Emergency Management and Disability Assistance

Problem Statement

The purpose of this case study is to discover how emergency management agencies in the metro area of Atlanta plan to accommodate persons with disabilities and special needs. The study will focus on the emergency management agencies, fire departments, and emergency medical teams that are responsible for vulnerable populations in emergencies. This study will review and analyze preparations for such populations, detailing the strategies (1) used in preparation for disasters, (2) used during disasters, and (3) used to rehabilitate and recover from powerful storms and other disasters. By detailing existing preparations, the researcher will uncover deficiencies in current planning procedures and will be better able to make recommendations for improvement. The research itself will be conducted onsite at each of the relevant agencies or departments. At this stage in the research, we define accountability for vulnerable populations as ensuring that persons with disabilities and special needs are cared for during any type of incident (whether natural, nuclear, biological, or chemical).

Purpose of the Study

The purpose of the study is to (1) better understand existing structures and procedures for ensuring the safety of vulnerable populations in emergencies, (2) uncover shortcomings in the existing infrastructure, and (3) recommend specific and effective strategies for improvement. These changes should make a tangible difference for those with disabilities and special needs, improving the rates of survival and injury for these populations in Atlanta and setting an example for other cities to follow. Accountability for vulnerable populations needs to become an integral part of any emergency management system.

Research Design

We theorize that improving planning and mitigation measures will improve real outcomes for persons with disabilities and special needs. To effect these changes, we must quantitatively and qualitatively analyze existing procedures. At present, we hypothesize that two of the best strategies for improvement will be (1) implementing GIS systems to account for persons with disabilities and special needs, and (2) appointing representatives for these populations. The GIS system allows public safety officials to document the location and status of individuals with special needs. Vulnerable individuals would register with emergency management organizations, providing contact information and accommodation requests. Mobility-limited individuals would, for example, plan alternative evacuation routes and transportation systems to be used in emergencies. Diabetics and others who depend upon life-saving medications would register their needs with the city, which would then compile the information and plan to have the necessary medications available to distribute. In cities in which GIS systems have been implemented, survival rates for those with disabilities and special needs have been greatly improved.

Research Intent

This study intends to incorporate both broad theories of emergency management and specific theories relating to persons with vulnerabilities to understand the existing infrastructure. Focusing on the metro area of Atlanta in particular, we hypothesize that this region could enhance their accountability for vulnerable populations by improving their preparations for these populations. Emergency management agencies must be aware of the size of the vulnerable populations within their jurisdiction, accounting for both the total number of vulnerable individuals and the specific needs of each individual within the population. This information should be stored in a database that is updated annually and reviewed to ensure that any specific population has not been left unaccounted for. Because of the variety of ways in which individuals can be vulnerable in emergencies, this task seems daunting to many agencies. Because those with disabilities and special needs suffer disproportionately in emergencies, the development of this type of database needs to become a higher priority for emergency management agencies and other departments.

Central Phenomenon of the Study

The central phenomenon of the research study is the lack of emergency preparation for persons with disabilities and special needs. Several recent studies have described the extent of the injuries and fatalities that these vulnerable groups have suffered – and continue to suffer – in emergencies. Despite increasing awareness of the problem, the situation has not improved. Those with disabilities and special needs continue to suffer disproportionately. To address this phenomenon, we must devote time and energy to research the extent of the situation and find ways to address the roots of the problem.

General Theme Review

The literature on emergency management and accountability for those with disabilities suggests that the organizational structure of emergency management groups plays a large role in their failure to accommodate vulnerable populations. To remedy the situation, the structure of emergency management agencies, fire departments, and emergency medical teams must be understood, reviewed, and improved. Research has consistently demonstrated that these organizations lack necessary oversight, access to resources, and information regarding the vulnerabilities of those within their jurisdiction.

Most emergency management literature analyzes oversight structures in emergency management agencies, and some literature focuses more specifically on oversight when accounting for persons with disabilities and special needs. A lack of oversight leads to a lack of planning, which results in the problems of unpreparedness that cause unnecessary death and suffering. These are major ethical issues that must be identified and publicized, generating attention to produce a public, popular demand for change. Several ethical issues that have been identified include:

1. The distribution and receipt of medical care, the provision of evacuation assistance, and the availability of temporary housing are disproportionately unavailable to those with disabilities and special needs.

2. Because those with disabilities and special needs are often dependent upon a caregiver, there is a risk that they will be left on their own without the resources with which to care for themselves.

3. Emergency management agencies, fire departments, and emergency medical teams are inadequately trained to support and care for those with disabilities and special needs.

4. Persons with disabilities and special needs have no representation in emergency management agencies and members of vulnerable communities are not consulted during the planning process.

5. Vulnerable populations are often inadequately warned of emergencies because of communication limitations, and consequently, find themselves left behind during evacuations.

These concerns make it clear that those with disabilities and special needs are often unable to care for themselves and require outside assistance from emergency management personnel. Emergency management organizations must be held accountable for their preparations – or the lack thereof – when dealing with these populations. To improve existing outcomes, these organizations must find ways to address each of the ethical issues discussed above.

Existing research on the subject demonstrates that accountability for vulnerable populations is a serious problem that needs to be publicly addressed. Emergency management agencies, fire departments, and emergency medical teams must be expected to improve their preparations for vulnerable populations and must be publicly held accountable for failure to do so. Likewise, organizations that adequately address the needs of vulnerable populations should receive positive attention for their efforts. Successful organizations in large, metropolitan areas can partner with smaller regional offices to coordinate care in nearby communities and rural areas to improve their outcomes.

Though most agencies report awareness of the problems that plague vulnerable populations, they consistently fail to take responsibility for the situation. These organizations have long been aware of the seriousness of the problem, but have failed to make positive progress. Given their awareness of the problem, and the lack of responsibility taken, these organizations should be the focus of future research and strategies for improvement. Many agencies state two main reasons for their failure to implement changes or improve their accountability – a lack of staff and a lack of funding. Adequate numbers of personnel are necessary to support a broad and effective infrastructure, and adequate funding is necessary to support the technical requirements necessary to meet the needs of vulnerable people (maintaining GIS systems, making paratransit vehicles available, providing warnings in alternative formats, providing for pharmaceutical distribution, etc.). To enact effective change, researchers must recognize the limitations that these organizations face when proposing solutions.

Research Questions

This study will analyze how vulnerable populations are accounted for before, during, and after emergency incidents. To better understand the existing situation, the study will investigate existing the procedures, funding sources, partnerships, and technological systems utilized by emergency management organizations in the metro area of Atlanta. Through this study, the following research questions will be addressed:

1. How are persons with disabilities and special needs in your respective are or responsibility (AOR) accounted for before, during, and after a disaster or emergency incident?

a. What are the registration requirements for persons with disabilities and special needs within your AOR?

2. What assistance do the caregivers need?

a. What evacuation plans are in place for those with disabilities and special needs before an incident?

3. What type of tracking system is being used by your agency to store information about persons with disabilities and special needs?

a. When was the last time the information was updated?

b. Who is responsible for updating the information?

4. What mitigation measures are in place for those restricted to assisted living communities, nursing homes, and hospitals?

5. What type of warning systems are in place and being used?

a. When was the system last updated?

b. How often is the system tested?

c. How can the system be improved?

d. How do you ensure the community is familiar with the system?

6. What type of funding does your agency or department receive for emergency preparedness?

a. Is that funding enough to support disaster and emergency incidents that may occur in the area?

b. How are the funds allocated for their respective communities?

7. What types of partnerships are established in your region?

In our research, we begin by inquiring broadly into how an organization prepares to accommodate vulnerable populations in emergencies. We then explore the needs of caregivers, the use of tracking systems, the use of mitigation measures, and the type of warning systems being used. To better understand available resources, we inquire into the sources, quantity, and allocation of funding within organizations. We conclude by inquiring into the structure of existing partnerships between emergency management organizations (both within and between communities). Understanding the research question provides a foundation for beginning the research process.

Theoretical Framework

This study will utilize a theoretical framework based on advocacy, generating data that is intended for practical, problem-solving applications. The current crisis of accountability requires an action-based agenda, aimed at producing real social change. The study will focus on improving accountability for vulnerable populations in the metro area of Atlanta, and consequently, improving their chances of surviving disasters and avoid injury. This will be achieved through a variety of measures aimed to improve awareness of the issues and emergency preparedness for these populations. These measures include proper representation during the planning phases of emergency management and the implementation of GIS systems. Appointing representatives of vulnerable populations to speak with emergency management organizations will help to ensure that their plans address the specific needs of each segment of the population. Implementing GIS systems will allow emergency management agencies to better identify and locate persons with disabilities and special needs in advance of emergencies. These measures, among others, will serve to reduce morbidity and mortality in the metro area of Atlanta.

An Advocatory Paradigm

Merriam-Webster defines a paradigm as “a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations and the experiments performed in support of them are formulated; broadly: a philosophical or theoretical framework of any kind” (Paradigm, n.d.). For this study, we will be working within a paradigm rooted in advocacy and active participation. According to Creswell, “the basic tenet of this worldview is that research should contain and action agenda for reform that may change the lives of participants, the institutions in which they live and work, or even the researchers’ lives” (2007, p. 21). This paradigm complements the nature of case study research because it allows the researcher the opportunity to educate the public about the struggles that persons with disabilities and special needs are facing. It also provides an avenue for generating support from emergency management and public safety agencies.

Encouraging Individual Accountability

In an article on the subject, Christoffel (2000) distinguishes between two levels of conduct that are relevant to advocacy. On the first level, public health personnel seek to empower individuals to take responsibility for themselves and prepare for emergencies. On the second level, public health personnel seek to empower communities to better care for themselves collectively. An advocacy-based theoretical framework must distinguish between improvements that can be made on an individual or collective level. This study seeks to offer avenues for both individuals and for communities to improve their accountability for those with disabilities and special needs, though it focuses on the role of emergency management organizations in particular. Though organizational changes are key, individual behaviors can play a large role in the success of any particular program. For example, GIS systems require vulnerable individuals to register with emergency management organizations and update their personal information periodically. Even though emergency management organizations are responsible for coordinating care and providing the necessary resources in emergencies, individuals must be prepared to cooperate with emergency management personnel when disaster strikes. Individuals can improve their chances of survival by registering with local organizations, receiving emergency preparedness training, and putting together emergency kits that contain the medications and other supplies that might need in a disaster. This study seeks to better understand the existing strategies that vulnerable individuals use to improve their outcomes and recommend areas for improvement. As a part of a larger strategy, Emergency management organizations may need to reach out to vulnerable individuals and provide them with the information, training, and resources with which to care for themselves in emergencies.

Encouraging Public Accountability

This study devotes extensive attention to the second level of conduct, looking for ways to improve outcomes for communities and networks of individuals. This can involve reducing community risks, reducing environmental dangers, or promoting community protections. Reducing community risks may involve equipping individuals with the resources necessary to care for themselves in emergencies, training emergency medical personnel to respond appropriately to the needs of vulnerable individuals, and acquiring the resources necessary to put the established plan into action. Promoting community protections may involve establishing evacuation facilities, setting up a system for the distribution of pharmaceuticals in emergencies, or making sure that warnings are provided in alternative formats. Each of these strategies contributes to the ability of a community to account for its most vulnerable members in emergencies.

On a broader level, reducing environmental dangers – preventing emergencies from occurring or from having catastrophic consequences – should be considered an avenue for improving community outcomes. Emergency management organizations should ensure that their communities are adequately prepared for the types of disasters that most commonly plague their region. Each community’s plan to accommodate vulnerable individuals must be specific to the particular needs of that community. Cities prone to hurricanes, for example, must train emergency management personnel to respond to vulnerable individuals in different ways than cities prone to earthquakes. Though there may be broad similarities between the plans that these communities implement, there will also be important differences that need to be negotiated within each community.

Design

The research design that will be implemented is a collective case study. Utilizing a case study design will allow the researcher to present a few selected cases that detail the research phenomenon. The researcher will draw conclusions based on the results of this case study, but will also incorporate previous research, existing literature, and other case studies when generalizing beyond the metro area of Atlanta. A case study will allow the researcher to examine a few cases in considerable detail, utilizing personal interviews to generate the necessary data. The data gathered through this research may have exploratory, descriptive, or explanatory purposes.

Design Rationale

The case study design is best equipped to analyze the current procedures used by emergency management organizations in the metro Atlanta area. This type of descriptive study aims to discover and describe what is happening in a few select situations and will use this information to find avenues for further research. This type of study provides a critical test of the theories supplied by emergency management literature and will determine whether the broad conclusions supplied by previous theorists hold up when analyzed in a small community. Whether these theories hold up could have broad implications for emergency management theories and their practical applications. To contextualize the information generated on the metro area of Atlanta, the researcher will compare this case study with other case studies that analyze the same problem. This study will reference other case studies to contextualize and support the conclusions suggested by this case study, which will help the researcher to better understand the phenomena at work in Atlanta.

The case study approach allows the researcher to perform a thorough, detailed investigation of a few select cases, which can produce a deeper degree of understanding than alternative methods. Achieving this depth of understanding is essential because of the complexity and interaction of multiple factors that affect accountability for vulnerable populations. This type of design is essential to (1) understanding the reasons why emergency management organizations have failed to be sufficiently accountable, and (2) uncovering solutions that are responsive to the needs of this particular community. Because the study is based upon a framework of advocacy and participation, the objective of the research is not to merely tell a story but to produce actual social change. The case study design will uncover avenues for improvement and options for future research on the subject.

Participants

Participants will be selected from emergency management agencies, fire departments, and emergency medical teams in the metro area of Atlanta. Participants may be managers, employees, or other types of members affiliated with these organizations. They will be selected by contacting each of these organizations via email and requesting volunteers for the study. Many high-ranking officials and individuals with decision-making power will be personally invited to participate, as their cooperation is essential to the success of the study. Once a list of willing participants has been compiled, the researcher will conduct a series of structured interviews with members of the relevant agencies. The list of participants will be analyzed to ensure that the participants are representative of their respective agencies – the study will aim to include a certain number of entry-level employees, a certain number of employees with some managerial experience, and a certain number of leaders that possess a large degree of decision-making power within their organization. This will help to avoid potential bias in the study’s results.

Research Site

The interviews will be conducted in the offices of emergency management personnel. Staging the interviews in the participants’ workplace will allow the researcher to observe participants in their normal environment and will ensure maximal convenience for those who generously volunteer their time and effort. A comfortable environment should also improve the quality of responses given by participants, encouraging cooperation and full disclosure. If a participant is uncomfortable with this arrangement, an alternative location will be made available. The researcher will arrive twenty minutes before the time that the interview is scheduled to begin and will record audio from the interviews. If a participant is uncomfortable with the recording device, written notes may be taken instead.

Researcher’s Role in Data Collection Procedures

The researcher will be directly involved throughout the entire research study. Throughout this study, the researcher will have multiple roles to fulfill. These roles include the (1) development and design of interview questions, (2) the collection of data via in-depth interviews, (3) the analyzing of generated data, (4) the preparation of data for the final report, and (5) the uncovering of potential implications and solutions to existing problems. This type of hands-on approach will ensure that data is accurately recorded, understood, and presented.

Sampling

The type of sampling that will be employed for this research study is maximum variation. In an article on this subject, Patton states that “the maximum variation sampling strategy turns...apparent weakness into a strength by applying the following logic: Any common patterns that emerge from great variation are of particular interest and value in capturing the core experiences and central, shared dimensions of a setting or phenomenon” (Patton, 2002, pg?). A maximum variation sampling method compliments the case study research method. Employing these methods together will provide stronger research.

This strategy is justified because it allows the researcher to document common patterns that have been experienced by all participants. Preliminary research suggests that several common patterns will emerge once the data has been collected. Case studies done in cities with similar emergency management systems have uncovered similar patterns, which the researcher plans to review in connection with this study. Using these other studies, the researcher will attempt to determine whether the patterns witnessed in other cities are similar to those experienced in the metro area of Atlanta. This will allow the researcher to determine what can be done to improve outcomes for vulnerable groups in Atlanta.

Sampling Selection

The sample will be selected from emergency management agencies, fire and emergency medical departments within the metro Atlanta, GA area. The researcher will work with various agencies to establish a diverse group of participants. The first phase will employ a questionnaire for the selection process. The researcher will use the information collected from the questionnaire to select candidates for interviews. The in-depth interviews with the selected participants will help to reveal more information about improving the research problem.

Sample Size

The size of the sample affects the generalizability of the study’s conclusions. The researcher must be able to identify the appropriate size that will provide the most reflective representation of the research participants. In an article on the subject, Lundsford and Lundsford (1995) state that, “each study should be considered on its own merits. The decision should be based on the judgment of the researcher or an advisory committee” [pg? – This source doesn’t appear in your references]. Given the size of the population with which we are working, we will sample _____ [insert sample size #] of individuals throughout the study. This will ensure that the data collected is adequately representative of the population.

The targeted audience for the research study is metro Atlanta, GA. The last count of persons with disabilities in the area was 2,751 in the year 2000 (American Towns, 2011) [This source doesn’t appear in your references]. Because the count has not been updated in 14 years, this number may not be useful. Research suggests that there may have been a significant increase in the number of persons with disabilities and special needs. [Replace the introduction to this paragraph with information on the size of various emergency management organizations]. Given the size of the population, the sample size of _____ [insert sample size #] will accurately reflect the nuances of this particular population. The size of this sample will provide adequate representation of the emergency management agencies, fire departments, and emergency medical teams in question.

Because of constraints on time and resources, the researcher will not be able to interview every member of each emergency management organization in Atlanta. The number of representative individuals chosen to participate in the study is based upon both the size of the population and the constraints of the researcher. To complete the study effectively, the researcher must have a broad understanding of who will be participating and how much time each interview will take. In an article on the subject, Creswell states that “for case study research, I would not include more than 4 or 5 case studies in a single study” [pg?]. Creswell believes that this number “will provide ample opportunity to identify themes of the cases as well as conduct-case theme analysis” (Creswell, 2007, p. 128). For this study, a sample size of ____ [insert sample size #] will be most effectively utilized by selecting these cases based upon their relevance to the research problem.

The research study will consider possible sampling errors. Sampling errors occur when there is a difference between the selected sample and the actual population for which the research is intended to be representative. To avoid sampling errors, the researcher has determined the sample size on data received from emergency management agencies. This ensures that the sample size is reflective of the population of emergency management organizations. The researcher must also take into consideration the actual cost and time associated with conducting the research study. Lundsford and Lundsford (1995) state that, “since the cost of a study is partially dependent on the number of subjects sampled, it is important to determine the fewest number of subjects required to yield valid results” [pg?]. Large sample size would take longer to process and cost a great deal of money compared with the smaller sample size that has been selected. The researcher would rather spend quality time with _____ [insert sample size #] participants than try to interview and process larger numbers of lower quality interviews.

Limitations

This study faces the potential methodological weaknesses of uncooperative participants or researcher error. If the researcher is unable to obtain accurate information from each interviewee or fails to preserve data from interviews, the strength of the study’s conclusions will be compromised. Understanding existing procedures will allow the researcher to determine whether appropriate plans have been made to accommodate individuals with disabilities or special needs in emergencies. To ensure full cooperation, the researcher will contact each emergency management agency at least a month in advance of the study and will follow up with them in the day or two prior to each scheduled interview. This will provide adequate time to ensure that all potential interviewees are ready and willing to participate on the scheduled days.

Validity Threats

A threat to internal validity would arise if the researcher failed to record or document interviews appropriately. A secondary threat would emerge if interviews were misplaced or misfiled because missing data would compromise the integrity of the researcher’s conclusions. To avoid the first scenario, the researcher will take specific steps to ensure that (1) a recording device is available well in advance of each scheduled interview, and (2) that she comes equipped with a secondary device to be used if the original recording device fails. To avoid the second scenario, the researcher will immediately transfer each recorded interview to a computer and make back-up copies available in other formats.

A threat to external validity would arise if participants provided false information during interviews. Because of the sensitivity of the questions being asked, some participants may provide inaccurate responses that understate or fail to disclose the realities of the situation. Some selected interviewees may opt not to participate at all, compromising the sampling procedure used to determine who should participate. Given these potential obstacles, the researcher will work closely with the emergency management organizations in Atlanta to ensure maximum honesty and cooperation. Information obtained through interviews will be fact-checked and further researched to ensure accuracy.

Ethical Concerns

Ethical concerns associated with this study involve the privacy and treatment of participants. The privacy of participants is essential – we do not want volunteers to experience negative consequences as a result of their cooperation. All interviews will be kept confidential unless participants give written consent for the researcher to disclose their identities in the final reports. The ethical treatment of participants will require that the researcher be especially attentive to how she communicates and interacts with those that she is studying. The researcher will maintain a professional demeanor and will remain mindful of the participant at all times. If participants require accommodations to make the interview-process accessible, alternative formats or interview strategies will be utilized.

All participants will be informed that their participation is completely voluntary and will sign written forms consenting to participation. These forms will address the ethical concerns discussed above and make sure that each participant is aware of the nature of the research being conducted, their rights as a participant, and how the research may be used. The consent forms will give the researcher permission to utilize any data collected during the interview process and will provide the option for participants to disclose or withhold their identities in the final report. Each participant will be allowed to have someone present with them during the interview process if this makes them feel more comfortable. To ensure that participants are treated well, the researcher will bring an assistant that will manage the recording device, take notes, and accommodate any needs that the participant may have.

Significance of the Study

The researcher hopes that the data generated through this study will contribute to improved care for those with disabilities and special needs during emergencies. The researcher aims to improve the preparedness process and procedures used within the metro area of Atlanta, Georgia. The information generated through this study will be compared with information generated through case studies on other cities and will be used to better understand the broader challenges that vulnerable populations face in emergencies. The data generated on Atlanta may have implications for cities with similar emergency management systems that are prone to similar types of emergencies. This study will have significant implications for those with disabilities or special needs in Atlanta, but may also generate future research that will have an impact on vulnerable populations in other parts of the world. Smaller cities in Georgia that lack access to necessary resources may partner with the larger metropolitan agencies in Atlanta to ensure that they are adequately prepared to meet the needs of their populations. The data generated through this study may be used in ways that benefit many cities in Georgia or even cities in other states. Other cities may discover that their strategies and setbacks are similar to those in Atlanta and may modify the recommendations made in this study to suit their respective needs.

The implications for social change are significant. Existing literature makes it clear that much must be done to adequately address the root causes of inadequate accountability for vulnerable populations. If the emergency management organizations in Atlanta can implement the recommendations made by this study, it could serve as an example for other cities to follow. Every city must do their part to ensure that those with disabilities and special needs will be adequately cared for in emergencies. Because of the seriousness of the present situation, the issue of accountability for vulnerable populations must become a priority in public health management. The issue deserves greater attention from public health officials and citizens of each community. Involving public health officials and communities is an essential strategy for improving accountability for those with disabilities or special needs.

References

Christoffel, K. K. (2000). Public health advocacy: process and product. American Journal of Public Health, 90(5), 722-726.

Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.

Paradigm. (n.d.). Merriam-Webster Online. Retrieved April 3, 2014, from http://www.merriam-webster.com/dictionary/paradigm

Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.