This document provides recommendations and guidelines for relief workers responding to hurricanes and tornadoes. It discusses personal needs like toiletries, clothing, and first aid supplies to bring. It also covers health risks from injuries, food/water, insects, and snakes. Psychological risks from trauma exposure are addressed, along with stress reduction techniques. Recommendations are given for vaccinations, water purification, and treating medical issues in remote settings.

1. New Perspectives, Inc. Hurricane/Tornado workers - staying safe in a hostile environment Dennis J. Carradin, Jr., LPCMH, NCC, BCETS Diplomate, American Academy of Experts in Traumatic Stress

2. CDC recommendations PERSONAL NEEDS RISK AND HEALTH RECOMMENDATIONS RISKS OF INJURY PREVENTING ELECTROCUTIONS RISKS FROM FOOD AND WATER RISKS FROM INSECTS RISKS FROM SNAKES OTHER HEALTH RISKS PSYCHOLOGICAL / EMOTIONAL SUPPORT

3. New Perspectives, Inc.Additional recommendations Personal medications Portable power Water filtration devices Identification and license Comforting

5. Toilet paper

7. PERSONAL NEEDSTOILETRIES Extra pair of prescription glasses, copy of prescription (Sun Glasses) Eyeglasses repair kit Contact lenses, lens cleaner, and eye glasses protective case Toothbrush / toothpaste Skin moisturizer Soap (Antibacterial), Shampoo Lip Balm

8. PERSONAL NEEDSTOILETRIES Razor, extra blades* Scissors* Nail clippers/tweezers* Q-tips, Cotton swabs Bandages and antibiotic ointment Foot powder, OTC medication that helps prevent foot fungus. Be very diligent about caring for your feet in sever environmental conditions

9. PERSONAL NEEDSCLOTHING Comfortable, light weight clothing Long pants Long sleeved shirts Hat Boots (A change of shoes for off duty time. You will need to give your feet a break, a second set of laces would be a good idea as well) Shower Shoes

10. PERSONAL NEEDSCLOTHING Rain Gear Bandana / handkerchief (not for nasal care – this can harbor germs) Towel (highly absorbent, travel towels if possible) Gloves: Leather gloves if physical labor will be performed; rubber gloves if handling blood or body fluids.

11. PERSONAL NEEDSCLOTHING Your may want to consider clothing to sleep in, depending on the exposure and conditions - this will allow you to air out your work clothing At least one small bottle of laundry detergent that you can hand wash items with when water is available.

12. Activities of Daily Living Sunglasses Safety Goggles Water proof watch Flashlight Small sewing kit for self repair of your garments

13. Activities of Daily Living Spare Batteries (Back up batteries for your cell phone and or palm ( I have seen these disposable batteries in Kmart) You may also want to consider rechargeable batteries that can be charged by solar power – see stores like Radio Shack for details. This may help you in areas where electricity and plug time is limited. Knife, such as a Swiss Army Knife or Leatherman*

14. SECURITY Money belt Cash Cell phone (with Charger) {See batteries above} Candles, Matches, Lighter in a ziplock bag Ziplock bags An item of comfort (i.e., family photo, spiritual or religious material)

15. SECURITY Identification – Originals in a water proof container or wallet, copies in two other places, license and certifications. Credit card - This may not be useful in the area where you are going, but you may need this in the event that you need to return in a family emergency – You might want to get the credit card that you add money to so that if “misplaced” it is not a security issue – (Identity theft)

16. SECURITY *Packed in checked baggage, may be confiscated if in carry-on commercial airliner

17. SECURITY I recommend that all clothing and electronic items be packed in a plastic Ziploc bags for water proofing. I would also suggest that you try to limit what your take. Minimal number of bags.

18. Risk and Health Recommendations “Relief workers should ideally be assessed by a health-care professional at least 4-6 weeks before travel so recommended vaccines can be completed and provide maximum benefit.”

19. Risk and Health Recommendations Tetanus / Diphtheria (Td) Primary series, and Td booster within 10 years. In an Emergency setting it is practice to provide a booster if you have not had an update within 5 years and you become injured (dirty wound). Hepatitis B Vaccine series for persons who will be performing direct patient care or have exposure top bodily fluids.

20. Risk and Health Recommendations Some agencies may require Hepatitis A vaccines as well. Hepatitis A vaccine(low probability of exposure, even under these conditions, in U.S.) No transmission from contaminated water has been identified in the U.S. since the 1980’s.

21. Risk and Health Recommendations Typhoid vaccine (low probability of exposure, even under these conditions, in U.S.) Cholera vaccine (low probability of exposure, even under these conditions, in U.S., plus no licensed cholera vaccine available in the U.S.)

22. Risk and Health Recommendations Meningococcal vaccine (no expectation of increased risk of meningococcal disease among emergency responders) Leptospirosis– Can occur in individuals who wade, swim, or bathe in waters contaminated by animal Urine; swineherd's disease, swamp fever, or mud fever Vibrio VulnificusCDC Update – 9/7/05 treatment Cephalosporins 3rd generation, Doxycycline. It is in the same family as bacteria that cause cholera

23. Leptospirosis www.medicardphils.com/ health/leptospirosis.asp, Google images www.mja.com.au/.../ ole10206_fm-1.html , Google images

24. Vibrio Vulnificus Written and edited by Kenneth Todar University of Wisconsin-Madison Department of Bacteriology All rights reserved. </HTML : Google Images

25. Risk and Health Recommendations rabies vaccine series (the full series is required for protection). Persons who are exposed to potentially rabid animals should be evaluated and receive standard post-exposure prophylaxis, as clinically appropriate. This means if you are exposed to a suspected animal you will need treatment

26. Risk and Health Recommendations Preventing Electrocutions – It is very important that you are aware of your environment. Caution with unknown equipment, as well as standing water.

27. Food and water – Risk of Disease Bacteria Parasites Hepatitis A Trusted sources of potable water should be utilized. In the event this inaccessible, water should be boiled or disinfected. There are also personal small water filtration devices that you can take with you. **see medications in the event of illness. www.cdc.gov/travel/foodwater.htm

28. Food and water – Risk of Disease Prevention is always the best medicine Wash your hand often If soap and water are not available use waterless alcohol based hand cleaners Only eat food that has been approved or you are certain is not contaminated Only drink water that you are sure is potable, or you have boiled or disinfected

29. Insect bites West Nile St. Louis Encephalitis Dengue According to the CDC out breaks of this kind has not been typical in this type of natural disaster. As recommended above it is still a good idea to keep a good supply of insect repellent. There is always the risk of anaphylaxis from hymenoptera (bees …)

30. Snake Bites always a threat Flooding can bring about Displaced reptiles Venom of small immature snakes can be more concentrated than that of a larger snake. All snakes should be left alone Snake bite – seek immediate Medical attention

31. Snake Bites always a threat If medical care is not immediately available immobilization of the affected limb and preferable the entire patient A loose fitting pressure bandage that does not restrict arterial and venous flow (but limit lymphatic flow) is recommended *Tourniquets are contraindicated unless you are advised by a specialist*

32. Weather Related Temperature Illnesses Hyperthermia Hypothermia Presentations on these environmental illnesses is subject for a program unto themselves. It is recommended however that you seek medical help when presented with symptoms related to these illnesses.

33. Weather Related Temperature Illnesses Hyperthermia Heat cramps Heat Exhaustion Heat Stroke

34. Weather Related Temperature Illnesses Heat Cramps Painful spasms of skeletal muscles Usually occurring in the legs and abdomen Body Temperature is usually normal Skin is moist

35. Weather Related Temperature Illnesses Heat Exhaustion Normal or below normal temperature Cool, Moist, Pale Skin Headache Nausea Dizziness and weakness Exhaustion

36. Weather Related Temperature Illnesses Heat Stroke High body Temperature Red, Hot, Dry Skin (this is a critical sign Progressive loss of consciousness Rapid, Weak pulse Rapid, Shallow Breathing

37. Weather Related Temperature Illnesses Hypothermia Shivering (absent in later stages) Slow, Irregular pulse Numbness Glassy Stare Decreasing level of Consciousness

38. MEDICATIONS You may want to ask your Doctor about taking these medications as a personal supply or there alternative if you have allergies to any of these medications. . IBUPROFEN ACETAMINOPHEN DIPHENHYDRAMINE DOXYCYCLINE Cipro Flagyl

39. MEDICATIONS You should also discuss with your Doctor any medications that you are currently taking. If your current medications require temperature control this may be an issue

40. Psychological Hurricane/Tornado Disaster workers, whether they are immediate responders or long term relief workers, may experience strong emotional reactions to the disaster. They may themselves be primary victims of the disaster, with the same burdens as other primary victims. They are repeatedly exposed to grisly experiences (e.g., recovering bodies), the powerful emotions and harrowing tales of victims. Their tasks may be physically difficult, exhausting, or dangerous. The demands of their tasks may lead to lack of sleep and chronic fatigue.

41. Psychological They face a variety of role stresses, including a perceived inability to ever do “enough.” Even if the limits of what they can do are imposed by reality or by organizational or bureaucratic constraints beyond their control (e.g., lack of supplies, lack of manpower), they may blame themselves. They may feel guilt over access to food, shelter, and other resources that the primary victims do not have. They may identify with the victims. They may feel guilt over the need to “triage” their own efforts and those of others or may blame themselves when rescue efforts have failed. They are exposed to the anger and apparent lack of gratitude of some victims

42. Psychological Symptoms of “Burnout” Among Relief Workers Excessive tiredness “Loss of spirit” Inability to concentrate Somatic symptoms (e.g., headaches, gastrointestinal disturbances) Sleep difficulties Grandiose beliefs about own importance (E.g., engaging in heroic but reckless behaviors, ostensibly in the interests of helping others; neglecting own safety and physical needs (e.g., showing a “macho” style of not needing sleep, not needing breaks) Cynicism Inefficiency Mistrust of co-workers or supervisors Excessive alcohol use, caffeine consumption, and smoking

43. Psychological “Rescue and relief workers are rarely prepared ahead of time either for their own reactions or to deal with the reactions of primary victims. Providing psychosocial assistance to these workers and providing them with adequate shelter, food, and rest, even when these are not available to the victims themselves, is a very high priority in disasters. It may seem unfair, but if the rescue and relief workers are unable to function efficiently, they can not help any one else” John H. Ehrenreich, Ph.D.

44. Psychological Stress Reduction Techniques for Workers Rest and Recreation Ventilation of Daily Issues Physical Exercise Relaxation Exercises Proper Nutrition Hydration Communication with Loved Ones

45. RESCOURCE LIST http://www.cdc.gov/ http://www.emedicine.com http://www.fema.gov http://www.redcross.org/index.html https://volunteer.ccrf.hhs.gov/ http://www.osha.gov/ Other sources – as in medical text, and survival guides. And experienced personnel

46. New Perspectives, Inc. Hurricane/Tornado workers - staying safe in a hostile environment 2055 Limestone Road, Suite 109 Wilmington, DE 19808 www.NewPerspectivesInc.com