Emergency Inclusion: Traumatic Brain Injury Survivor and First Responder Preparation Sara Fitzwater Miller, MPH, CBIS (T); Teresa McCourt, MS Background Historically, people with disabilities, including individuals with traumatic brain injury (TBI), are at an increased risk during emergency situations because responding localities have underprepared to effectively serve this group. Since 2006, regulations have been in place requiring the inclusion of people with disabilities in all aspects of preparedness plans. In emergency situations since 2006, including Hurricane Irma in 2017, the 1000-year flood in South Carolina in 2015, and the 1000-year flood in West Virginia in 2016, implementation of these inclusive protocols still fell short. It is postulated that a myriad of social and psychological factors influence the overall underpreparedness of people with disabilities in emergency situations. For example, identified risk factors for unpreparedness include the likelihood of people with disabilities to live in poverty influencing their financial ability to be adequately prepared. Another example is that people with disabilities may be less likely to believe that they are at risk for an emergency situation or natural disaster, or that it won’t be as bad as they are being told. Research suggests that in order to overcome these barriers, localities must work differently with people with disabilities in order to better prepare them for potential emergencies and their responders to address the unique needs of this group. In order to prevent reoccurring inefficiencies in emergency response, a review of the literature to determine promising practices was necessary. Objectives Identify ways that TBI survivors can prepare themselves for emergency situations Identify promising practices in emergency response system design for local communities Methods/Description of the Program An in-depth review was conducted on literature spanning back through 2009 that outlines research into emergency preparedness for individuals with disabilities. That research was overlaid with known potential characteristics of people with traumatic brain injury to identify potential needs in an emergency situation. Based on those needs, promising practices were extracted specific to individuals with TBI. Findings/Results Known potential characteristics of people with TBI: Headaches New learning difficulties Reading comprehension Fatigue Memory loss Concentration processing difficulties Impaired judgement Inability to multitask/prioritize Anxiety Impulsive behavior Changes in vision or hearing Body temperature regulation changes Failure to recognize deficits Inability to think abstractly Seizures Difficulty sleeping Word finding problems Problems organizing Slowed reaction time Lack of initiation Attention span difficulties Depression Rapid mood swings Gait problems Speech difficulties Recommended Emergency Preparedness Actions for Individuals with TBI Have an identification document on person that outlines your specific needs including important phone numbers Create a written plan Practice the safety plan regularly Develop a buddy system for support Prepare seven days of medication and personal/medical care supplies Keep important documents relating to your medical conditions easily accessible Acknowledge the locations of local emergency shelters and determine accessibility for your needs If you have a higher level of need than available, consult with your local emergency personnel in preparation For immediate assistance, contact emergency services directly rather than through their social media accounts, since these are not monitored during emergencies Recommended Emergency Preparedness Protocols and Emergency Response System Design for Local Communities Include individuals with disabilities in your planning and training scenarios Create policies specifically designed to aid individuals with TBI Know the population of TBI individuals in your coverage area Use television to provide emergency information Design emergency shelters to provide for specials needs, i.e., physical accessibility, quiet areas Prepare transportation for individuals with mobility disabilities Provide preparation training to individuals with TBI in preparedness Conduct periodic safety drills including individuals with TBI Be prepared to communicate to meet the needs of individuals with TBI (e.g., large print, picture signs, culturally sensitive language) Conclusions People with disabilities are at a higher risk of being unprepared in emergencies. First responders have historically have been underprepared to respond effectively to the needs of people with disabilities in emergencies. Federal guidelines now require the inclusion of people with disabilities in all aspects of emergency planning, preparation and training scenarios. Despite these more recent federal regulations, emergency preparedness for this special population is still lacking. There is limited research into best practices to ensure the safety of individuals with disabilities in emergencies. However, promising practices are beginning to emerge in the field. A study on comprehensive approaches is needed. References Alabama Department of Rehabilitation Service. (ND) Emergency preparedness for employees and customers with disabilities: an employer service of the business relations program. Retrieved on September 25, 2018. Bethel, J.W., Foreman, A.N., & Burke, S.C. (2011) Disaster preparedness among medically vulnerable populations. American Journal of Preventive Medicine, 40(2), pp. 139-143. doi:10.1016/j.amepre.2010.10.020. Federal Emergency Management Administration. NIMS implementation objectives for locals state, tribal, and territorial jurisdictions. (2018) Retrieved on September 25, 2018 from https://www.fema.gov/national-incident-management-system. Frumpkin, H. Bumps on the road to preparedness. (2011) American Journal of Preventative Medicine, 40 (2), pp. 272-273. doi: 10.1016/j/ampre.2010.11.001. Kruger, J., Hinton, C.F., Sinclair, L.B., & Silverman, B. (2018) Enhancing individuals and community disaster preparedness: individuals with disabilities and others with access and functional needs. Disability and Health Journal, 11 (2018), pp.170-173. doi: 10.1016/j.dhjo.2017.12.005 McDermott, S., Martin, K., & Gardner, J.D. (2016). Disaster response for people with disability. Disability and Health Journal, 9 (2016), pp. 183-185. doi: 10.1016/j.dhjo.2015.12.005 Smith, D.L., & Notaro, S.J. (2009) Personal emergency preparedness for people with disabilities from the 2006-2007 Behavioral Risk Factor Surveillance System. Disability and Health Journal, 2 (2009), pp. 86-94. doi:10.1016/j.dhjo.2009.01.001 Uscher-Pines, L., Hausman, A.J., Powell, S., DeMara, P., & Heake, G. (2009) Disaster preparedness of households with special needs in southeastern Pennsylvania. American Journal of Preventative Medicine, 37 (3), pp. 227-230. doi: 10.1016/j.amepre.2009.04.028 U.S. Federal Emergency Management Administration. (2018). National incident management system ICS 700. Retrieved on September 25, 2018 from https://training.fema.gov. The Traumatic Brain Injury Services are supported in part by the West Virginia Department of Health and Human Resources, Bureau for Behavioral Health and Health Facilities and the U.S. Department of Health and Human Services,Administration For Community Living Grant Number 90TBSG0038-01-00. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.