Hurricane Dorian Preparedness Action Plan For People With Lung Disease and CPAP Users

When a hurricane strikes, you are put into a changed environment.  However, if you have lung diseases or you are using oxygen at home, you may be affected more than others and need to have a plan how you will survive through those difficult days.

Your oxygen concentrator may not work, you may have to live without an air-conditioner exposing yourself to a hot humid weather and water damage may make your respiratory equipments inoperable.  These unexpected changes create havoc for people with lung diseases.

Hurricane season is June 1 to November 30.  You should plan ahead to develop your personal plan of action, in case you are affected by hurricanes, with the help of your physician.  Following information is provided to assist you to develop a ‘Breathe Easy Plan for Hurricane’, which will help you survive through the natural disaster.

1. Before hurricane:

a. Call your doctor to set up an appointment to discuss hurricane preparedness and ask following questions:

• Should I keep a two-week supply of inhalers and other medications on hand?
• Should I continue to use peak-flow to assess my lung function?
• If I am short of breath, which inhaler or respiratory medication, I can use more often or can increase the dose?
• Should I get an prescription for antibiotic to treat respiratory infection and start taking as soon as my symptoms appear?
• If I am short of breath, what is maximum number of times I can use the
  inhalers before I should go to the nearest emergency room?
• If I continue to be short of breath, which hospital I should go and whether you (your doctor) will be available there?
• Should I get a prescription for meter-dose inhaler in addition to my regular nebulizer medication?
• Can I increase the oxygen flow and what is the maximum flow, if I am short of breath (for those who are using oxygen at home)?
• Should I be admitted to the hospital as a precautionary measure, if I
  am not feeling well anyway or my lung disease is severe enough to
  require skilled nursing?

b. If you use oxygen, call your medical supply company for following information:

• Ask for a backup cylinder and how many hours will the cylinder last?
• If you ran out of backup cylinder, will they deliver additional oxygen cylinder?
• What is their emergency contact information, including their physical address?
• What additional supplies you will need to keep the equipment clean for at least two weeks?
• How soon after the storm, the oxygen supply will be replenished?

c. Call your electric company to notify them that you are using a
life-sustaining medical equipment that requires electricity. Even if
they can not guarantee the continuity of service, they may put your
area in their priority list, after the hurricane.

d. ‘Breathe Easy Plan for Hurricane’– Your Personal Action Plan

• Decide whether you will stay home or seek shelter at a Public
  Shelter. Pubic Shelters are usually located in schools and they will
  accept anyone who is self-sufficient and needs no outside professional
  assistance in performing activities of daily living.
• DO NOT stay alone if you are using oxygen therapy.
• Let your medical supply company know where you will be if you decide to leave your home.
• IF YOU ARE USING OXYGEN and need a shelter, please remember following:

1. You need to pre-register with the Lee County Public Safety Special Needs Program for Special Care Centers, managed by Lee County Emergency Management. Public Shelters do not accept patients with oxygen. Due to limited space, there is a waiting list for these centers.

2. In Lehigh Acres, Sunshine Elementary School at 600 Sarah Avenue is the designated Special Care Center. This is the only center which is equipped with air-conditioning.

3. Oxygen will be provided at Special Care Centers, concentrators are not necessary. However, you will need to bring your portable oxygen unit with extra oxygen if available.

4. If pre-assigned to a Special Care Center, you must be accompanied by a caregiver.

5. Call Special Needs Coordinator at 239-344-5401 for the registration form and further information.

• Evacuation and transportation notification: As the hurricane approaches, listen to the radio and television for evacuation warnings. Once any evacuation warning is announced, please call 477-3600 or 344-5401 to verify if the evacuation order is in effect for your location. If you pre-registered for Special Care Center and advised previously that you can provide your own transportation, you will not receive a telephone call to evacuate. However, if you advised that you needed transportation, you will be called and once you are notified, you must be ready to evacuate when your transportation arrives.
• If your physician determined that you will require hospitalization in the event of a hurricane, you will need a letter from your doctor stating such and the name of the hospital which you need to be taken. Without a letter on file, you will not be evacuated to a hospital in the event of a hurricane.
• Assemble your ‘Breathe Easy Hurricane Survival Kit’ and take this with you if you leave for any other location, including a Special Care Shelter:

1. A 14-day supply of inhalers, nebulizers and other essential medications.

2. Back-up oxygen cylinder including cleaning supplies for respiratory equipments.

3. A portable battery operated nebulizer machine.

4. Buy a DC invertor, which would permit you to operate a nebulizer from a car cigarette lighter.  Check with your respiratory equipment supplier for compatibility of the invertor with the nebulizer.

5. Water and non-perishable foods for 2 weeks.

6. A small cooler with frozen gel packs.

7. Flashlight, radio and extra batteries.

8. Blanket and pillows.

9. Keep important papers including your driver’s license, health insurance cards, medication list, physician’s name and emergency phone number in a water-proof container.

2.  During the hurricane:

a. Stay Calm: Emotional stress increases your heart rate, quickens breathing, makes breathing more difficult and demands more oxygen from the body.

b. Practice pursed-lip breathing, diaphragmatic breathing and conditioning exercises to help you breathe easier.

c. Do not use candles or open flames for any reason. Scented candles may also worsen your breathing disorder. Use battery powered lights only.

d. Listen only to local radio and television for hurricane advisories.

e. If your breathing get worse, increase the dose or frequency of inhalers or nebulizer or other respiratory medications as suggested by your physician.

f. If you do not get relief by doing above, call 911 for emergency help.  However, you should call 911, only when you have a life-threatening emergency or an impending one.

3. After the hurricane:

a. Stay indoors until the officials declare it safe to go outside.

b. Be aware that after the storm passes there may be hazards, i.e., downed electrical wires, debris, snakes, etc. Washouts may weaken roads. Bridges could collapse under heavy weight.

c. Restock your survival kit and wait for your medical supply company to replenish your oxygen and other medical supplies. Following a hurricane, Emergency Management will assist your oxygen provider to gain access to the area of your home for delivery of oxygen refills.

d. In the event of power outages or floods, keep the refrigerator doors closed as much as possible to maintain the cold temperature. The refrigerator will keep food cold for about 4 hours if it is unopened. A full freezer will keep the temperature for approximately 48 hours if the door remains closed.

e. Be aware that, perishable food such as meat, poultry, seafood, milk and eggs that are not properly refrigerated or frozen may cause illness if consumed, even if it is thoroughly cooked.

f. Mold and mildew grow quickly on anything wet. Get them out of your house immediately. If you have asthma, you may worsen your disease from the molds.

g. While clearing and cleaning up the debris in your yard, you may worsen your asthma from the exposure to surrounding foliage. Usually within 30-120 minutes after the exposure, you will start feeling chest tightness and difficulty in breathing. If you feel such symptom, use the inhalers or nebulizer prescribed by your physician immediately. If no relief of symptom, please report to your local emergency room.

h. An individual who starts having productive cough with yellow sputum, should start taking antibiotic, as directed by your physician, when symptoms first appear.

i. Protect yourself from Carbon monoxide (CO) poisoning:

• CO is an odorless, colorless gas that can cause sudden illness and death if you breathe it. Every year, more than 500 people die from accidental CO poisoning.
• People with chronic respiratory disorders are more susceptible to CO poisoning.
• Never use generators, grills, camp stoves or other such devices inside your home, basement, garage or even outside near an open window.
• If you must use an alternative source of fuel or electricity, be sure to use it only outside and away from open windows.
• Most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain and confusion.