Recommendations

More of DHS grant funds could be "targeted to medical surge activities."

Better effort should be made before a disaster to let hospitals "know ahead of time under what circumstances they would receive reimbursement from the Centers for Medicare & Medicaid Services (CMS) for medical care provided in alternate care sites during a mass casualty event."

HHS should consider more often "temporarily suspend[ing] the application of EMTALA in affected regions" of disasters.

HHS should consider more often "relaxing the sanctions and penalties arising from noncompliance with certain provisions of the HIPAA privacy rule, including the requirements to obtain a patient's agreement to speak with family members or friends."

"…some states suggested that the federal government could help their efforts in several ways, such as by convening medical, public health, and legal experts to address the complex issues associated with allocating scarce resources during a mass casualty event, or by developing demonstration projects to reveal best practices employed by the various states."

The federal government may consider implementing a "3-year funding cycle for the Hospital Preparedness Program."

Better efforts should be made to inform the public of how medical care may be delivered in an emergency.

Do not separate a person from his or her service animal for emergency transport except under the following criteria for exclusion of a service animal from a shelter, medical facility, or emergency vehicle:
• The animal is a direct threat to the emergency workers’ or shelter’s ability to provide services to others.
• The animal demonstrates aggressive behavior and cannot be controlled by its handler.
• The animal does not meet the definition of a service animal.
Target Agencies/Organizations: ( DHS DOT FEMA HHS STATES )

Establish a voluntary mechanism in the community (in conjunction with individuals with disabilities, family members, and disability organizations) to identify before an
emergency those individuals requiring special assistance for emergency transportation and to make that information available to emergency services providers. This includes a list of households with service animals.
Target Agencies/Organizations: ( ARC DHS DOD FEMA HHS STATES )

Establish policy to ensure that every effort is made for individuals with disabilities to keep their assistive devices or service animals with them during pre-hospital care and transport.
Target Agencies/Organizations: ( DHS DOT FEMA )

If evacuation or rescue efforts require separation of a person from his or her
assistive device or service animal, include plans for return of the device or service animal.
Target Agencies/Organizations: ( DHS DOT FEMA HHS STATES )

Encourage communities to build guidelines and operate a tiered dispatch and emergency response system so that limited pre-hospital medical services (EMS) can be used responsibly during a disaster for those with acute medical needs. With a focus on pre-planning and communication, EMS should not constitute the primary means of evacuation of uninjured people during a disaster.
Target Agencies/Organizations: ( DHS DOT FEMA HHS STATES )

Develop work continuity assurances with community agencies (e.g., ambulettes, busses, and shuttles) who may be involved in the transportation of people with disabilities. Non-emergency vehicles that can accommodate and assist with evacuation of individuals with disabilities during a disaster are a valuable resource that can relieve some of the burden on the EMS system.
Target Agencies/Organizations: ( DHS DOT FEMA STATES )

Waive license requirements for accessible vehicles during emergency and disaster situations.
Target Agencies/Organizations: ( DHS DOT FEMA HHS STATES )

Require emergency response vehicles, including medical vans, ambulances, and aero medical transport, to have tools to communicate with people who have a hearing loss, including the following: 
•  Medical forms that include information regarding the communication mode and functional needs of the individual along with other pertinent medical information. 
•  HAT, particularly in light of the possibility that individuals’ personal assistive devices may have been lost or damaged during the emergency. 
•  Pen and paper