PREPPING

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Prepping is the planning and set of practices that can lower vulnerability and enhance resilience against the effects of climate change. Most governments do it, businesses do it, health care systems can, and individuals should too. Here we dive into prepping on the level of the individual, and how healthcare workers can help their patients and clients become more resilient to both the direct and indirect health impacts of a changed climate.


PERSONAL READINESS

While preparing for every possible scenario is an extreme mindset and expense, prepping is not an all-or-nothing approach. Instead, start with the most basic preparation like a small home kit, and expand from there with supplies and plans you might need in various scenarios and settings. See these resources to get started:


EXTREME WEATHER EVENTS

PREPPING FOR OTHER CLIMATE CHANGE IMPACTS

While we can’t predict every extreme weather event, we can think about the frequency and typology of disaster-related mortality and morbidity, how that might change in the future, and what preparation measures might be indicated.

Principles of community preparation for extreme weather events:

Plan for days without access to water, cellular telephone coverage, and electricity. (FEMA now advises being able to manage on your own for 72 hours???)

NEJM’s Mortality in Puerto Rico after Hurricane Maria

https://www.nejm.org/doi/full/10.1056/NEJMsa1803972

Disruption of Medical Services table from article:

15% of households unable to get medicine

Unable to use respiration equipment

Roads damaged

Facility closed

Doctors unavailable

Unable to afford care

Transport issues

No 911 service

Unable to have dialysis

Establish processes now, and get familiar with the most vulnerable residents including chronically ill patients with respirators and other life-sustaining equipment that requires electricity. Nursing home residents are disproportionately affected by any disruption in basic utilities. (Lots of death/injuries from Katrina, Sandy, Harvey, Irma, Maria)


Morbidity and Mortality Associated with Disasters

https://link.springer.com/chapter/10.1007/978-0-387-32353-4_6

(SV note: have to do better at recording deaths and injuries, that’s inconsistently reported and not well tracked.)

(SV note: a future direction of research might be to consider whether increased terrorism should be considered an indirect health effect of climate change, and included in our preparation kits)

Lancet Countdown: From http://www.lancetcountdown.org/the-report/

Indicator 1.4: Annual weather-related disasters have increased by 46% from 2000 to 2013.

Hurricanes killed 75,000 people in 20th century ((Nicholls, Mimura,&Topping, 1995; Rappaport&Fernandez-Partagas, 1997; Shultz, Russell,

& Espinel, 2005). Most deaths occurred in Bangladesh and India.
(Most deaths occurred in developing nations)

Select causes of mortality during and immediately after disasters, ordered by frequency

Drowning
In motor vehicles
And in/when beaching boats
Falling trees (killed lots of Sandy people)
Fires
CO poisoning
Crushed or asphyxiated from falling structures
Electrocution
Blunt/penetrating trauma
Using a chain saw
Falls
Motor vehicle crashes
Cardiovascular events


Injuries related to hurricanes often occur after the hurricane:

Majority of injuries are

Cuts

Lacerations

Sprains

STrains/fractures

Corneal abrasions, insect bites/stings elevated

75% injured are male, substantial number of whom had been “injured while using chain saws during cleanup activities”


Lots of nonfatal and fatal CO poisoning, due to improper gas-powered generators (and, Steve bets, due to people cooking indoors with unsafe fuels)


Deaths in floods (related to hurricanes/storms or flash floods) are predominantly motor vehicle related, and the scenario is this: attempting to drive through flood waters. The road is obscured, the power of the water is too strong, or the road is just missing.


HEAT


ICE and SNOW


WILDFIRE

Smoke inhalation, burns


VOLCANOES/EARTHQUAKES/TSUNAMIS and TERRORISM


…and psychological morbidity

“Type of disaster has strong influence on particular health outcomes that occur.” PTSD followed by depression, anxiety, and panic disorders (Vlahov!)

Women experiencing chronic stress most likely to experience anxiety and increased alcohol use. Post bombings (Oklahoma City), women 2x as likely to have PTSD, depression, generalized anxiety


Journal of Homeland Security and Emergency Management

A Social Vulnerability Index for Disaster Management

2011

https://svi.cdc.gov/A%20Social%20Vulnerability%20Index%20for%20Disaster%20Management.pdf

Random notes below, things to review and develop further

Heat

Indicator 1.1: Between 2000 and 2016, temperatures rose by 0.9oC where people are living, nearly double the average across the globe.

Indicator 1.2: Between 2000 and 2016, the number of vulnerable people exposed to heatwave events has increased by around 125 million.

Indicator 1.3: Global physical labour capacity in populations exposed to temperature change has decreased by around 5.3% between 2000 and 2016.

Checklist for HCworker to discuss with patients

VBD

Indicator 1.6: Vectorial capacity for the transmission of dengue has increased by 9.4% (Aedes aegypti) and 11.1% (Aedes albopictus) due to climate trends since the 1950s.

Zika? WNV? Lyme?

Emergency Kit Resources

Stockpiling extra prescription medicine: from http://frugalnurse.com/2017/09/tips-stockpiling-prescription-meds/

Tip #1: Never wait until the last minute to refill your prescriptions! Always refill prescriptions as soon as you are allowed. If your insurance offers automatic refills by mail, sign up. That service usually gets your meds to you a few days earlier as they allow for mail delays.

Tip #2: Squirrel away one or two doses every month. I don’t mean skip a dose. Just see if you can work out your refill schedule (Tip #1) so you have an extra dose or two at the end of the refill period. Put it in a LABELED medication bottle with the year clearly marked.

Tip #3: Talk to your insurance company about getting an extra refill in case of an emergency. Some refills are so tightly controlled that squirreling away an extra dose just won’t be possible. In that case, talk directly to a customer service rep at your insurance company and explain that you want a small stockpile of your prescription meds in case of a natural disaster or other emergency.

(Now would be a good time to do this with all these disasters fresh in everyone’s minds!)

Some prescription medications are so expensive that an insurance company might not OK this. And even if they do, expect to pay the extra copay/coinsurance.

Tip #4: Ask your physician for a second prescription and pay cash. This is how my husband put together an emergency supply of his thyroid medication. He used the second prescription with Walmart’s online pharmacy, which offers low cash prices for many generic medications. We didn’t need to use our insurance coverage, so he was able to double up on his thyroid med for a few months.

Also keep a hard copy of your prescriptions, or take a picture and store it in your cell phone. You may need to seek refills at a pharmacy outside of your usual neighborhood or network.

Information and philosophy on prepping that is not disaster related, e.g. consider what health impacts climate change will have on us that isn’t a hurricane/flood.

Stuff that is longer term preparation, including reduction of our own footprint, general health, financial health, community involvement (sounding pollyannaish?)…

Indicator 1.7: The number of undernourished people in 30 countries vulnerable to climate change and highly dependent on regional food production has increased from 398 million in 1990 to 422 million in 2016.

  • Indicator 1.8: Globally, climate change alone has directly forced at least 4,400 to migrate and over 1 billion people may be at risk of migration by the end of the century, without further action.