Posts Tagged ‘vaccination’

Physical Labor (wish I looked so good doing it!). Photo by GollyGforce

Physical Labor (wish I looked so good doing it!). Photo by GollyGforce

Disaster recovery often means increased time outdoors and increased activity – walking, biking, and physical labor. Your skin, hands, and feet can pay the price, and heat and cold exposure become real risks. Small as well as large hazards abound, including broken glass, splinters, and uneven surfaces. In any situation with limited access to health care, you need to prevent even minor injury. You can best help yourself and others if you are functioning at your best. Even minor disability or pain will adversely affect your abilities. In addition, with limited sanitation and a potentially contaminated environment, minor injuries easily progress to infection (as well as using up supplies better saved for “unavoidable” events).

So before thinking of first aid as supplies and treatment, you need to think of first aid as prevention. The following items may not seem like first aid, but their importance is higher than bandages and medications.

Protect Your Body

Outdoor clothes. Photo by Rick McCharles.

Outdoor clothes. Photo by Rick McCharles.

Clothing: the more you cover up, the less skin you expose to injury. This means hats, long pants, and long sleeve shirts, even on a hot summer day. Disaster recovery is not the time to work on your tan. Most people turn to jeans and long sleeve t-shirts, but consider investing in higher tech alternatives (check out hiking and outdoor stores), particularly if you live in a warm climate. Light-colored, loose-fitting, and breathable are good, as is the ability to wash by hand and dry quickly. The grodiness factor goes up quickly after disasters, yet our “closet” of outfits is limited.

Shoes and socks: your feet can become a real life Achilles heel after a disaster. You step on things, twist ankles, and get blisters. You need sturdy, well-fitting comfortable shoes – not worn out tennis shoes. Expect to walk more than normal – make sure your shoes don’t cause blisters. Don’t buy shoes just to throw in your emergency kit – I wouldn’t want break in new shoes during a disaster! Do you remember hearing about trench foot in World War One? Well, guess what? Trench foot (more appropriately known as immersion foot) loves disasters. It happens when feet stay wet and cold for hours on end (that’s why it’s named after war trenches), and acts much like frostbite, with numbness, vascular shutdown, skin sloughing, and even necrosis and decay. It can occur in less than a day. If flood waters are a concern, you’ll need a second pair of dry shoes. Everyone also needs 2 pairs of good high socks – no anklets. You wash one pair every evening  and let them dry while wearing the other pair.Not Disaster Footware

Gloves: not all gloves are created equal. You probably should have a few different types, depending on your predicted activities. Pre-packed emergency backpacks often include fairly cheap canvas gloves. (What do you expect? They are often free for volunteers). These basic work gloves give you a bit of warmth, protection and grip, but won’t hold up to anything heavy, sharp, or wet.  Your most important gloves should be a sturdy pair of leather or multi-purpose work gloves that will stand up to heavy use, sharp objects, and some wetness. If major water exposure is likely, you’ll want waterproof work gloves. For food preparation and cleaning, throw a box of disposable plastic gloves into your emergency supplies. I carry a box of exam gloves in my car for emergency medical help – I won’t risk exposure to blood borne pathogens, even in a disaster. Powder free vinyl exam gloves are the” in-thing” to buy these days – they are the least likely to cause allergic reactions or skin irritation. Just like with shoes, no matter what glove you use, make sure they fit and are comfortable. Poorly fitting gloves make you clumsy, increasing your chance of injury.

Protect Your Skin

Sunscreen: For many of us, disaster recovery means a lot more time outside – doing repairs, waiting in line for supplies, walking instead of driving. This means a higher risk of sunburn, particularly if your normal sun exposure is low. With my fair skin, I can readily testify to the pain and disability caused by even “mild” sunburns. Add a few blisters, and now you have infection risk. Make sunscreen part of your daily disaster personal care. Put it on every exposed body surface 20-30 minutes before going outside, and repeat every few hours. SPF 30 is high enough – it blocks 97% of UVB rays. Higher SPF numbers don’t add much (except cost). Waterproof sunblock doesn’t exist, but water-resistant can save you from stopping as often for reapplication during wet or sweaty chores. Plan a large bottle for every person – don’t count on shopping for this after a disaster. Sunscreen lasts three years after purchase unless exposed to high temperatures (like the trunk of your car). It takes once ounce to cover an average body – or even more for some of us. If you plan to run around in a bikini and reapply every few hours, an average bottle lasts just a few days. Luckily, if you follow my clothing instructions, your sunscreen will last a lot longer!

Mosquito biting! Photo by dr_relling

Mosquito biting! Photo by dr_relling

Insect Repellent:  Flooding, broken pipes, spill clean-up, and sewage problems all create pools of standing water. If the climate is right, that means mosquito heaven, not to mention other biting bugs that plague us even in good times. The good news  – mosquitoes are worse in the evening when  limited light forces you to quit for the day. The bad news –  if your “shelter” is no longer mosquito proof, they’ll find you all night long. The idea of long pants and shirts helps with this as well, but make sure you include an adequate supply of insect repellent in your emergency supplies (and perhaps a mosquito net if you are in a high mosquito area). Check out Consumer Reports for an online review of the Best Insect Repellents.

Bolster Your Immunity – Shots and Vaccines

When was your last tetanus shot? I know mine was within the last 10 years, but not the actual date. It’s probably written down somewhere (doctor’s office, HR department), but not easily called to mind –  no way will I remember in a disaster!  Current recommendations are a combo vaccine called Tdap (tetanus, diphtheria, and pertussis) once as an adult (and again if you get pregnant), and a Td vaccine every 10 years. Considering the risk of cuts and abrasions by dirty objects in a disaster, make sure to stay on top of tetanus shots pre-disaster. Planning to get a tetanus shot after minor post-disaster injury is a waste of precious healthcare resources!

Don’t forget the wonderfully controversial topic of flu shots and other routinely recommended vaccines. Without getting into the argument, I will just comment that outbreaks of infectious disease (particularly influenza) increase after disasters. People crowd together (shelters, clinics, food and water distribution) at the same time that cleanliness and sanitation, including basic hand washing, drops. Exposure goes up while resistance drops from fatigue and stress. Personally, I always try to stay up on my vaccines. Current  vaccine recommendations can be found on the CDC  Adult Immunization website.

Diet and Bowels

OK – this isn’t really preventative first aid, but it is an important part of personal disaster health care planning that most people never think of! Most of us will have a cruddy diet after a disaster. Fresh fruits and vegetables are hard to come by. If you haven’t stashed food away, you’ll be stuck with whatever your community makes available. Fluid intake drops with limited fresh water supplies. Now imagine toileting without water or power – buckets, pit toilets, crowded shelters (even holes in the ground).  Let’s just say that norovirus might be a temporary relief for some.

Enemas - not a great disaster choice! Photo by Juhan Sonin.

Enemas – not a great disaster choice! Photo by Juhan Sonin.

If constipation belongs on your problem list (as it does for 17% of Americans), you’d better plan in advance for prevention.  Besides abdominal pain and discomfort, constipation can also lead to big time hemorrhoids, and “just-in-time” self treatment might be a tad difficult! Consider storing canned fruit and vegetables, dried fruit and nuts, brown rice, and other high fiber options. Drink fluids when you are given the chance. If you find yourself staying  in a shelter, don’t sit around – get up and help. Not only will the community benefit, but the exercise can help keep other things moving!

Some people may need to consider a fiber supplement or laxative prophylactically after a disaster until conditions normalize. Although a healthy diet and good fluid intake is always preferable, let’s face it – it might not be possible. Talk to your doctor now to find out about possible medication interactions, and whether there is a specific plan they recommend. Otherwise, do some reading before buying. Mayo Clinic has a reasonable page on Over-the-Counter Laxatives for Constipation. Some fiber supplements and laxatives require liquids to work – obviously not a great disaster choice. Consider experimenting with fiber supplements or bowel meds once or twice pre-disaster to find one you can tolerate without bloating or cramping.

The positive thing is that other routine dietary problems are unlikely to be a problem in the United States during the relatively short period of disaster recovery (with the exception of diabetic and renal diets, but that’s a whole other topic). Unless you chronically follow a rigid limited diet, you should have adequate body stores of vitamins and nutrients to get you through a few weeks or a month with a limited diet. In fact, Vitamin D levels might increase if you spend more time outside (in case you haven’t noticed, Vitamin D is the “deficiency de jour”, with ties to depression, cardiovascular disease, immune system dysfunction, etc). If you worry about vitamin deficiency, throw a bottle of multiple vitamins in your stash.

Monitor Yourself

One of the most important preventive measures in disaster is monitoring and taking care of yourself. Overwork and inadequate sleep leads to clumsiness and mistakes. Don’t work more than 12 hours a day– including home, family, and volunteer activities. In fact, we need to watch out for each other. Enforce a 12 hour work limit on those around you – it will keep everyone healthier, happier, and safer.

If you can do this, you'll probably be injury free. As for the rest of us... Photo by lyn tally.

If you can do this, you’ll probably be injury free. As for the rest of us…
Photo by lyn tally.

Keep an eye on your body. Adrenaline and endorphins can make us ignore normal warning signs of injury. Do a full body check daily, particularly hands, feet, and body folds. Try to include brief stretching and walking breaks in your recovery routine (walking while carrying or pulling things doesn’t count). We’ve all heard about (or experienced) work related musculoskeletal injuries in daily life – back pain, carpal tunnel, headaches, etc. Now imagine a bunch of out of shape people doing disaster recovery – many are walking time bombs for soft tissue strain and pain that can cut their disaster recovery efforts to zero.

I promise in my next blog, I’ll get to actual first aid/emergency medical care supply recommendations (a frequent request). However, I hope Part One has pointed out the most important premise of first aid. Do everything possible not to get injured in the first place!

Stay safe,

Sheila Sund, M.D.