PLAN - Special Needs

There is no workbook page for this entry, but if you have Special Needs, you will want to create your own documentation as discussed here.

OK, I'm sitting in my BOV about to drive away from what will be a disaster area in 24 hours.  What I haven't yet talked about with you is Special Needs.  You'll want to put some pages into your workbook and make some adjustments to your individual plans that revolve around Special Needs that you may have. 

DrugsThe most common form of Special Needs revolves around medical necessities.  You may take certain prescription medications, for instance.  You will want to continue to follow your recommended doses, especially during an emergency.  Your body, mind, and spirit are under a lot of stress, and now is not the time to miss your blood pressure medicine.  If you can afford to do so - and even if you can't - it's a good idea to have an extra 30 day supply of your prescription medications on hand.  Be sure to rotate it regularly.  Speak to your doctor about your desire to fill an extra prescription.  As long as it isn't for narcotics, you shouldn't have a problem.

If you are on any kind of narcotic therapy - like long term pain management - and you need to travel, be sure to keep your prescription bottles with you.  These have your name on them and will prove to law enforcement and medical personnel that you aren't a street junkie.

Another very common Special Need is glasses and contact lenses.  If you wear glasses, you should always have a spare pair.  Likewise with the contacts.  You should have a nice hard case for the glasses, and small amounts of any care products that you need to clean the contacts.  Your 60 second plan should involve putting on your glasses.  You should always keep your glasses in the same place next to your bed while sleeping so that you will always know where they are in case of emergency.  Having another spare pair in the car at all times isn't a bad idea if you can afford it.

We next get to Special Needs that are not so common.  One of Virginia's friends is in a wheelchair, and she has special needs that have to be addressed during bug-out.  I don't know what those are, so if you are in that situation you need to write down exactly what you need and what you need to do.

HemodialysisMy mother is on hemodialysis, and requires special care.  When she left the area for Katrina, she needed to be near a facility that could provide the services that she needs, so that was a consideration when making a decision on where to go.  She has a list of facilities in various areas that can handle her condition, and if you have similar needs it would be very prudent for you to know where the places are that can sustain your life if you leave your home city.

If you are undergoing any out-patient therapy, especially therapies that involve advanced medical facilities (like cancer treatments), you will want to have a list of facilities that can continue your treatment if you leave your home city.  You should keep up to date documentation on your on-going therapy so that you can inform anyone who needs to manage your continuing care.

Whatever Special Needs you have, you should prepare for them carefully.  Running out of medication or not receiving critical care is on the bad end of the whole good-bad scale...but you knew that already.

Another kind of Special Needs are the Special Needs of others.  If your parents or grandparents are in a nursing facility you should speak to the facility director and find out what the protocols are for evacuating the people who live in them.  If your parents or grandparents do not live in such a facility and either live on their own or live with you or another family member, you should coordinate with your entire family for their needs.  Older people should be treated just like children in some ways and in some cases.  While there are plenty of 80 and 90 year olds that are quite capable of handling their own affairs, there are many who cannot.  They may not have the physical strength, mental acuity, or even common sense to evacuate themselves or to make other preparations for even their basic needs.  During Katrina, many elderly people ended up dead or trapped in deplorable conditions because the family left them behind assuming that they were either being cared for or were caring for themselves. 

The same thing is true for anyone who cannot physically or mentally manage their own needs, whether or not they live in a care facility of some kind.  You should coordinate with other family members to insure that grandma is taken care of.  Grandma is either gonna go to Memphis with your sister or to Houston with you. Weird cousin Ernie goes with Aunt Martha to Uncle Frank's house (locked in the trunk if necessary).  Sometimes this is not possible, especially if you have other responsibilities or special needs yourself.  It's a bad idea to mix people with mental problems with children.  If you have to leave someone behind for whatever reason, that can be tragic on many levels.  Trying to manage your own family, however, may be as much as you can handle.  You need to think clearly about this and make good choices - whatever those choices may be.

Caring for people with Special Needs is a daunting task even in the best of times.  Caring for them when SHTF is an especially difficult nightmare even if you have prepared properly.  I have no doubt, for instance, the course my mother - and indeed all people who require hemodialysis - would take if they could not secure critical care.  You must think about this clearly and get a CLUE.

If you have a person in your family who does not travel well, has some kind of phobia about riding in a car, or who would otherwise completely freak out during SHTF, then you should talk to your doctor about having a small supply of sedatives on hand for such emergencies.  Having someone freaking out in the car while you're trying to escape from zombies is not going to be helpful. 

Just to be clear, YES, I DID JUST TELL YOU TO DRUG YOUR SPOUSE OR YOUR CHILDREN if they need it.  Don't bullshit yourself.  Talk to the doctor and get some knock-out pills or something.  It'll keep you from killing them or wrecking the car.  Benadryl works in a pinch.  Nyquil works too, but it has alcohol in it so I wouldn't recommend that. 

DogThe other side of Special Needs doesn't involve humans, it involves pets.  I'm going to have some additional things to say about pets later, but for now let's talk about them in this context.  If you are going to take your pets with you, that requires some forethought and planning.  You will need a proper travel kennel and provide for their needs on the road.  Where you can go is limited to places that will take pets, and if you have large pets or a large number of pets, that can be difficult.  If you choose to leave the pet home and leave them extra food and water, that can work out poorly as well.  People who own large numbers of pets may not be able to evacuate all of them.  This is something to think about BEFORE you buy that second Great Dane...  My personal philosophy is to not own pets at all.  I understand that other people feel that their pets are part of their family and would not live without dogs, cats, birds, or other critters in their lives.  That is a decision that everyone has to make on their own.  Just know, however, that if you make the decision to own pets then it is your responsibility to care for them.  I'm going to have some pretty shitty things to say about some pet owners later on, and I am going to tell you some real pet horror stories, and generally get really righteously pissed off in the context of the subject of people who didn't properly take care of their animals. 

The third kind of Special Needs involves wealth, and I am specifically speaking to collectors here or persons who have in their possession one or several items of important historical significance.  Owners of collections will know that collections of things can be very valuable, and they can also be difficult (or impossible) and expensive to insure.  If you own something special, you should make prior preparations to secure it properly and move it if you have to (if you even can.)  The one anecdote I will tell you here is about a man I know who had a very large collection of firearms in New Orleans.  He had over 250 guns in a vault room in his home...on the first floor.  Bad planning, that.  The room itself was impervious to fire, protected from all but the most skilled thieves, and even climate controlled; but it wasn't water proof.  Ouch. 

No matter what your special needs are, you should have an advanced strategy that includes:

1.  When possible, start your evacuation preparations early and evacuate especially early. 
2.  Wear a Medic Alert bracelet, or some other identifier indicating your condition and needs.
3.  Have coordinated plans with the facilities in the places to which you may evacuate.  Call them in advance and find out what their protocols are, and what you will need when you arrive.
4.  If you are going to be staying with friends or family, make sure that they can accommodate your Special Needs.  If they cannot, then you need to make other plans.  If you show up at my house with a Great Dane, that's not going to work for me.  I'll take you and your twelve kids, but I don't want a monster in my house that poops bigger than I do.

You should make workbook pages for each of your Special Needs and prioritize them appropriately.  You should invest the time, energy, and money to insure that you can care for your Special Needs.  You should get a CLUE about Special Needs.  That's Clear and Lucid Understanding of Everything. 

Otherwise it'll be your momma they fish out of the canal, and you won't sleep right for the rest of your life.


************* ADDENDUM *************

This next piece was not written by me, but was written by an Emergency Room doctor who dealt with Katrina evacuees coming to his city.  It is the best information I have read from this perspective.  It was specifically written by the good doctor for inclusion here, and it is used here with permission.  (Thanks, TheGrayMan!)

Medical needs:

One of the biggest logistic problems in any large-scale disaster is the medical piece, both injuries from the storm, and the medical needs of thousands of displaced persons. The latter virtually always overwhelm local/nearby facilities, particularly when there is storm damage to medical infrastructure. In the case of Katrina, consider that Charity Hospital and University Hospital collectively accounted for a large chunk of the inpatient beds in New Orleans... and both hospitals were effectively knocked out. 75% of the bed capacity of that city has not been restored post-Katrina, and they also lost 70+% of their physicians.

As for the "government vacation plan," the New Orleans airport because the primary med-evac location for "medical needs" evacuees during Katrina (several ad-hoc triage/treatment locations were established on freeway overpasses close to the city center). The medical staff at the airport included five DMAT teams (Disaster Medical Assistance Team), which typically include 25-50 PAs, nurses, EMTs, physicians, etc per team. They were completely overwhelmed, as they ended up treating several thousand high-acuity patients in a span of several days (that's almost a year's worth of high-acuity patients for a mid-size hospital ER). Incidentally, those DMAT teams and other FEMA assets were pre-positioned before the storm, putting the lie to the common politically-motivated assertion that the feds "did nothing."

Hundreds of critically ill patients were evacuated from area hospitals and nursing homes, taken to the airport, and forward-moved from there (there were many fatalities, as nursing facilities, hospitals, and long-term care facilities ran out of power, and their ventilators quit working... you can only "bag" a patient for so long until your hands get tired...). The "walking wounded" who weren't obviously dying or critically-injured were either given minimalist treatment at a triage point, or were greatly delayed in reaching definitive care, or other medical help.

Needless to say, this is not the situation where you want to run out of your blood pressure medications.

So what to do?

In the interest of not putting a further burden on already-overwhelmed EMS and NDMS personnel (as well as your own self-interest and preservation), you should have the following things ready to go before the disaster.

Current med list and allergies
Medical "problem list"
"Discharge summaries" from significant hospitalizations
Copy of a recent EKG
Copy of any cath reports and echocardiograms (if a heart patient)
List of your physicians, including office numbers
Insurance info

Medical gear: (if used)
Medication supply (including empty bottles, if out)
Oxygen, including concentrator or bottles
Monitoring equipment
CPAP/BiPAP machine
Nebulizer and meds
Portable power supply or inverter for using any of the above in a vehicle

With regards to records... access to good records is absolutely key for continuity of care. You can land in the care of the best physician in the world, and if he has no idea of what has been done to/for you, he'll end up reinventing the wheel, at significant cost and risk to you. Medication lists with dosages and dosing intervals are pure gold to any physician you encounter, and they definitely need to know your allergies. A medical problem list is equally useful (though they can often figure out 90% of your medical problems with a quick glance at your med list).

Records are particularly important if you're a cardiac patient. Old EKGs, old cath reports, and old echos are specific things physicians want to see when they're working you up for presumed heart disease. Note: it doesn't have to be "chest pain" that brings you to the ER or doctor's office... the "cardiac disease" possibility can be raised by any complaint of generalized weakness, shortness of breath, "passing out," dizziness, etc. Any of those will make your doctor want at least an EKG... and then he'll want an old one to compare it to, and so forth.

Medical records are sometimes needed in a time-critical fashion, and with HIPAA regulations (yeah... thanks, Congress ), everyone wants a faxed records release, then the records person (if the sending hospital even has one at night or on the weekends) has to find the records, copy them, fax them... then somebody at the receiving hospital has to notice those records sitting on the fax machine (the fax ringer is usually turned off so it doesn't add to the cacophony of beeps/buzzers in the ER). Hand-carrying those records with you can greatly expedite your care... I can't stress that enough. Even if it's an encyclopedia-sized file of records, shrink it down and put in on a USB thumb drive.

A couple of paragraphs are warranted here for chronic pain patients.

If you're one of those unfortunate individuals living with chronic pain, you know all about living with agony that would drive other people off the deep end... you hurt every day. For the record, I don't envy you, as you have a dependency on narcotics that can get you into extra trouble in a disaster situation. Unfortunately, while narcotics are used to make life livable for all kinds of people with all kinds of nasty chronic pain conditions, prescription drug abuse is a huge problem in the United States, and much of the street supply of prescription narcotics is diverted from legitimate medical use by theft, deception, fraud, doctor-shopping, etc.

To avoid problems, I must heavily emphasize good record-keeping, as well as following your pain contract, and using a particular chain pharmacy as a regular patient (chain of your choice). As an ER doc, I can't prescribe narcotics in the type/quantity you're typically accustomed to, primarily because that type of thing isn't within the scope of my practice, and I don't want to run afoul of the DEA, LE, or state medical board. That's not to say I can't help you, but that help is generally limited to a short-term script to stave off withdrawal until you can get in to another pain specialist... but that can take weeks, and that pain specialist will want records. Having a letter/records from your pain-management doctor can bolster your credibility, and using the same chain pharmacy will likewise generate a paper trail that will help convince any provider you encounter that you're on the level, and not simply doctor-shopping for the weekend's party supplies. National chain pharmacies have centralized computer systems, and they track prescriptions. The doctor can call the pharmacy and verify that your Rheumatoid Arthritis actually DOES require you to get 120 percocet per month, every month.

Narcotic withdrawal sucks... but isn't usually life-threatening; you'll just wish you were dead while you're going through it. This isn't conducive to good mental/physical health while you're simultaneously attempting to recover from whatever disaster has displaced you... so plan ahead. Have records, and if you're able, consider hoarding a small supply of your regular meds by halving dosages, etc. Then rotate out this "emergency stash" so it doesn't go out of date.

Also, be discrete about your med stash... anyone with nefarious purposes who spots it (like in a shelter or evacuation point) may recognize that it's worth hundreds or thousands of dollars on the street... and it'll disappear the moment you turn your back (or they'll mug you for it). Imagine evacuating to the Superdome, and having some sharp-eyed addict start spreading the word that you've got a ton of "vices and 3's" (Vicodin and Tylenol #3) that you ain't sharin... 'nuff said.

One additional note.

Some of this may seem like overkill... but believe me, you'd rather have more than not enough. Having records will also help differentiate you from the con artists who seem to crawl out of the woodwork during disasters. After Katrina, we had many people who had medical needs... yet we also had plenty of people who begged/pleaded/demanded med refills (often for narcotics or benzos), methadone, etc. We helped everyone we could, but we were scammed multiple times. People altered scripts, overdosed on the meds they were given, eloped from the ER after getting their narcotics, and so forth. Some people use disasters to selfishly feed their own addictions and agendas, and by so doing, burden an already-overwhelmed system. In fact, they're hoping you're too busy and harried to check up on them, and that you'll simply give them a script to be rid of them. These grifters create a skepticism towards disaster refugees that most refugees don't deserve. It's wrong... but it's human nature. Liars, thieves, and addicts who take advantage of disasters deserve nothing but scorn, arrest, and jail time.

If you evacuate, you should take all of your medications with you, particularly if they're controlled substances (like narcotics). Take any empty bottles (these help verify your prescriptions). You might also consider asking your physician for a prescription for a 30-day emergency supply of your regular medicine. Beware: some insurances only authorize refills at certain intervals, and they don't have any sort of provision for "emergency supplies." Be prepared to pay for your 30-day evacuation supply out of your own pocket.

In addition to meds, take any sort of "durable medical equipment" that you regularly use. This includes CPAP or BiPAP machines, Oxygen concentrators, Oxygen tanks, or other monitoring equipment, etc. Whatever area you evacuate to may not have access to similar equipment, or have already exhausted their supply by providing them to people who didn't prepare. If your 5-hour drive turns into 20 hours, do you have enough oxygen to make the trip? If you shelter-in-place, do you have backup power to run your concentrator? Also ensure you take your cigarette-lighter adapter for your durable medical equipment, or an inverter if it only runs on 120v.

A little foresight directed towards your medical needs can not only make you more comfortable, it can quite literally save your life.

Plan like your life depends on it... because it just might. 


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