Health and Safety

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Hygiene

Drinking Water

People who do not drink adequate amounts of water will become dehydrated. This may be due to lack of access to potable water, distraction and/or psychological effects of the disaster, and/or overexertion in self-rescue or relief efforts. Dehydration impairs judgment and overall health. A good rule of thumb is that a person who is not drinking enough water will have urine that is less than clear; i.e. yellowish or cloudy.

Approximately one gallon of water per person per day is necessary to health and life. People can survive for many days without food and tolerate other hardships, but lack of water can kill in two to seven days depending on temperature and level of exertion.

In times of crisis, follow advice from local officials. Local health departments or public water systems may urge consumers to use more caution or to follow additional measures than the information provided here.

Look for other sources of potable water in and around your home. When your home water supply is interrupted by natural or other forms of disaster, you can obtain limited amounts of water by draining your hot water tank or melting ice cubes. In most cases, well water is the preferred source of drinking water. If it is not available and river or lake water must be used, avoid sources containing floating material and water with a dark color or an odor. Generally, flowing water is better quality than stagnant water.

Water Purification

In order to drink the water, you must treat it. You cannot tell whether water is safe to drink by looking at it!

Several methods to purify water are listed.

Iodine can be used to treat water in emergency conditions.

Pre-Treatment Screening

The water to be purified needs to be as clean as possible prior to treatment. Start with the cleanest water available. For example, if municipal tap water is known to be contaminated, it is better than flood water. DO NOT USE FLOOD WATER UNLESS YOU HAVE NO OTHER ALTERNATIVE.

If there are any visible particles in the water to be treated, remove these particles by straining through cloth or by pouring from container to container.

Treatment

  • Boiling - Boiling is the most certain way of killing all microorganisms. According to the Wilderness Medical Society, water temperatures above 160° F (70° C) kill all pathogens within 30 minutes and above 185° F (85° C) within a few minutes. So in the time it takes for the water to reach the boiling point (212° F or 100° C) from 160° F (70° C), all pathogens will be killed. No need to keep the water boiling! (In other words, recommendations to boil water for five minutes, ten minutes, etc. are excessive. One minute at boiling temperature is sufficient.)

Note: To improve the flat taste of boiled water, aerate it by pouring it back and forth from one container to another and allow it to stand for a few hours, or add a pinch of salt for each quart or liter of water boiled.

  • Cheapest and Easiest Drinking Water - Solar Method (SODIS) and WHO approved - Learn and Teach - SODIS POTABLE WATER SODIS
  • Water - Purification - Solar Cooking
    • Solar cooking is another method for water safety. Solar Cooking, as boiling needs a source of energy which not always will be available. Solar cooks can be built cheaply with available resources, and if done appropriately can be used to warm up water for long enough to kill most germs. .
  • Filtration - Commonly available over the counter filters are intended to improve the taste of potable drinking water, NOT to purify non-potable water directly! Filters intended for use in camping are often inadequate to purify flood waters, which will contain contaminants. A high-end camping filter with iodine resin and/or rated by its manufacturer to remove viruses may be adequate. Military-grade filters intended for use in developing countries such as the British Berkefield will be suitable.
  • General Chemical Treatment Procedures
    • The effectiveness of all chemical treatment of water is related to the temperature, pH level, and clarity of the water. Cloudy water often requires higher concentrations of chemical to disinfect
    • If the water is cloudy or filled with large particles, strain it, using a cloth, before treatment. Large particles, if swallowed, may be purified only "on the outside"
    • Add the chemical to the water and swish it around to aid in dissolving
    • The water should sit for at least 30 minutes after adding the chemical to allow purification to occur. If using tablets, let the water sit for 30 minutes after the tablet has dissolved
    • Chemically treated water can be made to taste better by pouring it back and forth between containers, after it has been adequately treated. Other methods include adding a pinch of salt per quart or adding flavorings (e.g., syrup mix, etc.) after the chemical treatment period
    • Additional Water Help Including Bleach Method - Emergency Disinfection of Drinking WaterEPA
    • Note that water adequately treated with chlorine should slightly smell of chlorine, but not as much as typical pool water.
  • Iodine Tincture Treatment
    • You can use common household iodine from the medicine chest of first-aid kit to purify water. Iodine is light sensitive and must always be stored in a dark bottle. Iodine has been shown to be more effect than chlorine-based treatments in inactivating cysts. Let water stand for at least 30 minutes before use. Generally, the procedure is as follows:
      • Iodine Preparations
      • Preparation Iodine => Amount/Liter
      • Iodine Topical Solution 2% = 8 drops per liter
      • Iodine Tincture 2% = 8 drops per liter
      • Lugol's Solution 5% = 4 drops per liter
      • Povidone-Iodine (Betadine®) 10% = 4 drops per liter

Note: For cloudy water, use twice the amount of drops.

  • Chlorine Treatment With Household Bleach
    • Free chlorine is the most widely and easily used, and the most affordable of the drinking water disinfectants. It is also highly effective against nearly all waterborne pathogens (except Cryptosporidium parvum oocysts and Mycobacteria species). At doses of a few mg/litre and contact times of about 30 minutes, free chlorine generally inactivates >99.99% of enteric bacteria and viruses.
    • For point-of-use or household water treatment, the most practical forms of free chlorine are liquid sodium hypochlorite, solid calcium hypochlorite and bleaching powder (chloride of lime; a mixture of calcium hydroxide, calcium chloride and calcium hypochlorite).
    • The amount of chlorine needed depends mainly on the concentration of organic matter in the water and has to be determined for each situation. After 30 minutes, the residual concentration of active chlorine in the water should be between 0.2-0.5 mg/l, which can be determined using a special test kit.
    • In the home, UNSCENTED household bleach is typically 5.25 percent sodium hypochlorite. Always check labels. Eight to ten (8 to 10) drops of bleach per gallon of water is recommended by public health authorities, more if water is cloudy.
    • If testing is not available, the water should slightly smell of chlorine -- but not so much as pool water.

For more information:

wikiHow has a good step-by-step tutorial for the different methods of water purification which includes video instruction. See also Emergency Disinfection of Drinking Water by the US Environmental Protection Agency.

Sanitation in Disasters Resources

Simple summary: do not let people go to the bathroom wherever they want! Urine is relatively harmless but feces are not! Feces spread disease and must be properly disposed of.

Small groups can improvise a toilet with a five gallon bucket, a plastic bag and a bit of bleach. Avoid urination in this bucket to extend its usefulness.

Larger groups MUST designate a latrine area with porta-potties, trenches, whatever field expedients you can find PLUS handwashing facilities! The latter can be as simple as non-potable water in a hanging bucket with whatever soap can be found.

Injured, ill and sick people may have to be helped to defecate in bedpans, and the bedpans taken to the latrine area.

FAILURE TO WASH HANDS AFTER DEFECATION IS A MAJOR DISEASE OUTBREAK VECTOR.

Most are PDF files with illustrations which can be downloaded and printouts given to teams for training and to teams heading for relief work in affected areas


Handwashing Saves Lives

Clean hands save lives. How to do it:

  • HOW TO WASH YOUR HANDS from Handwashing In Emergency Situations (Center for Disease Control - USA)
  • Wash hands frequently, especially prior to preparing food or water, before and after giving medical care, and after defecation. An easy way to make sure you have washed your hands for enough time is the sing the "ABC Song." When the song is done your hands are clean. Failure to wash hands contributes to disease outbreaks!

When should you wash your hands?

  1. Before preparing or eating food.
  2. After going to the bathroom.
  3. After cleaning up a child who has gone to the bathroom.
  4. When tending to someone who is sick.
  5. After handling uncooked foods, particularly raw meat, poultry, or fish.
  6. After blowing your nose, coughing, or sneezing.
  7. After handling an animal or animal waste.
  8. After handling garbage.
  9. When treating a cut or wound.

Safety and Disease Prevention

Universal Precautions

Protect yourself while helping others. Universal Precautions include the use of barrier methods (gloves, masks, gowns, etc) to protect the rescuer from blood and bodily fluids that may transmit disease. In the absence of equipment, follow the rule "If it's wet, don't touch it!" with respect to bodily fluids and/or have injured persons use direct pressure on their own wound until a bandage can be found or made.

Protective Equipment

Rescuers should wear protective gear appropriate to the task. This will mean a hard hat or helmet, bright colored vest, goggles, leather gloves, long-sleeved shirts and pants, and sturdy footwear such as boots. If working in proximity to the water, a life jacket is essential. An injured rescuer imperils not only themselves but the entire rescue effort of which they are a part, and any persons who would have otherwise been saved. SAFETY FIRST.

First Aid Practices

Wounds should be protected from sources of infection. Hasty efforts at cleaning a wound are often inadequate and this task should be not be attempted under field conditions if better facilities are available. Bandages should not be continually removed and replaced with clean ones except under medical direction to do so.


Amputees, People Facing Amputation

Evacuees who are amputees, or who are at risk for amputation surgery, should have a Limb Loss Care Team assigned to them to assist with treatment and recovery. The Amputee Coalition of America (ACA), http://www.amputee-coalition.org, Toll free: (888) 267-5669, has a list of amputee support groups across the United States.

Evacuees who wear prosthetic devices should be given access to Orthotic & Prosthetic providers to service, and/or replace damaged or lost components.

In addition, the National Association of Social Workers has a Tip Sheet on Limb Loss and Social Work at http://www.helpstartshere.org/Default.aspx?PageID=1232.

Dead Bodies - Information on Handling

The health risks of handling dead bodies are often exaggerated. Avoidance of close contact is often sufficient for persons not tasked with handling the dead.

  • Possible risks with handling dead bodies
    • Exposure to bloodborne viruses occurs due to direct contact with non-intact skin of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid
    • Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections
  • Precautions to be used by all persons working with bodies
    • Vinyl or Latex gloves should be worn
    • Masks and protective eyewear or face shields should be worn during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes
    • Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.
    • Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Hands should be washed immediately after gloves are removed.
    • Graveyards should be at least 30m from groundwater sources used for drinking water
    • The bottom of any grave must be at least 1.5m above the water table with a 0.7m unsaturated zone.
    • Surface water from graveyards must not enter inhabited areas.
    • Ensure universal precautions for blood and body fluids
    • Ensure use of body bags
    • Ensure disinfection of vehicles and equipment
    • Bodies do not need to be disinfected before disposal (except in case of cholera)
    • Vaccinate workers against hepatitis B


Care for Infants

This info might be helpful to people working directly with families with young children. It is in regards to baby wearing (holding a baby, young child, etc. close to your body with the help of some type of cloth) and breastfeeding in emergency situations.

Baby wearing

Breastfeeding


General Information

UNSORTED




CDC Hurricane-Related Information for Health Care Professionals

Call for Volunteers (State and National) - Health Care Professionals

EDIT NOTE: Move to a volunteer section At this time, the U.S. Department of Health and Human Services (HHS) is NOT accepting individual medical and relief worker applications.

Intake & Health Surviellance FORMS (CDC) for Health Care Professionals (PDF & MS Word)

CDC Index of Printable Materials

EDIT NOTE: Move to a volunteer section

CDC Immunization Advisory

Tetanus Prevention


Disaster Mental Health Resources

See also

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