By AMERICAN HEART ASSOCIATION NEWS
When patients with cardiac health issues face evacuation due to flooding, fire or other natural disasters, a spike in stress and anxiety levels may be only the beginning. For sudden, jarring, life-changing events—like that of Hurricane Harvey in Texas and Louisiana this past week—can markedly disrupt months or years of steady treatment and control of heart disease and other conditions.
At last count, FEMA officials estimated 30,000 people will have evacuated their homes for shelters due to Harvey.
And just like that, what yesterday were quite manageable illnesses and conditions like high blood pressure, atrial fibrillation and diabetes can become life-threatening in an extended emergency. When people are forced to flee their homes without time to gather medicines, records, prescription refills and glucose monitors—plus essentials like batteries for medical devices and mobile phones—anxiety and complications can surge.
In times like these, patients and caregivers, in addition to first responders, can learn from doctors, nurses and emergency medical technicians who have been through similar trauma before.
“With [Hurricane] Katrina, the biggest issues were not the event itself, but trying to provide the [sustained] medical follow-up” said Paul Pepe, M.D., professor of emergency medicine at UT Southwestern Medical Center in Dallas, who served at the command center for Katrina in Baton Rouge and in on-scene reconnaissance of medical needs.
When citizens with existing medical conditions arrive in a distant city or makeshift shelter, even when they have not been able to pack a proper “go” kit, they can bolster their health status almost immediately by simply bringing existing medications in air-tight, waterproof plastic bags or containers.
Many electronic medication records maintained by national pharmacies can offer assistance in reconstructing key patient records, diagnoses and dosages from afar, said Pepe, who is also City of Dallas director of medical emergency services for public safety, public health and homeland security.
“The interruption of care needs to be handled as best as possible,” offered Keith Ferdinand, M.D., of the Tulane University Heart and Vascular Institute in New Orleans and immediate-past chair of the National Forum for Heart Disease and Stroke Prevention.
“The stress and anxiety related to a natural disaster can be overwhelming to patients—not only those immediately impacted by flooding, but to those who have seen their family and friends affected,” said Ferdinand. “This is especially felt by elderly patients moving, maybe for the first time in years, which can also lead to disorientation.”
Ferdinand knows firsthand. During Hurricane Katrina’s landing in 2005, he treated patients in Atlanta who were evacuated from New Orleans, nearly 500 miles away. “It was a loosely organized evacuation,” he recalled. But it was effective.
Emergency medicine doctors advise evacuees with existing conditions to:
–take an ample supply of medications while transferring
–have phone number of doctors, health insurance companies and a pharmacy available, separate from that saved on a cellphone contact list
–write on paper all diagnoses and recent treatments recalled, as well as histories of blood pressure or blood glucose levels that can be recalled, and enclose those papers in plastic to take with you
“When they get to the evacuation centers, the most important [readings] are blood pressure and glucose,” said Ferdinand, “because these can fluctuate greatly in a short time.” He adds that most pharmacies have interstate delivery systems that can operate efficiently across borders in emergencies.
Endocrinologist Tina Thethi, M.D., a colleague of Ferdinand’s at Tulane, points out that when diabetes patients arrive at a shelter or evacuation site after a hurricane, they are apt to be in “survival mode,” and greatly stressed. They may not have the option to be selective about what they eat, or to keep their routine, Thethi said. This then affects blood sugar maintenance and wound or infection healing.
In a 2010 study led by Thethi that appeared in Disaster Medicine and Public Health Preparedness, she and her colleagues found that measures of blood pressure and lipids showed varied rates of recovery post-Katrina “to predisaster levels.”
Anand Irimpen, M.D., chief of cardiology at Southeast Louisiana Veterans Health Care System in New Orleans, advises heart failure patients to be as diligent as possible in keeping prescription schedules during a flood or emergency.
Irimpen noted that “being separated from one’s medications can be catastrophic for diabetic and cardiac patients both short- and long-term.” In fact, a 2016 study in Circulation found an average three-fold increase in heart attack admissions at Tulane Medical Center in each of the 10 years after Katrina, compared with the two years before Katrina.
“We realized patients with heart attacks post-Katrina had higher incidence of hypercholesterolemia, medication noncompliance, smoking, substance abuse and psychiatric disturbances,” said Irimpen, who was the study’s senior author.
“Most patients [temporarily] neglected their health and tried to rebuild their homes and get their lives in order. Health was generally low in priority,” he said.