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Tuesday, September 16, 2014

Deaf and Hearing-Impaired Patients Require Special Consideration During a Disaster

article shared from JEMS (Journal of Emergency Medical Services)
Aly Lim, EMT-D, BFA | Amy Updike, AN, BSN, CEN | Andrew Mazurek, EMT-D | Gavin Macgregor-Skinner, BVSc, MSc, MPH, MRCVS | September 15, 2014

Large-scale disasters in the United States such as Hurricane Katrina and Superstorm Sandy created awareness that these events affect all segments of society, including the disabled and, among them, the hearing impaired. The U.S. Census Bureau’s Americans with Disabilities report from 2010 stated approximately 56.7 million people, 19% of the population, have a disability. About 7.6 million people said they experience difficulty hearing, including 1.1 million whose difficulty was severe and 5.6 million who used a hearing aid.1 However, the presence of the deaf/partially deaf community is increasing as both the baby boomers become older and troops come home from war in Iraq and Afghanistan.2
It’s the duty of emergency personnel, government agencies and the individual citizen to ensure they’re prepared for both natural and man-made disasters. However, some jurisdictions are better prepared than others when it comes to handicap-friendly responses in the wake of an imminent catastrophe. Special needs populations and individuals with disabilities are infrequently thought about or mentioned when someone refers to emergency preparedness. A study pertaining to deaf/partially deaf individuals specifically illustrates that out of 55 emergency operation plans reviewed, a little over half mentioned vulnerable populations whereas only 31% specifically mentioned deaf/partially deaf populations in their plan.3
Every emergency situation has a “golden hour,” defined as, “The first hour after the onset of out-of-hospital traumatic injury.”4 It’s the time following an incident when it’s crucial to respond and act decisively to preserve as much life and function as possible. There are special considerations healthcare providers must consider while providing care to individuals during the golden hour who are deaf/partially deaf to ensure they can be properly treated without losing time due to communication barriers.
Information dissemination, responder education, public education and technological advances will allow those with hearing disabilities to be better assisted during times of disaster and, more specifically, during the golden hour.
The U.S. has a long history of overlooking individuals with disabilities. Prior to and including the terrorist attacks of 9/11, disabled individuals weren’t educated like the rest of the population on how they should respond, evacuate and protect themselves during a major incident. This failure led to the Department of Homeland Security (DHS) setting aside grant monies for disability awareness programs in both governmental and communal sectors of
the community.
Although statistics have improved, Hurricane Katrina allowed awareness to be raised once again. Less than 30% of emergency shelters had American Sign Language (ASL) interpreters to assist deaf/partially deaf individuals, and 80% of TVs that projected emergency information in these shelters weren’t able to stream captions.2 As the problems are being identified, the issues are slowly being resolved.
Erie County is only one of five counties in New York state that has an Office of the Disabled (ECOD). According to its brochure, the office was created to ensure that Erie County’s citizens with disabilities would have a direct voice in county government—to make available to such citizens an advocate who could work within the county structure to develop and enhance services. It’s essential that all individuals within the governmental structure have a voice to seek change in order to live a better life.
Along with providing this representation, the ECOD is like a liaison to the lawmakers to ensure topics of importance aren’t merely glanced over without action. The ECOD provides this community with a liaison to both the Erie County Executive’s Office and the Erie County Legislature. Knowing where to turn and what avenues to take will surely help those who are disabled obtain the needed assistance that they require.
Information Dissemination
A study on emergency response communication for vulnerable populations showed substantial evidence that all emergency preparedness and response efforts aren’t effectively reaching vulnerable populations in the U.S, especially those who have barriers related to literacy, language, culture or disabilities. Because much of the emergency information is spread audibly, 48 million deaf/partially deaf individuals face higher risks of injury, death, and property loss as documented in recent U.S. disasters including the terrorist attacks on 9/11, Hurricane Katrina and Hurricane Rita (in the Gulf Coast area), and the 2007 California wildfires.5

One of the most suggested forms of communication for a deaf community is visual, whether as an interpreter on the news, closed-captioning, use of a paging system with text messages or pamphlets. Grant monies can be received through public education programs to help fund the expense associated with obtaining amenities.6
The American Red Cross publishes a booklet titled Disaster Preparedness and the Deaf Community for individuals with a hearing impairment. The booklet begins by making sure partially deaf individuals know the hazards that may threaten their jurisdiction. For example, is their community prone to a hurricane or snowstorm? Knowing the community disaster plans or at least having a general idea will allow individuals to realize how they’ll be notified.
Making a plan for a hearing-impaired individual can be as simple as meeting with family or friends, ensuring escape routes are known, making an emergency wallet card, establishing a plan for a service pet and knowing when to turn off utilities.7
Knowing a disability is present within an individual’s household is a critical piece of information for emergency responders, so it’s important to teach family members and the public about the various communication gadgets that can be used. At the very least, have a small notepad that already has the impairment written on the first page. On the emergency wallet card, be sure it clearly states they can’t hear and has a list of current medications, allergies and an emergency contact. This will save critical time within the golden hour.
Responder Education
Individuals with disabilities are more vulnerable in emergency situations and victimized seven times more than the general population.8 Therefore, responder education is a major aspect of preparing for emergencies where deaf/partially deaf individuals will be. Emergency management has been around for decades, but very rarely has it stressed to the personnel within its organizations the importance of providing accommodations for deaf/partially deaf individuals.
In fact, a recent study by researchers at the University of California, Berkeley, found most state emergency operations plans include no specific mention of deaf people.9
Through disability awareness training, responders can remain professional and know how to act and abide by regulations set forth by the state and federal governments through legislation such as the Americans with Disabilities Act. Through training, certain myths about deaf/partially deaf individuals can also be expelled. Prevalent myths include:
1. All deaf/partially deaf people read lips;
2. All deaf/partially deaf people use sign language;
3. Hearing aids help the deaf; and
4. Deaf people can’t speak.
In reality, only some deaf/partially deaf people read lips. It’s an acquired skill that can take years of practice. Likewise, only some know sign language. This is a separate language they may find just as frustrating to learn as someone without hearing impairment. Hearing aids only help the partially deaf because hearing aids don’t produce sound—they amplify it. Lastly, some deaf/partially deaf individuals can speak, but simply choose not to because it may not be the method of communication that works best for them. By expelling these myths alone, responders may be better prepared to react in an emergency situation.
Niagara University’s First Responders Disability Awareness Training (NUFRDAT) program has been developed to deal with many of the issues that have arisen and continue to arise in the emergency responder realm of the community. Law enforcement, fire service, EMS, 9-1-1 operators and dispatchers, and emergency managers each have their own sections within the training that best guides their encounters with the deaf/partially deaf community.8
In essence, this program requires the responder to take a step back and evaluate the circumstances before acting. For example, during a hurricane, citizens may be required to evacuate. If access to information isn’t readily available to the deaf/partially deaf individual, they won’t know the danger they could face.
A responder must remember that the deaf/partially deaf individual can’t hear warning sirens or radio alerts, as many of our alert systems are only audible. First-responding agencies may arrive at the home of this individual and become frustrated when the resident fails to comply with requests. Not knowing the individual can’t hear and doesn’t perceive the imminent danger could mistake a disabled individual for an insubordinate one. It must be kept in mind that if this person is taken from their home, they may need to bring accommodating equipment (text telephones, video phone, etc.), their service animal and a notepad and pen with them.
When communicating with a deaf/partially deaf patient, the most important thing to do is get the individual’s attention. Speak clearly and slowly, and don’t shout, cover your mouth or chew gum because this will render lip reading useless. Make sure the person speaking doesn’t have a mustache, as that also makes lipreading extremely difficult.10 Eye contact, facial expressions and gestures are extremely beneficial, as well as trying different approaches with fewer words to convey a message. If possible, talk with family or relatives who communicate with the individual on a daily basis.10
Planning Considerations
The emergency management and response aspect of the NUFRDAT program includes planning considerations for sheltering and mass care, registries, citizen emergency response team (CERT), access and functional needs as well as working with all-inclusive committees and Federal Emergency Management Agency Office of Disability Integration and Coordination.8 It’s imperative a disaster isn’t the first time a responder is exposed to someone who’s deaf/partially deaf.
It’s also important emergency drills incorporate deaf/partially deaf people. There’s no substitute for the real thing, and communication between responders and deaf/partially deaf patients can be practiced in a non-emergent setting. It will also give the deaf/partially deaf person a chance to share vital information and feedback about the drill.
It’s critical those involved in emergency preparedness recognize deaf/partially deaf individuals will go where they feel most comfortable during a disaster or emergency. This will surely be a place that has accessibility for them, so sheltering and mass care of the hearing impaired must be considered. Where are they going to sleep? Do we have to bring in ASL translators to effectively communicate? Where can we get a translator during a disaster’s golden hour? Do we have to bring accommodation devices with the individual? Are TVs equipped with closed-captioning available in the shelters and healthcare facilities?
During the golden hour, it may be more realistic to find a relative or friend who can help interpret versus getting an official interpreter on scene. Additionally, if emergency personnel radio ahead to the ED, a professional interpreter (or someone fluent in ASL) may already be at the hospital upon arrival. With regard to access, are all the needs of this deaf/partially deaf individual provided for? Can they know that a special room, announced over a public address system, is where people can take a shower, get food or use the toilet? Posted signage could alleviate this problem entirely.
Registries can be surveyed from the public when planning for an emergency to determine if a deaf/partially deaf individual lives within a jurisdiction. This registry could provide critical information at a time of a worst-case scenario (e.g., the individual broke their arms in an earthquake and responders need to know the patient’s medication allergies prior to rendering care.) The registry can also ensure these people are checked on during minor incidents.
More recently, developments in communication have made alerting those with hearing impairment even easier. In 2013, a team of five students from California State University, Northridge designed software for an Android application called Audio Alert that can interpret audio disturbances such as sirens, smoke alarms, car horns or even crying children, then translate them into flashing lights, vibrations and texts to those who couldn’t otherwise hear them. The free app, now available on Google Play, has not only turned smartphones and other mobile devices into personal emergency alert systems, but also brings attention to the need to design software specifically for the disabled.11
Public Education
Community education is needed to ensure preparedness to disasters when dealing with deaf/partially deaf individuals. Through community education programs, deaf/partially deaf individuals should also be taught to build a survival kit with basic needs and supplies such as food, water and medications. The following can be added: extra batteries for hearing aids or implants, visual alarms, pagers, teletypewriters, car charger for cell phone or pager, portable
battery-powered TV, battery-operated lantern, notebook and pen, and hearing ear service animal identification.6
There’s no better time than the present to talk with and teach a person, especially a deaf/partially deaf individual, how to ensure their own safety during a disaster. Meeting with a state or local emergency preparedness team to ensure effective communication during any emergency, meeting with local television stations to ensure that emergency information will be accessible, and learning about products and services that can help keep their family safe, will undoubtedly ensure the best possible results during and after a disaster.
Technological Advances
New devices and services available to help the deaf/partially deaf in a disaster include: visual alert systems, amplified auditory alert systems, vibrating alert devices, text-based alert systems and telecommunications.6 Visual alert systems such as alarm clocks, fire alarms, doorbells and baby monitoring systems can include strobe lights that go off with an alarm. Amplified auditory alert systems can include phones and hearing aids. Vibrating alert devices can include bed shakers or a vibrating phone to wake a sleeping person. Text-based alert systems notify the individual to a situation through a text message. Telecommunications include videophones to allow communication through signing.
In New York, a product called Next Generation 9-1-1 (NG9-1-1) is attempting to allow individuals with hearing impairments to call 9-1-1 on a videophone and have the call answered by a signing dispatcher. NG9-1-1 will be enabled by an interconnected system of local, regional and state emergency services Internet networks capable of handling text, data, images and video from wireless and digital communications devices.11 Unfortunately, this system is nowhere near complete. The issue lies in the fact that the current dispatch system is analog whereas the new videophone NG9-1-1 system is digital, so the old infrastructure can’t support the new technological requirements, among other issues.7 Despite this, advancing technology is inevitable and will continue to be developed.
More recent technology includes the Urgent Communication System (UCS) available as an application for Android mobile devices. The UCS is a simple menu-like pictogram sheet, and the patient simply points to the pain portion and severity level with a finger to communicate with remote supporters.12 The pictures and keywords help to speed communication and is potentially more accurate as the patient can pinpoint the place, severity and direction of the pain. Currently the UCS can be implemented solely on Android devices, but applications such as this need to be available for Apple iOS users as well and free of charge. Not surprisingly, the UCS was proposed by a partially deaf person.
Those responsible for planning for disasters have the responsibility to educate responders and the public about helping deaf/partially deaf members of the community. It’s through public preparedness that lives and property are saved from disaster’s deadly wrath.
The authors recognize there’s no need to reinvent the wheel when tailoring a response involving this special population, but to instead identify what lessons have already been learned and which should be shared. By sharing this type of information, responders can adjust and adapt their training practices to improve their response and response time to these victims in real-life situations. jems
1. Brault MW. (July 2012.) Americans with disabilities 2010. United States Census Bureau. Retrieved July 9, 2014, from www.census.gov/prod/2012pubs/p70-131.pdf.
2. Perlman A. Preparing for Emergencies with the Deaf and Hard-of-Hearing Communities. (2012). [Lecture.]
3. Ivey SL, Tseng W, Dahrouge D, et al. Assessment of state- and territorial-level preparedness capacity for serving deaf and hard-of-hearing populations in disasters. Public Health Rep. 2014;129(2):148–155.
4. Newgard CD, Schmicker RH, Hedges JR, et al. Emergency medical services intervals and survival in trauma: Assessment of the “golden hour” in a North American prospective cohort. Ann Emerg Med. 2010;55(3): 235–246.
5. Neuhauser L, Ivey S, Huang D, et al. Availability and readability of emergency preparedness materials for deaf and hard-of-hearing and older adult populations: Issues and assessments. PLoS One. 2013;8(2):1–11.
6. American Red Cross. (2005). Disaster preparedness and the deaf community. Retrieved July 9, 2014, fromwww.serve.mt.gov/wp-content/uploads/2010/10/Disaster-Preparedness-and-th....
7. Goldstein J, Brucato T. Assistive technology in the deaf & hoh community [PowerPoint presentation]. Deaf Adult Services: New York, 2012.
8. Niagara university first responders disability awareness training [brochure]. Niagara University: New York, 2011.
9. Fitzgerald S. Gaps in emergency preparedness for hearing impaired raise alarm. The Hearing Journal. 2013;66(3):20–22.
10. Bastian E. Preparing for emergencies with the deaf and hard-of-hearing communities. Oct. 5, 2012. [Lecture.]
11. Bartholomew D. (March 11, 2013.) CSUN’s phone app for deaf wins international software competition.Los Angeles Daily News. Retrieved July 17, 2014, from www.dailynews.com/sports/20130312/csuns-phone-app-for-deaf-wins-internat....
12. Hosono N, et al: The urgent communication system for deaf and language dysfunction people. In Yamamoto S (Ed.), Human interface and the management of information. Springer: Berlin, Germany, pp. 269–274, 2013.

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