Chronic diseases and natural hazards: impact of disasters on diabetic, renal, and cardiac patients.
BACKGROUND
Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response phase of disasters. Chronic disease exacerbations (CDE) account for one of the largest patient populations during disasters, and patients are at increased risk for adverse outcomes.


OBJECTIVE
The objective of this study was to assess the burden of chronic renal failure, diabetes, and cardiovascular disease during disasters due to natural hazards, identify impediments to care, and propose solutions to improve the disaster preparation and management of CDE.


METHODS
A thorough search of the PubMed, Ovid, and Medline databases was performed. Dr. Miller's personal international experiences treating CDE after disasters due to natural hazards, such as the 2005 Kashmir earthquake, are included.


CONCLUSIONS
Chronic disease exacerbations comprise a sizable disease burden during disasters related to natural hazards. Surveys estimate that 25-40% of those living in the regions affected by hurricanes Katrina and Rita lived with at least one chronic disease. Chronic illness accounted for 33% of visits, peaking 10 days after hurricane landfall. The international nephrology community has responded to dialysis needs by forming a well-organized and effective organization called the Renal Disaster Relief Task Force (RDRTF). The response to the needs of diabetic and cardiac patients has been less vigorous. Patients must be familiar with emergency diet and renal fluid restriction plans, possible modification of dialysis schedules and methods, and rescue treatments such as the administration of kayexalate. Facilities may consider investing in water-independent extracorporeal dialysis techniques as a rescue treatment. In addition to patient databases and medical alert identification, diabetics should maintain an emergency medical kit. Diabetic patients must be taught and practice the carbohydrate counting technique. In addition to improved planning, responding agencies and organizations must bring adequate supplies and medications to care for diabetic, cardiac, and renal patients during relief efforts.


CONCLUSIONS
By recognizing and addressing impediments to the care of chronic disease exacerbations after natural disasters, the quality, delivery, and effectiveness of the care provided to diabetic patients during relief efforts can be improved.
Department of Emergency Medicine, The State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA. andrewcmiller@optonline.net
Andrew C
AC
Miller
Bonnie
B
Arquilla
D002908:Chronic Disease; D003920:Diabetes Mellitus; D054597:Disaster Medicine / Q000458:organization & administration*; D004189:Disaster Planning; D004190:Disasters; D004632:Emergency Medical Services / Q000458:organization & administration*; D006331:Heart Diseases; D006801:Humans; D007674:Kidney Diseases