Gone with the Wind: Diaster Preparedness for Persons with ...


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  • After a disaster, there are physical and mental health challenges to be faced. Disasters disrupt thousands of lives a year. Being prepared and understanding what can happen can help reduce fears and anxiety. These are some of the objectives we will focus on today.
  • When I reported for duty as a disaster nurse, I was assigned to a 6 nurse team in a Red Cross Service Center where we ran a clinic. I didn’t think I would be focusing so much on persons with diabetes but what happened is that we started seeing many hurricane survivors with diabetes issues and the other 5 nurses I was working were not up to date on diabetes care so they referred all the diabetes issues to me. Thus I became diabetes disaster nurse. These are the issues I dealt with, and look..they all fall into the 7 AADE self care behaviors…
  • There were many medication challenges. Some of the survivors lost their medications and so med. schedules were not being followed. Pharmacies were closed in areas for almost a week due to power failure and roof leakage. FEMA flew in and mobilized and set up special tent clinics and pharmacies.
  • There were nutrition challenges.The majority of people in Florida had damage to their houses but were still able to pitch a tent or camp out in their yards. But since they had no air conditioning, refrigeration or power, their food spoiled. Stores were closed so there is limited food re-supply. Some people had food in their freezers that was thawing out, so they up their grills or camp fires and cooked their food. People start skipping and delaying meals. Some people lived in a shelters up to a month and there may be high carb foods.chips, pretzels, pasta, pastries Red Cross meal vans began driving to neighborhoods and offering a hot meal but meal delivery was sporadic. Your couldn’t plan on a set time when the meal vans would be in your neighborhood.
  • Survivors had a lot on their minds and often glucose testing was not a priority. During the Florida hurricanes, Becton Dickinson donated hundreds of BD glucometers. If you are ever in a disaster situations and need quantities of glucometers, BD has a website and toll free number to access disaster supplies. You must provide them with the Federal Disaster # and the tax ID # of the organization requesting the supplies. The Red Cross will usually coordinate this effort.
  • Hypoglycemia and hyperglycemia are challenges post disaster. People became over-exerted during clean up efforts and when climbing up on roofs to do repairs. I saw injuries related to hypoglycemia and people fainting and sustaining injuries. Hyperglycemia becomes a challenge if persons with diabetes are sedentary while living in a shelter. I was assigned to a 1000 person shelter in a gym and assessed many type 2 elderly who had high sugar due to inactivity.
  • Foot Care Challenges Do you know how many people lose their shoes and start walking around barefoot? This was dangerous, because there was broken glass, nails, wires, wood splinters and contaminated water to step in. As a Red Cross nurse I also did team outreach visits. I was assigned to a team of 3 people which consisted of a nurse, a mental health provider and family service volunteer. We did street sheet visits where we visited damaged homes and did family assessments to identify health, psychological and financial needs. We also performed minor first aid and passed out clean up kits- which consisted of bleach, mops and brooms.
  • Many people lose their glasses and contacts in a hurricane. The Red cross has eye glass vouchers that you can take to approved optometrists and get discounts on glasses.
  • Mental Health Challenges In the Florida hurricanes there were many elderly with type 2 diabetes who lived in trailer parks that were demolished. These people were sent to special needs shelters and then after 2 weeks FEMA brought in 1000 campers and set them up in a field and assigned the elderly to these trailers. I was assigned to a team to do trailer and camper home visits to assist health needs. People were beginning to get frustrated, anxious and depressed.
  • I saw people going through different psychological phases during this disaster Individuals proceed through these stages at their own pace. Reactions may vary. Persons providing disaster health services should be able to recognize these stages and provide interventions.
  • First there is the heroic phase. This occurs immediately after the disaster. Your Adrenaline is high. There are heroe and rescue efforts. Everyone is charged up to help everyone else, Each person has their own disaster survivor story they want to share..talking about what happened to them…
  • This progresses to the honeymoon phase. Here persons may continue to have sharing and helping or others may have social withdrawal. We had the elderly in campers, they lost their neighbors and social support they had before. Some of them couldn’t get down their camper stairs with their walkers, canes and oxygen tubing, they were becoming isolated and withdrawn.
  • This is followed by the disillusionment phase. In Florida today, one year later after the hurricanes, there are still blue tarps covering holes on roofs. People are frustrated because there are not enough repair men and maybe their insurance reimbursements do not cover the full cost of repairs.
  • Today in Florida, and for the next several years the reconstruction and adaptation phase will be going on. As a diabetes educator you may be in contact with hurricane survivors who have diabetes. Know where to find resources to assist or refer your clients. There are 2 main resources to turn to for assistance
  • Red Cross will be one of the first agencies responding. RC will handle immediate needs such as shelter, food, bedding clothes, eye glasses, medication and medical suppoy replacement.
  • The other agency is FEMA. They are responsible for individual and public assistance. They will assist with crisis counselling and financial loans.They will also organize for clean up of debris and restoration of power.
  • You are most likely to be alone. This may be a time before you can be helped or rescued.
  • As a home health nurse in Tampa, I had to review emergency evacuation plans with all patients on service, so that plans were already in place, even though it was hurricane “off-season”.
  • Important Disaster Information Safe places to go in your home, depending upon the disaster Exit Routes Location of utility cut-off valves and switches Where you will stay if you must leave your home Plans for any pets
  • Frio Insulin Cooler If in cold climate, insulated bags can protect from freezing. Show BD “What I Need to Do” booklet
  • SAME- automatically alerts you when a watch or warning is issued in your area.
  • Gone with the Wind: Diaster Preparedness for Persons with ...

    2. 2. Learning Objectives <ul><li>Describe the 2004 Florida hurricane aftermath and its impact on victims with diabetes </li></ul><ul><li>List the 4 psychological stages of a disaster </li></ul><ul><li>State components of a disaster action plan for persons with diabetes </li></ul><ul><li>Identify disaster training opportunities </li></ul>
    3. 3. Diabetes Special Needs and Challenges <ul><li>Medication </li></ul><ul><li>Nutrition </li></ul><ul><li>Monitoring </li></ul><ul><li>Activities </li></ul><ul><li>Foot care </li></ul><ul><li>Vision </li></ul><ul><li>Mental health </li></ul>
    4. 4. Medication Challenges <ul><li>Medication schedules not being followed </li></ul><ul><li>Inability to locate, purchase, re-fill Rx due to pharmacies and MD offices being demolished </li></ul><ul><li>Power failure causing inability of pharmacies to open </li></ul><ul><li>Lack of refrigeration </li></ul>
    5. 5. Nutrition Challenges <ul><li>Contaminated or spoiled food and water </li></ul><ul><li>Limited food supply </li></ul><ul><li>Skipped or delayed meals or snacks </li></ul><ul><li>Inability to cook due to power failure </li></ul><ul><li>High “carb” meals at shelter or mobile meal van sites </li></ul>
    6. 6. Glucose Monitoring Challenges <ul><li>Lost meter and supplies </li></ul><ul><li>Inability to obtain new supplies </li></ul><ul><li>Forgetting or not taking time to test </li></ul>
    7. 7. Activity Challenges <ul><li>Over-exercise when doing cleanup and repair work (hypoglycemia) </li></ul><ul><li>Disruption of regular activity patterns while living in a shelter (hyperglycemia) </li></ul>
    8. 8. Foot Care Challenges <ul><li>Lost footwear </li></ul><ul><li>Inadequate foot protection, unsafe conditions-nails </li></ul><ul><li>Inadequate foot first aid resulting in infected lacerations and broken bones </li></ul>
    9. 9. Vision Challenges <ul><li>Lost eye wear </li></ul><ul><li>Broken eye glasses </li></ul>
    10. 10. Mental Health Challenges <ul><li>Lack of sleep and rest causes increase in stress levels </li></ul><ul><li>Separation from family members and support systems </li></ul><ul><li>Isolation due to communication breakdown and lack of transportation as roads not cleared </li></ul><ul><li>Coping skills impaired-causing anger, depression, anxiety, frustration, grief, fear, resentment, and/or insecurity </li></ul>
    11. 11. Psychological Phases of a Disaster <ul><li>Heroic </li></ul><ul><li>Honeymoon </li></ul><ul><li>Disillusionment </li></ul><ul><li>Reconstruction </li></ul>
    12. 12. Heroic Phase (Emergency or Acute Phase) <ul><li>Occurs immediately after the disaster </li></ul><ul><li>Consists of the heroic rescue efforts of the community </li></ul><ul><li>Individuals aroused physically and emotionally, preoccupied with thoughts about their experience, discussing their anxieties </li></ul>
    13. 13. Honeymoon Phase <ul><li>Occurs one week to 3-6 months after the </li></ul><ul><li>disaster </li></ul><ul><li>A time of sharing and helping </li></ul><ul><li>Social attachment is high </li></ul><ul><li>Some may have social withdrawal </li></ul>
    14. 14. Disillusionment Phase <ul><li>Occurs 2 months to 1-2 years afterward </li></ul><ul><li>Feeling of anger, disappointment, resentment, and bitterness if/when expectations for recovery and support are not met </li></ul>
    15. 15. Reconstruction or Adaptation Phase <ul><li>May occur several years after the disaster </li></ul><ul><li>Physical as well as emotional reinvestment takes place </li></ul><ul><li>Troubling health symptoms disappear </li></ul>
    16. 16. Assistance for Disaster Recovery <ul><li>Red Cross Service Centers </li></ul><ul><li>Assist in handling the survivors immediate needs </li></ul><ul><li>Financial assistance for clothing, bedding, medication, eye glasses </li></ul><ul><li>Reconnect with community and support systems </li></ul>
    17. 17. Assistance for Disaster Recovery <ul><li>FEMA (Federal Emergency Management Agency) </li></ul><ul><li>Created in 1979 as a disaster relief organization </li></ul><ul><li>Responsible for individual assistance (housing, low interest loans, crises counseling) </li></ul><ul><li>Responsible for public assistance ( debris clean up and removal, provision of emergency public services), and providing assistance to states where disaster has overwhelmed the local and state government </li></ul>
    18. 18. Stop Panic- Be Prepared!
    19. 19. Diabetes Disaster Planning <ul><li>Planning ahead is crucial!! </li></ul><ul><li>The first 72 hours are most critical in a disaster. </li></ul>
    20. 20. Role of the Diabetes Educator <ul><li>Pre-planning and preparation are the keys to survival- do the “leg work” ahead of time. </li></ul><ul><li>Review Disaster Planning with your clients </li></ul><ul><li>before the disaster actually happens! </li></ul><ul><li>Encourage problem-solving skills and preventive thinking. </li></ul>
    21. 21. Be Ready!
    22. 22. Components of a Disaster Plan <ul><li>Important Disaster Information </li></ul><ul><li>Key Emergency Information </li></ul><ul><li>Diet Considerations During a Disaster </li></ul><ul><li>Food Supply and Storage </li></ul><ul><li>Medical and Other Supplies </li></ul><ul><li>Medication Storage </li></ul><ul><li>Sick Day Rules </li></ul>
    23. 23. Important Disaster Information <ul><li>Safest places to go, depending on type of disaster </li></ul><ul><li>Location of utility cut-off valves and switches </li></ul><ul><li>Alternate places to stay, should client need to evacuate </li></ul><ul><li>Plans for any pets </li></ul>
    24. 24. Key Emergency Information <ul><li>Local emergency contacts </li></ul><ul><li>Out-of-town contacts </li></ul><ul><li>Medical providers </li></ul><ul><li>Medication list, including allergies </li></ul><ul><li>Extra copies of prescriptions </li></ul><ul><li>Medical equipment needs </li></ul>
    25. 25. Diet Considerations During a Disaster <ul><li>If activity is reduced, most healthy people can survive on half of their usual intake for an extended period, and even go without food </li></ul><ul><li>for a few days if they have to. </li></ul><ul><li>With diabetes, these same rules do not apply. </li></ul><ul><li>There must be a balance of food groups and </li></ul><ul><li>adequate calories, especially when taking </li></ul><ul><li>insulin and/or oral agents. </li></ul>
    26. 26. Food Supply for 7 Days 1 can of prepared meat 6 pk. canned orange or apple juice 1 pkg dry, unsweetened cereal 6 cans lite or water-packed fruit 6 cans diet soda Sm box powdered milk 6 pk Parmalat milk 6 cans regular soda 1 jar peanut butter 1 gallon of water per day 1 jar soft cheese or 2 pk of 6 cheese crackers Lg box of crackers
    27. 27. Food Supply and Storage <ul><li>Don’t forget to include the following: </li></ul><ul><li>Eating utensils </li></ul><ul><li>Mechanical can opener </li></ul><ul><li>Disposable cups </li></ul><ul><li>Food items should be stored in rubber </li></ul><ul><li>tote or duffle bag, and replaced yearly. </li></ul>
    28. 28. Build a Kit!
    29. 29. Have a “Be Prepared” List with these supplies available: <ul><li>Emergency information (copy) </li></ul><ul><li>Insurance information (copy) </li></ul><ul><li>Prescriptions (copy) </li></ul><ul><li>Insulin and/or pills (include </li></ul><ul><li>OTCs) </li></ul>
    30. 30. Medical Supplies <ul><li>Syringes </li></ul><ul><li>Alcohol Swabs/ anti-bacterial wipes </li></ul><ul><li>Cotton balls and tissues </li></ul><ul><li>Blood Glucose Log </li></ul><ul><li>Insulin Pump supplies (if a “pumper”) </li></ul><ul><li>Glucometer & Urine Ketone Strips </li></ul><ul><li>Lancing device and lancets </li></ul>
    31. 31. Medical Supplies, cont. <ul><li>First Aid Kit </li></ul><ul><li>Quick-acting CHO (glucose tabs, OJ) </li></ul><ul><li>Glucagon Emergency Kit </li></ul><ul><li>Empty hard plastic detergent bottle with cap (for used lancets and syringes) </li></ul>
    32. 32. Other supplies <ul><li>Flashlight with extra batteries </li></ul><ul><li>Whistle/ noisemaker </li></ul><ul><li>Extra pair of glasses </li></ul><ul><li>Female sanitary supplies </li></ul><ul><li>Heavy work gloves </li></ul><ul><li>Tools </li></ul><ul><li>Cooler with dry ice or freezer packs </li></ul>
    33. 33. Other Supplies, cont. <ul><li>Radio with extra batteries </li></ul><ul><li>Pad/ pencil </li></ul><ul><li>Watch </li></ul><ul><li>Matches/ candles </li></ul><ul><li>Clothing and bedding </li></ul><ul><li>Extra socks; comfortable shoes </li></ul><ul><li>Cell phone </li></ul><ul><li>**Check batteries every 2-3 </li></ul><ul><li>months to prevent expiration </li></ul>
    34. 34. Medication Storage <ul><li>Insulin may be stored at room temperature </li></ul><ul><li>(59-86 º ) for 28 days </li></ul><ul><li>Insulin pens in use can be stored at room temp. according to manufacturer’s instructions. </li></ul><ul><li>In case of power failure, have small cooler with dry ice or freezer packs </li></ul><ul><li>Special insulin cooler on market requires water to activate chemical coolant gel </li></ul>
    35. 35. Sick Day Rules <ul><li>Remind client to take all medicines on time, or as close to schedule as possible </li></ul><ul><li>Instruct client to eat at times appropriate to work with their insulin </li></ul><ul><li>Reinforce importance of not skipping meals </li></ul><ul><li>If nausea or vomiting occurs, instruct client to sip regular cola, and suck on hard candies since they cannot eat. </li></ul>
    36. 36. Sick Day Rules, cont. <ul><li>Advise client to notify MD if blood sugar averages over 240 mg. </li></ul><ul><li>Instruct to test for ketones if blood sugar averages over 240 mg.,is vomiting, or has symptoms of hyperglycemia </li></ul>
    37. 37. If Medical Assistance Needed <ul><li>Advise clients to: </li></ul><ul><li>Go to nearest hospital </li></ul><ul><li>Contact the police </li></ul><ul><li>Contact the American Red Cross </li></ul><ul><li>Go to an Emergency Medical Center </li></ul>
    38. 38. Using a NOAA Weather Radio <ul><li>Best way to receive warnings from the weather service </li></ul><ul><li>Broadcasts warnings, watches, forecasts, and other hazard information 24 hrs/day </li></ul><ul><li>Average reception range is 40 mile radius </li></ul><ul><li>from transmitter </li></ul>
    39. 39. Radio Features to Look For <ul><li>Does it include battery back-up? </li></ul><ul><li>Have a Specific Area Message Encoder feature? </li></ul><ul><li>Receive all seven NOAA Weather Radio frequencies? </li></ul><ul><li>Can be purchased at retail electronic and sporting goods stores. </li></ul>
    40. 40. Training Saves Lives!
    41. 41. How Can I Help? <ul><li>Contact your local Red Cross or visit </li></ul><ul><li>www.redcross.org to find out how your knowledge, skills, abilities and enthusiasm can be matched with a meaningful experience. </li></ul>
    42. 42. A.R.C. Opportunities for Nurses <ul><li>Teaching classes in: </li></ul><ul><li>Community Disaster Education </li></ul><ul><li>First Aid </li></ul><ul><li>CPR </li></ul><ul><li>Providing: </li></ul><ul><li>Translating Services </li></ul><ul><li>Community services for seniors, the disabled, </li></ul><ul><li>and the homeless </li></ul>
    43. 43. Disaster Nursing <ul><li>Provide services on a local level for emergencies in your county: </li></ul><ul><ul><ul><li>Power outages </li></ul></ul></ul><ul><ul><ul><li>Victims of fire or accidents needing shelter </li></ul></ul></ul><ul><ul><ul><li>Disaster relief </li></ul></ul></ul>
    44. 44. Disaster Nursing, cont. <ul><li>After getting comfortable on the local level, sign up for national assignments when disaster strikes other areas, with wide-spread devastation, such as with the hurricanes in Florida, the bombings in Oklahoma City, etc. </li></ul>
    45. 45. Thank You ! Questions?? Together We Can Save a Life!