CREATED BY Tammy L. Henderson *** Simonne Miller Jennie Hendrix Minh Dinh Oklahoma State University

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1 (Win Henderson, FEMA Photo) CREATED BY Tammy L. Henderson *** Simonne Miller Jennie Hendrix Minh Dinh Oklahoma State University As part of the Disaster Series For Older Adults, the current work was supported by the following: Oklahoma Geriatrics Education Center (OKGEC), National Science Foundation Award NO , Oklahoma State University s College of Human Sciences Department of Human Development and Family Science, and Oklahoma Cooperative Extension Service. Any opinions, findings, or recommendations expressed in this document are those of the authors and do not necessarily reflect the views of these sponsors. Do not cite or use materials without the permission of authors granted via the Permission to Use Form included in the In-Service Training Kit. CONTACT: Dr. Tammy L. Henderson, Oklahoma State University, 233 Human Sciences, Stillwater, OK You mail call her at (OFFICE) or her at

2 DISASTER PREPARATION OVERVIEW Many people do not make adequate, if any, preparation for emergencies and disasters. Emergencies may include natural disasters, such as tornadoes, earthquakes, floods, hurricanes, and severe thunderstorms. Terrorist attacks or house fires are other disasters. To decrease feelings of anxiety and fear, and to reduce the loss of property, everyone needs to prepare. Most importantly, disaster preparedness may help to save lives. The current Disaster Preparedness Checklist was designed to assist older adults and their families prepare for disasters and emergencies. Prepare ahead for any emergency that may arise. The current Disaster Preparedness Checklist was designed to help individuals and families plan and prepare and to help persons with disabilities, mobility challenges, or other health problems. Careful planning will help quickly and efficiently react to sudden emergency situations. Everyone should review the Disaster Preparedness Checklist regularly and update it often. Anytime there is a change in addresses, phone numbers, physicians, pharmacies, medications, or other information included, the Disaster Preparedness Checklist should be corrected. Keep this and all emergency tools in a familiar place that can be easily reached in the event of an emergency. ACKNOWLEDGEMENTS Tammy L. Henderson, Ph.D., CFLE, Associate Professor in Human Development and Family Science, Oklahoma State University (OSU), Stillwater, OK. Simonne Miller, BS, Undergraduate Student in Human Development and Family Science, Oklahoma State University-Tulsa, Tulsa, OK. Jennie Hendrix, BA, Graduate Student in the College of Arts and Sciences, Oklahoma State University, Stillwater, OK. Minh Tuan Dinh, BS, Graduate Student in Spears School of Business, Oklahoma State University, Stillwater, OK. ** Send correspondence to first author: Tammy L. Henderson, Ph.D., CFLE, Associate Professor, Oklahoma State University, 233 HSCi- Human Development and Family Science, Stillwater, OK OFFICE:

3 TABLE OF CONTENTS Page About You... 1 Section I ~ Planning Tips... 2 Checklist 1.1 ~ Before a Disaster... 3 Checklist 1.2 ~ During a Disaster... 5 Checklist 1.3 ~ After a Disaster... 6 Section II ~ Emergency Contact Information... 7 Checklist 2.1 ~ Family & Friends Emergency Contacts... 8 Checklist 2.2 ~ Health & Medical Contacts... 9 Checklist 2.3 ~ Local Authorities Emergency Contacts National Emergency Contacts Section III ~ Personal Health Information Checklist 3.1 ~ General Health Concerns Checklist 3.2 ~ Prescriptions Checklist 3.3 ~ Personal Health Preparation Section IV ~ Finance Checklist 4.1 ~ General Finance Tips Section V ~ Insurance Checklist 5.1 ~ Insurance Policies & Providers Checklist 5.2 ~ Vehicle Information Checklist 5.3 ~ Household Inventory Section VI ~ Disaster Supplies Storage Checklist 6.1 ~ Important Documents to Pack Checklist 6.2 ~ Disaster Supply Kit for Home Checklist 6.3 ~ Disaster Supply Kit for Vehicle Section VII ~ Disaster & Your Pets Checklist 7.1 ~ Pet Information Checklist 7.2 ~ Disaster Preparation Guidelines for Pets I

4 TABLE OF CONTENTS (Continued) References Appendix A Contact Card & Calling Circle Appendix B Financial Planning for Disaster Storing Financial Files Safety Deposit Box Storage Appendix C Oklahoma Do Not Resuscitate (DNR) Consent Form Certification of Physician Form Appendix D Oklahoma Statutory Form for Power of Attorney II

5 ABOUT YOU Name: Address: Landline Phone Number: ( ) Cell Phone Number: ( ) Date of Birth: Allergies: Medications: Glasses: Hearing Aid: Blood Type: 1

6 SECTION 1 PLANNING TIPS The Planning Tips Section contains information for disasters of all types. These tips will help plan what to do before, during, and after a disaster. The tips are general. Here are some other general tips: Check with your area aging agencies or other sources to create individual plans for the specific disasters that may occur in your area. Check local weather reports to determine the most common natural disasters in your area. Develop a specific plan for natural disasters common to your area. Develop plans for emergencies, such as house fires. Knowing which disasters and emergencies are most likely in your area makes it much easier to create a plan that will work for you and your family. George Armstrong FEMA photo 2

7 Checklist 1.1 Before a Disaster DIRECTIONS: MARK YES FOR COMPLETED TASKS OR NO FOR THOSE NOT COMPLETED. IN SOME CASES TASKS MAY NOT APPLY TO YOU. YES NO CREATE A FAMILY COMMUNICATION PLAN Create a contact card or a Calling Circle for each family member.* Have family members keep the contact card or Calling Circle in a wallet, purse, backpack, etc. Choose a friend or relative who lives out of state who can be notified when family members are safe. YES NO PLAN ESCAPE ROUTES FOR YOUR HOME Draw a floor plan of your home, use a separate page for each level. Mark two escape routes from each room. Purchase rope ladders to hang from second story windows. Post a copy of the map at eye level in each room. Practice the escape routes for each room with your family. YES NO DESIGNATE A SAFE PLACE INSIDE YOUR HOME Choose a location on the first floor away from windows and objects that could injure you in a storm. Prepare this safe place for possible isolation. Make sure your disaster kit is easy to find and near the safest place in the home ** YES NO ESTABLISH A FAMILY CHECKPOINT Choose a place for everyone to meet in the event of an emergency. Understand that telephones may not be available and plan for this. Keep in mind transportation and traffic issues when choosing your location. Consider alternate transportation for family members who do not have a car. Make sure that everyone in the family knows the checkpoint. Record this information on your contact cards. NOTES: * See Appendix A for examples of Contact Cards and a Calling Circle. ** Information on how to create a Disaster Kit can be found in Section 5 of this document. 3

8 Checklist 1.1 Before a Disaster (continued) YES NO MAINTAIN THE INSIDE OF YOUR HOME Regularly clean out storage areas of trash, newspapers, or magazines. Make sure that dangerous objects, such as kitchen knives, are in a secure place. Check the placement of smoke detectors. Install smoke detectors in locations that allow everyone to hear the alarm from their bedrooms. Test smoke alarm batteries every month. Replace smoke alarm batteries at least once a year. Replace all smoke alarm detector units at least every 10 years. YES NO MAINTAIN THE OUTSIDE OF YOUR HOME Clear brush, downed tree limbs, and leaves regularly from your property. Have trees trimmed back from power lines. MAINTAIN YOUR VEHICLE YES NO Each month check the following: Lights Tire inflation and condition Spare tire inflation and condition Windshield washer fluid YES NO Every 3 months/3,000 miles check the following: Fluids (transmission, power steering) Filters (air, fuel) Battery Belts Hoses Change oil YES NO Every 6 months/6,000 miles check the following: Check windshield wiper blades YES NO Every 12 months/12,000 miles check the following: Brakes Spark plugs Steering and suspension Coolant (antifreeze) (American Red Cross, n. d.; Car Care Council, 2008; Federal Emergency Management Agency, 2004; U. S. Fire Administration, 2009) 4

9 Checklist 1.2 During a Disaster DIRECTIONS: MARK YES FOR COMPLETED TASKS OR NO FOR THOSE NOT COMPLETED. IN SOME CASES TASKS MAY NOT APPLY TO YOU. YES NO HAVE A BATTERY OPERATED RADIO Make sure it is easy to move around or transport. Listen for weather updates. YES NO IF STAYING IN YOUR HOME Gather your family and pets in your safe room. Do not leave your safe room until you hear the all clear from authorities over the radio. YES NO IF EVACUATING Save yourself, not your possessions. Bring in or secure outdoor furniture. Turn off power and gas to your home. Lock windows and doors. Follow the evacuation plan and routes you designed. (Federal Emergency Management Agency, 2004) 5 Michael Reiger FEMA Photo

10 Checklist 1.3 After a Disaster DIRECTIONS: AFTER A DISASTER, THESE TIPS WILL BE HELPFUL. MARK YES FOR COMPLETED TASKS OR NO FOR THOSE NOT COMPLETED. IN SOME CASES TASKS MAY NOT APPLY TO YOU. BE SURE TO REPLENSH ANY SUPPLIES USED FROM THE DISASTER KIT. YES NO LISTEN TO LOCAL RADIO OR TV Do not attempt to leave your safe room or return to your home after evacuation. Wait until given the all clear by local authorities. YES NO FOLLOW YOUR FAMILY COMMUNCATION PLAN Make sure your family knows you are safe. Make sure they know where you are. YES NO ONCE YOU CAN SAFELY RETURN HOME Assess the damage to your home, property, and vehicle. Contact your insurance carrier to file any necessary claims. (Federal Emergency Management Agency, 2004) 6 Adam Dubrova FEMA Photo

11 SECTION 2 - EMERGENCY CONTACT INFORMATION The Emergency Contact Information Section is a resource for personal, medical, and emergency contacts. The goal is to have correct contact information, including names, telephone numbers, and addresses for family, friends, medical professionals, and local authorities. It also places important contact information in one place. Before you fill out the Emergency Contact Information, keep in mind the following tips: Include at least one person outside your area in case long distance calls are easier to place during a disaster or emergency. Include at least one person with a traditionally wired landline telephone in case cellular phone towers are not working in the area. Keep emergency contact information with you during a disaster since you may not be near your telephone or address book. Keep emergency contact information somewhere in your home where it is easily visible and near a telephone. Jocelyn Augustino FEMA Photo 7

12 Checklist Family & Friends Emergency Contacts DIRECTIONS: FILL OUT THE CHART WITH AS MUCH INFORMATION AS YOU KNOW. REMEMBER TO INCLUDE AT LEAST ONE OUT OF TOWN CONTACT AND AT LEAST ONE CONTACT WITH A LANDLINE TELEPHONE. Contact Name Address Landline Phone Example: Cellular Phone David Copper 123 Magic Blvd, Stillwater, OK (AGS Foundation for Healthy Aging, 2007; American Red Cross, n. d.; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; Disaster Preparedness for the Elderly, 2009; North Carolina Department of Health and Human Services, 2007; Senior Resource Alliance Program, 2009; Texas Extension Disaster Education Network, 2009; University of Florida Institute of Food and Agricultural Sciences Extension, 2009) 8

13 Checklist Health and Medical Contacts DIRECTIONS: FILL OUT THE CHECKLIST WITH THE ADDRESS AND PHONE NUMBERS OF EACH OF YOUR MEDICAL PROVIDERS. INCLUDE SPECIALISTS AND MENTAL HEALTH PROFESSIONALS. Health Care Provider Address Phone Number Alternate Number Primary Physician: Specialist 1: Specialist 2: Optometrist: Dentist: Mental Health 1: Mental Health 2: (AGS Foundation for Health Aging, 2007; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; Disaster Preparedness for the Elderly, 2009; North Carolina Department of Health and Human Services, 2007; Senior Resource Alliance Program, 2009; Texas Extension Disaster Education Network, 2009; University of Florida Institute of Food and Agricultural Sciences Extension, 2009) 9

14 Checklist Local Authorities Emergency Contacts DIRECTIONS: FILL OUT THE CHECKLIST WITH THE ADDRESSES AND TELEPHONE NUMBERS OF LOCAL AUTHORITIES IN YOUR CITY. THIS INFORMATION CAN BE FOUND IN THE LOCAL TELEPHONE BOOK. Local Authority Address Phone Number Alternate Number Police Fire Hospital Emergency Room Poison Control Other: Other: Other: (AGS Foundation for Health Aging, 2007; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; Disaster Preparedness for the Elderly, 2009; North Carolina Department of Health and Human Services, 2007; Senior Resource Alliance Program, 2009; Texas Extension Disaster Education Network, 2009; University of Florida Institute of Food and Agricultural Sciences Extension, 2009) 10

15 National Emergency Contacts National Contact Contact Number Federal Emergency Management Agency (FEMA) TTY: Centers for Disease Control and Prevention TTY: Arson Bioterrorism Bomb Firearms Mine Hazards Non-Emergency Oil and Chemical Spills Suspicious Agricultural Purchases (Wheeling Jesuit University/Center for Educational Technologies, 2009) NOTE: All numbers are available 24 hours a day. 11

16 SECTION 3 PERSONAL HEALTH INFORMATION The Personal Health Information Section helps keep all of your health information in one place. In the event of an emergency or disaster, you may need to share your health information with others who can help care for you. Here are some tips: Keep your health information up-to-date. Keep a copy of your health information with you during a disaster or emergency. Discuss the information in these checklists with your family or close friends who live near you. Share your health information with family members or close friends who live near you. Keep your health supplies in one place. Give someone an extra key to your home in case they need to get your medicine or health equipment. Share where you keep your medicine with a family member or close friend who lives near you. Show others how to use your medical equipment, especially if you cannot care for yourself. Consult with your doctor on how to prepare for a disaster with your specific health concerns. Your doctor may have tips or alternative plans that you and your local network can implement if your normal procedures will not work. Never change your medical practices without consulting your doctor first. 12 Win Henderson. FEMA Photo

17 Checklist General Health Concerns DIRECTIONS: LIST EACH OF YOUR HEALTH CONCERNS, INCLUDING PHYSICAL DISABILITIES, ALLERGIES, AND MENTAL HEALTH CARE, AND WHAT YOU DO TO TREAT THEM. Health Concern or Disabilities Example: Cannot breath when nervous 1. Treatment Method & Equipment Talk to me or use portable life support Comments Machine Series: PLS 0123L (American Red Cross, n. d.; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; Disaster Preparedness for the Elderly, 2009) 13

18 Checklist 3.2 Prescriptions DIRECTIONS: LIST ALL YOUR PRESCRIPTIONS. KEEP ORIGINAL PACKAGING FOR MEDICATIONS IN YOUR DISASTER KIT. CONSULT YOUR DOCTOR OR PHARMACIST FOR GENERIC DRUG NAMES IN CASE YOUR BRANDS ARE NOT AVAILABLE DURING A DISASTER. Drug Name Purpose Dosage Strength Example: Cholesterol 10mg Lipitor Color/ Shape White/ Oval Dosage Frequency Once a day ( morning) Special Instructions Cannot eat grapefruit Prescribing Physician Dr. Johnson (AGS Foundation for Healthy Aging, 2007; Federal Emergency Management Agency, 2004; Disaster Mental Health, n. d.; Disaster Preparedness for the Elderly, 2009; Gibson & Hayunga, 2006; North Carolina Department of Health and Human Services, 2007) 14

19 Checklist Personal Health Preparation DIRECTIONS: MARK YES FOR COMPLETED TASKS OR NO FOR THOSE NOT COMPLETED. IN SOME CASES TASKS MAY NOT APPLY TO YOU. YES NO SHARE INFORMATION WITH YOUR LOCAL NETWORK Discuss your health concerns and treatment methods. Share a detailed list of special foods needed for your diet. Teach at least one person how to operate necessary equipment. Teach at least one person how to administer treatments. Share where you store your health equipment. Make sure someone has a key to your home or knows where you keep your spare key. YES NO PREPARE YOUR EMERGENCY EQUIPMENT Have an extra set of batteries for any medical devices that require batteries, such as hearing aids. Plan how you will use electric equipment if the power is out. Have a generator or extra batteries on hand for power outages. Plan how to keep necessary medications refrigerated with ice packs or an ice chest if the power is out. YES NO PLAN FOR YOUR DISABILITY Register with the city or county emergency information office so that you can be contacted quickly during a disaster. Regularly check with local shelters to see if they have the facilities for your special needs. Discuss specific plans with family members. Determine what help you will need during a disaster and ask for it. (AGS Foundation for Healthy Aging, 2007; American Red Cross, n. d.; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; Disaster Preparedness for the Elderly, 2009; North Carolina Department of Health and Human Services, 2007; Senior Resource Alliance Program, 2009; University of Florida Institute of Food and Agricultural Sciences Extension, 2009) 15

20 SECTION 4 - FINANCE The Finance Section will help you prepare your personal finances in case of disasters or emergencies. During an emergency, your access to bank accounts and money may be limited. It is important to set aside funds to use during emergency situations. Planning how to handle finances if you must evacuate will relieve some stress. Use the general tips in this section along with your personal budget to plan for emergencies and crises. Michael Reiger FEMA Photo 16

21 Checklist General Finance Tips DIRECTIONS: MARK YES FOR COMPLETED TASKS OR NO FOR THOSE NOT COMPLETED. IN SOME CASES TASKS MAY NOT APPLY TO YOU YES NO EMERGENCY FUNDS Determine your monthly budget. Save at least three months living expenses for an emergency fund.* YES NO FINANCES DURING A DISASTER Have as much cash on hand as you can gather. Purchase debit cards in case banks are closed. Remember to use debit cards before the expiration date, typically one year, but may vary. (Keown, 2009; Pearsons Personal Finance, n. d.) NOTE: * See Appendix B for more information Larry Lerner FEMA Photo 17

22 SECTION 5 - INSURANCE The Insurance Section will help you plan for disasters and emergencies. Here are some tips to remember: Discuss with your insurance agent the coverage of each policy. Inventory your property for appliances, electronics, computers, and jewelry. Inventory small items, such as radios, DVD players, digital cameras, recorders, and other items. When you purchase new policies or make changes to any of your current policies update all checklists. Be sure to list everything you would need replaced, not just the big ticket items. If you must evacuate, remember to do the following: Include copies of all your policies, such as personal property, homeowners, boat, dental, flood, etc. Make a list of all of your policies homeowners, health care, dental care, life insurance, flood, fire, and hazard coverage, automobile, and more. Use the Household Inventory guide in this section and add extra pages where necessary. Include as much information or serial numbers as you can. Take pictures if possible. The more detailed you are, the easier it will be for you to file a claim after a disaster. Keep updated copies of all insurance policies in your disaster kit as well as a secure off-site location, such as a safety deposit box. 18

23 Checklist Insurance Policies and Providers DIRECTIONS: LIST INSURANCE POLICIES AND PROVIDERS. ATTACH COPIES OF POLICY INFORMATION IF AVAILABLE. Policy Type Policy # Company Agent s Name Contact Number Coverage Dates Example: Life Allstate Mark Weiser Dec 23, 2012 Life Health Long-Term Care Homeowners/ Renters Auto Specialty Specialty (American Red Cross, n. d.; Disaster Mental Health, n. d.; Disaster Preparedness for the Elderly, 2009) 19

24 Checklist Vehicle Information DIRECTIONS: LIST INFORMATION FOR EACH VEHICLE INCLUDED ON YOUR AUTO INSURANCE POLICY. Make Model and VIN Year License Tag Number Example: Ford Mustang/ OSU PHG (AGS Foundation for Healthy Aging, 2007; Federal Emergency Management Agency, 2004; Disaster Mental Health, n. d.; North Carolina Department of Health and Human Services, 2007) 20 Marvin Nauman FEMA Photo

25 Checklist Household Inventory DIRECTIONS: INVENTORY ALL LARGE AND SMALL HOUSEHOLD ITEMS. INCLUDE SERIAL NUMBERS ON ELECTRONICS AND OTHER ITEMS. ITEMIZE AND INCLUDE APPRAISALS OF COLLECTIBLES, JEWELRY, ANTIQUES, ETC. Category Item Number of Units FURNITURE Armoire Bed Bookshelf Chair Desk Dresser Entertainment Unit Sofa Table Other: Other: DECORATIVE FURNISHINGS Area Rug Artwork Drapes Linens Mirror Other: Other: ELECTRONICS Computer DVD Player Home Theater Speaker System Stereo Television Other Other PERSONAL ITEMS Accessories Clothing Jewelry Other Other Original Cost Purchase Date Serial/I.D. Number Estimated Value 21

26 Checklist 5.3 Household Inventory (continued) Category Item Number of Units HOUSEWARES Bakeware China Cutlery Dishes Pots/Pans Silverware Other Other COLLECTIBLES/HOBBIES Antiques Books Crafts Quilts Other Other SEASONAL ITEMS Christmas Tree Christmas Ornaments Lawn Furniture Tools Other Other APPLIANCES Dishwasher Microwave Oven/Stove Refrigerator Washing Machine/Dryer Other Other Original Cost Purchase Date Serial/I.D. Number Estimated Value (American Red Cross, n. d.; Family Disaster Preparedness, 2009; Federal Emergency Management Agency, 2004; Keown, 2009) 22

27 SECTION 6 DISASTER SUPPLIES STORAGE The Disaster Supplies Section will help you create a disaster supply kit. Creating a disaster supply kit allows you to organize supplies that are most important to have at hand during a disaster or emergency. These supplies are essential whether you are isolated inside your home or forced to evacuate. Make sure to include supplies for every member of your family living in the home. Keep disaster supplies in a cool, dry location and remember to check your supplies frequently. Make sure to replace any supplies after you use them. Jennifer Smits FEMA Photo 23

28 Checklist Important Documents to Pack DIRECTIONS: MARK YES FOR DOCUMENTS THAT YOU HAVE OR NO FOR THOSE YOU DO NOT. KEEP ORIGINAL COPIES OF IMPORTANT DOCUMENTS IN A SAFE PLACE OUTSIDE OF YOUR HOME. LET SOMEONE IN YOUR FAMILY KNOW WHERE YOU KEEP THESE ITEMS. YES NO PERSONAL IDENTIFICATION Driver s License State Identification Card Passport Social Security Card Birth Certificate YES NO PERSONAL LEGAL DOCUMENTS Health Records Living Will/Advance Directive Do Not Resuscitate papers (DNR) See Appendix C Power of Attorney papers See Appendix D Trusts/Property Wills YES NO INSURANCE DOCUMENTS Health insurance policies Health insurance I.D. cards Life insurance policies Automobile insurance policies Official copy of automobile ownership papers Homeowners/Renters insurance policy Official copy of property deeds Household inventory list (AGS Foundation for Healthy Aging, 2007; American Red Cross, n. d.; Department of Homeland Security, n. d.; Disaster Mental Health, n.d.; Disaster Preparedness for the Elderly, 2009; Family Disaster Preparedness, 2009; North Carolina Department of Health and Human Services, 2007; Petty, 2002; Senior Resource Alliance Program, 2009) 24

29 Checklist Disaster Supplies for Home DIRECTIONS: MARK YES FOR SUPPLIES IN YOUR DISASTER SUPPLY KIT AND NO FOR ITEMS NOT INCLUDED. KEEP SUPPLIES IN ONE LOCATION WHERE THEY ARE EASY TO FIND AND TRANSPORT IF YOU NEED TO EVACUATE. YES NO THREE TO FIVE DAYS WORTH OF FOOD AND WATER Canned Food Stored in a cool, temperature controlled, dry environment. Keep cans good no more than two years. Check expiration dates on food every six months. Non-refrigerated protein shakes and juices Ready to eat meals Non-perishable, high energy foods Water: one gallon per person, per day YES NO FOOD PREPARATION SUPPLIES Re-sealable plastic bags Aluminum foil or saran wrap Disposable cups, plates, and silverware Manual can opener All purpose knife Trash bags for garbage Ice packs and a small cooler Water proof matches Chlorine bleach YES NO SEASONAL CLOTHING SUPPLIES (FOR THREE TO FIVE DAYS) Hat Sunglasses Scarf Gloves Extra Undergarments Shorts Pants Short sleeved shirt Sweatshirt/sweater Raincoat or poncho Jacket Walking shoes & extra socks Boots & extra socks 25

30 Checklist Disaster Supplies for Home (continued) YES NO FIRST AID KIT Antibiotic ointment Gauze Cotton Band-aids Adhesive tape Sterile dressing Dust mask Rubbing alcohol Peroxide Antacids Cough medicine/cough drops Tylenol or equivalent Thermometer Tweezers Cold pack Medical gloves, non-latex CPR breathing barrier YES NO HYGIENE SUPPLIES Hand sanitizer Soap Shampoo Washcloth Towel Towelettes Toilet paper Comb/Brush Tooth brush Tooth paste Razor Shaving cream Feminine supplies Contact lens solution Extra contact lenses Extra eye glasses 26

31 Checklist Disaster Supply Kit for Home (continued) YES NO PERSONAL ITEMS Family photographs Sentimental items Toys, books, and games for children Two way radio with batteries Prepaid debit or Visa cards or cash (monitor expiration date) YES NO TOOL SUPPLIES Tool set Flashlight with batteries (Check every 6 months) Signal flares Sports whistle to signal for help (AGS Foundation for Healthy Aging, 2007; American Red Cross, n. d.; Caldwell, 2007; Federal Emergency Management Agency, 2004; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; Dyer, et al., n. d.; Family Disaster Preparedness, 2009; Marily, 2007; North Carolina Department of Health and Human Services, 2007; University of Florida Institute of Food and Agricultural Sciences Extension, 2009) Michael Reiger FEMA Photo 27

32 Checklist Disaster Supply Kit for Vehicle DIRECTIONS: MARK YES FOR SUPPLIES IN YOUR DISASTER SUPPLY KIT AND NO FOR ITEMS NOT INCLUDED. YES NO CAR SUPPLIES Keep a full tank of gas Extra set of car keys and house keys Car battery charger (Check bimonthly) Jumper cables Maps (local and national) GPS or compass Vehicle fuel YES NO TOOL SUPPLIES Tool set Flashlight with batteries (Check every six months) Signal flares Whistle to signal for help YES NO FIRST AID KIT Antibiotic ointment Gauze Cotton Band-aids Adhesive tape Sterile dressing Dust mask Rubbing alcohol Peroxide Antacids Cough medicine/cough drops Tylenol or equivalent Thermometer Tweezers Cold pack Medical gloves, non-latex CPR breathing barrier (American Red Cross, n. d.; of Homeland Security, n. d.; Federal Emergency Management Agency, 2004; North Carolina Department of Health and Human Services,

33 SECTION 7 DISASTER AND YOUR PETS During an emergency it is easy to forget about the supplies your pet will need. This section will help you include your pet s needs with your own disaster plan. When putting together your disaster supply kit, make one for your pets. Put the pet disaster supplies with yours in a cool, dry place. Mike Howard FEMA Photo 29

34 Checklist Pet Information DIRECTIONS: FILL OUT THE FOLLOWING INFORMATION FOR EACH OF YOUR PETS. ATTACH A RECENT PICTURE OF YOUR PET TO THIS INFORMATION IN CASE YOU ARE SEPARATED. PUT A COPY OF THIS INFORMATION WITH YOUR OTHER IMPORTANT DOCUMENTS. Pet s Name: Type of Pet: Breed: Size Description: Coloring: Age: Veterinarian: Medications: Special Needs: (Federal Emergency Management Agency, 2004; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; North Carolina Department of Health and Human Services, 2007) Jocelyn Augustino FEMA Photo Jocelyn Augustino FEMA Photo 30

35 Checklist Disaster Preparation Guidelines for Pets DIRECTIONS: MARK YES FOR TIPS YOU ARE USING IN YOUR PET DISASTER PLAN AND NO FOR TIPS YOU ARE NOT USING. YES NO PREPARE A PET DISASTER KIT Food and water for three to five days for each pet Medications and medical records stored in a waterproof bag Litter box supplies: Extra box, litter, scoop, and bag to clean up waste Sturdy leashes, harnesses, and/or pet carrier for transportation Pet beds or toys Updated identification tags with your current contact numbers YES NO PLAN FOR YOUR PETS IF YOU ARE NOT HOME DURING DISASTER Ask a neighbor to care for your pet during a disaster. Make sure your neighbor and pets are comfortable with one another. Let your neighbor know where a key to your home is and where you keep your pet disaster kit if they must evacuate with your pet. Plan a checkpoint where you and your neighbor can meet and you can retrieve your pet. YES NO PLAN WHAT TO DO DURING AN EVACUATION Take your pets with you so they are not injured or lost. Do not wait for evacuation orders to leave. Leaving early will avoid emergency officials forcing you to leave pets in a rush. Find a safe place ahead of time that will take your pets. YES NO PLAN WHAT TO DO IF YOU ARE STAYING IN YOUR HOME Bring pets indoors as soon as there seems to be a problem. Keep pets restrained on leashes or in pet carriers so they stay with you at all times. Do not allow pets to roam, even in familiar areas. Smells may be unfamiliar after a disaster and they could easily get lost. Be patient with your pets. They may be affected by stress just as much as you are. (American Red Cross, n. d.; Federal Emergency Management Agency, 2004; Department of Homeland Security, n. d.; Disaster Mental Health, n. d.; Humane Society of the United States, 2009; North Carolina Department of Health and Human Services, 2007) 31

36 REFERENCES The AGS Foundation for Healthy Aging. (2007). Emergency preparedness tips for older adults. Retrieved on June 8, 2009 from American Red Cross. (n. d.). Preparing for disaster for people with disabilities and other special needs. Retrieved on March 26, 2011 from Caldwell, M. (2007). Five Food Storage Safety Tips. Retrieved on June 11, 2009 from Car Care Council. (2008). Service interval schedule. Retrieved on March 26, 2011 from Department of Homeland Security. (n. d). Ready America: Prepare, plan, and stay informed get a kit. Retrieved on February 15, 2010 from Department of Homeland Security. (n. d). Ready America: Prepare, plan, and stay informed seniors. Retrieved on May 13, 2009 from Department of Homeland Security. (n.d.). 30 tips for emergency preparedness. Retrieved on May 13, 2009 from Disaster Mental Health. (n. d.). Disaster preparedness for the elderly: A checklist. Retrieved on June 26, 2009 from Disaster Mental Health. (n. d.). How can I, as a senior citizen, prepare for disasters? Retrieved on June 20, 2009 from Dyer, C., Festa, N. A., Cloy, B., Regev, M., Schwartzberg, J. G., James, J., Khaine, A., Poythress, L., Vogel, M., Burnett, J, et al. (n.d.). Recommendations for best practices in the management of elderly disaster victims. Retrieved on June 8, 2009 from Federal Emergency Management Agency (2004). Are you ready? An in-depth guide to citizen preparedness. Retrieved on April 1, 2010 from Federal Emergency Management Agency. (2004). Preparing for Disaster. Retrieved on June 20, 2009 from Gibson, M., & Hayunga, M. (2006). We can do better: Lessons learned for protecting older persons in disasters: Washington, D. C.: AARP Public Policy Institute. 32

37 Humane Society of the United States. (2009). Disaster preparedness for pets. Retrieved on March 26, 2011 from Keown, A. J. (2009). Personal Finance: Turning Money into Wealth. Retrieved on December 2, 2009 from Marily (2007). Canned food storage safety. Retrieved on June 11, 2009 from North Carolina Department of Health and Human Services. (2007). DHHS family disaster plan (2007). Retrieved on June 8, 2009 from Oklahoma Geriatrics Education Center. (OKGEC) (2007). The disaster series on older adults. Retrieved on June 5, 2009 from Petty, R. (2002) offers important lessons in disaster preparedness. Retrieved on February 01, 2010 from Public Legal Forms. (n. d.). Oklahoma statutory form for power of attorney. Retrieved on April 1, 2010 from Senior Resource Alliance Program. ( ). Disaster preparedness: Preparing for hurricanes and other possible disasters. Retrieved on June 10, 2009 from GdQSmhjEcu9y4JmX1RmPGsYN8W8SIonGtFk9jf6Frk5VQAe70aA%3D%3D Texas Extension Disaster Education Network (EDEN). ( ). Creating a support network for older adults. Retrieved on June 26, 2009 from protect/creating-a-support-network-for-older-adults.php United States Fire Administration. (2009). Learn about smoke alarms. Retrieved on March 26, 2011 from University of Florida IFAS Extension. (2009). Preparing for a disaster: Strategies for older adults. Retrieved on June 5, 2009 from University of Oklahoma College of Medicine. (n. d.). Oklahoma do-not-resuscitate (DNR) consent form. Retrieved on April 1, 2010 from Wheeling Jesuit University/Center for Educational Technologies. (2009). National emergency contact directory. Retrieved December 2, 2009, from 33

38 Appendices

39 Appendix A Contact Card and Calling Circle

40 Contact Card and Calling Circle Directions: Fill out the Calling Circle for each family member or close friend. You should call the person after you on the circle, who will then call the person after them, and so on. If the person you are to contact cannot be reached, call the next person in the circle until someone is reached. Try to reach anyone you may have missed after a successful contact. The calling circle is complete once you have been contacted again. In an emergency, please contact: Name: Relationship: Landline Telephone: Cellular Telephone: Address: In an emergency, please contact: Name: Relationship: Landline Telephone: Cellular Telephone: Address: You Name: Phone #: Name: Phone #: Name: Phone #: Name: Phone #: Name: Phone #: Name: Phone #: Name: Phone #: 36

41 Appendix B Financial Planning For Disaster

42 Financial Planning For Disaster GOAL Increase savings Save emergency funds that may cover three months of living expenses (e.g., rent, mortgage, electricity, telephone, food, etc.) Reduce debts Try to pay off as many bills as possible Try to pay off your credit cards debts, as much as possible Evaluate insurance needs such as: Homeowners or renters Fire Flood Secure health care, Medicare, or Medicaid Meet with financial planner to write a will or start a trust Give to charities such as Red Cross, Transfer estate properties Shred the following Nontax-related checks over a year old Records from cars and boats you no longer own Expired insurance policies Expired warranties Nontax-related credit card slips over a year old PRIORITY LEVEL DESIRED ACHIEVEMENT DATE ANTICIPATED COSTS/ SAVINGS (Keown, 2009) NOTE: See Pearson Personal Finance webpage for additional information on financial planning: NOTE: * Find out what types of hazard insurance plans exist in your area 38

43 Storing Financial Files YES NO Tax Record Tax returns Paychecks W-2 forms 1099 forms Charitable contributions Alimony payments Medical bills Property taxes Any other documentation YES NO Investment Record Bank records and nontax-related checks less than one year old Safety deposit box key and location information Stock, bond, and mutual fund transactions Brokerage statements Dividend records Any additional investment documentation YES NO Retirement & Estate Planning Copy of will &/or trust Pension plan documentation IRA documentation Keogh plan transactions Social Security information Any additional retirement documentation (Keown, 2009) 39

44 Safety Deposit Box Storage YES NO Investment Records Certificates of deposit Listing of bank accounts Stock and bond certificates Collectibles YES NO Retirement & Estate Planning Copy of will &/or trust Nondeductible IRA record YES NO Personal Planning Copy of will &/or trust Mortgage or Deed for home Title insurance policy Birth certificates Death certificates Alimony Adoption Divorce Military Immigration Documentation of valuables * Reciepts for home repair and/or improvements Auto title(s) Listing of insurance policies Credit card information ** (Keown, 2009) NOTE: * Videotape or photos **Account numbers and telephone numbers 40

45 Appendix C Oklahoma Do Not Resuscitate (DNR)

46 OKLAHOMA DO-NOT-RESUSCITATE (DNR) CONSENT FORM I,, request limited health care as described in this document. If my heart stops beating or if I stop breathing, no medical procedure to restore breathing or heart function will be instituted by any health care provider including, but not limited to, emergency medical services (EMS) personnel. I understand that this decision will not prevent me from receiving other health care such as the Heimlich maneuver or oxygen and other comfort care measures. I understand that I may revoke this consent at any time in one of the following ways: 1. If I am under the care of a health care agency, by making an oral, written, or other act of communication to a physician or other health care provider of a health care agency; 2. If I am not under the care of a health care agency, by destroying my do-notresuscitate form, removing all do-not-resuscitate identification from my person, and notifying my attending physician of the revocation; 3. If I am incapacitated and under the care of a health care agency, my representative may revoke the do-not-resuscitate consent by written notification of a physician or other health care provider of the health care agency or by oral notification of my attending physician; or 4. If I am incapacitated and not under the care of a health care agency, my representative may revoke the do-not-resuscitate consent by destroying the do-notresuscitate form, removing all do-not-resuscitate identification from my person, and notifying my attending physician of the revocation. I give permission for this information to be given to EMS personnel, doctors, nurses, and other health care providers. I hereby state that I am making an informed decision and agree to a do-not-resuscitate order. OR Signature of Person Signature of Representative (Limited to an attorney-in-fact for health care decisions acting under the Durable Power of Attorney Act, a health care proxy acting under the Oklahoma Rights of the Terminally III or Persistently Unconscious Act or a guardian of the person appointed under the Oklahoma Guardianship and Conservatorship Act.) This DNR consent form was signed in my presence. Date Signature of Witness Address Date Signature of Witness Address 42

47 CERTIFICATION OF PHYSICIAN (This form is to be used by an attending physician only to certify that an incapacitated person without a representative would not have consented to the administration of cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. An attending physician of an incapacitated person without a representative must know by clear and convincing evidence that the incapacitated person, when competent, decided on the basis of information sufficient to constitute informed consent that such person would not have consented to the administration of cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. Clear and convincing evidence for this purpose shall include oral, written, or other acts of communication between the patient, when competent, and family members, health care providers, or others close to the patient with knowledge of the patient's desires.) I hereby certify, based on clear and convincing evidence presented to me, that I believe that (Name of Incapacitated Person) would not have consented to the Name of Incapacitated Person administration of cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. Therefore, in the event of cardiac or respiratory arrest, no chest compressions, artificial ventilation, intubations, defibrillation, or emergency cardiac medications are to be initiated. Physician's Signature/Date Physician s Name (PRINT) Physician's Address/Phone Witnesses must be individuals who are eighteen (18) years of age or older who are not legatees, devisees or heirs at law. It is the intention of the Legislature that the preferred, but not required, do-notresuscitate form in Oklahoma shall be the form set out in subsection B of this section. Disclaimer: The preceding form is the state of Oklahoma s current Do-Not-Resuscitate Consent form. With any legal document you will want to consult a professional for assistance and advice. If you choose to implement a Do-Not-Resuscitate order for yourself you should use this version as a reference. Understand that while this is a legally binding document it can be changed or revoked if you feel it is necessary. You can check for updated versions of this form for your particular state of residence through your primary care physician, personal attorney, or through the University of Oklahoma College of Medicine at (University of Oklahoma College of Medicine, n. d.) 43

48 Appendix D Oklahoma Statutory Form for Power of Attorney

49 OKLAHOMA STATUTORY FORM FOR POWER OF ATTORNEY NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM POWER OF ATTORNEY ACT. IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER HEALTH-CARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO. I (insert your name and address) appoint (insert the name and address of the person appointed) as my agent (attorney-in-fact) to act for me in any lawful way with respect to the following initialed subjects: TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF (N) AND IGNORE THE LINES IN FRONT OF THE OTHER POWERS. TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE GRANTING. TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT NEED NOT, CROSS OUT EACH POWER WITHHELD. INITIAL (A) Real property transactions. (B) Tangible personal property transactions. (C) Stock and bond transactions. (D) Commodity and option transactions. (E) Banking and other financial institution transactions. (F) Business operating transactions. (G) Insurance and annuity transactions. (H) Estate, trust, and other beneficiary transactions. (l) Claims and litigation. (J) Personal and family maintenance. 45

50 (K) Benefits from Social Security, Medicare, Medicaid, or other governmental programs, or military service. (L) Retirement plan transactions. (M) Tax matters. (N) ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL ANY OTHER LINES IF YOU INITIAL LINE (N). SPECIAL INSTRUCTIONS: ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE POWERS GRANTED TO YOUR AGENT. (Attach additional pages if needed.) UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED. This power of attorney will continue to be effective even though I become disabled, incapacitated, or incompetent. STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER OF ATTORNEY TO CONTINUE IF YOU BECOME DISABLED, INCAPACITATED, OR INCOMPETENT. I agree that any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party learns of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. 46

51 Signed this day of, 20 (Your Signature) (Your Social Security Number) State of (County) of This document was acknowledged before me on (Date) by (Name of principal) (Signature of notarial officer) (Seal, if any) (Title and Rank) My commission expires: BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT. Disclaimer: The preceding form is the state of Oklahoma s current Power of Attorney Statutory form. With any legal document you will want to consult a professional for assistance and advice. If you choose to implement a Power of Attorney for yourself you should use this version as a reference. Understand that while this is a legally binding document it can be changed or revoked if you feel it is necessary. You can check for updated versions of this form for your particular state of residence through your personal attorney or through Public Legal Forms at (Public Legal Forms, n. d.) 47

52 This document is available at humansciences.okstate.edu/disasterchecklist The authors would like to thank Louisiana project collaborators New Orleans Council on Aging, East Baton Rouge Council on Aging, Council on Aging in St. Tammany, the Governor s Office on Elderly Affairs, the Advocate, Catholic Charities, Archdiocese of New Orleans, Shiloh Missionary Baptist Church, and others for their assistance with this project.

Copyright on July 6, 2010 by Tammy L. Henderson, Simmone Miller, Jennie Hendrix, and Minh Dinh. Checklist for Disaster Preparedness.

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