Emergency Evacuation Preparedness: Taking Responsibility For Your Safety A Guide For People with Disabilities and Other Activity Limitations

When completing your emergency health information (forms included at back of chapter) be sure and include:

• Disability/Conditions emergency personnel might need to know about (if you are not sure, list it):

Examples:

• Epilepsy, heart condition, high blood pressure, respiratory problem, HIV positive.

• My disability, due to a head injury, sometimes makes me appear confused or drunk. I have a psychiatric disability. In an emergency, I may become confused or overwhelmed. Help me find a quiet corner and I should be fine in about 10 minutes. If this does not happen, give me one pill of (name of medication) located in my (purse, wallet, pocket, etc.).

• Multiple Chemical sensitivities:  I react to......., my reaction is......., do this......... (these conditions may not be commonly understood by emergency personnel and therefore explanations should be detailed and specific).

• Prescriptions,

• Dosage,

• Times taken,

• When first prescribed and how long you have been on the drug,

• Other details regarding specifications of administration/regimen, i.e., insulin

Example:

• I take Lithium and my blood level needs to be checked every______.

Allergies (sensitivities):

• Adhesive tape

• Morphine, Codeine, Demerol or other narcotics

• Latex

• Novocain or other anesthetics

• Iodine or Methiolate

• Aspirin, Emperin or other pain remedies

• Sun exposure

• Detergents, fabric softeners

• Sulfa drugs

• Tetanus, antitoxin or other serums

• Pesticides

• Eggs, milk, chocolate or other foods

• Insect bites, bee stings

• Environmental sensitivities

• Other:

Examples:

• Diesel exhaust can kill me. Do not put me in or near idling emergency vehicles.

• I can speak when provided with clean air and low electromagnetic fields. Take me to fresh air and turn off electrical equipment.

Immunization and Dates (shots) examples:

• Flu,

• Pneumonia/ Pneumococcal,

• Tetanus/diphtheria,

• Polio (IPV or OPV), 

• Measles‑mumps‑rubella (MMR), 

• H. influenzae type b (HIB), 

• (Chicken Pox) Vericella,

• Hepatitis A,

• Hepatitis B, 

• Measles-Mumps-Rubella,

• Rubella  9.

Communication (or a speech-related disability) examples:

• I speak using an artificial larynx, if it is not available, I can write notes to communicate.

• If (under stress after a seizure), I may not make sense for a while. Leave me alone for 10-15 minutes and my mind should clear.

• I speak slowly, softly and my speech is not clear. Find a quiet place for us to communicate. Be patient! Ask me to repeat or spell out what I am saying if you cannot understand me!

• I use a (word board, augmentative communication device, etc.) to communicate. In an emergency, I can point to words and letters.

• I cannot read. I communicate using an augmentative communication device. I can point to simple pictures or key words on a sheet which you will find in my wallet or emergency supply kit.

• I may have some difficulty understanding what you are telling me, please speak slowly and use simple language.

• My primary language is ASL (American Sign Language). I am deaf and not fluent in English, I will need an ASL interpreter. I read only very simple English. Try using gestures.

• I am hard of hearing. Get my attention before speaking to me. Look at me when you speak so I can speechread.

Equipment examples:

• Motorized wheelchair

• Suction machine

• Home dialysis

• Respirator

• Cochlear implant

• Indwelling catheter

Other examples:

• I need specific help with: walking, eating, standing, dressing, transferring, etc.