Washington State: Suggested Principles for Supporting the Health, Safety and Security of Aging or Disabled During a Pandemic Flu Outbreak
One of this project’s objectives is to find and aggregate best practices from around the country. Dr. Marc Roberts a Professor of Economy, Department of Health Policy Management, Harvard University, contacted us with information about his team’s work with Washington State, specifically for vulnerable populations during pandemic flu. They developed “Suggested Guiding Principles for Supporting the Health, Safety, and Security of Aging or Disabled Washingtonians During a Pandemic Influenza Outbreak.” We have quoted and included the guiding principles below. Even though they were written with Washington State as the intended audience, they are broad enough to be adopted by any State with minor tweaking.
Principle #1: Planning for pandemic influenza in Washington State should support the Department of Health, first responders, and all medical professionals to take all appropriate measures to ensure equal access for aging people and people with disabilities by:
- Providing the same range, quality or standard of care or emergency response as provided to other Washingtonians;
- Providing the healthcare and emergency response needed by persons with disabilities specifically because of their disabilities, and services designed to minimize and prevent further disabilities;
- Providing these services and supports as close as possible to people’s own communities, including in rural areas;
- Making an equal effort to secure informed consent from aging people and people with disabilities, as other Washingtonians regarding the provision of treatment;
- Prevent denial of health care, health services, food, fluids on the basis of age, perceived disability, or disability.
Principle #2: Planning a public health, emergency, and medical response to pandemic influenza in Washington State must be comprehensive, community based, and coordinated at the regional level.
Principle #3:Planning for pandemic influenza in Washington State, should recognize that Washingtonians who are aging or who have disabilities, have the right to the highest attainable standard of health without discrimination on the basis of age, perceived disability, or disability.
Principle #4:The aim of planning for pandemic influenza in Washington State should be to keep the health care system functioning and to deliver acceptable quality of care to preserve as many lives as possible.
Principle #5: If those infected by pandemic influenza are facing quarantine, aging people and people with disabilities should be given the same opportunities to preserve the integrity of their family units as other Washingtonians.
Principle #6: To the greatest extent possible Planning for pandemic influenza in Washington State should prioritize the communication of clear information, using accessible modes and formats before, during, and after the outbreak.
Principle #7: To the greatest extent possible aging people and people with disabilities, should not be separated from the support people, adaptive equipment, or working animals which contribute to their ability to follow the instructions necessary to be healthy, safe, and secure.
Although these principles don’t specifically address transportation, principle #2, which mentions comprehensive planning, certainly would include it.
We want to hear from you, does your State or organization have anything similar?
Related articles
Research on Pandemic Planning: Summary of Findings
An AATA bus, with the blue-roofed Blake Transit Center in the background. (Photo credit: Wikipedia)
Our team, which is working on developing a guidebook for small urban and rural communities for transportation planning during a pandemic, first conducted a literature review to identify the current domestic and international research. The team evaluated the research based on its applicability, conclusiveness of findings, and usefulness for pandemic planning for U.S. public transportation. Of note, only 5 of the documents directly addressed small urban or rural transit agencies.
Below we highlight of few of the findings.
Overview
In general, many of the reviewed documents discussed:
- the importance of using social distancing measures during a pandemic event;
- promoting public awareness and effective risk communication on pandemic preparedness and response, and;
- effectively communicating and coordinating across types of agencies and organizations (e.g., public health, transportation, emergency management, etc.) at multiple levels (i.e., local, state, and/or federal).
There were a few stand-out guides:
- Arizona Pandemic Influenza Operational Plan (2008) includes:
- detailed steps for pandemic response across all state government functions;
- coordination between agencies;
- specific response strategies for public awareness, include distributing educational materials to passengers and providing guidance to employees who must travel.
- King County Metro system’s (in Seattle, Washington) pandemic plan includes:
- social distancing measures,
- emphasis on services to special needs groups,
- and instructions for employees on workspace sanitization.
Find a summary of all of the State and local plans we reviewed in the tab above or click here: https://pandemictransportation.wordpress.com/state-and-local-pandemic-plans/.
We have also included the research documents we reviewed in this blog site. Each document includes a brief summary, a sentence or two about the best practices the document provides, identification of any gaps or opportunities, and a hyperlink to the document itself.
Let us know if we missed anything!
Schools and Pandemic Planning–Many are Unprepared
Post by: Kim Stephens
English: A 2010 Girardin MB-II school bus belonging to Boston Public Schools. (Photo credit: Wikipedia)
The All Hazards/Pandemics Preparedness and Response Bulletin is an email sent out weekly with content curated by Andre La Prarie of the Public Health Agency of Canada. Today, this article, Many Schools Unprepared For Next Pandemic, struck me as interesting since it has a tangential relation to transportation: we tend to assume that school buses are a possible alternative if transportation needs exceed a cities capability during a crisis. However, based on this journal article and study, most of the surveyed schools were not keeping updated general pandemic plans.
Many Schools Unprepared For Next Pandemic
Biosecurity researchers surveyed approximately 2,000 school nurses at elementary, middle, and high schools about their preparations for pandemics, like swine flu or SARS, and published their results on Thursday in the American Journal of Infection Control.
The results showed that since the swine flu pandemic in 2009, less than half of schools had updated their crisis plans or had developed a plan to address biological events. Only a third of schools had instructed children on how to protect themselves from infection, only a third had stockpiled personal protective equipment, and only half of schools coordinated their relief plans with local and regional agencies.
Almost no schools ever ran school disaster exercises that included infectious disease scenarios. And nearly one in four schools had no staff members who were trained in the disaster plan.
http://abcnews.go.com/blogs/health/2012/08/30/many-schools-unprepared-for-next-pandemic/
Are school buses part of your plan?
Planning Transportation for People with Access and Functional Needs in a Pandemic
Post by: Raymond E. Glazier, Ph.D.
Public transit systems in small cities and rural areas, if they exist at all (forty percent of rural counties are without), already face serious challenges: budget cuts and layoffs because of the weak economy, long distances because of low population density, and vulnerable user populations because non-metro counties, especially in the South, have larger proportions of the poor, the elderly, and persons with disabilities. In fact, poverty, age, and disability often coincide. So providing transportation to vulnerable populations in an influenza pandemic scenario, and that scenario is inevitable, would seem to be the makings of a Perfect Storm. But ‘it ain’t necessarily so.’
An influenza pandemic is a situation in which there is widespread and spreading infection with a new influenza virus to which we don’t have any natural immunity. The rapid spread, significant mortality, and subsequent waves of illness of a pandemic cause far greater damage and human suffering than typical, more limited occurrences of influenza. Persons at immediate, serious risk of death from infection include the elderly and many persons with disabilities, who may have weakened immune systems; most will require transportation to receive inoculation, or in some cases immediate medical treatment. Travel demand will therefore be unusually high in very difficult service provision circumstances, including staff reduction due to illness with the influenza virus or absenteeism because staff is fearful of contracting it through daily contact with many riders.
Organization, planning, and training can prevent a threat from becoming a disaster. Flexibility and ‘thinking outside the box’ are of over-arching importance in all three aspects. In fact, non-metro transportation systems have some distinct advantages: a) Given the difficult constraints under which they operate, nimble creativity has been a survival instinct for many small city and rural systems; b) They know their ridership in a much more ‘up close and personal’ sense than do the very impersonal urban mass transit systems; c) Pandemics usually spread out from urban centers to less densely populated areas, giving non-metro providers greater notice that a flu pandemic is in progress.
Organization
Bus Display (Photo credit: WSDOT)
Although there are only about 1200 rural public transportation systems in the nation, the nation’s elderly and persons with disabilities are served by 3700 specialized transportation systems that received Section 5310 federal funding for capital investments like equipment purchases; many are operated by local human service agencies, including a good number in non-metro areas. Because of the Title II provisions of the Americans with Disabilities Act (ADA), public transportation systems should have lift-equipped vehicle fleets or paratransit service with specially equipped vehicles to serve passengers who use wheelchairs or other mobility devices.
It is important to build and sustain relationships with other service providers – Paralyzed Veterans of America and other disability-specific service organizations, local human service providers that may have a transport service, taxi companies, school bus vendors (schools will probably be closed, freeing up buses and drivers), ambulance services, fire and rescue departments – and other community organizations like Independent Living Centers which serve persons with diverse disabilities, senior centers, other human service agencies, local public health departments, school departments, religious institutions (services are likely to be suspended). Local emergency management should coordinate among all these actors to prepare a pandemic response, including the transportation component. All component entities may require disability awareness training in advance of a crisis that has transportation implications, as most public emergencies do.
Planning
Having a strategic contingency plan is also of paramount importance to the community and its transportation needs. Transportation workers, who come in contact with many persons each day, are at greater risk for infection than most people in a pandemic situation that makes their services even more crucial. A key part of advance planning for a pandemic is making arrangements for their early inoculation, once a vaccine becomes available. Transportation personnel should be in line with health care providers, first responders, and utility workers for first available doses of vaccine. Recruitment of volunteer drivers and driver aides, as needed to cover absenteeism should be part of the plan; the plan should include their advance training and indemnification.
Planners need to know the size and characteristics of the at-risk population in the catchment area – the elderly, the indigent (hence carless), and persons with disabilities – net of double-counting. Special route plans can be prepared and regularly updated to provide transportation of all at-risk persons to their closest healthcare facility (hospital or clinic) for inoculation or treatment. Persons with disabilities, as well as their advocates must be at the table as planning participants, and all seniors and persons with disabilities should be informed about pandemic plans. The emergency planning motto is “Nobody left behind.”
Training
Transportation providers at all levels require training that makes them aware of the needs and constraints of persons with disabilities of all types and all ages. Local Centers for Independent Living and disability advocacy organizations can help train workers, including volunteers on treating individuals with disabilities with respect and dignity in a way that is not patronizing: When and how to help, recognizing disabilities, how to act / how not to act, what to say / what not to say, disability etiquette, treating people like people.
Most passengers are seen at their worst in a difficult time like a pandemic; people are confused, anxious, fearful, stressed to the max; persons with disabilities and the elderly are feeling especially vulnerable. Everyone must be aware of the specific functional needs of at-risk individuals:
- Maintaining Independence: Individuals who need supports that enable them to be independent in daily activities must not lose touch with these supports during the course of an emergency or a disaster situation.
- Communication: Individuals who have limitations that interfere with the receipt of and response to information (blind / low vision, Deaf / hard of hearing) will need information provided in methods and media they can understand and use.
- Supports: Before, during, and after an emergency, individuals may become disconnected from caregivers, family, or friends and be unable to cope in a new environment. Service animals like guide dogs and service monkeys, in addition to personal care assistants must always be permitted to accompany the individual who needs them.
- Medical Care: Individuals must not become separated from their medical support systems used to manage their conditions; this incudes prescription drugs and access to provider networks connected to their particular insurance coverage.
Related Resources –
- The Federal Emergency Management Agency (FEMA) published this disability awareness guide for first responders; it can be equally useful for transportation providers; http://www.usfa.fema.gov/downloads/pdf/publications/fa-235-508.pdf
- Easter Seals offers pointers on disability good manners: http://www.easterseals.com/site/PageServer?pagename=ntl_etiquette
- The suggestions for cleaning / disinfecting railcars apply to all passenger vehicles: http://www.flu.gov/planning-preparedness/transportation/cleaning_railcar.html
- The CDC has issued pandemic planning guidance for local government entities’
- This paper documents the needs of at-risk populations in a flu pandemic: http://www.phe.gov/Preparedness/planning/abc/Documents/at-risk-panflu.pdf
- The CDC’s travel industry flu pandemic checklist is a useful planning tool: http://www.flu.gov/planning-preparedness/business/travelchecklistpdf.pdf
- This publication has specific examples of ‘outside the box’ thinking in real-life applications: Transit Cooperative Research Program. Guidebook for Change and Innovation at Rural and Small Urban Transit Systems. National Academy Press, Washington, D.C. 2001. http://onlinepubs.trb.org/onlinepubs/tcrp/tcrp_rpt_70a.pdf
Is your organization planning for this? Please let us know.
Related articles
- Transit System Planning For Infectious Disease Outbreaks (pandemictransportation.wordpress.com)
- Accessible Travel and Outdoor Programs in Pennsylvania (uromed.com)
Transportation Guidebook Development
This blog site has been stood up as a way to communicate to stakeholders throughout the process of the development of a Transportation Guidebook for a use in pandemic planning by smaller cities and rural communities.
The first task in the process of development is to analyze, describe, and critique pertinent domestic and international research on the basis of applicability, conclusiveness of findings, and usefulness for pandemic planning for U.S. public transportation.
We will be reviewing collected materials and identify pertinent domestic and international research and preliminary recommendations. We will document these finding in a simple data base, some of these materials can be found in the “research” tab of this blog.
Evaluation Summary: Upon completing the analysis preformed by our Team, the research will be arrayed against the stated criteria of applicability, conclusiveness of findings and usefulness for a pandemic planning guide. We do this to ensure that the foundational material for the Guide is comprehensive and reflective of current standards and practices.
Research Matrix: At the conclusion of this analysis a research matrix will be the created in order to provide a visualization of the data as well as an easily accessible reference for Phase II.
Do you have research material you believe the team should be aware of? Please let us know in the comments section below.
Planning Transportation for Pandemic Flu 