Polk County Special Populations Planning

1. Jay Shrader, DirectorWestern Region Partnership for Public Health Preparedness Kathy Poirier, DirectorPolk County Emergency Management Rick Gates, Veterans Service Officer Polk County Veterans Affairs Polk County Special Populations Planning

2. Polk County • Population: 43,886 • Age Distribution • Under 5: 5.9% (6.4) • Under 18: 26.2% (25.5) • Over 65: 15.1% (13.1) • Persons below poverty: 7.1% (8.1) • Persons per square mile: 45.0 (98.8) • Persons with a Disability (age 5+): 6,860 (790,917) • 8 Public Schools, 3 Parochial, 3 Medical Centers • 45 Minutes from MPLS • Largest Municipality: 2,000+ • 2 radio stations, no daily newspapers • 400 lakes and rivers – heavy tourist area

3. Objectives • Provide overview of the Polk County Special Needs Plan for Disasters and Emergencies • Provide overview of the Polk County Special Needs Registry • Discuss successes, unexpected findings, and barriers

4. The Catalyst… • Following Hurricane Katrina, Governor Doyle ordered evacuation plans • CDC / HHS placed great emphasis on special populations planning • After Action Report from recent exercises • Media and stakeholder’s inquiries forced action • Polk County resident approached County Board Chairperson

5. The Process • Process took from May - November of 2006 • Established and received buy-in from core committee: EM, PH, VA, HS, Home Care, Aging • Research and fact finding • Seminole County EM, Florida • Community engagement • 12 meetings; 120 participants • Business, government, special needs individuals • Plan and Registry reviewed and signed into County EOP in November 2006 • Registry live in December • Website Developed with on-line registry www.co.polk.wi.us/emgt

6. The Plan • Goal: Reach everyone in a community!!!! • Push vs. Pull Communication • Shelter-in-Place vs. Evacuation • CDC Categories: Economic Disadvantage, Limited Language Competence, Disability, Cultural / Geographic Isolation, Age, and Pets/Animals (Added by Committee)

7. The Plan • Category, Subset, Point of Contact, Barriers to Reach / Concerns, Estimated Population Size, Communication Mechanism, Location, Action Needed

8. The Registry • Result of planning process – Committee driven • Intended for individuals with severe health and medical needs • Purpose of Registry is two fold: • Special needs can self-identify • Emergency Responders have data to foster effective response • Both on-line and paper applications • 2006 Planning Year; 2007 Implementation, Testing, Exercising; 2008 Updating and Revising • Registry has 18 individuals thus far

9. The Registry • Disclaimer, disclaimer, disclaimer on forms, posters, website, etc: The Registry is a voluntary program and in no way ensures immediate or preferential treatment in an emergency. Individuals must have their own individual plan for the first 48-72 hours of an emergency. • Information to be used only during an emergency. • Corp Counsel reviewed legal and liability issues including HIPPA (based on HHS Memo re: Hurricane Katrina and voluntary approach)

10. HHS Memo re: HIPPA

11. Registry Eligibility The Registry is for those individuals who are not in a care facility, such as a hospital, nursing home or congregate living facility. These facilities are required to have an evacuation plan in place for their residents and patients to be transported to another healthcare facility. The Registry is for individuals who are not part of a group facility and have no other alternative but to seek assistance from the County.  • Must be a Polk County resident. • Individuals, who due to mobility restrictions, require assistance of others with medical management activities of daily living and basic needs, when that assistance may be unavailable during an emergency or disaster. • They have a respiratory condition requiring special equipment such as monitors or oxygen. • There may be other conditions which would render an individual eligible for special needs emergency sheltering and these will be considered by the review of the registration form by a Review Team. 

12. The Registry Operations Flow Special Needs Registry Application Completed On-Line – Applicant information downloaded into Special Needs Registry database Completed Paper and mailed in Emergency Management Receives Email Notification Sent to Emergency Management EM sends applicant letter confirming receipt of letter Instant Email Verification Receipt sent to Applicant EM and PH convene Review Team Application Approved – Level assigned Application Denied Additional Information Needed EM updates registry Review Team member contacts applicant for additional info EM sends out letters and other resources

13. The Registry at Work • During an incident, EM will query the database to determine affected population. • EM will notify ER partners via phone, email, dispatch, radio or fax of special needs population in geographical area. EM may work with local PH to develop a Command Caller Scenario. • EM or designee will attempt to contact individual or emergency contact of the incident and provide/receive status. • ER community will use data to establish an effective response.

14. Other Issues • Cost: In kind support of approx $600.00 per year for materials • Staffing: EM Director manages logistics; Review Team oversees operations • Maintenance: registrants must update application annually • Training: training to ER responders on the registry and ethical considerations when dealing with special populations (section in plan)

15. Registry Levels of Enrollment Determined by Review Team: • Level 1: Requires urgent attention. Individual’s medical information indicates immediate emergency response assistance is necessary for survival. • Level 2: Requires moderate attention. Individual’s medical information indicates an eventual emergency response is necessary but is not considered immediate or life-threatening. • Level 3: Requires little attention. Individual’s medical information indicates there is no immediate attention required. However, if time and resources permit, the individual should be contacted by emergency responders. • Not eligible for the program.

16. Registry Examples: Level 1 • 45 YR Male: Live with spouse; hearing loss, end stage renal failure (life sustaining equipment) • 65 Yr Male: lives alone; severe diabetic, left leg amputated, wheelchair, partially deaf and blind, insulin dependant • 44 Yr Male: Lives alone with caregiver; gun-shot in chin, paralyzed from neck down

17. Registry Examples: Level 2, 3 • Level 2 • 90 Yr Female: lives alone, blind • Level 3 • 74 Yr Male: lives with spouse, cancer of the stomach (removed), g-tube feeder; special dietary needs • To be reviewed • 36 Yr Female: lives alone, brain cancer, diabetes, kidney disease, seizures, wheelchair bound • 63 Yr Female: lives with sister, quadriplegic, insulin dependant, brain injury, life sustaining medications

19. Website FAQ

20. Online Application

21. Paper Application

23. Registry Poster

24. Letter Sent

25. Resource Sent

26. What worked? • Core committee very dedicated • Support from administration and department heads • Community buy-in and participation • Debate is healthy… we’re a very healthy committee! • In-kind support (IT, Corp Counsel, EM, VA, PH, Home Care, Aging) • It’s working, so far!

27. Barriers • Defining Special Populations • Levels of Enrollment in Registry need to be more defined • Must have same individual (s) facilitate the process from A to Z • Must have same agency reps in process from A to Z • Time consuming – resource intensive • Long term commitment unknown yet • Marketing • Getting people signed up • Equal workloads among players!!!

28. Unexpected Findings • Positive public perception of local government • Cohesion among community agencies and governmental departments • Excitement and enthusiasm • Interest among counties across WI

29. Next Steps • MOU’s with participating agencies • Establish Line of Succession • Continue Outreach Training / Education • GIS (Geographic Information Services) • Exercise

30. Questions? • Jay Shrader jasons@co.polk.wi.us(715)485-9116 • Kathy Poirierkathyp@co.polk.wi.us(715)485-9280 • Rick Gatescvso@co.polk.wi.us(715)485-9244