THE INFORMED PATIENT

By LAURA LANDRO

A Medical Checklist for Disasters

September 7, 2005

FOR ANYONE with a medical condition or disability, the devastation left by Hurricane Katrina provides a grim reminder of the need for preparations in the event of a natural disaster or other emergency.

Medical experts are renewing calls for emergency preparedness, urging patients with special medical needs to plan for the worst no matter where they live -- and to take extra steps to protect the most defenseless family members such as children and the elderly.

People with disabilities or chronic health problems such as diabetes, asthma, heart disease, AIDS and cancer depend on ready access to doctors' offices, pharmacies, medical-supply shops and hospitals. While health-care groups and government agencies work to provide alternative emergency care in a crisis, the situation in New Orleans shows that such help isn't always swiftly available.

So government agencies and disease-advocacy groups are recommending several measures to make sure people have important medical supplies on hand: Keep at least two weeks' extra supply of prescription medications and a record of the original prescriptions, prepare an emergency kit with important medical supplies and printed information on special care for a particular disease, maintain portable electronic or paper copies of medical records, and get a medical identification bracelet for any chronic condition or medication allergy.

Patients should also learn what their options would be in the aftermath of any disaster, including where to turn for alternative care, and what do to if even their preparedness efforts fail -- say, if flood waters or loss of refrigeration destroys a supply of medication.

Last week, the Food and Drug Administration (www.fda.gov) issued special guidelines on the use of drugs that may have been contaminated by flooding or unsafe water and the use of temperature-sensitive drugs in a temporary electrical-power failure. For instance, while the three U.S. insulin manufacturers recommend that insulin be stored in a refrigerator, the FDA site says all insulin products may be left unrefrigerated at up to 86° Fahrenheit for up to 28 days and still maintain potency. The FDA also offers guidelines for substituting different types of insulin in the event of an emergency.

As health-care teams scramble to aid survivors in New Orleans and other affected areas, one of the most pressing needs has been insulin and supplies crucial to the survival of diabetics. "People often don't take the necessary precautions, because most of us aren't that organized, and then something happens and it's too late," says Nathaniel Clark, an Alexandria, Va., endocrinologist and vice president for clinical affairs of the American Diabetes Association. "Each patient needs to think about what they would need to take in their car or in a backpack to properly manage their health if they had to leave their home for two weeks."

But doctors typically write prescriptions for a 30-day supply of medications, and insurance companies often won't pay for more. Dr. Clark advises any patient who depends on a regular medication to always ask the doctor to write an extra prescription for an emergency supply. If necessary, it may be advisable to pay for the extra drugs out of pocket for the peace of mind. Public-health experts also advise keeping an eye on expiration dates of extra medications and replacing them when necessary; expired medicines often lose potency, and they can even be harmful.

Keeping prescriptions at chain pharmacies may make it easier to get supplies if access to local pharmacies becomes limited. Thirty-four Rite Aid stores, for example, are closed as a result of Katrina but the company says customers can get prescriptions filled at any Rite Aid across the country because of its satellite-linked computer system. It will also fill prescriptions from other pharmacies, help track down prescriptions from insurance companies and doctors, disregard co-pays and provide a 30-day supply of medications at no cost in cases of need.

It is also important to ask doctors what steps to take in the event that you don't have enough medication to last through an emergency. Suddenly stopping blood-pressure medications, for example, may cause chest pain, irregular heartbeat or even heart attack. But for some conditions, such as high cholesterol, it may be possible to stretch medications out by skipping every other dose or cutting pills in half. The American Red Cross suggests asking your doctor if it would be safe to go without one dosage periodically, until an adequate supply has been accumulated. It is also helpful to know in advance what steps can be taken if no medications are available. Patients with Type 2 diabetes, for example, may not have as pressing a need for insulin, Dr. Clark notes, but would have to more carefully monitor their food intake.

Other government Web sites offer guidelines to help prepare for disasters ranging from terrorist attacks to volcanic eruptions, including information for those with special medical needs and those with disabilities. The federal Department of Homeland Security's ready.gov site, the Federal Emergency Management Agency's fema.gov and the Centers for Disease Control and Prevention (www.cdc.gov) provide instructions on planning for disasters, preparing first-aid kits and caring for wounds in an emergency.

The Red Cross has extensive resources on its site to help prepare for disasters (www.redcross.org/services/disaster) and sells emergency-preparedness kits for home and workplace use. It also offers advice for disaster planning for patients with special needs including those who are wheelchair-bound or have sight, hearing or learning disabilities.

Disease groups, pharmaceutical companies and medical-supply companies around the country are offering emergency services including medications, dialysis for kidney patients and chemotherapy for cancer patients. In addition, many are offering emergency-preparedness tips on their Web sites. The American Diabetes Association, for example, (diabetes.org) suggests storing three days of diabetes supplies, which could include oral medication, insulin, insulin-delivery supplies, extra batteries for a glucose meter or pump, a quick-acting source of glucose such as tablets, and a commercially available emergency kit with glucagon, the hormone used to treat severe low blood sugar in diabetics who are unable to take sugar by mouth.

For parents of children with diabetes, the group also stresses that parents plan ahead and know which staff members at a school or day-care center will assist the child in the event of an emergency evacuation. The American Academy of Pediatrics, which is developing a network of pediatric professionals to accompany organizations responding to disasters on a short-term notice, offers family-readiness kits that can be downloaded from its Web site (www.aap.org) including sample emergency-information forms for children with diabetes, leukemia and heart failure.

• Send e-mail to Informedpatient@wsj.com.

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