Medical-dependent household preparedness

For households where one or more members depend on a refrigerated medication, a power-driven medical device, a specific feeding routine, or a clinical-care schedule, the standard three-day kit was never designed for you. It was designed for healthy adults who can adapt and improvise. This page routes every member's specific clinical dependency to the right preparation system before a crisis removes the ability to improvise — insulin that requires refrigeration, a CPAP that must run every night, dialysis that cannot be delayed, an infant whose feeding depends on a clean water supply and formula stock.

This page does not duplicate the clinical content in those specialized resources. Its job is simpler: given your household's composition, it tells you which pages to open first, in what order, and why the routing matters.

FEMA's Access and Functional Needs (AFN) framework recognizes this planning gap explicitly — it calls power-dependent and medically complex household members a distinct preparedness category requiring individualized planning, not a modified version of the standard plan. The Functional Needs Support Services (FNSS) guidance from FEMA (2010, fema.gov/sites/default/files/2020-07/fema_functional-needs-support-services-guidance.pdf) extends that logic to shelter operations, oxygen continuity, and dialysis access planning at the community level. This page applies the same logic at the household level.

Educational use only

This page provides general preparedness routing for medically complex households. It is not a substitute for guidance from any treating physician, specialist, equipment supplier, or home-health agency. Medication thresholds, device settings, dietary restrictions, and emergency protocols are individual — your provider knows details this page cannot. Confirm every threshold and protocol listed in the linked pages with your treatment team before an event, not during one.

Before you start

Skills: Basic familiarity with each household member's medications, devices, and routine. Ability to locate the household's medication bottles, device manuals, and emergency contact numbers.

Tools: Notepad or single sheet of paper, a household calendar, a waterproof folder or zip-lock bag for the documentation kit.

Time estimate: Dependency mapping exercise: 15 minutes. Full profile build (per profile): 30–60 minutes using the linked pages. Annual review: 20 minutes.

Action block

Do this first: On a single sheet of paper, list every household member by name and write next to each name: (1) any medication that requires refrigeration, (2) any powered medical device they depend on overnight or daily, (3) any condition that becomes life-threatening within 48–72 hours if treatment is interrupted. (15 minutes) Time required: Active: 15 min mapping exercise; 30–60 min per profile page; 20 min annual review Cost range: inexpensive (planning exercise; equipment costs addressed in linked pages) Skill level: Beginner Tools and supplies: Tools: notepad, household calendar. Supplies: none. Infrastructure: none. Safety warnings: See Educational use only above — decisions made using this routing page have life-safety implications through the clinical content in linked pages.

Medical dependency routing

Missing a dependency in your initial mapping exercise is the single most common planning failure for medically complex households. Before you route to any profile page, walk through your home medicine cabinet, your refrigerator, every outlet a medical device uses, and any disability accommodation in the home — not just what you recall from memory. A missed dependency discovered during an event cannot be corrected in the moment.

How to use this page

Work through the four household profiles below. Most medically dependent households match more than one profile — a diabetic grandparent and an infant grandchild in the same home is common. For each profile your household matches, open that profile's primary page and complete its "Do this first" action before reading further here.

If two or more profiles apply, use this tiebreaker sequence — route in this order when you cannot address all profiles in the same week:

  1. Power-dependent device users (Profile 4): an oxygen concentrator or dialysis machine fails immediately when power goes out; the window to act is measured in hours
  2. Chronic conditions with refrigerated medications (Profile 1): insulin loses efficacy; the window is days
  3. Infant and toddler care (Profile 3): formula supply, water safety, and fever thresholds are time-sensitive but the planning window is longer
  4. Older adult care (Profile 2): critical but carries the longest safe planning runway of the four profiles

This ordering matches the "Medical/Water/Energy first wave" logic in preparedness self-assessment — prioritize by mortality risk window, not by who seems most vulnerable in day-to-day life.

Profile 1: Adult chronic conditions

Who this is for: Households where any adult member manages diabetes (including insulin-dependent), heart disease, COPD, asthma, dialysis-dependent kidney failure, hypertension requiring daily medication, or any condition where a 48–72 hour interruption in treatment carries serious medical risk.

Chronic conditions represent the largest single category of medical dependency in U.S. households. Six in ten U.S. adults live with at least one chronic disease, according to CDC data. In a power outage, the dependencies that matter operationally are: refrigerated insulin, dialysis access, inhaler supply depth, anticoagulant monitoring, cardiac medication continuity, and oxygen for COPD patients.

The core question for this profile: What happens to this person in 48 hours if the pharmacy is closed, the refrigerator is off, and the dialysis clinic is inaccessible?

Primary page: Chronic conditions and disaster preparedness

That page covers: - Insulin storage by formulation (28–56 day room-temperature windows by brand type, cooler strategy) - Asthma and COPD inhaler stockpiling, nebulizer power continuity, and peak-flow AQI thresholds - Heart conditions: anticoagulant INR monitoring, beta-blocker abrupt-cessation risk, exertion management - Dialysis disruption protocol (3-day emergency diet, fluid restriction, daily weight monitoring, ER triggers) - Oxygen dependence: concentrator power sizing math, tank logistics - Device power consumption table with watt-hour sizing formula - Chronic Conditions Documentation Kit (laminated card + go-bag packet) - Access and Functional Needs (AFN) registry guidance — register with your local emergency management office so that utilities and first responders have a record of your dependency

Supporting pages:

Field note

The Chronic Conditions Documentation Kit is not optional — it is the single item that allows a caregiver, first responder, or evacuation shelter staff member to manage the patient's needs if the patient themselves cannot communicate. A diabetic patient in hypoglycemic confusion cannot tell a shelter worker which insulin formulation they use or what their typical dose is. Write it down. Laminate it. Put one copy in each go-bag.

Profile 2: Older adult care

Who this is for: Households where any member is 65 or older — especially those with cognitive decline (dementia, Alzheimer's), fall risk, dependence on hearing aids, mobility aids (walkers, canes, power wheelchairs), or advance directives that affect medical decision-making in emergencies.

Older adults are hospitalized at higher rates during and immediately after disasters than any other age group, per HHS Administration for Community Living and CDC research. The reason is not that disasters are harder on older bodies alone — it is that the infrastructure older adults depend on (pharmacy access, caregiver availability, routine, equipment) is exactly what disasters disrupt first.

The core question for this profile: If this person's normal caregiver is unavailable for 72 hours, who takes over, and do they know everything they need to know?

Primary page: Elder care and caregiver preparedness

That page covers: - Medication audit for cognitively impaired adults (the caregiver, not the patient, often holds the full medication picture) - Fall-hazard survey and home layout stabilization before disruption - Dementia routine continuity — evacuating an adult with Alzheimer's requires the same comfort objects, the same meal schedule, and the same caregiver voice if at all possible - CMS 42 CFR 483.73 requirements for emergency planning in assisted-living settings — relevant if your elder family member is in a facility and you need to understand what the facility is legally required to provide - Caregiver burnout mitigation — the caregiver incapacitating themselves mid-crisis is a named failure mode, not an edge case - End-of-life documents: DNR, POLST, living will, healthcare proxy — which document controls what, and where to keep copies

Supporting pages:

AARP Disaster Resilience Toolkit (aarp.org/livable-communities/tool-kits-resources/info-2022/aarp-disaster-resilience-tool-kit.html) is an independent Tier 2 resource that structures the three steps for caregivers: assess needs, engage a support network, create a plan. It pairs well with the clinical depth on elder-care.md.

Profile 3: Infant and toddler care

Who this is for: Households with any member under 3 years old — including newborns, exclusively formula-fed infants, breastfeeding mothers, and any child in the fever-threshold age range where the clinical thresholds differ significantly from adult guidance.

Infant preparedness is not smaller-scale adult preparedness. The failure modes are categorically different: a newborn's fever threshold that triggers an emergency room visit is 100.4°F (38°C) — the same temperature that a healthy adult would treat with ibuprofen and fluids. An infant cannot receive supplemental water before 6 months without hyponatremia risk. Formula powder requires water heated to at least 158°F (70°C) for the first 30 days of life to address Cronobacter risk. These thresholds are not intuitive for adults who have not recently cared for an infant.

The core question for this profile: Do you have a 3-week supply of formula? Do you know the fever threshold for your infant's exact age in weeks?

Primary page: Infant and toddler emergency preparedness

That page covers: - Formula stockpiling and rotation (12–18 month shelf life, FIFO, formula types by allergy profile) - Breastfeeding continuity (maternal hydration requirements, pump-and-store, cooler strategy, donor milk) - Water precautions by age tier — including the no-supplemental-water-under-6-months rule - Fever thresholds by exact age tier: neonate (0–28 days), young infant (1–3 months), infant (3–12 months), toddler (1–3 years) - Dehydration recognition (sunken fontanelle, wet-diaper count by age) - Infant CPR orientation — two-thumb encircling technique (per 2025 AHA/AAP update) - Infant choking response — 5 back blows + 5 chest thrusts (never abdominal thrusts under 1 year) - 72-hour go-bag contents for infants, evacuation carrier guidance

Supporting pages:

Profile 4: Power-dependent device users

Who this is for: Households where any member depends on a device that requires continuous or nightly electrical power — CPAP or BiPAP machines, oxygen concentrators, electric wheelchairs, home dialysis machines, feeding pumps, ventilators, infusion pumps, or any device that would cause immediate medical deterioration if power were interrupted for more than 4–8 hours.

This is the profile with the shortest planning window. Each device has a different load, a different clinical consequence for interruption, and a different backup path.

An oxygen concentrator drawing 300–400 watts runs for 5–6 hours on a typical 1,000 watt-hour portable power station. A CPAP at 30–60 watts (without humidifier) can run significantly longer on the same station. A home dialysis machine may draw 500–1,000 watts and requires a different backup strategy than CPAP. Match the math to the specific device, not to a generic "medical equipment" load estimate.

Profile 1 overlap

Many power-dependent users also have an underlying chronic condition (heart disease, COPD, ESRD) — that's why Profile 4 and Profile 1 share chronic-conditions.md as their primary page. The chronic-conditions page is structured to serve both: the early sections cover the condition itself, and the device-power tables near the end cover the equipment math. If you're a Profile 4 household, scroll past the clinical sections to the device tables; if you're a Profile 1 household whose condition does not yet involve powered devices, the clinical sections are your primary focus.

The core question for this profile: If the power goes out right now, how many hours until the person's device fails — and what is your backup plan?

Primary page: Chronic conditions and disaster preparedness

The device power consumption table on that page lists CPAP/BiPAP (30–60 W / 70–120 W with humidifier), nebulizer (50–70 W), oxygen concentrator (300–400 W), and the sizing formula for calculating watt-hours of backup needed per 24-hour period.

For backup power sizing and system design:

For medication refrigeration backup — if the power-dependent household also involves refrigerated medications:

Utility medical baseline registration: Most U.S. state utility commissions require electric utilities to maintain a medical baseline customer list. Contact your electric utility directly to request enrollment — registration typically requires a physician's statement of medical necessity. Enrolled customers are often prioritized for earlier power restoration after outages. This is a no-cost administrative action that costs 30 minutes of effort.

Field note

When sizing backup power for a CPAP, check whether your machine supports DC input directly — many modern CPAP machines can run from a 12V or 24V DC source, which is far more efficient than running through an inverter. A machine drawing 30 watts from DC draws only 2.5 amps from a 12V battery bank per hour. At inverter efficiency (~85%), the equivalent AC draw adds 15–20% overhead. For multi-night backup, DC-direct operation can extend your runtime by 30–40% on the same battery capacity.

Multi-profile households

Most medically complex households are not one profile — they are two or three overlapping. A household with a 78-year-old with diabetes on insulin, a 6-week-old grandchild, and a CPAP user is simultaneously Profiles 1, 3, and 4. Planning for each profile independently is correct. Planning for them as a system is what makes the difference when a crisis compresses time.

Practical guidance for multi-profile households:

Use the any-1 mortality-window tiebreaker. When you cannot address everything at once, prioritize by the shortest window to serious harm: power-dependent device failure (hours) → refrigerated medication failure (days) → infant feeding and fever response (days, with a longer window) → elder-care coordination (days to weeks). Address the shortest window first.

The documentation kit must cover everyone. A single household documentation kit — one per go-bag, one stored offsite — should include every household member's medication list, device serial numbers and supplier contacts, advance directives, treating physician contacts, and insurance information. A medically complex household leaving during an evacuation order with no documentation is entirely dependent on memory under stress.

Designate a second-qualified person for every dependency. For insulin administration, for CPAP mask fitting, for infant choking response, for medication administration to a cognitively impaired elder — at least one additional adult in or near the household must know how to perform the action. Single-person dependency knowledge is a named failure mode. If the primary caregiver is incapacitated, the dependency cascade fails.

Re-run the dependency mapping exercise annually. Household composition changes. Medications change. A child who was an infant last year is now a toddler with different thresholds. A grandparent's condition may have progressed. The dependency map is not a one-time document — it is a living record that requires an annual 15-minute update.

For a full multi-Foundation readiness score, work through the preparedness self-assessment, which scores all 12 Foundations and surfaced Medical as a Wave 1 priority for households with any dependency in Profiles 1–4.

Failure modes

These are the most common ways medical-dependent household preparedness fails — each observed across real disaster events and caregiver planning exercises.

Routing-page paralysis

Recognition: The household reads this page, acknowledges the dependencies, and does not open any of the four profile pages because the scope feels overwhelming.

Remediation: Open one page — the profile that matches your household's shortest mortality window. Complete only that page's "Do this first" action (15 minutes). Stop. Return in one week and open the next profile page. Incremental progress across four weeks closes the gap; attempting everything at once produces no progress.

Single-person dependency knowledge

Recognition: Only one adult in the household knows how to administer insulin, fit the CPAP mask, mix formula correctly, or manage the dialysis routine. That person is the primary caregiver and there is no documented backup.

Remediation: Identify a second adult — a household member, a neighbor, a nearby family member — and walk them through the dependency routine once. Write a brief on one page: what the routine is, what the critical thresholds are, what to do if the person in need cannot communicate. File it in the documentation kit.

Devices-without-power-backup blindspot

Recognition: The household contains a CPAP, an oxygen concentrator, or a refrigerator with insulin, but there is no generator, no portable power station, and no plan for a multi-day outage.

Remediation: Start with load math. Add the wattages of every device that must run. Multiply by the number of hours of overnight use. Add 25% for inverter losses. That is your minimum watt-hour target. Batteries and backup power stations covers the sizing from that number forward. If the load exceeds what a portable power station can handle economically, whole-home off-grid design covers permanent battery bank and generator integration.

Caregiver burnout incapacitation

Recognition: The primary caregiver has been managing one or more complex dependencies for weeks or months under crisis conditions. They are not sleeping adequately, not eating adequately, and their own judgment and response time have degraded. The dependency cascade is now at risk because the person managing it is compromised.

Remediation: Build a caregiver-respite plan before a crisis. Identify two other people who can cover for 24–48 hours. Establish a mutual aid relationship with neighbors or nearby family. AARP's Disaster Resilience Toolkit (aarp.org/livable-communities/tool-kits-resources/info-2022/aarp-disaster-resilience-tool-kit.html) structures the caregiver-support network assessment as a formal planning step. The vulnerable household members in crisis page covers mutual aid networks at the community coordination level.

Dependency planning checklist

  • Complete the 15-minute dependency mapping exercise (one sheet: name, medications requiring refrigeration, powered devices, 48–72 hour risk conditions)
  • Identify which of the four profiles applies to your household (more than one is typical)
  • Open the primary page for each matching profile and complete its "Do this first" action
  • Build or update the household documentation kit (medications, devices, prescribers, advance directives, insurance) — one copy per go-bag, one stored offsite
  • Calculate backup power requirements for every power-dependent device (running watts × hours + 25% inverter loss)
  • Register with your electric utility's medical baseline or life-support customer list (if applicable)
  • Designate a second-qualified person for every dependency routine and verify they can execute it
  • Register your household's Access and Functional Needs (AFN) with your local emergency management office — contact information is at ready.gov/older-adults or your county emergency management agency website
  • Set a calendar reminder for an annual dependency-map review — especially after any change in household composition or medical condition

Sources and next steps

Last reviewed: 2026-05-18

Source hierarchy:

  1. FEMA Functional Needs Support Services Guidance (Tier 1, FEMA federal preparedness guidance)
  2. FEMA Access and Functional Needs Fact Sheet — May 2024 (Tier 1, FEMA)
  3. Ready.gov — Older Adults (Tier 1, FEMA Ready.gov)
  4. American Diabetes Association Emergency Preparedness Statement (Tier 2, ADA peer-reviewed statement)
  5. AARP Disaster Resilience Toolkit (Tier 2, AARP/FEMA collaboration)

Legal/regional caveats: Electric utility medical baseline programs vary significantly by state and utility — enrollment requirements, priority restoration policies, and program names differ. Contact your specific utility for current enrollment procedures. AFN registry programs are administered at the county level; practices vary.

Safety stakes: high-criticality topic — recommended to verify thresholds before acting.

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