Patients With Access and Functional Needs in a Disaster

Sharon E. Mace, MD; Constance J. Doyle, MD


South Med J. 2017;110(8):509-515. 

In This Article

Abstract and Introduction


Individuals with special healthcare needs have some of the highest morbidity and mortality rates during disasters. Efforts to triage, transport, shelter, or treat vulnerable populations often fail to take into consideration disabilities and social situations, including caregiver availability. Communication, medical care, independence, supervision, and transportation needs should be considered in emergency preparedness planning. Inconsistencies with the definitions and scope of individuals with special healthcare needs exist. The problems and complexity of vulnerable populations, as well as potential solutions are considered to assist planners and disaster responders in the preplanning, mitigation, treatment, and recovery of these individuals.


Resources are limited in disasters. The most vulnerable people, including those with special healthcare needs (SHCN), often are overlooked and are the least likely to receive available resources. They may fall prey to others who would exploit or abuse them.[1]

Challenges exist in dealing with individuals with SHCN. Communication is problematic. Individuals with SHCN include people with visual, hearing, or cognitive impairment; those unable to speak or understand English; those who are distrustful and/or fearful of authority (eg, illegal immigrants, former prison inmates); and those who are socially, economically, or geographically isolated (eg, those living in rural locations, military veterans, homeless people). Even when vulnerable individuals understand what is occurring, they may be unable to evacuate because of their limited mobility, lack of transportation, or both.

Evacuation or sheltering in place presents difficulties: general shelters are unprepared to accommodate vulnerable people, who may be neglected or unnoticed.[1] Stranded individuals need medicine, food, and relief supplies. Sheltering in place without electrical power can be fatal for those who are dependent on technology (ie, individuals who are dependent on ventilators). Infants/children, frail older adults, and individuals with SHCN depend upon caregivers, support systems, or both to maintain the activities of daily living (ADLs). If they are separated from caregivers, then support systems fail.