Lisa Katzki, RN, BSN, PHN

For patients who require life-sustaining medications, emergency preparedness is essential. Here is a game plan to guide you and your patients when facing the unexpected.

	When the subject of emergency preparedness comes up in my home state of California, the focus is always on earthquakes. One of the first things that you hear in these conversations is not “if” it will happen but “when.” This axiom holds true in almost any part of the country. In the Southeast, it is hurricanes. In the Plains, it is the threat of a tornado. The same is said about blizzards in the East, ice storms in the North, and floods in the river valleys.

	Sad but true, nature is not the only antagonist. In a post 9/11 world, we must consider the possibility of any and all man-made disasters as well. People on medications must also be prepared for emergencies of all types—and the pharmacist and pharmacy staff can help them on their path toward preparedness. Here are some practical and helpful hints that you, as a pharmacist, can offer to your patients.

	Emergency preparedness is important for everyone. It is even more important for people who require medications—and especially those on life-sustaining medications such as insulin, coumadin, epinephrine, or medications for anti-seizure, hypertension, or anti-rejection, to name a few. The list of drugs used to treat significant and severe medical conditions is long and involved. Emergency preparedness for these patients requires planning and thought. It is, however, human nature to procrastinate. We tend to worry more about the immediate challenges that each day brings rather than prepare for the challenge of some future event.

	There are basics in life that we all take for granted—

water, food, warmth, shelter, lighting, communication, sanitation, first aid, and medications.

 These are the basics necessary for comfort and survival. Yet, in an emergency, these may suddenly be unavailable. These needs are amplified for those on life-sustaining medications. The purpose of emergency preparedness is to become as self-sufficient as possible when electrical power, water, sewage, and community assistance are cut off—a very likely scenario in emergency situations. Here are some steps you can take to prepare for these situations and discuss with your patients. You simply need to invest a short amount of time and a small amount of resources to get prepared for when disaster strikes.

	Think of the various places where you may need the basics of life. These are the places where you or members of your family would likely be—and may likely be stuck&mdash;when an emergency happens.	

		The most common locations are in your home, car, place of work, or school. For your home and car, keep an emergency supply kit that covers these categories— water, food, warmth, shelter, lighting, communications, sanitation, first aid, and medications. Keep your home kit in a location that will not likely be obstructed or damaged in an emergency. You may want to store your emergency kit outside your house, but in a secure, protected area. It is a good idea to keep a “grab and go bag” of supplies in a location within your home that will be easily accessible if you have to leave in a hurry.

		Ask at your place of work and your children’s school if they have an emergency plan of action and appropriate supplies for their staff and/or students. Many schools and companies have supplies. Inquire as to the type and quantity. Seek out the assistance of companies that specialize in disaster preparedness if necessary. Until those locations are adequately prepared, keep an emergency supply kit there as well. Remember to supplement with your unique needs, such as medication and accessory supplies such as syringes.

		At a minimum, keep 3 days’ worth of necessary supplies. Depending on the scope of the disaster, it could easily take that long or longer for assistance to reach your area. Assume that you will be on your own without water, power, sewage (flushing toilets), or community assistance. In order to calculate how much water, food, or necessities you will need, see the specifics below. Do not forget to consider your pets in your calculations.

		Check your emergency supplies at least once a year. Stock up with supplies that have the longest shelf life possible. There is water and food that is specially packed so that it can be stored for 5 years or longer. Many medications, however, do not have long shelf lives. It is important to make sure that you always have an unexpired supply of the medicines you use.

		Let’s now take a look at the specifics. We will go over both the needs common to everyone and the needs unique to a person taking medication.

A person cannot survive long without water. Besides oxygen, water is the most important human nutrient. This makes water the most important item in your disaster survival kit, particularly since your normal water source is likely to be cut off following a disaster. The American Red Cross recommends storage of 1 gallon per person per day. Half of that is for drinking and half is for cooking and sanitation. Store more than that if you live in a warm climate. A 2-week supply in your home and a 3-day supply in your car is optimal.

		Learn where to find other sources of water in or near your home. A hot water tank is one of the best sources. There is also water in canned foods and in fresh or frozen fruits and vegetables. Also consider rainwater, streams, rivers, ponds, lakes, or natural springs. Avoid water with floating material, an odor, or dark color. Before drinking water from any of these sources, purify it by boiling it, distilling it, or adding chlorine or water purification tablets.

Daily intake varies from person to person. While your recommended daily intake is most likely higher, the Coast Guard approves rations that provide a minimum of 800 to 1200 calories per person per day. You may need more calories if you are pregnant or nursing. There are also other medical conditions that may require a higher calorie allotment.

		Store foods that you are used to eating. Foods that do not require refrigeration, preparation, or cooking are best. If you have canned food, be sure to have a nonelectric can opener available! Check your stored food each year and replace anything that has expired or will expire within the year. There are specially packed food items such as high-calorie food bars, freeze-dried meals, and cans that have shelf lives of 5 years and beyond.

		If you have allergies, or are a person with diabetes, store foods compatible with your diet requirements. Monitor your blood glucose more frequently than usual.

For much of the year, it can get cold. If your electricity or gas is cut off, so probably is your usual source of warmth. If you have a fireplace, keep a stockpile of wood. Pack blankets and sleeping bags. You can purchase survival blankets made of Mylar that reflect back body heat. These blankets are inexpensive and compact.

		If you have poor circulation, hands and feet could be more vulnerable. Without proper warmth and protection, you risk frostbite leading to irreparable damage. Help protect yourself by storing gloves and extra socks in your kit. Also store instant heat packs (available at camping stores and emergency preparedness retailers). Insulin and many other medications are also vulnerable to cold. Keep these protected as much as possible.

Your home may become damaged and uninhabitable. Set up a buddy system with friends or relatives to make sure that you have someone you can stay with. Ideally, you should have a local buddy as well as an out of the area buddy. The best way to set this up is to offer to reciprocate—both parties benefit and become prepared. Additionally, pack a tent or tarps in your kit. These can serve as a short-term solution.		

			Your kit should include basic tools such as a shovel, pry bar, hammer and nails, manual screwdriver and screws, duct tape, marking pen, hard hat, work gloves, safety goggles, a wrench that can be used to shut off your gas and water connections, and a dust mask. Learn how to shut off your gas, water, and electricity. Ask your local power company for help. In the event that you do need to turn your gas off, do not turn gas back on. Your gas company will need to do that for you.

			Keep cash on hand—in small bills&mdash;as change and credit card/ATM machines will be unavailable.

			Keep your gas tank at least half full at all times.

Power outages are common after any disaster. Be prepared with a flashlight in your kit, car, and in at least 3 rooms of your house. Change the batteries when you change your clock for daylight savings time. The ideal flashlight is one powered by battery, solar, or hand crank, or one that stays charged in an outlet and is therefore fully charged when the power goes out.

We have many ways to communicate, for example, land phone, cell phone, smartphone, text messaging, instant messaging, and e-mail. Keep your cell phone charged and with you at all times, especially when you drive, in case a regional emergency occurs. If you have your own personal emergency, like a breakdown or an accident, and you can’t call, texting or e-mail may work, so also keep your laptop charged.

			Decide on a meeting place with your loved ones ahead of time. If you leave your home, leave a note on the door saying where you’ve gone and how to reach you. Also have a secondary plan in place in case the area around your home is inaccessible.

			Remember to pack a radio—one powered by solar, hand crank, or batteries. Always pack extra batteries.

The best way to avoid illness following an emergency is to keep up hygiene. The number 1 way to prevent the transmission of disease is proper hand washing. In the absence of running water, use products such as a waterless hand gel. This does not replace the need for washing with soap and water, but is the next best thing and it will help prevent cross contamination and disease transmission. In addition, store soap, towelettes, a bucket, portable toilet seat (available from emergency preparedness retailers), toilet paper, and a box of garbage bags. Include items such as a toothbrush, toothpaste, comb, brush, contact lens supplies, and feminine supplies.

Build or purchase a wellstocked first aid kit. Your first aid kit should include:

				3 × 3" or 4 × 4" sterile gauze pads

Lisa Katzki, RN, BSN, PHN

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