with the others. "A difficult element was how to address clients who refused to give consent but who would clearly need assistance in the event of an emergency or disaster," she said Consortium members revisited selfdetermination guidelines developed by the Federal Emergency Management Agency to ensure that individuals participate in decisions about receiving assistance and they have the right to refuse help. Siroto said that consortium members considered whether they could create a single consent form, whether agencies without specific consent could justify "piggybacking" on efforts by agencies that do such, approval, or whether they might they might simply bring in help as needed. They rejected all of possibilities and decided that agencies must each work separately with the clients who have come to them for their specific type of service. She said that the group is continuing to grapple with this issue.
One incalculable resource that the consortium agencies discovered following the Sept. 11 disaster was the older clients themselves. Mushkin observed that many of the staff members "were very traumatized by the events, and in some instances, they were more upset than our clients. Some of our clients had lived through wars and other types disasters in the past, and actually saw as survivors, whereas some of our staff members, particularly those who were youger, had never gone through anything like this. Actually, some of our clients provided strength for our staff."She added that many staffers also responded in the ensuing weeks by volunteering thier services-sometimes even after a long day's work-to provide help such as counseling families that had lost loved ones at Ground Zero.
A new report outlines how to aid elders whether in floods, quakes or other disasters.
One incalculable resource was the older clients themselves.…
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: Emergency Preparedness: Lessons for All from Sept. 11 Attack. Contributors: Kleyman, Paul - Author. Magazine title: Aging Today. Volume: 24. Issue: 3 Publication date: May/June 2003. Page number: 7. © American Society on Aging Jan/Feb 2009. Provided by ProQuest LLC. All Rights Reserved.
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