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An introductory overview of emergency preparedness and disaster response for housecall providers and others who care for older adults & people with disabilities in the community.
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Disasters & Emergency Preparedness
Wen Dombrowski, MD, MBAChief Medical Information Officer & Vice President for Connected Health
VNA Health Group
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Elderly & Disabled are Disproportionately Affected
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Vulnerable even more so after disaster (physical & cognitive limit + chaotic environ)
Difficult to locate & track vulnerable Limited shelter options & difficult to
access Limited geriatric specialists to provide
care Foster cooperation beforehand among
clinicians + community orgs + city agencies
Address post-disaster, long-term needs: food, housing, healthcare, entitlements
Challenges & Lessons Learned from Recent Disasters
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Key issues Basic needs: shelter, fuel, clothing,
bedding Mobility: disability, transport, assistive
devices Health: access to services, food, water,
sanitation, psychosocial needs Family & social: separation, dependants,
security, changes in social structures Economic & legal: income, land,
information, documentation, skills training
Older People in Disasters: HelpAge International Guidelines
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What can I do to prepare my
patients for an emergency?
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Hazard Vulnerability Analysis
Failure of Networks: Electric, Communications, I.T. , Transportation, Water
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Network with city/state EM officials & community orgs Stockpile supplies; review vendor contracts Plan for water & electric failures Back up records Identify funds if normal payment interrupted Have alternate communication devices Establish phone tree & staff contact list Plan alternate transportation routes See “Business Continuity Planning” resources
1st Prepare Your Own Practice:Are You Ready?
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Family plan for communication & evacuation
Staff plan for communication & who works Cell phone + landline phone + contact lists Supplies in car:
◦ cash; gas; maps; crank charger◦ bottled water & food; medical supplies◦ booster cables, tire patch kit, flares, flashlight,
shovel, blankets, gloves, clothes
Prepare Your Family & Your Staff
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GeriGoBag: fanny pack or attachable to wheelchair ◦ Medication list & 7-day supply◦ Medical history in 1 page & description of baseline mental/physical
status◦ Personal info (name, address, phone, insurance #, adv directives)◦ Contact info for family, neighbors, police/fire, PCP, pharmacy
Devices & Equipment◦ **Power generators, car adapters, & backup batteries ◦ Glasses, hearing aids & batteries, dentures◦ Canes, walkers, wheelchairs, prostheses◦ Respirators, oxygen, other equipment◦ Simple instruction labels◦ Signs stating deaf or don’t know English
Evacuation plan◦ Where are shelters that can meet special needs & how get
there◦ Options if not able to evacuate with assistive devices
Prepare Your Patients: Special Considerations
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Identify frail & disabled before & after disaster◦Your patient list: backup EMR◦Family caregivers & neighbors◦Homecare agencies, community orgs, fire dept.,
ER◦Volunteer outreach◦Opt-in registries too limited (but if your local region has one, consider joining it)◦Insurance claims & SSD databases more likely to
be comprehensive (need data sharing agreements)
Beware of exploitation & abuse
Where Are People In Need?
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Mental Health: sleep, delirium, depression, PTSD
Dehydration: limited water, avoiding urination Nutrition: difficulty chewing (hard & dry
foods), appetite loss, inability to feed self, special diets
Mobility: transport, assistive devices, pressure sores, inaccessible bathrooms
Infection Control: hygiene, close quarters Comorbidities: cardiac, respiratory, etc Advanced Directives: e.g. discuss w/
terminally ill patients who wish to be Do Not Hospitalize
Emergency Response Issues
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Ethical Duty to Plan: more than organizing resources, find ways to deal w/ dilemmas in advance
Information sharing & privacy Clinicians reluctant to work when personal risk Life & death decisions Allocation of scarce resources (e.g. bed or
ventilator) Age discrimination Loss of personal autonomy Decision-making capacity Advanced directives (e.g. DNH) Prognosis uncertainties Withdrawing life-support
Ethical & Legal Issues
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http://www.nahc.org/assets/1/7/EP_Binder.pdf http://
www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-geriatrictoolkit-nov2009.pdf
http://www.ready.gov/individuals-access-functional-needs http://www.fda.gov/downloads/MedicalDevices/Productsand
MedicalProcedures/HomeHealthandConsumer/UCM252812.pdf
http://www.handicap-international.fr/bibliographie-handicap/5CooperationInternationale/contextes_urgence/Helpage_guidelines.pdf
Select References & Resources
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