General Guidelines

• Hearing impaired individuals react just as hearing individuals during times of crisis.
• Cooperation, networking, communication, exchange with Associations of hearing impaired (“Nothing about us without us”) is essential.
• Hearing impaired mostly see themselves as part of a “linguistic and cultural minority group”, not as disabled.
• Hearing impaired people are a heterogenic group according to their communication skills. Some are unable to understand or read spoken language. Similarly, there might be a need of simplification of spoken/written language. Some are able to communicate in sign language or signed language (means sound accompanying signs). Communication skills depend on the time of becoming hearing impaired (pre-, peri-, postlingual adaption), severity of hearing loss, other diseases/disabilities, age, socialization and education. Universal design means to take all possible kinds of communication skills into account.
• Use and adapt existing structures and services, try to find universal designs. Services should be offered all over the country and should not be centralized.
• Sensitization of population (possible zero-responders) and professionals about deafness/hearing impairment.
  Sensitization via: school-education; information material (e.g. via flyer, internet & media); trainings. Sensitization should include: self-experience (e.g. in Israel, fire fighters are required to work for 30 hours with disabled people); culture, ethnic and socio-economic factors; communication skills & possibilities to communicate; rights of hearing impaired; learning basics about/in sign language.
• To ensure communication with hearing impaired speaking sign language, the possibility to call interpreters in emergency without going through whole bureaucracy should be implemented. Solve financial issues for communication with interpreters.
• Develop information material about acute, mid- and long-term services for hearing impaired after disasters. Produce different versions according to communication skills (written design, videos, media, internet, blogs etc.).
• Communication advice:
  Speak slowly and clearly, do not shout (as many hard of hearing people show symptoms of hypo- and hyperacusia at the same time).
  Use basic signs, gestures or cards etc. that symbolize cohesion, help, security etc.
  Ask what the hearing impaired person has understood or ask to repeat your communicated information to make sure he/she did understand your message.
• Cave: The way of humor used in deaf culture differs from the way of humor used in hearing culture. Humor can lead to misunderstandings.

Emergency Preparedness

• Information (e.g. about existing dangers, present situation and development after disaster) should be communicate in different ways: TV, media, Internet, SMS, Apps, etc. (in written text, spoken language, sign language).
• Assemble a network of interpreters (translating via video vs. in personal) to be called upon during times of emergency who are trained in specific fields such as medicine or welfare.
• Create information material in cooperation with hearing imapired associations (in written text, spoken language, sign language) for hearing impaired including the rights of hearing impaired; recommendation to have all necessary equipment (e.g. cell phone, hearing aid with spare battery, etc.) with you; information about inclusive alert- and emergency-call-systems; informations about stress reaction after disaster; general advice how to cope with stress reactions; services and particularly how to access services (address & contact details).
• Hearing impaired individuals should be educated in preparedness of disaster, first aid, etc. (e.g. via hearing impaired associations)
• Collect a voluntary database of people with disability for easier contact, crisis communication and warning.
• Use multi-sensual alert-systems (e.g. sound, vibration and flashlight) and emergency-call-systems (e.g. Telephone, SMS, FAX, Apps, Skype, Internet, E-Mail).
• Develop possibilities of communication that work without electricity in case electricity does not work during disaster (e.g. writing with pencil on paper, prepare pictures where hearing impaired people can show where it hurts, laminated sign language alphabet etc.)
• Create inclusive standards for evacuation and emergency routines for employers/schools/communities/public-traffic systems/ public places etc. In particular hearing impaired individuals should take part in disaster drills and simulation.

Emergency Response

Psychological First Aid

• Try not to separate hearing impaired individuals from each other or their relatives/friends as these people promote their feeling of security and their chance to communicate and receive information.
• When evacuating hearing impaired individuals let them take their compensatory equipment with them if possible. (e.g. notebook, hearing aid, mobile phone).
• Specific communication advice:
  Ask for preferred way of communication (e.g. spoken language, written language, sign language).
  Call sign language interpreters if hearing impaired prefer sign language. If you cannot arrange direct interpretation use remote sign language interpretation.
  Stay in eye-contact and observe their mimes and reactions.
  Make sure there is enough light so they can see your face and what is going on around them.
• Use signal symbols (e.g. logos, orange vest, and blanket) in chaotic situations so that they can orientate visually.
• Do not wear helmets etc. outside the danger zone to give hearing impaired individuals the chance to lip-read or see facial expressions.
• Be aware, that hearing impaired individuals are most vulnerable in the dark or while asleep when they cannot compensate their hearing loss with the visual sense.

Psychosocial Aftercare

• Psychiatric centers should be able to treat hearing impaired in general not only at one place per country. (Example for best practice: PsySurdus - an online psychiatric service for Deaf including listening webcam, chat and e-mail. Communication is based on French Sign Language (LSF) - Link: http://www.sos-surdus.fr/).
• Make preferred way of communication possible. Sign language interpreter should automatically be provided, should be organized in advance – should not be the responsibility of the hearing impaired individual.
• Specific communication advice:
  Make use of technical devices/materials possible that can assist communication.
  When using sign language interpreters, sit directly opposite the client and avoid looking at the sign language interpreter while speaking and listening.
• Hearing impaired individuals have the same needs as hearing individuals in the therapy situation e.g. closeness, empathy, humor etc.
• Psychopathology: Hearing impaired suffer from same psychiatric disorders as hearing individuals but there is evidence for generally increased incidence of psychiatric problems in this population. Incidence of PTSD is not well illuminated so far. There is a need for more research. Hard of hearing people or people who suffer on increasing loss of hearing often report of Hyper- and Hypoacusia at the same time. This phenomenon is very similar to hyper arousal syndrome of traumatized people. Personnel should find out if a person is affected by this syndrome.
• Therapy and Sign Language: Trauma treatment is difficult if it has to be done via a sign language interpreter; eye contact is extremely important during therapy, this is lost if one uses an interpreter. Therapists speaking sign language is the preferred option. If therapists are not able to speak sign language it is preferable to use same interpreter if multiple sessions are needed. Physically present interpreters are preferred instead of interpretation via ’Verba Voice’. Sign language interpreters have to remain neutral and should be unknown to the deaf and hard of hearing individual.
• Hearing impaired individuals are used to be guided by hearing individuals, they also do expect that in the context of therapy. The content and procedure of therapy and the role of the therapist as person who helps and supports the patient to help himself must be explained.
• Visual material to support the therapeutic interventions can be useful.
• Stabilization techniques which make use of bilateral stimulation and body movement are preferable over techniques that make use of imagination.
• Technical terms like ‘skill’ or ‘trigger’ must be paraphrased and explained. It can be useful to agree with the patient on a gesture for these terms.
• Provide contact information for support groups for hearing impaired individuals (e.g. crisis groups, bereavement groups)
• Information of important meetings/sessions should be provided in written form.