How can patients with chronic non-communicable diseases (NCDs), such as diabetes, hypertension, and heart disease, be prepared for and managed during crisis situations like flooding and displacement, both pre and post disaster?

Managing Chronic Non-Communicable Diseases in Crisis Situations: Pre- and Post-Disaster Preparedness

Patients with chronic NCDs must prepare for disasters by maintaining portable medical documentation, securing a 7-14 day medication supply, identifying alternative care facilities, and establishing communication plans, while post-disaster management requires immediate medication access, dietary restrictions, and rapid facility relocation to prevent decompensation and mortality. 1

Pre-Disaster Patient Preparation

Essential Documentation and Medication Management

• Patients must carry waterproof copies or summaries of their complete medical records, including current medications, dosages, treatment schedules, and recent laboratory values at all times 1
• Secure a minimum 7-14 day emergency supply of all essential medications including insulin, oral hypoglycemic agents, antihypertensives, diuretics, anti-arrhythmic agents, and immunosuppressants for transplant patients, as medication loss in destroyed homes is a primary cause of chronic disease decompensation 1
• Store medications in waterproof, portable containers that can be grabbed immediately during evacuation 1

Alternative Care Facility Identification

• Identify and document at least 2-3 alternative healthcare facilities outside the disaster-prone area that can provide ongoing NCD care, including dialysis centers for renal patients 1
• Pre-register with alternative facilities when possible, particularly for dialysis-dependent patients who require immediate access to life-saving therapy 1
• Map evacuation routes to these facilities and keep updated contact information (phone, email, physical addresses) readily accessible 1

Communication Planning

• Establish multiple communication methods including online user groups (Google Groups, Yahoo Groups) that can serve as virtual meeting sites once internet access is restored after evacuation 1
• Provide healthcare providers with secondary contact information including addresses where patients will likely evacuate to, as cellular systems, landlines, and internet are typically incapacitated during disasters 1
• Patients should be instructed to log into pre-established websites to reestablish contact with healthcare providers after displacement 1

Disease-Specific Education

• Dialysis patients must receive education on the renal emergency diet emphasizing fluid and dietary restriction, particularly potassium restriction, as they may go several days without dialysis during relocation 1
• Diabetic patients must understand hypoglycemia recognition and management during periods of food scarcity and stress, as disaster situations alter insulin requirements 1, 2
• All NCD patients should understand early warning signs of disease decompensation requiring immediate medical attention 1

Post-Disaster Management in Shelters

Immediate Medication Access

• The primary post-disaster priority is securing essential medications within 24-48 hours, as patients are at extremely high risk for decompensation of previously stable chronic conditions without insulin, antihypertensives, diuretics, and other critical medications 1
• Establish emergency medication distribution systems at shelters through coordination with local and national agencies, as medication loss is the most significant challenge following infrastructure destruction 1
• Patients with organ transplants require immediate access to immunosuppressant medications to prevent rejection 1

Facility Relocation and Continuity of Care

• Dialysis-dependent patients must be transferred to functioning facilities within 48-72 hours maximum, as hospitalizations and mortality increase significantly in patients who miss treatment sessions 1
• Prior planning for disaster-related evacuation significantly improves patient outcomes, as demonstrated by lessons from Hurricane Katrina where 700 dialysis patients were successfully relocated to Baton Rouge 1
• Patients on peritoneal dialysis at home may be able to continue treatment if supplies can be obtained, avoiding the need for facility-based care 1

Shelter-Based Management Strategies

• Healthcare professionals should visit evacuation centers regularly to assess NCD patients and provide ongoing care, as access to usual healthcare facilities is disrupted 3
• Evacuation centers must have reliable power sources for medical equipment including insulin refrigeration, nebulizers, CPAP machines, and oxygen concentrators 4, 3
• Establish temporary treatment hubs at or near shelters for medication distribution, blood glucose monitoring, blood pressure checks, and basic disease management 3

Dietary and Lifestyle Modifications

• Implement strict fluid restriction protocols for dialysis patients who cannot access treatment, typically limiting intake to 500-1000 mL per day depending on residual urine output 1
• Provide potassium-binding resins (e.g., sodium polystyrene sulfonate) to dialysis patients to prevent life-threatening hyperkalemia during treatment gaps 1
• Diabetic patients require modified meal planning with shelter food supplies, prioritizing consistent carbohydrate intake to match available insulin 1

Cardiovascular Risk Mitigation

• Recognize that natural disasters are associated with increased cardiovascular mortality due to effects on blood pressure, blood viscosity, hemostatic factors, and acute/chronic psychological stress 1
• Monitor blood pressure closely in hypertensive patients and prioritize antihypertensive medication distribution, as stress and medication interruption cause dangerous elevations 1
• Identify patients at highest cardiovascular risk (known coronary disease, heart failure, arrhythmias) for priority medical attention and early evacuation if needed 1

Critical Pitfalls to Avoid

Common Mistakes in Pre-Disaster Planning

• Failure to update evacuation plans annually leaves patients unprepared when disasters strike, as contact information and alternative facilities change over time 1, 4
• Inadequate medication stockpiling (less than 7 days supply) results in dangerous treatment gaps, as pharmacy access may be impossible for 1-2 weeks 1
• Not establishing alternative communication methods before disasters leaves patients unable to contact healthcare providers when traditional systems fail 1

Post-Disaster Management Errors

• Delaying patient relocation beyond 72 hours for dialysis-dependent patients significantly increases hospitalization and mortality risk 1
• Assuming all patients can tolerate missed treatments without dietary modifications leads to life-threatening hyperkalemia and fluid overload in renal patients 1
• Failing to prioritize medication distribution in the first 48 hours results in preventable decompensation of diabetes, hypertension, heart failure, and other NCDs 1

Evidence Quality Considerations

The recommendations are primarily derived from Kidney International guidelines 1 documenting lessons learned from major disasters including Hurricane Katrina, Hurricane Sandy, and multiple earthquakes (Kobe, Marmara, Tohoku). These guidelines represent the highest quality evidence available, based on real-world outcomes from large-scale disasters affecting thousands of NCD patients. The American College of Critical Care Medicine and Society of Critical Care Medicine recommendations 4 provide additional infrastructure and systems-level guidance. While much of the evidence focuses on dialysis patients (who face the most immediate life-threatening risks), the principles of medication access, documentation, alternative facility identification, and communication planning apply universally to all chronic NCDs including diabetes, hypertension, heart disease, and transplant patients 1, 3, 5, 6.