When planning for emergencies or disasters involving childcare programs, managing medication is essential. Depending upon the circumstances, you may have to either “shelter in place”--remain in your childcare setting--or evacuate to a safer location. Think about your plan in this situation: a natural disaster has occurred 20 miles from your facility and emergency personnel require everyone to stay where they are until further notice. You expect to be moved to another shelter before evening.

Whether staying or evacuating, if you have children or adults who take prescribed medications, these medications and supplies must be available to them, disaster or not. A three-day supply of essential medications is the bare minimum to have in stock.

If you care for children with chronic or life-threatening health conditions, you may need to keep even larger supplies of medications. Consider keeping a separate supply of medications (and related equipment) in safe storage to be used only in an emergency. Be sure the health care plans for each child with a serious condition includes information on how to manage specific conditions during an emergency.

Part of the emergency planning process is to clearly identify the responsibilities of each staff member. Assign the task of quickly gathering locked medication supplies and health care plans to specific, dependable staff members--one person designated as “in charge of medications,” and the another as “medications back-up” in case the designated person is injured or unavailable. The use of two small, locked cases for medication storage, one for refrigerated medications and one for other medications, will make them easier to transport in the event of a disaster.

Diabetes Care

If you have an insulin-dependent child or staff member in your program, you should maintain at least a three-day supply of insulin and supplies, including syringes, blood glucose testing strips and tester (with extra batteries), cleansing wipes, and sharps disposal containers. All items used daily for routine diabetes care should be included in disaster medication preparation.

Storage rules for insulin vary by type and manufacturer. Ask parents to provide the package insert or the pharmacy information sheet. Insulin in use (open) can be stored unrefrigerated. Generally, unopened insulin or insulin pens can be safely refrigerated until their expiration dates. Keep an insulated bag and cold pack to use for unopened insulin storage in the event of a power outage. Check expiration dates and rotate the insulin supply to avoid waste.

Quick sources of sugar, such as canned orange juice and packaged snacks, also should be stored with the medication materials and not counted as part of nutrition supplies. Include guides for signs/symptoms of low and high blood sugar as well as copies of all health care plans. If possible, more than one person should be trained in diabetes management and be familiar with the children involved. Check state regulations on who can administer injectable medications as it can vary from state to state.

Allergies

Preparations also must be made for dealing with children or adults with life-threatening allergies. Anaphylaxis is a serious life-threatening reaction to a substance, which may cause widespread hives or swelling of the face, lips, or tongue. Any child or staff member who has suffered anaphylaxis in the past should have an EpiPen or EpiPen, Jr. prescribed by their medical provider and stored with the emergency supplies. Keep the “pen” out of direct sunlight and do not refrigerate it. Check expiration dates and replace pens as needed. Remember, an EpiPen is only a temporary source of relief, and must be followed with emergency care by a physician, which might be difficult to obtain during an evacuation or sheltered emergency. Be sure staff is trained in use of the EpiPen.

Medical providers also may order antihistamines to be used to manage life-threatening allergies. These medications should be stored with the EpiPens, along with information describing anaphylaxis symptoms and specific interventions.

Asthma

For children or adults with asthma, nebulizers often are the most effective way to dispense asthma medication. Keep the nebulizer device ready to grab if you have to evacuate. Additional tubing, mouthpieces, and any other nebulizer equipment should be stored with the medications in the disaster supply kit. Community groups such as the Lions, Elks, Moose, Rotary, or Kiwanis, may donate portable nebulizers. Be sure the battery is kept fully charged. Ask parents to check with their medical provider for alternative solutions to relieving an asthma attack in case there is no electricity.

Some older children, as well as staff, may use inhalers. Secure extra ones for the disaster kit and store in the locked medication box. Asthma can be aggravated by stress, so present a calm manner to the children if an incident occurs. Be alert to asthma triggers that may accompany a disaster, such as dust, smoke, or chemicals in the air.

Enteral/Tube Feedings

Some children may use feeding tubes because of medical conditions and/or difficulties in feeding, chewing and/or swallowing. If you have such a child in your care, you may need alternate ways of giving them their optimal nutritional intake. Extra formula for these children should be included in the disaster supplies kit. Written health care plans should include information on how to nourish such children in case of an emergency or evacuation. To discourage tube blockages, drinking water should be used to flush the tube before and after each feeding, and you should plan for extra water.
Remember to give water between feedings as directed to avoid dehydration. Locate a quiet spot and strive to make the feeding for the child as close to the usual routine as possible. Rinse feeding syringes and other materials with water after the feeding is completed. Follow storage directions on the formula container, remembering to discard any leftover formula at the end of each feeding.

Other Chronic and Acute Conditions

Examples of chronic conditions that may need managing for children and adults include seizure disorders, sickle cell anemia, cardiac concerns, and hypertension. Include all necessary equipment when gathering medications for these conditions.

Medications prescribed to treat acute conditions, such as antibiotics for infection, must be continued during an emergency or disaster event. These medications should already be stored in a locked medicine box and refrigerated, if needed. Include measuring tubes, cups, or calibrated spoons to use for accurate dosing.

Continue careful documentation of medications administered during the crisis. Make particular note of side effects, if any. The staff person assigned to administer medications should also check the supplies after the emergency and maintain a count of supplies.

Janie Sailors, RN, NCSN
Health Specialist, Training and Technical Assistance Services (TTAS)
Western Kentucky University

RESOURCES

A list of supplies for an emergency preparation/disaster supply kit, Federal Emergency Management Agency (FEMA), C St., SW Washington, D.C. 20472; 202-566-1600; www.fema.gov/rrr/diskit.shtm

Caring for Our Children, National Health and Safety Performance Standards, second edition, has information on medications as well as emergency planning. Print copies are available from the American Academy of Pediatrics, PO Box 747, Elk Grove Village, IL 60009-0747; 888-227-1770; www.aap.org. The text is available online, nrc.uchsc.edu.