Section Sponsored by:

When a major disaster such as the Haiti earthquake strikes, it reminds us of the vulnerability of people who are dependent on long-term oxygen and ventilators at home. Yet the conversation between respiratory care clinicians and patients about emergency planning needs to continue long after the headlines fade.

It may seem like a daunting task to increase your patients' preparedness, especially when their complex care plans appear overwhelming on a daily basis. The key is to make discussions frequent, short, realistic, and specific to your patients.

While an all-hazard approach to disaster planning is important, it also helps to know what types of emergencies, human caused and natural, have occurred in your area. This can help customize your planning. For example, if your patients have chronic obstructive pulmonary disease and live in an area prone to wildfires, they need to be aware that smoke and fire debris raise the risk of respiratory distress.

Also consider the physical structure where your patients live. If they reside in apartments, how will they exit if the elevators are not accessible? The apartment complex may have an emergency generator, but does it only power main corridors? You will want to figure out these answers long before a disaster hits.

If they live in houses, make sure they own backup generators of adequate size and they have enough fresh gasoline fuel stored safely to support equipment, lighting, and appliances for 72 hours. Draw the floor plans of their homes to identify escape routes and safe places to stay for each type of disaster. If a patient cannot reach a basement during a tornado, is there a first-floor room without windows?

Determine several methods for your patients to communicate during an emergency. It may seem obvious that they should keep a cell phone charged and have extra batteries. But cell phone towers may be down or overwhelmed. A touch-tone phone that does not require an electrical outlet is a possible alternative. Think about how they also could access email, pagers, text messaging, two-way radios, and ham radios. Remind your patients to keep emergency numbers handy.

Familiarize your patients with their medical equipment. Ensure that they know the working time of any internal batteries that support their ventilator systems and how low-battery alarms operate. Contact their medical equipment vendor to determine ways to recharge batteries if the electricity fails, such as connecting jumper cables to a vehicle battery or using a converter that plugs into a cigarette lighter.

Many checklists are available to create a basic disaster survival kit. You can help your technology-dependent patients acquire other "must-have" items specific to their conditions. Patients who use oxygen should have a full backup cylinder that will last at least 48 hours. Advise them to contact their oxygen supplier and ask if and how the supplier will provide refills during a crisis. They should find out the priority of deliveries in such cases and exactly where they stand on that list. It is likely home oxygen delivery trucks will be delayed or unable to travel, so this should not be patients' only plan.

When preparing for these worst-case scenarios, consult with your patients' physicians about what flow rate adjustments can be made to stretch out oxygen supplies. Be sure to record the reduced flow numbers on the equipment so that your patients can refer to them easily. Another approach is to teach your patients how to use a home pulse oximeter to titrate and conserve oxygen during an emergency.

If appropriate, practice pursed-lip breathing with your patients, which helps to bring up their oxygen levels when they start to feel anxious and short of breath.

Patients who use ventilators should check with their insurers to see if they qualify to receive a secondary emergency ventilator or at least a backup rechargeable battery. Other equipment and items to have readily available include cleaning supplies for respiratory equipment, portable suction equipment, secretion clearing aids such as a cough in-exsufflator, extra ventilator circuits, spare tracheostomy supplies, and a manual resuscitation bag.

Your patients should have a two-week supply of medication on hand, although insurance rules may make this difficult. Be sure patients know how to store medications appropriately and to rotate it before it expires. Recommend that they keep the patient information handouts that come with each prescription in a plastic bag so that they will have a convenient list of medications.

If your patients use stationary nebulizers for breathing treatments, advise them to consult their physicians about using metered-dose inhalers as a substitute, in case the power fails. Purchasing a portable, battery-powered nebulizer is another option.

Help your patients assemble copies of important documents: vital patient care information, prescriptions, equipment make and serial numbers, a living will, medical power of attorney, and insurance cards.

Encourage your patients to establish a universal support team by contacting the utility company, police and fire departments, and local emergency management office. Patients should let these offices know they are dependent on life-support devices and should be put on priority response lists if they exist.

Often, however, the first responders in a disaster will not be trained emergency personnel. They will be family, neighbors, friends, and co-workers. Your patients should not expect to rely on any one person, such as a personal attendant, who may not be available within minutes if a major disaster strikes.

They should build their support team anywhere they spend a large part of their day - work, home, school, and volunteer sites. Traits to look for are people who are strong, calm, dependable, and good communicators. Offer your patients assistance in teaching others how to operate and repair their equipment. Suggest simple written instructions for laminated cards that can be attached to equipment.

It is also important to cover evacuation plans. At what point should your patients leave their homes, where will they go, and how will they get there? Identify at least two sites - preferably with family or friends - where they could relocate and store backup equipment.

Going to a shelter is usually a last resort because they can be uncomfortable, germy, cold places. Some communities, such as those in hurricane-prone regions, have medical shelters that provide supervised care to pre-registered people with specific medical needs.

Wherever your patients go, make sure they know to bring supplies, important papers, and extra clothing. If possible, they should notify their medical equipment provider in advance so that oxygen refills can be redirected there.

Once your patients have reviewed their response plans with their physicians and given copies to their support team, do not sit back and wait for a disaster to happen. Practice emergency drills and make revisions as necessary. Your commitment to continuous disaster planning and education will save lives.

June Isaacson Kailes is a disability policy consultant and associate director of the Center for Disability and Health Policy at Western University of Health Sciences, Pomona, Calif. She can be reached at jik@pacbell.net and www.jik.com. Contact Sharlene George at sgeorge@advanceweb.com.