Personal Protective Actions You Can Take in a Flu Pandemic

Young woman under the covers in bed blowing her nose.

Every fall and winter the United States experiences epidemics of seasonal influenza (flu). Sometimes a flu pandemic occurs due to a new flu virus that spreads and causes illnesses around the world. We cannot predict when a flu pandemic will occur, but over the past 100 years, we have documented four flu pandemics resulting in close to 1 million deaths in the United States alone. 1Get a flu vaccine! The most important way to prevent the flu in everyone 6 months and older is to get a yearly flu vaccine.

When a flu pandemic happens, it can take up to 6 months before a vaccine against a new flu virus is available. Antiviral drugs can help manage the symptoms of the flu, shorten the time you are sick by 1 or 2 days, and prevent serious flu complications, like pneumonia. But, there may be a limited supply of these medications during a pandemic so nonpharmaceutical interventions (or NPIs) may be the only prevention tools available during the early stages of a pandemic.

There are things you can do, apart from getting vaccinated and taking medications, to help slow the spread of a flu pandemic. NPIs, also known as “community mitigation measures,” are important because they will be the first line of defense in the absence of a pandemic vaccine. NPIs may be more effective when used early and in a layered approach (i.e., using more than one measure at a time). During the 1918 pandemic, cities that put NPIs in place quickly reported fewer deaths.2,3 NPIs may be used in different settings, including homes, schools, workplaces, and places where people gather (e.g., parks, theaters, and sports arenas).

Personal protective measures to prevent flu at all times

Photo of someone washing their hands in a sink.CDC recommends using some NPIs to prevent seasonal flu and other respiratory infections. To help prevent the flu, you should always:

  • Stay home when sick and away from others as much as possible,
  • Stay away from people who are sick as much as possible,
  • Cover your coughs and sneezes with a tissue,
  • Wash your hands often with soap and water,
  • Avoid touching your eyes, nose, or mouth, and
  • Regularly clean surfaces and objects that you use a lot.

Personal protective measures to prevent flu during a pandemic

Many of these NPIs would still be recommended during a pandemic, but some would be reserved for use during a flu pandemic. Depending on the severity of a pandemic, CDC might recommend:

  • Stay home if exposed to a sick household member,
  • Use a face mask when sick and out in crowded community settings, and
  • Implement community measures to reduce exposure to pandemic flu (coordinating school closures, limiting face-to-face contact in workplaces, and postponing or canceling mass gatherings).

CDC is preparing for a flu pandemic

There is always a threat that a flu pandemic will arise, so CDC is taking steps to prepare. In 2017, CDC issued updated community mitigation guidelines to help state and local public health departments and their community partners make plans before the next pandemic happens. Visit www.cdc.gov/npi to access the updated guidelines; plain-language planning guides for the general public and community settings; and additional NPI communication, education, and training materials. You can find more information about seasonal and pandemic flu at www.cdc.gov/flu and at www.cdc.gov/flu/pandemic.

Footnotes:

1 Past Pandemics: https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html

2 Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A. 2007; 104:7582-7.

3 Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918–1919 influenza pandemic. JAMA. 2007; 298:644-54.

The Power of Us

Evacuteer checking someone in during 2017 full-scale city assisted evacuation exercise.

“I am a Katrina survivor.” These were the first words out of Joan Ellen’s mouth when I spoke with her. And she was one of the lucky ones. She made it out of New Orleans before Hurricane Katrina made landfall on August 29, 2005. But not everyone was so fortunate. One of Joan Ellen’s neighbors did not evacuate because she could not bring her old dog with her to a shelter and would not leave him behind. Her neighbor died in the flooding. Joan Ellen recalls, “If I had known I would have taken her with me.”

Evacuations are more common than you might think. Every year people across the United States are asked to evacuate their homes due to fires, floods, and hurricanes. However, there are many reasons people may not be able to evacuate– including issues that New Orleans’ residents face, like lack of transportation, financial need, homelessness, and medical or mobility issues.

No one left behindJoan Ellen returned to her home in New Orleans 48 days after Hurricane Katrina. She likes to tell people, “I only had a foot of water – but it was a foot over my roof.” The thing she remembers most vividly about going home was not the destruction, but the smell. When Joan Ellen heard a radio announcement that they were recruiting volunteers to help in a mandatory evacuation she signed up. She has been training other Evacuteers since she joined the organization in 2009. She loves the casual definition of family that keeps people together in the event of an evacuation. “Family is anybody we say is family, and we will keep everybody together. In New Orleans we are only two degrees of separation.”

According to FEMA’s Preparedness in America report, people in highly populated areas were more likely to rely on public transportation to evacuate in the event of a disaster. In the event of a mandatory evacuation, approximately 40,000 people living in New Orleans will need assistance to evacuate because they don’t have a safe or alternative option.

After learning from Hurricane Katrina, the City of New Orleans will now call a mandatory evacuation nearly three days in advance of a dangerous or severe storm making landfall on the Louisiana coast. Everyone must leave during a mandatory evacuation until officials declare the city safe for re-entry.

Mobilizing the Evacuteers

The City also started City Assisted Evacuation (CAE) to help people who are unable to evacuate on their own. Through this program, the city provides free transportation for residents, along with their pets, to a safe shelter. CAE counts on volunteers from Evacuteer.org, a local non-profit organization that recruits, trains, and manages 500 evacuation volunteers called “Evacuteers” in New Orleans. As the Executive Director of this organization I tell people, “We are a year-round public health preparedness agency that promotes outreach to members of the community that aren’t always easy to reach, nor trusting of government, about their options and the evacuation process. The goal is to make sure that everyone using CAE is treated with dignity throughout the entire process.”

Lit evacuspot in Arthur Center
Evacuspot outside of Arthur Monday Multipurpose Center

Evacuteers receive a text message if the City of New Orleans calls for a mandatory evacuation. Teams are assigned to seventeen pickup points, called Evacuspots, placed in neighborhoods around the city. The Evacuteers help register people and provide information about the evacuation process. When residents go to an Evacuspot, Evacuteers will give every person a ticket, a wristband, and a luggage tag to help track their information and ensure that families stay together. After the paperwork is filled out, evacuees are transported to the downtown Union Passenger Terminal bus station where they will board a bus, and for a smaller percentage, a plane, to a state or regional shelter. When the city is re-opened after the storm passes, the process will bring residents back home to New Orleans.

An artistic approach to save lives

Each Evacuspot is marked by a statue of a stick figure with his arm in the air, and looks as though he is hailing a safe ride out of the city. Erected by international public artist, Douglas Kornfeld, the statues are a public art initiative led, and fundraised, by Evacuteer.org. Installed at each of the pick-up points in 2013, the stainless steel statues measure 14-feet tall, and stand as a reminder to residents year-round that there is a process to ensure everyone has the opportunity to safely evacuate.

Do you know what to do?

  1. Have a plan. Know where your family will meet, both within and outside of your neighborhood, before a disaster.
  2. Fill ‘er up. Make sure you have a half a tank of gas at all times in case of an unexpected evacuation. If an evacuation seems likely, make sure your tank is full.
  3. Keep your options open. Have alternative routes and other means of transportation out of your area. Choose several destinations in different directions you can go to evacuate.
  4. Leave early. Plan to take one car per family to reduce congestion and delay.
  5. Stay alert. Do NOT drive into flooded areas. Roads and bridges may be washed out and be careful of downed power lines.

Learn more

Read our other National Preparedness Month blogs:

Preparedness and Response in Action: Stories from the States

Celebrating 15 Years of PHEP

CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement is a critical source of funding, guidance, and technical assistance for state, local, tribal, and territorial public health departments to strengthen their public health preparedness capabilities.  Since 9/11, the PHEP program has saved lives by building and maintaining a nationwide public health emergency management system that enables communities to rapidly respond to public health threats.

The following stories are examples of how PHEP has equipped states for each of the four stages of preparedness: Ready. Steady. Show. Go!

READY: Planning for the inevitable6 domains of preparedness

Often the emergency managers and public health professionals who respond to an emergency are personally impacted by the same event. The ability of emergency response staff to take action during a disaster is limited when they are stranded in their homes due to an ice storm, without power, or unable to make it into the office.

The Connecticut State Department of Health, led by Jonathan Best, took on the challenge to ensure that operations can run smoothly even when their own staff are directly impacted by an emergency. They developed the Red Sheet Program, which trains three people for every key position in the emergency management structure – a primary contact with two back-ups. This means the health department can be fully staffed and ready to respond to a crisis within 20 minutes.

STEADY: Solving two problems at once

As the saying goes, even the best laid plans often go awry. Planning is an essential part of any preparedness program, but it is often difficult to imagine every scenario and obstacle that may arise during an emergency. But we also know that practice is the best way to identify and address those gaps– and practice is exactly what the Oklahoma State Department of Health does to improve its preparedness programs.

In September 2016, the Oklahoma Strategic National Stockpile team prepared to conduct a full-scale exercise of its ability to distribute medical countermeasures – medications and other products used to prevent and treat health conditions that may arise during a public health emergency.  Before the exercise began, the state realized they had shipments of flu vaccines that they needed to distribute around the state and the team distributed the vaccines as part of their regularly scheduled exercise. The team transported 11,960 doses of vaccine to eight local health departments while simultaneously completing this practice exercise.

SHOW: Creating a culture of preparedness

Emergencies impact all sectors of health, and experts from across departments are often asked to weigh in, from epidemiologists, to laboratorians, to mental health experts. However, public health staff in these positions may not often consider their roles in an emergency situation.

To build a culture of preparedness across the entire Oregon Health Authority, the Emergency Operations Division provided all staff with a 72-hour emergency kit, worked to enroll staff in the Health Alert Network, and trained staff on the Incident Management System. Since this initiative, staff personally feel more prepared for an emergency, and more staff are now prepared to respond should the need arise. “The culture has shifted. People are now talking in the elevator about what they would do in the event of a large-scale disaster,” acting PHEP director Akiko Saito said. “If we can build this culture of preparedness here, then we’re better equipped to build community resiliency on a larger scale.”

GO! Putting plans into action

While we all hope that emergencies never occur, they are inevitable and the true test of any preparedness system. Washington experienced an outbreak of mumps that affected more than 800 people of all ages in late 2016 and early 2017.

During this outbreak, the state and local health departments in Washington investigated new cases, advised local school districts on prevention measures, and developed culturally appropriate risk communication materials. Due to a robust preparedness system and the efforts of the health department staff and partners, more than 5,000 more people were vaccinated for measles, mumps, and rubella compared to previous years.

For 15 years, PHEP has been there, from Katrina to SARS; Joplin to H1N1 influenza. To find out more about how the PHEP program has equipped jurisdictions to prepare for, respond to, and recover from public health emergencies, check out our Stories from Field.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

Preparing for the Worst-case Scenario

"ROTTERDAM, HOLLAND - SEPTEMBER 5, 2010: Demonstration of handling of car crash victim by medics at the annual World Harbor Days in Rotterdam, Holland on September 5"
New York City completed a functional exercise to help the city’s hospital system prepare for emergency medical personnel to treat and transport children, like this young girl, after a catastrophic event.

Setting the Stage

Celia Quinn
Celia Quinn, MD, MPH CDC Career Epidemiology Field Officer assigned to NYC Department of Health and Mental Hygiene

Imagine this: Explosions across New York City target elementary schools. Hundreds of severely injured and traumatized children, teachers, and parents flood hospital emergency departments in the five boroughs. Municipal emergency medical services (EMS) are rushing to respond.

Fortunately this scenario wasn’t really happening – it was part of an exercise conducted on May 25, 2017. The exercise was designed to test the ability of the New York City (NYC) Healthcare System to respond to a massive surge of pediatric trauma patients, exceeding the usual resources of this large and complex healthcare system.

Identifying the Players

As a CDC Career Epidemiology Field Officer assigned to NYC, I worked with the experts in the Pediatric Disaster Coalition and the Fire Department of New York (FDNY). We designed an exercise that reflected the number of injured children who would need to go to the hospital and the type of injuries they might experience if a similar event really happened.

NYC has 62 acute care hospitals that participate in the 911 system. Of these, 16 are level 1 trauma centers designated by the NYC Department of Health  (this includes three pediatric level 1 trauma centers and 4 burn centers). A total of 28 hospitals care for pediatric patients and have, during the past seven years with the assistance of the NYC Pediatric Disaster Coalition, developed pediatric-specific components of their overall disaster plans to prepare them to receive pediatric patients from an incident like the one invented for this exercise. All 28 hospitals participated in the exercise.

Coordinating Resources

Hospitals who participated in the exercise were challenged to rapidly respond to more than 60 simulated patients with a range of injuries and conditions:

  • a 7-year-old boy unresponsive after a traumatic injury to his head

    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
    Hospital nursing leadership reports on the status of nursing staff, while the hospital’s Public Information Officer looks on.
  • A toddler with burns to the face, chest, and abdomen
  • A 12-year-old distraught after witnessing another child lose arms in an explosion

Hospitals had to assess the resources that were available to care for the patients, including

  • What nursing and specialty staff could be made immediately available?
  • What medications and equipment, including imaging equipment and burn supplies, were needed to care for the children?
  • What communications and incident command processes would each hospital use to mobilize staff and other resources in the situation described in the exercise?
  • Which patients needed to be transferred to specialty hospitals to receive care for their injuries?

Coordination between FDNY and hospitals was critical to the success of this exercise – it supported interfacility transfers for patients who required specialty care or to better match hospital resources with patient needs. During the exercise, I met with FDNY leadership from EMS and Office of Medical Affairs physicians, and leaders from NYC Emergency Management and the Health Department at the Fire Department’s Operations Center. There, we tested the communications between hospitals, FDNY, and a volunteer pediatric intensive care physician who was trained to assist FDNY’s Office of Medical Affairs to prioritize patients for urgent interfacility transfers.

Measuring Success

Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.
Hospital Incident Command leadership discusses the availability of resources to make more pediatric beds available.

This exercise revealed that 28 NYC hospitals were able to rapidly and dramatically increase their pediatric critical care capacity. It was the largest exercise NYC has done that was focused primarily on caring for injured children. During the exercise, these hospitals:

  • More than doubled the number of beds in pediatric intensive care units (PICUs) and added 1,105 pediatric inpatient beds, so children could stay in the hospital for an extended period of time
  • Opened 203 operating rooms that could treat children who needed surgery

During the exercise, we also identified some challenges, including

  • More than half of the hospitals did not have enough supplies that could be used to treat critically injured children
  • A limited number of pediatric specialists, including doctors who could perform brain surgery on children as well as ear, nose, and throat specialists
  • Hospital resources (beds, supplies, and staff) would have been further strained if the disaster scenario had also included large numbers of adults

We were able to identify ways to improve each hospital’s process and further develop our citywide plans to respond to any emergency that strains our healthcare system. As a pediatrician and a parent of two young New Yorkers, I’m grateful that so many dedicated people are working together to make sure that city and hospital plans account for the unique needs of children in disasters.

The NYC Department of Health and Mental Hygiene receives federal funds used to support state and local public health and healthcare system preparedness through the aligned Hospital Preparedness Program (HPP) – Public Health Emergency Preparedness (PHEP) cooperative agreement. NYC used HPP funds to fund the NYC Pediatric Disaster Coalition to design and conduct the exercise, and coordinate participation of hospitals in the exercise.

Read our other National Preparedness Month blogs:

Empowering Kids to Make Their Families Safer

American-Red-Cross-volunteer-with-pillowcase-in-Alaska_BLUR

After graduating from college I moved to Anchorage, Alaska for a year of post-graduate service through the Jesuit Volunteer Corps NW and AmeriCorps. I served as the Preparedness and Casework Specialist for the American Red Cross of Alaska. Though often overlooked, Alaska is the largest state in the country (more than twice as big as Texas!) and has more coastline than the rest of the United States combined. While a large portion of the population lives in Anchorage, dozens of Native Alaskan villages are scattered all across the state, often hundreds of miles apart.

Education in action If I learned one thing about disaster preparedness education, it’s that you never know when your students will need to put what you taught them into action. I specifically remember one Friday afternoon teaching a group of students on the military base about what to do during an earthquake. We discussed various scenarios such as what to do if you are sleeping or playing at recess when an earthquake occurs. Two days later, a 7.1 magnitude hit the Anchorage area in the middle of the night, one of the larger earthquakes the area had experienced in a few years. The next morning, the teacher contacted me to tell me about how the students were able to use what I had taught them just days before to stay safe during the earthquake. This reaffirmed my belief of the value and effectiveness of The Pillowcase Project and educating students about disaster preparedness.While in Alaska, I spent a good portion of my time managing The Pillowcase Project, a Red Cross youth preparedness program for students between the ages of 8 and 11. The program educates children about how to prepare for emergencies they might experience in their communities. Since the program started in Alaska, The Pillowcase Project has reached youth all over the state and has even crossed the Arctic Circle!

Pillowcases are not just for pillows

During Hurricane Katrina, a Red Crosser noticed college students were carrying their belongings in pillowcases as they evacuated to emergency shelters. Their actions inspired The Pillowcase Project, which uses an everyday household item to hold the necessary items for an emergency kit. Putting all of these supplies in one place makes it easier to grab and go in the event of an emergency.

The Pillowcase Project has reached over 800,000 children both nationally and globally. Trained instructors, mostly volunteers like me, share the curriculum with children in schools, after-school programs, summer camps, scout groups, and various venues.

Beyond the standard preparedness education curriculum, students decorate a pillowcase with symbols that are personal reminders of things that make them feel safe and brave. They are instructed to fill it with emergency essentials such as a first aid kit, flashlight, batteries, spare clothes, and a toothbrush. We also encourage students to include a comfort item such as a favorite stuffed animal or photographs of their friends and family to provide additional support during a stressful time. We also teach coping skills such as breathing exercises and positive visualization techniques, so our students know how to stay calm in stressful situations.

Learn. Practice. Share.Pillowcase Project education session in Los Angeles, CA

Research from FEMA shows that one of the best ways to promote family preparedness is by educating children, who then feel empowered to share what they learned with their families. It is often difficult to convince adults of the negative impact a disaster could have on their family and how important it is to be prepared. This is why The Pillowcase Project seeks to educate students; 8-11 year-olds who are able to accurately relay information and comprehend the curriculum to share it with others. The curriculum centers around three pillars:

  • LEARN. Kids learn about the types of natural disasters that are most likely to happen in their community or neighborhood. In the case of Alaska, we focused on earthquakes and home fires.
  • PRACTICE. We talked through different scenarios that were tailored to the children in the group, because one child might live in a trailer, one on the 7th floor of an apartment building, and one in a two story house.
  • SHARE. We always encouraged the kids to go home and share the information and skills they have learned with their family and friends. The kids I worked with were always so enthusiastic and excited to tell people about what they had learned, which makes this a very proactive preparedness education program.

Sounding the Alarm

7 people are killed in a home fire, and another 36 people are injured every day in the United States.No matter where or what kind of home you live in, you are at risk of experiencing a home fire. That is why every child educated through The Pillowcase Project learns home fire safety and prevention, not limited to how to properly maintain a smoke alarm to how to safely get out of a burning home.

Red Cross volunteers and partners all across the country install free smoke alarms, replace batteries in existing alarms, and help families create escape plans. This year, this Sound the Alarm effort will install its one-millionth smoke alarm. An impossible feat without the dedication and passion of those who believe in the value of disaster preparedness education and prevention.

Learn More

Read our other National Preparedness Month blogs:

Ready Now!

Cars driving on a highway are stuck in traffic because of a snow storm.

Nickole Cheron, Disability Coordinator for the city of Portland, Oregon
Nickole Cheron, Disability Coordinator for the city of Portland, Oregon

A rare winter storm in 2008 buried Portland, Oregon under more than a foot of snow, leaving the city gridlocked. Like many others around the city, Nickole Cheron was stuck in her home for eight days. But for Nickole—who was born with spinal muscular atrophy, a genetic disease that weakens the body’s muscles over time—the storm was potentially life-threatening.

To live well with her disability, Nickole depends on outside assistance to get through her days, relying on a wheelchair and full-time caregivers for most routine tasks. Being alone and without assistance was not an option. Fortunately, Nickole had taken steps to prepare. She had signed up for Ready Now!, an emergency preparedness training program developed by the Oregon Office of Disability and Health, and she quickly put what she learned into action.

The Ready Now! training, presented in partnership with Oregon Health Sciences University, is specially designed to educate people with disabilities on how to prepare themselves for a disaster or an emergency situation.

“The most important thing I learned from the training was to have a back-up plan in case of an emergency,” Nickole says. “When I heard the snowstorm was coming, I emailed all my caregivers to find out who lived close by and would be available. I made sure I had a generator, batteries for my wheelchair, and at least a week’s supply of food, water and prescription medication.”

Nickole says the training was empowering and reinforced her confidence to face an emergency situation with a disability. She felt better informed about the potential risks people with disabilities could encounter during a disaster. For example, clinics might close, streets and sidewalks might be impassable, or caregivers might be unable to travel.

Preparedness is a mindset

 Preparedness means always thinking about what might happen and how it might affect you and those around you, and then taking steps ahead of time to stay safe and healthy. Everyone faces a unique set of risks and has unique needs. People with disabilities – like Nickole – often must rely more on others, especially in emergencies.

For the millions of Americans who have disabilities, events like extreme weather, fires, floods, acts of terrorism, and disease outbreaks present a special set of challenges. One of the important lessons from the response to Hurricane Katrina was that gaps existed in pre-disaster planning among people with disabilities and local emergency management agencies.

While no one can predict every emergency, Ready Now! and other programs like it help people with disabilities and their family members plan ahead to protect themselves. For Nickole, it may have saved her life.

Share Nickole’s story and the following resources with friends, family, and neighbors:

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How to Be Smart (About Preparedness)

Dramatic sky in contrast with the afternoon sun on a November afternoon in Limburg, the Netherlands

Emergencies are everywhere: from floods to flu, tornadoes to terrorists… How do you prepare for all of it?

Trying to prepare for every possibility can seem impossible. But you can be smart about preparing for the emergencies and situations you are most likely to experience. Start by looking around at where you live, the people in your life, and the places you go on a day-to-day basis. Ask yourself questions, then figure out what steps you can take.

For example:

  • Are you living in tornado alley? Pick a safe place in your home to take shelter.
  • Do you work in a large office building? Know how to evacuate during a fire.
  • Do you travel often? Make a kit with prescription and over-the-counter medicines, your health insurance cards, and copies of your prescriptions.
  • Do you have children? Make a plan with them about where to meet up if you are separated.
  • Do you have a loved one with diabetes? Have a plan if they run out of insulin or if they have low blood sugar.
  • Do you have pets? Make sure your emergency plan includes them, too.

Emergencies come in all different shapes and sizes. We often hear about preparedness in the context of natural disasters and infectious disease outbreaks, but preparedness is also about getting your flu shot every year and wearing your seatbelt when you drive. Preparedness is knowing what to do if your child starts choking or how to help if your coworker has a seizure.

Preparedness also means reaching out to those around you. Do you know someone with a disability who may need extra help when evacuating during an emergency? Are there elderly people living in your neighborhood who are particularly vulnerable to extreme heat?

Of course, something unusual can always happen. (After all, who would have anticipated Snowpocalypse 2014 in Atlanta, Georgia?) But in preparing for the most likely situations, you may find yourself better prepared for the unexpected.

Get a kit. Make a plan. Be informed.

Read our other National Preparedness Month blogs:

Recognizing the Vital Work of Our Nation’s Public Servants

Greg Burel receiving SAMMIE award.
Photo credit: Aaron Clamage/clamagephoto.com

In April 2015, an Ohio doctor made an urgent call to CDC concerning a possible life-threatening botulism outbreak that posed a risk to as many as 50 people who had attended a church potluck dinner.

Within hours, CDC, the Ohio Department of Health, and a local hospital had determined that botulism antitoxin was needed to treat the food-borne illness. They made an immediate request to the only U.S. source: CDC’s Strategic National Stockpile (SNS).

Greg Burel received the request just after 2 p.m. that day. He quickly issued his approval and set in motion a process that rapidly deployed and delivered botulism antitoxin to Ohio just after midnight to help save the lives of 18 people who had become seriously ill.

For Burel, this was all in a day’s work.

Burel serves as Director of the Division of Strategic National Stockpile at CDC, where he manages the federal government’s $7 billion Strategic National Stockpile of emergency medicines and medical supplies, which are stored in warehouses across the country.

In a public health emergency, the U.S. pharmaceutical supply chain may be unable to immediately provide a medical countermeasure that may be required to prevent, mitigate, or treat adverse health effects resulting from an intentional, accidental, or naturally occurring public health emergency. SNS ensures the right medicines and supplies are available when and where they are needed to save lives.

And The Sammie Goes To…

In recognition of his exceptional leadership and unmatched excellence in the management of CDC’s SNS, Burel was the recipient of one of this year’s prestigious Samuel J. Heyman Service to America Medals―also known as the “Sammie” award―specifically in the Management Excellence category. In his decade-long tenure as Director of SNS, Burel has spearheaded 10 large-scale responses, including national responses to flooding, hurricanes, and influenza pandemics, and more than 30 small-scale deployments for the treatment of individuals with life-threatening infectious diseases including the botulism outbreak and the Ebola crisis.

Burel’s most recent challenge has been dealing with the Zika virus. In the wake of the Zika virus outbreak, SNS is working with diverse partners such as CDC Foundation, commercial pharmacies, and vector control companies to implement public health interventions that wouldn’t have been possible without the expertise and capability of SNS staff to bring it all together. “It’s more than just having the right product on the shelf and an established plan to use it,” Burel said. “We recognize the shifting realities of today’s public health threats and work with partners spanning the public and private spectrum to develop the capacity to respond to any public health emergency.”

Under Burel’s watch, the SNS has steadily expanded its focus so that it is capable of responding to all the global hazards of the 21st century. He says, “I am honored to receive the prestigious Sammie Award, and privileged to work alongside the many esteemed public servants who play an instrumental role in the stockpile’s daily operations.”

With more than 30 years of civil service, Burel has risen through the ranks of the federal government to become a proven leader in medical supply chain logistics, disaster and emergency management, financial management, quality improvement, and organizational design. He began his career at the Internal Revenue Service, and served in leadership roles in the General Services Administration (GSA) and the Federal Emergency Management Agency (FEMA).

The “Oscars” of Government Service

Burel is one of many dedicated and hardworking federal employees across the world. The Sammie Award is an award program that publically highlights excellence in the federal workforce. The awards are also known as the “Oscars” of government service and honor those employees who have made the commitment to make our government and our nation stronger. They are named for the Partnership for Public Service’s late founder, Samuel J. Heyman, who was inspired by President Kennedy’s call to serve in 1963. These awards align with his vision of a dynamic and innovative federal workforce that meets the needs of the American people. The prestigious medals are awarded to a handful of federal employees each year for outstanding service to their country and humanity.

For More Information

Fred the Preparedness Dog—Tails from Kansas

Fred witnesses the governor of Kansas signing a proclamation naming September "National Preparedness Month"

It all started when Fred jumped into the bathtub.

It was one of those warm, Kansas summer days, back in 2013. Fred the German Shepherd had just joined our family, and my wife eagerly captured all his adorable dog-moments with her camera. So when Fred hopped into the tub, she quickly snapped a photo and sent it to me.

Having worked in emergency preparedness for ten years, I saw something more in that picture: Fred was doing a good job of being prepared.

The bathtub is where my family shelters when there are weather warnings in our area. I posted Fred’s photo on social media at work and added a caption: “Fred knows where to go in case of severe weather. You should too.”

Continuing the theme, we had the idea to put a child’s backpack on Fred. We filled the backpack with basic supplies every family needs in an emergency. The next photo went up online: “Even Fred has an emergency kit!”

It skyrocketed from there. What began as a series of photos of Fred turned into a full-blown preparedness campaign for children ages 6-12 all across the state.

Lessons from a dog

Fred in bathtub
Fred knows where to take shelter in case of severe weather.

It turns out Fred has a lot to teach kids about preparedness, and he’s perfect for the job. Kids are always curious about Fred and relate to him in a special way.

Together, Fred and I travel to schools and events across Kansas, teaching kids how to keep themselves and their families safe. Fred now has his own purple hiking bag, which he wears everywhere, because you never know when an emergency might happen. When we go to schools, kids help unpack the kit and see what’s inside. As they take out the items, we talk about each one. We talk about the flashlight, the maps, the contact numbers, the hand wipes, the first-aid kit.

“We can just put a Band-Aid on Fred, right?” I ask the kids.

“No!” they yell back.

I take out a compress and wrap Fred’s head, demonstrating the importance of knowing about different kinds of first aid and how and when to use them.

I also show them Fred’s teeth. We talk about how strong he is and how hard he can bite. We show kids how to approach Fred safely and avoid animal bites.

We talk about making sure family pets are accounted for in an emergency plan. During Hurricane Katrina, we saw that many people will not leave home without their pets, even when their own lives are in danger. We encourage kids and their families to find hotels ahead of time where pets can stay too, or to find a kennel nearby that can be used in case of emergency.

At the end of each school visit, as the children clap, Fred barks his appreciation in return.

Fred gets the message out  

Fred keeps a busy schedule these days. Last month, we met the governor of Kansas as September was officially declared Preparedness Month for the state. As part of National Preparedness Month, we have plans to attend the 10th Annual Emergency Services Showcase, which lets kids meet first responders like firemen and policemen face-to-face so they’re not afraid of them when they need them. We’re also going to Preparedness Day at the Kansas State Fair, and then off to a hospital. Along the way, we’ll be seeing more classrooms full of kids around the state.

Today, Fred’s efforts are backed with funding from CDC that has enabled us to create a suite of materials, including preparedness-themed coloring books and stickers we send home with kids after we meet them. The materials reinforce the three most important things everyone can do to be ready: Get a kit. Make a Plan. Be informed.

Fred also has his own iPhone app, and a website and Facebook page where he posts about his latest adventures.

Fred the Preparedness Dog is the mascot for the Kansas Department of Health and Environment Preparedness Program. His mission is to increase family and pet preparedness for all types of emergencies.

Read our other National Preparedness Month blogs: