If you have diabetes, heart disease or another chronic illness (like me), your chances are higher.

A 2008 study titled Chronic disease and natural hazards: impact of disasters on diabetic, renal and cardiac patients found that chronic diseases are exacerbated during and immediately following natural disasters (Miller & Arquilla, 2008). That means, if you have diabetes before a disaster strikes your symptoms will probably get worse.

In the regions affected by Hurricanes Katrina and Rita, up to 40% of the people lived with at least one chronic disease like diabetes (Jhung et, al., 2007). Chronic disease can also be heart disease, Chronic Obstructive Pulmonary Disease (COPH), cancer, asthma, arthritis, autoimmune diseases and addictions. For more information on chronic diseases in general, visit CDC.gov https://www.cdc.gov/chronicdisease/index.htm

Nationwide 1 in 2 adults has a chronic disease and 1 in 4 have more than 1. What does that have to do with disasters and emergency response? A great deal.

The people (like myself) with chronic disease usually see their symptoms get worse during disasters. This is what that exacerbation word up top means. Sometimes those symptoms get so bad that people end up in the hospital or seeking care for their symptoms. Sometimes, the symptoms are so bad that people die.  A study from Tulane University School of Medicine found that hospital admissions for heart attacks are three times higher in New Orleans up to 10 years post hurricane Katrina (Chronic disease post Hurricane Katrina, 2016). This data was compared to pre-Katrina rates and controlled for typical population factors. In that same study, post-Katrina patients had significantly higher risk factors for heart attacks because their heart disease, diabetes and high blood pressure was not being well managed.

Why do these symptoms get worse during disasters?

The first reason is the disaster itself. Earthquakes, wildfires, hurricanes, floods, mudslides, tornadoes, even Arizona Haboobs cause major disruptions in the environment and our lives. Haboobs stir up dust that increases symptoms of asthma and COPD (not to mention Valley Fever). Floods expose diabetics to nasty sewage water that can increase the chances of skin infections. So if you outlive the actual disaster and don’t get crushed by the earthquake, you are probably going to have a really hard time managing your asthma and you might die from it.

The second reason is exposure to temperature extremes, lack of food and water and they physical and emotional trauma. Many of the medications we take to control chronic diseases make dealing with extreme temperatures very difficult. A lack of food or water for someone with diabetes usually means low blood sugar and a trip to the emergency room. If that emergency room is unavailable or you are stuck in an inaccessible area, you might die.  The stress of the emergency leads to anxiety, forgetfulness, depression, increased blood pressure and increased exacerbation of chronic disease illness.

The third reason is lack of medications. Many evacuees forget (or don’t have time) to bring their medications with them. In Houston and Florida, many evacuees didn’t even know what medications they took for their conditions. During hurricane Katrina, local and federal responders set up emergency pharmaceutical dispensing areas where evacuees could get over the counter and prescription medications. 73% of the medications dispensed were for chronic care in general with 39% of that being for people with heart disease (Jhung et. all., 2007). So if you survive the tornado itself and you are now trapped in your underground bunker for a week and you didn’t bring your heart medications with you… well you see where I’m going.

What can we do about it?

Be the healthiest version you can be.

I’m not saying you need to be super thin or compete in American Ninja Warrior training. I’m saying, take care of yourself. Manage your chronic condition to the best of your ability. Manage your symptoms well now so that when disaster strikes, you have a greater chance of survival.

• Take your medication as prescribed
• Talk to your doctor about everyday management
• Sign up for Chronic Disease Self-Management Classes http://azlwi.org/
• Know your nutrition needs and try to live that everyday
• Find ways to reduce stress: practice meditation, prayer, yoga, whatever appeals to you

Be the preparedest (not a word) version you can be.

I’m not saying you need to build a bunker (unless you live in a tornado infested area). I’m saying, take some time to build an emergency preparedness kit. Prepare for the management of your chronic illness away from home by including:

• At least a seven day supply of all your medications
• A cooler with those insta cool packs for medications that need refrigeration
• A list of medications and dosages you normally take or
• Empty bottles of your medications stored in your kit
• Add special equipment for disease monitoring (glucose machine, blood pressure cuff)
• Instructions on how to take your medication in case you need help with dispensing
• Over the counter medications you normally take
• Comfort foods or special diet foods
• A list of physicians with their contact information
• A list of facilities with their addresses that you receive regular care at (cancer and dialysis treatment)

Be the championingest (I’m gonna make this work) version you can be.

I’m not saying you need to lead the charge in your neighborhood. I’m saying, since 1 in 2 Americans have a chronic disease, it’s smart to build a network of support:

• Ask neighbors if they need help building emergency preparedness kits
• Advocate chronic disease self-management
• Encourage others to eat for their health and know their nutrition needs
• Find trustworthy people to help with medication dispensing during emergencies
• If you have other family members with chronic disease needs, plan together

How I’m going to start

The one thing that really hit home with me was how evacuees didn’t know their own medications. I’m lucky and I only need to take one medication on a regular basis so it’s easy for me to remember the name and dose but I couldn’t tell you the names and doses of medications my family takes. Something with an A? Something that sounds like propanol? That one that causes massive diarrhea? My husband probably doesn’t know what I take. The first thing I’m going to do this weekend is to take our old bottles and put them in the go kit. It’s a first step for me and it can be a first step for you too.

Disclaimer: I’m obviously not a physician of any kind. Just a public health emergency planner who thinks about disasters a lot.

References if you really want them:

Miller, A., and Arquilla, B. (2008). Chronic disease and natural hazards: impact of disasters on diabetic, renal, and cardiac patients. Prehosp Disaster Med. 2008 Mar-Apr;23(2):185-94.

Jhung, M. A., Shehab, N., Rohr-Allegrini, C., Pollock, D. A., Sanchez, R., Guerra, F., & Jernigan, D. B. (2007). Chronic disease and disasters medication demands of Hurricane Katrina evacuees. American Journal Of Preventive Medicine, 33(3), 207-210.

Chronic disease post Hurricane Katrina. (2016). Australian Nursing & Midwifery Journal, 24(6), 15.