For Clinicians | Power Outage Medical Readiness

For Clinicians | Power Outage Medical Readiness 

Insulin Storage, Oxygen Backup, and Planning for Days Without Power

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Why are power outages lasting so much longer now?

I lost power three times in two weeks this month out here in Utah. Two different accommodations, hours-long each time. And neither was some rural place where electricity could kinda expect to be spotty. Just normal neighborhoods in my wild-fire infested Utah. The kind of thing that used to be a flicker, the microwave clock blinking, back on before you’d even found the flashlight. Not anymore.

Here’s what changed, and it changed on purpose. Across the West, when Red Flag fire conditions hit, utilities now switch off the automatic reclosers that used to snap a line back on within seconds of a fault. The logic is sound: a recloser that re-energizes a downed wire into dry brush is exactly how you start a wildfire. So the line stays dead until a crew physically patrols and inspects the circuit before restoring it. That turns a few-second blip into hours, and a genuine fault into days. Xcel’s December shutoffs on the Colorado Front Range came back over days, not hours. And storms and grid strain are doing the same thing in plenty of places that have never heard the term Red Flag.

For most households, that’s an inconvenience. A spoiled fridge, a tense night, some swearing at the breaker box. For a patient on insulin, home oxygen, or a ventilator, the gap between “a few hours” and “a few days” is the gap between fine and a real crisis. And the mental model most of us still counsel from, the fridge holds a couple hours so you’ll be okay, was built for the short outage that’s on its way out.

That’s the shift I want to talk about today. Outages are getting longer, in some places by design, and the patients who can least afford a long one are the same ones we send home with the most temperature-sensitive medications and the most power-hungry devices.The medical side is missing a space. Our medical side has three parts: the medications, the devices, and the systems most patients have never heard of. We’ll take them by acuity, because that’s how you’d triage it anyway.

How long is insulin safe out of the fridge?

Of course we have to start with the big kahuna: insulin, because it’s the one patients panic over and the one where a wrong answer in either direction does harm. The FDA numbers are more forgiving than most patients expect, and stricter than most realize in one specific spot. Vials and cartridges, opened or unopened, hold up unrefrigerated at 59 to 86F for up to 28 days and keep working.¹ The exception that catches people: insulin already in a pump reservoir or tubing is good for only 48 hours, and insulin that’s been diluted or drawn out of the manufacturer’s vial should go within two weeks.¹ All of it assumes the product is still within its expiration date, and is product-specific. Read the label that’s actually in the patient’s hand, not a general number in your head.

Then widen out, because insulin isn’t the only thing in the door of that fridge. Most refrigerated meds want 36 to 46F. A closed refrigerator holds a safe temperature for only about two to four hours once the power’s out, and a full freezer that remains shut buys you roughly 48 hours. After that, the move is a cooler with ice packs as long as the medication is kept off direct contact with the ice. Which brings us to the one instruction nobody should ever get wrong: do not freeze these medications to be safe. Freezing destroys insulin and a long list of biologics outright. The patient who buries a vial in the freezer to be extra careful has just ruined it. Dang it!

And here’s the caveat that should change how we counsel, straight out of a 2025 review of room-temperature stability across 150 refrigerated drugs: stability is drug- and brand-specific, and the same active ingredient can behave differently from one manufacturer to the next.² Worse, a degraded medication can look and smell completely normal. No cloudiness, no off color, nothing to catch by eye. So the cold chain can’t be judged by appearance, and “it looked fine” is not clearance. The real counseling line is: tell me your exact product, how warm it got, and for how long, and we’ll check it against the manufacturer’s data instead of your eyes.

Plenty else in that fridge is temperature-sensitive too: biologics like adalimumab and etanercept, many vaccines, some liquid antibiotics, certain eye drops. The pattern holds for all of them. Know the specific product’s window, keep it cold without freezing it, and when there’s any doubt, the pharmacist has the manufacturer’s stability data so the patient isn’t guessing.

Oxygen, ventilators, and CPAP: build the backup plan before the lights go

Now to the devices, where the stakes spread across a wide range, so we triage by acuity.

At the top are ventilators and home oxygen. For these patients, a long outage isn’t an inconvenience, it’s an emergency, because the equipment has to keep running. The most useful thing we can do is make sure they have a written backup plan, worked out with their equipment supplier before the power ever goes out. A good plan answers three questions: how long the backup battery lasts, whether there’s a backup oxygen supply that doesn’t need electricity, and where this patient goes if the power stays out. The supplier builds the plan. We’re usually the one who has to tell the patient to ask for it, because most never have.

One thing worth flagging to them: not every generator or battery can safely run a medical device. Some will damage the equipment, some just won’t power it.³ So the plan shouldn’t assume the generator in the garage will do the job. Have the patient confirm the right backup equipment with their supplier, and test it once before they’re counting on it in the dark.

Then there’s CPAP and BiPAP, and here I get to lower the temperature a little. These run 30 to 90 watts, they run at night, and a missed night or two, while nobody’s idea of a good time, is not a life-threatening event for the large majority of users. So the counseling here is mostly reassurance plus one practical option: a CPAP battery pack, the kind that covers a night or two, is cheap insurance and easy to keep charged. The CPAP population is huge, and a lot of them are carrying more worry about an outage than the clinical risk actually warrants. Telling them that, plainly, is its own kind of care.

What is the medical baseline program, and the other systems you can put in motion?

Here’s the part most patients have never heard of, and the part where you, specifically, can do something today. There’s a whole support layer behind all of this that most people never see, and the clinician (hey, you!) is often the one who unlocks it.

The medical baseline program (some utilities call it a life-support registry) is the big one. It’s a utility program the patient enrolls in, and it usually takes a licensed clinician’s signature to certify they depend on electricity for medical equipment: oxygen, a ventilator, CPAP, dialysis, a feeding pump, a powered wheelchair. Once they’re enrolled, depending on the utility, they get an extra energy allowance, advance notice of planned shutoffs, and sometimes priority for restoration.⁴ Benefits vary by utility and state, but the form is short and you’re the one who signs it. It may be the highest-leverage five minutes you can spend for an electricity-dependent patient.

A few more worth keeping in your back pocket:

• Emergency refills. During a declared emergency, pharmacists in many states can dispense an emergency supply, often up to 30 days, without a fresh prescription. And HHS’s EPAP program provides a free 30-day supply to uninsured people in federally-declared disaster areas.⁵ Patients rarely know either one exists.
• A buffer supply. Push for at least a 7-day cushion of essential medications, 30 days if their plan allows it. The patient living refill-to-refill is the one a long outage hurts first.
• A current medication list + the pharmacy where the medications are filled. Written down, on paper, kept with them. When someone gets displaced to a shelter or a relative’s house, that list is what lets the next clinician or pharmacist help fast.

And for scale, so none of this feels like an edge case: the federal emPOWER program counts more than 4.6 million electricity-dependent Medicare beneficiaries living independently.⁶ That’s a large, mapped, known-to-be-at-risk population, and some of them are sitting in your case load right now.

Appropriate medical preparation, applied to the grid

Step back from the parts of power outages here and look at the shape of the thing. Everything above is the same move: get the plan in place before access breaks, not during. The buffer supply and the written med list from a minute ago, the backup plan with the DME supplier, the registry form, all of it is preparation done while the lights are still on, so a long outage is something the patient is ready for instead of something happening to them.

That’s the whole idea behind how we think about the JaseCase, and it works in two layers. Layer one is the patient’s own medications: a real buffer of what they take every day, plus that current, written list. Layer two is contingency medications for the acute things that don’t wait for the power company, the infection or the injury that shows up at hour thirty of a blackout when nothing’s open and nobody’s reachable.

Let’s be clear about what the kit is and isn’t, because the temptation in an article like this is to overclaim. The JaseCase does not refrigerate insulin and is not a fix for the cold chain. If your patient’s question is “how do I keep my insulin cold for three days,” the answer is the cooler, the pharmacist, and the registry, not a kit. What the kit is, is the contingency layer: a prescribed, clinician-built set of medications for the predictable acute problems, ready before access is the thing standing in the way.

That’s appropriate medical preparation applied to the grid. We’re a family team of physicians, PAs, and pharmacists, and the standard is the same one running through this whole article: clinically grounded, calm, planned in advance, and a complement to the patient’s own clinicians, never a replacement for them. A longer-outage world doesn’t change that standard. It just makes the case for it harder to argue with.

Last Points

Outages aren’t what they used to be. In a lot of places they run longer now, sometimes on purpose, and the patients who feel it first are the ones depending on a cold medication or a powered device. The good news: almost none of this takes heroics. It takes a plan made early.

So the next time you’ve got a patient on insulin, oxygen, a ventilator, or CPAP in front of you, take the two minutes. Tell them their specific medication’s storage window and where to confirm it. Make sure the device-dependent ones have a real backup plan with their supplier. Sign the medical-baseline form. Nudge the buffer supply and the written med list. None of it is hard, and all of it has to happen while the power is still on.

That’s the whole point. The work of being ready for a long outage gets finished before the lights go out, or it doesn’t get done at all.

Sources

1. FDA. Information Regarding Insulin Storage and Switching Between Products in an Emergency. Vials and cartridges (opened or unopened) may be left unrefrigerated at 59-86F for up to 28 days and keep working; insulin in a pump reservoir or tubing should be discarded after 48 hours; insulin diluted or removed from the manufacturer’s vial within 2 weeks. (Pairs with CDC, Managing Insulin in an Emergency.) https://www.fda.gov/drugs/emergency-preparedness-drugs/information-regarding-insulin-storage-and-switching-between-products-emergency
2. Stability of Refrigerated Medications at Room Temperature: Implications for Transport, Delivery, and Patient Safety. Cureus. 2025;17(9):e93213. Of 150 refrigerated medications with room-temperature stability data, 22.8% remained stable for at least 24 hours; stability varied by brand even among products with the same active ingredient, so brand-specific data must be prioritized; degradation is not visually detectable. https://pmc.ncbi.nlm.nih.gov/articles/PMC12465357/
3. American Lung Association. Preparing for a Power Outage as a Medical Device User. Ventilator users need a manual resuscitation bag plus external batteries and a plan to relocate; oxygen suppliers should provide non-electric backup tanks; CPAP/BiPAP users need a battery or car adapter; notify the utility of life-sustaining equipment and confirm any generator can safely run the device. https://www.lung.org/blog/power-outage-preparation
4. PG&E / California Public Utilities Commission. Medical Baseline Program. Clinician-certified enrollment for households dependent on electricity for medical equipment; provides an additional energy allowance at the lowest rate and, depending on the utility, outage notification and restoration priority. Benefits and eligibility vary by utility and state. https://www.cpuc.ca.gov/consumer-support/financial-assistance-savings-and-discounts/medical-baseline
5. HHS ASPR. Emergency Prescription Assistance Program (EPAP): a free 30-day supply of medications, supplies, and limited DME for uninsured people in a federally-declared disaster area, renewable while the program is active. NABP Model Rules and many state boards also permit pharmacists to dispense an emergency supply (commonly up to 30 days) during declared emergencies. https://aspr.hhs.gov/EPAP/Pages/epap-for-patients.aspx
6. HHS emPOWER Program (ASPR and CMS). More than 4.6 million Medicare beneficiaries live independently and rely on electricity-dependent durable medical or assistive equipment, or essential health services; the data and maps are used by public-health authorities in all 50 states. https://empowerprogram.hhs.gov/