A fundamental paradox underlies planning to identify and reach vulnerable populations in a widespread emergency. The paradox is that identifying special populations and their needs requires resources that are available mostly to over-arching organizations, such as states, but only a local community can really understand and reach its own special populations. The paradox is compounded by the demands of daily public health work, and lack of staff and lack of funding often prevents comprehensive planning at every level.

State level planners are usually sufficiently removed from local exigencies that most statewide plans do not include special or vulnerable populations, with the sometime exceptions of translations into Spanish. Yet state level planning is key to enabling a process that can help at the local level in counties and municipalities.

An ongoing discussion in public health communication has been the jurisdictional level at which effective planning can take place. Most citizens assume that "government" planning permeates every level of federal, state and local activity. But public health professionals know that planning can and should take different forms to various community needs. The best results come from cooperative efforts.

Kelly Reinhardt of Jane Mobley Associates conducting a workshop

It is an ambition thrown into dramatic relief by recent disasters. Images that dominated the media in the aftermath of Hurricane Katrina shocked a nation that had imagined its governments at every level were prepared for most widespread emergencies – if not terror, then at least weather-related events. The ugly reality of Katrina revealed that the most vulnerable people – poor, sick, aged, mentally or physically challenged or others outside the channels of mainstream communication – were disadvantaged in the broadest sense of the word. At the same time, the communication failures around Katrina underscored the widely broadcast recognition that communication gaps or errors have continued to plague response to terror events in America in the past five years – notably the events surrounding September 11, 2001, as well as the anthrax attacks that followed.

By now it is clear that communication is an element of emergency preparedness that has not uniformly received the priority focus required to reach all citizens effectively with information they can use to help themselves and others. Combining the broad-based requirements of public health crisis and risk communication planning -- "Be First. Be Right. Be Credible." -- with the localized challenges of identifying and reaching special populations is daunting.

Few planning models exist, and much of the information about effective communication activities is anecdotal and limited to event-specific experiences in particular locations. But debate about whether preparedness communication planning at a state level can really make a difference in individual/local communities was set aside in Kentucky, and the project begun because Kentucky's DPH decided that state level planning for vulnerable populations not only could make a difference for communities statewide, it had to.

Why? Much of Kentucky's population can be considered "vulnerable." By national standards, Kentucky's population is disproportionately poor; moreover, the state is home to an increasing population of limited- or non-English speaking residents, as well as comparatively high numbers of migrant workers, residents who are disabled and a growing elder population. The rural areas of Kentucky are legendary for their difficult topography and remoteness from modern services. Kentucky needed planning to reach those populations with actionable information simply to meet a baseline of emergency readiness set by the state Commissioner of Public Health in 2001: "to process large numbers of sick people, whatever the reason."

The Kentucky results thus far include:

• an accessible body of knowledge about people living in the state, both vulnerable and mainstream residents: how they get information, whom they trust, what triggers their action-related decisions in health emergencies;
  
• a developing database of community outreach resources that augments the state Health Alert Network;
  
• a growing volunteer "safety net" of resource people trusted by different populations (e.g. deaf, Hispanic, remote rural);
  
• closer connections with traditional and non-traditional media outlets throughout the state;
  
• collateral materials that support the planning initiative and raise public awareness of Kentucky Department for Public Health and emergency preparedness;
  
• successful use of some elements of the plan for events such as ice storms, Monkey Pox and hurricane aid; and
  
• future phases to continue the work into increasingly localized settings in cities, towns and rural areas.

Perhaps the most important lesson of the process to date has been the recognition of the gap between "preparedness authorities" (elected and appointed officials, health and emergency professionals, the media) and the public at large. While excellent planning has linked agencies, health and emergency services providers and many levels of government, the links stopped there in terms of communication planning. Research confirms that this is true in many states. In general, comprehensive emergency planning has been designed to connect authorities, agencies and providers – but little has been done to build an operational, connected network from this top level to the ground level.

Kentucky now has in place a statewide database -- a community outreach information network (in Kentucky called the KOIN) -- designed to operate during an extended power outage and focused on reaching vulnerable populations . This state has taken a leadership role in building the connections needed to create a safety net for all its citizens, as well as providing an emergency communications preparedness model of effective collaboration across all jurisdictions, deep into communities and neighborhoods.