Emergency planning with disability and access needs

Standard emergency planning assumes that every household member can self-evacuate quickly on foot. That assumption fails for roughly one in four Americans who live with some form of disability, and for the estimated 2.5 million Americans who depend on powered medical equipment — oxygen concentrators, power wheelchairs, feeding pumps, ventilators — that stops functioning within hours of a power outage. Preparedness plans that ignore these realities don't protect the people who need protection most.

Federal Emergency Management Agency (FEMA)'s framework calls these Access and Functional Needs (AFN) — recognizing that the needs are operational planning problems, not personal limitations. Planning around specific needs produces workable solutions. Planning around generic categories does not.

Build person-specific profiles

Start with a written profile for each household member who has access needs. The profile drives every other planning decision.

Document for each person:

Mobility baseline: Can they walk independently, with assistance, or only with a device? How far? At what pace?
Transfer needs: Can they move from wheelchair to car seat independently, or does it require two people?
Power-dependent equipment: What devices require power, what is the battery backup duration, and what is the consequence of a power failure?
Medications: Which medications are essential, what is the required temperature range for storage, and how many days of supply are on hand?
Communication needs: Does this person communicate using an AAC device, hearing aids, or other augmentative technology? What is the backup if that device fails?
Heat/cold tolerance: Some conditions (MS, spinal cord injury) make temperature regulation difficult; extreme heat or cold becomes a life-safety issue faster than for others

Field note

Write this profile on a single laminated card. Keep one with the person's medications, one with the go-bag, and one with the primary caregiver. A caregiver who is rushed during an evacuation does not have time to recall complex medical histories under stress — the card does it for them.

Power-dependent equipment: the 72-hour problem

A power outage that lasts 72 hours is a planning benchmark for most households. For someone dependent on an oxygen concentrator, home dialysis, or an electric wheelchair, that 72-hour window can be a life-threatening emergency.

Oxygen concentrators have no battery and stop functioning the moment power fails. Options:

Maintain a supply of portable oxygen tanks as backup — confirm duration in tanks with your prescribing physician
Register with your utility's medical baseline or life support equipment program to receive priority restoration notification
Have a battery-powered portable concentrator rated for your required flow rate

Power wheelchairs: Batteries must be recharged approximately every 12–24 hours of use. A manual chair backup is recommended when the power wheelchair is the primary mobility device. A lightweight transport chair weighing 15–20 pounds (6.8–9 kg) can be transported when a power chair cannot. Keep both the power chair charger and a car charger (12V adapter if available for the model) accessible.

Other powered devices: Identify the battery backup duration for every device in your plan. Portable power stations (rated in watt-hours) can run many medical devices for hours to days; confirm the device's wattage requirement against the power station's capacity before purchasing.

Stair and multi-floor egress

Elevators must not be used during fire or seismic events. For wheelchair users in multi-story buildings, stair descent requires planning before the emergency.

Evacuation chairs are purpose-built devices that allow a single attendant to safely guide a mobility-impaired person down stairs. A governor controls descent speed to approximately 1 meter per second (3 feet/second), allowing a small attendant to manage a significantly heavier passenger. Models designed for buildings can be stored in a stair enclosure and deployed in under two minutes.

If you live in a multi-story building and use a wheelchair or have limited stair mobility:

Identify which floor exit leads to grade (not all ground floors connect directly to street level)
Know where the nearest area of refuge is on your floor — a fire-rated enclosure designed as a waiting area for emergency responders
Ensure at least two trained people know your evacuation procedure and have practiced it

Caregiver backup planning

A plan dependent on a single caregiver fails the moment that caregiver is unavailable, injured, or unreachable.

Cross-train at least two additional people who can provide support:

A neighbor who can initiate evacuation if the primary caregiver cannot be reached
A family member in the area who knows the access needs, equipment location, and medical priorities
A friend or community member enrolled in a mutual aid network

Establish a check-in protocol: during any developing emergency, the person with access needs calls or texts a pre-designated contact at a set interval. If check-in is missed, the contact initiates the backup plan. See mutual aid networks for how to formalize this within a community structure.

Medication planning for access needs

For prescription medications that cannot be interrupted — anticoagulants, insulin, antiseizure medications, psychiatric medications — the planning standard is a 7-day minimum supply, with 30 days as a more robust target.

Insulin: Requires refrigeration. In a power outage, insulin kept between 59–77°F (15–25°C) remains effective for 28 days after opening. Know your medication's tolerance window. Carry a small insulated case with reusable cooling packs in your go-bag.

Temperature-sensitive medications: Identify which of your medications require refrigeration, and how long they can safely remain at room temperature. Your pharmacist can tell you the specific window. Build an insulated medication carrier into your go-bag.

Supply depth: Document the days-on-hand for each essential medication. Refill at 30 days remaining for critical medications, not when the bottle runs out. Most insurance plans permit early refills during declared emergencies.

Never separate a person from essential mobility and medical devices

During evacuation, the instinct to leave equipment that slows departure can feel practical. It is not. A wheelchair, communication device, or medication pump is survival equipment. Losing it sharply increases medical risk and may create a situation the household cannot manage. Stage the equipment for rapid loading — pre-built ramps for vehicle loading, a pre-packed medication kit in the go-bag — so it never has to be a choice.

Shelter-in-place adaptations

If the access needs profile makes evacuation difficult, a well-prepared shelter-in-place may be the better default option. This requires ensuring:

The home can support the person for the expected duration without power (have backup for all powered equipment)
Medical supply depth is adequate for extended stays
Community support is checked in and can provide assistance

For the shelter-in-place decision framework, see bug-in planning.

Community notification systems

Many counties maintain a special needs registry where residents with mobility or medical equipment dependencies can pre-register. During a declared emergency, this registry enables first responders and emergency managers to prioritize outreach. Registration does not guarantee evacuation assistance, but it ensures responders know where to look first.

Search "[your county] special needs registry" or contact your local emergency management office to register.

Practical checklist

Build a written access needs profile for each household member with specific mobility, equipment, and medication details — laminate it, make three copies
Identify every power-dependent medical device and document its battery backup duration
Register with your utility's life support equipment or medical baseline program
Build a power backup plan for each power-dependent device: portable power station, backup batteries, or alternative device
Cross-train at least two additional caregivers and practice the evacuation procedure with them
Confirm stair descent method for any multi-story building occupant with limited mobility
Stock a 30-day supply of essential medications; store in a pre-packed waterproof medication kit
Register with your county's special needs registry if applicable
Test the full evacuation procedure with all persons and all equipment — time it

For overall departure planning, see evacuation planning. For community-level support that can supplement household caregiver capacity, see mutual aid networks.