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"The next few days, staying hydrated is the big thing and avoiding consuming contaminated foods and water. ... If you can do that, you're probably OK for a week," -- Dr. Joseph Guarisco, chairman of the Department of Emergency Medicine at the Ochsner Clinic Foundation in New Orleans Please scroll down to view this page's content.

Table of contents
1 Health

1.1 Drinking Water
1.2 Water Purification
1.3 Sanitation in Disasters Resources
1.4 Handwashing Saves Lives
1.5 Safety and Disease Prevention
1.6 Dead Bodies - Information on Handling
1.7 Care for Infants

1.7.1 Baby wearing
1.7.2 Breastfeeding

2 Disease

2.1 Disease Surveillance

2.1.1 Cholera
2.1.2 Dengue Fever
2.1.3 Malaria
2.1.4 Post-traumatic stress prevention
2.1.5 Acute Kidney Failure

2.2 HEALTH CARE PROFESSIONALS (http://www.bt.cdc.gov/disasters/hurricanes/index.asp) - Local, State and Federal (CDC) Advisories
2.3 More Resources

2.3.1 CDC Hurricane-Related Information for Health Care Professionals
2.3.2 Call for Voluteers (State and National) - Health Care Professionals

2.3.2.1 Louisiana Waives Temporary Physician Licensure Requirements

2.3.3 Intake & Health Surviellance FORMS (CDC) for Health Care Professionals(pdf & MS Word)
2.3.4 Emergency Wound Management for Health Care Professionals
2.3.5 CDC Index of Printable Materials
2.3.6 CDC Immunization Advisory
2.3.7 Tetanus Prevention
2.3.8 Environmental Health & Toxicology Links
2.3.9 Disaster Mental Health Resources
2.3.10 Health Situation Reports - Daily Advisory

2.4 Medical and Safety Precautions: Returning Evacuees and Civilians Traveling to Gulf States Recovery Region http://www.bt.cdc.gov/disasters/hurricanes/index.asp

2.4.1 Special Precautions for Evacuees Returning Home to Gulf States Recovery Areas
2.4.2 FEMA Registration of Returning Evacuees
2.4.3 General Advice for anyone travelling to the Gulf states recovery area
2.4.4 Travel Supply Checklist: Returning Evacuees and Civilian Recovery Personnel
2.4.5 Preparation & Planning Before Departure
2.4.6 Demographics of Recovery Areas

2.5 Environmental Concerns - Water Safety - Chemical Exposure - Toxic Gases - Mold
2.6 First Aid & Health Reminders

2.6.1 Rest & Nutrition
2.6.2 Worksite Safety
2.6.3 Wildlife & Outdoor Hazards
2.6.4 Safety & Security Concerns
2.6.5 Electronic Devices & Hazards

2.7 Field Mangement of Minor Personal Injuries and Illness

2.7.1 Splinter Removal
2.7.2 Minor Cuts and Abrasions(links)
2.7.3 Minor puncture Wounds
2.7.4 Minor Burns
2.7.5 Snake Bites
2.7.6 Insect Bites & Stings - Fireants
2.7.7 Plant Allergy: Poison Ivy / Oak (Rhus dermatitis)

Health

Drinking Water

People who do not drink adequate amounts of water will become dehydrated. This may be due to lack of access to potable water, distraction and/or psychological effects of the disaster, and/or overexertion in self-rescue or relief efforts. Dehydration impairs judgment and overall health. A good rule of thumb is that a person who is not drinking enough water will have urine that is less than clear; i.e. yellowish or cloudy.

Approximately one gallon of water per person per day is necessary to health and life. People can survive for many days without food and tolerate other hardships, but lack of water can kill in two to seven days depending on temperature and level of exertion.

Water Purification

In order to drink the water, you must treat it. You cannot tell whether water is safe to drink by looking at it!

Several methods to purify water are listed.

Iodine can be used to treat water in emergency conditions.

  • Pre-Treatment Screening

The water to be purified needs to be as clean as possible prior to treatment. Start with the cleanest water available. For example, if municipal tap water is known to be contaminated, it is better than flood water. DO NOT USE FLOOD WATER UNLESS YOU HAVE NO OTHER ALTERNATIVE.

If there are any visible particles in the water to be treated, remove these particles by straining through cloth or by pouring from container to container.

  • Boiling - Boiling is the most certain way of killing all microorganisms. According to the Wilderness Medical Society, water temperatures above 160° F (70° C) kill all pathogens within 30 minutes and above 185° F (85° C) within a few minutes. So in the time it takes for the water to reach the boiling point (212° F or 100° C) from 160° F (70° C), all pathogens will be killed. No need to keep the water boiling! (In other words, recommendations to boil water for five minutes, ten minutes, etc. are excessive. One minute at boiling temperature is sufficient.)
  • Cheapest and Easiest Drinking Water - Solar Method (SODIS) and WHO approved - Learn and Teach - SODIS POTABLE WATER SODIS (http://www.sodis.ch/Text2002/T-Howdoesitwork.htm)
  • Water - Purification - Solar Cooking
    • Solar cooking is another method for water safety. Solar Cooking (http://www.solarcooking.org), as boiling needs a source of energy which not always will be available. Solar cooks can be built cheaply with available resources, and if done apropriately can be used to warm up water for long enough to kill most germs. .
  • Filtration - Commonly available over the counter filters are intended to improve the taste of potable drinking water, NOT to purify non-potable water directly! Filters intended for use in camping are often inadequate to purify flood waters, which will contain contaminants. A high-end camping filter with iodine resin and/or rated by its manufacturer to remove viruses may be adequate. Military-grade filters intended for use in developing countries such as the British Berkefield will be suitable.
  • General Chemical Treatment Procedures
    • The effectiveness of all chemical treatment of water is related to the temperature, pH level, and clarity of the water. Cloudy water often requires higher concentrations of chemical to disinfect
    • If the water is cloudy or filled with large particles, strain it, using a cloth, before treatment. Large particles, if swallowed, may be purified only "on the outside"
    • Add the chemical to the water and swish it around to aid in dissolving
    • The water should sit for at least 30 minutes after adding the chemical to allow purification to occur. If using tablets, let the water sit for 30 minutes after the tablet has dissolved
    • Chemically treated water can be made to taste better by pouring it back and forth between containers, after it has been adequately treated. Other methods include adding a pinch of salt per quart or adding flavorings (e.g., syrup mix, etc.) after the chemical treatment period
    • Additional Water Help Including Bleach Method - Emergency Disinfection of Drinking WaterEPA (http://www.epa.gov/OGWDW/faq/emerg.html)
    • Note that water adequately treated with chlorine should slightly smell of chlorine, but not ss much as typical pool water.
  • Iodine Treatment
    • Iodine is light sensitive and must always be stored in a dark bottle. Iodine has been shown to be more effect than chlorine-based treatments in inactivating cysts. Let water stand for at least 30 minutes before use. Generally, the procedure is as follows:
      • Iodine Preparations
      • Preparation Iodine => Amount/Liter
      • Iodine Topical Solution 2% = 8 drops per liter
      • Iodine Tincture 2% = 8 drops per liter
      • Lugol's Solution 5% = 4 drops per liter
      • Povidone-Iodine (Betadine®) 10% = 4 drops per liter
  • Chlorine Treatment With Household Bleach
    • Free chlorine is the most widely and easily used, and the most affordable of the drinking water disinfectants. It is also highly effective against nearly all waterborne pathogens (except Cryptosporidium parvum oocysts and Mycobacteria species). At doses of a few mg/litre and contact times of about 30 minutes, free chlorine generally inactivates >99.99% of enteric bacteria and viruses.
    • For point-of-use or household water treatment, the most practical forms of free chlorine are liquid sodium hypochlorite, solid calcium hypochlorite and bleaching powder (chloride of lime; a mixture of calcium hydroxide, calcium chloride and calcium hypochlorite).
    • The amount of chlorine needed depends mainly on the concentration of organic matter in the water and has to be determined for each situation. After 30 minutes, the residual concentration of active chlorine in the water should be between 0.2-0.5 mg/l, which can be determined using a special test kit.
    • In the home, UNSCENTED household bleach is typically 5.25 percent sodium hypochlorite. Always check labels. Eight to ten (8 to 10) drops of bleach per gallon of water is recommended by public health authorities, more if water is cloudy.
    • If testing is not available, the water should slightly smell of chlorine -- but not so much as pool water.

Sanitation in Disasters Resources

Simple summary: do not let people go to the bathroom wherever they want! Urine is relatively harmless but feces are not! Feces spread disease and must be properly disposed of.

Small groups can improvise a toilet with a five gallon bucket, a plastic bag and a bit of bleach. Avoid urination in this bucket to extend its usefulness.

Larger groups MUST designate a latrine area with porta-potties, trenches, whatever field expedients you can find PLUS handwashing facilities! The latter can be as simple as non-potable water in a hanging bucket with whatever soap can be found.

Injured, ill and sick people may have to be helped to defecate in bedpans, and the bedpans taken to the latrine area.

FAILURE TO WASH HANDS AFTER DEFECATION IS A MAJOR DISEASE OUTBREAK VECTOR.

Most are PDF files with illustrations which can be downloaded and printouts given to teams for training and to teams heading for relief work in affected areas

Handwashing Saves Lives

  • Clean hands save lives. How to do it:

HOW TO WASH YOUR HANDS from Handwashing In Emergency Situations (http://www.bt.cdc.gov/disasters/hurricanes/handwashing.asp) (Center for Disease Control - USA)

Wash hands frequently, especially prior to preparing food or water, before and after giving medical care, and after defecation. An easy way to make sure you have washed your hands for enough time is the sing the "ABC Song." When the song is done your hands are clean. Failure to wash hands contributes to disease outbreaks!

When should you wash your hands? 

  1. Before preparing or eating food.

  2. After going to the bathroom.

  3. After cleaning up a child who has gone to the bathroom.

  4. When tending to someone who is sick.

  5. After handling uncooked foods, particularly raw meat, poultry, or fish.

  6. After blowing your nose, coughing, or sneezing.

  7. After handling an animal or animal waste.

  8. After handling garbage.

  9. When treating a cut or wound.


Safety and Disease Prevention

  • Universal Precautions

Protect yourself while helping others. Universal Precautions include the use of barrier methods (gloves, masks, gowns, etc) to protect the rescuer from blood and bodily fluids that may transmit disease. In the absence of equipment, follow the rule "If it's wet, don't touch it!" with respect to bodily fluids and/or have injured persons use direct pressure on their own wound until a bandage can be found or made.

  • Protective Equipment

Rescuers should wear protective gear appropriate to the task. This will mean a hard hat or helmet, bright colored vest, goggles, leather gloves, long-sleeved shirts and pants, and sturdy footwear such as boots. If working in proximity to the water, a life jacket is essential. An injured rescuer imperils not only themselves but the entire rescue effort of which they are a part, and any persons who would have otherwise been saved. SAFETY FIRST.

  • First Aid Practices

Wounds should be protected from sources of infection. Hasty efforts at cleaning a wound are often inadequate and this task should be not be attempted under field conditions if better facilities are available. Bandages should not be continually removed and replaced with clean ones except under medical direction to do so.

Dead Bodies - Information on Handling

The health risks of handling dead bodies are often exaggerated. Avoidance of close contact is often sufficient for persons not tasked with handling the dead.

  • Possible risks with handling dead bodies
    • Exposure to bloodborne viruses occurs due to direct contact with non-intact skin of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid
    • Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections
  • Precautions to be used by all persons working with bodies
    • Vinyl or Latex gloves should be worn
    • Masks and protective eyewear or face shields should be worn during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes
    • Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.
    • Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Hands should be washed immediately after gloves are removed.
    • Graveyards should be at least 30m from groundwater sources used for drinking water
    • The bottom of any grave must be at least 1.5m above the water table with a 0.7m unsaturated zone. **Surface water from graveyards must not enter inhabited areas.
    • Ensure universal precautions for blood and body fluids
    • Ensure use of body bags
    • Ensure disinfection of vehicles and equipment
    • Bodies do not need to be disinfected before disposal (except in case of cholera)
    • Vaccinate workers against hepatitis B

Care for Infants

This info might be helpful to people working directly with families with young children. It is in regards to baby wearing(holding a baby, young child, ect close to your body with the help of some type of cloth) and breastfeeding in emergency situations.

Baby wearing

Breastfeeding

Disease

Disease Surveillance

Disease Surveillance

  • In disease surveillance following are important
    • a network (perhaps a hierarchy with some extra confirmation points) of trusted sources
    • case definitions (are we counting deaths, diseased, people at risk? do we count those with diarrea? do we need to define "fever"?)
    • needed data (do we need the age of the people with that disease? or just the numbers? what do we need to know?)
    • ways to communicate the data to the people who count up the numbers
    • ways to spread the information to people who can do practical things
  • In case of Malaria
    • It is important to track weekly case numbers and provide laboratory-based diagnosis (perhaps only for a % of fever cases to track the slide/test positivity rate), to pick up the early stages of a malaria epidemic
    • Active search for fever cases may be necessary to reduce mortality in remote areas with reduced access to health care services

Cholera

  • Causes
    • Cholera is an intestinal infection caused by a bacteria - and is often linked to contaminated supplies of drinking water
    • The bacterium is part of the flora of brackish water and estuaries - it is when this water gets into the drinking supply that an outbreak can start
  • Symptoms
    • It causes severe diarrhoea and vomiting, and patients, particularly children and the elderly, are vulnerable to dangerous dehydration as a result
    • Most symptomatic cases are hard to distinguish from other illnesses that cause diarrhoea - it is only in one in 10 that severe symptoms such as dehydration occur.
  • Corrective Measures
    • Clean water and rehydration salts are required, but they are often in short supply in areas where they are needed most
    • Normally, rehydration salts are the only treatment given, although severely dehydrated patients may need intravenous fluids
    • Antibiotics can reduce the amount of diarrhoea
    • Systems for hygienic disposal of human wastes also need to be brought in
    • Cooking practices need to be made as safe as possible - where practicable, food needs to be cooked thoroughly and eaten while hot, and raw fruit and vegetables avoided unless they are peeled first
    • Handwashing after going to the toilet is a vital measure to prevent the spread of the disease

Dengue Fever

  • Causes
    • Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. People get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite.
  • Symptoms
    • Symptoms of typical uncomplicated dengue usually start with fever within 5 to 6 days after a person has been bitten by an infected mosquito. Symptoms include: high fever, up to 105 degrees Fahrenheit, severe headache. retro-orbital (behind the eye) pain, severe joint and muscle pain, nausea and vomiting, and rash. The rash may appear over most of the body 3 to 4 days after the fever begins. A second rash may appear later in the disease. Most children infected with dengue virus never develop typical symptom
  • Treatment
    • There is no specific treatment for dengue fever, and most people recover completely within 2 weeks. To help with recovery, health care experts recommend getting plenty of bed rest, drinking lots of fluids, taking medicine to reduce fever. People with dengue fever should NOT take aspirin. Acetaminophen or other over-the-counter pain-reducing medicines are safe for most people.
  • David W. Moskowitz, MD, FACP, is willing to volunteer a patent-pending approach he believes will work for Dengue Fever, which has been successful against West Nile virus encephalitis and uses readily available pharmaceuticals. Healthcare providers can email him at dwmoskowitz@genomed.com


Malaria

  • Causes
    • Malaria is caused by infection of a parasite which is carried from person to person via mosquitoes
    • Increase in the cases of Malaria recently because of development of resistance to traditional drugs, mosquitoes becoming resistant to insecticides and changes in the environmental conditions
  • Symptoms
    • The first is high fever, followed a few hours later by chills. Two to four days later, this cycle is repeated
    • The most serious forms of the disease can affect the kidneys and brain and can cause anaemia, coma and death
  • Corrective measures
    • The spread of the disease can be reduced by cutting down the mosquito population, for example by filling ditches where mosquitos breed
    • Early diagnosis can lead to successful treatment so education in spotting the symptoms of malaria is important
    • Bed nets coated in insecticide have also reduced the incidence of the disease by up to 35%, according to the World Health Organisation
    • Artemisinin-based combination therapy should be provided when a falciparum malaria epidemic is confirmed



Post-traumatic stress prevention

  • Disaster Mental Health Resouces CDC Diosaster Resouces (http://www.bt.cdc.gov/mentalhealth/)
  • National Child Traumatic Stress Network (http://www.nctsnet.org/nccts/nav.do?pid=hom_main)
  • Links and information related to psychological support for trauma after any disaster
  • Medline Plus (http://www.nlm.nih.gov/medlineplus/posttraumaticstressdisorder.html)
  • National Center for PTSD (http://www.ncptsd.org/facts/disasters/fs_rescue_workers.html)
  • Self Care and Self Help (http://www.ncptsd.org/facts/disasters/fs_self_care_disaster.html)
  • Survivior Fact Sheet (http://www.ncptsd.org/facts/disasters/fs_survivors_disaster.html)
    • Most disaster survivors only experience mild, normal stress reactions, and disaster experiences may even promote personal growth and strengthen relationships. However, as many as one out of every three disaster survivors experience some or all of the following severe stress symptoms, which may lead to lasting Posttraumatic Stress Disorder (PTSD), anxiety disorders, or depression:
      • Dissociation (feeling completely unreal or outside yourself, like in a dream; having "blank" periods of time you cannot remember); Intrusive reexperiencing (terrifying memories, nightmares, or flashbacks); Extreme attempts to avoid disturbing memories (such as through substance use; Extreme emotional numbing (completely unable to feel emotion, as if empty); Hyper-arousal (panic attacks, rage, extreme irritability, intense agitation); Severe anxiety (paralyzing worry, extreme helplessness, compulsions or obsessions); Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)
      • Most child and adult survivors experience one or more of these normal stress reactions for several days: Emotional reactions: temporary (i.e., for several days or a couple of weeks) feelings of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, or emotional numbness (difficulty feeling love and intimacy or difficulty taking interest and pleasure in day-to-day activities); Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame; Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, startling easily, racing heartbeat, nausea, change in appetite, change in sex drive; Interpersonal reactions in relationships at school, work, in friendships, in marriage, or as a parent: distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling
  • Helping Children and Adolescents Cope with Violence and Disasters, NIH Publication No. 01-3518, dated 2001 (http://www.nimh.nih.gov/publicat/violence.cfm)
    • Youngsters who have experienced a catastrophic event often need support from parents and teachers to avoid long-term emotional harm. Most will recover in a short time, but the few who develop PTSD or other persistent problems need treatment.
    • For children 5 years of age and younger, typical reactions can include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging. Parents may also notice children returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.
  • Center for Treatment of Psychotrauma (http://www.traumaweb.org/symptoms.shtml)
    • The symptoms that characterize Post-Traumatic Stress Disorder (PTSD) can be divided into three main categories: Re-experiencing; Avoidance; Hyper-arousal
    • Natural Recovery Process (http://www.traumaweb.org/coping.shtml) What can be done immediately after the traumatic event? Return to routine: Try to get back to normal, as much as this is possible. Take care to get enough sleep: At this stage the body expends an enormous amount of energy and sleep is the way to restore this energy. Stay in touch: Keep in touch with those near to you, family and friends, and share your feelings with them. Limit media exposure: Try to control the amount of news and disturbing pictures you are exposed to via television, radio and newspapers. Postpone judgment to a later time: At this stage many people blame themselves for their behavior during the event. In many cases this is unjustified, but they have trouble seeing that on account of the emotional turmoil they are currently experiencing.
    • Theraputic Resources (http://www.swin.edu.au/bioscieleceng/neuropsych/ptsd/) world-wide listing from Australia.

Acute Kidney Failure

A frequent problem in land-based earthquakes is kidney failure from crush injuries and/or dehydration. The disruption of drinking water supplies, will also cause acute kidney failure due to dehydration.

  • Acute kidney failure normally requires kidney dialysis. Machines for blood-based dialysis ("hemodialysis"), or supplies for peritoneal dialysis can be quite scarce in devastated areas.
  • A new treatment which has been successful in pilot clinical trials in both adults and infants involves the use of an already existing medicine infused intravenously into the survivor's arm. For details: dwmoskowitz@genomed.com

HEALTH CARE PROFESSIONALS (http://www.bt.cdc.gov/disasters/hurricanes/index.asp) - Local, State and Federal (CDC) Advisories

CONDITIONS IN THE RECOVERY AREA CHANGE RAPIDLY. MANY NEW DISEASE AND HEALTH ADVISORIES ARE BEING POSTED BY THE C.D.C. and STATE HEALTH AUTHORITIES AS RECOVERY EFFORTS PROGRESS.

NEW ADVISORIES WILL BE POSTED REGULARLY. PLEASE REFER BACK OFTEN.

SPECIFIC CDC RECOMMENDATIONS


  • UNSORTED

Botulism Information from the CDC (http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism_g.htm#How%20can%20botulism%20be%20prevented)

Food Safety Threats from the CDC (http://www.bt.cdc.gov/agent/food/)

Tetanus Information from the CDC (http://www.cdc.gov/nip/diseases/tetanus/vac-chart.htm)

Emergency Response Cards for Chemical Agents from the CDC (http://www.bt.cdc.gov/chemical/erc.asp)

Comprehensive Insect Identificaion (http://strano16.interfree.it/insects.htm) National Institute of Mental Health (http://www.nimh.nih.gov/healthinformation/traumaticmenu.cfm) - Coping with traumatic events

More Resources

http://www.umm.edu/online/online.htm#Dermatologyhttp://www.dhh.state.la.us/http://www.dhh.louisiana.gov/offices/?id=145

http://www.thrombosis-consult.com/articles/Textbook/126_snake.htmhttp://www.emedicinehealth.com/Collections/CO1624.asp

http://www.emedicinehealth.com/Collections/CO1624.asp

http://www.ncemi.org/cse/contents.htm

Clanup and Safety for Rescue Workers (http://www.bt.cdc.gov/disasters/hurricanes/workers.asp)


Recommendations for Hurrican Relief Workers (http://www.cdc.gov/travel/other/hurricane/hurricane_relief_workers.htm)

Traveler's Health Kit (http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=recs&obj=travelers-health-kit.htm&cssNav=browseoyb)

About Leptospirosis (http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm)

http://www.hhs.gov/katrina/

http://www.bt.cdc.gov/disasters/workers.asp


https://volunteer.ccrf.hhs.gov/

http://www.epa.gov/safewater/faq/emerg.html Emergency Disinfection of Drinking Water from EPA

http://www.bt.cdc.gov/disasters/hurricanes/infectiousdisease.asp Emergency Wound Care after a Natural Disaster

http://emarketing.delmarlearning.com/ems/EMS_news_jun05_Job_Posting.asp

http://www.bt.cdc.gov/disasters/woundcare.asp


http://dmoz.org/Health/Public_Health_and_Safety/


…General Information http://familydoctor.org/symptom.xml?element=flowchart

http://canoesaskatchewan.rkc.ca/survival/firstaid.htm

http://www.dhec.sc.gov/health/mch/childcare/

http://www.mayoclinic.com/findinformation/firstaidandselfcare/index.cfm

http://www.bbc.co.uk/health/first_aid_action/

http://www.nols.edu/Publications/FirstAid/ColdInjury.shtml

http://www.parasolemt.com.au/manual/topics.htm

http://www.bt.cdc.gov/disasters/hurricanes/katrina.asp - From the Centers of Disease Control. Factsheets dealing with health concerns in the aftermath of the hurricane.

http://dmoz.org/Health/Conditions_and_Diseases/Food_and_Water_Borne/ - Directory of links on food and water borne agents of disease

http://dmoz.org/Health/Public_Health_and_Safety/ - Directory of links.

CDC Hurricane-Related Information for Health Care Professionals

Call for Voluteers (State and National) - Health Care Professionals

Louisiana Waives Temporary Physician Licensure Requirements

Intake & Health Surviellance FORMS (CDC) for Health Care Professionals(pdf & MS Word)

Emergency Wound Management for Health Care Professionals

CDC Index of Printable Materials

CDC Immunization Advisory

Tetanus Prevention

Environmental Health & Toxicology Links

Disaster Mental Health Resources

Health Situation Reports - Daily Advisory

http://www.gov.state.la.us/2005%20Executive%20orders/26PublicHealthEmergencyDeclaration.pdf

Medical and Safety Precautions: Returning Evacuees and Civilians Traveling to Gulf States Recovery Region http://www.bt.cdc.gov/disasters/hurricanes/index.asp

Special Precautions for Evacuees Returning Home to Gulf States Recovery Areas

  • Municipal services may be severely limited or non-existent.
  • Bring enough FOOD and WATER to last several days.
  • Police, fire and EMS services may not have returned to pre-hurricane levels - BE CAREFUL.
  • ALWAYS carry identification and proof of residency with you.
  • Some areas are still under military and law enforcement jurisdiction - follow all instructions.
  • Remember that hurricane season lasts through October - come prepared.
  • Rapid flooding may occur due to already damaged storm drainage systems.
  • Check daily on area curfews.

FEMA Registration of Returning Evacuees

If you have not done so, immediately register with FEMA for disaster aid and services.

  • Apply by Phone: Call 1-800-621-FEMA (3362)
  • For those with speech or hearing disabilities: Call TTY 1-800-462-7585

OR

General Advice for anyone travelling to the Gulf states recovery area

  • Adequate preparation and planning before entering the recovery area will help prevent personal injury and keep you from having to use an over-burdened health care system.
  • The following guidelines and suggestions are intended for the personal safety and comfort of civilian volunteers traveling to the recovery areas affected by Hurricanes Katrina and Rita and evacuees returning home.
  • Group leaders should review this information with young or inexperienced volunteers.
  • Individuals that have not lived in rural southern areas may be unfamiliar with the potential dangers of wildlife and outdoor hazards.
  • Always ask for guidance from local residents if you are venturing into unfamiliar surroundings.
  • Please observe all local, state and federal regulations when entering the Katrina recovery area.

Current advisory from LA Dept. of Health and Hospitals - Sept 09, 2005 : http://www.dhh.louisiana.gov/offices/publications/pubs-145/ID%20Advisory%20for%20Rescuers.pdf

Travel Supply Checklist: Returning Evacuees and Civilian Recovery Personnel

  • The checklist is not intended to be comprehensive or to cover every eventuality.
  • The checklist will focus on essential, easily transported items needed during moderate to extreme disruption of normal municipal services.
  • The checklist is a basic guide for personal health and hygeine needs for those travelling to regions affected by hurricane Katrina.
  • Use plastic not glass containers whenever possible
  • Some are optional, many may prove to be essential. Review carefully.
  • Purchase as many supplies and provisions before departure.


DOCUMENTS & IDENTIFICATION

  • Drivers license - Photo ID - Checkbook - Credit / debit cards
  • Lease/ mortgage documents - power, water, phone bills - motor vehicle registration
  • Detailed travel itinerary – for family / friends / email to yourself or others
  • Insurance documentation *passport *immigration documents
  • Licensures *Certifications (CPR, ACLS) *Social security Number
  • List of emergency phone numbers of your friends / family / contacts
  • Personal address book (hard copy) *PIM / Palm Pilot / Organizer
  • Local contact phone numbers *police *fire *EMS * Social Services
  • Ballpoint pen *pencil *note pad (see Pocketmod (http://www.pocketmod.com) )
  • Maps of region / city *Calendar / date book
  • Keys: house-car-destination *lock / door codes


PERSONAL MEDICATIONS

  • Tetanus shot up to date *Check need for hepatitis vaccine
  • Consider water purification tablets (giardia) – available at local camp supply stores
  • Consider antibiotic prophylaxis for travelers diarrhea – consult physician
  • Medications you will require (OTC and prescription) *Epi-pen for sting allergy
  • ASA *Acetaminophen *Pepto bismol *anti-diarrhea (lomotil)
  • Benadryl *Decongestant *Nasal spray *Inhaler *Eye drops *Antacid
  • Lip balm (chap stick) *Petroleum jelly (vaseline)
  • Diabetic supplies *insulin *needle / syringes *glucose tester / strips
  • Assorted bandaids *adhesive / surgical tape *gauze pads *cotton balls
  • Q-tips *corn pads (moleskin) *antibiotic ointment *antifungal cream *cortisone cream
  • Prepackaged alcohol wipes.


TRAVEL GEAR

  • Day pack *Shoulder bag *waist pouch *travel vest *walking shoes
  • Comfortable waterproof work boots, broken in, spare laces, double socks *sandals
  • Adjustable nylon belt *Thin leather work gloves (garden supply stores)
  • Hat *rain hat *parka / windbreaker *poncho *work out clothes
  • bathing suit / quick dry shorts


HYGIENE TOILETRY

  • Razor *shave cream / shave brush *small unbreakable mirror
  • toothbrush *toothpaste * dental floss *water filtration device
  • bar soap *Hand cleaner / sanitizer *liquid soap / shampoo *conditioner
  • deodorant / anti-perspirant *hair clips / tie-backs *condoms
  • tampons /sanitary napkins *Toilet paper *Tissues (Kleenex) *sanitary wipes


PERSONAL ITEMS

  • Bandanna / scarf *inflatable pillow *eye (sleep) shades *ear plugs, disposable
  • Pillows - towels - bed sheets - blankets
  • Dental retainer / appliance *measuring spoons *eye dropper *syringe
  • Extra pair of glasses and /or contacts * case for contacts / glasses *cleaning fluid
  • Sunglasses *Sunscreen *wash cloth/ sponge/ towel *zip lock bags
  • safety pins *sewing kit *matches *storm proof lighter
  • mesh bag *solar shower *plastic trash bags (lawn size for emergency poncho)
  • Protective eye-wear (plastic goggles) *2 pair vinyl / latex gloves
  • Whistle or signaling device *compass *small tape measure
  • multi-tool w/ knife, scissors (pliers) & screwdriver *nail clippers / file
  • tweezers *plastic wrap *duct tape *bandage scissors *food storage bags / containers
  • masking tape *shipping tape *wire cutters *surgical forceps/hemostats


ELECTRONICS

  • laptop *radio *camera
  • cell phone/ battery / charger *batteries
  • personal flashlight, extra batteries *keychain LED light
  • hand-held spotlight, waterproof


EXTRAS – GROUP TRAVEL

  • mesh hammock - sleeping bag - mosquito netting
  • brooms - buckets - mops - rags
  • mountaineering stove (butane, propane can’t be shipped by air)
  • Tarp *small hammer *Axe / hatchet *collapsible shovel *nylon rope *para cord
  • bungie / tie downs *tent / stakes / ground cloth *mosquito netting *signal flare
  • Assortment of nails, screws & fasteners *electrical tape *waterproof case / dry bag
  • air mattress / pump *portable stove *cookware *utensils *lantern
  • plates /bowls/ cups *camp chairs *hammock

Preparation & Planning Before Departure

  • Assume the worst, hope for the best…..prepare for both.
  • Your primary mission: help- not hinder- recovery efforts.
  • Adequate preparation will ensure that you do not become an additional casualty of a disaster.
  • Individuals in poor health or those with special medical needs should limit travel to the Katrina recovery area.
  • DO NOT bring pets to the disaster recovery region. They are easily lost or injured.


  • If time permits, attend a CPR or ACLS course before departing or after arrival.
  • If you have had CPR or ACLS training, review the basics no matter how experienced you are.
  • Keep abreast of health advisories, water purity reports and disease surveillance by the CDC and local authorities.
  • Expect to be self-sufficient in areas of storm destruction, reduced facilities, power outages and limited communications.
  • Keep a written inventory of all supplies and provisions. Label everything (especially clothing) !


  • Replace all expended supplies and provisions BEFORE they are needed again.
  • Check weather conditions and forecasts before departing and regularly during your visit.
  • The SE U.S. can be uncomfortably humid through September and air conditioning may be limited.
  • Additional storms may occur. Hurricane season extends to the first of November in the SE U.S.
  • CONFIRM flight schedules, transportation, local contacts, work assignments and accommodations before leaving. RECONFIRM!


  • Expect some travel delays into and out of the recovery area. Be patient and cooperative.
  • DO NOT just “show up‿ without specific plans, food, water, housing and transportation.
  • AIR TRAVEL may be restricted or have reduced services – if you fly, take as much by carry-on as possible.
  • AIRPORT SECURITY (T.S.A.) prohibits knives, files, sharp objects, lighters, matches, weapons and many other items in carry-on baggage. Observe all security advisories during air travel.
  • Declare any questionable items to airport security to avoid delays.


  • Consider using a cargo vest and/or waist pack.
  • ALWAYS carry fresh, clean water with you at all times, while traveling and at the worksite.
  • KEEP identification, travel documents and essential medications WITH YOU at all times.
  • Pack MREs, dry food and non-perishable items to last at least 2 days in case of unforeseen circumstances.
  • Pre-packaged plastic utensils, napkins, salt, pepper, bouillon cubes, soup mix, sweetener, cocoa, tea bags and instant coffee are easily transported.


  • Travel-sized toiletries, sealable plastic bottles and compact containers are sold at most camping suppliers and pharmacies.
  • Square or rectangular food storage containers are easily nested and/or packed with supplies to save space.

Demographics of Recovery Areas

Louisiana is divided into “parishes‿, not counties. The other states in the recovery area are divided into counties. http://en.wikipedia.org/wiki/Louisiana http://en.wikipedia.org/wiki/Mississippi http://en.wikipedia.org/wiki/Alabama http://en.wikipedia.org/wiki/Florida

  • Much of the recovery area outside cities and towns may be farm land, forest or may be sparsely populated.
  • Stores, gas stations, restaurants and service facilities may be many miles apart.
  • Know your destination, travel distance, roadside services and important local landmarks before leaving populated areas.
  • Many residents have had limited travel outside of the recovery area. Although Southerners are polite and gracious hosts, don't be surprised or offended if strangers are approached cautiously.

Environmental Concerns - Water Safety - Chemical Exposure - Toxic Gases - Mold


First Aid & Health Reminders

  • Always call for assistance or medical care for injuries and illness.
  • DO NOT attempt to move ill or injured victims unless there is a clear danger of further injury.
  • Immediately rinse open or puncture wounds with clean water.
  • Slow or stop bleeding with elevation and pressure. Remove clothing near the injury to inspect for additional trauma.
  • Apply a clean, dry dressing to wounds when possible. If bleeding continues, apply a second dressing over the first and apply pressure (not to puncture wounds).
  • If bleeding does not slow or stop , then remove dressings to inspect the wound. Re-bandage as needed.
  • Sanitary napkins, paper towels, clean clothing and fresh linens can serve as emergency bandages.
  • Umbrellas, walking canes and plastic pipe can be used for an emergency splint.
  • DO NOT attempt to remove deeply embedded objects or projectiles from yourself or others.
  • Rest, elevate and immobilize injured limbs. Apply cold every ½ hours for first 24 hours.
  • DO NOT apply tourniquets or tight dressings to injuries without medical advice.
  • Keep the injured quiet, immobile and provide a safe shelter until further help arrives.
  • Remain calm and focused. Panic may cause further injury to the victim or yourself.
  • Maintain scrupulous hygiene of skin, hands, nails, teeth and scalp to prevent injury or infection.
  • Your feet are your most important mode of transportation. Protect them from wetness and injury.
  • Prevent or promptly care for blisters and minor burns.
  • Remove splinters promptly. Wood, fibers, plastic or other foreign material may cause infection.
  • Minor cuts, scrapes and abrasions should be promptly cleaned and observed for swelling, pain, redness or heat. These are the signs of inflammation and may indicate infection.
  • DO NOT administer any of your prescription medications to others without medical advice.

The American Red Cross (http://www.redcross.org) has published post-hurricane safety guides

  • Power Outages (http://www.redcross.org/services/disaster/0,1082,0_563_,00.html)
  • Food Safety (http://www.redcross.org/services/disaster/0,1082,0_565_,00.html)
  • Chainsaw Safety (http://www.redcross.org/pubs/dspubs/chainsaw.pdf) (Pdf format)
  • Water Treatment (http://www.redcross.org/services/disaster/0,1082,0_133_,00.html)

Rest & Nutrition

  • The urgency of recovery efforts may dull your appetite or reduce thirst.
  • Maintain a REGULAR schedule of water and nutritional intake.
  • Eat and drink "by the clock" if you have to.
  • Avoid heavy meals, fatty foods and those high in sugar.
  • Limit intake of alcohol and soft drinks.
  • Get adequate SLEEP to maintain alertness.
  • Take breaks if needed to maintain concentration.

Worksite Safety

  • Hearing protection is especially important around machinery, generators, chainsaws and aviation. Soft foam disposable ear plugs are inexpensive and sold at most pharmacies.
  • Leather work gloves should be worn when clearing debris or handling building material.
  • Generators, heavy equipment, chain saws, etc. may cause severe burns.
  • Avoid and promptly report noxious fumes, odors or gases. They might pose a risk of ignition, explosion, illness or injury.
  • Wear only approved breathing masks or respirators when working around thick dust, fumes and smoke.
  • Hard hats are required at construction sites.
  • Standard eyewear does not provide adequate vision protection or side panels. Most safety goggles can be worn over your standard glasses.
  • Clear plastic safety goggles should ALWAYS be worn during construction work, when clearing debris, while operating chain saws or near flames.
  • Immediately flush eye injuries or chemical exposures with clean water. Seek medical evaluation.
  • DO NOT attempt to handle potentially hazardous, explosive, inflammable, toxic or corrosive chemicals unless you have been adequately trained to do so.
  • Work within your physical capabilities. Physical injuries will keep you from recovery efforts.
  • Falling objects and ground obstructions can cause serious injury.
  • DO NOT attempt to operate unfamiliar machinery or tools without instruction or supervision.
  • Chainsaws should only be used by properly trained or experienced individuals.

Wildlife & Outdoor Hazards

  • DO NOT attempt to feed stray wildlife. Rabid, diseased or injured animals may attack without warning.
  • Hurricanes disrupt natural habitats. Raccoons, possum and deer may enter populated areas with disease or present transportation hazards on roads.
  • Inspect yourself and others daily for ticks. Remove ticks completely with tweezers or forceps by slowly pulling up and away from the skin until the mouth releases.
  • Poisonous snakes are common in the SE United States. Do not attempt to capture snakes no matter how small or innocuous they seem.
  • Snake bites should receive prompt medical attention. Work boots and long pants should be worn in areas likely to harbor snakes.
  • Wasps, hornets, bees and other stinging insects usually don't strike unless disturbed. If encountered, move away slowly and do not "swat" at them.
  • Individuals with known allergies to stings (hymenoptera) should always carry an adrenaline (epinephrine) self-injection device - Epi-pen- and receive prompt medical attention if stung.
  • Black bears are occasionally encountered in the recovery areas. Do not leave food out or in open containers in populated areas or campsites.
  • Bears usually avoid humans unless they are hungry, provoked or their cubs are threatened. Report all bear sightings to wildlife authorities.
  • Alligators and crocodiles inhabit much of the wetlands and coastal region of the recovery area. One million live between Florida and Louisiana. DO NOT approach, threaten or attempt to feed them.
  • Poison Ivy can be found throughout the recovery areas. Even dead plants have enough toxic oil to cause allergic reactions. "Leaves of three, leave it be!"
  • Red bugs (chiggers), gnats, mosquitoes, horse & deer flies and other biting insects are common in the recovery area. Use insect repellant before exposure.
  • Fire ants and venomous spiders may be found in the Katrina recovery area. (more to come)

Safety & Security Concerns

Information

  • Frequently monitor status of recovery efforts or changing conditions by radio / TV / Internet.
  • DO NOT act on “rumors‿ or unsubstantiated information.
  • DO NOT make un-necessary cell phone or land line calls.


Caution

  • Approach unfamiliar or poorly lit areas carefully.
  • Locate alternate or emergency exits before entering any unfamiliar location.
  • Stay clear of damaged buildings or structures- they can collapse, injuring you and others.


Uniformed Personnel

  • DO NOT attempt to “help‿ or interfere with police, fire, rescue, military or medical personnel unless requested to do so.
  • DO NOT try to enter restricted areas or private property without permission or proper authorization.
  • Police and military will consider unauthorized civilians in restricted areas to be a potential threat.
  • Promptly identify yourself to law enforcement or military personnel when requested.
  • Written orders, work requests, permits or other documents should be with you at all times.


Guns and Ammunition

  • DO NOT carry, conceal or transport firearms and ammunition unless you have a permit to do so AND it is with you.
  • Firearms must be kept safe from children, unloaded and with trigger locks in place.
  • Each state has different licensure requirements for the transport and concealment of weapons.
  • Observe all local laws and regulations that govern the transport, use or discharge of firearms.


Follow Regulations

  • Firearm carry permits may not be valid in states that did not issue them.
  • Always check with local or state law enforcement if in doubt.
  • Immediately inform police or military of any potential weapons in a vehicle if stopped or asked to allow a vehicle search.


Co-operate

  • At check points, traffic stops or accident sites, DO NOT attempt to exit your vehicle unless requested to do so by law enforcement or military.
  • When approached by military or law enforcement, KEEP YOUR HANDS VISIBLE AT ALL TIMES.
  • If in doubt, ask for proper identification of anyone in plain clothes acting as law enforcement or military.
  • Record the name, badge number or vehicle identification if the situation permits.


Money

  • Do not carry or reveal large amounts of cash.
  • Many areas may not have functioning ATMs.
  • Banks may have limited hours of operation or services in the recovery area.

Electronic Devices & Hazards

Power

  • Consider all downed electrical power lines to be dangerous. Notify authorities immediately if encountered.
  • The storm and floods may have damaged electrical circuits in dwellings and outdoor buildings.
  • Reliable electric power may be limited or non existent – adjust to "low-tech" and hard copy.
  • Charge all portable electronic devices before departing and maintain charges if possible.
  • Rechargeable batteries will save time and money if power is available.
  • Try to keep battery sizes the same (ex: all AA)
  • Car chargers may be the only power source.


Supplies

  • Be very selective in what devices you bring!
  • Bring chargers/power cords for any electrical devices you transport.
  • IF your laptop is essential, bring power cord, adapter, phone line, network patch cord and storage media (disks, floppies).
  • Chargers, cords, batteries and accessories for electronic devices may not be available in remote or isolated areas.


Spectrum

  • Use surge protectors whenever possible.
  • Radios with AM-FM, TV band, Short Wave and Weather are preferred.
  • Portable games, CD players and MP3 devices without AM/FM radios are NOT essential.
  • Hand held scanners, CB radios and two-way communicators MUST NOT interfere with rescue and recovery operations.
  • Ham, emergency and short range communication bands are essential for rescue and recovery personnel.
  • Avoid any non-emergency use of bandwith in the recovery areas.

Field Mangement of Minor Personal Injuries and Illness

Splinter Removal

  • Gently clean the wound with fresh water and mild soap or wipe with alcohol (may sting!)
  • Remove any obvious foreign material with a clean tweezers or forceps.
  • Use a magnifying glass or loupes, if available.

If material is not easily or completely removed:

  • Sterilize a needle or knife tip by flame (3-4seconds) or with "rubbing" alcohol (Isopropyl).
  • Gently pierce the skin over the splinter enough to expose the foreign material.
  • Attempt removal with tweezers or forceps.
  • Try to remove object in the opposite direction that it entered skin.
  • If no tweezers or forceps, attempt pushing object out with needle or knife tip.
  • Flush with clean water.
  • If foreign material remains, repeat steps above.
  • Do not probe deeply or cause further injury.

After removal:

  • Pat wound dry, apply antibiotic ointment and cover lightly.
  • Elevate affected area as much as possible during next 24 hours.
  • Observe carefully for redness, pain, swelling or warmth. This may indicate infection.
  • Individuals with diabetes or impaired immune system should seek medical follow-up
  • Systemic antibiotics not routinely needed unless wound was grossly contaminated.
  • Seek tetanus immunization if needed (last “booster‿ greater than 10 years ago).http://www.cdc.gov/nip/vaccine/tetanus/default.htm


Foreign material not removed:

  • Clean and bandage, elevate area, apply ice and seek medical evaluation

Mayo Clinic - http://www.mayoclinic.com/invoke.cfm?objectid=144BD72A-4C91-47A7-81B45DFF8D19977D

"Simple Medical Emergencies" - http://www.ncemi.org/cse/cse1106.htm

Minor Cuts and Abrasions(links)

CDC Wound Care Recommendations - http://www.bt.cdc.gov/disasters/woundcare.asp

Minor puncture Wounds

Minor Burns

Snake Bites

Insect Bites & Stings - Fireants

Plant Allergy: Poison Ivy / Oak (Rhus dermatitis)

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