A recent study on disability and earthquake, there were more than twice the number of disabled children victims than normal victims.Although the importance of preparation is recognized by families and PWDs (People with Disability) they appear to be under-prepared to meet family disaster need. It is understood that it would be more beneficial if we provide opportunities for disaster preparedness education, safety planning and help build effective family preparedness plans and to connecting families to local emergency management and responders. It is also understood that the people who are most involved with PWDs on a daily basis before the disaster strikes, will make the biggest difference on disaster preparedness for the PWDs. Hence, as healthcare providers, we can make difference in disaster preparation by providing individualized disaster preparation training as a part of our routine service delivery.
I have collected a few resources and compiled it into a story. This article, in form of a story, aims to give practical ideas on how we can better prepare our clients for a disaster/emergency. In this story I portray a physiotherapist who finds herself trapped in a body of a 10 year old. Let’s find out how she gets ideas for a “Modified Plan of Care- for disaster preparedness” for her clients.
I must have fallen asleep while I was texting my friend when the second earthquake happened. Suddenly everything became very confusing and weird. I looked around and this was not my room. Lucky to be alive, I thought. Then I started looking around and was confused by what I saw. I was wearing a funny pink night dress (I hate pink) and I was in a strange room which was not mine. Looking at my hands and they seemed as tiny as a child’s. I was startled and wanted to shout for help but I had lost the power to speak. Thankfully I was still able to see. I did not know whether people were out looking for me and whether my family was alright. I started thinking about my daily regimes; appointments I had planned with my clients, plans for training the next day. I also had mixed feelings about my plans of getting married next year. I felt a strong jolt of un-ease somewhere in my gut as I thought of all these. I can easily drift away at this point, cease to exist, and no one will have any idea about me being alive or dead.
As time passed, I started feeling more hopeless. I was not able to move my legs. It seemed like hours and I started drifting in and out of consciousness.
Training to react to disasters: Practice Drills:
- Mobility training:
“I should not give up” I thought. I had so much to look forward to in life. I had to try something if I was to be rescued. I remembered that I had been texting my friend when all this happened. Where is my mobile? I could call someone if I could find my mobile. I tried to move to search my mobile, but I could not feel my legs. After trying in vain, I remembered how I taught and practiced this before while I was demonstrating commando-crawling to my patients in the past. I commando-crawled across the dusty floor in search of my mobile.
- Training to be fit:
After what seemed like hours, I could move only few inches. Despite being a fit person, I was having such hard time moving around. I wondered how difficult it might be for person who actually has to depend on using hands for mobility and for everything, especially if not trained before. Once I am out of this , I promised myself, I would focus more on fitness related activities for my clients. We do need some prior preparation and fitness to be able to save ourselves.I finally found my mobile but no network. A day had already passed since I was trapped here.
- Disaster/ Emergency kit preparation- Keeping it handy:
At this moment I remembered “Kashi”, one of my clients. I used to call him “dai” (brother in Nepali). We were discussing the contents of disaster kit one day after the first major earthquake (Gorkha earthquake)- that was when he lost his right leg. I had come home and made a kit for myself too. It was somewhere under my bed. Perhaps if I can reach it, I could survive until I am rescued. With much effort I finally crawled my way to the kit. I gladly nibbled ‘Wai Wai’ (a popular ready-to-eat snack) and drank some water that I found stored in my kit.
- Pulmonary fitness and functional training:
After some water and food my head cleared. I remembered that I had a whistle: I could let people know that I was trapped here. So I reached out for the whistle in the bag and blew as hard as I could. I thought to myself , “So this is why lung function, hand function and strength is so important” -finding and blowing the whistle needs all of these things.
After hours of intermittently whistling, my lungs were exhausted and my legs were aching. Then, I heard noises above me. I whistled louder. At last they found me!
Disaster management and training drills (As a therapist and other health care professionals)
“I am Prakash” the man said. “I am a physiotherapist and I am here to help you out. Your legs are trapped and you might be hurt. Let’s carry you out. Let me know if you are uncomfortable at any stage”. I was checked for my injuries then transported safely from the floor into a stretcher. There were at least 3 people transferring me. They were always very meticulous.. They were well coordinated and everyone knew what they had to do. I felt safe during my transportation to the ambulance. I started wondering about this physiotherapist, Prakash. He was confident and well trained. I was feeling guilty that I was not as prepared as he was for the disaster. I was also somewhat proud however, that like me, he was a physiotherapist and that he was doing a wonderful job.
Advantages of pre-planning with the family members
My family was nowhere to be seen. I remembered that we had planned to meet at the chowk (courtyard) once we were safe. I tried to tell my rescuer but I still could not speak. Suddenly someone was holding my hand and looking at a band on my left wrist. I had not realized it was there. Prakash said “Ok, so Sumnima, (Sumnima, I thought, I am not Sumnima! She is one of my clients,) you need to have Tegratol, this anti-epileptic drug” (I don’t need it, Sumnima does, I thought again). Doses are mentioned, good. “We will contact your mother on the number written in your wrist band. ” Hajur (respectable form of Hello in Nepali) aunty, she is alright, we are taking her to Dhulikhel hospital… Yes, yes, we do have her disaster kit… She was hanging on to it… Yes, we found the medication, I know…we will give her the medicines immediately… Yes, she is fine please do not worry… we found her eating ‘Wai Wai’ so she is fine… Please come to the hospital… We will have her registered under the given name… Yes okay. I will keep the mobile with her at all times and a trained personal assistant is assigned to people with severe disability… Yes, she will be assigned one at the Hospital… yes you can be in touch with the personal assistant too. okay ”
Diverse Referral Mechanism- Comprehensive Care Management
I was very much confused by all the strange things happening around me. People wrongly identifying me as my patient, me not being able to walk or talk, the strangeness of the place I was in and the clothes that I was wearing. I tried to make sense of all these things while I was transported to the ambulance. Once in the ambulance, Prakash and the other woman were talking. Prakash said “…but it is good that the special school called us regarding her contact details, otherwise it would have been impossible to trace her “. The Woman says- “yes , thankfully we have this system now. Otherwise we would have no idea of how many people with disabilities need help and how we would coordinate all of this?”
Alternate methods of communication
Prakash said “Oh, I think she is awake… Hi Sumnima, I hope you remember me. Are you hurt or feeling pain anywhere?” Prakash showed me a communication board that I frequently used with my clients at the clinic. There were many pictures on it. I was tired of all the confusion surrounding me. I did not want to think any more and just followed his directions. I moved my hands and pointed to a ‘sad face’ on the communication board. He asked again “Where?” and flipped to other page. I pointed to the legs. That was very convenient and helpful since I had not been able to speak at all. I drifted away once again.
I realized I was now in the pediatric ward on one of the hospital beds with many children around me. My mother was next to me. The nurse was about to inject me. I reached forward to hold my mother’s hand. That was when everything vanished and I woke up on the floor of my own room. I had fallen down from my bed when I was reaching out to my mother in my dream. I was sweating profusely and my heart was racing as if I had been running.
Although this was only dream, a bad dream, I could not shake this off. I could do so many more things to prepare my clients for any kind of disaster. I looked at the wall clock, it was 4 am. I started typing on my laptop – “Modified Plan of Care”. This would include aspects of disaster preparation training.
The most effective way to manage a disaster is to be prepared. Research has shown that although awareness campaigns, suggestions, and booklets improve knowledge about how to prepare for disaster, people do not carry these things out back in the home. As health care professionals, we have a greater role in preparing our clients for disaster by making disaster preparation more effective. How can we achieve this? Take this story as an example to build a “Modified Plan of Care- for disaster preparedness” for your individual client who has a disability. Practice mobility drills, practice making emergency/disaster kits, discuss their strategies of escape, ask about where they live, help keep track of them when needed by informing the authorities. Of course, add any other ideas that you already have.
A disaster cannot be prevented, but preparation for a disaster can minimize its impact.
So, are we prepared to be prepared?
- Tanaka S. Issues in the support and disaster preparedness of severely disabled children in affected areas. Brain Dev. 2013 Mar;35(3):209-13.
- Wolf-Fordham S, Curtin C, Maslin M, Bandini L, Hamad CD.Emergency preparedness of families of children with developmental disabilities: what public health and safety emergency planners need to know. J Emerg Manag. 2015 Jan-Feb;13(1):7-18.
- Shenhar G, Radomislensky I, Rozenfeld M, Peleg K.The impact of a national earthquake campaign on public preparedness: 2011 campaign in Israel as a case study. Disaster Med Public Health Prep. 2015 Apr;9(2):138-44.
Image from Google images