What Can Chronically Ill Patients Do to Brace for Natural Disasters?

More than a year after Texas’ most devastating hurricane, simply saying the word “Harvey” prompts a pause for reflection.

“It’s amazing to see how people from the bottom of their hearts reached out to help each other in a crisis,” said Dr. Tracie Kirkland, who cares for patients in Katy, Texas, a town 30 miles outside of Houston, while also teaching at the USC Suzanne Dworak-Peck School of Social Work Department of Nursing.

With 95 major disasters declared in the state since 1953, Texans are all too familiar with the impact of emergencies on vulnerable communities. According to NASA, at least one major disaster is declared in Texas nearly every calendar year, meaning local residents are more likely to experience displacement and medical trauma than those elsewhere in the United States.

When disasters occur — in Texas and anywhere else — trauma prevention is often the focus of planning efforts, but medical providers have emphasized the need for more robust emergency response plans for communities in need.  

Data from the CDC shows that people living with chronic conditions are among the most vulnerable communities, as they experience greater limitations with daily activities like walking or eating, and they are densely populated in many of the states that are most susceptible to natural disasters.

In 2017, the United States endured 16 separate natural disasters with damage costs greater than $1 billion — the highest number for any year on record. With the frequency and cost of natural disasters like hurricanes Harvey and María on the rise, experts say it’s critical to give special attention to patients whose medical treatment plans will be disrupted in the wake of a natural disaster.

U.S. Landscape of Natural Disasters and Chronic Conditions.

Go to a text-only version U.S. Landscape of Natural Disasters and Chronic Conditions. 

The Landscape of Chronic Conditions in the U.S.

Chronic conditions include any diagnosis that affects an individual for three or more months, and are responsible for seven out of every 10 deaths in the United States, according to the CDC. In 2015, the following conditions were the 10 most common chronic diagnoses in the United States, indicated by a recent report from the Centers for Medicare and Medicaid Services:

  • Hypertension
  • Hyperlipidemia
  • Arthritis
  • Diabetes
  • Ischemic heart disease
  • Chronic kidney disease
  • Depression
  • Heart failure
  • Chronic obstructive pulmonary disease (COPD)
  • Alzheimer’s disease

Among the most vulnerable populations for chronic conditions are children and older adults, two groups that often require caregivers. In the United States, more than 80 percent of older adults have at least one chronic condition, and about 50 percent have at least two. Managing multiple chronic conditions at once can be cumbersome and may increase the likelihood of complications.

Individuals across the life span with chronic conditions have specific care needs that put them at greater risk for life-threatening complications during the devastation of a natural disaster. According to Kirkland, these needs include:

  • Around-the-clock care by a family member or licensed professional, depending on severity of diagnosis
  • Frequent monitoring of vital signs and symptoms
  • Medication taken with specific foods multiple times a day
  • Frequent trips to specialists or primary care providers
  • Equipment for monitoring or aiding bodily functions

“The psychological stress alone can increase a person’s risk of a heart attack,” Kirkland said, leaving people who are already at risk even more vulnerable.

The Impact of Natural Disasters

In the wake of a natural disaster, the complicated task of managing a chronic condition becomes even more challenging. People are sometimes tasked with finding resources or health care support while they are trapped in their homes or after they are forced to evacuate.

“The goal for first responders is always safety, but part of that safety is making sure people have their medication,” Kirkland said. “They might survive the initial rescue but could have an increased risk of death because they are missing medication.”

According to Kirkland, common challenges that complicate management of chronic diagnoses may include:

  • Limited access to medical providers or medication for emergency prescriptions
  • Disruption of care continuity when clinics close due to water and electrical damage
  • Reduced mobility when carrying medical equipment like oxygen tanks
  • Displacement from homes when individuals are forced to evacuate their residences

Kirkland said access to care “can mean life or death.” For example, people with renal failure require dialysis three or more times per week. People with epilepsy rely on strict adherence to medical treatment plans and consistent access to medication. People with diabetes depend on insulin and food to monitor blood sugar levels. But if patients can’t get to a clinic or if clinics lose power, their health will suffer.

Preparing for an Emergency

While many emergency response plans emphasize a provider’s role in medical treatment, the reality of natural disasters proves that people don’t always have continuous access to providers and should plan accordingly with a caregiver.

“A family member involved in chronic condition management must know how to assess for symptoms of acute patients and notice clinical changes that require more emergent care,” Kirkland said.

According to Kirkland, people with chronic conditions can take direct steps toward preparing for natural disasters or emergencies, including the following:

  • Maintain a 10-day supply of all necessary medications.
  • Wear a bracelet that helps first responders identify an individual with a chronic condition or specific care requirement.
  • Organize a supply of emergency food, battery-operated flashlights and a change of clothes.
  • Have devices at home that monitor vital signs and changes in physical health.
  • Ensure family members and close neighbors know how to administer care.
  • Develop an evacuation plan, including identifying stable buildings in the community for shelter.
  • Sign up for community warning systems for weather alerts.
  • Organize communication with family members in the event of lost power.
  • Create an updated list of emergency phone numbers for providers and medical facilities, and keep the list somewhere accessible.

Kirkland also suggested that caregivers ask questions during a loved one’s annual physical, and spend one-on-one time with a provider to talk about at-home medical treatment plans. Just as hospitals and organizations have contingency plans for emergencies and evacuations, it’s critical for individuals to develop reliable plans for themselves and their family members.

As a provider, establishing a trustworthy relationship with a patient is a venue for them to ask questions and feel supported in managing their conditions, according to Kirkland. “Take any opportunity to solicit their thoughts,” she said.

Kirkland also encouraged providers to bring up contingency plans with their patients and become familiar with community resources so that they can educate patients about where to seek help after a natural disaster.

In Texas, camaraderie continues to bring residents together long after Harvey’s extensive destruction.

“People risked their lives to save one another,” Kirkland said. “Because the communities rallied around each other, they were able to save each other.”

Please note that this article is for informational purposes only. Individuals should consult a health care professional before following any of the information provided. For more information about preparing for natural disasters, visit the Department of Homeland Security.

Citation for this content: Nursing@USC, the online FNP program from the University of Southern California