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Caring for special-needs patients is challenging in disasters. They cannot be triaged, treated or discharged without consideration of their disabilities, including caregivers and social situations. The US Government's response to all hazards requires planning for challenges to communication, medical care, independence, and supervision (CMIST) for vulnerable populations. Vulnerable patients, by lack of any other plan or unavailability of an alternate caregiver, may converge on the emergency department, whether or not there is a medical problem. Language, hearing, seeing, and understanding must be included in patient care and discharge in an expedited manner during a disaster situation. Patients with powered devices and/or underlying medical problems may need access to services such as dialysis or electricity. Vulnerable populations have higher risk for injury and recovery from traumatic disasters. Patients with rotating caregivers, whether in an institution or independent, need alternative caregiver plans. Those patients with service animals will need to have animals included in their plans. Supervised nursing home patients, group home patients, psychiatric patients, minors, and high security patients cannot be released to shelters or other venues without adequate supervision. Before being released from medical care, one must ensure that supervision needs for vulnerable persons are met. Vulnerable casualties must also be protected from abuse and fraud. Individuals dependent on handicap access or public transportation or mobility aids will need plans for alternate transportation prior to a disaster. If the patient is not able to return to their normal community setting, discharge planning to alternate facilities will be part of the planning to prevent unnecessary admission to a hospital that may already be over capacity. Central repositories of information must be available to emergency department and social service personnel to allow caregivers and family to reconnect with patients, and to help with expedited care and discharge.
