Disasters – large scale events that have an extreme impact on life and property – disproportionately affect people with disabilities. They are more likely to have difficulty evacuating without assistance, are more likely to be segregated in shelters, and have more difficulty recovering in the disaster’s aftermath. Individuals with disabilities who are independent in their day-to-day lives may lose access to their caregivers (paid/volunteer staff or family members), transportation, accessible living or working environments and assistive technologies.
People with disabilities are significantly less prepared than the general population (Smith & Notaro, 2015) and are more likely to be severely impacted by the disaster. Under “blue skies” conditions assistive technology (AT) is critical to the independence and well-being of people with disabilities; in an emergency or disaster, access to AT may mean survival and/or the difference in recovery from the event. Thus, involvement of state AT programs in emergency management efforts is a natural fit.
Four Phases of Emergency Preparedness
One of the first steps to engaging in statewide emergency management (EM) efforts is to become familiar with the structures, terminology, and acronyms/abbreviations used in these efforts on the national, regional and local levels. For example, the term “access and functional needs” is the current terminology used by emergency managers to refer to people with disabilities (although this term also includes people with special needs due to permanent or temporary medical conditions as well as individuals who do not speak English). Conversely, state AT programs seeking engagement with emergency management personnel may need to share the language and acronyms relating to disability. For a good example on this topic, visit the Special Education and Disability Acronyms website page.
Four Phases of Emergency Preparedness
Emergency preparedness is typically conceptualized as having four phases: Preparedness; Response; Recovery; and Mitigation.
Emergency preparedness is based on the notion that there are certain predictable factors that will occur in an emergency or disaster, and the effects of these factors can be reduced or eliminated by taking steps in advance of the occurrence. The Federal Emergency Management Agency (FEMA) and the respective state emergency management agency, the Centers for Disease Control (CDC) as well as state public health agencies have online resources to promote personal preparedness for people with disabilities.
People who use AT should develop a plan, a “go kit” in the case of evacuation as well as supplies that will facilitate their ability to “shelter in place”. Several state AT programs have developed preparedness resources with a focus on people who use AT. As resources are developed they will be added to this webpage. For immediate assistance, you can contact AT3info@ataporg.org.
First responders include personnel such as police, fire, and other emergency workers who may be involved in assisting people with disabilities in safely evacuating their premises (whether at work or home) and in some cases transporting them to emergency shelters. It is helpful for first responders to understand the nature of various disabilities (including issues related to communication) and the importance of AT, and to have training on these topics. Agencies responsible for operating shelters may need assistance in developing, acquiring and deploying assistive technology resources that will enable people with disabilities to be safely housed in an accessible “general population” shelter when appropriate, rather than segregated in a restrictive medical needs shelter. State AT programs have developed resources to help train first responders as well as shelter personnel; suggested lists of AT for shelters (including not limited to AT for mobility and communication); and strategies to identify AT needs of survivors in the shelter.
Recovery from emergencies and disasters may take a long time, depending upon the extent of the event and the robustness of the infrastructure prior to the event. For example, months after Puerto Rico was devastated by the 2017 hurricanes, the island was still without reliable power or telephone service. Many individuals with disabilities has lost their AT; others had new and unmet needs for AT devices and services as a result. While federally-declared disasters may provide some support for the replacement of AT, available funds may not cover the loss or it may take a long time. Reused AT may be a valuable resource to provide individuals with device loans to bridge the time between loss and replacement.
The mitigation phase of emergency management refers to efforts related to reduce the (future) impact of emergencies. This may include additional steps in planning, training, and community preparation. For example, state AT programs may be develop Memoranda of Understanding with community partners and EM officials that outline the ways in which the state program may be called upon in the event of a disaster declaration.
Corona Virus (COVID-19) Pandemic
According to The Centers for Disease Control and Prevention (CDC), “[m]ost people with disabilities are not more likely to become infected with or have severe illness from COVID-19. However, some people with disabilities might be more likely to get infected or have severe illness because of
- underlying medical conditions,
- congregate living settings, or
- systemic health and social inequities.”
Everyone should practice regular preventive care including wearing masks, social distancing, and vaccination. The CDC’s website has many resources including guidance regarding symptoms, what to do if you feel sick, and preparation for an outbreak in your area: CDC Covid-19 Information and Covid-19 and People with Disabilities.
Among the many resources on the CDC website is guidance designed to assist citizens in cleaning and disinfecting public spaces including your workplace, school, home, and business. Explore the CDC Guidance on Cleaning and Disinfecting. The decision tree and guidance may provide assistance as AT Act programs develop or modify operational plans as restrictions ease.
The Administration on Community Living (ACL) has a website that will be continually updated throughout the course of the COVID-19 outbreak.
Several other federal agencies have dedicated web pages including the US Department of Education. Note in particular interim guidance relating to services to young children and students with disabilities.
During spring and summer 2020, AT3/ATAP engaged state and territory AT Act programs about their response to the COVID-19 pandemic. This report, AT Act Programs COVID-19 Response Summer 2020 provides insights into how the AT programs have adapted to meet the new demands of the COVID environment and safely provide services to individuals with disabilities of all ages including older adults.
Health Insurance Coverage
Because of the impact of this emergency on health insurance, it is important to review materials that relate to coverage for assistive technology devices and services.
In addition to information coming from international sources such as the World Health Organization (WHO), the federal government, including the Centers for Disease Control (CDC), you should check with your state regarding issues like authorization for, delivery of, and funding for tele-rehabilitation services.
The Centers for Medicare & Medicaid Services (CMS) website has helpful information for AT programs to understand the waivers and flexibilities available to public programs for the COVID-19 emergency.
Department of Education
The U.S. Department of Education’s Covid-19 Resources page includes guidance and policies related to elementary and secondary education, special education, postsecondary education, and other aspects of lifelong learning. The Centers for Disease Control and Prevention (CDC) also continues to provide updated guidance for school settings.
Department of Health and Human Services (HHS)
Office of Civil Rights (OCR)
OCR has issued guidance reviewing legal standards and best practices for improving access to COVID-19 vaccination programs and ensuring nondiscrimination on the basis of race, color, and national origin. Whether information is distributed via flyers, online information portals, or in person at vaccine distribution sites, there is a legal obligation that COVID-19 vaccination programs be accessible and free of discriminatory barriers that limit a communities’ ability to receive vaccinations and boosters. The new guidance ensures that entities covered by civil rights laws understand their obligations under Title VI of the Civil Rights Act of 1964 and Section 1557 of the Affordable Care Act, laws requiring that federally assisted health care providers and systems ensure fair, equitable access to vaccines. Recipients of Federal financial assistance includes state and local agencies, hospitals, and health care providers administering vaccines and boosters.
The HHS OCR Guidance on telehealth identifies technologies that could be used for telehealth and those that cannot be used for telehealth, here is an excerpt from the guidance on the HHS website. Note that just because a telehealth service is permitted does not assure payment by public or private insurance payers. In addition, telehealth/telerehab providers representing licensed professions should check with their state’s respective licensing body.
Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.
Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.
Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.
- Skype for Business / Microsoft Teams
- Zoom for Healthcare
- Google G Suite Hangouts Meet
- Cisco Webex Meetings / Webex Teams
- Amazon Chime
- Spruce Health Care Messenger
Note: OCR has not reviewed the BAAs offered by these vendors, and this list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products. There may be other technology vendors that offer HIPAA-compliant video communication products that will enter into a HIPAA BAA with a covered entity. Further, OCR does not endorse any of the applications that allow for video chats listed above.
Under this Notice, however, OCR will not impose penalties against covered health care providers for the lack of a BAA with video communication vendors or any other noncompliance with the HIPAA Rules that relates to the good faith provision of telehealth services during the COVID-19 nationwide public health emergency.
Administration for Community Living (ACL)
The Administration for Community Living (ACL) has a Covid-19 resource page.
- The National Rehabilitation Information Center (NARIC), which is funded through ACL, is actively collecting NIDILRR grantee community publications on their Covid-19 Special Collections web page.
Sanitization/Cleaning of Phones and Electronics
While the CDC recommends you wash your hands frequently and avoid touching your face, it is harder to clean the other things that touch your face – especially your phone. When reviewing advice and products, note whether there is a claim to kill bacteria or viruses. Even if it is “only” going to take care of bacteria, it doesn’t hurt to clean your electronics!
Apple advice on how to clean your apple products.
PC magazine addresses “spring cleaning” for a variety of electronics, including headphones, phones, and tablets and laptops.
How to Disinfect Your Phone and Electronics From Viruses and Germs
And of course, refer to the archived AT3 webinar (November 6, 2019) on “basic” sanitization and cleaning procedures
Ultraviolet Radiation (UV)
The application of UV radiation in the health-care environment (i.e., operating rooms, isolation rooms, and biologic safety cabinets) is limited to destruction of airborne organisms or inactivation of microorganisms on surfaces. The effect of UV radiation on postoperative wound infections was investigated in a double-blind, randomized study in five university medical centers and the investigators reported the overall wound infection rate was unaffected by UV radiation, although postoperative infection in the “refined clean” surgical procedures decreased significantly (3.8%–2.9%). No data support the use of UV lamps in isolation rooms.
New CDC Study Confirms Effectiveness of UV-C Disinfection to Combat Harmful Pathogens
What are ultraviolet (UV) light sanitizers?
UV light is nature’s disinfectant, but can it kill coronavirus?
The challenges associated with the pandemic can be stressful, overwhelming, and cause strong emotions in adults and children. Public health actions, such as social distancing, are necessary to reduce the spread of COVID-19, but they can make us feel isolated and lonely and can increase stress and anxiety. The CDC offers healthy ways to cope with stress. Learning to cope with stress in a healthy way will make you, the people you care about, and those around you become more resilient.
The AT3 Center offers helpful information in the “AT News and Tips” blog, AT for Managing Anxiety.
The AT3 Center webinar, Managing Social Isolation, Anxiety and Depression through the Use of Assistive Technology Tools, highlights tools that may be helpful in reducing stress.
National Disability Rights Network (NDRN) has a variety of resources related to key areas of concern for people with disabilities in this national crisis. The NDRN website has links to topical briefs including issues related to transportation, housing, rationing of health care, incarceration, and special education. There’s also an accessible video guide (with captions available in English, Spanish, and simplified Chinese) targeted at people in group homes, nursing homes, and other residential facilities.
Material for Families
State and Territory AT programs may be the only entity available to assist consumers with information particular to assistive technology devices and services. This may especially be true for families who rely on the schools for AT services for their children. PrAACticalAAC has a comprehensive compilation of materials to explain the virus (e.g. social stories); visual supports for handwashing; visual schedules (especially good to have if parents are suddenly home schooling!) and communication (sample boards; symbols; vocabulary).
PrAACtical Resources: Dealing with the Covid-19 Pandemic
Relevant AT3 Center blog posts
The AT3 Center’s blog, “AT News and Tips”, has topics of interest and relevance for emergency management and resources. Subscribe to our AT News and Tips blog for emergency management resources and more in-depth information about assistive technology devices, services, and innovations from the state and territory AT programs. Follow and Explore the AT3 Blog for interesting AT information.
State AT Programs in the time of Corona Virus (COVID-19) Webinar Recording
Emergency Management and AT Programs Webinar
Recommendations for Emergency Managers For Improving the Delivery of Disaster Assistance to Disaster Survivors with Disabilities (pdf) (March 2019).
This document, produced by US Department of Homeland Security (DHS) Office for Civil Rights and Civil Liberties, is a synthesis of information gleaned from listening sessions held in communities affected by the 2017 and 2018 natural disasters. Recommendations support the engagement of state AT Act programs in all phases of emergency and the promotion of personal preparedness of people with disabilities, especially those who use power-dependent assistive technology and durable medical equipment.
Preserving Our Freedom: Ending Institutionalization of People with Disabilities During and After Disasters (pdf). Specific recommendations that involve assistive technology are included.
NCD recommends the FCC reestablish their Emergency Access Advisory Committee to establish effective communication access requirements for alerts, warnings and notification, including provision of American Sign Language and other existing and new assistive technology. These guidelines should be developed in consultation and collaboration with DOJ, applying the requirements for equal effective communication access. Implementation should include monitoring and enforcement by the FCC and the Department of Justice.
NCD recommends that HHS establish a process for states and territories for loaning and replacing durable medical equipment, consumable medical supplies, assistive technology, disability services and supports, as well as disaster case management to disaster survivors with disabilities in order to provide equal access and non-discrimination throughout emergency response to meet immediate health, safety, and independence needs.