New emergency preparedness tools to enable millions more people to shelter in place

Although the nation has invested billions of dollars preparing to respond to emergencies, current plans leave millions of Americans at risk because they do not account for critical problems people face when they actually try to protect themselves.

To fix this fundamental flaw, The New York Academy of Medicine is releasing a report and tools—available at www.redefiningreadiness.net —that will enable households, work places, schools and early childhood/youth programs, and governments to anticipate and address problems they would face in emergencies. The tools are released during National Preparedness Month, an initiative of the U.S. Department of Homeland Security.

The report, With the Public's Knowledge, We Can Make Sheltering in Place Possible, is based on two years work gathering the insights and experiences of nearly 2,000 people who live and work in four communities around the country. It identifies serious and unanticipated problems that currently make it neither feasible nor safe for many people to shelter in place. In conjunction with that report, the Academy is releasing four Shelter-in-Place Issue Sets (in both Spanish and English) to help members of households and organizations recognize and address their own vulnerabilities in these kinds of emergencies. Sheltering in place means staying inside whatever building you happen to be in—a workplace, school, store, or at home—for a period of a few hours to several days in order to stay safe, even if that requires you to be separated from other family members.

“Sheltering in place is a very important protective strategy in situations ranging from dirty bombs, toxic explosions, and chemical spills to much more common emergencies, like electrical blackouts and snowstorms,” said Roz D. Lasker, MD, Director of the Academy's Center for the Advancement of Collaborative Strategies in Health and Division of Public Health, and lead author of the report.

The Academy's main report documents that the emergency preparedness instructions being given to people and organizations do not address many important sheltering-in-place issues and sometimes make matters worse. Among the many gaps it uncovered:

• The public is being instructed to keep a supply of food and water in their homes, and most keep their medications there as well. But in a shelter-in-place emergency, many people will not be at home and will need to take shelter in other buildings, so their home-supply of food, water, or medicines won't be accessible.
• The public is being told to identify places for family members to reunite in the event of an emergency. But those instructions don't address situations in which it might be unsafe to go to such a place, such as if you would have to go through a danger zone to get there.
• While instructions describe how to identify and seal “safe rooms” in homes, schools, and other buildings, they pay little attention to assuring that the rooms can accommodate the number of people who are likely to need shelter, provide them with breathable air and tolerable temperatures, or give them safe access to water, food, lavatories, telephones, and medical supplies.
• Schools have been preparing for emergencies that affect the school directly, but children are also at risk if their parents and other guardians need to shelter in place because of an emergency and no other adult is available to pick the children up or be at home with them after school.

“The disconnect between current instructions and the problems people face in shelter-in-place emergencies isn't surprising, since the public never had an opportunity to think about these situations in such detail before,” Lasker said.

The Academy has been harnessing the public's knowledge about emergencies for several years now, with generous support from the W. K. Kellogg Foundation. In 2004, the Academy's research study, Redefining Readiness: Terrorism Planning Through the Eyes of the Public, predicted that large numbers of people would suffer or die unnecessarily in emergencies, because planners were developing instructions for the public to follow without finding out whether it is actually possible, or safe, for all groups to do so. The prediction was proven to be correct during Hurricane Katrina, when many people could not follow instructions to evacuate due to barriers that had not been identified or addressed beforehand.

Over the past two years, the Academy has been working to prevent such needless death and suffering with teams in four Redefining Readiness demonstration sites in Carlsbad, NM; Chicago, IL; Savannah, GA; and southeast Oklahoma. In more than 200 small group discussions, almost 2,000 residents from diverse backgrounds explored the particular problems they would face trying to protect themselves in shelter-in-place emergencies, and the actions that they and other people and organizations could take. “Because of these efforts, we now know how to protect many more Americans in shelter-in-place emergencies than is currently possible,” said Lasker.

The insights generated in the small group discussions provided the basis for the Academy's four Shelter-in-Place Issue Sets, which are tailored specifically to people in households, work places, schools and early childhood/youth programs, and governments. These practical tools—which consist of sets of questions rather than instructions—are designed to help users become aware of critical protection problems that their own household or organization can address and to develop workable solutions. The four issue sets are available on-line in Spanish as well as English.

Nan D. Hunter, JD, Director of the Center for Health, Science, and Public Policy at Brooklyn Law School and a co-author of the Academy's new report, highlighted the importance of these tools for schools and work places. “The issue sets can help these organizations avoid liability by clarifying what they might reasonably be expected to do in shelter-in-place emergencies,” Hunter said. “Government agencies and private philanthropies can go a long way toward helping schools and work places realize those expectations – protecting employees, students, and customers in the process – by integrating the use of the issue sets in their current grant programs and by providing schools and work places with other incentives and supports.”

“This work is an important example of ways in which the Academy can play a role in assuring that individuals and communities affected by policies and programs have a great voice in creating them and thereby making them more effective” said Jo Ivey Boufford, MD, Academy President.