Motivation and History 

In the 1970s and 80s, decades before Hurricane Katrina, a handful of us California advocates documented the deep and dramatic lack of equal and inclusionary emergency services for people with disabilities. Examples of this discrimination included people with disabilities being turned away from shelters (wheelchair and mobility scooter users, service animal users, blind people, Deaf people, etc.). When attempting to register at a shelter, people with disabilities were sometimes separated from families and significant others, and asked to go to or sent to medical shelters or other facilities and institutions (hospitals, nursing homes, and other long-term care facilities). Rather than working to make sure people remained in their homes in the community, there was the misconception that it was better to admit people to nursing facilities. Once admitted, leaving was extremely difficult as people lost their community support, such as housing, personal attendants, etc. 

The common belief was that people with disabilities were sick, needed medical care, needed protection, needed supervision, and thus needed “special shelters.” What may appear as acute, vulnerable, and fragile to the untrained and biased eye is just the everyday disability-lived experience.

People with disabilities were and continue to be confronted with the indiscriminate application of the medical model. The false belief is that most people with disabilities need medical services and medical care. This implicit bias to see people with disabilities as ‘sick’ or ‘unwell’ unnecessarily overburdened scarce emergency medical resources. 

Experienced community-based disability services staff ready to help at shelters were turned away because of a “lack of proper credentials.”

In 2007, I conceived and pitched the concept of FAST to the California Department of Social Services, which contracted and worked with me to develop the FAST concept, plans, and training course. In 2010, it was accepted as a FEMA Course.

Intent and Objectives 

In California, where FAST originated, the intent was to work together better and smarter by providing disability-related assistance through increasing capacity. This meant building partnerships with community-based organizations (CBOs), cities, counties, states, the American Red Cross, and other Voluntary Organizations Active in Disaster (VOAD) to develop the teams. They would be made up  of government workers and community disability service staff, especially those with lived experience. This included blending government workers’ competencies and skill sets with those of community disability service providers.

By applying nimble, flexible, and scalable competencies, team members would complement and augment shelter workers to address the complexities of supporting people with disabilities in maintaining their health and safety, and surviving emergencies. Together, team members had a working knowledge of cross-disability access needs  (hearing, vision, mobility, speech, and/or memory and understanding, mental health, and behavioral health). Teams may move to other shelters and return to shelters as needed or requested.

Team members would:

• Operate using a social model of disability and apply the independent living philosophy, with an emphasis on honoring people’s rights to dignity of risk, choice, and self-determination.
• Identify and address stigmatizing biases, stereotypes, and beliefs.
• Understand how to comply with civil rights laws and protections, and have the skills to help put physical, programmatic, and communication access in place.
• Identify and assist in meeting needs such as replacing medications, essential equipment, mobility devices, supplies, and personal assistants to help with activities of daily living (dressing, eating, grooming, toileting, transferring, or communicating.)
• Work with shelter personnel and other emergency response workers to identify and meet essential functional needs so people could stay as independent as possible at shelters and maintain their health, safety, and independence.

FAST support decreased the impact and gaps caused by the disaster disruption and degradation of critical support systems and customized environments, which typically work barring emergencies. These disruptions contributed to severe disproportionate impacts during emergencies for people with disabilities.

Team Makeup:

Eligible individuals for FAST team membership included people with the core capabilities and skills needed to work effectively with people with disabilities. These skills were not something they would acquire through FAST training, but they already had those competencies and skills.

The intent was a group of combined skills and experience working with people with varying access and functional needs, such as older people, people with chronic health, mental health and behavioral health conditions, people with intellectual and developmental disabilities, hearing loss, and vision loss. In other words, people would bring their awareness and skill sets to a team. Team members had the knowledge, skills, and ability to work in their area(s) of access and functional needs.

Present

FAST programs have evolved with customized focuses, resources, and versions depending on location. (See below “Examples of expanded FAST roles”). Some states and local governments have active FAST, while others have inactive FAST. There is no definitive data to track how many teams are in development versus how many teams have deployed, and how many are deployment-ready. There is a lot of focus on the start-up process and training, but less on deployment and sustainable teams. Some current conceptual FAST practices exhibit some “medical model” influence, undermining the principles of independence and community-based support. Much information about FAST needs to be collected and analyzed, and some critical questions are listed in the “Investigate the options” below.  

The California FAST website, describes FAST eligibility as a “minimum of two years” experience working with and/or the AFN (access and functional needs) community.” At the local government’s request, a team of 2-8 trained members deploys to emergency shelters. 

In California and elsewhere, unlike the original intent, many teams have morphed into government-centric teams instead of a mixed makeup of government workers and community partners.

Government-only FAST, as opposed to a preferred mixed makeup team of community and government workers, may involve some people with disabilities who happen to be government employees. There is no assurance that they bring to their role the needed lived experience or skills at applying independent living values and a social model to delivering services rooted in understanding the details, diversity, nuances, and complexity of living with a variety of access needs.

Payment and Reimbursement:

Why the transition to government-only teams? It is easier and takes less effort to train, recruit, and deploy government workers because of expense reimbursement, insurance, and liability issues. CBO  participation is a sizable unresolved barrier. A significant weakness overlooked in FAST’s initial conception is the expense reimbursement, insurance, and liability issues.

Because of this, disability services staff often must volunteer with no reimbursement. The expectation that all community partners will volunteer their time does not work.

Although many community-based organizations have non-profit tax status, this does not mean volunteers do their work. Community-based organizations have contractual payroll, operating expenses, compliance, and deliverable obligations. Staff serving on teams means the CBO must cover staff salaries, overtime, travel, etc., which is sometimes impossible without additional funding.

The lesson to apply is that agreements with CBOs must include the who, what, where, when, why, how, and reimbursement details agreed on in advance.

Future

FAST was conceived in 2006 – 2007. What is slowly changing is the growing recognition of the need for disability-inclusive planning, services, processes, and training. The outdated disability implicit biases are now more frequently challenged, models are shifting, and acceptance and adoption of inclusion are increasing. The number of state and local access and functional needs coordinators in emergency management continues to grow.

Establishing or Reworking and Refining

There are many ways to institute FAST, and there is no one right way. There is much to consider and investigate regarding whether a FAST concept will work for you. 

For readers interested in establishing or reworking and refining FAST, consider broadening the focus and roles, refreshing and augmenting the training, renaming FAST, defining measures of success, and investigating different FAST programs in terms of what is working and what needs to change. 

Broadening the Focus

FAST’s sheltering focus is too narrow. Some local governments never or rarely open shelters. The FAST roles before, during, and after disasters  should be flexible and customizable. (See “Examples of Expanded FAST Roles” below).

Expanding the Makeup of Potential Community Partners

Use the expertise of local community partners instead of only using a state team that may be disadvantaged and may not be as familiar with local resources, culture, norms, and demographics.

The responding partners should consist of and represent diversity in experiences to provide effective services. For example, in the context of privilege and ableism, it means avoiding implicit disability biases and inaccurate assumptions such as everyone having stable internet connections, money to buy emergency supplies, a usable vehicle, and the ability to walk, lift, run, see, hear, speak, remember, and understand.

Expand the definition of potential community partners to include overlooked segments such as:

Partners should include:

• Community-based organizations – including service organizations that are disability-led and organizations that serve people with vision, hearing, moving, learning, remembering, understanding, reading, mental, behavioral, cognitive, intellectual, developmental, and chemical sensitivity disabilities.
• Business partners can be instrumental in quickly getting resources such as over-the-counter consumable supplies and mobility aids (canes, crutches, wheelchairs, mobility scooters, crutches, walkers), reading glasses, hearing aids, etc., to bridge the lengthy process for the replacement of customized devices.
• Business Emergency Operations Councils (BEOCs) exist in some communities to conduct continuity planning and form partnerships with other businesses to support preparing for, responding to, and mitigating emergency risks. 
• Health entities: managed care organizations, community clinics, health care coalitions, home health agencies, infusion centers, vendors of consumable medical supplies (oxygen, durable medical equipment, pharmacy services including mail-order plans systems).

Examples of Expanded FAST Roles:

• Checking for and helping to remove any physical, equipment, programmatic, and communication access barriers identified at mass care sites.
• Messaging/Alerts: to force multiply and amplify messages during sunny (non-disaster) days and the time-sensitive reach of emergency information to diverse communities during bad days. For example, some organizations that support people with intellectual disabilities are skilled at providing and reinforcing easy-to-understand messages using plain language, pictures, and repetition. These organizations use existing connections to reach diverse populations in complex media environments through culturally appropriate methods, customized distribution, and multiple languages. Continually test methods to improve message distribution reach.
• Life-safety or wellness checks: (also known as welfare or safe and well checks) FAST members of organizations can check in with individuals who they work with to determine if they have what they need at a mass care site, while sheltering in place, or if they need help evacuating. These checks, for people sheltering in place, involve phone calls, texts, emails, and in-person visits, including automated check-in systems that ask individuals to respond by indicating they are “ok” or “need help.” When people are not heard from, community organization staff, with the help of FAST, can reach out first to pre-identified higher-risk (versus reaching out to all) people. Risk criteria may include those they support who are geographically isolated, lack help from relatives, friends, and neighbors, cannot use, understand, or be reached by alert and notification systems, are transportation-dependent, and are unable or least able to get to transportation pick-up points and points of distribution.
• Individual preparedness plans: the time and skill it takes to help people develop detailed emergency plans are underestimated and undervalued. Some of these tasks include:
  • Helping people overcome denial to address sometimes scary, disturbing, and uncomfortable issues.
  • Developing and maintaining a helper list (also called support teams and support networks)  of people who agree to help when needed and check on each other in an emergency.
  • Developing a communications plan involving different means of communicating with helpers in an emergency, such as landline, cell phone, text, email, or messaging app.
  • Planning for power outages.
  • Planning for the details needed to shelter-in-place or evacuate.
  • Sheltering in place planning.
  • Evacuation planning.
  • Labeling equipment with name, phone numbers, and email address.
  • Entering helper contact information into cell phones and having hard copies for use on other phones and devices when there is no access to a cell phone or other digital information.
  • Collecting critical documents (paper and digital copies for a “grab and go” bag and Keep It With You (KIWY) items that include:
    • List of essential equipment serial numbers, date of delivery, and payers.
    • Health insurance cards.
    • Medication lists and prescriptions.
    • Deed/lease.
  • Signing up for local alerts and notifications (text messages, sometimes phone calls, and emails that provide information on weather conditions and emergencies).
• Staffing Technical Expert Panels: Virtual deployments with consultation, when needed, from subject matter experts for complex problem-solving. For example, preventing someone who lived in the community from having to go to a nursing home or other institutions.
• Evacuation assistance from structures.
• Transportation out of and back to affected disaster areas.
• Personal assistant services (other names are attendant, caregiver, or direct support worker.)
• Divert and transition people from institutions.
• Sign language interpreting.
• Debris removal from accessible paths.
• Mucking and gutting.
• Telehealth services.
• Trainers.
• Navigating local, state and federal benefit programs such as FEMA’s Individual Assistance.
• Mass care site accessibility surveyors (shelters, points of distribution (PODs), disaster recovery, and assistance centers).
• Service navigators, including assistance at disaster recovery and assistance centers and PODs.
• Assisting in updating and replenishing government and non-government (e.g., Red Cross) emergency supply caches.

Training:

Many who took FAST training during blue sky times cannot apply what they learned for years, and many trained individuals are no longer available. Therefore, it is crucial to devote greater focus and resources to ongoing training and just-in-time training at the beginning of deployments. This training should consist of refresher information such as short practical, tactical steps, and using existing field operation guides (FOGs), job aids, etc.

FAST training should be reserved for people who are eligible to become team members. Since there are few courses that address access and functional needs, many take FAST training to get this information, knowing they cannot be a team member due to pre-existing disaster-related obligations.

Others take the training because they are considering what it takes to develop, maintain, and sustain a FAST program, which calls for a separate training designed for FAST program administrators.

Measuring success:

Evaluation methods typically focus only on the process versus results. For example, in training, positive participant training evaluations of content and instructors, the number of training sessions delivered, and participants who passed the post-training test are all process measures.

Success training measures should focus on impact and results. Here are a few examples:

• Beyond the process, the impact of “easy-to-access short, just-in-time training” could be measured by users rating how helpful and usable the content is at reinforcing the “how-to” specifics of roles and responsibilities of deployed individuals.  
• Drills and exercise success measures should include the number of community partners who participate in honest assessments of drills and exercises (hot washes and after-action reports), and what is translated into the lessons applied through new or revised processes, procedures, protocols, policies, and training that get applied in the field by deployed partners. 
• The number of people who received food, water, supplies, or evacuation because of life-safety checks, which results in protecting their health, safety, and independence.
• The number of implemented individual emergency plans that result in people surviving and protecting their health, safety, and independence. Planning for how to collect this data is an unaddressed research question. 

Renaming FAST

Existing FAST also have different names. Many endorse changing “assessment” to assistance regarding a FAST name change, as assessment is not enough without follow-up assistance. Others suggest changing “service” to “support.” 

Investigate the options:

Define your intent and goals, and consider investigating existing FAST programs and other options. What is working, and what needs change?

Other options exist to leverage partnerships and maximize impact from effectively working with and contracting with diverse community partners to prepare for, respond to, recover from, and mitigate the effects of disasters and emergencies. When adequately prepared, community partners with critical planning, response, and recovery capacity roles can reach and help more people than the government alone to prevent deaths and injuries. (See Return on Investments in Public Engagement). 

There is a common underestimation of what it takes to develop, operationalize, maintain, and sustain FAST. Avoid iceberg planning by diligently exploring the layers of detail under the surface including: 

• Defending program value and measuring success
• Budgets
• Administrator and staff responsibilities
• Ongoing recruitment of new team members, including background checks, supervisor clearance, and certification
• Training (including updates, refreshers, leader training, just-in-time, and recruiting new trainers, and the training of trainers)

Identify and interview local jurisdictions and states with FAST deployment experience versus those focused on the start-up activities of adapting training and recruiting teams. Even in California, the number of people trained is impressive, but the number of team deployments is small.

Questions to Ask When Starting a FAST Program

• What are the intent, goals, and objectives?
• What are your budget line items, such as FTEs, trainer stipends, training facilities, lodging, meals, transportation, vests, fingerprinting, and accommodations?
• What else should the budget include?
• What does it take to sustain teams (staff time recruiting, FAST host or coordination responsibilities, deployments, refreshing training, just-in-time training, and more)?
• What innovations and customizations have you put in place?
• Do you use regional teams that allow small counties to pool resources and offer mutual aid?
• What works? What needs change?
• What are the details regarding involvement with community partners (agreements, contracts)?
• How to screen for people who can demonstrate their ability to apply independent living values and the social model to their practice?

Teams and numbers of active members:

• How is a team defined: ideal versus actual? (number of members, skill sets, leader, the mix of community partners [Centers for Independent Living, Area Agencies on Aging, other disability organizations, etc.], and government employees)?
• How many identify as people with lived disability experience?
• What are the best methods to screen candidates who understand and integrate independent living core values and the social model approach to disability into their practice?

Active deployable list:

• Currently, how many are on the active deployable list? Number of community partners and government employees?
• Has everyone on the list taken a FAST Course?
• How often is the deployable list updated?
• In the last two years:
  • How many teams deployed, how many individuals in each team, and to which events?
  • How many members are on the active deployable list?
  • How many survivors were served at each event?

Training:

• If you offer FAST training:
  • Has everyone on the active deployment list taken the FAST Course, been certified, and had their background checked?
  • How often is a FAST course taught?
  • In addition to the FAST Course, do team members have prerequisite training that they must complete, and if yes, which ones?
  • Do you offer FAST leader training, and if yes, how often?
  • Do you offer FAST refresher training, and if yes, how often?
  • Do team members participate in government-sponsored drills and exercises?
  • Do you offer FAST advanced training, and if so, how often?
  • Do you offer FAST “just-in-time training” before deployments (use of “how to” tools, checklists, and field operation guides)?

Evaluation:

• How are outcomes, impact, performance, and successes measured?

Summary

There is much to consider and investigate regarding whether a FAST program or other options are right for you. Explore all the options that leverage partnerships to maximize impact from effectively working with and contracting with diverse community partners to prepare for, respond to, recover from, and mitigate the effects of disasters or emergencies. Be thoughtful, comprehensive, and diligent in exploring the details.

Resources

Community partners:

• 12/10/20 CA Disaster Coalition Recording – FAST
• Health Plan Member-Focused Emergency Practices Roadmap (2021) A report from the World Institute of Disability written by June Isaacson Kailes, Disability Policy Consultant, investigates and documents promising member-centered emergency interventions. These critical procedures include applying lessons from COVID-19 and other co-occurring and previous emergencies.

Competencies:

• Moving Beyond Etiquette to Actionable Practice Competencies July 31, 2023 By June Kailes

Site Surveys:

• The National Shelter System and Physical Accessibility - Time to Look Under the Hood (2017) focuses on physical accessibility, one of the many mass care criteria used by the American Red Cross’s National Shelter System (NSS). This focus on facility access is motivated by being repeatedly told (in my role as a trainer, consultant, and policy analyst) by emergency management professionals that they do not need to survey their mass care sites for physical accessibility because they can depend on the information in the NSS. The information in this article is derived from informal discussions with American Red Cross staff and volunteers. These discussions resulted in inconsistent and sometimes contradictory information regarding NSS. What follows is a list of questions and concerns regarding NSS’s information accuracy, surveyor competencies, and uniformity in applying standardized policies and procedures across divisions and regions. For example, different survey versions of physical access questions appear to be used in NSS and in different regions.