““Gone With the Wind”Gone With the Wind”

DISASTER PREPAREDNESS DISASTER PREPAREDNESS FORFOR

PERSONS WITH DIABETESPERSONS WITH DIABETES

Learning ObjectivesLearning Objectives

• Describe the 2004 Florida hurricane Describe the 2004 Florida hurricane aftermath and its impact on victims with aftermath and its impact on victims with diabetesdiabetes

• List the 4 psychological stages of a disasterList the 4 psychological stages of a disaster• State components of a disaster action plan State components of a disaster action plan

for persons with diabetesfor persons with diabetes• Identify disaster training opportunitiesIdentify disaster training opportunities

DiabetesDiabetesSpecial Needs and ChallengesSpecial Needs and Challenges

• Medication Medication • Nutrition Nutrition • Monitoring Monitoring • Activities Activities • Foot care Foot care

• Vision Vision • Mental healthMental health

Medication ChallengesMedication Challenges

• Medication schedules not being followedMedication schedules not being followed• Inability to locate, purchase, re-fill Rx due Inability to locate, purchase, re-fill Rx due

to pharmacies and MD offices being to pharmacies and MD offices being demolisheddemolished

• Power failure causing inability of Power failure causing inability of pharmacies to openpharmacies to open

• Lack of refrigeration Lack of refrigeration

Nutrition ChallengesNutrition Challenges

• Contaminated or spoiled food and waterContaminated or spoiled food and water• Limited food supplyLimited food supply• Skipped or delayed meals or snacksSkipped or delayed meals or snacks• Inability to cook due to power failureInability to cook due to power failure• High “carb” meals at shelter or mobile meal High “carb” meals at shelter or mobile meal

van sitesvan sites

Glucose Monitoring ChallengesGlucose Monitoring Challenges

• Lost meter and suppliesLost meter and supplies• Inability to obtain new suppliesInability to obtain new supplies• Forgetting or not taking time to testForgetting or not taking time to test

Activity ChallengesActivity Challenges

• Over-exercise when doing cleanup and Over-exercise when doing cleanup and repair work (hypoglycemia)repair work (hypoglycemia)

• Disruption of regular activity patterns while Disruption of regular activity patterns while living in a shelter (hyperglycemia)living in a shelter (hyperglycemia)

Foot Care ChallengesFoot Care Challenges

• Lost footwearLost footwear• Inadequate foot protection, unsafe Inadequate foot protection, unsafe

conditions-nailsconditions-nails• Inadequate foot first aid resulting in infected Inadequate foot first aid resulting in infected

lacerations and broken boneslacerations and broken bones

Vision ChallengesVision Challenges

• Lost eye wearLost eye wear• Broken eye glassesBroken eye glasses

Mental Health ChallengesMental Health Challenges• Lack of sleep and rest causes increase in stress Lack of sleep and rest causes increase in stress

levelslevels• Separation from family members and support Separation from family members and support

systemssystems• Isolation due to communication breakdown and Isolation due to communication breakdown and

lack of transportation as roads not clearedlack of transportation as roads not cleared• Coping skills impaired-causing anger, Coping skills impaired-causing anger,

depression, anxiety, frustration, grief, fear, depression, anxiety, frustration, grief, fear, resentment, and/or insecurityresentment, and/or insecurity

Psychological Phases of a Psychological Phases of a DisasterDisaster

• HeroicHeroic• HoneymoonHoneymoon

• DisillusionmentDisillusionment• ReconstructionReconstruction

Heroic PhaseHeroic Phase(Emergency or Acute Phase)(Emergency or Acute Phase)

• Occurs immediately after the disasterOccurs immediately after the disaster• Consists of the heroic rescue efforts of the Consists of the heroic rescue efforts of the

communitycommunity• Individuals aroused physically and Individuals aroused physically and

emotionally, preoccupied with thoughts emotionally, preoccupied with thoughts about their experience, discussing their about their experience, discussing their anxietiesanxieties

Honeymoon PhaseHoneymoon Phase

•Occurs one week to 3-6 months after the Occurs one week to 3-6 months after the

disasterdisaster•A time of sharing and helpingA time of sharing and helping•Social attachment is highSocial attachment is high•Some may have social withdrawalSome may have social withdrawal

Disillusionment PhaseDisillusionment Phase

• Occurs 2 months to 1-2 years afterwardOccurs 2 months to 1-2 years afterward• Feeling of anger, disappointment, Feeling of anger, disappointment,

resentment, and bitterness if/when resentment, and bitterness if/when expectations for recovery and support are expectations for recovery and support are not metnot met

Reconstruction or Adaptation Reconstruction or Adaptation PhasePhase

• May occur several years after the disasterMay occur several years after the disaster• Physical as well as emotional reinvestment Physical as well as emotional reinvestment

takes placetakes place• Troubling health symptoms disappearTroubling health symptoms disappear

Assistance for Disaster Assistance for Disaster RecoveryRecovery

Red CrossRed Cross Service Centers Service Centers

• Assist in handling the survivors immediate needsAssist in handling the survivors immediate needs• Financial assistance for clothing, bedding, Financial assistance for clothing, bedding,

medication, eye glassesmedication, eye glasses• Reconnect with community and support systemsReconnect with community and support systems

Assistance for Disaster Assistance for Disaster RecoveryRecovery

FEMAFEMA (Federal Emergency Management Agency) (Federal Emergency Management Agency)

• Created in 1979 as a disaster relief organization Created in 1979 as a disaster relief organization • Responsible for Responsible for individual individual assistance (housing, low interest assistance (housing, low interest

loans, crises counseling)loans, crises counseling)• Responsible for Responsible for public assistancepublic assistance ( debris clean up and ( debris clean up and

removal, provision of emergency public services), and removal, provision of emergency public services), and providing assistance to states where disaster has providing assistance to states where disaster has overwhelmed the local and state governmentoverwhelmed the local and state government

Stop Panic-Stop Panic-Be Prepared!Be Prepared!

Diabetes Disaster PlanningDiabetes Disaster Planning

• Planning ahead is crucial!!Planning ahead is crucial!!• The first 72 hours are most The first 72 hours are most

critical in a disaster.critical in a disaster.

Role of the Diabetes EducatorRole of the Diabetes Educator

• Pre-planning and preparation are the keys Pre-planning and preparation are the keys to survival- do the “leg work” ahead of time.to survival- do the “leg work” ahead of time.

• Review Disaster Planning with your clientsReview Disaster Planning with your clients

before the disaster actually happens!before the disaster actually happens!• Encourage problem-solving skills and Encourage problem-solving skills and

preventive thinking.preventive thinking.

Be Ready!Be Ready!

Components of a Disaster PlanComponents of a Disaster Plan

• Important Disaster InformationImportant Disaster Information• Key Emergency InformationKey Emergency Information• Diet Considerations During a DisasterDiet Considerations During a Disaster• Food Supply and Storage Food Supply and Storage • Medical and Other Supplies Medical and Other Supplies • Medication StorageMedication Storage• Sick Day RulesSick Day Rules

Important Disaster InformationImportant Disaster Information

• Safest places to go, depending on type of Safest places to go, depending on type of disasterdisaster

• Location of utility cut-off valves and Location of utility cut-off valves and switchesswitches

• Alternate places to stay, should client need Alternate places to stay, should client need to evacuateto evacuate

• Plans for any petsPlans for any pets

Key Emergency InformationKey Emergency Information

• Local emergency contactsLocal emergency contacts• Out-of-town contactsOut-of-town contacts• Medical providersMedical providers• Medication list, including allergiesMedication list, including allergies• Extra copies of prescriptionsExtra copies of prescriptions• Medical equipment needsMedical equipment needs

Diet Considerations During a Diet Considerations During a DisasterDisaster

• If activity is reduced, most healthy people can If activity is reduced, most healthy people can survive on half of their usual intake for an survive on half of their usual intake for an extended period, and even go without foodextended period, and even go without food

for a few days if they have to.for a few days if they have to.• With diabetes, these same rules do not apply.With diabetes, these same rules do not apply.

There must be a balance of food groups and There must be a balance of food groups and

adequate calories, especially when takingadequate calories, especially when taking

insulin and/or oral agents.insulin and/or oral agents.

Food Supply for 7 DaysFood Supply for 7 DaysLg box of Lg box of crackerscrackers

1 jar soft cheese 1 jar soft cheese or 2 pk of 6or 2 pk of 6

cheese crackerscheese crackers

1 gallon of water 1 gallon of water per dayper day

1 jar peanut1 jar peanut

butterbutter6 cans regular 6 cans regular sodasoda

6 pk Parmalat 6 pk Parmalat milkmilk

Sm box Sm box powdered milkpowdered milk

6 cans diet soda6 cans diet soda 6 cans lite or 6 cans lite or water-packed water-packed fruitfruit

1 pkg dry, 1 pkg dry, unsweetened unsweetened cereal cereal

6 pk. canned 6 pk. canned orange or apple orange or apple juicejuice

1 can of 1 can of prepared meatprepared meat

Food Supply and StorageFood Supply and Storage

Don’t forget to include the following:Don’t forget to include the following:• Eating utensilsEating utensils• Mechanical can openerMechanical can opener• Disposable cupsDisposable cups

Food items should be stored in rubberFood items should be stored in rubber

tote or duffle bag, and replaced yearly.tote or duffle bag, and replaced yearly.

Build a Kit!Build a Kit!

Have a “Be Prepared” ListHave a “Be Prepared” Listwith these supplies available:with these supplies available:

• Emergency information (copy)Emergency information (copy)• Insurance information (copy)Insurance information (copy)• Prescriptions (copy)Prescriptions (copy)• Insulin and/or pills (include Insulin and/or pills (include

OTCs)OTCs)

Medical SuppliesMedical Supplies

• SyringesSyringes• Alcohol Swabs/ anti-bacterial wipesAlcohol Swabs/ anti-bacterial wipes• Cotton balls and tissuesCotton balls and tissues• Blood Glucose LogBlood Glucose Log• Insulin Pump supplies (if a “pumper”)Insulin Pump supplies (if a “pumper”)• Glucometer & Urine Ketone StripsGlucometer & Urine Ketone Strips• Lancing device and lancetsLancing device and lancets

Medical Supplies, cont.Medical Supplies, cont.

• First Aid KitFirst Aid Kit• Quick-acting CHO (glucose tabs, OJ)Quick-acting CHO (glucose tabs, OJ)• Glucagon Emergency KitGlucagon Emergency Kit• Empty hard plastic detergent bottle with Empty hard plastic detergent bottle with

cap (for used lancets and syringes)cap (for used lancets and syringes)

Other suppliesOther supplies• Flashlight with extra batteriesFlashlight with extra batteries• Whistle/ noisemakerWhistle/ noisemaker• Extra pair of glassesExtra pair of glasses• Female sanitary suppliesFemale sanitary supplies• Heavy work glovesHeavy work gloves• ToolsTools• Cooler with dry ice or freezer packsCooler with dry ice or freezer packs

Other Supplies, cont.Other Supplies, cont.• Radio with extra batteriesRadio with extra batteries• Pad/ pencilPad/ pencil• WatchWatch• Matches/ candlesMatches/ candles• Clothing and beddingClothing and bedding• Extra socks; comfortable shoesExtra socks; comfortable shoes• Cell phoneCell phone **Check batteries every 2-3 **Check batteries every 2-3 months to prevent expirationmonths to prevent expiration

Medication StorageMedication Storage

• Insulin may be stored at room temperature Insulin may be stored at room temperature (59-86(59-86ºº) for 28 days) for 28 days• Insulin pens in use can be stored at room Insulin pens in use can be stored at room

temp. according to manufacturer’s temp. according to manufacturer’s instructions.instructions.

• In case of power failure, have small cooler In case of power failure, have small cooler with dry ice or freezer packswith dry ice or freezer packs

• Special insulin cooler on market requires Special insulin cooler on market requires water to activate chemical coolant gelwater to activate chemical coolant gel

Sick Day RulesSick Day Rules

• Remind client to take all medicines on time, Remind client to take all medicines on time, or as close to schedule as possibleor as close to schedule as possible

• Instruct client to eat at times appropriate to Instruct client to eat at times appropriate to work with their insulinwork with their insulin

• Reinforce importance of not skipping mealsReinforce importance of not skipping meals• If nausea or vomiting occurs, instruct client If nausea or vomiting occurs, instruct client

to sip regular cola, and suck on hard to sip regular cola, and suck on hard candies since they cannot eat.candies since they cannot eat.

Sick Day Rules, cont.Sick Day Rules, cont.

• Advise client to notify MD if blood sugar Advise client to notify MD if blood sugar averages over 240 mg.averages over 240 mg.

• Instruct to test for ketones if blood sugar Instruct to test for ketones if blood sugar averages over 240 mg.,is vomiting, or has averages over 240 mg.,is vomiting, or has symptoms of hyperglycemiasymptoms of hyperglycemia

If Medical Assistance NeededIf Medical Assistance Needed

Advise clients to:Advise clients to:• Go to nearest hospitalGo to nearest hospital• Contact the policeContact the police• Contact the American Red CrossContact the American Red Cross• Go to an Emergency Medical CenterGo to an Emergency Medical Center

Using a NOAA Weather RadioUsing a NOAA Weather Radio

• Best way to receive warnings from the Best way to receive warnings from the weather serviceweather service

• Broadcasts warnings, watches, forecasts, Broadcasts warnings, watches, forecasts, and other hazard information 24 hrs/dayand other hazard information 24 hrs/day

• Average reception range is 40 mile radiusAverage reception range is 40 mile radius

from transmitterfrom transmitter

Radio Features to Look ForRadio Features to Look For

• Does it include battery back-up?Does it include battery back-up?• Have a Specific Area Message Encoder Have a Specific Area Message Encoder

feature?feature?• Receive all seven NOAA Weather Radio Receive all seven NOAA Weather Radio

frequencies?frequencies?

Can be purchased at retail electronic and Can be purchased at retail electronic and sporting goods stores.sporting goods stores.

Training Saves Lives!Training Saves Lives!

How Can I Help?How Can I Help?

Contact your local Red Cross or visit Contact your local Red Cross or visit

www.redcross.orgwww.redcross.org to find out how your to find out how your knowledge, skills, abilities and enthusiasm knowledge, skills, abilities and enthusiasm can be matched with a meaningful can be matched with a meaningful experience.experience.

A.R.C. Opportunities for NursesA.R.C. Opportunities for NursesTeaching classes in:Teaching classes in:• Community Disaster EducationCommunity Disaster Education• First AidFirst Aid• CPRCPRProviding:Providing:• Translating ServicesTranslating Services• Community services for seniors, the disabled,Community services for seniors, the disabled, and the homelessand the homeless

Disaster NursingDisaster Nursing

Provide services on a local level for Provide services on a local level for emergencies in your county:emergencies in your county:

• Power outagesPower outages• Victims of fire or accidents needing shelterVictims of fire or accidents needing shelter• Disaster reliefDisaster relief

Disaster Nursing, cont.Disaster Nursing, cont.

After getting comfortable on the local level, After getting comfortable on the local level, sign up for national assignments when sign up for national assignments when disaster strikes other areas, with wide-disaster strikes other areas, with wide-spread devastation, such as with the spread devastation, such as with the hurricanes in Florida, the bombings in hurricanes in Florida, the bombings in Oklahoma City, etc.Oklahoma City, etc.

Thank You !Thank You !

Questions??Questions??

Together We Can Save a Life!Together We Can Save a Life!