6/6/2012 1 June 7, 2012 EMERGENCY SITUATIONS AND GENERATIONAL TRENDS: RESTRICTED ACCESS TO HEALTHCARE Edward Stemley, M.S., Pharm.D. Vice Chair, Division of Clinical and Administrative sciences Clinical Assistant Professor Xavier University of Louisiana College of Pharmacy Emergency Situations: Restricted Access to Healthcare 3 P’s to determine need for self‐care during emergency situations ◦ Based on sheltering and isolation risk 1.Proximity 2.Predictability 3.Preparedness Emergency Situations: Restricted Access to Healthcare Natural Disasters ‐Floods ‐Tornadoes ‐Extreme Heat ‐Thunderstorms ‐Winter Storms ‐Drought ‐Hurricanes ‐Tsunamis ‐Earthquakes ‐Volcanoes ‐Landslides ‐Wildfires Declared Disasters ‐Nuclear Plants ‐Technological ‐Pandemic ‐Hazardous Mat.
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6/6/2012
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June 7, 2012
EMERGENCY SITUATIONS AND GENERATIONAL TRENDS:
RESTRICTED ACCESS TO HEALTHCARE
Edward Stemley, M.S., Pharm.D.
Vice Chair, Division of Clinical and Administrative sciences
Clinical Assistant Professor
Xavier University of Louisiana
College of Pharmacy
Emergency Situations: Restricted Access to Healthcare
3 P’s to determine need for self‐care during emergency situations ◦ Based on sheltering and isolation risk
1.Proximity
2.Predictability
3.Preparedness
Emergency Situations: Restricted Access to Healthcare
Emergency Situations: Restricted Access to Healthcare Natural Disasters
‐Hurricanes
• Tropical cyclone and/or tropical storm
• Major safety risk: flying debris, floods, landslides
• Seasonal: June – November (Atl.), May – November (Pcf.)
• Predictability: 48‐96 hour notice
Emergency Situations: Restricted Access to Healthcare Natural Disasters
‐Tornado
• Rotating funnel‐shaped cloud that extends from thunderstorm to ground
• Major safety risk: flying debris, wind damage
• Semi‐Seasonal: associated with thunderstorms
• Predictability: limited. Up to 12 hours warning
Emergency Situations: Restricted Access to Healthcare Natural Disasters
‐Earthquake
• Sudden rapid shaking of the earth
• Major safety risk: falling objects, debris, collapsing walls
• Predictability: impossible
‐Wildfires
• Fire in woodland setting, rural area, or remote mountain site
• Predictability: associated with dry weather. No warning.
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Emergency Situations: Restricted Access to Healthcare 84 y.o. AA female with early onset
dementia is married to a 80 y.o. AA male with HTN, Type II DM with secondary retinopathy & renal insufficiency. The couple refused admission to LTAC and currently live at home in Gulfport, MS. The couple does have an evacuation plan and emergency kit, including emergency supplies, but no medications.
The National Weather Service has just issued a Category 2 hurricane warning for the MS coastline to make landfall within 48 hours.
Based on the 3 P’s, should the couple shelter‐in‐place and engage in self‐care?
a. Yes, there is not enough warning to evacuate
b. Yes, hurricanes typically cause isolated damage, so health care should be available in their area
c. No, the hurricane warning has provided sufficient time to evacuate
d. A & B are correct
e. None of the above
Emergency Situations: Restricted Access to Healthcare Hurricane Katrina Victims Trapped on Rooftops
• First priority is surviving flood waters
• Association between poor health management and survival may be overlooked
• Emergency rescue could take hours to days
• Need for self‐care is imminent!!! Source: Jocelyn Augustino, Public Domain, via FEMA
Emergency Situations: Restricted Access to Healthcare Devastation 2 months post Katrina
• Survival remains as first priority
• Shelter‐in‐Place
• Emergency shelter
• Evacuate
• Private vs. public health insurance
• Association between poor health management and survival may be overlooked
• Restoration of health resources could take months to years
• Need for self‐care is imminent!!!
Source: Infrogmation, CC2.5G,, via Wikimedia
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Emergency Situations: Restricted Access to Healthcare Charity Hospital and Clinics: Regional Safety‐Net Health System post Katrina
• Immediately closed
• Later permanently closed
• Months to years post Katrina
• Satellite hospital to replace damaged hospital
• Level I trauma center
• Ambulatory health centers
• Need for self‐care is imminent!!!
Source: Infrogmation, CC2.5G,, via Wikimedia
Emergency Situations: Restricted Access to Healthcare Charity Hospital and Clinics: Regional Safety‐Net Health System post Katrina
• Immediately closed
• Later permanently closed
• Months to years post Katrina
• Satellite hospital to replace damaged hospital
• Level I trauma center
• Ambulatory health centers
• Need for self‐care is imminent!!!
Source: Infrogmation, CC2.5G,, via Wikimedia
Emergency Situations: Restricted Access to Healthcare Memorial Baptist Hospital and Clinics: Private Health System post Katrina
• Immediately closed
• Health‐care replace immediately by volunteers (red cross) or redistributed to open facilities
• Years post Katrina
• Acquired and reopened by another private health system
• Need for self‐care is imminent!!!
Source: Infrogmation, CC2.5G,, via Wikimedia
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Emergency Situations: Restricted Access to Healthcare Memorial Baptist Hospital and Clinics: Private Health System post Katrina
• Immediately closed
• Health‐care replace immediately by volunteers (red cross) or redistributed to open facilities
• Years post Katrina
• Acquired and reopened by another private health system
• Need for self‐care is imminent!!!
Source: Infrogmation, CC2.5G,, via Wikimedia
Emergency Situations: Restricted Access to Healthcare Red Cross Medical Tent and Emergency Supplies
• Opened weeks to months post Katrina
• Minimal medical services provided to treat urgent conditions
• Resource for limited medical supplies and medication
• Need for self‐care is imminent!!!
Source: Infrogmation, CC2.5G,, via Wikimedia
Emergency Situations: Restricted Access to Healthcare
Declared Disasters ◦ Industry / Technology Related Hazardous Materials Released improperly during production, storage, transportation, or disposal
Safety risk: explosive, flammable, combustible, poisonous, and radioactive
Predictability: can determine susceptibility. No warning
Nuclear Power Plants Radioactive material released into atmosphere accidentally
Safety risk: exposure (contact or inhalation) to radioactive material
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Emergency Situations: Restricted Access to Healthcare
Declared Disasters ◦ Bioterrorism Bombs Deliberate explosion used a weapon
Predictability: limited ability to determine susceptibility. No warning.
Proximity: usually confined to small geographic area.
Nuclear Blast Explosion emitting intense light and heat, damaging pressure wave, and widespread radioactive material
Predictability: limited ability to determine susceptibility. No warning.
Proximity: usually widespread geographical area targeted
Emergency Situations: Restricted Access to Healthcare Graniteville, SC Derailment
• Survival remains as first priority
• Shelter‐in‐Place
• Emergency shelter
• Evacuate
• Association between poor health management and survival may be overlooked
• Evacuation orders could take hours to days
• Need for self‐care is imminent!!!
Source: EPA, CC2.5G, via Wikimedia
Emergency Situations: Restricted Access to Healthcare Graniteville, SC Derailment
• Survival remains as first priority
• Shelter‐in‐Place
• Emergency shelter
• Evacuate
• Association between poor health management and survival may be overlooked
• Evacuation orders could take hours to days
• Need for self‐care is imminent!!!
Source: EPA, CC2.5G, via Wikimedia
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Generational Trends: Restricted Access to Healthcare
Approximately 80 % of adults > 65 years old have at least one chronic health condition
Approximately 50 % of older adults have at least two chronic conditions
Adults aged 65 or older ◦ Nearly ½ have hypertension ◦ 35.6 % have arthritis ◦ 20.4 % have coronary heart disease ◦ 19.9 % have cancer ◦ 15.2 % have diabetes ◦ 8.6 % have had a stroke
1. He et al. 65+ in the United States: 2005 2. The state of aging and health in America 2004 3. Aldrich N, Benson WF. Prev Chronic Dis, 2008
Hurricane Katrina (2005)
Adults aged 60 and over ◦ 15 % of the total population ◦ 74 % of hurricane‐related deaths
Estimated 200,000 people with chronic medical conditions, who were evacuated or isolated after Hurricane Katrina, lacked access to their medications and usual sources of care
49 % of adult evacuees sheltered at Austin Convention Center arrived with acute illnesses ◦ 31 % had special dietary needs
3. Aldrich N, Benson WF. Prev Chronic Dis, 2008 4. The federal response to hurricane Katrina: lessons learned, 2006
5. Vest JR,Valadez AM. Prehosp Disast Med 2006
Hurricane Katrina (2005)
Survey of 680 evacuees living in Houston shelters in September 2005
◦ 41 % reported having chronic health conditions such as heart disease, hypertension, diabetes, and asthma
◦ 43 % indicated that they were supposed to be taking a prescription medication
◦ 29 % of those who were supposed to take prescription drugs said they had problems getting prescriptions filled
1. Aldrich N, Benson WF. Prev Chronic Dis, 2008 2. The Washington Post/Kaiser Family Foundation/Harvard University. Survey of hurricane Katrina evacuees, 2005
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Adapted from Evans, J. International Journal of Older People Nursing,
Review Plan & Check Kit ◦ Annually ◦ Medically Related Changes
◦ Caregiver
Case Study
84 y.o. AA female with early onset dementia is married to a 80 y.o. AA male with HTN, Type II DM with secondary retinopathy & renal insufficiency. The couple refuse admission to LTAC and currently live at home in Gulfport, MS. The couple does have an evacuation plan and emergency kit including emergency supplies but no medications.
As hurricane season approaches, the couples would like to add medications to their emergency kit. What should their health care professional recommend for this man and his wife with vision impairment and dementia, respectively?
a. A prefilled pill box with Braille & large letters for at least a seven day supply of medication
b. An audible glucometer
c. A preset alarm wrist watch to utilize for diet, exercise, and medication reminders
d. Self‐care guidelines to assess and manage acute diabetic, hypertension, and dementia episodes
References Aldrich, N. (2008). Disaster preparedness and the chronic disease needs of vulnerable older adults. Preventing Chronic
Disease , 5(1), A27
Wan, H., Sengupta, M. Velkoff, V. A., & Debarros, K. A. (2005). U. S. Census Bureau, current publication reports, 65+ in the United States: 2005. Washington, DC: U. S. Government Printing Office. Retrieved from http://www.census.gov/prod/2006pubs/p23‐209.pdf
Centers for Disease Control and Prevention, Merck Institute of Aging and Health. (2004). The State of aging and health in America 2004. Washington, D.C.: Merck Institute of Aging and Health. Retrieved from http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf
Adelman, D. A., & Legg, T. J. (2010). Caring for older adults with dementia when disaster strikes. Journal of Gerontological Nursing, 36(8), 13‐17
Gatty, B. (2009). Disaster planning for elderly ‘woefully inadequate.’ Long‐Term Living, 58(8), 55‐56. Retrieved from http://www.ltlmagazine.com
The Washington Post/Kaiser Family Foundation/Harvard University. (2005). Survey of hurricane Katrina evacuees. Menlo Park (CA): The Henry J. Kaiser Family Foundation. Retrieved from http://www.kff.org/newsmedia/upload/7401.pdf
American Diabetes Association. (2002). Diabetes mellitus and exercise. Diabetes Care, 25, S64‐S68. Retrieved from http://care.diabetesjournals.org/content/25/suppl_1/s64.full.pdf html
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References United States. Executive Office of the President. (2006). The Federal response to Hurricane Katrina: Lessons learned.
(PREX 1.2:K 15). Washington: GPO. Retrieved from http://www.whitehouse.gov/reports/katrina‐lessons‐learned.pdf
Deeny, P, Vitale, CT, Spelman, R, & Duggan, S. (2010). Addressing the imbalance: Empowering older people in disaster response and preparedness. International Journal of Older People Nursing, 5(1), 77‐80
Vest, J.R., & Valadez, A.M. (2006). Health conditions and risk factors of sheltered persons displaced by Hurricane Katrina. Prehospital and Disaster Medicine, 21(2), 55–58
Evans, J. (2010). Mapping the vulnerability of older persons to disasters. International Journal of Older People Nursing, 5, 63–70
Fonseca, V.A., Bennett, M.V., Booker, B., Cefalu, W.T., et al. (2007). American Diabetes Association Statement on Emergency and Disaster Preparedness: A report of the Disaster Response Task Force. Diabetes Care, 30(9), 2395‐2398
Center for Disease Control and Prevention. (2011, December 11). Physical activity for everyone: How much physical activity do older adults need?. Retrieved from http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html
American Diabetes Association. (2012). Standards of medical care in diabetes ‐ 2012. Diabetes Care, 35, S11‐S63
Lexi‐Comp Online. (n.d.). Retrieved from http://online.lexi.com/ Hudson, OH: Lexi‐Comp, Inc
Cryer, PE. (2008). The barriers of hypoglycemia in diabetes. Diabetes, 57, 3169‐3176
Resources
Information on Herbals & Supplements ◦ FDA Tips For The Savvy Supplement User: Making Informed Decisions And Evaluating
Information ‐ http://www.fda.gov/food/dietarysupplements/consumerinformation/ucm110567.htm
◦ USDA ‐ http://fnic.nal.usda.gov/dietary‐supplements ◦ Mayo Clinic ‐ http://www.mayoclinic.com/health/herbal‐supplements/SA00044
Resources
Out of medication ??? ◦ Emergency Prescription Assistance Program (EPAP) Federally‐identified disaster area Valid prescription or other means to verify an existing prescription
No other public or private drug or durable medical equipment (DME) coverage Up to 30 days supply for acute illness Replacement of maintenance medication and DME Direct result of disaster Secondary while in transit from disaster area to designated shelter
For More Information on EPAP http://www.phe.gov/Preparedness/planning/epap/Pages/default.aspx
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Resources
Emergency Preparedness ◦ PrepareNow.Org: Supporting special needs and vulnerable populations in disaster
http://www.preparenow.org/prepare.html
◦ FEMA – Caring for someone with dementia in a disaster
http://www.fema.gov/plan/prepare/dementia.shtm
It’s important to prepare forpossible disasters and otheremergencies. Natural and human-caused disasters can strike suddenly,at any time and anywhere. There arethree actions everyone can take thatcan help make a difference …
Be Red Cross Ready Checklist
� I know what emergencies or disasters are most likely to occur in my community.
� I have a family disaster plan and have practiced it.
� I have an emergency preparedness kit.
� At least one member of my household is trained in first aid and CPR/AED.
� I have taken action to help my community prepare.
At a minimum, have the basicsupplies listed below. Keep supplies inan easy-to-carry emergency preparednesskit that you can use at home or take withyou in case you must evacuate.
• Water—one gallon per person, per day(3-day supply for evacuation, 2-weeksupply for home) • Food—non-perishable,easy-to-prepare items (3-day supply forevacuation, 2-week supply for home) •Flashlight • Battery-powered or hand-crankradio (NOAAWeather Radio, if possible) •Extra batteries • First aid kit • Medications(7-day supply) and medical items • Multi-purpose tool • Sanitation and personalhygiene items • Copies of personaldocuments (medication list and pertinentmedical information, proof of address,deed/lease to home, passports, birthcertificates, insurance policies) • Cell phonewith chargers • Family and emergencycontact information • Extra cash •Emergency blanket • Map(s) of the area
Consider the needs of all familymembers and add supplies to yourkit. Suggested items to help meetadditional needs are:• Medical supplies (hearing aids with extrabatteries, glasses, contact lenses, syringes,cane) • Baby supplies (bottles, formula,baby food, diapers) • Games and activitiesfor children • Pet supplies (collar, leash, ID,food, carrier, bowl) • Two-way radios •Extra set of car keys and house keys •Manual can opener
Additional supplies to keep at homeor in your kit based on the types ofdisasters common to your area:• Whistle • N95 or surgical masks •Matches • Rain gear • Towels • Workgloves • Tools/supplies for securing yourhome • Extra clothing, hat and sturdy shoes• Plastic sheeting • Duct tape • Scissors •Household liquid bleach • Entertainmentitems • Blankets or sleeping bags
�Meet with your family or householdmembers.
� Discuss how to prepare and respond toemergencies that are most likely tohappen where you live, learn, workand play.
� Identify responsibilities for eachmember of your household and plan towork together as a team.
� If a family member is in the military,plan how you would respond if theywere deployed.
Plan what to do in case you areseparated during an emergency� Choose two places to meet:
• Right outside your home in case ofa sudden emergency, such as a fire
• Outside your neighborhood, incase you cannot return home orare asked to evacuate
� Choose an out-of-area emergencycontact person. It may be easier to textor call long distance if local phonelines are overloaded or out of service.Everyone should have emergencycontact information in writing orprogrammed into their cell phones.
Plan what to do if you have toevacuate� Decide where you would go and whatroute you would take to get there. Youmay choose to go to a hotel/motel,stay with friends or relatives in a safelocation or go to an evacuation shelterif necessary.
� Practice evacuating your home twice ayear. Drive your planned evacuationroute and plot alternate routes on yourmap in case roads are impassable.
� Plan ahead for your pets. Keep a phonelist of pet-friendly hotels/motels andanimal shelters that are along yourevacuation routes.
Learn what disasters or emergenciesmay occur in your area. These eventscan range from those affecting only you andyour family, like a home fire or medicalemergency, to those affecting your entirecommunity, like an earthquake or flood.
� Identify how local authorities will notifyyou during a disaster and how you will getinformation, whether through local radio,TV or NOAAWeather Radio stations orchannels.
� Know the difference between differentweather alerts such as watches andwarnings and what actions to take ineach.
� Know what actions to take to protectyourself during disasters that may occurin areas where you travel or have movedrecently. For example, if you travel to aplace where earthquakes are common andyou are not familiar with them, make sureyou know what to do to protect yourselfshould one occur.
�When a major disaster occurs, yourcommunity can change in an instant.Loved ones may be hurt and emergencyresponse is likely to be delayed. Makesure that at least one member of yourhousehold is trained in first aid and CPRand knows how to use an automatedexternal defibrillator (AED). This trainingis useful in many emergency situations.
� Share what you have learned with yourfamily, household and neighbors andencourage them to be informed.
Emergency Contact Cards for AllHousehold MembersGet your cards online athttp://www.redcross.org /prepare/ECCard.pdf.
� Print one card for each family member.
�Write the contact information for eachhousehold member, such as work, schooland cell phone numbers.
� Fold the card so it fits in your pocket,wallet or purse.
� Carry the card with you so it is available inthe event of a disaster or other emergency.Let Your Family Know You’re Safe
Tell your loved ones about the American Red Cross Safe and Well Web site available throughRedCross.org. This Internet-based tool should be integrated into your emergencycommunications plan. People within a disaster-affected area can register themselves as “safeand well” and concerned family and friends who know the person’s phone number or addresscan search for messages posted by those who self-register. If you don’t have Internet access,call 1-866-GET-INFO to register yourself and your family.
Be RedCrossReadyGet a kit. Make a plan. Be informed.
For more information on disaster and emergency preparedness, visit RedCross.org.