Strategies in emergency

preparedness for

transportation-dependent

populations

**A PRODUCT OF THE NATIONAL CONSORTIUM ON HUMAN SERVICES
TRANSPORTATION**

**Introduction**

From the events of September 11, 2001 to the devastation wrought by
recent hurricanes in Florida and all along the Gulf Coast, the manner in
which plans, procedures, and responses to emergency events are
implemented, clearly, can save lives and rebuild communities. The need
to safely and efficiently transport people---particularly those for whom
community and public transportation is the primary means of
mobility---before, during, and after emergency situations, is a crucial
consideration.

Many people live independently and have access to personal
transportation or are otherwise able to arrange transportation for
themselves. In emergency preparedness and response plans, particular
attention must be given to individuals who lack this capacity, whether
they live independently or in a group setting. Typically, these groups
include older adults; persons with disabilities (including physical,
auditory, visual, psychiatric, intellectual, learning, and cognitive
disabilities); persons living in nursing homes, assisted living
facilities, or other residential facilities; and persons without access
to personal transportation. Another population of concern is individuals
in acute care or inpatient facilities; their needs are being addressed
by the Department of Health and Human Services.

In emergency situations, public and community transportation is
essential in efforts to evacuate the general public from threatened
areas and locate and transport the most vulnerable citizens in a region.
Community transportation also serves as a key element of response
efforts. The same mobility services that can move vulnerable populations
out of harm's way in advance of emergencies can also greatly assist in
local recovery efforts by reconnecting people with vital human services,
work, school, shopping, and more.

In April 2006, the National Consortium on the Coordination of Human
Services Transportation convened a day-long discussion among public and
private transportation providers, community organizations, governmental
agencies, and national organizations on emergency preparedness
transportation. The focus of the panel's discussion was the role that
public and community transportation services have had---and can
have---in responding to emergency situations, particularly in
transporting those individuals that may require assistance during an
emergency.

This document builds upon the critical discussions that took place that
day and provides an overview of the importance of planning for the
transportation of individuals requiring assistance during an emergency.
Additionally, it discusses specific strategies that communities have
employed to facilitate safe and appropriate transportation, and it
uncovers the challenges that remain to improving transportation for
these transportation-dependent populations in the event of an emergency
situation.

**Background**

Some older adults; people with physical, hearing, visual, psychiatric,
intellectual, learning, and cognitive disabilities, people with limited
English proficiency, and persons with low incomes---as well as people
living in group settings---require specific considerations in
transportation planning during emergency situations. Because of expected
increases in these populations, this planning will only become more
important with time. It is estimated that by 2030 the number of persons
over the age of 65 will double---reaching 70 million---with the fastest
growing segment of that population being those over the age of 85.
Today, a full third of the older population has disabilities that
negatively impact their mobility. In addition, during the 2000 Census,
52 million people identified themselves as living with at least one
disability, and 3 million of those individuals reported that
transportation challenges result made them unable to leave their homes.
Also in that Census, more than 10 million people reported that they do
not speak English well or that they do not speak English at all, which
is noteworthy because there is a high correlation between persons with
limited English proficiency and the use of community and public
transportation, particularly during the first years after their arrival
in the United States. Language barriers, both written and verbal, may
inhibit people from accessing transportation information that is
especially critical with regard to emergency evacuation.

With limited or no access to private automobiles, a lack of financial
resources, inherent language barriers, and higher probabilities of
medical conditions requiring attention and/or medication, the mobility
of the populations mentioned above is limited under the best of
circumstances. The common transportation challenges of these
populations, however, become urgent in an emergency situation. To ensure
the safety of their most vulnerable residents, communities must begin
planning and coordinating transportation efforts as soon as possible.

**The Importance of Planning and Coordination**

Advance planning for and coordination of the transportation needs of
vulnerable populations significantly contribute to successful emergency
responses in which people are transported safely and efficiently away
from a threatened or dangerous area. Many communities have
developed---or are in the process of developing---Emergency Operations
Plans to formalize the elements of emergency response. Including
transportation provisions as part of these plans is critical to meeting
the service needs of transportation-dependent populations during an
emergency. These planning discussions also underscore the resources
required for transportation providers and agencies involved in emergency
response.

The essential first step in planning for the transportation needs of
residents requiring mobility assistance during an emergency is
collaboration among a variety of partners. Of particular importance is
an established and well-used partner network among transportation
interests, the other organizations and agencies involved in emergency
response, and a variety of community-based services including advocacy
organizations, agencies that serve the specific transportation-dependent
populations, employment and training providers, health and human service
agencies, and local faith-based organizations. Communities can build
strong networks by convening frequent meetings of these partners, and
providing updates, conducting drills and exercises to test and refine
emergency plans, and coordinating communication mediums such as phone
trees and e-mail groups.

**Identifying People Needing Transportation Assistance**

It is often said that in emergency situations, what you do not know is
the most dangerous element in the response equation. Identifying and
tracking the locations and needs of transportation-dependent people
during emergencies are considerations that require a preemptive
community-wide effort. These processes are greatly enhanced when a
well-developed partner network is established. Transportation providers,
other organizations and agencies involved in emergency response, and a
variety of community-based services including advocacy organizations,
agencies that serve the specific transportation-dependent populations,
employment and training providers, health and human services, and local
faith-based organizations may work together in the development of a
voluntary, self-identified registry of persons requiring transportation
assistance in the event of an emergency. Before an emergency occurs,
this would mean establishing information that confirms the locations
of---and particularly concentrations of---individuals who require
transportation during an evacuation. This type of planning information
must include the type of transportation these transportation-dependent
people require and where they need to be taken in order to ensure their
safety.

By fostering relationships with relevant community stakeholders,
transportation providers often learn first-hand of individual or group
needs and are able to pull together a more accurate list of persons
needing transportation during an emergency. Establishing relationships
with nursing homes, workforce development agencies and One Stop Career
Centers, senior centers, residential and non-residential facilities that
serve people with disabilities, and homeless shelters, facilitates
developing essential information for many communities need to identify
transportation needs.

Inseparable from this data collection process is the need to match
individual needs with appropriate service provisions, including the
availability of accessible vehicles with capacity for wheelchair
securement locations, and accounting for the transport of personal
caregivers.

Finally, each individual's right to privacy must be considered during
this identification and location process. No individual can be required
to provide medical or other private information as a prerequisite to
receiving transportation or other services during an emergency. The
Health Insurance Portability and Accountability Act (HIPAA) is intended
to protect individuals' privacy during the electronic exchange of
medical and financial information to and from "covered entities,"
(defined in HIPAA law as health care plan, health care clearinghouses,
and health insurance providers) and is not meant to impede access to
care. Information regarding HIPAA privacy rules and signed
authorizations may be obtained through
http://www.hhs.gov/ocr/hipaa/decisiontool/tool/auths.html.

**Public Involvement and Community Outreach**

Once those people in need of mobility in an emergency situation have
been identified and located, a process to communicate with them must be
established. Communities have developed diverse and innovative methods
to improve communication among partner networks and the public prior
to---and during--- emergencies. Building relationships with groups or
representatives of those most likely to be in need of transportation
during emergencies has produced effective communication procedures when
the emergency actually occurs. Involving older adults, persons with
disabilities, and low-income and other transportation-dependent
populations in the development of transportation preparedness and
response plans not only spreads knowledge of how to access those
services, but also builds confidence and familiarity with them.

The application of various technological tools has also fostered
effective communications. The immediacy and widespread use of the
internet, e-mail, and other computer-based applications quickly
distributes information thru these media during emergencies. However,
not all people have access to computers or trust these sources as
legitimate, and in some instances information given these formats has
indeed been incorrect. To provide greater control and accurate access to
information, many communities use corresponding communications methods
involving phone, radio, television, closed captioning, and other
outlets. Of course, all electronic-based communications media are
impacted in a disaster site if power or communication infrastructure is
destroyed, so contingency plans for communication in these circumstances
are important for transportation-dependent populations.

A well-conceived and executed communications effort is necessary to
relay information to the public, particularly with regard to
transportation-dependent populations. Information on how, when, and
where transportation services will be provided during emergencies should
be well known within the community before an emergency occurs. This
includes designated route maps and emergency transit stop locations,
promoting information hotlines with TTY service, and producing
informational materials in various formats including large type,
Braille, audio, symbols/pictures, and appropriate languages. In
addition, all public information should be provided in language that is
easy to understand, avoiding excessive transportation jargon and complex
sentences. The existing 211/511 human service telephone information
systems that are available in some areas of the United States may serve
as a means of conveying evacuation and transportation information in
emergency situations.

There will be occurrences when no transportation can reasonably and/or
reliably be provided at some point past a critical stage in an
emergency. This fact must be communicated as well. The general public,
and especially transportation-dependent individuals, their families, or
those who care for them should be informed about the transportation
services available in the event of an emergency situation. With accurate
and complete information regarding the emergency plan and their
transportation options, persons requiring mobility assistance are better
able to make informed decisions and evacuate at the earliest possible
moment rather than find themselves left behind as transportation
availability ceases when the emergency conditions intensify.

**Equipment and Vehicle Support**

Public and community transportation providers have developed emergency
practices that respond to the unique challenges of operating before,
during, and after emergencies. Critical issues such as accessible
vehicles, appropriate lift and securement equipment, liability coverage,
the availability of fuel, regulations addressing the involvement of
charter bus companies, or the use of transit or intercity rail cars on
non-standard routes or tracks must be addressed in
emergencies---especially so with regard to transportation for older
adults and persons with disabilities. By structuring and formalizing
agreements among partners and suppliers concerning these issues before
an emergency takes place, transportation providers can reduce ad-hoc
decision making and ensure more reliable, safe, and timely service for
vulnerable populations.

These contractual agreements must be in place well in advance of an
emergency in order to address the expected volume of need. For example,
during one emergency situation it was discovered that the same
transportation provider held contracts for the evacuation of multiple
facilities and during the actual emergency did not have enough vehicles
or drivers to meet all of the agreements. Contingency plans for
additional vehicles and personnel must be developed in advance to ensure
that all components of contractual agreements can be met simultaneously,
if necessary.

Not only are the procedural elements of emergency communication
important, the infrastructure necessary to facilitate these connections
among responders is equally essential. For example, it is important to
have equipment such as radio systems that can operate even when
electronic devices fail due to power outages or when centrally located
control facilities are not available. So that dispatch remains
coordinated in the event of a power and/or computer failure, printed
copies of all scheduled trips for a full week ahead should be kept on
file. These are occasionally overlooked components of effective
emergency communication systems.

When vehicle fleets are threatened by disaster situations, transit
operators often relocate their vehicles to safer locations. In addition
to protecting the organization's assets, this also ensures that vehicles
can be deployed quickly to begin the response effort. Establishing these
locations prior to an emergency and having these locations identified
within the emergency plan will further enhance emergency efforts.

Transportation providers have also found that fuel to run the vehicles
is often in short supply during emergencies. Securing agreements to
provide fuel and entering into cooperative agreements with other
community agencies that also need a reliable fuel supply, such as police
and fire departments, can increase the likelihood of an undisrupted fuel
supply. In pre-emergency meetings, public and community transportation
operators must ensure that their services are
viewed---appropriately---as vital and have access to fuel.

Vehicles that are used to transport persons with disabilities must be
fully accessible as per federal guidelines, and agreements should be in
place prior to an emergency regarding their locations and availability.
In addition, transportation providers must be prepared to accommodate
and transport service animals that may accompany some passengers.

Appropriate advance planning, strong community partnerships, contractual
agreements ensuring access to necessary equipment and vehicles,
identifying and locating transportation-dependent populations, and
public involvement and outreach, are all essential strategies to
providing safe and efficient transportation for persons requiring
mobility assistance in the event of an emergency.

**Useful Practices in Providing Transportation during Emergencies**

Communities experienced in emergency situations have utilized an array
of best practices to respond to transportation needs and provide
mobility services accordingly. These practices not only serve as
examples of how specific areas have performed in emergency conditions,
they also serve as potential models illustrating responses that work,
and those that do not. These examples illustrate the value of advance
emergency planning and coordination among agencies, showing how
understanding the transportation needs of the community can help address
transit-specific issues.

Communities throughout the country have utilized several strategies in
crafting functional and responsive plans for the role of transportation
services during emergency situations. In summary, these best practices
include:

• Clarifying rules and regulations at local, state, and federal levels
of government that might otherwise impede effective and efficient
mobility for people who are transportation dependent;

• Developing voluntary registries of persons who identify themselves as
requiring transportation assistance during an emergency, including the
specific nature of their transportation need (e.g. door-to-door service,
lift-equipped vehicle, caregiver transportation);

• Utilizing existing 211/511 human service telephone information systems
(where available) to relay information to those populations in need of
transportation services during an emergency;

• Establishing chains of responsibility to eliminate confusion as to who
holds what responsibility once an emergency plan is enacted;

• Understanding the disaster management procedures of federal and state
offices;

• Securing agreements on where and when vehicles might be staged and
stored during emergency situations, which vehicles are accessible, and
specific plans for the transport of persons in need of transportation
assistance;

• Building interagency and mutual aid agreements during the planning
process that establish resources such as the shared use of accessible
vehicles, fuel, scheduling and dispatching data, and the identification
of those individuals requiring transportation assistance;

• Considering the impact of personal concerns such as the desire by
employees of transportation providers and other responders first to
secure the safety of their own loved ones and property;

• Developing funding agreements in advance to allow services to be
deployed immediately during an emergency event, and

• Utilizing quality management practices to continually re-examine
actions to determine both successes and inefficiencies in previous
response situations, and making changes accordingly. Lessons learned
from past efforts are credited by numerous communities with improving
their overall emergency plans, and those for transportation as well.

**Conclusion: Ongoing Challenges**

Just as no two emergencies are the same, neither are the responses. The
real challenge is to develop the relationships among key organizations
and the best practices that allow for the most effective response by
public and community transportation. Although no single solution or best
practice might alleviate all concerns, discussion among leaders at all
levels of government, community agencies, and populations impacted by
emergency conditions will produce innovations and procedures to better
address the specific transportation needs of transportation-dependent
populations in many communities.

Even as communities make progress in identifying those who require
transportation assistance during emergencies, that vital process still
remains one of the most vexing challenges in planning for emergencies.
The questions of who is located go before an emergency, where they need
to go, and where they ultimately went are ones that are not only
difficult to answer, but are in perpetual flux. Improvements in this
area can best be accomplished by developing and sharing effective
methods of collecting data; establishing common and responsive criteria
for determining and locating these individuals; creating a system of
check-points through which public and community transportation services
feed into the broader emergency evacuation/response; and building
information-sharing capabilities among agencies at the local level.

Additionally, while many local agencies have some interaction with
federal programs, a large number of these are unfamiliar with the
culture and procedures of the relevant federal agencies. This disconnect
hinders the ability of these local agencies to respond with needed
transportation services during disasters in which federal agencies are
involved. Better information about how federally supported programs
operate would have enormous benefit in enhancing emergency services
involving transportation providers. Improved and clarified circulars and
fact sheets from federal agencies and question-and-answer sessions with
officials from all levels of government will bring positive developments
in this area.

A lack of coordination among transportation providers themselves can
present barriers to more effective services. Transit and intercity rail
operators, private motor coach companies, paratransit services,
ambulance services, school bus networks, and others can---and do---fill
important roles in transporting vulnerable populations during and after
an emergency. However, due to regulations, frayed relationships, or just
communication lapses, confusion, service gaps, or acrimony can result.
While transportation providers in numerous communities have overcome
these challenges to craft a multi-faceted response for persons in need
of transportation assistance during an emergency, others still find
these barriers significant.

Because communications is a vital aspect of any emergency response
effort, sharing information during emergencies requires dual approaches.
First are the relationships among providers, agencies, organizations and
individuals that need to share information on emergency plans before and
communicate directives and procedures during an actual emergency. Second
are the various technologies required to help distribute that
information. The benefits and limitations of the available
communications media available demand a well-integrated system to most
effectively and accurately broadcast information to those in need of
assistance as well as those participating in the response effort. An
important factor in the communications process is appropriate public
education using a variety of formats including large-type, TTY, Braille,
audio, symbols/pictures, and various languages.

The more planning done prior to an emergency situation, the more
prepared communities are to deal with emergencies and the resulting
transportation needs of older adults, persons with disabilities, and
those without access to personal transportation. Such planning must
include the network of stakeholders, including transportation providers,
emergency response personnel and management officials, and a variety of
community-based services, including advocacy organizations, agencies
that serve the transportation-dependent populations, employment and
training providers, health and human service providers, local
faith-based organizations, and representatives from those populations
most likely to utilize transportation services in the event of an
emergency. The collaborative nature of such a network will ensure that
every community responds to an emergency by providing efficient and
accessible transportation for all of its citizens.

**About the National Consortium on Human Services Transportation**

The National Consortium on the Coordination of Human Services
Transportation is an alliance of national non-profit organizations and
associations dedicated to promoting mobility and the delivery of
coordinated human services transportation to all individuals with
disabilities, persons with low incomes, older adults, and youth. It
promotes active and open collaboration among organizations with an
interest in coordinating and insuring mobility opportunities for access
to health, education, recreation, employment and other life sustaining
activities. The Consortium conducts research, education, information
development and dissemination, technical assistance, and outreach
activities to service agencies, transportation providers, policy makers,
and the general public.

The Consortium operates under the auspices of the Community
Transportation Association of America and includes representatives from
associations and organizations with interest in transit and human
service issues. Consortium products are based on research related to the
coordination of human services and mobility services. Support for the
Consortium comes from the U.S Department of Transportation, Federal
Transit Administration in collaboration with the Federal Interagency
Coordinating Council on Access and Mobility.