You work with your patients for the day-to-day management of their diabetes. But do they know what to do in a disaster?
Staying safe during the COVID-19 pandemic has involved a set of responses including shelter in place, quarantine, wearing protective gear such as face coverings, and social distancing. Other kinds of disasters, such as hurricanes, tornadoes, floods, and earthquakes, require an entirely different set of responses.
Planning for these kinds of natural disasters remains important for everyone, but there’s extra urgency to this task for people who have diabetes or related health conditions such as hypertension and kidney disease. Jeffrey B. Kopp, MD, Chief of the NIDDK Kidney Diseases Section, discusses the role of health care professionals in helping their patients plan for disaster and know what to do when a disaster is imminent or has occurred.
Q: How has disaster planning for health care needs evolved since Hurricane Katrina in 2005?
A: After every disaster, emergency health care planners go back and think about lessons learned, so that we can respond even better in any subsequent disaster. We’ve learned a lot since Hurricane Katrina, which taught our nation about the fragility of our infrastructure, including our health care systems. Our knowledge has been refined through the many natural disasters that have occurred in the years since. New systems have been developed, at the federal, state and local levels, and our resiliency has improved.
At the public health level, we’ve improved in terms of identifying in advance those people who will need special assistance and providing help in emergency situations. For example, the U.S. Department of Health and Human Services now maintains a nationwide emPOWER Map. At the state, territory, county, and ZIP code levels, this map displays the total number of Medicare beneficiaries who depend on electricity for at-home medical equipment such as oxygen concentrators or home dialysis machines. The information is used to help individuals and their support teams prepare evacuation plans and routes and to find emergency shelters and other resources. The maps also help emergency coordinators prioritize areas for restoration of services after the disaster.
The Kidney Community Emergency Response (KCER) was created in the aftermath of Hurricane Katrina. Its goal is to minimize disruption to dialysis services, for example, by ensuring that dialysis centers have backup generators and arrangements for access to clean water in emergency conditions. KCER maintains a hotline with information on which dialysis centers are open during an emergency.
Finally, compared with 2005, there is much more disaster planning guidance today for health care professionals, for the general public, and for people with specific health care needs (see the resources below).
Q: How important is disaster planning at the individual level?
A: It is critical. We should all be prepared, even when we think we don’t need to be. We might anticipate certain disasters during certain seasons—such as tornadoes, wildfires in the hot seasons, hurricanes in late summer, and blizzards in winter, depending on our geographic region—but no matter where we live, unexpected disasters can occur at any time, such as an electrical blackout or a chemical spill.
And while being prepared is important for all of us, it is critical for people with chronic health conditions like diabetes, hypertension, and kidney disease. Sudden and dangerous threats to health can occur when people are unable to maintain their medication regimen, are separated from their usual access to care and support, must skip or improvise meals, lose sleep, are coping with unsanitary conditions, and are experiencing stress from the emergency situation. These changes in routine can progress quickly into dehydration or an immediate and serious health crisis such as diabetic coma, stroke, heart attack, fluid overload, or kidney failure. Fortunately, planning ahead can make this kind of health crisis much less likely to happen.
Q: Is this an issue that health care professionals should raise with their patients?
A: Yes. It is incumbent on health care professionals to help their patients with planning for a disaster. The conversation can be conducted by any member of the health care team—the primary care physician, specialist, nurse practitioner, nurse, or diabetes educator. However, everyone on the team can reinforce the message that planning for disaster is part of creating an overall diabetes management plan. It is important to document the discussion in the medical chart and on the problem list, so as to alert other team members that this information has been communicated. It is also important to review the information with the patient annually and document that as well.
Q: What sort of guidance should be provided?
A: Encourage your patients to do basic logistics planning: Where will they go if they must leave their home suddenly? How will they get there? Who will meet them there? They should review their plans with family members or friends, get their feedback, and enlist their help in evacuation or other emergency response actions they may need to take.
Everyone should have a “go-kit” to take with them if they must evacuate, but people with diabetes also need to have ready a week’s worth of medicine plus supplies such as a glucose meter, test strips, lancets, glucose tablets, syringes, medical equipment, and spare batteries. People who use insulin can store it in the refrigerator with an insulated lunch bag nearby, ready to pack and go. If they can, they should keep extra insulin and injection kits in multiple places, such as at work as well as at home, in case they get stuck in one location.
You can also encourage your patients to stay informed and prepared. They should tune in to weather reports and listen for what local leaders say about threatening conditions or evacuation. They should keep their phone and any medical devices charged at all times, especially when bad weather is predicted. If they have a car, they should keep sufficient gas in the tank.
Here are some other ways you can encourage patients to prepare for disaster:
- Encourage them to keep current on vaccinations, including the annual influenza vaccine.
- Advise them on how to obtain a medical alert ID bracelet. This can be important if they need medical care but are not in a condition to talk.
- Suggest they use their smart phone to store contact information (health care professionals, pharmacy, clinic) and to store photos of their health insurance card, medicine bottle and medical device labels, and health-related documents (recent hemoglobin A1C results, other laboratory work, dialysis prescription, or hospital discharge papers).
- Advise them on how to obtain replacement medicine if they lose their medicine or the prescription or if they are far away from their usual pharmacy when they need a refill. One strategy is to put images of current prescriptions on a smart phone.
- You may also want to advise patients on the safest way to change the particular insulin formulation that they use, which is sometimes necessary in a disaster when local pharmacy supplies may be limited.
- Provide them with contact information for their county emergency management office. Through that office, they may be able to obtain advice on transportation and other services for people with special needs, and they can sign up to receive alerts or register for special assistance. The office may also be able to tell them how to register with their water and power companies for priority restoration of services.
- Encourage them to evacuate early. As soon as local leaders advise people in the community to evacuate, they should go to their preplanned location. That way, they don’t risk being trapped without access to electricity, clean water, medical supplies, and sanitary conditions. Some may travel to friends or relatives in areas that are unlikely to be affected by the disaster. Others may travel to a nearby special needs shelter. When they arrive at a shelter, they should alert workers about their health conditions, so that they can get the support they need.
Q: How often should disaster planning be discussed between a patient and his or her health care professional?
A: At minimum, disaster planning can be addressed yearly, such as in the annual review of the diabetes management plan. At this time, the patient can be reminded to replace items with expiration dates such as medications, food, or batteries.
Q: Is there any other advice that health care professionals should share with patients?
A: A very important message to convey to patients is that they should confront any disaster with a positive mental attitude. You can emphasize that, while the situation will be stressful, they will be prepared, there are people to help, and we will all get through this. This can go a long way to making the experience more bearable.
Guidance for health care professionals
- Planning Resources by Setting: Outpatient Clinics and Urgent Care (CDC)
Guidance for people with diabetes
- Be Prepared! (CDC)
NIDDK Director Griffin Rodgers, MD, MACP, offers guidance on managing chronic diseases during volatile situations such as a pandemic or other disaster.
How do you address disaster planning with your patients? Share below in the comments.