Emergency Nursing

Erickson R. Bernardo, MAN, RN

NCM 118
Nursing Care of Clients in
Emergency Situations
Environmental Emergencies
• Heat Related Emergencies • Lightning
• Drowning and Submersion • Soil Erosion / Landslide
Injuries • Volcanic Eruption
• Stings and Bites • Floods
• Poisoning
1. Heat Related Emergencies
• Heat emergencies are health crises caused by exposure to hot
weather and sun.
• Heat emergencies have three stages:
1. heat cramps
2. heat exhaustion
3. heatstroke
• All three stages of heat emergency are serious.
Heat Cramps
• Mildest form of heat illness and consist
of painful muscle cramps and spasms
that occur during or after intense
exercise and sweating in high heat.
• First stage of heat emergency.
• Usually happen with physical activity in
the heat, but they can also occur
without active physical activity.
Heat Exhaustion
• More severe than heat
cramps and results from a
loss of water and salt in the
body.
• Occurs in conditions of
extreme heat and excessive
sweating without adequate
fluid and salt replacement;
occurs when the body is
unable to cool itself properly
and, if left untreated, can
progress to heat stroke.
Heat Stroke
• Most severe form of heat
illness, occurs when the body's
heat-regulating system is
overwhelmed by excessive heat.
• It is a life-threatening
emergency and requires
immediate medical attention.
Management
1. Call 911 or go to the emergency room if the heat emergency is
causing vomiting, seizures, or unconsciousness.
2. Don’t give the person anything to drink if they’re vomiting or
unconscious.
3. Never offer a drink containing alcohol or caffeine to someone
experiencing a heat emergency.
Management – Heat Cramps
1. Move to a cooler area, out of direct sunlight.
2. Gently massage the cramping muscle.
3. Stretch the muscle gently.
4. Drink cool water or sports drinks every 15 minutes.
Management – Heat Exhaustion
1. Move to a cooler area, out of direct sunlight.
2. Loosen clothing.
3. Apply cool, wet towels to your face, neck, chest, and limbs.
4. Have someone fan your skin.
5. Drink cool water or sports drinks every 15 minutes.
6. Don’t drink too quickly.
Management – Heat Stroke
1. Move the person to a cooler area, out of direct sunlight.
2. Loosen clothing.
3. Remove any sweaty clothing.
4. Apply cool, wet towels to the face, neck, chest, and limbs.
5. Apply ice, if you have it, to the underarms, wrists, and groin.
6. Fan the person’s skin.
7. Offer cool water or sports drinks every 15 minutes if the person is
conscious.
Prevention
• The best way to avoid a heat emergency is to stay in the shade or in a
ventilated, air-conditioned area during the hottest parts of the day.
1. Rest as often as possible.
2. Wear light-colored, loose clothing.
3. Drink water frequently.
4. Avoid alcohol.
5. Help prevent a heat emergency in others by checking frequently
on older adults and children.
2. Drowning and Submersion Injury
• Drowning is essentially respiratory impairment from liquid
submersion.
• Accounts for at least 360,000 deaths annually worldwide.
• Non-fatal drowning events occur much more frequently than deaths.
• Quickly causes respiratory and cardiac arrest from hypoxemia, while
survivors can sustain pulmonary, neurologic, cardiovascular, and other
injuries.
Definitions
• Drowning – "The process of experiencing respiratory impairment
from submersion or immersion in liquid."
• Fatal drowning – A drowning event with a fatal outcome.
• Non-fatal drowning – A drowning event in which the process of
respiratory impairment is stopped before death, and the victim
survives.
• Rescue – An intervention that prevents progression to drowning in an
individual who is submerged but at no time develops respiratory
symptoms or impairment.
Definitions
• The World Health Organization has proposed a framework to further
classify non-fatal drowning based on the severity of respiratory
impairment immediately after the drowning process has stopped:
• Mild impairment: Breathing, involuntary distressed coughing and fully
alert
• Moderate impairment: Difficulty breathing and/or disoriented but
conscious
• Severe impairment: Not breathing and/or unconscious
• DO NOT USE:
• "near-drowning," "secondary drowning," "wet drowning," and "dry
drowning”
Risk Factors
• Inadequate adult supervision or
being around bodies of water
while alone
• Inability to swim or
overestimation of swimming
capabilities
• Risk-taking behavior
• Use of alcohol
• Hypothermia
• Concomitant trauma, stroke, or
myocardial infarction
• Having a seizure disorder
• Developmental/behavioral
disorders (in children)
• Undetected primary cardiac
arrhythmia
• Hyperventilation prior to a
shallow dive (in order to prolong
underwater duration)
Nursing Management
• Immediate assessment and stabilization of the patient’s airway
• Provide adequate oxygenation
• Maintain cerebral perfusion
• Continuous monitoring
• Provide rewarming methods
• Initiate cardiopulmonary resuscitation (CPR) if necessary
• Ensure absence of complications
3. Stings and Bites
• Considered to be environmental emergencies resulting from insect
stings, animal bites, human bites, fish stings, and jelly fish stings.
• Possible complications to bites and stings include pain, bleeding,
infection, envenomation, and anaphylaxis.
Risk Factors
• Live near wetlands
• Work or live with animals
• Work or spend a lot of time outdoors
• Live in warmer climates
• Fail to use proper protection
• Do not use flea and tick prevention for pets
• Collect insects as a hobby
Signs and Symptoms
• Most common • Severe allergic reaction
• Mild swelling • Problems breathing or
• Redness wheezing
• Pain • Swelling, redness, or hives
• Heat • The throat feels like it is
• Itching closing
• Belly pain, nausea or
vomiting
• Headache, muscle aches, or
cramps
• Weakness
• Fever, chills, or sweating
Management
• Remove insect and stinger if still attached to skin
• When removing stingers, use a sideways scraping motion to avoid
further envenomation
• Inspect patient’s clothing and remove any other insects and stingers
• Apply a cold pack at 20 minute on / off intervals for pain relief and to
reduce swelling
• Provide further analgesia as required according to pain scale
• Consider administration of Tetanus Toxoid
• Document assessment findings, interventions and outcomes
Snake Bites
• While many snakes are harmless, the bite of some species can be
venomous and even deadly.
Symptoms
• Puncture marks at the wound • Rapid heart rate, weak pulse, low
• Redness, swelling, bruising, blood pressure
bleeding, or blistering around the • Disturbed vision
bite • Metallic, mint, or rubber taste in
• Severe pain and tenderness at the the mouth
site of the bite • Increased salivation and sweating
• Nausea, vomiting, or diarrhea • Numbness or tingling around face
• Labored breathing (in extreme and/or limbs
cases, breathing may stop • Muscle twitching
altogether)
Management
• Seek medical attention as soon as possible (dial 911 or call local
Emergency Medical Services [EMS]).
• Lay or sit down with the bite in a neutral position of comfort.
• Remove rings and watches before swelling starts.
• Wash the bite with soap and water.
• Cover the bite with a clean, dry dressing.
• Mark the leading edge of tenderness/swelling on the skin and write
the time alongside it.
Do NOT do any of the following:
• Do not pick up the snake or try to trap it. NEVER handle a venomous
snake, not even a dead one or its decapitated head.
• Do not wait for symptoms to appear if bitten, get medical help right
away.
• Do not apply a tourniquet.
• Do not slash the wound with a knife or cut it in any way.
• Do not try to suck out the venom.
• Do not apply ice or immerse the wound in water.
• Do not drink alcohol as a painkiller.
• Do not take pain relievers (such as aspirin, ibuprofen, naproxen).
• Do not apply electric shock or folk therapies.
Spider Bites
• When a spider bites, it may leave
two marks on the skin.
• Some spider bites can produce
severe symptoms, but very few are
life threatening, and most spiders
cannot bite humans.
Symptoms
• two marks where the fangs
broke the skin
• sharp pain at bite site
• sweating
• nausea, vomiting and
abdominal pain
• burning sensation
• swelling
• blistering
Management
• Apply an ice pack on and off the bite for 10 minutes at a time. Always
wrap ice or an ice pack in a cloth.
• Elevate the area to reduce swelling.
• Give antihistamine, such as diphenhydramine (Benadryl), to help with
itching.
• Clean the area with soap and water to prevent infection.
• Apply antibiotic ointment to the area if blisters develop.
Bee Stings
• A bee sting is a painful injury that happens after a bee pierces your
skin and injects venom.
Symptoms
• Mild reaction • Severe allergic reaction
• Instant, sharp burning pain at • Skin reactions, including hives
the sting site and itching and flushed or pale
skin
• A red welt at the sting area • Difficulty breathing
• Slight swelling around the sting • Swelling of the throat and
area tongue
• Moderate reaction • A weak, rapid pulse
• Extreme redness • Nausea, vomiting or diarrhea
• Swelling at the site of the sting • Dizziness or fainting
that gradually enlarges over the • Loss of consciousness
next day or two
Management
• Remove the sting by sliding or scraping your fingernail across it,
rather than pulling at it.
• Wash the area and apply a cold pack to reduce the swelling.
• If there is significant pain and swelling, over-the-counter pain
medication (such as paracetamol) or an antihistamine may give some
relief.
Tick Bites
• Tick bites can be harmless or they can
infect you with diseases like Lyme
disease or spotted fever.
• It’s best to try to prevent tick bites or
to find tick bites early.
Symptoms
• Fever
• Chills
• Muscle pain
• Headaches
• Tiredness
• Itchiness or irritation, but
usually not right away
• Skin rash
Management
• Tug gently but firmly with blunt tweezers near the head of the tick at
the level of the skin until it releases its hold on the skin.
• Avoid crushing the tick's body or handling the tick with bare fingers as
this could expose one to the bacteria in the tick.
• Wash the bite area thoroughly with soap and water.
• Do not use kerosene, petroleum jelly (such as Vaseline®) or hot
cigarette butts to remove the tick.
• Do not squeeze the tick's body with fingers or tweezers.
Jellyfish Sting
• Jellyfish stings are fairly common
problems for people swimming,
wading or diving in oceans.
• The long tentacles trailing from the
jellyfish can inject venom from
thousands of microscopic barbed
stingers.
Symptoms
• Difficulty breathing
• Chest pain
• Muscle cramps
• Skin blisters
• Numbness or tingling
• Nausea or vomiting
• Difficulty swallowing (dysphagia)
• Abdominal pain
• Excessive sweating (hyperhidrosis)
Management
• Wash the tentacles and venom off the affected area of the body with
seawater. Don’t use freshwater.
• Using tweezers or gloved hands, remove any tentacles in the skin.
• Apply vinegar or rubbing alcohol to the affected area to stop any
more firings of nematocysts. (DO NOT use vinegar for Portuguese
man-of-war stings, though. It can cause more venom to be released
from the nematocysts.)
• To help reduce the pain, put calamine lotion or hydrocortisone cream
on a jellyfish sting.
• Use an ice pack or hot water to help with the pain and swelling.
4. Poisoning
• A poison is any substance that, when ingested, inhaled, absorbed,
applied to skin, or produced within the body in relatively small
amounts, injures the body by its chemical reaction.
• Represents the harmful effects on the human body of accidental or
intentional exposure to toxic amounts of any substance.
• Injury or death due to swallowing, inhaling, touching or injecting
various drugs, chemicals, venoms or gases.
Types
• Ingestion
• Inhalation
• Injection
• Absorption
Symptoms
• The symptoms of poisoning depend on the substance and the amount
taken in.
• Some poisonous substances, such as carbon monoxide, interfere with
the blood's ability to carry oxygen.
• Others, such as bleach, burn and irritate the digestive system.
General Symptoms
• feeling and being sick
• diarrhea
• stomach pain
• drowsiness, dizziness or weakness
• high temperature
• chills (shivering)
• loss of appetite
• headache
• irritability
• difficulty swallowing (dysphagia)
• breathing difficulties
• producing more saliva than normal
• skin rash
• blue lips and skin (cyanosis)
• burns around the nose or mouth
• double vision or blurred vision
• mental confusion
• seizures (fits)
• loss of consciousness
• coma, in severe cases
Signs of a Medicine or Drug Overdose
• Paracetamol
• Paracetamol is a widely used over-the-counter painkiller.

• yellowing of the skin and the whites of the eyes (jaundice)

• loss of co-ordination
• low blood sugar (hypoglycemia), which can cause symptoms
including sweating, trembling and irritability
Signs of a Medicine or Drug Overdose
• Aspirin
• Aspirin is an anti-platelet medicine that thins the blood and
reduces the risk of blood clots forming (arterial thrombosis).

• sweating
• rapid breathing
• ringing in the ears (tinnitus)
• temporary hearing loss
Signs of a Medicine or Drug Overdose
• Tricyclic Antidepressants
• Tricyclic antidepressants are used to treat clinical depression, as
well as a number of other mental health conditions, such as panic
disorder and obsessive compulsive disorder (OCD).

• excitability
• dry mouth
• large pupils
• irregular or rapid heartbeat
• low blood pressure, which can cause symptoms including
lightheadedness and fainting
Signs of a Medicine or Drug Overdose
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• SSRIs are a newer type of antidepressant that are also used to
treat mental health conditions such as OCD and anxiety disorder.

• feeling agitated
• tremor (shaking)
• uncontrolled movement of the eyes (nystagmus)
• severe muscle tension
Signs of a Medicine or Drug Overdose
• Beta Blockers
• Beta blockers are used to treat a number of conditions that affect
the heart or blood, such as high blood pressure (hypertension),
angina and heart failure.

• low blood pressure, which can cause symptoms such as

lightheadedness and fainting
• a slow heartbeat (below 60 beats per minute)
Signs of a Medicine or Drug Overdose
• Calcium-Channel Blockers
• Calcium-channel blockers are used for the treatment of high blood
pressure and angina.

• feeling agitated
• low blood pressure, which can cause symptoms such as
lightheadedness and fainting
• chest pain
• a slow heartbeat (below 60 beats per minute)
Signs of a Medicine or Drug Overdose
• Benzodiazepines
• Benzodiazepines are a type of tranquilizer, often used on a short-
term basis to treat anxiety and sleeping problems (insomnia).

• coordination and speech difficulties

• uncontrolled movement of the eyes (nystagmus)
• shallow breathing
• drowsiness
Signs of a Medicine or Drug Overdose
• Opioids
• Opioids are a type of stronger painkiller used to treat moderate to
severe pain. They include codeine and morphine, as well as the
illegal drug heroin.

• small pupils
• shallow breathing
• drowsiness
Signs of a Medicine or Drug Overdose
• Stimulant Overdose
• If you take too much of a stimulant-like drug, such as cocaine,
amphetamine, crack or ecstasy, overdose signs can include:

• anxiety and paranoia

• restlessness or agitation
• hallucinations
• high temperature
• chest pain
• rapid breathing
• irregular or fast heartbeat
Signs of a Medicine or Drug Overdose
• Cannabis Overdose
• If you smoke (or eat) too much cannabis, you may experience the
following symptoms:

• paranoia
• hallucinations
• numbness in your arms and legs
Management
• To maintain normal VS
• To decontaminate the site of exposure
• To prevent and reduce absorption
• To enhance elimination
• To relieve symptoms
• To prevent further organ damage or impairment without delay
Management
• Activated charcoal
• sometimes used to treat
someone who's been poisoned;
the charcoal binds to the poison • Ventilator
and stops it being further
absorbed into the blood
• Antidotes
• these are substances that either
prevent the poison from working
or reverse its effects
• Sedatives
• may be given if the person is
agitated
• may be used if the person stops
breathing
• Anti-epileptic medicine
• may be used if the person has
seizures (fits)
Nursing Management
• Supportive care
• Most important element in managing acute poisoning; based on the
clinical status and requires no knowledge specific to the poison
involved.
• Maintenance of respiration and circulation are primary concerns.
• Measures for respiratory support include inserting an airway, giving
humidified oxygen, and providing mechanical ventilation.
• Volume depletion (resulting from vomiting, diarrhea, or sweating) can
compromise circulation; should be restored by administering normal
saline or Ringer’s solution.
Nursing Management
• Supportive care
• Severe hypoglycemia may occur, resulting in coma; levels of blood
glucose should be monitored.
• For coma of unknown etiology, IV dextrose should be given
immediately—even if information on blood glucose is lacking.
• Acid-base disturbances may occur; determination of arterial blood
gases will facilitate diagnosis and management.
• If convulsions develop, IV diazepam is the treatment of choice.
Nursing Management
• Poison identification
• Treatment of poisoning is facilitated by knowing the identity and dosage
of the toxicant.
• A history is one way to identify the toxic agent.
• Positive identification can be made using analytic techniques.
• Gas chromatograph/mass spectrometer can provide qualitative and
quantitative information.
• Analyses can be performed on specimens of urine, blood, and gastric
contents; performed on sequential blood samples taken about 2 hours
apart.
Nursing Management
• Prevention of further absorption
• By reducing the absorption of a poison, we can minimize blood levels,
and thereby significantly decrease morbidity and mortality.
• For ingested poisons, three procedures are available:
• giving activated charcoal
• gastric lavage and aspiration
• whole-bowel irrigation
• Induction of emesis with syrup of ipecac, either at home or in the clinic,
is no longer recommended.
• When poison exposure is topical, surface decontamination is employed.
Nursing Management
• Promotion of poison removal
• Measures that help eliminate poison from the body shorten the
duration of exposure and, if implemented before plasma levels have
peaked, can reduce the maximum level of poison achieved.
• Removal of poison can be promoted with drugs and with
nonpharmacologic techniques.
• The drugs used for poison removal act by increasing renal excretion of
toxic agents.
• Nonpharmacologic methods of poison removal include peritoneal dialysis,
hemodialysis, and exchange transfusion.
Nursing Management
• Use of specific antidotes
• An antidote is an agent administered to counteract the effects of a
poison.
• Examples include naloxone (to reverse poisoning by heroin and other
opioids) and physostigmine (to treat poisoning by atropine and other
anticholinergic drugs).
• Unfortunately, although antidotes can be extremely valuable, these
agents are rare: For most poisons, no specific antidote exists.
 Vitamin K
Protamine sulfate
N-acetylcysteine
Flumanezil
Digibind
Naloxone
Activated charcoal
Calcium gluconate
Glucose
5. Lightning
• Lightning is a frequent occurrence worldwide with an estimated 50
occurrences per second and 20% of those resulting in ground strikes.
• It is impossible to know exactly, but it is estimated that worldwide
there are approximately 24,000 fatalities with ten times as many
injuries annually due to lighting.
• Most of these incidents are avoidable.
Lightning
• Lightning carries a staggering amount of energy (30– 110 thousand
amps) and voltage (10 million volts) that is delivered in a massive
pulse over only a few milliseconds.
• For reference, a typical household current measures 110-120 volts
and 15 amps, and a typical power line can deliver >7,000 volts.
• Lightning is neither DC nor AC current, but rather a massive impulse
of electrons moving in a single direction
Mechanism of Strike
• Direct strike (5%) – lightning makes
direct contact with subjects, more
commonly fatal
• Contact injury (15%) – lightning
strikes an object that a victim is
directly holding or touching with
direct passage of current
• Side splash (30%) – lightning
strikes an object (i.e. tree, pole,
building) and current subsequently
“jumps” to a victim
• Ground current (50%) – current
travels through the ground to the
victim, whose body is of lower
resistance than the ground
• Blunt trauma – secondary to the
wave of force generated by
lightning strike
• Electrical streamers – lightning
that travels upward into the sky
and delivers a charge that passes
over a victim, not as powerful as a
strike coming from the sky
Management
• IV fluid resuscitation
• Mannitol-induced diuresis, alkalinization of the urine, or aggressive
fluid resuscitation
• In hypertensive or normotensive patients, fluid restriction is
recommended
• Fasciotomy is generally not needed
• Prophylactic antibiotics not indicated
• Update tetanus if indicated
• Burns are generally too superficial to require treatment with topical
agents
Prevention
• Seek shelter in an large enclosed indoor structure or fully-enclosed
metal-topped vehicle, even small structures such as golf shelters and
shallow caves can be capacitors for lightning energy.
• Flash-bang rule helps estimate distance from an observer.
• Count the seconds between the flash of lightning and bang of thunder.
• The time in seconds/5 = approximate number of miles.
• 30-30 rule:
• when lightning is observed, count time until thunder heard and if the
time is <30 seconds, seek shelter and wait 30 minutes from the time of
the last lightning or thunder before leaving
Prevention
• If in a group, spread people out to prevent side splash.
• Avoid singular tall structures such as trees or isolated flat areas.
• Assume the ‘Lightning position’ if in an exposed area an unable to
retreat (crouch over planted feet with heels touching or sit cross-
legged preferably over a pad, backpack, or other limited conduction
surface).
6. Soil Erosion / Landslide
• Landslides and debris flows are
caused by a number of factors, such
as earthquakes, heavy rain, volcanic
eruptions and poor land
management.
• They often occur in mountainous
regions where loose material can
easily slide downhill.
• The force of rocks, soil and other
debris moving quickly down a slope
can devastate everything in its path.
Warning Signs
• Doors or windows stick or jam for
the first time.
• New cracks appear in plaster, tile,
brick or foundations.
• Outside walls, walks or stairs begin
pulling away from the building.
• Slowly developing, widening cracks
appear on the ground or on paved
areas.
• Underground utility lines break.
• Bulging ground appears at the base
of a slope.
• Water breaks through the ground
surface.
• Fences, retaining walls, utility poles
or trees tilt or move.
• Faint rumbling sound that increases
in volume as the landslide nears.
The ground slopes downward in one
specific direction and may begin
shifting in that direction under the
feet.
Health Threats
• Rapidly moving water and debris that can lead to trauma.
• Broken electrical, water, gas and sewage lines that can result in injury
or illness.
• Disrupted roadways and railways that can endanger motorists and
disrupt transport and access to health care.
Areas at Risk
• Areas where wildfires or construction have destroyed vegetation.
• Areas where landslides have occurred before.
• Steep slopes and areas at the bottom of slopes or canyons.
• Slopes that have been altered for construction of buildings and roads.
• Channels along a stream or river.
• Areas where surface runoff is directed.
Before a landslide:
• Get a ground assessment of your property.
• Your county geologist or county planning department may have
specific information on areas vulnerable to landslides.
Minimize home hazards
• Plant ground cover on slopes to stabilize the land, and build retaining
walls.
• Build channels or deflection walls to direct the flow around buildings.
• Remember: If you build walls to divert debris flow and the flow lands
on a neighbor's property, you may be liable for damages.
During a landslide:
• If inside a building
• Stay inside.
• Take cover under a desk, table or other piece of sturdy furniture.
After a landslide:
• Run to the nearest high ground in a direction away from the path.
• If rocks and other debris are approaching, run for the nearest shelter
such as a group of trees or a building.
• If escape is not possible, curl into a tight ball and protect your head.
• Remember that flooding may occur after a mudflow or a landslide.
• Stay away from the slide area; there may be danger of additional
slides.
• Check for injured and trapped persons near the slide area. Give first
aid.
After a landslide:
• Remember to help your neighbors who may require special assistance
– infants, elderly people, and people with disabilities.
• Listen to a battery-operated radio or television for emergency
information.
• Check for damaged utility lines. Report any damage to the utility
company.
• Check the building foundation, chimney, and surrounding land for
damage.
• Replant damaged ground as soon as possible. Erosion caused by loss
of ground cover can lead to flash flooding.
7. Volcanic Eruptions
• Volcanic dangers include not only an eruption of a mountain and
associated lava flows, but also ash fall and debris flows.
Major health threats
• Volcanoes spew hot, dangerous gases, ash, lava, and rock that are
powerfully destructive.
• People have died from volcanic blasts.
• Health concerns after a volcanic eruption include infectious disease,
respiratory illness, burns, injuries from falls, and vehicle accidents
related to the slippery, hazy conditions caused by ash.
• When warnings are heeded, the chances of adverse health effects
from a volcanic eruption are very low.
Before a volcanic eruption:
• Plan ahead. Have emergency supplies, food and water stored.
• Plan an evacuation route away from rivers or streams that may carry
mud or debris flow.
• Keep a battery-operated radio available at all times.
• If there is an eruption predicted, monitor the radio or TV for
evacuation information. Follow the advice given by authorities.
After a volcanic eruption:
• Do not approach the eruption area.
• Be prepared to stay indoors and avoid downwind areas if ash fall is
predicted.
• Evacuate if advised to do so by authorities.
• Be aware of stream and river channels when evacuating.
• Move toward higher ground if mudflows are approaching.
• Follow the evacuation signs posted along roads and highways.
If there is ash fall in your area:
• Protect your lungs. Infants, the elderly and those who have
respiratory conditions such as asthma, bronchitis, emphysema and
other chronic lung and heart diseases should be particularly careful to
avoid breathing ash.
• Stay inside. Close doors, windows and dampers. Place damp towels at
door thresholds and other draft sources.
• When outside, wear a single-use (disposable) facemask.
• Those most at risk should limit outdoor activities. Keep children and
pets indoors.
If there is ash fall in your area:
• If you have asthma or another respiratory condition – or have a child
with asthma – pay attention to symptoms such as wheezing and
coughing, or more severe symptoms such as chest pain or tightness,
shortness of breath and severe fatigue.
• If you wear contact lenses, protect your eyes by wearing glasses or
protective goggles or by removing your contacts.
• If you find ash in your drinking water, use an alternate source of
drinking water such as purchased bottled water.
• Put stoppers in the tops of your drainpipes.
If there is ash fall in your area:
• Protect dust-sensitive electronics.
• Keep roofs free of ash in excess of 4 inches.
• Remove outdoor clothing before entering a building.
• Wash vegetables from the garden before eating.
• Minimize travel — ash may be harmful to your vehicle.
• Frequently change oil and air filters in your automobile.
8. Floods
• Floods are the most common and widespread of all natural disasters.
Health risks
• Wound infections
• Skin rash
• Gastrointestinal illness
• Tetanus
• Leptospirosis
• Melioidosis (along the Gulf Coast)
Before a flood:
• Plan for evacuation including where you are going to go and the route
you will follow.
• Prepare your home for a flood.
• Purchase flood insurance.
• Keep all insurance policies and a list of valuable items in a safe place.
• Take photos or a videotape of the valuables you keep in your home.
• Listen to your radio or television for reports of flood danger.
• Keep your car filled with gas.
During a flood:
• Do not try to walk or drive through flooded areas. Water can be
deeper than it appears and water levels rise quickly.
• Stay away from moving water; moving water six inches deep can
sweep you off your feet.
• Stay away from disaster areas unless authorities ask for volunteers.
• Stay away from downed power lines.
• If your home is flooded, turn the utilities off until emergency officials
tell you it is safe to turn them on.
• Wash your hands frequently with soap and clean water if you come in
contact with floodwaters.
After a flood:
• Wear gloves and boots when cleaning up.
• Open all doors and windows. Use fans if possible to air out the
building.
• Wash all clothes and linens in hot water.
• Discard mattresses and stuffed furniture.
• Wash dirt and mud from walls, counters and hard surfaced floors with
soap and water. Disinfect by wiping surfaces with a solution of one
cup bleach per gallon of water.
• Discard all food that has come into contact with floodwater. Canned
food is alright, but thoroughly wash the can before opening.
Leptospirosis
• Bacterial disease that occurs
worldwide and can cause serious
illnesses such as kidney or liver
failure, meningitis, difficulty
breathing, and bleeding.
• Cases of leptospirosis can increase
after hurricanes or floods when
people may be exposed to
contaminated water or use it for
drinking or bathing.
Causes
• Encountering water or soil
containing urine or bodily fluids
from infected animals
• Directly touching urine or bodily
fluids from an infected animal
• Eating food or drinking water
contaminated by urine
• Animals like rodents, dogs,
livestock and wildlife can spread
leptospirosis
• During hurricanes or heavy rain
events, animal urine in the soil
and other surfaces can get into
floodwater, contaminating it and
other natural water sources like
streams
Symptoms
• Fever • Diarrhea
• Headache • Abdominal pain
• Chills • Jaundice (yellowing of the skin
• Muscle aches and eyes)
• Red eyes • Skin rash
• Vomiting/nausea • Cough
Prevention
• Treat water to make it safe to drink by boiling or using an appropriate
chemical treatment.
• Cover cuts or scratches with waterproof bandages or other coverings
that seal out water.
• Do not wade, swim, bathe, submerse your head in, or swallow
floodwater or any fresh water source that may contain animal urine or
be contaminated by floodwater runoff.
• Wear waterproof protective clothing, shoes or boots near floodwater
or other water or soil that may be contaminated with animal urine.
• Prevent rodent infestation by keeping food, water and trash in closed
containers, and trapping any rodents you see.