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National Commission on Children and Disasters: 2010 Report to the President and Congress

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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11. Evacuation

Recommendation 11.1: Congress and Federal agencies should provide sufficient funding to develop and deploy a national information sharing capability to quickly and effectively reunite displaced children with their families, guardians, and caregivers when separated by a disaster.

  • DHS should lead the development of a nationwide information technology capability to collect, share, and search data from any patient and evacuee tracking or family reunification system.
  • DHS should support the development of voluntary consensus-driven standards for data collection and data sharing through a joint Federal, non-Federal, and private sector process.
  • Government agencies should ensure the collection of appropriate data on evacuated children, particularly unaccompanied minors.

Families may become separated during the chaos of a disaster, especially when it necessitates evacuation. A no-notice disaster occurring while children are in schools, afterschool programs, and child care facilities increases the likelihood that children will be separated from parents and guardians. Hurricanes Katrina and Rita demonstrated the consequences of a large-scale evacuation, as more than 5,000 children became separated from their families.377 More than 34,000 calls were placed to a special hotline that the National Center for Missing and Exploited Children established after the storms and it took 6 months for the last child to be reunited with their family.378 The longer a child is separated from parents and loved ones, the more he or she is at risk for physical injuries, abuse, abduction, and emotional trauma.379

The inability to track the movement and location of evacuated persons was a major factor delaying family reunification after Hurricanes Katrina and Rita.380 Limitations in tracking patients evacuated on various Federal, State, and private-sector aircraft were also identified.381 In subsequent years, a number of States have developed or purchased systems for tracking evacuees.382 States also have the option of using the National Mass Evacuation Tracking System (NMETS), a State-based system developed and released by the Federal Emergency Management Agency (FEMA) on June 1, 2010. NMETS is offered in three versions: a manual paper-based system, a low-tech computer database and an advanced technology system.383 State-based systems, however, have limited ability to track people who cross State lines, especially if the information is stored and used within the person's originating State only and interstate agreements to share information are not in place. After Hurricane Katrina, evacuated households, many of which relocated out of State, moved an average of 3.5 times over a 6-month period.384

In addition to evacuee tracking systems, tools were developed within the public and private sectors to reunite family and friends displaced by disasters. Congress authorized the creation of the National Emergency Child Locator Center385 and the National Emergency Family Registry and Locator System386 within the Post-Katrina Emergency Management Reform Act.387 Other prominent reunification tools have been created by the American Red Cross, Google, and the National Library of Medicine.388

The development of these various evacuee tracking systems and family reunification tools is encouraging; however, the absence of an overarching information technology capability that allows these systems to share data on displaced persons nationally remains a significant gap. The Commission recommends that Congress and relevant Federal agencies, including the Department of Homeland Security (DHS), the Department of Health and Human Services (HHS), and the Department of Defense (DoD) provide the necessary funding to develop a national information sharing capability that addresses the significant challenge of quickly and effectively reuniting displaced children with their families, guardians, and caregivers when separated by a disaster. The Commission recognizes that the development of the infrastructure for a national information sharing capability with appropriate standards, guidelines, and protocols would require significant funding over multiple years, but believes this investment is necessary and supports current efforts to address this significant gap.

The Commission recommends that DHS, as the Federal coordinating agency for Mass Evacuation,389 lead the development of a nationwide information technology capability to collect, share, and search data from any patient and evacuee tracking or family reunification system. HHS and DoD should also have a major role in developing this capability, as they utilize a patient tracking system for patients evacuated by the HHS National Disaster Medical System.390

In its Interim Report, the Commission examined the Agency for Healthcare Research and Quality's (AHRQ) Recommendations for a National Mass Patient and Evacuee Movement, Regulating, and Tracking System.391 According to the AHRQ report, the system would provide the capability to link existing Federal, State, tribal, local, community, and private systems that track the location and health status of patients and evacuees at health care facilities, disaster shelters, and other locations where patients and evacuees gather during an evacuation.392 Since the Interim Report, efforts to advance the creation of this system have progressed.393 DoD and AHRQ drafted a statement of work (SOW) reflecting Federal requirements, which establishes a task-oriented approach allowing for incremental creation of the system as funds become available. A multi-agency memorandum of understanding394 is being finalized to establish policy for the national system, perform legal and regulatory reviews, examine existing tracking and regulating systems, and complete the SOW with Federal, State, tribal, local, and private industry representatives. In the next phase, the DoD project will look to bring together an interagency Executive Oversight Committee and one or more working groups to address the issues surrounding the creation of this platform. Additionally, the DHS Science & Technology Directorate awarded a contract to address the creation of Extensible Markup Language (XML)-based standards that will enable the exchange of information between legacy systems, through a "system of systems" approach.395 The Commission supports the objectives of the AHRQ recommendations and is encouraged by the recent progress on this initiative.

The Commission recommends that DHS direct an accrediting body, such as the American National Standards Institute (ANSI),396 to convene a panel of interested public and private parties to address the collection and sharing of information on evacuees. Federal, State, local, and private-sector entities would identify existing voluntary consensus standards or help accelerate their development should no suitable standards be identified.397 Common standards and protocols on privacy policies are needed to address the disclosure, access, activation, use, and storage of information on evacuees, as well as "a threshold level of confidentiality" that stakeholders agree to meet.398

Challenges and concerns regarding national data collection and sharing arose during discussions at the Commission's February 2010 Long-Term Disaster Recovery Workshop.399 Participants questioned what information should be collected; who should have access to this information and how it can be used; and how this system will balance the critical need to share personally identifiable information (PII) while adhering to privacy and confidentiality laws and regulations, such as the Privacy Act,400 the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule,401 and the Family Educational Rights and Privacy Act (FERPA).402 Questions remain about whether sharing PII during an emergency for the purpose of evacuee tracking is explicitly prohibited by privacy laws or limited by interpretations of laws. The Commission recognizes the importance of ensuring privacy and confidentiality of personal information, and in certain cases, strengthened privacy regulations are needed during disasters to protect children. Yet, information such as the location of unaccompanied minors can speed family reunification and should be shared with appropriate agencies and organizations when it is clearly in the best interest of a child.

The Commission recommends that evacuee tracking systems utilized by all levels of government collect appropriate data on evacuated children, particularly unaccompanied minors. A 2006 White House report called on DHS and the Department of Transportation to evaluate State and local evacuation plans and singled out unaccompanied minors as one subgroup that must be addressed in those plans.403 In response to suggestions from the Commission during NMETS development, FEMA improved NMETS's ability to track children by adding an "unaccompanied minor" check box and additional information fields to each of the versions of NMETS.404 Simultaneously, processes and procedures must be in place to allow youth, parents, and legal guardians to review information that is collected about them and that may be disclosed, and allow them to approve or amend their information.405

Recommendation 11.2: Disaster plans at all levels of government must specifically address the evacuation and transportation needs of children with disabilities and chronic health needs, in coordination with child congregate care facilities such as schools, child care, and health care facilities.

Following Hurricanes Katrina and Rita, a 2006 Government Accountability Office report on the evacuation of vulnerable populations due to disasters found increased efforts in some States and localities to address the evacuation needs of "transportation-disadvantaged" populations, including persons with disabilities, but also found that many disaster plans were still lacking in this area.406 Results from a 2007 University of Kansas survey of 30 FEMA-declared disaster sites found that 57 percent of county emergency managers did not know how many persons with mobility limitations lived within their jurisdiction.407 While attention to the unique needs of children in disaster planning is increasing, more attention is necessary on evacuation planning for children with disabilities and chronic health needs.408

The Commission recommends that DHS/FEMA and relevant Federal and non-Federal agencies fully address the needs of children with disabilities and chronic health needs in evacuation and transportation plans. A 2009 report from the National Council on Disability stressed that evacuating persons with disabilities is more time- and resource-intensive compared to persons without disabilities; therefore, local pre-event evacuation planning is crucial.409 Planning that addresses the evacuation of populations with disabilities or chronic health needs must also consider children's unique developmental characteristics and dependency needs, such as: the need to keep children with their guardians, family members and/or caregivers; medication, medical equipment, and service animals; and appropriate messaging and risk communication about how to evacuate and the risks of not evacuating. Individuals and families with disabilities and chronic health needs must be included in the emergency planning process, alongside emergency management agencies, State and local education agencies, transportation providers, and non-governmental organizations.410 In addition, many children spend a significant amount of time in schools and child care, and some reside in group homes or juvenile justice facilities; therefore, planning for the evacuation of children with disabilities and chronic health needs should be required for these child congregate care settings and conducted in coordination with emergency managers.411,412

Transportation assets, particularly vehicles with accessible features for children with disabilities, must also be identified and organized in advance of a disaster.413,414 School buses and public transportation have been suggested as possible resources for mass evacuation during a disaster.415 A report by the Western Transportation Institute found that 92 percent of total possible passenger seats within 24 Gulf Coast counties and parishes were on school buses.416 However, school buses are not always air-conditioned, and most lack wheelchair tie-downs and spaces for accommodating wheelchairs.417 The report recommended that additional research be conducted on identifying and providing transportation for children following a disaster, with an emphasis on multi-agency planning, especially with child care facilities, schools, hospitals, emergency management agencies, and law enforcement agencies.418

According to the U.S. Department of Education, more than 6.6 million children ages three to 21 have a diagnosed disability, representing 13.4 percent of total public school enrollment.419 FEMA's Comprehensive Planning Guide 301 includes specific guidance for planning for the evacuation of schools and addressing the unique needs of students with disabilities.420 The guide suggests that school-based plans should ensure the participation of students and staff with disabilities in the event of an evacuation, lockdown, or shelter-inplace. In addition, it recommends that all school-based plans address a wide variety of disabilities, including visual, hearing, mobility, cognitive, and emotional.421 These plans must ensure that evacuation vehicles and evacuation sites are accessible to students and staff with disabilities, and address reunification of students with their families and guardians after evacuation.422 Pursuant to the Individuals with Disabilities Education Act, schools are required to provide transportation that accommodates students with disabilities.423 As part of the Individualized Education Plans (IEP) mandated for students with disabilities, schools should include plans for evacuating and providing appropriate transportation for these students.424 A planning tool from the National Fire Protection Association includes a checklist addressing issues regarding safe evacuation of students with disabilities that can be included with each student's IEP.425

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