In a way, preparedness reminds us of the washing machine commercials from years ago, in which the repairmen were “the loneliest guys in town.” The appliances were so reliable that they never broke down. Though washing machines are hardly exotic, this brand was incredibly safe: no risk of parts exploding, flooding, or causing damage. The appliances were worry-free. Similarly, preparedness may not be an exciting topic, but by putting strategies in place beforehand, households can rest easier by minimizing possible damage from emergencies.
Nurses can be essential change agents for encouraging households to make basic preparations in case of disaster by educating patients on reasonable precautions that would make significant differences for the safety and health of all in their homes.
Weather and Well-Being
According to the National Oceanic and Atmospheric Administration (NOAA), hazards from extreme weather are nothing new. “Over 15 years (2005-2019), there have been 156 separate billion-dollar weather or climate disasters in the US that have cost a combined $1.16 trillion in damages.” Across much of the nation, July 2023 brought record-high temperatures and devastating floods.
Weather changes are a global issue, as the earth had its hottest July in 174 years. The United Nations initiative on Climate Action explains why this phenomenon is progressing worldwide. “Today, we are experiencing unprecedented rapid warming from human activities, primarily due to burning fossil fuels that generate greenhouse gas emissions.”
The impact of a drastically changing climate spans numerous areas that affect health, especially heat-related ones. States such as Arizona recently endured weeks of sustained temperatures that exceeded 110℉. A Tucson resident recently lamented, “We have air conditioning but didn’t want to be outside long enough to go to the movies.” Even for short durations, exposure to extreme heat for those in frail health can be hazardous.
The CDC reports that more than 600 people in the US are killed yearly by extreme heat. Heat-related illnesses can be relatively minor – including heat rash, sunburn, and cramps – with straightforward treatments. If untreated, these conditions can progress from heat exhaustion to life-threatening heat stroke, requiring prompt medical intervention.
According to the Mayo Clinic, patients with heat exhaustion often sweat heavily with a rapid pulse. Their skin could be cold, pale, and clammy. They’d possibly have nausea, muscle cramps, fatigue, dizziness, headache, or fainting. Risk factors include exposure to a high heat index, strenuous activity, dehydration, alcohol use, and overdressing. Seek immediate help if the person becomes confused or loses consciousness or if their core body temperature exceeds 104℉. If the condition leads to heat stroke (“hyperthermia”), there can be permanent damage to the brain and vital organs, leading to death.
According to the NIH, heat stroke results in approximately 4,100 US ED visits annually. The majority occur in the summer months and require hospital admission.
The most alarming symptom of heat stroke is a change in mental status – such as confusion, delirium, combativeness, and seizures. Nurses should pay special attention to factors that increase sensitivity to heat, causing progression to levels that can be fatal.
Age: Under four and over 65. The body’s ability to regulate its temperature isn’t fully developed in children. In older adults, illness, medicines, and other factors can affect the body’s ability to control temperature.
Drugs: Some medications can affect the body’s ability to stay hydrated and respond to heat. These include beta-blockers, diuretics, antihistamines, tranquilizers, and antipsychotics – as well as illegal drugs such as cocaine and amphetamines, which can increase core temperature.
Obesity: Excess weight can affect the body’s ability to regulate temperature and retain heat.
Sudden temperature changes: The body may need more time to acclimate to a higher heat index.
Preparedness regarding the impact of extreme weather on health includes patient and provider education and having essential supplies on hand to address most local threats.
The key to preparedness is knowing your local risk factors and planning ahead. For example, much of the Midwest is subject to tornado warnings. Coastal communities often brace themselves for hurricane season, while flooding is possible anywhere. The Center for Disaster Philanthropy reports the surprising impact of floods in the northeast US during 2023. For example, five to eight inches of rain fell on one July day in the Hudson Valley, canceling hundreds of flights and disrupting train services; considered a ‘1000-year event.’ Snow emergencies are especially commonplace for northern states, causing extreme cold, icy roads, and frozen pipes. Medical conditions include hypothermia and other cold-related issues. A common denominator across many weather disasters is the loss of electricity.
For many residents, losing power for a few hours is an inconvenience. The hassle is reduced when flashlights with fresh batteries are on hand. Recovery is even better for residences with generators, especially when the devices switch on automatically when needed. Using candles as a primary lighting source is discouraged, as candles are among the top five causes of house fires.
Power outages are life-threatening for those who depend on electronic devices to survive. Help your patients to ensure they have backup sources of power and systems for notifying urgent resources rapidly. Advise households to pay special attention to food safety, as some items shouldn’t be consumed if left at room temperature for an extended time. Also, warn them never to walk into a wet basement in case downed wires can cause electrocution.
Building Blocks of Preparedness
Regardless of the hazards, there are three hallmarks of excellent preparedness in case disaster strikes: Be informed, make a plan, and build a kit. Nurses can be pivotal in guiding households to ‘start where they are’ in these areas.
Learn about the hazards in your area and how to access local resources for help. Monitor reliable outlets for changing weather conditions; updates on hazards, emergency alerts, and warnings; and whether to stay home or evacuate.
This step includes planning for communications with family, friends, care providers, and household members. It’s often wise to have a contact from out of state because that person may not be subject to the disaster and thus would be a source for those affected to share updates. Loved ones can prepare for the specific needs in the household, such as each person’s age, dietary and medical needs, cultural issues, and service animals.
Build a Kit
Also called a 72-hour kit’ or ‘bug-out bag,’ items can be prepared thoughtfully in advance to support rapid evacuation during an emergency. Even if it’s determined that sheltering in place is the best option, it helps to have a bin of items to sustain the household in the immediate hours and days when disaster strikes. Consider a supply list to see what items would be most helpful.
Nancy Burns (EMT, CHEP, AFAA, AHA-I) is the Upper Merrimack Valley Medical Reserve Corps Coordinator at the Westford, MA Health Department. Learn more about the national MRC program and how to support their efforts here.