Preparing everyone for the worst: Two ORAU projects incorporating DEIA into emergency planning

Emergency planning discussion guides

When it comes to national preparedness, ORAU works diligently with the federal government creating resources to equip communities for emergency response. One of those resources includes a CDC discussion guide series for emergency planners. The guide encourages local leaders to consider five social determinants of health—economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context—in their preparedness planning. Not only do these discussion guides prompt thoughtful conversation, but they also seek to solve challenges.

ORAU Health Education Specialists Jennifer Burnette and Will Artley understand that diversity, equity, inclusion and accessibility (DEIA) means we must pay attention to a wide variety of people who may be at increased risk of harm during an emergency.

In 2023, a Ready.gov campaign focused on preparing older adults for disasters, specifically older adults from communities that are disproportionately impacted by all-hazard events. Senior adults can face greater risks when they live alone, have lower incomes, have a disability or live in rural areas.

Sometimes, rural areas aren’t just far from a city center. Sometimes, rural communities hit by emergency have unique challenges, such as fewer resources. Because a one-size-fits-all strategy doesn’t always work for everyone, forethought and ingenuity can go a long way toward a successful emergency response in these areas.

“In remote places like Alaska, emergency planners use the Iditarod sled dogs to deliver medicine and other life-saving supplies to the hardest to reach areas. It’s not just a tradition,” Burnette explained. “They use it as a tool to prepare for emergencies when the power goes out, and there’s no refrigeration. Planning exercises help us think through scenarios like this so we can anticipate needs of the elderly and those who are homebound.”

Part of Burnette’s and Artley’s scope of work with the published discussion guides incorporated what they called promising practices. As an example, they pointed to using a learning from the Hurricane Katrina disaster. The city produced a guide that includes 17 city-assisted evacuation spots for New Orleans in the future. Because lack of transportation was one of the biggest challenges during that emergency, the team identified evacuation spots that are strategically placed to help people who may not have a car or are dependent on public transportation. From those locations, future evacuees will be taken to the Smoothie King Center—a large indoor arena in New Orleans that that will serve as a central staging area—where they will be registered and next steps can be taken to get them to safety. This learning and experience can be applied to other communities across the country as emergency planners work through hazard vulnerability analyses on their locality.

See ORAU’s contributions:

• Introduction
• Instructions
• Economic Stability
• Education Access and Quality
• Health Care Access and Quality
• Neighborhood and Built Environment
• Social and Community Context

Responsive mental health planning in emergencies

Another important part of national preparedness ORAU is addressing is how best to communicate with and assist people during a crisis. This can be for emergencies of scale like natural or radiological disasters, or individual emergencies related to mental illness and chronic homelessness. ORAU Health Education Specialist Matthew Schnupp is raising awareness about these challenges and the gravity of planning ahead with a mental health and DEIA lens in mind.

Most recently, Schnupp says the COVID-19 pandemic amplified the strain on healthcare providers and particularly those who serve patients with mental illnesses. This is on top of an astonishingly high background prevalence of mental illness. The CDC says one in five adults live with mental illness (whether it’s anxiety, depression or something else) and one in 25 say the affliction is serious enough to interfere with daily life in a major way.

Though their activities may be heroic, providers and responders are not immune to mental health stressors. According to one study by Burrowes et al about the impact of COVID-19, Schnupp says 37% of healthcare providers say they intend to leave the field in the next five years. Preparedness and burnout mitigation needs to start now, as finding providers for disruptive events is already challenging.

Schnupp highlights the importance of preparedness planning with an intentional focus on mental health, socioeconomic and DEIA factors. In exercises that walk through scenarios like sheltering in place for storms or other threats, it’s imperative to ask questions like:

• How do our response plans accommodate different demographics in rural/urban settings?
• How will access to food, water, safety and healthcare be provided and triaged?
• How will we consider the mental health component of emergency response (for both the general population and responders)?
• How will we reach and help those who are homeless and transient?
• How will long-term sheltering in place—which is linked to loneliness—affect suicidal ideation?

A common denominator Schnupp kept returning to in his research and projects is the need to build relationships before an emergency hits: “Plans break in an emergency, but the worst mistake people can make is to not have a plan and key relationships in the first place,” Schnupp said. He continued that this is especially important with populations at increased risk for harm—like those who deal with homelessness, who experience social or economic disadvantage or those with medical conditions. It’s critical for community leaders and emergency responders to know each other so they have a voice of influence. Then, when the time comes, shared guidance will be better communicated and potentially more effective.

“Having a trusted messenger who recurs throughout any type of intervention or emergency response is vital to success,” Schnupp said. “The messenger needs to understand the local context. They need to be identifiable by those affected and someone who cares about them.”

To answer his own question about how we can prepare, Schnupp points to engaging community partners. “Be brave enough to care. Be intentional about closely listening to what is important for community and faith-based organizations, so we can build trust and confidence,” Schnupp said.

While emergencies are usually unexpected, we can do our best to anticipate the what-ifs like natural disasters and large-scale accidents. As we proactively plan our response to these incidents, it’s our responsibility to consider everypopulation including all neighborhoods, demographics and health statuses. ORAU is leading the charge to ensure no one is overlooked.