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Nurses Note: Special Considerations for Those with CLL/SLL When Preparing for Floods and Other Natural Disasters

In science and medicine, information is constantly changing and may become out-of-date as new data emerge. All articles and interviews are informational only, should never be considered medical advice, and should never be acted on without review with your health care team.

Our hearts go out to all of those affected by Hurricane Ian last week. Living through the event of a flood, fire, earthquake, tornado, hurricane, and even a bad snowstorm is challenging enough. But often we don’t think about the chaos that can occur in the immediate aftermath or how to navigate the long recovery and rebuilding period thereafter.

As someone who has volunteered as a nurse during recovery efforts after catastrophic earthquakes (Haiti), hurricanes/flooding (Harvey & Wilma), and an F5 tornado (Joplin), I have personally seen the devastation. As a result, I cannot stress enough the importance of preparing for a natural disaster. Minimally having food, water, and first aid supplies on hand is extremely important. But it is also valuable for everyone to have a more detailed plan in place to help prepare them for challenges that come afterward. This is even more important for those living with cancer since immunocompromised individuals (such as those with CLL/SLL) are highly vulnerable to situations that can occur after a natural disaster.

Anytime there is catastrophic flooding, exposure to floodwater places all individuals at risk for infectious diseases, chemical hazards, and injuries. But those who are immunocompromised are at an even higher risk if they are exposed to infection or mold. 

The CDC recommends that everyone should have an emergency kit in their home that includes first aid supplies (such as antiseptic spray and bandages, rubbing alcohol, and topical antibiotic cream), fire extinguishers, a battery-powered emergency radio, enough fresh water and nonperishable foods to last at least 72 hours (for both you and pets), flashlights, extra batteries, and sleeping bags or extra blankets. It is also a good idea to have alternate ways to charge your cell phones in case you need to contact 911.

In addition to having emergency supplies on hand, it is important for those with CLL/SLL to also consider the following:

Medical Records

Keep a paper copy of your medical records on hand in a safe dry place that you can grab at a moment’s notice. You might also consider keeping your records on a flash drive, however, if power is out in your area accessing the information on a flash drive may not be feasible. Your records should include lab results, other illnesses or health problems, immunization history, all your diagnoses, surgical history, all medications and dosages that you are on (including over-the-counter medications and vitamins), allergies, and names/phone numbers of your healthcare team. Also, keep a hard copy of your healthcare provider’s names and phone numbers with your records.

Medications

If there is advanced notice of a possible natural disaster (such as is the case with hurricanes) make sure you are filling as many prescriptions as possible ahead of time so that you have at least a one-week supply on hand. Place medications in large waterproof freezer bags (in their bottles) and keep them close to you if you are sheltering in place, just in case you need to grab them quickly and take them with you. If there is advance warning of a natural disaster (such as a hurricane) talk to your pharmacist about refilling prescriptions early so that you have an extra supply on hand. Some pharmacies will allow you to refill prescriptions a few days early if there is an emergency evacuation order pending in your area.

If flooding has occurred, the FDA recommends throwing away any medication that has encountered floodwater. If a medication you are taking needs to be reconstituted into a liquid, only use water that you know is clean (preferably bottled water). If you lost power, refrigerated medications can typically remain cold for up to 24 hours. After 24 hours with no electricity, it is important to find another way to keep refrigerated medications cool until the power is restored. If available, use a cooler with clean ice or another source of refrigeration. If your medications have not been kept refrigerated for 24 hours, they should be discarded for safety reasons.

Hygiene

Consider keeping soap and hand sanitizer in your emergency kit. Since we are still in the midst of the COVID-19 pandemic, include extra masks in your emergency kit and wear an N95 or KN95 mask when you must come in contact with other individuals.

Keep any cuts or wounds clean and covered with bandages. If you have access to triple antibiotic ointment in your emergency kit, reapply it daily when you are cleaning any wounds or changing bandages.

As an immunocompromised individual, it is very important to avoid mold that can grow very quickly after floodwater has come in contact with your home or other belongings. If there was water damage, dry items out as soon as possible, and do not re-enter your home unless it is deemed safe to do so. If you cannot avoid mold, it is of utmost importance to protect yourself by covering your nose and mouth with an N95 mask and protecting your skin and eyes from coming in contact with any mold particles by wearing long-sleeved shirts, long pants, gloves, and goggles. After leaving an area with known mold, shower and change your clothes right away if possible. If you have known mold exposure and develop worsening symptoms such as fever or cough, contact a healthcare provider as soon as possible.

Food and Water

As mentioned previously, always try to have at least a 72-hour supply of food and water on hand. It is even better to have 1-2 weeks worth available. Have a plan for how you will boil or purify water with no electricity, such as water purification tablets or a pot, camping stove, and fuel. 

Keep a manual can opener in your emergency kit to open canned goods. If you have pets, store away their food, some clean water, and medication in a dry place too.

In addition to power outages that prevent refrigerators from cooling, some foods might have been contaminated by flood waters and will be harmful to you if consumed. After your refrigerator has been without power for 24 hours, it is recommended to throw out any remaining food that cannot be kept cool through another means such as a cooler with ice. 

Avoid fruits and vegetables from gardens that have been flooded with contaminated water. Make sure that all meats are thoroughly cooked, and fruits/vegetables have been thoroughly washed in safe water. Do not eat cooked foods that have been left at room temperature for more than two hours. When preparing food on countertops etc., ensure that all food-contact surfaces that may have previously come in contact with flood water have been properly disinfected with a bleach solution.

When natural disasters strike (particularly flooding) access to clean water can be very difficult if water treatment plants lose electricity or sustain damage, and grocery stores will most likely not be open or have supplies restocked. If you are not sure if the water available to you is safe, drink only bottled water or water that has been boiled for at least one full minute. Consider keeping jugs of water on hand that are put aside only for the use of brushing teeth, washing wounds, and frequent handwashing. It is also very important to remember that if you do bathe or shower and are not positive if the available water is clean, be careful not to get the faucet water in your mouth, eyes, or any open cuts/wounds.

Keep learning and stay well.

Robyn Brumble, MSN, RN
Director of Scientific Affairs & Research
CLL Society