When we talk about mass casualties event, code orange or disaster preparedness, emergency people automatically stops what they are doing and listen. (I do it!)
It is rare events that nobody wishes to happen, but we have to be adequately prepared to respond. Every hospital has a book, a protocol and procedures and it is supposed to be up to date! A specific section should be about special population, which elderly is part of.
In order to convince you that elderly is an important consideration when editing a code orange protocol; let’s review a few events.
During the Hurricane Katrina in 2005, 49% of victims were people 75 years old and older (1). A more Quebec tragedy, a fire in a nursing home at l’Ile Verte made 32 victims. The great blizzard of New York in 1996 paralyzed thousands of homes under snow x days. A few deaths were recorded, mostly elderly trying to get out of the home shovelling. Why all these people died? Were we unprepared? There is probably a major gap there.
Elderly are not adults with grey hair in this situation. A great proportion of them will have chronic morbid conditions, physical and cognitive impairment. Those are limitations that can have enormous impact on morbidity and mortality during a disaster.
The Red cross has two different guides for elderly. One guide is basically disaster plan that should be done by seniors themselves in case of emergency situation. Everyone should have some sort of a plan depending on the area you live and the most likely disaster that could happen (hurricane, earthquake, snowstorm, etc.).There is another guide for people with special needs but I found it very brief about senior.
What else is out there? A student did a systematic review on the subject and found some interesting idea (it will be published someday). Here is a brief summary.
Chronic health conditions could have significant effect during a disaster. Elderly are more likely to suffer from more than one that is usually well controlled with medications. But what happen when you do not have enough medication and the disaster is prolonged for days? The negative symptoms start to appear and threatened their comfort and life. It is important to have some sort of plan. For example, when a hurricane or any other disaster is announced, pharmacies are now aloud to provide more medications than the usual “need to be out of 75% of pill before renewal”. Elderly are advised to have at least 3 days of medication supplies in case of emergency. Rescuers and shelter should have a plan to access to more common medication in case if the disaster last more than 3 days.
Physical impairment has a major effect when evacuation is needed. More than 50% of older adults need some gait aid to walk around. In case of emergency, nursing home needs to have a very solid plan to evacuate elderly with wheel chairs or even stretchers. Many nursing homes are reluctant to do exercise evacuation plan because it is a traumatizing experience for elderly, even if the emergency is not real and planned in advance. What could be the best way to do it? Video and meeting are now explored. Rescuers have to be prepared and have a plan if evacuation is needed. Special vehicles? Anticipate extra time and staff for elderly mobilisation.
Cognitive impairment is another concern. When elderly needs to be evacuated in a shelter, we have to think about organizing a special section with less noise and extra trained staff in case they become in crisis. Also, they may not fully understand instructions. Rescuers have to make sure they have their glasses, hearing aids and they have to be very patient, calm and understanding.
There are numerous other advices and planning tips that could be discussed. This was just summary of the big issues and some solutions.
Finally, I invite you to get involve in your local disaster committee, review carefully your disaster plan and think about how you would address the special needs of elderly in case of emergency. See? Geriatric emergency medicine is so cool!!
- Brunkard J, Namulanda G, Ratard R. Hurricane Katrina deaths, Louisiana, 2005. Disaster medicine and public health preparedness. 2008 Dec;2(4):215-23. PubMed PMID: 18756175.