What are the top 10 chronic diseases that should be prioritized in emergency situations like cyclone flooding?

Top 10 Chronic Diseases Requiring Priority Management in Cyclone Flooding Shelters

The following 10 chronic diseases must be prioritized in emergency shelter settings during cyclone flooding, as they pose the highest risk for acute decompensation, morbidity, and mortality when treatment is interrupted.

Priority Chronic Disease List

1. End-Stage Renal Disease (ESRD) Requiring Dialysis

• Dialysis-dependent patients face life-threatening complications within 48-72 hours without treatment, including hyperkalemia, fluid overload, and uremia 1
• These patients must be transferred to functioning dialysis facilities within 48-72 hours maximum to prevent hospitalization and death 2
• Implement strict fluid restriction (500-1000 mL/day) and provide potassium-binding resins (sodium polystyrene sulfonate) for patients who cannot access dialysis 2

2. Insulin-Dependent Diabetes Mellitus (Type 1 and Insulin-Requiring Type 2)

• Insulin interruption leads to diabetic ketoacidosis within 24-48 hours, a life-threatening emergency 2
• Patients require modified meal planning with shelter food supplies, prioritizing consistent carbohydrate intake to match available insulin 2
• Hypoglycemia risk increases during food scarcity and stress, as disaster situations alter insulin requirements 2

3. Advanced Heart Failure (NYHA Class III-IV)

• Patients with severe heart failure decompensate rapidly without diuretics, ACE inhibitors, and beta-blockers 1, 3
• Interruption of medications leads to acute pulmonary edema, requiring ICU-level care with respiratory rate >25, oxygen saturation <90%, or systolic BP <90 mmHg 3
• These patients have marked limitation of activity and are at high risk for cardiac arrest during disasters 1

4. Severe Chronic Obstructive Pulmonary Disease (COPD)

• Patients with COPD (FEV1 <25% predicted, baseline PaO2 <55 mmHg) require continuous access to inhalers, nebulizers, and oxygen 1
• Medication interruption leads to acute exacerbations requiring mechanical ventilation 1
• Shelter conditions with poor air quality and stress significantly worsen respiratory status 4

5. Severe Asthma

• Acute asthma exacerbations increase during disasters due to stress, allergen exposure in shelters, and medication interruption 4
• Patients require immediate access to rescue inhalers and controller medications 2
• Respiratory infections spread rapidly in crowded shelters, triggering life-threatening exacerbations 4

6. Uncontrolled Hypertension

• Hypertension exacerbation is one of the most common chronic disease complications during disasters, leading to stroke and myocardial infarction 4, 5
• Disaster-related stress combined with medication interruption causes acute blood pressure elevation 4
• Antihypertensive medications must be secured within 24-48 hours to prevent cardiovascular events 2

7. Epilepsy and Seizure Disorders

• Interruption of anti-epileptic medications leads to breakthrough seizures and status epilepticus within 24-72 hours 2
• Seizures in shelter settings pose significant injury risk and require immediate medical intervention 4
• Patients need consistent access to their specific anti-epileptic regimen without substitution 2

8. Immunosuppressed Patients (Transplant Recipients)

• Transplant patients require uninterrupted immunosuppressant therapy to prevent organ rejection 2
• Even brief interruptions (48-72 hours) can trigger irreversible rejection episodes 2
• These patients are at extremely high risk for infections in crowded shelter conditions 1

9. Advanced Liver Disease (Child-Pugh Score ≥7)

• Patients with decompensated cirrhosis require diuretics, lactulose, and monitoring for hepatic encephalopathy 1
• Medication interruption leads to ascites, spontaneous bacterial peritonitis, and variceal bleeding 1
• These patients have high mortality risk during disasters due to limited hepatic reserve 1

10. Active Cancer Requiring Chemotherapy

• Patients on active chemotherapy face treatment interruption leading to disease progression 4, 6
• Immunocompromised cancer patients have extremely high infection risk in shelter settings 1
• Pain management becomes critical as analgesic supplies may be interrupted 4

Critical Implementation Priorities

Immediate Actions (0-24 Hours)

• Establish emergency medication distribution systems at shelters through coordination with local and national agencies 2
• Identify all patients with the above 10 conditions through systematic screening 2
• Secure essential medications within 24-48 hours, as patients are at extremely high risk for decompensation without insulin, antihypertensives, diuretics, and other critical medications 2

Early Phase (24-72 Hours)

• Transfer dialysis-dependent patients to functioning facilities within 48-72 hours maximum 2
• Implement disease-specific protocols for fluid restriction, dietary modifications, and medication substitution when necessary 2
• Establish monitoring systems for early warning signs of disease decompensation 2

Common Pitfalls to Avoid

• Inadequate medication stockpiling (less than 7 days supply) results in dangerous treatment gaps, as pharmacy access may be impossible for 1-2 weeks 2
• Delaying patient relocation beyond 72 hours for dialysis-dependent patients significantly increases hospitalization and mortality risk 2
• Failure to maintain portable medical documentation leaves providers unable to prescribe appropriate medications during emergencies 2
• Underestimating chronic disease burden in disaster planning, as 77% of evacuated patients requiring care have underlying chronic medical conditions 6