Tips for First Responders
and
Texas Resources for Services and Supports

Contents:

• General Tips
• Seniors
• People With Service Animals
• People With Mobility Impairments
• People With Mental Illness
• People With Visual Impairments
• People Who Are Deaf Or Hard Of Hearing
• People With Cognitive Disabilities
• People With Autism

Dear Reader:

Whether you are a First Responder assisting in an emergency caused by a natural disaster or a terrorist attack, or you are a community volunteer providing assistance to people in need, you may encounter people with some type of disability. Some disabilities, such as those involving physical impairments, may be obvious. Other disabilities, such as mental illness, are more difficult to detect. In many cases, you can’t tell just by looking at the person whether they have a disability.

Supporting people with disabilities is easier if you remember they are “people first” and their disability is only a part of who they are.  People with disabilities simply want to be treated with dignity and respect, just like anyone else.  In supporting people with disabilities, take time to listen to what they are telling you either with their words or behaviors. It is always best to start by asking how you can help or assist.

Many first responders have requested quick, easy-to-use guidelines for assisting persons with disabilities. These tip sheets provide information about many types of disabilities and can be used during emergencies as well as during routine encounters. They are not meant to be comprehensive, but contain specific information that you can read quickly either before or while you are actually responding to an incident. In addition to the tips for responding to people, information about where to locate services for people is also provided.

If you would like more information about how to best assist people with disabilities or have suggestions for future editions of this guide, please contact us. Our contact information is at the end of this guide.

Helpful Contacts in Texas

• Texas Health and Human Services Information and Referral Line: “2-1-1” is a free, easy-to-remember phone number connecting callers with health and human services in their area. No matter where you live in Texas, you can dial 2-1-1 and get referrals to services available in your community.
• Texas Medicaid: http://www.hhsc.state.tx.us/Medicaid/contacts.html,
• Medicaid Client Hotline: (800) 252-8263
• CHIP/Children's Medicaid: (800) 647-6558
• Advocacy, Inc., (512) 454-4816 or (800) 828-7839, http://www.advocacyinc.org
• Texas Center for Disability Studies, The University of Texas at Austin, (512) 232-0740 or (800) 828-7839, txcds@uttcds.org, http://tcds.edb.utexas.edu/
• Texas Council for Developmental Disabilities, (512) 437-5432 or (800) 262-0334 tcdd@tcdd.state.tx.us, http://www.txddc.state.tx.us
• Center on Disability and Development, Texas A&M University, (979) 845-4612, sharp@tamu.edu, http://ucd.tamu.edu

General Tips

Always ask the person how you can best assist.

Ask for/Look for:

• An identification bracelet with special health information.
  
• Emergency contact information to reach the person’s family.
  
• Essential equipment and supplies (for example: wheelchair, walker, oxygen, batteries, communication devices [head pointers, alphabet boards, speech synthesizers, etc.])
  
• Medication.
  
• Mobility aids (for example, wheelchair, cane, walker or an assistance or service animal) ? Special health instructions (for example: allergies).
  
• Special communication information (for example:, is the person using sign language?)
  
• Signs of stress and/or confusion (for example, the person might say [s]he is stressed, look confused, withdraw, start rubbing their hands together).
  
• Conditions that people might misinterpret (for example, someone might mistake Cerebral Palsy for drunkenness).
  
• Try to include the person in conversations with other people; don’t talk about a person in front of that person.
  
• If the person does not use words to speak, look for gestures or other behaviors that communicate what the person is wanting to express.
  
• Don’t assume that people do not understand just because they don’t use words to communicate.

Seniors

Always ask the person how you can best assist them.

• Some elderly persons may respond more slowly to a crisis and may not fully understand the extent of the emergency. Repeat questions and answers if necessary. Be patient! Taking time to listen carefully or to explain again may take less time than dealing with a confused person who may be less willing to cooperate.
  
• Reassure the person that they will receive medical assistance without fear of being placed in a nursing home.
  
• Older people may fear being removed from their homes – be sympathetic and understanding and explain that this is temporary.
  
• Before moving an elderly person, assess their ability to see, hear, and walk; adapt rescue techniques for sensory impairments.
  
• Persons with a hearing loss may appear disoriented and confused when all that is really “wrong” is that they can’t hear you. Determine if the person has a hearing aid. If they do, is it available and working? If it isn’t, can you get a new battery to make it work?
  
• If the person has a vision loss, identify yourself and explain why you are there. Let the person hold your arm and then guide them to safety.
  
• If possible, gather all medications before evacuating. Ask the person what medications they are taking and where their medications are stored. Most people keep all their medications in one location in their homes.
  
• If the person has dementia, turn off emergency lights and sirens if possible. Identify yourself and explain why you are there. Speak slowly, using short words in a calming voice. Ask yes or no questions: repeat them if necessary. Maintain eye contact.

Contacts for Services and Supports:

Department of Aging and Disability Services, (512) 438-3011, www.dads.state.tx.us
Area Agencies on Aging, (800) 252-9240, http://www.dads.state.tx.us/contact/aaa.cfm

People with Service Animals

Traditionally, the term “service animal” referred to seeing-eye dogs. Today there are many other types of service animals.

• Remember – a service animal is not a pet.
  
• Do not touch or give the animal food or treats without the permission of the owner.
  
• When a dog is wearing its harness, it is on duty. In the event you are asked to take the dog while assisting the individual, hold the leash and not the harness.
  
• Plan to evacuate the animal with the owner. Do not separate them!
  
• Service animals are not registered and there is no proof that the animal is a service animal. If the person tells you it is a service animal, treat it as such. However, if the animal is out of control or presents a threat to the individual or others, remove it from the site.
  
• A person is not required to give you proof of a disability that requires a service animal. You must accept that he/she has a disability. If you have doubts, wait until you arrive at your destination and address the issue with the supervisors in charge.
  
• The animal need not be specially trained as a service animal. People with psychiatric and emotional disabilities may have a companion animal. These are just as important to them as a service animal is to a person with a physical disability – please be understanding and treat the animal as a service animal.
  
• A service animal must be in a harness or on a leash, but need not be muzzled.

Contacts for Services and Supports:

Texas Hearing and Service Dogs, (512) 891-9090 or (877)TEX-DOGS   www.servicedogs.org/

People with Mobility Impairments

• Always ask the person how you can help before attempting any assistance. Every person and every disability is unique – even though it may be important to evacuate the location where the person is, respect their independence to the extent possible. Don’t make assumptions about the person’s abilities.
• Ask if they have limitations or problems that may affect their safety.
• Some people may need assistance getting out of bed or out of a chair, but CAN then proceed without assistance. Ask!
  
  Here are some other questions you may find helpful:
  
• “Are you able to stand or walk without the help of a mobility device like a cane, walker, or a wheelchair?”
• “You might have to [stand] [walk] for quite awhile on your own. Will this be ok? Please be sure and tell someone if you think you need assistance.”
• “Do you have full use of your arms?”
• When carrying the person, avoid putting pressure on his or her arms, legs or chest. This may result in spasms, pain, and may even interfere with their ability to breathe.
• Avoid the “fireman’s carry.” Use the one or two person carry techniques.

Crutches, Canes or Other Mobility Devices

A person using a mobility device may be able to negotiate stairs independently. One hand is used to grasp the handrail while the other hand is used for the crutch or cane. Do not interfere with the person’s movement unless asked to do so, or the nature of the emergency is such that absolute speed is the primary concern. If this is the case, tell the person what you’ll need to do and why.

Ask if you can help by offering to carry the extra crutch.

If the stairs are crowded, act as a buffer and run interference for the person.

Evacuating Wheelchair Users

If the conversation will take more than a few minutes, sit down to speak at eye level.

Wheelchair users are trained in special techniques to transfer from one chair to another. Depending on their upper body strength, they may be able to do much of the work themselves.

Ask before you assume you need to help, or what that help should be.

Carrying Techniques for Non-Motorized Wheelchairs

The in-chair carry is the most desirable technique if possible.

One-person assist:

• Grasp the pushing grips, if available.
• Stand one step above and behind the wheelchair.
• Tilt the wheelchair backward until a balance (fulcrum) is achieved.
• Keep your center of gravity.
• Descend frontward.
• Let the wheels gradually lower to the next step.

Two-person assist:

• Positioning of second rescuer:
• Stand in front of the wheelchair.
• Face the wheelchair.
• Stand one, two, or three steps down (depending on the height of the other rescuer).
• Grasp the frame of the wheelchair.
• Push into the wheelchair.
• Descend the stairs backward.

Motorized Wheelchairs

Motorized wheelchairs may weigh up to 100 pounds unoccupied, and may be longer than manual wheelchairs. Lifting a motorized wheelchair and user up or down stairs requires two to four people.

People in motorized wheelchairs probably know their equipment much better than you do! Before lifting, ask about heavy chair parts that can be temporarily detached, how you should position yourselves, where you should grab hold, and what, if any, angle to tip the chair backward.

Turn the wheelchair’s power off before lifting it.

Most people who use motorized wheelchairs have limited arm and hand motion. Ask if they have any special requirements for being transported down the stairs.

Contacts for Services and Supports:

Department of Aging and Disability Services, (512) 438-3011, www.dads.state.tx.us
Coalition of Texans with Disabilities, (512) 478-3366, www.cotwd.org
United Cerebral Palsy of Texas, (512) 472-8696 or (800) 798-1492, www.ucpa.org/main.cfm
Advocacy, Inc., (512) 454-4816 or (800) 828-7839, www.advocacyinc.org

People With Mental Illness

You may not be able to tell if a person has a mental illness until you have begun the evacuation procedure.

If a person begins to exhibit unusual behavior, ask if they have any mental health issues you need to be aware of. However, be aware that they may or may not tell you. If you suspect someone has a mental health issue, use the following tips to help you through the situation.

• In an emergency, the person may become confused. Speak slowly and in a normal speaking tone.
• If the person becomes agitated, help them find a quiet corner away from the confusion.
• Keep your communication simple, clear, and brief.
• If they are confused, don’t give multiple commands – ask or state one thing at a time.
• Be empathetic – show that you have heard them and care about what they have told you. Be reassuring.
• If the person is delusional, don’t argue with them or try to “talk them out of it.” Just let them know you are there to help them.
• Ask if there is any medication they should take with them.
• Try to avoid interrupting a person who might be disoriented or rambling – just let them know that you have to go quickly.
• Don’t “talk down” to them, yell, or shout.
• Have a forward leaning body position – this shows interest and concern.

Contacts for Services and Supports:

Department of State Health Services, (512) 458-7111, www.dshs.state.tx.us
Texas Mental Health Consumers, (512) 451-3191, www.tmhc.org
Mental Health Association of Texas, (512) 454-3706, www.mhatexas.org
National Alliance for the Mentally Ill of Texas, (512) 693-2000, or (800) 633-3760 www.namitexas.org
Advocacy, Inc., (512) 454-4816 or (800) 828-7839, www.advocacyinc.org


People with Visual Impairments

There is a difference between visual impairment and blindness. Some people who are “legally blind” have some sight, while others are totally blind.

• Announce your presence, speak out, and then enter the area.
  
• Speak naturally and directly to the individual.
  
• Do not shout.
  
• Don’t be afraid to use words like “see,” “look,” or “blind.”
  
• State the nature of the emergency and offer them your arm. As you walk, advise them of any obstacles.
  
• Offer assistance but let the person explain what help is needed.
  
• Do not grab or attempt to guide them without first asking permission.
  
• Let the person grasp your arm or shoulder lightly for guidance.
  
• They may choose to walk slightly behind you to gauge your body’s reactions to obstacles.
  
• Be sure to mention stairs, doorways, narrow passages, ramps, etc.
  
• When guiding someone to a seat, place the person’s hand on the back of the chair.
  
• If leading several individuals with visual impairments, ask them to guide the person behind them.
  
• Remember that you’ll need to communicate any written information orally.
  
• When you have reached safety, orient the person to the location and ask if any further assistance is needed.
  
• If the person has a service animal, don’t pet it unless the person says it is OK to do so. Service animals must be evacuated with the person.
  
• Refer to the section on People with Service Animals.

Contacts for Services and Supports:

Department of Assistive and Rehabilitative Services, (512) 424-4000 or (800) 628-5115 www.dars.state.tx.us
Advocacy, Inc., (512) 454-4816 or (800) 828-7839, www.advocacyinc.org

People Who are Deaf or Hard of Hearing

There is a difference between being hard of hearing and being deaf. People who are hearing impaired vary in the extent of hearing loss they experience. Some are completely deaf, while others can hear almost normally with hearing aids.

• Hearing aids do not guarantee that the person can hear and understand speech. They increase volume, not clarity.
  
• If possible, flick the lights when entering an area or room to get their attention.
  
• Establish eye contact with the individual, not with the interpreter if one is present.
  
• Use facial expressions and hand gestures as visual cues.
  
• Check to see if you have been understood and repeat if necessary.
  
• Offer pencil and paper. Write slowly and let the individual read as you write.
  
• Written communication may be especially important if you are unable to understand the person’s speech.
  
• Do not allow others to interrupt you while conveying the emergency information.
  
• Be patient – the person may have difficulty understanding the urgency of your message.
  
• Provide the person with a flashlight to signal their location in the event they are separated from the rescue team. This will facilitate lip-reading or signing in the dark.
  
• While written communication should work for many people, others may not understand English well enough to understand written instructions in English. Keep instructions simple, in the present tense, and use basic vocabulary.

Contacts for Services and Supports:

Department of Assistive and Rehabilitative Services, (512) 424-4000 or (800) 628-5115 www.dars.state.tx.us
Advocacy, Inc., (512) 454-4816 or (800) 828-7839, www.advocacyinc.org

People with Cognitive Disabilities

Smile and Say:

• My name is…. I’m here to help you, not hurt you.
• I am a … (name your job).
• I am here because … (explain the situation).
• I look different than my picture on my badge because … (for example, if you are wearing protective equipment).

Show:

• Your picture identification badge (as you say the above).
• That you are calm and competent.

Give:

• Extra time for the person to process what you are saying and to respond.
• Respect for the dignity of the person as an equal and as an adult (example: speak directly to the person).
• An arm to the person to hold as they walk or your elbow to help them find their balance.
• If possible, quiet time to rest (as possible, to lower stress/fatigue).

Use:

• Short sentences.
• Simple, concrete words.
• Accurate, honest information.
• Pictures and objects to illustrate your words. Point to your ID picture as you say who you are, point to any protective equipment as you speak about it.

Predict:

• What will happen (simply and concretely).
• When events will happen (tie to common events in addition to numbers and time, for example, “By lunch time…” “By the time the sun goes down…”).
• How long this will last – when things will return to normal (if you know).
• When the person can contact/rejoin loved ones (for example: calls to family, re-uniting pets).

Ask for/Look for:

• An identification bracelet with special health information.
• Essential equipment and supplies (for example: wheelchair, walker, oxygen, batteries, communication devices [head pointers, alphabet boards, speech synthesizers, etc.]).
• Medication
• Mobility aids (for example, wheelchair, cane, walker or an assistance or service animal).
• Special health instructions (for example: allergies).
• Special communication information (for example, is the person using sign language?)
• Emergency contact information to reach the person’s family. 
• Someone who is with the person who has already learned important information about supporting that person. It is possible that support staff, family, or a friend will be with the person.
• Signs of stress and/or confusion (for example, the person might say [s] he is stressed, look confused, withdraw, start rubbing their hands together).
• Conditions that people might misinterpret (for example, someone might mistake Cerebral Palsy for drunkenness).

Repeat:

• Reassurances (for example, “You may feel afraid. That’s OK. We’re safe now.”)
• Encouragement (for example, “Thanks for moving fast. You are doing great. Other people can look at you and know what to do”).
• Frequent updates on what’s happening and what will happen next. Refer to what you predicted will happen. ( For example, “Just like I said before, we’re getting into my car now. We’ll go to… now.”)

Reduce:

• Distractions. For example: lower volume of radio, use flashing lights on vehicle only when necessary.

Explain:

• Any written material (including signs) in everyday words.
• Public address system announcements in simple words.

Share:

• The information you’ve learned about the person with other workers who’ll be assisting the person.

Contacts for Services and Supports:

Department of Aging and Disability Services, (512) 438-3011, http://www.dads.state.tx.us
Advocacy, Inc., (512) 454-4816 or (800) 828-7839, http://www.advocacyinc.org
The Arc of Texas, (512) 454-6694 or (800) 252-9729, http://www.thearcoftexas.org
Texas Advocates, (512) 454-6694 or (800) 252-9729, http://www.thearcoftexas.org/ta/

People With Autism

The person may or may not be able to communicate with words.  They should be approached gently and spoken to softly as high levels of sensory input may cause agitation.

• Understand that a person with autism may become stressed when their regular routine is disrupted.
  
• Unless absolutely necessary, don’t touch someone with autism without the person’s permission.  Many people with autism are very sensitive to touch and simple touch can be painful.
  
• Understand that rocking, repetitive motion, and repeating words or phrases can be comforting to a person with autism during an emergency.
  
• Avoid loud noises, bright lights, and high levels of activity whenever possible.
  
• Recognize that individuals with autism are better able to function if they know what to expect.  Take time to explain to them who you are, what is happening, and where they are going.  The explanation may need to be repeated numerous times to reduce the individual’s anxiety.

Contacts for Services and Supports

Department of Aging and Disability Services, (512) 438-3011, http://www.dads.state.tx.us
Texas Center for Disability Studies, (512) 232-0740, http://tcds.edb.utexas.edu/

The First Responder Tips are adapted from material originally developed by the New Mexico Governor’s Commission on Disability, the Center for Development and Disability at the University of New Mexico, Office of Health Emergency Management at the New Mexico Department of Health, and the American Association on Health & Disability. We gratefully acknowledge their original work Tips for First Responders.

Funding for the development and printing of this material was provided by the Texas Council for Developmental Disabilities and the Texas Center for Disability Studies at The University of Texas at Austin.

Additional copies are available on request. For information please contact:

Texas Center for Disability Studies
The University of Texas at Austin, M/C L4000
J. J. Pickle Research Campus
10100 Burnet Road, Bldg. 137 (TCB), Room 1.154
Austin, TX 78758-4445
(512) 232-0740 / (800) 828-7839
txcds@uttcds.org
http://tcds.edb.utexas.edu