New comms infrastructure increases response capability during emergencies involving disabled people

Published:  08 June, 2012

BCAS is one of the largest ambulance services in the world, providing pre-hospital emergency health care to the population of British Columbia across an area that spans 945,000 square kilometers, from 187 ambulance stations. It is also the first ambulance service in the world that has set up a dedicated infrastructure that greatly increases capability and performance of response teams when dealing with disabled people in an emergency, writes Paul Dixon.

Over the past 40 years, there has been a marked increase in the number of people with disabilities living independently in the community as public awareness and attitudes have evolved. Many people with disabilities and a growing senior population use assistive equipment and devices to function independently on a daily basis: mobility aids, communication aids, medical equipment, and service animals. Communities have become more inclusive as building codes have evolved to make residences, offices, schools and public facilities accessible to all. Public transit is in most jurisdictions now widely accessible to those in wheelchairs or with mobility issues. Disabled people are not a single unified group – they have different priorities and face different challenges. There are as many disabilities as there are individuals, whether physical, intellectual, mental or sensory characteristics or conditions. These can be the result of illness, injury or congenital condition.

All too often, individuals with disabilities or functional limitations have a higher level of disaster vulnerability than those without disabilities, for a number of reasons. Often it is a matter of their socioeconomic situation, which magnifies their vulnerability before the disaster even occurs. Large-scale disasters, such as Hurricane Katrina, have shown that the disabled and elderly in the community will suffer a much higher rate of death and/or serious injury than the community at large.

Recognising this, emergency management professionals have adopted the term “vulnerable population” to include those commonly seen as disabled, the growing segment of seniors and other segments of society. The British Columbia Coalition of Persons with Disabilities (BCCPD) acts as a voice for all disabled people in British Columbia, principally as an advocacy voice with all levels of government in order to promote full participation. 

In 2006, seeing the severe impact of Katrina on the vulnerable segments of communities, the BCCPD created the Emergency Preparedness for People With Disabilities Committee (EPPDC), with an inclusive membership of emergency management professionals, representatives of government agencies and members of the BCCPD community. Emergency Preparedness Project has been a leader in promoting the inclusion of people with disabilities in emergency preparedness in BC and Canada. Through a partnership with Volunteer Canada, this project trained over 200 individuals representing over 120 community organizations from BC, Yukon, Alberta, Ontario and New Brunswick in emergency planning for people with disabilities.

The training manual that accompanies the program, Prepare to Survive - Prepare to Help, is full of exercises and resources for community groups who want to play a role in emergency planning and response in their communities. Building from this program, EPPDC then developed Strategic Inclusive Training for Emergencies (SITE) that is specifically for businesses to include employees and clients in emergency preparedness plans.

Emergency planning cannot be designed only for large-scale events or the “big one”. Everyday emergencies in any community can have a devastating impact on vulnerable people. In November 2011, a deaf couple living in Bowmanville, Ontario narrowly escaped death when their apartment building was destroyed by fire. Not able to hear the building’s fire alarms, the sleeping couple was not aware of their dire predicament. First arriving fire crews were told by building residents that everyone had evacuated, so firefighters went straight to work fighting the fire.  It was a very startled firefighter who encountered the couple in a hallway as they were attempting to flee.  This happens all too often in communities around the world, with firefighters or paramedics responding to an incident unaware of the complete circumstances that may have tragic consequences.

There two sides to the situation – personal responsibility for one’s wellbeing as well as the ability of first responders or emergency personnel to meet public expectations. Often, individuals take little or no responsibility for their situation or personal preparedness while emergency response personnel face unrealistic expectations. EPPDC undertook a project that would engage the entire community in emergency planning with a goal of creating long-term cross-sector relationships by including emergency management professionals and first responders as well as employees of disability organizations. Beyond simply raising awareness of these groups, the EPPDC sought at the same time to raise awareness within the community of those most at risk – the disabled and vulnerable, with the aim of assisting these people to create personal preparedness plans and build personal support networks.

One of the keys was developing a common language and a straightforward assessment tool that would allow people on both sides of the equation to have a common baseline and language both expressing needs and understanding what those needs are. The Functional Needs Framework looks at the needs a person will have in an emergency rather than simply stating their situation. For example, rather than simply saying that a person has cerebral palsy the Functional Needs Framework asks the question “what will the needs of a person Cerebral Palsy be in these functional areas” and then filters the question through the C-MIST process:

C-MIST (Communication – Medical – Independence – Supervision – Transportation)


Communication Needs includes people who:

  • Have a limited ability or no ability to speak
  • Have limited or no ability to speak, read or understand English
  • Have reduced or no ability to speak, see or hear
  • Have limitations in learning and understanding

During an emergency people with communication needs may not be able to:

  • Hear verbal announcements
  • See directional signs to assistance services
  • Understand the message

Medical Needs includes people who need assistance with:

  • Activities of daily living – bathing, eating etc.
  • Managing chronic, terminal, contagious health conditions
  • Managing medications, IV therapy, tube feeds
  • Dialysis, oxygen, suction
  • Managing wounds, catheters, ostomies
  • During an emergency:
  • Some people may be separated from family and friends. Early identification of needs and disaster response intervention can avoid costly deterioration of health and functional independence
  • Operating power dependent equipment to sustain life

Functional Independence includes people who use assistive equipment and devices to function independently on a daily basis, such as:

  • Mobility aids – wheelchairs, walkers, scooters
  • Communication aids – hearing aids, computers
  • Medical equipment – oxygen, syringes
  • Service animals
  • Require medications to function independently

During an emergency:

  • Individuals may become separated from their assistive equipment and
  • Devices or service animal
  • Evacuate individuals with disabilities with their assistive equipment whenever possible
  • Do not separate an individual from their service animal at Reception Centres

Supervision Needs includes people who have any of the following:

  • Dementia, Alzheimer's
  • Depression
  • Schizophrenia
  • Transfer trauma
  • Brain injury
  • Developmental disabilities
  • Severe mental illness

Transportation Needs includes people who cannot drive due to:

  • Disability
  • Age
  • Temporary injury
  • Poverty
  • Addiction
  • No access to vehicle
  • Legal restrictions

While initially envisioned to be used in a post-disaster environment to enable emergency management personnel to more quickly process victims of large-scale events, the C-MIST protocol has been adopted by the British Columbia Ambulance Service (BCAS) in its 911 first response emergency medical protocols.

BCAS is one of the largest ambulance services in the world, providing pre-hospital emergency health care to the population of British Columbia across an area that spans 945,000 square kilometers, from 187 ambulance stations. Three dispatch centres in Vancouver, Victoria and Kamloops operate off a linked, redundant CAD system that allows any one centre to take over operations from the others in the event of a system failure. In 2010, BC Ambulance recorded 625,000 dispatch events including surface ambulance, rotary-wing and fixed-wing air ambulances.

BC Ambulance has undertaken the responsibility of collecting information from citizens based on the C-MIST protocols and storing that information in a database within its computer dispatch (CAD) system. The address is “flagged” within the CAD system so that when an incident is created at any address with a C-MIST record, a notification will displayed to the emergency medical dispatcher (EMD). Unlike many police or fire CAD systems that store information relative to specific addresses and then automatically display the relevant information within the body of the electronic file, privacy legislation dictates a different approach, as the information is health considered as part of a personal health record.  The emergency call taker or dispatcher will be prompted to open a PDF file in a separate window that will display the information sheet submitted by the individual. The relevant information based on the C-MIST protocol will then be added to the narrative field of the incident report as “C-MIST alert – communication need”, or whatever the case may be, without revealing any personal or privileged information about the individual. 

The BCAS CAD system is linked directly to the regional fire department dispatch CAD systems, so that events requiring fire/rescue response as well will receive the extra information at the same time as the ambulance crews. For responders on a five-minute response model, that simple piece of information can be all they need to provide the highest level of service upon arrival. 

The five C-MIST protocols have been given unique icons to allow them to be incorporated into cards that can be carried in wallets, purses or pockets to enable to persons to explain their situation more readily should they require emergency assistance away from home. The icons are being produced as cards that can be placed in windows to alert rescuers in both first response situations such as the fire in Bowmanville or in the aftermath of massive disasters such as Katrina.

For more information on C-MIST and BC Ambulance or to read more about BCCPD’s emergency programs go to:

  • Operation Florian

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