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Why are Special Medical Needs Patients Political Hot Potatoes?

While great strides have been made to develop large-scale disaster evacuation plans for America’s citizens, our most vulnerable minorities have been left behind asking to be heard. Federal laws require equal and integrated treatment of persons requiring specialized medical assistance. However, our federal evacuation system has resisted development of a national capability, instead deferring responsibilities to the states.

The majority of states simply do not have the resources to implement full-scale evacuation of these populations during statewide disasters. Lacking viable options, many defer to local authorities who either incorrectly assume the federal government meets requirements or that certain populations fall outside the responsibilities of government. This passing of the hot potato between federal, state, and local governments needlessly delays the development of a critically important, national response capability for special medical populations.

While laws such as U.S. Code §753(b)(4) (A)(I) (ii)(iii) require equal federal treatment of these patients, instead of building a federal capability, the federal government has instead attempted to meet legal requirements by authorizing states through grant funding to provide implementable special patient evacuation plans. However, states have not been successful in meeting this requirement for large scale disasters, and federal laws have continued unabided for decades.

States have found that the complexity of the problem requires greater resources than can be obtained at the state or local level. They have cited several reasons for not solving special needs patient evacuations needs including insufficient:

• Transporters to quickly move all special needs patients.
• Specialized equipment to quickly transport all special needs patients.
• Receiving beds for certain special needs patients.
• Coordination for safe, effective and fast evacuation of all special needs patients.

During my discussions with most state agencies and many local ones, they have shared complex examples of special medical needs patients requiring solutions. Examples include:

• A neonate hospital on the Atlantic coast requires the ability to quickly evacuate 150 critical care neonates when a hurricane approaches, but no federal, state, or Emergency Management Assistance Compact capability exists to transport these children or to absorb them into capable receiving hospitals.

• A group of behavioral facilities along the gulf coast houses over 400 physically and mentally disabled patients who must permanently remain in specially made “lounge” chairs. Because of their odd sizes, the chairs cannot be transported by conventional ambulances or paratransit vehicles. No local, state, or federal service has been identified to transport these patients during an emergency.

• A verified burn center in the Midwest noted that because burn facilities run near capacity, no region can absorb a full evacuation of a center. Without a national transportation capability, most large-scale burn incidents continue to rely on lesser care options.

None of the many examples I have examined are insurmountable. All can be accomplished through current communication and logistical technologies. However, they require a collective will of our federal government and states to integrate specialized, rapid-response resources. We no longer have a reason to postpone answering the voices of our special medical populations. We no longer have a reason to leave the requirements of our laws unfulfilled. It is high time we develop a national evacuation capability for patients with special medical needs.

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