Disaster Planning Must Include the Elderly and People with Disabilities

Lessons Learned from Katrina

HONOLULU—Because physical medicine and rehabilitation (PM&R) physicians care for people with disabilities and the elderly, these doctors play a critically important role in disaster preparedness, according to Mark A. Young, M.D., M.B.A.

“The needs of people with disabilities are unique and critical and demand to be addressed in disaster planning,” says Dr. Young, a Baltimore-based PM&R physicians who serves on the faculty of the University of Maryland/ Sinai Hospital PM&R residency program and is chairman of physical medicine and rehabilitation at the Maryland Rehabilitation Center.

Dr. Young, who is also an adjunct associate professor at New York University Medical Center Rusk Institute of Rehabilitation Medicine and a professor in the department of orthopedic sciences at the New York College of Podiatric Medicine in New York City, will speak on November 9 at the American Academy of Physical Medicine and Rehabilitation’s 67th Annual Assembly on “Rehabilitation Services’ Care Contribution in Natural and Man-Made Disasters.”

Dr. Young notes that when undertaking disaster planning, it is important to understand that many rehabilitation diagnoses are separate from medical diagnoses. Rehabilitation conditions include neurological deficits, communications disorders, mobility disorders and vision and hearing impairments Contingencies for these patients require advanced effort for evacuation. Groups including the elderly and others with brain injury, spinal cord injury and stroke may also require special evacuation guidelines and procedures

“People with sensory deficits, including those who are blind or deaf, require very special accommodation and consideration for safe and complication-free evacuation,” explains Dr. Young. “It is the role of PM&R physicians to develop protocols for proper evacuation techniques for people with disabilities. This is an important population, and one that often goes ignored.”

“We learned a lot from Hurricane Katrina in 2004,” states Dr. Young, who spearheaded a national rehabilitation humanitarian volunteer campaign known as “Operation Functional Recovery” composed of volunteer rehabilitation providers. Dr. Young was joined by Mathew H.M. Lee, M.D., of the New York University School of Medicine Rusk Institute and other AAPM&R and International Society of Physical and Rehabilitation Medicine members in the volunteer effort.

“Although many ‘medical patients’ were evacuated from New Orleans and the Gulf region in the days immediately following the hurricane, many persons with disabilities remained in the affected region,” Dr. Young continues. “A significant number of patients with functional deficits decided to stay close to home rather than face the hardship and difficulties of evacuation. People suffered not only physical but also psychological set backs from the hurricane.”

Disaster survivors frequently require rehabilitation for months and even years later. “Many of the Katrina rehab issues surfaced months later,” comments Dr. Young. “One of the lessons we learned from Katrina is that the rehabilitation population requires our help and expertise during and after a disaster.”

In addition to transportation challenges, rehabilitation patients face a variety of complications. Existing neurological issues related to conditions such as stroke, spinal cord injury and brain injury often worsen following a disaster. In some circumstances mobility deficits become exacerbated in patients with lower extremity wounds, and chronic pain conditions become magnified.

“New Orleans has one of the largest diabetic population in the south,” Dr. Young explains. “We were surprised to learn how many people with diabetes lost their glucometer monitoring devices and fled the hurricane without shoes. Unfortunately, Medicare only allows one pair of shoes a year.” Many patients with diabetes, peripheral neuropathies, pain and peripheral vascular disease developed problems with skin and developed wounds that ran the gamut from skin ulcers to limb amputation.

Although there is no exact statistic that describes the number of people who are disabled to some measurable extent, Dr. Young contends that this population is large enough for PM&R physicians to be concerned about addressing their critical needs. He says that Louisiana had a large rehabilitation population including the elderly and people with diabetes.

The government and healthcare providers agree that it is important to think of disability in advance. AAPM&R is involved in the process to create proper planning strategy to better serve the needs of people with disabilities during times of disaster.

“It’s our role as PM&R physicians to step up to the plate to make decisions to serve the needs of people with disabilities,” concludes Dr. Young. “We must be true to the roots and tradition of our field in serving the needs of people with disabilities. Our knowledge of disability medicine will make disaster preparedness and disaster recovery easier.”

The American Academy of Physical Medicine and Rehabilitation is the national medical specialty society of more than 7,500 physical medicine and rehabilitation (PM&R) physicians, also called physiatrists. Physical medicine and rehabilitation physicians focus on restoring function. They care for patients with acute and chronic pain and musculoskeletal problems like back and neck pain, tendinitis, pinched nerves, and fibromyalgia. They also treat people who have experienced catastrophic events resulting in paraplegia, quadriplegia, or traumatic brain injury and individuals who have strokes, orthopaedic injuries, or neurological disorders such as multiple sclerosis, polio, or ALS.

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Editor’s Note: Dr. Young has no financial interests, arrangements or affiliations to disclose that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

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