Planning for Emergencies

Don’t wait for an emergency to start planning! Planning for emergencies can keep you and the patient safe, especially if you are in an area with frequent natural disasters.

Emergencies impact patients who have organ failure, transplant, or a left ventricular assist device (LVAD) in many ways. For example,

• Loss of electricity for medical devices
• Limited access to medications
• Dehydration from limited access to clean drinking water
• Extreme heat or cold
• No access to health care
• No safe route to the transplant center
• Flooding that causes mold, fungus, or bacteria
• High winds that cause valley fever, cocci, or pollen
• Poor air quality from wildfire smoke

Preparing for an Emergency or Natural Disaster

• Ask your transplant center about their emergency planning procedures
• When you plan, include your homecare agency, pharmacy, and medical equipment company
• Tell your power company about the patient and ask for priority service when power returns
• Know what medical devices are affected by a power outage or evacuation:
  • oxygen concentrator
  • LVAD
  • Continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) machine
  • Nebulizer
  • Ventilator
  • Feeding pump
  • Inotropes pump
  • IV medication pump
  • LifeVest defibrillator
  • Vest chest therapy device
  • Home dialysis equipment
• Plan for power alternatives, like a generator or portable batteries. (If you use a generator, follow the instructions exactly to prevent carbon monoxide poisoning.)
• Plan where you will stay (family, friend, emergency shelter) if power outages last a long time
• List the addresses and phone numbers of the closest hospital, fire department, and police station 
• If there is a disaster alert, immediately ask for extra:
  • Oxygen tanks
  • Dressing/bandage supplies
  • Medications
  • Supplies for diabetes
• Write a list of all medication and medical equipment (make, model, type and supplier)
• Review a basic family emergency plan will all family members.  (Remember to plan for pets)
• Pre-register yourself and the patient with local emergency medical shelters. Ask if you can have a private area in the shelter, because of the patient’s increased risk of infection.
• If you have an RV or trailer, plan different housing depending on weather. (A trailer might not be safe in extreme heat or high winds)
• Create an evacuation, or exit, plan before an emergency happens
• Evacuate immediately when there is a disaster alert
• Tell your transplant or LVAD center when you get to a safe place. Continue to tell them where you are during a disaster
• Have First Aid Kits at home and in every car.  For a family of 4, the American Red Cross recommends: 
  • 2 absorbent compress dressings (5 x 9 inches) 
  • 25 adhesive bandages (assorted sizes)
  • 1 adhesive cloth tape (10 yards x 1 inch) 
  • 5 antibiotic ointment packets (approximately 1 gram) 
  • 5 antiseptic wipe packets 
  • 2 packets of aspirin (81 mg each) 
  • 1 emergency blanket
  • 1 breathing barrier (with one-way valve)
  • 1 instant cold compress 
  • 2 pair of non-latex gloves 
  • 2 hydrocortisone ointment packets (approximately 1 gram each) 
  • 1 3 in. gauze roll (roller) bandage
  • 1 roller bandage (4 inches wide) 
  • 5 3 in. x 3 in. sterile gauze pads 
  • 5 sterile gauze pads (4 x 4 inches) 
  • Oral thermometer (non-mercury/non-glass)
  • 2 triangular bandages 
  • Tweezers
  • Emergency First Aid guide
• Make an Emergency Kit. FEMA recommends: 
  • Water: one gallon per person, per day (3-day supply for evacuation, 2-week supply for home)
  • Food: non-perishable, easy-to-prepare items (3-day supply for evacuation, 2-week supply for home)
  • Flashlight
  • Battery-powered or hand-crank radio (NOAA Weather Radio, if possible)
  • Extra batteries
  • First aid kit (see above for recommended items)
  • Medications (7-day supply) and medical items
  • Multi-purpose tool, like a Swiss Army knife
  • Sanitation and personal hygiene items
  • Copies of personal documents (medication list and pertinent medical information, proof of address, deed/lease to home, passports, birth certificates, insurance policies)
  • Cell phone with charger
  • Family and emergency contact information
  • Extra cash (ATMs might be inoperable)
  • Extra fuel for generator and car
  • Extra house and car keys
  • Towels, plastic sheeting, duct tape, scissors, and work gloves
  • Medical-care items, baby supplies, pet supplies (if needed)

Emergency Preparedness Resources

• Federal Emergency Management Agency (FEMA): 1-800-621-FEMA (3662) or 1-800-462-7585, https://www.fema.gov/
• Transitional sheltering assistance

Resources for individuals, businesses, and communities: 

• Disasterassistance.gov
• Ready.Gov
• Disaster Relief information
• The American Red Cross
• FDA tips about medical devices and hurricane emergencies

Phone Apps

• In Case of Emergency (ICE)
• FEMA
• American Red Cross
• Center for Disease Control
• National Hurricane Center
• Flood and water level tracking
• Earthquake interactive mapping
• Weather 
• Radio 
• Pharmacy 
• Healthcare patient portal
• Local community emergency preparedness apps (like JaxReady in Jacksonville, FL)
• Flashlight

Pandemic

Plan how you will care for the patient (before and after transplant) if there is a pandemic or other large-scale disease outbreak. 

• Ask your transplant team how they plan for a pandemic. Ask each program the patient is listed with
• Ask what tests are required and how to complete them (if the patient is in the evaluation process).
• Tell your transplant coordinator if the patient is sick or hospitalized
• The patient has a better chance of staying on the transplant list (pre-transplant)
• The transplant team can help prevent organ damage or rejection (post-transplant)
• Tell your transplant team if the patient’s insurance changes
• Follow Centers for Disease Control and Prevention (CDC), local, and state guidelines to stay healthy and safe during the pandemic
• Take care of your physical health:
  • Eat nutritious food and drink water
  • Be active. Get outside for a change of scenery
  • Brush your teeth and bathe regularly
• Take care of your mental health
  • It’s normal to feel anxious, sad, frustrated, disappointed, and angry
  • Ask for a referral to a mental health provider if these feelings become overwhelming
  • Always be honest with your support team and the transplant team
• Ask about hospital visitor policies during the event, as you might not be able to visit the patient as you had planned to do
  • Hospitals might have a no visitor policy, limited visitor policy, or shorter visiting hours
  • If you cannot stay at the hospital with the patient, call or video chat as much as you can 
• Ask about your transplant center’s Telehealth options. Telehealth allows providers to use a computer, phone, or tablet to see patients safely during a pandemic

Adapted from “11 Things You Can Do to Get Ready for a Kidney Transplant During COVID-19.” End Stage Renal Disease National Coordinating Center (ESRD NCC). Accessed June 15, 2020.

Flu Season

Flu (influenza) season is usually from October to May every year. The flu spreads easily between people. Flu symptoms can include:

• Headache
• Body ache
• High fever
• Sore throat
• Fatigue
• Runny nose

Your transplant team will probably recommend that you and the patient get the flu vaccine. Talk to your doctor and the transplant team about the flu vaccine. 

Help your transplant patient stay healthy and safe. In addition to the vaccine:

• Wash your hands often
• Don’t touch your eyes, nose, and mouth
• Cover your mouth when you cough
• Don’t get close to people who are sick 
• Follow good health habits (eat healthy food, drink water, sleep enough, etc.)