When the power goes out during a hurricane, ice storm, or wildfire evacuation, most people think about flashlights and bottled water. But for occupational therapists who work with clients who depend on medical equipment — ventilators, oxygen concentrators, electric wheelchairs, home dialysis machines, infusion pumps, stairlifts, or powered hospital beds — a power outage is not an inconvenience. It is a life-threatening emergency.
This is one of the most clinically urgent — and most frequently overlooked — areas where occupational therapy can make a profound and measurable difference in disaster preparedness. And as natural and human-made disasters continue to increase in frequency and severity, the window for proactive OT intervention is narrowing (American Occupational Therapy Association [AOTA], 2023).
Why Equipment-Dependent Clients Are Disproportionately at Risk
Research consistently identifies people with disabilities and those who rely on electricity-dependent medical equipment as among the most vulnerable populations during disasters (Engelman et al., 2022). The stakes are immediate: oxygen concentrators typically provide only four to eight hours of battery backup before failure; powered wheelchairs become immovable; infusion pumps and home dialysis machines cease to function. For individuals whose survival and daily function depend on these devices, the loss of power is not simply an inconvenience — it is a medical emergency that can escalate within hours.
According to the U.S. Department of Health and Human Services, emergencies with prolonged power outages can quickly create life-threatening situations for people who depend on durable medical equipment (DME) (Administration for Strategic Preparedness and Response Technical Resources, Assistance Center, and Information Exchange [ASPR TRACIE], 2019). Despite this, standard community emergency management plans rarely incorporate individualized protocols for technology-dependent individuals. This is the gap that occupational therapy is uniquely positioned to fill (AOTA, 2023).
The OT Advantage: Already in the Home
One of the most underappreciated features of occupational therapy practice is that OTs are already in the home. Unlike most other healthcare professionals, we are observing the physical environment, the equipment, the daily routines, and the caregiver relationships in real time. We are positioned to see, document, and address disaster-related risks as a natural extension of our standard evaluation and intervention processes (Estes et al., 2023).
Research published in the American Journal of Occupational Therapy has noted that while the majority of OTs believe the profession has a role in disaster management, few have received formal training or have incorporated disaster preparedness into their practice (Estes et al., 2023). This is a significant clinical gap — and one that training can meaningfully close.
A Practical OT Framework for Equipment-Dependent Clients
The following five-step framework can be integrated into any home health, community, or hospital-based OT practice.
Step 1: Complete a Full DME Power Profile.
For every client who uses powered or battery-operated medical equipment, develop a documented power profile that includes:
- Device name, model, and clinical function
- Normal power requirements and battery backup duration
- Manual operation instructions (if available)
- Location of backup power sources, chargers, and instruction manuals
- Name and contact information of the DME supplier
This profile becomes the foundation of the client’s personalized emergency plan and should be updated at every recertification visit (ASPR TRACIE, 2019).
Step 2: Connect Clients to Life Support Equipment Utility Registries.
Most utility companies offer Life Support Equipment (LSE) or Medical Baseline programs that flag electricity-dependent households for priority power restoration and advance notification of planned outages. Pacific Gas and Electric (PG&E) in California, for example, offers a Medical Baseline Program that provides additional bill credits and priority notifications to households where occupants depend on life-sustaining equipment (Pacific Gas and Electric Company, 2025). Despite the widespread availability of these programs, most clients and caregivers are entirely unaware of them. OT referral to these programs is a direct, measurable, and high-impact safety intervention.
Step 3: Build a Power-Failure Protocol Into the Care Plan.
For each critical device, work collaboratively with the client and caregiver to document a tiered power-failure response. Specifically:
- At what point does device failure become a medical emergency? (Define clinical thresholds)
- What is the backup plan for the first two to four hours? (Battery packs, vehicle adapters, neighbor with a generator)
- What is the plan if power is unavailable for 24–72 hours? (Relocation to a shelter with accessible power, contact with DME supplier for loaner equipment, 911 activation criteria)
Written protocols posted visibly in the home — and held by all caregivers — reduce dangerous delays in crisis decision-making (Special Needs Alliance, 2025).
Step 4: Address Mobility Continuity.
A common and dangerous gap in home emergency planning is the absence of a manual mobility alternative for clients whose primary mobility device is powered. A client who relies exclusively on a power wheelchair will be completely immobilized during a prolonged outage if no manual chair is available and if they and their caregiver have not practiced transfers (Pacific Gas and Electric Company, 2025).
The OT role here is twofold: advocate for the procurement of a manual backup mobility option, and conduct graded practice of manual wheelchair use and transfers before an emergency occurs. This is task analysis and occupational grading in direct service of safety — precisely the kind of intervention that distinguishes OT from other disciplines.
Step 5: Practice and Grade the Evacuation.
Research consistently demonstrates that emergency plans that have been rehearsed yield better outcomes than plans that exist only on paper (Special Needs Alliance, 2025). OTs are trained to grade activities — beginning with simple steps in a controlled environment and progressively adding complexity. Apply this same approach to evacuation rehearsal:
- Walk through the device shutdown and transfer sequence during a calm, planned visit
- Practice gathering the emergency kit while maintaining necessary equipment
- Rehearse the path from the bedroom to the exit with backup mobility in use
- Identify and problem-solve any environmental barriers encountered during practice.
The Cascade Effect of Power Loss
Power failure does not affect a single device in isolation — it creates a cascade of functional losses that compounds rapidly. In multi-unit residential buildings, elevators fail. Electronic door locks cannot be operated. Smart home assistive technology that a client with a physical disability uses for environmental control — thermostat, lighting, intercom — becomes inoperable. Automated medication dispensers stop functioning. Each of these represents another layer of occupational disruption, stacked on top of the primary device failure.
When an OT takes the time to map this cascade during a non-crisis evaluation, they can build a far more comprehensive and realistic safety plan than any generic emergency preparedness checklist can provide. This is the depth of assessment that clients with complex medical needs deserve — and that occupational therapy is uniquely trained to deliver (Gill, 2025).
The Advocacy and Systems Level
Beyond individual client intervention, OTs trained in disaster preparedness can advocate at a systems level: training emergency shelter staff on accommodating power-dependent residents, consulting with hospital discharge planning teams to ensure power-contingency plans are included for medically complex patients before they go home, and contributing to community emergency management planning processes (AOTA, 2023; Engelman et al., 2022). This is an emerging and high-impact area of OT practice — one that the profession has identified as a critical priority as the frequency of disasters continues to rise.
Take the Next Step
The AOTA-approved course Disaster Preparedness, Response & Recovery: The Role of OT from The Home Accessibility Therapist LLC gives you the practical checklists, client-centered frameworks, and evidence-based strategies to bring this work into your practice immediately. Modules address the full spectrum of disaster phases and include specific content on clients with dementia, clients with autism, and equipment-dependent individuals across all care settings.
At just $49 for 0.5 AOTA-approved CEUs, this course is among the most direct investments you can make in your clients’ safety — and your professional readiness.
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References
Administration for Strategic Preparedness and Response Technical Resources, Assistance Center, and Information Exchange. (2019). Durable medical equipment in disasters. U.S. Department of Health and Human Services. https://files.asprtracie.hhs.gov/documents/aspr-tracie-durable-medical-equipment-in-disasters.pdf
American Occupational Therapy Association. (2023). Disability-inclusive disaster risk reduction. AOTA SIS Quarterly — Home and Community Health. https://www.aota.org/publications/sis-quarterly/home-community-health-sis/hchsis-11-23
Gill, P. (2025, September 15). Roles of occupational therapists: Disaster preparedness and recovery. Elmhurst University. https://www.elmhurst.edu/blog/roles-of-occupational-therapists-disaster-preparedness-and-recovery/
Engelman, A., Ivey, S. L., Tseng, W., Dahrouge, D., Brune, J., & Neuhauser, L. (2013). Responding to the deaf in disasters: establishing the need for systematic training for state-level emergency management agencies and community organizations. BMC health services research, 13, 84. https://doi.org/10.1186/1472-6963-13-84
Engelman, A., Ivey, S. L., Tseng, W., Dahrouge, D., Brune, J., & Neuhauser, L. (2022). Responding to the deaf in disasters: Establishing the need for and feasibility of a health communication program. AOTA SIS Quarterly — Home and Community Health. Referenced in: American Occupational Therapy Association. (2023). Disability-inclusive disaster risk reduction.
Estes, R. I., Delgado, G. M., & Hollywood, K. E. (2023). Perception of OTs as responders in disaster management. American Journal of Occupational Therapy, 77(Supplement 2), 7711510228p1. DOI:10.5014/ajot.2023.77S2-PO228
Pacific Gas and Electric Company. (2025, March 11). Emergency planning tips for people who rely on electric or battery-dependent medical devices. PG&E Safety Action Center. https://www.safetyactioncenter.pge.com/articles/35-emergency-planning-tips-people-rely-electric-battery-dependent-medical-devices
Special Needs Alliance. (2025, November 12). Emergency preparedness for people with disabilities. https://www.specialneedsalliance.org/the-voice/emergency-preparedness-for-people-with-disabilities/
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