Chronic conditions in emergencies

Six in ten U.S. adults live with at least one chronic disease, according to CDC data — and those households face a fundamentally different emergency landscape than healthy ones. When the power goes out, insulin needs refrigeration. When supply chains break, dialysis patients cannot skip treatments. When wildfire smoke blankets a region, someone with COPD or asthma faces a respiratory crisis that a healthy neighbor will barely notice. Chronic-condition emergency preparedness requires a household-specific plan built around each person's specific dependencies — not a generic kit with extra batteries.

Educational use only

This page provides general preparedness information for households managing chronic medical conditions. It is not a substitute for guidance from your treating physician, nephrologist, cardiologist, pulmonologist, or other specialist. Medication thresholds, device settings, and emergency protocols vary by individual condition and treatment plan. Confirm every threshold and protocol on this page with your provider before an event. Do not alter prescribed medications or device settings without professional guidance.

Before you start

Skills: Familiarity with each household member's chronic condition, current medications (including dose, schedule, and consequence of a missed dose), and all powered medical devices. The ability to read a medication label for storage requirements and temperature sensitivity.

Materials: A printed one-page Chronic Conditions Card (see Documentation Kit section); 30-day minimum supply of all life-critical prescriptions; device-specific backup power (see Medical Device Power Continuity); a thermometer for monitoring medication storage temperature; a cooler, reusable ice packs, and a digital thermometer for insulin and biologics.

Time required: Active: 15 min to create an initial Chronic Conditions Card; 2–4 hr for a complete household plan (power sizing, documentation kit, supply audit); ongoing: 30-min quarterly review.

Related: Medication stockpiling, medical index, vulnerable household members, energy backup systems

Action block

Do this first: Write a one-page Chronic Conditions Card (tablet or paper) listing every prescription medication, powered medical device, treating physician name and phone, and what happens without treatment for 72 hours — for every affected household member (15 min) Time required: Active: 15 min card draft; 2–4 hr complete household plan; quarterly 30-min review Cost range: inexpensive for documentation kit and medication buffer; moderate investment for portable power station; significant investment for whole-home generator or backup oxygen concentrator Skill level: beginner for documentation and stockpiling; intermediate for power sizing math; advanced for dialysis or oxygen-dependence scenarios Tools and supplies: Tools: digital thermometer, battery-powered alarm clock, cooler with lid. Supplies: reusable ice packs, metalized polyester barrier film bags for medication insulation, laminated card stock, waterproof document pouch. Infrastructure: UPS (uninterruptible power supply — a battery device that provides near-instant power switching to protect electronics from outage gaps) or portable power station, sized per device wattage. Safety warnings: See Educational use only above — confirm all thresholds and protocols with your treating provider before an event

Diabetes and insulin management

Insulin is the most temperature-sensitive common medication in household emergency kits. Getting its management right during a power outage is a matter of timing and awareness, not panic.

Insulin storage rules during outages

Refrigerated (unopened) insulin stores at 36–46°F (2–8°C) and lasts through the labeled expiration date. This is the long-term reserve. Keep a 30-day supply of refrigerated insulin as your baseline stockpile and rotate stock using the oldest first.

In-use or room-temperature insulin follows a different clock. Per FDA emergency guidance on insulin storage and switching, most insulin formulations remain stable at room temperature up to 77°F (25°C) for 28 days after opening. Rapid-acting analogs (insulin aspart, insulin lispro, insulin glulisine) tolerate room temperature up to 28–30 days depending on manufacturer labeling. Long-acting analogs (insulin glargine, insulin detemir, insulin degludec) vary: insulin detemir labels a 42-day room-temperature window; insulin degludec extends to 56 days (8 weeks) at up to 86°F (30°C) per manufacturer labeling. Mixed/NPH formulations typically allow 28 days at room temperature. Always verify your specific product's package insert — these windows differ by formulation.

The key rule: once insulin has been at room temperature for its labeled window, do not return it to the refrigerator and assume the clock resets. Discard and open a fresh refrigerated vial.

Cooler strategy for refrigerated insulin

When power loss is expected to exceed 24 hours:

Gather a hard-sided insulated cooler (minimum 1-quart (1-liter) capacity), reusable ice packs or block ice, and a digital probe thermometer.
Pre-chill the cooler for 30 minutes before placing insulin inside.
Place a barrier — a paper towel or folded cloth — between the ice pack and the insulin vials. Direct contact with ice can freeze insulin; freezing destroys insulin irreversibly.
Target interior temperature 36–46°F (2–8°C). Check with the probe thermometer every 8–12 hours.
Keep the cooler in the coolest available location: a basement, interior room, or shaded outdoor space.

Block ice lasts 3–5 days in a well-insulated cooler versus 1–2 days for bagged cubed ice. A full cooler holds temperature longer than a half-full one — fill unused space with water bottles.

Frio cooling wallets (evaporative pouches activated by soaking in water) maintain insulin at 59–77°F (15–25°C) for 45 hours from a single soak without electricity. They are inexpensive, reusable, and effective for travel or short outages without access to ice.

Monitoring blood glucose without smart devices

Most continuous glucose monitors (CGMs) and smart insulin pens require a smartphone, cellular data, or a charged device to transmit readings. During outages, fall back to a traditional glucometer with manual test strips. Stock a 90-day supply of test strips specific to your backup meter — test strip compatibility is brand-locked, and strips degrade once opened. Keep spare lancets, alcohol swabs, and a lancing device in the backup kit.

Monitor blood glucose at your normal schedule. If readings are trending high and you are uncertain whether the insulin you are using has degraded, contact your prescriber by phone before adjusting doses. Do not adjust doses on your own based on a suspicion of degradation alone.

Field note

Keep one insulin pen (not vial) in your every-day carry bag at all times. Insulin pens do not require a syringe and are less breakable in transit. In a sudden evacuation, the pen in your bag is more accessible than vials and a sharps kit in a storage drawer.

Asthma and COPD

Asthma (airway inflammation causing reversible bronchospasm) and COPD (chronic obstructive pulmonary disease, predominantly from smoking-related airway destruction) both cause breathing difficulty and both worsen dramatically when air quality degrades — wildfire smoke, power outages affecting air filtration, and disrupted access to nebulizers create compounding risks.

Inhaler stockpiling

The single highest-leverage preparation for asthma and COPD households is maintaining a consistent inhaler stockpile. Most US insurance plans allow early refills within the last 7–10 days of a 30-day supply. Use this window consistently to build a 30-day buffer.

Know your inhaler types and stock them separately:

Rescue inhaler (short-acting beta-agonist, SABA — e.g., albuterol/salbutamol): this is your emergency medication. Stock at minimum two devices — one in every location you routinely occupy (home, vehicle, workplace). A household with asthma should never have fewer than two functional rescue inhalers available.
Controller inhaler (inhaled corticosteroid, ICS, or ICS/LABA combination): this is your daily maintenance medication. Missing controller doses for several days reduces airway baseline protection and increases rescue inhaler requirement. Treat this like blood pressure medication — do not let it run out.
COPD-specific medications (long-acting muscarinic antagonists, LAMAs — e.g., tiotropium; or LABA/LAMA combinations): these are once-daily maintenance medications. Their once-daily design means one missed dose is significant. Build a 30-day buffer.

Metered-dose inhalers (MDIs) do not work correctly when the propellant is depleted. Keep the device's dose counter in view — most modern devices count down from 200. Do not rely on the "float test" (floating the canister in water) to estimate remaining doses; it is inaccurate.

Nebulizer power continuity

Electric nebulizers require AC power. Most draw 50–100 watts during use and typically run 10–15 minutes per treatment, two to four times daily. Total daily energy draw: roughly 40–100 watt-hours per day. A portable power station rated at 300–500 watt-hours provides 3–12 days of nebulizer operation, depending on treatment frequency and device efficiency. Disable all heating elements if using battery power to extend runtime.

Battery-powered portable nebulizers exist and are worth the investment for COPD households — they operate on AA batteries or USB power and eliminate the AC dependency entirely. Carry a backup set of batteries.

Peak flow monitoring during smoke events

A peak flow meter is an inexpensive, battery-free device that measures how fast you can exhale air — it quantifies bronchospasm severity before you feel acutely short of breath. Readings below 80% of your personal best indicate developing airway compromise; below 50% is a medical emergency.

During wildfire smoke events or high air quality index (AQI) days:

Measure peak flow at the same time each morning before taking rescue medication.
Compare to your personal best (established with your provider during a well period).
If peak flow drops below 80% of personal best: increase rescue inhaler use per your provider's written action plan and move indoors to filtered air.
If peak flow drops below 50% of personal best: treat this as an acute asthma attack. Take rescue inhaler immediately and seek emergency care.

The AQI scale from EPA: 0–50 (green, good); 51–100 (yellow, moderate — sensitive individuals should limit prolonged outdoor exertion); 101–150 (orange, unhealthy for sensitive groups — COPD and asthma patients should avoid outdoor exposure); 151+ (red/purple — all COPD and asthma patients stay indoors per CDC wildfire smoke guidance for people with chronic conditions).

Shelter-in-place air quality strategy: Close windows and doors. Run a HEPA (high-efficiency particulate air) air purifier. If HEPA is unavailable, a box fan with a tightly taped furnace filter (MERV-13 or higher) provides partial PM2.5 filtration. Seal window gaps with tape and wet towels. Air conditioner recirculation mode filters some smoke particles, but older systems without HEPA filters are only partially effective.

Heart conditions

Heart disease covers a wide spectrum — coronary artery disease, heart failure, arrhythmias, valve disease — each requiring different medications and different protocols during disruption. Three areas require specific planning.

Anticoagulant management

Warfarin (brand name Coumadin) requires INR (International Normalized Ratio) monitoring — a blood test measuring clotting time — at least once a month under stable conditions and as often as twice weekly after dose changes or illness. Warfarin has a narrow therapeutic window: an INR below 2.0 risks clot and stroke; above 3.0 risks serious bleeding. A missed INR test during a multi-day outage is an accepted risk for short disruptions (under 1–2 weeks), but longer disruptions require a plan.

Home INR meters (point-of-care coagulation monitors — battery-operated handheld devices using a fingerstick blood drop to measure INR) are available and are covered by some insurance plans. If you take warfarin, owning a home INR meter and a 30-day supply of test strips is a worthwhile investment in supply-chain resilience. Ask your prescribing provider about home testing eligibility.

Newer oral anticoagulants (NOACs/DOACs — direct oral anticoagulants, including rivaroxaban, apixaban, dabigatran, edoxaban) do not require regular blood monitoring, which makes outage management simpler. The critical preparation is maintaining a 30-day supply buffer and never letting the prescription run below a 7-day reserve.

Do not stop any anticoagulant without medical guidance. Sudden cessation significantly increases clot and stroke risk.

Cardiac medication stockpiling priorities

The following heart medications require specific attention beyond general stockpiling guidance:

Beta-blockers (metoprolol, carvedilol, atenolol): sudden discontinuation causes rebound hypertension and can precipitate dangerous tachycardia (abnormally fast heart rate). These should never run out. Minimum 30-day buffer; 60 days preferred for rural households.
Nitroglycerin (sublingual tablets for acute angina — chest pain from reduced blood flow): degrades quickly after opening, especially in heat and humidity. Replace sublingual tablets on a 90-day rotation cycle from opening date. Nitroglycerin spray formulations are more stable and preferable for stockpiling.
ACE inhibitors and ARBs (lisinopril, ramipril, losartan, valsartan): standard stockpiling rules apply. No abrupt-cessation risk as acute as beta-blockers, but interruption worsens heart failure and blood pressure control.
Diuretics (furosemide/Lasix, spironolactone, torsemide): used in heart failure to prevent fluid overload. Missing doses allows fluid to accumulate in lungs (pulmonary edema — fluid in the air sacs of the lungs) and lower extremities. Keep a 30-day buffer.

Exertion management

Physical labor during a disaster — moving debris, operating manual tools, carrying water — places cardiovascular demand on a heart that normally operates within an established, medicated baseline. For households with coronary artery disease or heart failure, this demands explicit planning:

Know your prescribed exercise limits from your cardiologist. Write them on your Chronic Conditions Card.
Assign physically demanding tasks to household members without cardiac conditions where possible.
Work in short intervals with rest breaks. Ten minutes of heavy exertion followed by ten minutes of rest is safer than 30 minutes continuous.
Heat dramatically increases cardiac workload. Prioritize shade and cooling during any physical labor above 85°F (29°C).
Know the warning signs requiring immediate cessation and rest: chest pain, pressure, or tightness; shortness of breath beyond what the exertion warrants; lightheadedness; irregular or pounding heartbeat.

An AED (automated external defibrillator — a portable device that analyzes heart rhythm and delivers an electric shock to restore normal rhythm in sudden cardiac arrest) should be considered for households with cardiac conditions, particularly those in rural areas with extended EMS response times. AEDs are affordable to moderate investment and available without prescription. They require minimal training — most modern devices provide real-time voice guidance.

Dialysis dependence

Hemodialysis removes waste products, toxins, and excess fluid from the blood when kidneys have failed (end-stage renal disease, ESRD). Standard outpatient hemodialysis occurs three times per week, 3–4 hours per session. Missing a session is not inconsequential.

Per National Kidney Foundation guidance, missing dialysis allows dangerous accumulation of: - Potassium (hyperkalemia — elevated blood potassium): elevated potassium causes heart arrhythmias, including ventricular fibrillation (a potentially fatal heart rhythm), at serum levels above roughly 6.0 mmol/L - Fluid (hypervolemia — excess fluid volume): fluid overload causes pulmonary edema and hypertension; the threshold for emergency intervention is typically 5 pounds (2.3 kg) above the patient's established dry weight - Urea and creatinine: uremic symptoms (nausea, confusion, seizure) develop with prolonged buildup

Clinic-disruption emergency protocol

Register with your dialysis clinic's emergency notification system before any event. Most major dialysis networks (DaVita, Fresenius, independent clinics) have formal disaster protocols that include redirecting patients to operating satellite facilities. Store the clinic's emergency phone number in your go-bag documentation.
Know the nearest backup dialysis sites — typically large hospital dialysis units or out-of-area clinic locations. Ask your clinic to document these for you pre-event.
Use your clinic-issued emergency diet during any disruption. Per National Kidney Foundation emergency meal planning, the standard 3-day emergency diet restricts fluid intake to less than 500 cc (about 16 ounces or 2 cups) per day, limits sodium to roughly 1,500 mg/day, restricts potassium to roughly 1,500 mg/day by avoiding high-potassium foods (bananas, tomatoes, potatoes, oranges, dried fruits), and limits high-phosphorus foods (dairy, nuts, beans, cola drinks, processed foods). This is much stricter than your usual dialysis diet and is designed specifically for the short-term disaster window. Ask your renal dietitian for a printed copy in advance.
Weigh yourself daily if you have a scale. Most hemodialysis patients are advised to limit gain to no more than about 2.2 lb (1 kg) per day between sessions; sudden weight gain or a cumulative gain above roughly 5 pounds (2.3 kg) over your established dry weight signals dangerous fluid accumulation and is an actionable trigger to seek emergency dialysis.
Go to the emergency room if you experience shortness of breath, significant leg swelling, irregular heartbeat, confusion, or weakness. Emergency dialysis is available at most hospital emergency departments.

Dialysis cannot be safely postponed

Missing more than one dialysis session is a medical emergency. Electrolyte imbalances — particularly elevated potassium — can cause fatal cardiac arrhythmias within 24–48 hours of a missed session in some patients. The emergency diet and fluid restriction are harm-reduction measures, not equivalents to dialysis. Do not attempt to manage multiple missed sessions at home without medical contact.

Peritoneal dialysis (PD) considerations

Peritoneal dialysis patients perform their own exchanges at home using dialysate solution. PD requires: - Adequate dialysate supplies (typically 30+ days on hand for stable patients — verify this with your care team as a non-negotiable stockpile target) - Clean working surface and hand hygiene supplies - Power only for cycler-assisted exchanges (manual CAPD exchanges — continuous ambulatory peritoneal dialysis, which the patient performs manually during the day — require no electricity)

Learn CAPD manual exchange technique even if you currently use an automated cycler. Power outages make this technique your fallback.

Oxygen dependence

Home oxygen therapy may be delivered via stationary oxygen concentrator, portable oxygen concentrator (POC), or compressed oxygen tanks. Each has distinct power and supply considerations.

Stationary oxygen concentrators

Standard home oxygen concentrators draw 275–600 watts continuously, depending on flow rate and model — a 5-liter-per-minute (5 LPM) unit typically runs 300–400 watts. Running one for 8 hours per night requires 2,400–3,200 watt-hours of battery capacity. Add 25% for inverter conversion losses: effective battery requirement of 3,000–4,000 watt-hours for overnight operation only.

This is a significant power demand. A standard portable power station in the 500–1,000 watt-hour range is not sufficient for an overnight run. Options:

A large portable power station (2,000+ watt-hours) handles 6–8 hours of concentrator use without a generator
A 3,500–5,000 watt generator with a runtime of roughly 8 hours at half load on 2–3 gallons (7.6–11.4 liters) of gasoline, run outdoors only, provides reliable power with planned refueling
Compressed oxygen tanks (E-tanks, typically 680 liters of oxygen per tank) provide backup when power fails — duration depends on flow rate (an E-tank at 2 LPM lasts roughly 5 hours)

Coordinate with your home oxygen equipment supplier before any event. They are federally required to have emergency plans for their patients. They may be able to pre-position additional tanks or identify alternative equipment.

Portable oxygen concentrators (POCs)

POCs draw 60–200 watts and run on removable battery packs (typically 3–12 hours per battery depending on settings). Key preparations:

Own at least two fully charged battery packs so one charges while one is in use
Confirm whether your POC is pulse-dose (delivers oxygen only on inhalation — more efficient) or continuous-flow. Most FAA-approved POCs for aircraft use pulse-dose; if your oxygen need requires continuous flow, confirm your device is rated for that use
Store POC batteries at room temperature (below 77°F (25°C)) — heat degrades lithium battery capacity. Do not store in a hot vehicle

Oxygen tank logistics: A home supply of 3–5 E-tanks provides 15–25 hours of backup at 2 LPM, enough to bridge a 24–48-hour grid outage. Coordinate with your supplier to pre-position this volume before hurricane season or wildfire season if you live in a risk zone. Do not store compressed oxygen tanks near heat sources, open flames, or in enclosed spaces without adequate ventilation. Secure tanks upright; a falling tank can break the valve and become a projectile.

Refrigerated medications beyond insulin

A broader category of medications requires refrigeration. Temperature management during outages applies to all of them.

Medication category	Typical cold-chain requirement	Room-temperature window	Notes
Insulin (by type)	36–46°F (2–8°C), unopened	28–56 days depending on formulation	See diabetes section above; verify specific product label
Biologics (adalimumab, etanercept, abatacept, etc.)	36–46°F (2–8°C)	14 days (adalimumab, Humira); varies by product	Verify each biologic's specific package insert — excursion tolerance varies significantly
Epinephrine auto-injector (for anaphylaxis)	Room temperature 68–77°F (20–25°C) is the standard storage	NOT refrigerated; protect from heat above 86°F (30°C) and from light	The solution turns pink or brown when degraded — inspect visually through the window before each use
Glucagon emergency kit	36–46°F (2–8°C) for liquid formulations	Most liquid glucagon kits: stable at room temperature for limited time (check label); reconstituted powder: use immediately	Newer nasal powder glucagon (Baqsimi) stores at room temperature up to 86°F (30°C)
Some vaccines (if household stockpiling for travel)	35–46°F (2–8°C) for inactivated vaccines; frozen for live attenuated	Generally not stable at room temperature	Household stockpiling of vaccines is not standard practice — consult provider
Certain liquid antibiotics (reconstituted)	36–46°F (2–8°C) after mixing	7–14 days maximum after reconstitution	Pre-mixed liquid antibiotics are not suitable for stockpiling; use tablets/capsules instead

Practical checklist for refrigerated medications:

Identify every refrigerated medication in the household and write its room-temperature tolerance window on the medication's storage container
Own a digital probe thermometer — cooler temperature assessment by feel is unreliable
Stock a 30-day supply of all refrigerated medications, rotating stock so older product is used first
Know the visual degradation signs for each medication (color change, cloudiness, particle formation)

Medical device power continuity

The range of powered medical devices in private homes has expanded significantly. Most operate from standard AC power and have no internal battery. During outages, they fail silently.

Power consumption reference

Device	Typical watt draw	Notes
CPAP without humidifier	30–60 W	Most modern CPAP machines list draw on the nameplate label
CPAP with heated humidifier	70–120 W	Disable humidifier when on battery to extend runtime 3–4×
BiPAP (bi-level positive airway pressure)	60–90 W	Higher draw than CPAP due to dual-pressure delivery
Stationary oxygen concentrator (5 LPM)	300–400 W	Confirm from device nameplate; varies by brand
Portable oxygen concentrator	60–200 W	Battery-equipped; see oxygen section
Home nebulizer	50–100 W during use	Used 10–15 min per treatment, 2–4×/day
Electric wheelchair / power chair charger	100–300 W during charging	Charge fully before any predicted event
Infusion pump (IV/subcutaneous)	10–30 W	Most have internal battery backup — verify duration
Hospital-grade bed (positioning)	300–500 W during adjustment	Minimal draw at rest; critical for repositioning-dependent patients

Sizing your backup power

Use this formula: Device wattage × hours of use per day × number of backup days × 1.25 (inverter loss factor) = minimum battery watt-hours needed.

Example for CPAP without humidifier, 8 hours per night, 3 nights of backup: 60 W × 8 hr × 3 nights × 1.25 = 1,800 watt-hours minimum. A portable power station of 2,000 watt-hours (moderate investment) meets this requirement.

Example for stationary oxygen concentrator, continuous 24-hour use, 1 day backup: 350 W × 24 hr × 1.25 = 10,500 watt-hours. This requires a generator — battery power alone at this scale is a significant investment.

For most CPAP and nebulizer users, a portable power station in the 500–1,500 watt-hour range (moderate investment) covers several nights of single-device use. The energy-intensive devices — concentrators, powered beds, infusion pumps running continuously — require generator or utility-level backup.

CPAP-specific tip: Disabling the heated humidifier and heated tubing reduces draw from 70–120 watts to 30–60 watts. Most patients tolerate one to two nights without humidity, especially if a small moisture-absorbing mask spray is used. This change can triple or quadruple battery runtime.

Field note

Write the wattage of every critical device on a piece of tape stuck to the device, along with its hours-per-day use. When sizing backup power in a hurry during a developing outage, you will not want to be searching for manuals or squinting at nameplates.

Dementia and cognitive impairment

Power outages disrupt the environmental cues that anchor daily routine for people with dementia — lighting changes, altered ambient sounds, absence of normal television or radio schedules. This disruption directly worsens sundowning (increased confusion, agitation, and behavioral disturbance in late afternoon and evening) and elopement risk (wandering away from home, often at night).

Maintaining routine during outages

Routine is the most powerful behavioral stabilizer for people with dementia. Maintain it precisely:

Keep medication administration times identical to normal schedule. Use a battery-powered alarm clock, not a phone-based alarm that may lose battery. Pre-fill a weekly pill organizer before an event.
Maintain consistent mealtimes and meal composition. Novel foods cause refusal and distress. Stock familiar foods in the emergency supply.
Replace lost lighting with battery lanterns positioned in familiar locations — the bedroom nightstand, the bathroom, the kitchen. Use warm-spectrum bulbs where possible; cool blue-spectrum LED lighting increases confusion in some dementia patients.
Limit news media and crisis-content exposure. Hearing repeated emergency broadcasts increases anxiety without providing actionable information to the patient.
Pre-brief all household members and any caregivers on the patient's baseline behaviors and on what a sundowning episode looks like for that individual. Responses differ between patients.

Elopement prevention during emergencies

Elopement risk increases during evacuations, power outages, and any disruption to familiar environment. Per Alzheimer's Association guidance:

Install door chimes or pressure-sensor alarms on all exit doors — these are inexpensive and do not require power if battery-operated
Place the patient's photo (current, showing face clearly) in a waterproof bag in every go-bag. Emergency responders need this if the patient cannot self-identify
Register with your local law enforcement's vulnerable-persons registry (Silver Alert or equivalent) before an event
Brief neighbors with the patient's name, appearance, and that they may wander — neighbors are often the first to see an elopement in progress
If a person with dementia cannot be located: call 911 no more than 15 minutes after determining they are missing; do not wait to expand your own search first. Per Alzheimer's Association search guidance, approximately 94% of people who wander are found within 1.5 miles (2.4 km) of the starting location. Focus initial search in the direction of their dominant hand.

Chronic Conditions Documentation Kit

Every chronic-condition household needs a documentation kit that survives evacuation and works when internet is unavailable.

One-page Chronic Conditions Card (laminated)

Front side per household member: - Full name, date of birth, primary diagnosis/diagnoses - All current medications: drug name (generic), dose, schedule, and what happens if missed for 72 hours - Known allergies and adverse reactions - Emergency contacts (two people beyond the household, with phone numbers) - Treating physician name, practice name, direct phone number, after-hours coverage number - Nearest pharmacy and pharmacy phone - Health insurance carrier, policy number, group number

Back side: - All powered medical devices: device type, manufacturer, model number, serial number, required power input (voltage/wattage), supplier name and emergency phone - Special instructions for the patient if they are incapacitated or confused (e.g., "Do not give this patient any medications containing potassium") - Current advance directives location (living will, POLST — Physician Orders for Life-Sustaining Treatment — or DNR orders)

Waterproof documentation packet (go-bag copy)

Beyond the one-page card, the go-bag packet should contain:

Copies of advance directives and POLST/DNR if applicable
Copy of the most recent medication reconciliation from the treating physician
List of all previous surgeries and significant diagnoses with dates
Immunization records
Health insurance cards (front and back copies)
Disability placard or service-animal documentation if applicable

Laminate the card and keep it in the household's primary emergency binder. Keep a second copy in every go-bag. Review and update quarterly — medication changes are common and an outdated card is worse than no card if it misdirects emergency responders.

Pre-registering with local emergency management

Many US counties and municipalities maintain Access and Functional Needs (AFN) registries — databases of residents who may need evacuation assistance due to medical needs, mobility limitations, or cognitive impairment. Registration is voluntary and does not guarantee evacuation assistance, but it puts your household on the radar of emergency planners.

Contact your county emergency management office or check their website before an event. Some utility companies maintain separate medical baseline programs that provide priority restoration for households with life-sustaining electrical equipment — ask your utility company about this program.

Failure modes

Insulin appears cloudy or discolored

Recognition: The vial or pen cartridge shows visible cloudiness, particles, or a pink/brown color change. All insulin formulations except NPH (which is intentionally cloudy) should be clear and colorless; any deviation indicates degradation.

Remediation: Stop using the suspect vial immediately. Switch to the next refrigerated backup vial. If no backup is available, contact your prescriber by phone before adjusting doses or attempting to use degraded insulin. Do not return a degraded vial to the refrigerator and continue using it.

Dialysis patient develops shortness of breath, leg swelling, or rapid weight gain

Recognition: Weight gain greater than 2.2 lb (1 kg) in a single day, or a cumulative gain above roughly 5 lb (2.3 kg) over the patient's established dry weight, or breathing difficulty at rest — any of these indicate dangerous fluid accumulation.

Remediation: Apply strict fluid restriction under 500 cc (about 16 oz) per day and limit potassium to 1,500 mg/day per the clinic-issued emergency diet. If breathing is labored at rest, or if cumulative weight gain has crossed the 5 lb (2.3 kg) threshold, go to the emergency room — emergency dialysis is available at most hospital emergency departments. Do not attempt to manage multiple missed sessions at home without medical contact.

CPAP or BiPAP stops mid-night during an outage

Recognition: Device alarm sounds, airflow ceases, or the patient wakes with breathing difficulty or oxygen-desaturation symptoms (confusion, headache, gasping).

Remediation: If any distress is present, have the patient sit upright — this reduces airway collapse risk. Switch the device to a UPS or portable power station if one is sized for the device's wattage. Disable the heated humidifier to reduce power draw by 40–60%. Monitor SpO2 with a pulse oximeter if one is available. Go to the emergency room if cyanosis (blue lips or fingertips) or persistent respiratory distress develops.

Dementia patient cannot be located

Recognition: The patient is missing and has not been seen for 15 minutes.

Remediation: Call 911 immediately — do not expand the household search alone first. Per Alzheimer's Association guidance, approximately 94% of people who wander are found within 1.5 miles (2.4 km) of the starting location; focus the initial search in the direction of the patient's dominant hand. Provide the emergency operator with the patient's name, description, current photo from the go-bag, and any medical ID bracelet information. Activate a Silver Alert through law enforcement if the patient is eligible.

Oxygen concentrator alarm sounds during an outage

Recognition: The device displays a low-O2 or low-flow alarm, or loses power entirely and stops producing oxygen.

Remediation: Switch to the E-tank backup at the prescribed liters-per-minute flow rate. Contact your home oxygen equipment supplier — they are federally required to have emergency protocols for their patients and may be able to deliver additional tanks. Monitor SpO2 if a pulse oximeter is available. Go to the emergency room if cyanosis (blue lips or fingertips) or respiratory distress develops.

Warfarin patient cannot get an INR test for 10 or more days

Recognition: A scheduled INR test has been missed and no home coagulation meter is available, leaving clotting status unknown for an extended period.

Remediation: Maintain the prescribed warfarin dose — do not adjust on suspicion alone; arbitrary dose changes outside a therapeutic range cause more harm than a brief monitoring gap. Avoid starting new medications and avoid significant changes in dietary vitamin K intake (high-vitamin-K foods such as leafy greens affect warfarin levels). ER trigger: any unexplained or unusual bleeding (bleeding gums, blood in urine or stool, severe or sudden headache) or any signs of clotting (chest pain, sudden limb weakness, shortness of breath, vision changes). These are emergencies regardless of outage status.

Practical checklist

Chronic-condition emergency planning is an extension of good disease management, not a separate discipline. The medication stockpiling page covers the mechanics of building and rotating your prescription buffer. For the broader household view — including planning for children, elderly members, and caregivers — see vulnerable household members in crisis. For the backup power systems that underpin medication refrigeration and device continuity, the energy foundation covers generator sizing, battery banks, and whole-home backup approaches.

Sources and next steps

Last reviewed: 2026-05-17

Source hierarchy:

FDA Information Regarding Insulin Storage and Switching Between Products in an Emergency (Tier 1, FDA — insulin room-temperature stability by formulation)
CDC Wildfire Smoke and People with Chronic Conditions (Tier 1, CDC — AQI thresholds and inhaler guidance)
National Kidney Foundation — Missing Dialysis Treatment Is Dangerous (Tier 1, National Kidney Foundation — missed-session consequences and fluid guidance)
Alzheimer's Association — Wandering and Elopement (Tier 1, Alzheimer's Association — sundowning triggers and elopement search guidance)

Legal/regional caveats: Medication stockpiling beyond a standard 30-day supply may require prescriber coordination and may be constrained by insurance refill policies that vary by carrier and state. Access and Functional Needs (AFN) registry programs are administered at the county level and vary significantly in scope — contact your local emergency management office for local enrollment procedures. Dialysis clinic disaster protocols are regulated by CMS (Centers for Medicare and Medicaid Services) Conditions for Coverage but are implemented locally; confirm your clinic's specific protocol directly.

Safety stakes: life-safety topic — verify against current local/professional guidance before acting.

Next 3 links:

→ Medical supply stockpiling — build and rotate the medication buffer this page depends on
→ Vulnerable household members in crisis — household-level planning for dependents, including AFN registry and caregiver coordination
→ Energy foundation — generator sizing, portable power stations, and backup systems for device and refrigeration continuity