Living with a disability can be a real challenge, Kevin Burk said Thursday in a press conference announcing a new emergency form that could help save the lives of those disabled.

“It takes heart, takes spirit, a lot of courage…the most important thing it takes is the help of a good support team,” said Burk, who is the Washington County Coordinator for the Southern Indiana Center for Independent Living.

Washington County Emergency Management Director Desi Alexander, Police Chief Troy Merry and Fire Chief Tom Day will work with Kevin Burk, the Washington County Coordinator for SICIL develop a form that will provide additional information for disabled residents. The information will help emergency personnel be able to act quicker to save these residents in times of emergencies.

“We came up with this idea – the emergency ADA form…. that hopefully will help those with disabilities become more independent and get help in the need of an emergency,” said Burk.

He’s doing that by working to come up with an information database for those disabled residents in the community. The form is to assist Washington County Emergency Services in more effectively responding to an emergency situation that a disabled person may experience.

“All our lives we’ve been taught what to do In case of a fire,” Burk noted. “We’ve been taught there is a place you can meet outside. Those who are disabled can’t easily do that. What would that plan entail if you physically could not get out of the house in case of a fire? Or if you could not mentally process what was going on? This form will help get information to those who can help you.”

The purpose is to ensure that 911 dispatches and emergency response personnel are aware, in advance, of any information the public feels would be helpful.

Information includes the name, age and physical description of all those in the household as well as telephones numbers, emails, etc.

Burk said he contacted Salem Police Chief Troy Merry and Salem Fire Chief Tom Day after a city council meeting last year and quickly sold them on the idea.

“Kevin had a great idea when he came up with this,” said Day. “I don’t know why we didn’t think of this years ago, but sometimes it takes someone from a different outlook. It’s going to help the disabled community and I’m so happy that it’s information that’s going to help us. We only know what [information] we’re given through that radio.”

The four-page form is available at the Salem Police Department, City Hall, Salem Fire Department and the Washington County Detention Center. (A digital copy is also available at – linked from this story)

Disabled residents in the community are asked to fill out the forms and return them to the Sheriff’s Department where the information will be made available to 911 dispatchers.

Another important feature of the form is letting 911 dispatchers know what room in the house a particular person likes to be in.

Day said he immediately saw a huge benefit. “When we’re on the way to an accident scene, this information is what we normally are trying to track down on the way,” he said during a meeting in City Hall on Thursday. “Everything like this helps us prepare for what we will find on the scene of a fire, accident or some other scene. “

Kevin said he had heard about it in a meeting and began thinking of his families own emergency plan.

“I’ve had this conversation with my wife. What would happen if our house caught fire? I was born with muscular dystrophy. My wife would have to make a decision to leave me and go save our kids. I would be waiting for the emergency personnel to come and save me,” said Burk. “Any information they had about where I was at in the house, would help them find me and get me out quicker.”

Day was quick to point out the form is not mandatory – “This is strictly voluntary,” he said. “And we’re not saying you’re going to get a better service if you fill this information out….but it will give us more information which can help us help you more.”

Merry added that any information is great information in the face of the unknown.

“The best time we have for information is on the way to a scene. This right here is going to fill us in on a lot of information,” said Merry. “When we get to the scene, there isn’t a lot of time to find out information. This is going to help us a lot.”

Merry said the Salem Police Department responds to a lot of calls where friends, relatives and neighbors request a safety check on residents.

“A neighbor hasn’t seen someone in a few days,” said Merry. “If this tells us what room someone is regularly found in, then it’s going to help us track them down. Or if we have someone who likes to wander off, then we’ll be able to know they might not be in a house during a fire and expand our search elsewhere. Dispatch is going to have a wealth of information now.”

Day said the database information will work well for the EMS, too.

“There is an increase in those who are obese and if the EMS has to deal with an obese person, sometimes they need to call the fire department for help. With this, they might be able to know what the situation is and call us out at the same time which is going to save time.”

When 911 was established in the early 90s in Washington County, officials collected information from residents about who was in their homes, what kind of hazardous chemicals or flammable materials might be at their homes, in garages or barns.

Desi Alexander, Washington County Emergency Management Director said in many cases this information is outdated. “People have moved and the information hasn’t been updated. We are working to update that information.”