According to an Annual Report on People with Disabilities, nationally, in 2022, 13.9% of the U.S. populations identified as having a disability which is more than 46 million people. CDC’s campaign, Disability Impacts All of Us, informs us that in 2024 more than 1 in 4 (28.7%) adults in the United States have some type of disability. Individuals with a disability can be found in every demographic category, with both visible and invisible disabilities, and most people will join this group at some point in their lives. People with disabilities are incredibly resilient. They have to be. However, when it comes to the full disaster cycle, resilience must be a shared responsibility. It has to be. Disabilities impact daily life, but their impacts can be significantly exacerbated by disasters. Because of this, emergency management practitioners who have dedicated their lives to ensuring the safety of individuals before, during, and after disasters, have both a moral and legal responsibility to understand the needs of this population and ensure that response and recovery is equally accessible to individuals with disabilities.
Each individual has a unique set of impacts and needs based upon their disability or disabilities. Disability categories include, but are not limited to, cognition, mobility, independent living, hearing, vision, and self-care but most people with disabilities have multiple disabilities. For practitioners, it is difficult to impossible to anticipate every individual’s needs in response and recovery. To address this challenge, June Isaacson Kailes and Alexandra Enders developed the concept of access and functional needs (AFN) to operationalize support to individuals with disabilities through the framework of C-MIST (communication, maintaining health, independence, support, safety, and self-determination, and transportation).
The C-MIST framework shifts practitioners’ focus from who – who has what diagnoses, and will they be impacted the disaster – to what – what needs will present during the response and how can my agency prepare for those. The C-MIST framework ensures that emergency management practitioners can weave access and functional needs into plans, messaging, equipment, and other areas where their programs and services will intersect with people with disabilities. This framework can also assist individuals, families, and caregivers with their own preparedness and response.
Applying the C-MIST Framework
FEMA’s Office of Disability Integration and Coordination has identified 14 Potential Points of Inequity in the Disaster Cycle where emergency management programs and services intersect with the public. As a practitioner begins to apply the C-MIST framework, these points of inequity can identify programmatic areas to focus on. Some key areas identified include planning, alerts and warning, emergency public information, evacuation and transportation, sheltering, provision of communication aids and assistive services, recovery, medical care/health, power supply, dietary needs and availability of drinking water, registration for disaster recovery services, and interim and long term housing.
Communication
Many individuals need assistance with communication due to hearing, vision, speech, cognitive, or an intellectual disability. Information provided by emergency management and other public safety organizations must be provided through multiple methods, interpreted and/or signed, and simple enough that anyone can understand the content. For individuals with communication needs, consider how you receive your information and identify sources in advance that are accessible to you but also come from a verified, reliable source.
Maintaining Health
Most individuals with disabilities do not need medical services or medical care due to their disability during or after a disaster, but some may need access to supplies or support to maintain their health. Practitioners should consider how to ensure access to a dependable power source, medication replacement, and provision of essential supplies. Speak with the local center for independent living about their recommendations for supplies and equipment to include in a plan or stockpile. To find CILs across the country, consult the ILRU Directory.
For individuals, develop a list of essential needs, stock up on supplies as able, and ensure your list is included in your go bag. Additionally, ensure your medical records are accessible; keep a list of information about your treatment facility, medications and dosages in your emergency kit; and add pertinent medical information to your electronic devices for quick access by emergency personnel, if necessary.
Independence
Kailes identifies independence as “the overarching goal” of addressing all of these access and functional needs to ensure that individuals are able to maintain their pre-disaster level of function to the greatest extent possible. If emergency management practitioners are implementing C-MIST throughout their programs and services, this goal is much more achievable in most disasters.
Support, Safety, & Self – Determination
Safety and support address important services that may have been disrupted during a disaster including, but not limited to, personal care services, family members, or home health. Loss of supports can make it difficult for individuals with disabilities to maintain health and independence after a disaster. Safety and support may also include individuals with Alzheimer’s dementia, or others who experience disorientation or confusion in new or stressful environments. For practitioners, this is a need primarily in mass care operations but also in evacuations. Examples of how to address safety and security include providing extra staff to assist these individuals or providing a more secure area of a shelter.
Self-determination is the retention of an individual’s opportunity and ability to make decisions for themselves including choosing to take risks, direct their care, and exercise control over the accommodations and services provided to them.
Transportation
Transportation is an essential part of any disaster response, and many individuals have transportations needs due to disabilities and/or lack of access to personal vehicles. For practitioners, it is critical to plan for accessible transportation in advance of an event because publicly owned accessible transportation may be very limited and some private providers require at least 24 hours or more of advanced notice. Accessible transportation access also requires accessible, debris-free boarding locations with curb ramps and clearly visible signage. For individuals who require accessible transportation, make sure to learn about your city or town’s plans and resources, speak to your transportation provider in advance, and know if the provider has a special program or requirements for evacuations.
Some Additional Advice from FEMA
In addition to the advice above, FEMA recommends some meaningful actions for consideration. These include:
Create a support network. Keep a contact list of people familiar with your situation who can best help you in a disaster, such as medical providers, social workers, alternative caregivers and family members.
Plan for power outages. Make sure you have a charger with your electronic devices, with portable or solar-powered chargers being ideal backups during power outages. Talk to your healthcare provider in advance so you know what to do if you lose power. For example, power outages can cause problems such as refrigerated insulin going bad and dialysis centers being unable to help people on kidney dialysis.
Stay informed. Tune in for new information. Keep a NOAA Weather Radio broadcasting channel tuned to your local emergency station to monitor TV or radio broadcasts. You can find your local emergency station by visiting NWR Station Search (weather.gov). Follow mobile alerts and warnings about severe weather in your area. Download the FEMA App. Get weather alerts from the National Weather Service for up to five different locations anywhere in the United States.
Build an emergency kit. Your emergency kit should include unique items to meet your needs or a family member’s individual needs in various emergencies. Keep the kits stored in airtight plastic bags and put your entire disaster supplies kit in one or two easy-to-carry containers such as plastic bins or a duffel bag in an easily accessible location. Your kit should include items unique to you, such as medicine, backup batteries for your medical devices, what you need to safely transfer, and items required to answer the call of nature.
Dan Stoneking is the Owner and Principal of Stoneking Strategic Communications , the Author of Cultivate Your Garden: Crisis Communications from 30,000 Feet to Three Feet , the Founder and Vice President of the Emergency Management External Affairs Association , and an Adjunct Professor in the Communications Department at West Chester University.
Dawn Brantley is the Director of the Massachusetts Emergency Management Agency, founder of the Inclusive Emergency Management Community, and an attorney specializing in the application of non-discrimination laws to emergency management.