Vocabulary List

• Shelter in Place: Whether you are at home, work, or anywhere else you frequent regularly, there may be situations when it's best to stay where you are and avoid uncertain circumstances outside.

• Stay At Home: Remain indoors as much as possible and try to only leave your home when necessary.

• Mass Care: Mass care shelters provide life sustaining services to disaster survivors.

• Evacuation: An evacuation occurs when people and pets are removed from or are requested or required to leave a certain area that is not safe.

• Triage: preliminary assessment of residents, patients or casualties in order to determine the urgency of their need for treatment and the type of treatment required.

(Evacuation | Ready.Gov, n.d.; Shelter | Ready.Gov, n.d.)

Objectives

This Week's Objectives:

• Describe actions to take before, during, and after evacuation due to an emergency, disaster, or hazard.

• Identify the three ways to shelter during a disaster or emergency.

• Identify three methods for treating water so that it is drinkable and usable for individuals and families. 

• Describe methods to maintain food safety and sanitation during an emergency situation. 

Evacuation

(Evacuation | Ready.Gov, n.d.)

Many kinds of emergencies can cause you to have to evacuate. In some cases, you may have a day or two to prepare while other situations might call for an immediate evacuation. Planning is vital to making sure that you can evacuate quickly and safely no matter what the circumstances.

Evacuation Strategies

(Planning Considerations: Evacuation and Shelter-in-Place, 2019)

Transportation planning considerations should include staging, departure points, transportation centers, and shelter locations. Jurisdictions may choose to employ one of the transportation concepts below to facilitate the movement of evacuees (people needing to leave an area due to a disaster, hazard, or emergency): 

Hub and Spoke (Figure 1) moves and aggregates evacuees in short trips from numerous pickup locations to evacuation centers, which in turn provide evacuation to mass care centers. Hub and spoke maximizes routes and provides immediate movement of people from dangerous locations to a safer location temporarily. This transportation model allows jurisdictions to triage the needs of individuals, which may only be access to temporary shelter or access to personnel to facilitate the rental of a vehicle or other means to evacuate and provide care for themselves and their family directly. 

Point-to-Point (Figure 2) moves evacuees directly from the point of departure to a host jurisdiction or shelter. Point-to-point is the fastest, most direct and least resource-intensive evacuation action in the immediate operational period. However, it has limited capacity for surges during large displacements. Shelters can come to capacity quickly, increasing travel for evacuees. Additionally, this model is not ideal if the host location has not been determined, such as in the instance of no-notice events that have an unpredictable pattern. 

To ensure safe and efficient evacuation, Emergency Managers must consider the event (for example, emergency or disaster) and then assess the status of the incident that is occurring. Much of the status assessment relates to human safety. Animal safety should also be considered, and many times it will be the responsibility of the individual or family to ensure safe evacuation for their pets. 

As part of status assessment, an Emergency Manager must decide if there is a threat to human safety. This is usually done by using one of three assessments: no threat to human safety, immediate threat to human safety, or potential threat to human safety. If there is no threat to human safety, then as it implies, there is no need to evacuate. If there is an immediate threat to human safety, then an Emergency Manager or Incident Commander would order an immediate evacuation. If there is a potential threat to human safety, then another assessment needs to be made in terms of ordering a post-event evacuation. 

Ordering a post-event evacuation involves two possible decisions: wait and reassess or start evacuation. If the wait and reassess option is chosen, then it leads back to assessing the status of the event or incident in which evaluating human safety again would result. If the start evacuation option is chosen, then the Emergency Manager would need to determine an evacuation approach, such as the Hub and Spoke or Point to Point Evacuation Models, or another suitable evacuation method. Once an evacuation approach is selected, then you would carry out the evacuation. Consider these concepts to help you complete the Decision Tree for Community Evacuation assignment.

Before an Evacuation

• Learn the types of disasters that are likely in your community and the local emergency, evacuation, and shelter plans for each specific disaster.

• Plan how you will leave and where you will go if you are advised to evacuate.

• Check with local officials about what shelter spaces are available for this year. 

• Identify several places you could go in an emergency such as a friend’s home in another town or a motel. Choose destinations in different directions so that you have options during an emergency.

• If needed, identify a place to stay that will accept pets. Most public shelters allow only service animals.

• Be familiar with alternate routes and other means of transportation out of your area.

• Always follow the instructions of local officials and remember that your evacuation route may be on foot depending on the type of disaster.

• Come up with a family or household plan to stay in touch in case you become separated. Have a meeting place and update it depending on the circumstance.

• Assemble supplies that are ready for evacuation. Prepare a go-bag you can carry when you evacuate on foot or public transportation and a go-bag with supplies for traveling longer distances if you have a car. 

• Do the following if you have a car:

• Keep a full tank of gas if an evacuation seems likely. Keep a half tank of gas in it at all times in case of an unexpected need to evacuate. Gas stations may be closed during emergencies and unable to pump gas during power outages. Plan to take one car per family to reduce congestion and delay.

• Make sure you have a portable emergency kit in your car.

• If you do not have a car, plan how you will leave if needed. Decide with family, friends, or your local emergency management office to see what resources may be available.

During an Evacuation

• Identify a local resource for a list of open shelters during an active disaster in your local area.

• Listen to a battery-powered radio and follow local evacuation instructions.

• Take your emergency supply kit.

• Leave early enough to avoid being trapped by severe weather.

• Take your pets with you but understand that only service animals may be allowed in public shelters. Plan how you will care for your pets in an emergency now.

• Do the following if time allows:

• Call or email the out-of-area contact in your family communications plan. Tell them where you are going.

• Secure your home by closing and locking doors and windows.

• Unplug electrical equipment such as radios, televisions, and small appliances. Leave freezers and refrigerators plugged in unless there is a risk of flooding. If there is damage to your home and you are instructed to do so, shut off water, gas, and electricity before leaving.

• Leave a note telling others when you left and where you are going.

• Wear sturdy shoes and clothing that provides some protection such as long pants, long-sleeved shirts, and a hat.

• Check with neighbors who may need a ride.

• Follow recommended evacuation routes. Do not take shortcuts because they may be blocked.

• Be alert for road hazards such as washed-out roads or bridges and downed power lines. Do not drive into flooded areas.

After an Evacuation

If you evacuated for the storm, check with local officials both where you’re staying and back home before you travel.

• If you are returning to disaster-affected areas after significant events, prepare for disruptions to daily activities and remember that returning home before storm debris is cleared is dangerous.

• Let friends and family know before you leave and when you arrive.

• Charge devices and consider getting back-up batteries in case power-outages continue.

• Fill up your gas tank and consider downloading a fuel app to check for outages along your route.

• Bring supplies such as water and non-perishable food for the car ride.

• Avoid downed power or utility lines because they may be active with deadly voltage. Stay away and report them immediately to your power or utility company.

• Only use generators outside and away from your home. Never run a generator inside a home or garage and do not connect it to your home's electrical system.

Sheltering

(Shelter | Ready.Gov, n.d.)

Sheltering is appropriate when conditions require that you seek protection in your home, where you work, or other location when other emergencies arise. The length of time you are required to take shelter may be short, such as during a tornado warning. Or, the time you are required to take shelter might be longer, such as during a pandemic. In all cases, it is important that you stay informed and follow the instructions of local authorities.

Choosing to take shelter is necessary in many emergencies. This can mean Stay-At- Home, Going to a Mass Care Shelter, or Sheltering in Place. Here’s the distinction:

Mass Care Shelter

Mass care shelters provide life sustaining services to disaster survivors. Even though mass care shelters often provide water, food, medicine, and basic sanitary facilities, you should plan to take your emergency supply kit with you so you will have the supplies you need. Mass care sheltering can involve living with many people in a confined space, which can be difficult and unpleasant. 

• Be prepared to take cleaning items with you like soap, hand sanitizer, disinfecting wipes, or general household cleaning supplies to disinfect surfaces.

• All shelters accept service animals, but many public shelters and hotels do not allow pets inside. Know a safe place where you can take your pets before disasters and emergencies happen.

Sheltering in Place

Whether you are at home, work, or anywhere else you go to regularly, there may be situations when it's best to stay where you are and avoid any uncertainty outside. 

Here are some indicators and steps to take if the situation arises:

• Use common sense and available information to assess the situation and determine if there is immediate danger.

• If you see large amounts of debris in the air, or if local authorities say the air is badly contaminated you may want to shelter in place.

Here are some tips for sheltering in place:

• Local authorities may not immediately be able to provide information on what is happening and what you should do.

• Pay attention to local media outlets for official news and instructions as they become available.

• Bring your family and pets inside.

• Lock doors, close windows, air vents, and fireplace dampers.

• Turn off fans, air conditioning, and forced air heating systems.

• Take your emergency supply kit unless you have reason to believe it has been contaminated.

• Go into an interior room with few windows if possible.

• Seal all windows, doors, and air vents with thick plastic sheeting and duct tape. Consider measuring and cutting the sheeting in advance to save time.

• Cut the plastic sheeting several inches wider than the openings and label each sheet.

• Duct tape plastic at corners first and then tape down all edges.

• Be prepared to improvise and use what you have on hand to seal gaps so that you create a barrier between yourself and any contamination.

Sealing a room is considered a temporary protective measure to create a barrier between you and potentially contaminated air outside. This type of sheltering in place requires pre-planning, by purchasing plastic sheeting and duct tape that you would keep in your emergency supply kit. 

Stay-at-Home

• Remain indoors as much as possible and try to only leave your home when necessary. You can still use outdoor spaces such as patios, porches, and yards.

• In epidemic and pandemic situations, outdoor activities such as walking, jogging, and exercise are fine if you practice social distancing.

• Essential services such as grocery shopping, the gas station, pharmacies, and going to the Post Office are still fine to do.

• Limit visitors if possible. Try to use video chatting. Call the people you would normally text.

Determining Water Needs

(Water | Ready.Gov, n.d.)

Store at least one gallon of water per person per day for several days, for drinking and sanitation. A normally active person needs about three quarters of a gallon of fluid daily, from water and other beverages. However, individual needs vary depending on age, health, physical condition, activity, diet, and climate.

Take the following into account:

• Children, nursing mothers, and sick people may need more water.

• A medical emergency might require additional water.

• If you live in a warm weather climate, more water may be necessary. In very hot temperatures, water needs can double.

Water Tips

Never ration drinking water unless ordered to do so by authorities. Drink the amount you need today and try to find more tomorrow. Minimize the amount of water your body needs by reducing activity and staying cool.

First drink water that you know is not contaminated. If necessary, suspicious water, such as cloudy water from regular faucets or water from streams and ponds, can be used after it has been properly treated. If water treatment is not possible, delay drinking suspicious water as long as possible but identify ways to not become dehydrated.

Do not drink carbonated or caffeinated beverages instead of drinking water. Caffeinated drinks and alcohol dehydrate the body which increases the need for drinking water.

If you must prepare your own containers of water, purchase food-grade water storage containers. Before filling with chlorinated water, thoroughly clean the containers with dishwashing soap and sanitize the bottles by cleaning with a solution of one teaspoon of non-scented liquid household chlorine bleach to a quart of water. Water that has not been commercially bottled should be replaced every six months.

Water Treatment

If you have used all of your stored water and there are no other reliable clean water sources, it may become necessary to treat suspicious water. Treat all water of uncertain quality before using it for drinking, food washing or preparation, washing dishes, brushing teeth, or making ice. In addition to having a bad odor and taste, contaminated water can contain microorganisms (germs) that cause diseases such as dysentery, cholera, typhoid, and hepatitis.

There are many ways to treat water. Often the best solution is a combination of methods. Before treating, let any suspended particles settle to the bottom or strain them through coffee filters or layers of clean cloth.

Boiling: This is the safest method of treating water. In a large pot or kettle, bring water to a rolling boil for one full minute, keeping in mind that some water will evaporate. Let the water cool before drinking.

Boiled water will taste better if you put oxygen back into it by pouring the water back and forth between two clean containers. This also will improve the taste of stored water.

Chlorination: You can use household liquid bleach to kill microorganisms. Use only regular household liquid bleach that contains 5.25–6.0 percent sodium hypochlorite. Do not use scented bleaches, color safe bleaches, or bleaches with added cleaners.

Add 1/8 teaspoon of bleach per gallon of water, stir and let stand for 30 minutes. The water should have a slight bleach odor. If it doesn’t, then repeat the dosage and let stand another 15 minutes. If it still does not smell of chlorine, discard it and find another source of water.

Other chemicals, such as iodine or water treatment products sold in camping or surplus stores that do not contain 5.25–6.0 percent sodium hypochlorite as the only active ingredient are not recommended and should not be used.

Distillation: While boiling and chlorination will kill most microbes in water, distillation will remove microbes (germs) that resist these methods, as well as heavy metals, salts, and most other chemicals. Distillation involves boiling water and then collection of only the vapor that condenses. The condensed vapor will not include salt or most other impurities.

To distill, fill a pot halfway with water. Tie a cup to the handle on the pot’s lid so that the cup will hang right-side-up when the lid is upside-down (make sure the cup is not dangling into the water) and boil the water for 20 minutes. The water that drips from the lid into the cup is distilled.

Suggested Emergency Food Supplies

(Food | Ready.Gov, n.d.)

After a disaster, there may be power outages that could last for several days. Stock canned foods, dry mixes, and other staples that do not require refrigeration, cooking, water, or special preparation. Be sure to include a manual can opener and eating utensils.

Consider the following things when putting together your emergency food supplies:

• Store at least a several-day supply of non-perishable food (3–5 days).

• Choose foods your family will eat.

• Remember any special dietary needs.

We suggest the following items when selecting emergency food supplies. You may already have many of these on hand. 

• Ready-to-eat canned meats, fruits, and vegetables plus a can opener.

• Protein or fruit bars.

• Dry cereal or granola.

• Peanut butter.

• Dried fruit.

• Canned juices.

• Non-perishable pasteurized milk.

• High energy foods.

• Food for infants and babies.

• Comfort or stress foods.

Food Safety and Sanitation

Without electricity or a cold source food stored in refrigerators and freezers can become unsafe. Bacteria in food grow rapidly at temperatures between 40 and 140 degrees Fahrenheit, and if these foods are consumed, you can become very sick. Thawed food usually can be eaten if it is still refrigerator cold. It can be re-frozen if it still contains ice crystals. Remember, when in doubt, throw it out.

Do:

• Keep food in covered containers.

• Keep cooking and eating utensils clean.

• Throw any food that has come into contact with contaminated water.

• Throw away any food that has been at room temperature for two hours or more.

• Throw away any food that has an unusual odor, color, or texture.

• Use ready-to-feed formula. If you must mix infant formula, use bottled water or boiled water as a last resort.

Do not:

• Eat foods from cans that are swollen, dented, or corroded, even though the product may look safe to eat.

• Eat any food that looks or smells abnormal, even if the can looks normal.

• Let garbage accumulate inside, both for fire and sanitation reasons.

Alternative cooking sources can be used in times of emergency including candle warmers, chafing dishes, fondue pots, or a fireplace. Charcoal grills and camp stoves are for outdoor use only. Commercially canned food may be eaten out of the can without warming.

Managing Food Without Power

• Keep the refrigerator and freezer doors closed as much as possible.

• The refrigerator will keep food cold for about four hours if it is unopened.

• Refrigerated or frozen food should be kept at 40 degrees Fahrenheit or below for proper food storage.

• Use a refrigerator thermometer to check temperature.

• Refrigerated food should be safe as long as the power was out for no more than four hours.

• Discard any perishable food such as meat, poultry, fish, eggs, or leftovers that have been above 40 degrees Fahrenheit for two hours or more. 

Using Dry Ice:

• Know where you can get dry ice prior to a power outage.

• Twenty-five pounds of dry ice will keep a 10 cubic foot freezer below freezing for three to four days.

• If you use dry ice to keep your food cold, make sure it does not come in direct contact with the food.

• Use care when handling dry ice. Wear dry, heavy gloves to avoid injury.

Shelter Assessment

(CDC Shelter Assessment Tool | Emergency Preparedness and Response, 2022)

Disaster shelters provide protection for refuges and safely house individuals and emergency responders. Emergency managers and environmental health practitioners play a key role in protecting the health and living environment of occupants of disaster shelters by conducting pre-occupancy and post-event assessments of these facilities. The assessment is not a substitute for local shelter inspection procedures or planning activities.

A standard assessment form is intended to do the following: 

• Serve as a standardized instrument for rapidly assessing and monitoring environmental health conditions in shelter facilities, before and after a disaster event.

• Cover selected environmental health areas ranging from basic food safety and water quality to pet (companion animal) wellness.

• Assist in identifying and prioritizing environmental health and safety issues in disaster shelters.

• Provide shelter management officials and disaster managers with actionable information and recommendations for improving the living environment of the shelter occupants.

• Capture data and create documentation for use in future planning, disaster training, and improvement of the operations of disaster shelters.

• Complement inspection forms, but not replace.

Evacuation Triage and Prioritization

Using the healthcare setting as one example, triage can be defined as the sorting and categorizing of patients based on clinical severity in order to maximize the results for the most number of patients, especially when there are limited resources available. Triage is a proven method that is used in multiple scenarios in a variety of environments throughout the world. You may be familiar with the process of triage upon initial arrival of patients to a medical facility or upon arrival to the scene when there are multiple casualties. Triage in these situations involves using the START (Simple Triage and Rapid Transport) method or similar tool designed for the environment such as a hospital, residential facility, or an emergency department. Triage, however, does not stop after the first iteration. It must be continually used and reevaluated during any transition of care or when resources or situations change. 

Triage is done in order to prioritize which patients are to be moved first and determine by what means they are transported based on available resources, acuity of the patients (acuity means the priority in which a patient is treated), and treatments or monitoring needed in route of being transported; hence the term evacuation triage.

Just as patients undergo triage when entering a medical treatment area such as an emergency department, triage of patients is necessary before transferring them to other treatment areas or different facilities based on the disaster or emergency occurring. When the needs outstrip resources, triage must be utilized to maximize the results for the number of patients. 

A key difference is to understand that providers are not triaging patients to prioritize treatments. Instead, they are triaging to prioritize evacuation. In our healthcare setting example, it is important to recognize that the patients are already in a treatment area and receiving medical care at this point. The reasons that would necessitate evacuation include being transferred to receive specific care, go to a higher level of care, or to clear space in a treatment area to make room for new patients coming in. And as indicated earlier and as another real world example to consider, the Hub and Spoke transportation model allows jurisdictions to triage the needs of individuals. This type of triage process may only be access to temporary shelter or access to personnel to facilitate the rental of a vehicle or other means to evacuate and provide care for themselves and their family directly. To keep triage evacuation simple, emergency managers can ask this question: How quickly do we need to move a person or family from their current location to the next?

The table below is a tool that emergency managers can use to determine evacuation triage and prioritization. Such a tool using Red—Yellow—Green is a basic way to determine how evacuation should work and who to prioritize based on needs and circumstances. Such a tool can be written by developing appropriate triage criteria (for example, maximum assistance, some assistance, minimal assistance), identifying personnel or organizations to support the effort (for example, security staff, bus drivers, emergency medical technicians, and so on), and what resources would be needed (for example, ambulances, vehicles, and so on). Prioritization can then be as simple as First, Second, Third, Last in terms of when to evacuate or transport. 

(Koser & Suchenski, 2023)

Coping with a Disaster

It is natural to feel stress, anxiety, grief, and worry during and after a disaster. Everyone reacts differently, and your own feelings will change over time. Notice and accept how you feel. Taking care of your emotional health during an emergency will help you think clearly and react to the urgent needs to protect yourself and your family. Self-care during an emergency will help your long-term healing. People with preexisting mental health conditions should continue with their treatment plans during an emergency and monitor for any new symptoms.

Take the following steps to cope with a disaster:

• Take care of your body: Try to eat healthy well-balanced meals, exercise regularly, and get plenty of sleep. Avoid alcohol, tobacco, and other drugs.

• Connect with others: Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships, and build a strong support system.

• Take breaks: Make time to unwind and remind yourself that strong feelings will fade. Try taking in deep breaths. Try to do activities you usually enjoy.

• Stay informed: When you feel that you are missing information, you may become more stressed or nervous. Watch, listen to, or read the news for updates from officials. Be aware that there may be rumors during a crisis, especially on social media. Always check your sources and turn to reliable sources of information like your local government authorities.

• Avoid too much exposure to news: Take breaks from watching, reading, or listening to news stories. It can be upsetting to hear about the crisis and see images repeatedly. Try to do enjoyable activities and return to normal life as much as possible and check for updates between breaks.

• Seek help when needed: If distress impacts activities of your daily life for several days or weeks, talk to a clergy member, counselor, or healthcare professional.

Look out for these common signs of distress:

• Feelings of feelings of fear, anger, sadness, worry, numbness, or frustration.

• Changes in appetite, energy, and activity levels.

• Difficulty concentrating and making decisions.

• Difficulty sleeping or nightmares.

• Physical reactions, such as headaches, body pains, stomach problems, and skin rashes.

• Worsening of chronic health problems.

• Increased use of alcohol, tobacco, or other drugs.

If you experience these feelings or behaviors for several days in a row and are unable to carry out normal responsibilities because of them, seek professional help. 

As everyone responds to emergencies and disasters in different ways, emergency managers should develop the knowledge and skills to better understand how to apply the resources available to assist communities with mental and emotional health needs. Visit Centers for Disease Control: Coping with a Disaster or Tramatic Event to learn more.

(Taking Care of Your Emotional Health, 2019)

References

CDC Shelter Assessment Tool | Emergency Preparedness and Response. (2022, May 25). https://emergency.cdc.gov/shelterassessment/index.asp

Evacuation | Ready.gov. (n.d.). Retrieved September 22, 2023, from https://www.ready.gov/evacuation

Food | Ready.gov. (n.d.). Retrieved September 22, 2023, from https://www.ready.gov/food

Koser, B., & Suchenski, M. (2023). EMS Evacuation Triage. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537075/

Planning Considerations: Evacuation and Shelter-in-Place. (2019). https://www.fema.gov/sites/default/files/2020-07/planning-considerations-evacuation-and-shelter-in-place.pdf

Shelter | Ready.gov. (n.d.). Retrieved September 22, 2023, from https://www.ready.gov/shelter

Taking Care of Your Emotional Health. (2019). https://emergency.cdc.gov/coping/selfcare.asp

Water | Ready.gov. (n.d.). Retrieved September 22, 2023, from https://www.ready.gov/water